Progression of ductal carcinoma in situ to invasive breast cancer: comparative genomic sequencing

Abstract

Several models have been described as potential mechanisms for the progression of ductal carcinoma in situ (DCIS) to invasive breast cancer (IBC). The aim of our study was to increase our understanding of DCIS progression by using massive parallel sequencing of synchronous DCIS and IBC. We included patients with synchronous DCIS and IBC (n = 4). Initially, IBC and normal tissue were subjected to whole exome sequencing. Subsequently, targeted sequencing was performed to validate those tumor-specific variants identified by whole exome sequencing. Finally, we analyzed whether those specific variants of the invasive component were also present in the DCIS component. There was a high genomic concordance between synchronous DCIS and IBC (52 out of 92 mutations were present in both components). However, the remaining mutations (40 out of 92) were restricted to the invasive component. The proportion of tumor cells with these mutations was higher in the invasive component compared to the DCIS component in a subset of patients. Our findings support the theory that the progression from DCIS to IBC could be driven by the selection of subclones with specific genetic aberrations. This knowledge improves our understanding of DCIS progression, which may lead to the identification of potential markers of progression and novel therapeutic targets in order to develop a more personalized treatment of patients with DCIS.

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The role of pre-operative α-blockade in patients with normotensive phaeochromocytoma or paraganglioma: A retrospective cohort study

No abstract available

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Comparison of a novel clinical score to estimate the risk of REsidual neuromuscular block Prediction Score and the last train-of-four count documented in the electronic anaesthesia record: A retrospective cohort study of electronic data on file

BACKGROUND Residual neuromuscular block (rNMB) after surgery is not difficult to identify if proper neuromuscular monitoring is used, but many clinicians do not use quantitative neuromuscular monitoring. OBJECTIVE The aim of this study was to develop a REsidual neuromuscular block Prediction Score (REPS) to predict postoperative rNMB and compare the predictive accuracy of the prediction score with train-of-four count (TOFC) measurement at the end of a surgical case. DESIGN Retrospective cohort study of data on file. DATA SOURCE Electronic patient data and peri-operative data on vital signs, administered medications, and train-of-four ratio (TOFR) obtained in the postoperative recovery rooms [postanaesthesia care unit (PACU)] at Massachusetts General Hospital in Boston, Massachusetts, USA. PATIENTS Quantitative TOFR measurements obtained on admission to the PACU were available from 2144 adult noncardiac surgical patients. MAIN OUTCOME MEASURE Presence of rNMB at PACU admission, defined as a TOFR of less than 0.9. RESULTS In the score development cohort (n=2144), rNMB occurred in 432 cases (20.2%). Ten independent predictors for residual paralysis were identified and used for the score development. The final model included: hepatic failure, neurological disease, high-neostigmine dose, metastatic tumour, female sex, short time between neuromuscular blocking agent administration and extubation, aminosteroidal neuromuscular blocking agent, BMI more than 35, absence of nurse anaesthetist and having an experienced surgeon. The model discrimination by C statistics was 0.63, 95% confidence interval (0.60 to 0.66), and risk categories derived from the REPS had a higher accuracy than the last documented intra-operative TOFC for predicting rNMB (net reclassification improvement score 0.26, standard error 0.03, P 

https://ift.tt/2IBhwGR

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

BACKGROUND Circulating cardiac troponin levels are powerful predictors of prognosis in many clinical settings, but their association with outcomes after noncardiac surgery is unclear. OBJECTIVES The aim of this systematic review was to summarise current evidence on the association of pre-operative troponin elevation with postoperative major adverse cardiac events (MACE) and mortality in patients undergoing noncardiac surgery. DESIGN Systematic review of observational studies with meta-analysis. DATA SOURCES PubMed, EMBASE and Science Citation Index Expanded (ISI Web of Science) from their inception to 1 October 2017. ELIGIBILITY CRITERIA Observational studies reporting the associations between pre-operative troponin levels and MACE and all-cause mortality after noncardiac surgeries were included. RESULTS Ten studies met the eligibility criteria. The entire body of evidence addressing the research question was based on a total of 10 371 patients: 4.7 to 68.3% (median 23.8%) of patients had elevated troponin levels before surgery. Elevated pre-operative troponin was significantly associated with short-term MACE (seven studies, 5180 patients: odds ratio (OR) 6.92, 95% confidence interval (CI) 3.85 to 12.42), short-term mortality (five studies, 6103 patients: OR 4.23, 95% CI 2.27 to 7.89) and long-term mortality (two studies, 760 patients: OR 2.51, 95% CI 1.47 to 4.29). The associations remained significant when only multivariate-adjusted results were analysed. Overall, the reviewers' certainty about the summary estimates of the associations was very low. CONCLUSION Current evidence suggests that pre-operative high troponin levels are significantly associated with adverse cardiac events and mortality after noncardiac surgery. TRIAL REGISTRATION This systematic review was registered in the International Prospective Register of Systematic Reviews (Centre for Reviews and Dissemination 42017077837).

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Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study

BACKGROUND Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions. OBJECTIVES The current study investigated if deep compared with no NMB improved the surgical view during laparoscopic ventral hernia repair. DESIGN Crossover study. SETTING The study was carried out at Herlev and Gentofte Hospital, University of Copenhagen, Denmark and conducted from May 2015 until February 2017. PARTICIPANTS A total of 34 patients were randomised in an investigator-initiated, assessor-blinded crossover design of deep vs. no NMB during laparoscopic ventral hernia repair. INCLUSION CRITERIA Adults scheduled for elective laparoscopic ventral hernia repair. EXCLUSION CRITERIA Known allergy to any study medication, known homozygous variants in the butyrylcholinesterase gene, severe renal disease, neuromuscular disease, lactating or pregnant women, any indication for rapid sequence induction. INTERVENTIONS Deep NMB was established with rocuronium and reversed with sugammadex. Anaesthesia was conducted with propofol and remifentanil. MAIN OUTCOME MEASURES The primary outcome was evaluation of surgical view assessed on a five-point rating scale. Other outcomes included the surgical conditions during laparoscopic suturing of the hernia defect. RESULTS We found no difference in ratings for the surgical view when comparing deep with no NMB: mean −0.1 (95% confidence interval −0.4 to 0.2) (P = 0.521, paired t test). However, deep compared with no NMB improved the rating score for surgical conditions while suturing the hernia defect (P = 0.012, Mann–Whitney U test). No differences were found in either total length of surgery (P = 0.76) or hernia suturing time (P = 0.81). CONCLUSION Deep compared with no NMB did not change the rating score of the surgical view immediately after introduction of trocars during laparoscopic ventral hernia repair, but the surgical condition were improved during suturing of the hernia. TRIAL REGISTRATION ClinicalTrials.gov, NCT02247466.

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Oral ulcer due to dabigatran capsule

Description 

An 80-year-old man with cerebral infarction and no neurological deficits was hospitalised for right empyema. Although the patient's condition improved with antimicrobial therapy and right thoracic drainage, a swelling in his right cheek was observed during clinical rounds. Oral examination revealed ulceration on the right buccal mucosa (figure 1A) with an embedded blue solid matter (figure 1B), which was removed. After confirming the history of prescribed medications, the removed matter was determined to be a dabigatran capsule (figure 1C), and oral ulcer due to dabigatran was suspected. With conservative measures, re-epithelialisation was achieved within 2 weeks.

Figure 1

(A) Oral ulcer on the right buccal mucosa, (B) the removed solid matter, (C) the dabigatran capsule.

Dabigatran is currently used as an alternative to warfarin for venous thromboembolism and non-valvular atrial fibrillation. Dabigatran is formulated with...

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Deep vs. moderate neuromuscular blockade during laparoscopic surgery: A systematic review and meta-analysis

BACKGROUND Previous studies have reported that deep neuromuscular block (posttetanic-count 1 to 2 twitches) improves surgical conditions during laparoscopy compared with moderate block (train-of-four count: 1 to 2 twitches). However, comparisons of surgical conditions were made using different scales and assessment intervals with variable results. OBJECTIVE To explore the heterogeneity of previous comparisons between deep and moderate neuromuscular block. DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched from inception to October 2017. ELIGIBILITY CRITERIA Our meta-analysis included RCTs comparing the effects of deep with moderate neuromuscular block on surgical field conditions during laparoscopic surgery. The frequency of excellent or good operating conditions on a surgical rating scale was compared. Heterogeneity was assessed by subgroup analyses. RESULTS Eleven RCTs involving 844 patients were included. On the surgical rating scale, the frequency of excellent or good operating conditions was higher with deep block compared with a moderate block (odds ratio 2.83, 95% confidence interval 1.34 to 5.99, P = 0.007, I2 = 59%). We analysed surgical rating according to the number of assessments made. There was a significant difference in surgical rating with multiple assessments, but no difference when the assessment was made on only one occasion. A significant difference in rating was noted with variable abdominal pressures; there was no significant difference with the same fixed abdominal pressure. Trial sequential analysis demonstrated that the cumulative z-curve crossed the O′Brien–Fleming significance boundary. However, required information size was not achieved. CONCLUSION Deep block was associated with excellent or good surgical rating more frequently than moderate block. However, this finding was not consistent on subgroup analyses based on frequencies of assessment of surgical conditions and abdominal pressure. Further studies are required to address the heterogeneity and power shortage demonstrated by the trial sequential analysis.

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Intra-operative cutaneous temperature monitoring with zero-heat-flux technique (3M SpotOn) in comparison with oesophageal and arterial temperature: A prospective observational study

BACKGROUND Continuous monitoring of core temperature is essential during major surgery as a way of improving patient safety. Oesophageal probes or specific arterial catheters are invasive methods used in this setting. A new noninvasive device based on zero-heat-flux (ZHF) technique (SpotOn) seems promising but has been poorly investigated during rapid core temperature changes (RCTC). OBJECTIVE To assess the accuracy of a SpotOn sensor vs. an oesophageal probe or specific arterial catheter during a slow change in core temperature of less than 1 °C within 30 min and RCTC ≥ 1 °C within 30 min. DESIGN Prospective observational study. SETTING Operating rooms at the University Hospital of Poitiers, France. PATIENTS Fifty patients scheduled for major abdominal surgery under general anaesthesia were enrolled from June 2015 to March 2016. Data from 49 patients were finally analysed. Among these, 15 patients were treated with hyperthermic intraperitoneal chemotherapy. INTERVENTION Each patient had a ZHF sensor placed on the skin surface of the forehead (TempZHF) and an oesophageal probe (TempEso) used as a reference method. Twenty-two patients also had a thermodilution arterial catheter (TempArt) placed in the axillary artery. MAIN OUTCOME MEASURES Core temperature was continuously recorded from the three devices after induction of anaesthesia. Comparison of temperature measurements between methods was made using the Bland and Altman method during two separate periods according to the speed of core temperature changes. RESULTS Compared with TempEso, bias and limits of agreement for TempZHF were 0.1 ± 0.5 °C during slow core temperature changes periods and 0.6 ± 1.8 °C during RCTC periods (P = 0.0002). Compared with TempArt, these values were −0.1 ± 0.4 and 0.5 ± 1.7 °C, respectively (P = 0.0039). The ZHF sensor was well tolerated. CONCLUSION A SpotOn sensor using the ZHF method seems reliable for core temperature monitoring during abdominal surgery when variations in core temperature are slow rather than rapid. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02869828.

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Comparison of noninvasive and minimally invasive pulse contour analysis to measure stroke volume during major surgery: A prospective observational study

No abstract available

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Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness: A systematic review and meta-analysis

BACKGROUND The accuracy of respiratory variation of the inferior vena cava (rvIVC) in predicting fluid responsiveness, particularly in spontaneously breathing patients is unclear. OBJECTIVES To consider the evidence to support the accuracy of rvIVC in identifying patients who are unlikely to benefit from fluid administration. DESIGN Systematic review and meta-analysis. DATA SOURCE We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILCAS and WHO Clinical Trial Registry from inception to June 2017. ELIGIBILITY CRITERIA Case–control or cohort studies that evaluated the accuracy of rvIVC in living adult humans were included. A study was included in the meta-analysis if data enabling construction of 2 × 2 tables were reported, calculated or could be obtained from authors and met the above cited criteria. RESULT A total of 23 studies including 1574 patients were included in qualitative analysis. The meta-analysis involved 20 studies and 761 patients. Pooled sensitivity and specificity of rvIVC in 330 spontaneously breathing patients were 0.80 [95% confidence interval (CI) 0.68 to 0.89] and 0.79 (95% CI 0.60 to 0.90). Pooled sensitivity and specificity of rvIVC in 431 mechanically ventilated patients were 0.79 (95% CI 0.67 to 0.86) and 0.70 (95% CI 0.63 to 0.76). CONCLUSION Decreased inferior vena caval respiratory variation is moderately accurate in predicting fluid unresponsiveness both in spontaneous and mechanically ventilated patients. The findings of this review should be used in the appropriate clinical context and in conjunction with other clinical assessments of fluid status. IDENTIFIER CRD 42017068028.

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Device or target? A paradigm shift in airway management: Implications for guidelines, clinical practice and teaching

No abstract available

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Haemodilution and head-down tilting induce functional injury in the rat optic nerve: A model for peri-operative ischemic optic neuropathy

BACKGROUND Mechanisms of peri-operative ischaemic optic neuropathy remain poorly understood. Both specific pre-operative and intra-operative factors have been examined by retrospective studies, but no animal model currently exists. OBJECTIVES To develop a rodent model of peri-operative ischaemic optic neuropathy. In rats, we performed head-down tilt and/or haemodilution, theorising that the combination damages the optic nerve. DESIGN Animal study. SETTING Laboratory. ANIMALS A total of 36 rats, in four groups, completed the functional examination of retina and optic nerve after the interventions. INTERVENTIONS Anaesthetised groups (n>8) were supine (SUP) for 5 h, head-down tilted 70° for 5 h, head-down tilted/haemodiluted for 5 h or SUP/haemodiluted for 5 h. We measured blood pressure, heart rate, intra-ocular pressure and maintained constant temperature. MAIN OUTCOME MEASUREMENTS Retinal function (electroretinography), scotopic threshold response (STR) (for retinal ganglion cells) and visual evoked potentials (VEP) (for transmission through the optic nerve). We imaged the optic nerve in vivo and evaluated retinal histology, apoptotic cells and glial activation in the optic nerve. Retinal and optic nerve function were followed to 14 and 28 days after experiments. RESULTS At 28 days in head down tilted/haemodiluted rats, negative STR decreased (about 50% amplitude reduction, P = 0.006), VEP wave N2-P3 decreased (70% amplitude reduction, P = 0.01) and P2 latency increased (35%, P = 0.003), optic discs were swollen and glial activation was present in the optic nerve. SUP/haemodiluted rats had decreases in negative STR and increased VEP latency, but no glial activation. CONCLUSION An injury partly resembling human ischaemic optic neuropathy can be produced in rats by combining haemodilution and head-down tilt. Significant functional changes were also present with haemodilution alone. Future studies with this partial optic nerve injury may enable understanding of mechanisms of peri-operative ischaemic optic neuropathy and could help discover preventive or treatment strategies.

https://ift.tt/2OzA7Z3

Bilateral parameatal cysts with associated hypospadias presenting in a newborn baby

Description 

A male infant presented to the neonatal team on day 1 of life with concerns over cysts on his penis. He had been born at term in good condition following an emergency caesarean section for face presentation and suboptimal cardiotocograph. There was no relevant antenatal history of note and no significant family history.

He had a normal examination other than his genitalia. He had a coronal hypospadias with two symmetrical cystic lesions measuring 2–3 mm each on the glans penis, just distal and lateral to the opening of the urethral meatus on the ventral surface (figure 1). There was no obvious discharge or surrounding erythema. By day 2, there was some mild superficial ulceration of the cyst surfaces. Both testes were palpable in his scrotum. He was discharged home after confirmation of a good urinary stream.

Figure 1

Male genitalia demonstrating two parameatal urethral...

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Sarcoidosis and HIV infection in a native Saudi man

Sarcoidosis is a rare condition among native Saudis. It typically presents with asymptomatic chest radiographs, exertional breathlessness and cough. The coexistence of sarcoidosis and HIV is also rare, and the overlap of the symptoms makes their differential diagnosis challenging. Nevertheless, the outcome of sarcoidosis is favourable with or without the presence of HIV. We present a case of a 55-year-old native Saudi man with extremely atypical sarcoidosis presentation coexisting with HIV. This case highlights the association between the two pathologies, and the difficulties encountered in establishing a proper diagnosis in the presence of two overlapping diseases.

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End-tidal carbon dioxide monitoring improves patient safety during propofol-based sedation for breast lumpectomy: A randomised controlled trial

BACKGROUND The use of sedation is becoming more commonplace. Although pulse oximetry is a standard monitoring procedure during sedation, it cannot accurately detect early hypoventilation. End-tidal carbon dioxide (EtCO2) monitoring can be an earlier indicator of airway compromise; however, the existing literature is limited to a few studies with varying outcomes. OBJECTIVES To evaluate whether EtCO2 monitoring decreases the incidences of CO2 retention and apnoeic events in propofol-based sedation. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Two hundred women (aged 18 to 65 years, ASA physical status 1 or 2) who were scheduled for breast lumpectomy between June 2017 and August 2017. INTERVENTIONS Patients were allocated randomly to receive either standard monitoring or standard monitoring and EtCO2 monitoring. MAIN OUTCOME MEASURES The primary outcome was the incidence of CO2 retention. The secondary outcomes were the number of actions taken to restore ventilation, variations in PaCO2 and pH, the frequency of apnoea and the recovery time. RESULTS CO2 retention occurred significantly less often in the EtCO2 monitoring group (10 vs. 87%; P 

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Heart of the matter: reverse takotsubo syndrome in an anthracycline-exposed oncology patient

A 24-year-old man with acute myelogenous leukaemia and a history of anthracycline treatment is hospitalised for non-anthracycline chemotherapy. He develops new-onset heart failure requiring intesive care unit (ICU) admission during his stay. There is debate as to the aetiology of his heart failure, whether anthracycline cardiotoxicity or takotsubo syndrome. He is diuresed and discharged home with close follow-up. Ultimately, the retrospective use of two-dimensional speckle-tracking echocardiography derived strain helps diagnose reverse takotsubo syndrome.

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Haemodynamic evaluation and optimisation of brain-dead donors with oesophageal Doppler during organ harvesting: A feasibility study

No abstract available

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Cardiac arrest due to critical stenosis of a bicuspid aortic valve mimicking left main coronary artery occlusion on ECG

A 49-year-old man presented to the emergency room after a cardiac arrest. On arrival, the patient's ECG showed ST-segment elevations in the aVR and anteroseptal leads with diffuse ST depression suggestive of left main coronary artery occlusion. Subsequent coronary catheterisation showed normal coronaries but revealed severe stenosis of his bicuspid aortic valve. A surgical replacement of the aortic valve was performed, and the patient recovered successfully.

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Dexamethasone concentration affecting rocuronium-induced neuromuscular blockade and sugammadex reversal in a rat phrenic nerve-hemidiaphragm model: An ex vivo study

BACKGROUND The concentration range of dexamethasone that inhibits neuromuscular blockade (NMB) and sugammadex reversal remains unclear. OBJECTIVE To evaluate the effects of dexamethasone on rocuronium-induced NMB and sugammadex reversal. DESIGN Ex vivo study. SETTING Asan Institute for Life Sciences, Asan Medical Center, Korea, from July 2015 to November 2015. ANIMALS One hundred sixty male Sprague–Dawley rats. INTERVENTIONS We assessed the effect of four concentrations of dexamethasone [0, 0.5, 5 (clinical concentrations) and 50 μg ml−1 (experimental concentration)] on partial NMB on 40 phrenic nerve–hemidiaphragm preparations (n=10 per concentration). Once the first twitch of train-of-four (TOF) had been depressed by 50% with rocuronium, dexamethasone was administered. To assess the effect of dexamethasone on sugammadex reversal, 120 phrenic nerve–hemidiaphragm preparations were used in three subexperiments (n=40 per experiment), using three administration regimens of rocuronium–equimolar sugammadex: a single dose, a split-dose (split 1/2 and 1/2) and a reduced split-dose (split 1/2 and 1/4). After complete NMB was achieved, dexamethasone and sugammadex were administered. MAIN OUTCOME MEASURES The change in the first twitch height, the recovery time to a TOF ratio at least 0.9, and the TOF ratio at 30 min were evaluated. RESULTS There were no significant differences in the first twitch height among groups (P = 0.532). With a single dose of sugammadex, dexamethasone did not affect the recovery time to a TOF ratio at least 0.9 (P = 0.070). After using a split-dose of sugammadex, the recovery time to a TOF ratio at least 0.9 was delayed only at a concentration of 50 μg ml−1 of dexamethasone. With a reduced split-dose of sugammadex, the TOF ratio at 30 min was lowered only by a concentration of 50 μg ml−1 of dexamethasone (P 

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Pericardial effusion as first presentation of disseminated non-Hodgkins lymphoma

A 46-year-old woman with quiescent lupus presented with worsening pleuritic chest pain and dyspnoea. Bedside echocardiogram confirmed large pericardial effusion with cardiac tamponade. Emergency bedside pericardiocentesis was performed. Pericardial fluid cytology confirmed diffuse large B cell lymphoma, stage four on positron emission tomography. Conventional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy achieved good response in all sites except the pericardium. Progressive cardiac involvement was complicated by atrioventricular conduction block requiring permanent pacemaker. Second-line palliative chemotherapy was performed.

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Postoperative stroke: The picture is out of focus

No abstract available

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Hereditary angioedema: a mother diagnosing her child using Google as a diagnostic aid

Hereditary angioedema (HAE), due to C1-inhibitor deficiency, is a rare autosomal dominant and potentially life-threatening disease characterised by recurrent oedema attacks of skin, mucosa and viscera. Due to the rarity and the fact that symptoms of HAE imitate other forms of angioedema and other conditions, HAE may be misdiagnosed, especially in emergency settings. Consequently, patients with HAE may experience significant delays in diagnosis. Without an accurate diagnosis patients with HAE may not receive proper treatment. At times 'Doctor Google' may be an important tool in establishing the diagnosis. The aim of this case report is to emphasise the importance of listening to patients and relatives and being humble to 'Doctor Google'. Furthermore, the aim is to remind all healthcare personal of HAE and the importance of considering the rare differential diagnoses to common symptoms.

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Duration of the action of rocuronium in patients with BMI of less than 25: An observational study

BACKGROUND The duration of rocuronium in patients with BMI more than 30 kg m−2 is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m−2 is unclear. OBJECTIVE The objective of this study was to investigate whether a BMI less than 25 kg m−2 affects the duration of rocuronium in doses adjusted for actual body weight. DESIGN A prospective, observational, single-centre study. SETTING The operating room of a teaching hospital from 1 June 2008 to 30 June 2015. PATIENTS Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI 

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Translational pain research: an update from European Pain Federation educational platform

No abstract available

https://ift.tt/2ICEzRB

Correction: Severe capillary leak syndrome with cardiac arrest triggered by influenza virus infection

Ebdrup L, Druey KM, Mogensen TH. Severe capillary leak syndrome with cardiac arrest triggered by influenza virus infection. BMJ Case Rep 2018. doi: 10.1136/bcr-2018-226108.

In this published article, an author's name has been misspelt.

The correct name is Kirk M Druey.

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Borderline Mucinous Testicular Tumour: Diagnostic and Management difficulties

A 45-year-old man presented with right-sided testicular swelling and pain. An examination found a tender, firm right testis, a clinically normal left testis and no palpable lymphadenopathy. Tumour and inflammatory markers were within normal limits. A scrotal ultrasound scan showed an intratesticular, avascular lesion measuring 4.4x2.6x1.8 cm. A CT scan of his chest/abdomen/pelvis (CT C/A/P) showed no metastatic or primary lesions. An elective right-inguinal orchidectomy was subsequently performed. Histopathology showed a cystic mucinous tumour lined with intestinal-type epithelium. Differentials of metastatic adenocarcinoma, possibly of a gastrointestinal origin, a monodermal teratoma, or a borderline mucinous tumour of the testicle (BMTT) were considered. Following 12 p genetic studies and a colonoscopy, both of which found no abnormalities, a presumptive diagnosis of a BMTT was made. The patient is to have an annual urological review with a CT C/A/P and 5 yearly colonoscopies.

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An open-label pilot study on preventing glucocorticoid-induced diabetes mellitus with linagliptin

Numerous patients develop diabetes in response to glucocorticoid therapy. This study explored the efficacy, safety, and preventive potential of the dipeptidyl peptidase-4 inhibitor, linagliptin (TRADJENTA®), i...

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Advancing Freund's and AddaVax Adjuvant Regimens Using CpG Oligodeoxynucleotides

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


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Effects of Vitamin D levels and supplementation on atopic dermatitis: A systematic review

Pediatric Dermatology, EarlyView.


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The use of rituximab in treatment of epidermolysis bullosa acquisita: Three new cases and a review of the literature

Dermatologic Therapy, EarlyView.


https://ift.tt/2DTLbvZ

Anterior, frontal congenital triangular alopecia, redundancy in therapy without improvement

Dermatologic Therapy, EarlyView.


https://ift.tt/2O22cJ6

Recombinant NS3 Protein Induced Expression of Immune Modulatory Elements in Hepatic Stellate Cells During Its Fibrotic Activity

Viral Immunology, Ahead of Print.


https://ift.tt/2IBa0vz

Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Thyroid nodules are very common, occurring in up to 50% of patients. The best imaging method for evaluation of thyroid nodules is ultrasound. The American Thyroid Association guidelines for management of thyroid nodule offers a system for classifying thyroid nodules from benign to very low, low, intermediate and highly suspicious for thyroid cancer depending on the findings of ultrasound. Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology^®for the Public – Highlighted Article appeared first on American Thyroid Association.

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Correction to: Tumour origin and R1 rates in pancreatic resections: towards consilience in pathology reporting

The authors regret that one of the author's given name was missing and a typographical error was present in Reference 26 of the above article. These are presented correctly in this article.

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LAP it up, fuzz ball: a short history of LC3-associated phagocytosis

Jennifer Martinez

https://ift.tt/2DXyY9M

Reviewers’ list December 2018

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Management and outcome of epistaxis under direct oral anticoagulants: a comparison with warfarin

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2Oxvw9P

Patient‐derived organoids: New co‐clinical model to predict treatment response in cancer?

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


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FDA Clears Omadacycline (Nuzyra) for Two Infections

Omadacycline is a modernized tetracycline with broad-spectrum activity that is designed to overcome tetracycline resistance.
FDA Approvals

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Peanut allergy – individual molecules as a key to precision medicine

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


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Efficacy and Safety of Antibiotic Therapy in Early Cutaneous Lyme Borreliosis

This network meta-analyses of 19 randomized clinical trials conducted in the United States and Europe examines antibiotic agents and treatment modalities to assess treatment effectiveness and drug-related adverse outcomes in early cutaneous Lyme borreliosis.

https://ift.tt/2O39PiD

Exercise for Leg Ulcers

In this issue of JAMA Dermatology, Jull et al use meta-analysis to suggest an additional healing benefit of exercise in patients with venous leg ulcers (VLUs). Combining and analyzing data from 5 relatively small studies (the largest with 63 participants), the authors found that 61% of participants (57 of 94) who exercised and received compression healed at 12 weeks compared with 46% (44 of 96) of participants who received compression alone. Although the type of exercise administered varied among the trials, the results were driven by 2 studies that used progressive resistance exercises involving calf muscle strengthening coupled with physical activity (walking). In addition to providing rationale for an adjunctive therapeutic modality for patients with VLUs, this article also highlights the power of properly performed meta-analysis to provide clarity where previously none existed.

https://ift.tt/2P31Kqp

Alopecia Universalis and Chronic Graft-vs-Host Disease Treated With Ruxolitinib

This case report describes alopecia universalis and chronic graft-vs-host disease occurring after allogenic hematopoietic stem-cell transplantation and treated with ruxolitinib.

https://ift.tt/2NZNpyK

Introducing “Images in Dermatology”

It is often said that dermatology is a "visual specialty." While it is more than that, there is no escaping the central importance of the clinical examination to dermatologic diagnosis. The appearance, the morphology, the shape and distribution of lesions—these features are the illustration of illness, the manifestation of cutaneous or even systemic disease. The critical role of the physical examination, imparting the ability to make a diagnosis visually, is part of the art of dermatology and is shared by few other medical specialties.

https://ift.tt/2P9rvFE

Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers

This systematic review and meta-analysis of 5 clinical trials examines the association of different exercise interventions with venous leg ulceration healing when used as an adjuvant to any form of compression.

https://ift.tt/2O39Q6b

Acrodermatitis Continua of Hallopeau

This case report describes the occurrence of acrodermatitis continua of Hallopeau being mistaken for recurrent cellulitis.

https://ift.tt/2P5R4Yb

Photobiomodulation effect on the proliferation of adipose tissue mesenchymal stem cells

Abstract

The use of mesenchymal stem cells (MSCs) in tissue engineering has been extensively investigated. The greater the proliferation of this cellular group, the greater the regenerative and healing capacity of the tissue to which they belong. In this context, photobiomodulation (PBM) is an efficient technique in proliferation of distinct cell types. However, its parameters and mode of action are still unclear and require further investigation. This study aimed to evaluate the PBM action with different energies in MSCs of adipose tissue (hASCs). We used hASCs, seeded in 24-well plates, with 3 × 10⁴ cells per well, in culture media. We used a total of four experimental groups, one with hASCs and simulated PBM and three other groups, which received PBM irradiation at 24, 48, and 72 h, with a 660-nm laser and power of 40 mW and energy of 0.56, 1.96, and 5.04 J. We performed analyses of MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromidefor) and trypan blue to evaluate cell proliferation and viability, 1 h after PBM irradiation. Software Graph PadPrism 7.0 was used. Intergroup comparisons were performed with ANOVA two-way and we used the Tukey post hoc test. Mitochondrial activity evaluated by MTT revealed the statistical difference in the first 24 h for group with more high energy when compared to control group; and in the 72 h for two irradiated groups when compared to the control group. The trypan blue test showed significant differences at the end of the experiment for two irradiated groups LG1 (4.52 × 10⁴ ± 0.2) and LG2 (4.85 × 104 ± 0.8), when compared to the control group (1.87 × 10⁴ ± 0.7). Both tests failed to be statistically different at the end of the experiment for groups LG1 and LG2 and observed a reduction in cellular mitochondrial growth and activity for group LG3. We conclude that PBM with energy close to 0.56 and 1.96 J promote proliferation of hASCs, and higher energy, such as 5.04 J, can be harmful.

https://ift.tt/2yf2x0i

Dr David Pothier 1973‐2018

Clinical Otolaryngology, EarlyView.


https://ift.tt/2Oycmkl

TGF-β1-induced airway smooth muscle cell proliferation involves TRPM7-dependent calcium influx via TGFβR/SMAD3 (Revision)

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Ming Chen, Wei Zhang, Jianting Shi, Shanping Jiang

Abstract

Background

TRPM7 in mast cells plays a key role in asthma. However, the effect of TRPM7 on TGF-β1-induced airway smooth muscle cell (ASMC) proliferation remains unclear. Therefore, we designed this study to explore whether TRPM7 is involved in TGF-β1-induced ASMC proliferation.

Methods

An asthmatic mouse model was established, and the expressions of TGF-β1 and TRPM7 in mice lungs were detected using enzyme-linked immunosorbent assay (ELISA) and western blotting. In addition, murine ASMCs were cultured and stimulated with TGF-β1. Possible TGF-β1 and TRPM7 interactions were examined using RT-PCR and western blotting analyses with ASMCs. The effect of TRPM7 knockdown on ASMC calcium influx was assessed by the fluorescent indicator indo-1. MTT and flow cytometry were applied to evaluate the effects of TRPM7 knockdown on ASMC proliferation and apoptosis.

Results

TGF-β1 elevated the expression of TRPM7 via TGFβR/SMAD3. Knocking down TRPM7 decreased the intracellular Ca²⁺ concentration and cellular proliferation of ASMCs, although apoptosis remained unaffected.

Conclusions

Our initial findings suggest that TRPM7 inhibition may prevent asthma-induced airway remodeling.

https://ift.tt/2P90zpC

Hearing loss in preschool children from a low income South African community

Publication date: Available online 3 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Shouneez Yousuf Hussein, De Wet Swanepoel, Faheema Mahomed-Asmail, Leigh Biagio de Jager

Abstract

Objective

This study aimed to determine and describe hearing loss among preschool children in a South African community representative of typical low- and middle income countries (LMIC).

Method

Children between the ages of 3-6 years received a hearing screening at their early childhood development (ECD) center. If a child failed the hearing screening, he/she was seen for a follow-up rescreen and diagnostic assessment if necessary at their ECD center or closest referral clinic. Diagnostic testing consisted of otoscopy, tympanommetry and pure-tone diagnostic audiometry.

Results

A total of 6424 children were screened at ECD centers with a referral rate of 24.9%. Follow-up assessments were conducted on 45.3% (725) of these children. Diagnostic testing revealed that 9.3% of children presented with impacted cerumen and 18.7% presented with a hearing loss (56.5% binaural). Binary logistic regression revealed no gender or age effects (p>0.05). Conductive hearing loss (65.2%) was the most common type of hearing loss found in children.

Conclusions

Most preschool children who failed the hearing screening and received a diagnostic assessment were in need of intervention services for conductive hearing losses, followed by sensorineural and mixed losses.

https://ift.tt/2P8o6qP

Maternal risk factors for severe microtia/atresia in China: A case-control study

Publication date: Available online 3 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Qiang Liu, Xinmiao Fan, Shuang Liu, Li Wang, Yulin Jiang, Xiaowei Chen

Abstract

Objective

Microtia/atresia is a severe malformation of the external ear. Previous studies have reported the potential risk factors on microtia, whereas few focused on severe microtia/atresia. The aim of the study was to investigate the effects of maternal exposure to environmental risk factors in patients with severe microtia/atresia in China.

Methods

A case-control study was conducted. Cases were patients with severe microtia/atresia who presented to PUMCH between January 2014 and October 2017. A total of 322 patients with severe microtia/atresia were enrolled and 322 normal controls matched 1:1 with the patients by sex, age and nationality were enrolled. The designed questionnaires were completed and data were gathered. Odds ratios were estimated with logistic regression models along with 95% confidence intervals in severe microtia/atresia.

Results

Most cases were males(68.6%), and the cases were observed more common in unilateral(80.7%), right-sided (54.0%). Multivariate logistic regression analysis showed that threatened abortion (OR 4.066,95% CI = 2.360–7.007), NSAIDs (OR 2.576,95% CI = 1.079–6.148), virus infection (OR 1.933,95% CI = 1.148–3.256), anemia (OR 1.902,95% CI = 1.026–3.526), miscarriages (OR 1.804,95% CI = 1.425–2.285), maternal age (OR 1.079,95% CI = 1.015–1.148) and paternal age (OR 1.061,95% CI = 1.003–1.122) were associated with a higher risk of severe microtia/atresia.

Conclusion

These results support that some maternal risk factors could be associated with severe microtia/atresia.

https://ift.tt/2xVqnz8

The pedicled levator labii superioris alaeque nasi flap: A durable single-stage option for reconstruction of full-thickness nasal defects

Publication date: Available online 2 October 2018

Source: American Journal of Otolaryngology

Author(s): I.I. Kevin Moore, Richard Thompson, Timothy Lian

Abstract

Importance

Repair of full-thickness nasal defects can often be associated with multi-stage operations that can result in significant physical and psychological morbidity for patients. We present a single-stage option for reconstruction of these defects.

Objective

Demonstrate the utility of the pedicled levator labii superioris alaeque nasi flap and consistency of its vascular pedicle.

Design

Anatomical study using fresh cadavers.

Setting

Academic medical center.

Main outcome and measures

Evaluation of vascular anatomy of pedicled flap and measurements of distances with relationship to facial anatomic landmarks.

Results

With few noted anatomic variations, the vascular pedicle of the pedicled levator labii superioris alaeque nasi flap arises from the superior labial artery and is reliably located within 1 cm lateral and inferior of the nasal sill.

Conclusions and relevance

As a robust single-stage option, the pedicled levator labii superioris alaeque nasi flap can serve as a powerful option in the arsenal of the reconstructive surgeon. The technique for harvest is simple with attention to a few anatomic variations as described herein, and excellent results can be obtained with proper application.

https://ift.tt/2RgYz05

Response to letter

Publication date: Available online 2 October 2018

Source: American Journal of Otolaryngology

Author(s): Margaret I. Engelhardt, Alexandra C.G. Fonseca, Zhen J. Huang, Zi Yang Jiang, Sancak Yuksel, Soham Roy

https://ift.tt/2P5o4ji

Tongue psoriasis: Clinical aspects and analysis of epidemiological associations in 313 children, with a systematic literature review

Publication date: October 2018

Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 10

Author(s): D. Pourchot, C. Chiaverini, E. Bourrat, S. Barbarot, P. Vabres, T. Hubiche, C. Droicourt, M. Piram, I. Kupfer-Bessaguet, M. Ferneiny, E. Puzenat, X. Balguérie, A. Beauchet, A.-C. Bursztejn, E. Mahé, Groupe de recherche de la Société française de dermatologie pédiatrique

Summary

Background

Little information is available on the prevalence and clinical aspects of tongue involvement in children with psoriasis. The aim was to evaluate the prevalence, clinical aspects and risk factors concerning tongue involvement in children with psoriasis.

Patients and methods

This study was carried out in two stages. We performed a multicentre, cross-sectional study in 23 French dermatology centers. All children seen for psoriasis during the one-year study were systematically included. The clinical features of the tongue and of psoriasis were recorded. Association with clinical aspects of psoriasis and comorbidities was evaluated. We then carried out a literature review to evaluate the prevalence of tongue involvement in children with psoriasis and its positive predictive value for psoriasis. A search was conducted in the PUBMED database using the following keywords: "child" and "psoriasis" and ("tongue" or "glossitis" or "migratory glossitis" or "benign migratory glossitis" or "geographic tongue" or "fissured tongue").

Results

7.7% of the 313 children with psoriasis had tongue involvement. The clinical aspects were geographic tongue (4.2%), fissured tongue (2.8%) and both (0.64%). There was no association between tongue involvement and the clinical characteristics of the children. Two hundred and ninety-five articles were referenced and 3 were analysed. Psoriasis is very rare in cases of tongue abnormalities.

Conclusion

The prevalence of tongue involvement was 7.7% in children with psoriasis. No clinical or epidemiological association was shown. Tongue involvement does not modify the management of psoriasis. In the literature review it was not possible to evaluate either the prevalence of tongue involvement in psoriasis or the positive predictive value thereof.

Résumé

Introduction

Il y a peu d'informations dans la littérature sur les atteintes de la langue au cours du psoriasis de l'enfant. L'objectif était d'évaluer la fréquence, les aspects cliniques et les facteurs de risque d'atteinte linguale chez les enfants psoriasiques.

Patients et méthodes

Ce travail a été effectué en deux étapes : (1) une étude transversale a été menée dans 23 centres dermatologiques français, notant les aspects cliniques de la langue et du psoriasis chez les enfants atteints de psoriasis, ainsi que les associations et les comorbidités ; (2) une revue systématique de la littérature a ensuite été effectuée afin d'évaluer la prévalence l'atteinte linguale chez l'enfant et sa valeur prédictive du psoriasis. Une recherche a été réalisée en interrogeant la base de données PUBMED. Les mots clés saisis étaient : « child » et « psoriasis » et (« tongue » ou « glossitis » ou « migratory glossitis » ou « benign migratory glossitis » ou « geographic tongue » ou « fissured tongue »).

Résultats

(1) Parmi 313 enfants atteints de psoriasis 7,7 % présentaient une atteinte linguale sous forme de langue géographique (4,2 %), langue fissurée (2,8 %) ou les deux (0,6 %). L'atteinte linguale n'était associée à aucune particularité démographique ou clinique, ni aucune comorbidité. (2) Parmi 295 articles référencés, 3 ont finalement été retenus. Le psoriasis reste très rare en cas d'anomalie linguale.

Conclusion

La prévalence de l'atteinte linguale chez les enfants psoriasiques était de 7,7 %. Aucune association clinique ou épidémiologique n'a été montrée. L'atteinte linguale ne modifie pas la prise en charge du psoriasis. La revue systématique de la littérature ne permettait pas d'évaluer une prévalence de l'atteinte linguale dans le psoriasis ni la valeur prédictive positive de cette atteinte.

https://ift.tt/2zNYgTG

Editorial board

Publication date: October 2018

Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 10

Author(s):

https://ift.tt/2IzR4xa

What Is the Non-calcifying Langerhans Cell-Rich Variant of Calcifying Epithelial Odontogenic Tumor?

https://ift.tt/2RmQ43G

What Is the Non-calcifying Langerhans Cell-Rich Variant of Calcifying Epithelial Odontogenic Tumor?

https://ift.tt/2RmQ43G

What Is the Non-calcifying Langerhans Cell-Rich Variant of Calcifying Epithelial Odontogenic Tumor?

https://ift.tt/2RmQ43G

Retrieval of a retained video capsule endoscope with laparoscopic surgery

Abstract

Capsule endoscopy (CE) is commonly used for examining and diagnosing gastrointestinal disease, especially small bowel disease. Capsule retention is a well-known and significant complication of CE and requires surgical or endoscopic removal. Most reports described the retrieval of retained CE via laparotomy. We report a case of successful retrieval of the capsule using laparoscopic surgery.

https://ift.tt/2RgKWxX

An autologous dendritic cell vaccine polarizes a Th-1 response which is tumoricidal to patient-derived breast cancer cells

Abstract

Breast cancer remains one of the leading causes of cancer-associated death worldwide. Conventional treatment is associated with substantial toxicity and suboptimal efficacy. We, therefore, developed and evaluated the in vitro efficacy of an autologous dendritic cell (DC) vaccine to treat breast cancer. We recruited 12 female patients with stage 1, 2, or 3 breast cancer and matured their DCs with autologous tumour-specific lysate, a toll-like receptor (TLR)-3 and 7/8 agonist, and an interferon-containing cocktail. The efficacy of the vaccine was evaluated by its ability to elicit a cytotoxic T-lymphocyte response to autologous breast cancer cells in vitro. Matured DCs (≥ 60% upregulation of CD80, CD86, CD83, and CCR7) produced high levels of the Th1 effector cytokine, IL12-p70 (1.2 ng/ml; p < 0.0001), compared to DCs pulsed with tumour lysate, or matured with an interferon-containing cocktail alone. We further showed that matured DCs enhance antigen-specific CD8 + T-cell responses to HER-2 (4.5%; p < 0.005) and MUC-1 (19%; p < 0.05) tetramers. The mature DCs could elicit a robust and dose-dependent antigen-specific cytotoxic T-lymphocyte response (65%) which was tumoricidal to autologous breast cancer cells in vitro compared to T-lymphocytes that were primed with autologous lysate loaded-DCs (p < 0.005). Lastly, we showed that the mature DCs post-cryopreservation maintained high viability, maintained their mature phenotype, and remained free of endotoxins or mycoplasma. We have developed a DC vaccine that is cytotoxic to autologous breast cancer cells in vitro. The tools and technology generated here will now be applied to a phase I/IIa clinical trial.

https://ift.tt/2O1u6Fd

The challenge of choosing the correct biologic for the correct asthma patient

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Panida Sriaroon, Thomas B. Casale

https://ift.tt/2xUJtW1

Closing the gap: Understanding African American asthma knowledge and beliefs

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Jade B. Tam-Williams, Bridgette L. Jones

Abstract

Background

African American children are disproportionately affected by asthma (13% vs 8% non-Hispanic white Americans) and experience 30% higher asthma-related deaths than whites. Knowledge regarding asthma and asthma treatment among African Americans has been postulated as a potential contributor to this observed health disparity. Compared with the amount of studies on asthma, few investigations provide insight into the baseline knowledge and beliefs of African Americans regarding asthma.

Objective

Assess knowledge and beliefs regarding asthma symptoms, diagnosis, treatment, prognosis, and stigmas in a general community sample of African Americans.

Methods

Using community-based participatory research techniques, we developed and implemented a cross-sectional survey to explore asthma knowledge and beliefs among African American adults in a Midwestern city.

Results

Among the 158 African American adults who completed the survey, general asthma knowledge was good, with awareness of the genetic contribution to asthma and general asthma symptomatology (eg, 92% aware of nighttime cough as a symptom). However, asthma-related misconceptions were also revealed. Thirty-three percent of respondents were concerned about addiction to asthma medication, and 60% of respondents believed that inhaled corticosteroids were dangerous or did not know.

Conclusion

This study reveals important insights into asthma knowledge and beliefs among African Americans that may be used to address disparities in asthma outcomes in this population.

https://ift.tt/2y9OWra

Management of food allergies and asthma in schools

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Michele N. Pham, Julie Wang

https://ift.tt/2xUrLBJ

In vitro allergy testing: Where are we now?

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Irene J. Mikhail, Elizabeth Erwin

https://ift.tt/2ybaUtZ

Pediatric bronchial hyperresponsiveness and asthma phenotypes

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Miles Weinberger

https://ift.tt/2xULMIE

Editorial Board

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s):

https://ift.tt/2ydkRqE

Information for Authors

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s):

https://ift.tt/2xYoxNE

Table of Contents

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s):

https://ift.tt/2y6hHFc

Information for Readers

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s):

https://ift.tt/2xWd6pL

Occupational exposure to furry animals and asthma: The complex interconnection between work and everyday life

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Gennaro Liccardi, Luigino Calzetta, Manlio Milanese, Mariano Scaglione, Paola Rogliani

https://ift.tt/2ydCFBV

Authors' response

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Anh Dao, David I. Bernstein

https://ift.tt/2xWRARR

Ifetroban in Treating Patients With Malignant Solid Tumors at High Risk of Metastatic Recurrence

Conditions:   Anatomic Stage II Breast Cancer;   Anatomic Stage IIA Breast Cancer;   Anatomic Stage IIB Breast Cancer;   Anatomic Stage III Breast Cancer;   Anatomic Stage IIIA Breast Cancer;   Anatomic Stage IIIB Breast Cancer;   Anatomic Stage IIIC Breast Cancer;   Clinical Stage II Esophageal Adenocarcinoma;   Clinical Stage II Esophageal Squamous Cell Carcinoma;   Clinical Stage II Gastric Cancer;   Clinical Stage II Gastroesophageal Junction Adenocarcinoma;   Clinical Stage IIA Esophageal Adenocarcinoma;   Clinical Stage IIA Gastric Cancer;   Clinical Stage IIA Gastroesophageal Junction Adenocarcinoma;   Clinical Stage IIB Esophageal Adenocarcinoma;   Clinical Stage IIB Gastric Cancer;   Clinical Stage IIB Gastroesophageal Junction Adenocarcinoma;   Clinical Stage III Esophageal Adenocarcinoma;   Clinical Stage III Esophageal Squamous Cell Carcinoma;   Clinical Stage III Gastric Cancer;   Clinical Stage III Gastroesophageal Junction Adenocarcinoma;   Distal Esophagus Squamous Cell Carcinoma;   Esophageal Carcinoma;   Estrogen Receptor Negative;   HER2/Neu Negative;   Limited Stage Small Cell Lung Carcinoma;   Malignant Solid Neoplasm;   Non-Small Cell Lung Carcinoma;   Pancreatic Adenocarcinoma;   Pathologic Stage II Esophageal Adenocarcinoma;   Pathologic Stage II Esophageal Squamous Cell Carcinoma;   Pathologic Stage II Gastric Cancer;   Pathologic Stage II Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIA Esophageal Adenocarcinoma;   Pathologic Stage IIA Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIA Gastric Cancer;   Pathologic Stage IIA Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIB Esophageal Adenocarcinoma;   Pathologic Stage IIB Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIB Gastric Cancer;   Pathologic Stage IIB Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage III Esophageal Adenocarcinoma;   Pathologic Stage III Esophageal Squamous Cell Carcinoma;   Pathologic Stage III Gastric Cancer;   Pathologic Stage III Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIA Esophageal Adenocarcinoma;   Pathologic Stage IIIA Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIIA Gastric Cancer;   Pathologic Stage IIIA Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIB Esophageal Adenocarcinoma;   Pathologic Stage IIIB Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIIB Gastric Cancer;   Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIC Gastric Cancer;   Postneoadjuvant Therapy Stage II Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage II Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage II Gastric Cancer;   Postneoadjuvant Therapy Stage II Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage III Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage III Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage III Gastric Cancer;   Postneoadjuvant Therapy Stage III Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIA Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIA Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage IIIA Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIB Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIB Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage IIIB Gastroesophageal Junction Adenocarcinoma;   Progesterone Receptor Negative;   Prognostic Stage II Breast Cancer;   Prognostic Stage IIA Breast Cancer;   Prognostic Stage IIB Breast Cancer;   Prognostic Stage III Breast Cancer;   Prognostic Stage IIIA Breast Cancer;   Prognostic Stage IIIB Breast Cancer;   Prognostic Stage IIIC Breast Cancer;   Stage I Pancreatic Cancer;   Stage IA Pancreatic Cancer;   Stage IB Pancreatic Cancer;   Stage II Lung Cancer;   Stage II Pancreatic Cancer;   Stage IIA Lung Cancer;   Stage IIA Pancreatic Cancer;   Stage IIB Lung Cancer;   Stage IIB Pancreatic Cancer;   Stage III Lung Cancer;   Stage IIIA Lung Cancer;   Stage IIIB Lung Cancer;   Stage IIIC Lung Cancer;   Triple-Negative Breast Carcinoma
Interventions:   Drug: Ifetroban Sodium;   Other: Placebo
Sponsors:   Vanderbilt-Ingram Cancer Center;   Cumberland Pharmaceuticals
Not yet recruiting

https://ift.tt/2IySZ5f

GSK3359609 Plus Tremelimumab for the Treatment of Advanced Solid Tumors

Condition:   Neoplasms
Interventions:   Drug: GSK3359609;   Drug: Tremelimumab;   Drug: Docetaxel;   Drug: Paclitaxel;   Drug: Cetuximab
Sponsors:   GlaxoSmithKline;   MedImmune LLC
Not yet recruiting

https://ift.tt/2Ox7onJ

Concurrent Neoadjuvant Chemoradiotherapy Plus Durvalumab (MEDI4736) in Resectable Stage II/IIIa NSCLC

Condition:   Potentially Resectable Stage II/IIIa NSCLC
Intervention:   Drug: durvalumab
Sponsor:   Yonsei University
Not yet recruiting

https://ift.tt/2Iz3gOT

A new case of the pilomatrixoma rare in the preauricular region and review of series of cases

Abstract

Pilomatrixoma is considered a rare benign tumor arising from the hair follicle, most common in the head and neck region, but it is rarely diagnosed on a clinical basis. This report describes a new case of giant pilomatrixoma in a 36-year-old female patient. The nodule was localized in the preauricular area on the right side, appearing as a slow-growing, fixed, painless, with a hardened consistency, unusual giant (4.5 cm). A cone-beam computed tomography (CBCT) examination showed a slightly hyperdense lesion, and fine-needle aspiration cytology (FNAC) revealed peripheral blood and mononucleated inflammatory cells. After enucleation of lesion, a diagnosis of pilomatrixoma was confirmed. The differential diagnosis of pilomatrixoma is broad, because its characteristics also can be found in other lesions common to the head and neck. Thus, a lesion in the head and neck, adherent to the skin, and well demarcated, mainly in the young and in females, should be suspected as pilomatrixoma.

https://ift.tt/2OvWFtS

Clinical Evaluation of Microneedling Therapy in the Management of Facial Scar: A Prospective Randomized Study

Abstract

Purpose

To evaluate the therapeutic efficacy and complications of microneedling (dermaroller) therapy as a treatment modality in the treatment of facial scars resulting from acne, trauma and surgery.

Materials and Methods

Fifty patients with facial acne scar, traumatic scar, hypertrophic scars and scars with skin discoloration reporting to our institute were included in the study. Microneedling procedure was performed with the help of dermaroller. Postoperative wound was evaluated by three evaluators by comparing preoperative and postoperative clinical photographs.

Results

Seven out of the total 50 patients (14%) showed an excellent response to dermaroller treatment, while 26 patients (52%) had a good response. Fourteen patients (28%) had fair response, and 3 patients (6%) had poor response.

Conclusion

Microneedling therapy with dermaroller is one of the simplest, yet most effective skin treatments for scars, stretch marks, deep wrinkles, etc. The dermaroller is a definitive credit crunch skin rescue option. It is simple yet effective and suitable for all skin types and skin tones.

https://ift.tt/2IytP6z

A new case of the pilomatrixoma rare in the preauricular region and review of series of cases

Abstract

Pilomatrixoma is considered a rare benign tumor arising from the hair follicle, most common in the head and neck region, but it is rarely diagnosed on a clinical basis. This report describes a new case of giant pilomatrixoma in a 36-year-old female patient. The nodule was localized in the preauricular area on the right side, appearing as a slow-growing, fixed, painless, with a hardened consistency, unusual giant (4.5 cm). A cone-beam computed tomography (CBCT) examination showed a slightly hyperdense lesion, and fine-needle aspiration cytology (FNAC) revealed peripheral blood and mononucleated inflammatory cells. After enucleation of lesion, a diagnosis of pilomatrixoma was confirmed. The differential diagnosis of pilomatrixoma is broad, because its characteristics also can be found in other lesions common to the head and neck. Thus, a lesion in the head and neck, adherent to the skin, and well demarcated, mainly in the young and in females, should be suspected as pilomatrixoma.

https://ift.tt/2OvWFtS

Skin cancer and welding

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2IELB8B

Biomarkers in Food Allergy

Abstract

Purpose of Review

To familiarize the reader with the concept of precision medicine in food allergy by dealing with the current biomarkers for the diagnosis, prognosis, and management of the disease.

Recent Findings

Many efforts have been devoted in order to characterize reliable biomarkers able to identify specific phenotypes and endotypes in food allergy. Specific IgE (sIgE), sIgE/total IgE ratios, and T cell assays are just a few candidates that have been investigated over time. With the advent of omics sciences, a new era is commencing. A better understanding of pathogenesis of food allergy and mechanisms of action of the different therapeutic options will allow the accurate selection of the appropriate patient.

Summary

In the near future, advances in technologies and data interpretation will allow a better understanding of the pathogenesis of food allergy and the identification of proper biomarkers for a personalized treatment tailored on the specific patient's profile.

https://ift.tt/2IyTPyW

Relation between adenoid size and otitis media with effusion

Publication date: Available online 2 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): L. Skoloudik, D. Kalfert, T. Valenta, V. Chrobok

Abstract

Aims

This study compares the efficacy of adenoidectomy on otitis media with effusion (OME) in patients with different size of adenoids and the connection between differently sized adenoids and middle ear effusion.

Material and methods

Children with a history of at least 3 months' OME underwent adenoidectomy and myringotomy without the insertion of a tympanostomy tube. Treatment assignment was stratified by adenoids' size causing choanal obstruction (grade I-III) and according to Eustachian tube ostium obstruction (grade A–C). The subjects were followed for 12 months.

Results

Adenoidectomy was significantly more effective in children with adenoids in contact with torus tubarius (grade B, C) compared to those with small adenoids without contact (P < 0.001). The volume of the adenoids was irrelevant (P = 0.146). The size of adenoids did not affect the viscosity of the middle ear secretion. The distribution of mucous and serous secretion was not dependent on the size of adenoids; the efficacy of adenoidectomy was 82% in mucous as well as serous secretion.

Conclusion

The relation between adenoids and torus tubarius is more important than the volume of the adenoids. The viscosity of middle ear fluids (serous or mucous) did not influence the rate of treatment efficacy.

https://ift.tt/2ybgsEQ

Effect of anaerobic cure of self-etch adhesive on degree of conversion and shear bond strength

Abstract

Objective

The main aim was to evaluate the effect of postponing the curing of the adhesive layer until the first layer of composite resin is applied—hereby oxygen-inhibited layer (OIL) formation and its detrimental effect on the degree of conversion (DC) of self-etch adhesives should be prevented. For this purpose, the degree of conversion and shear bond strength of four current market self-etch adhesives were evaluated, assessing the effect of curing the adhesives anaerobically and then under two different thicknesses of composite resin, and compare this to the samples cured alone and in air.

Materials and methods

The degrees of conversion were obtained by attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy, after the samples were prepared on a glass slide. The samples were either light-cured in air or anaerobically under a clear matrix strip alone, under 2 mm of cured composite resin or under 4 mm of cured composite resin. To determine the shear bond strength (SBS), extracted molars were halved and set in acrylic. Prefabricated cured cylinders of composite resin (TPH 3, 2.4 mm in diameter) of two different lengths are placed over the adhesives under the following conditions: light-cured conventionally (2-mm-long cylinder) and light-cured anaerobically under the uncured end of the piece of composite resin (using both 2- and 4-mm-long cylinders as separate treatments). After another incubation for 24 h at 37 °C, the samples were subjected to shearing using the Bisco Shear Bond Strength Tester.

Results

The degree of conversion of the one-step self-etch adhesives was not statistically different when cured anaerobically under a clear matrix strip or cured anaerobically under 2 mm of composite resin. These results were greater than those cured under 4 mm. Shear bond strength between samples cured in air and anaerobically were similar under 2 mm of composite resin tubes, while those cured anaerobically under 4 mm of resin showed lower shear bond strength.

Conclusion

When cured anaerobically, one-step self-etch adhesives show a greater degree of conversion and no significant difference in degree of conversion and shear bond strength when compared to those cured in air under the same thickness of composite resin.

Clinical relevance

The results obtained from DC and SBS analysis show promise in placing the uncured adhesive under the composite resin and curing both the adhesive and restoration material simultaneously.

https://ift.tt/2Rh2ERM

Comparison of linear and volumetric measurements obtained from periodontal defects by using cone beam-CT and micro-CT: an in vitro study

Abstract

Objectives

To assess linear and volumetric measurement accuracy of periodontal defects (class 2 furcation, fenestration, dehiscence, and three-wall intrabony defect) by using CBCT and micro-CT images obtained at different voxel sizes.

Material and methods

We created 66 periodontal defects in human dry mandibles. Images of teeth with defects were taken by Planmeca Promox 3D Max (CBCT) at voxel sizes of 0.2 and 0.075 mm and super-argus PET/CT (micro-CT) at voxel sizes of 0.12 and 0.06 mm. All defects were then linearly (depth, width, and height) and volumetrically measured by 3D-DOCTOR software. Differences between voxels were assessed by Wilcoxon signed rank test. Bland-Altman limits of agreement and ICCs were calculated to assess agreement between the methods. Significance was set at p < 0.05.

Results

Volumes measured by micro-CT (0.12–0.06 mm) were higher than those of CBCT (0.2–0.075 mm) measurements regardless of the voxel size. ICC between micro CT and CBCT methods was found to be statistically significant for all types of defects in terms of volume (p < 0.001), height (p < 0.05), width (p < 0.001), and depth measurements (p < 0.001).

Conclusion

CBCT provides useful information regarding linear and volumetric measurement of periodontal defects in vitro.

Clinical relevance

Size and volume of periodontal defects may play an important role in the determination of the most appropriate treatment plan and disease prognosis along with outcome assessment.

https://ift.tt/2ybHDPJ

Biomarkers in Food Allergy

Abstract

Purpose of Review

To familiarize the reader with the concept of precision medicine in food allergy by dealing with the current biomarkers for the diagnosis, prognosis, and management of the disease.

Recent Findings

Many efforts have been devoted in order to characterize reliable biomarkers able to identify specific phenotypes and endotypes in food allergy. Specific IgE (sIgE), sIgE/total IgE ratios, and T cell assays are just a few candidates that have been investigated over time. With the advent of omics sciences, a new era is commencing. A better understanding of pathogenesis of food allergy and mechanisms of action of the different therapeutic options will allow the accurate selection of the appropriate patient.

Summary

In the near future, advances in technologies and data interpretation will allow a better understanding of the pathogenesis of food allergy and the identification of proper biomarkers for a personalized treatment tailored on the specific patient's profile.

https://ift.tt/2IyTPyW

Flow cytometric assessment of leukocyte kinetics for the monitoring of tissue damage

Publication date: Available online 2 October 2018

Source: Clinical Immunology

Author(s): Wouter B.L. van den Bossche, Kyrill Rykov, Cristina Teodosio, Bas L.E.F. ten Have, Bas A.S. Knobben, Maurits S. Sietsma, Karin Josiassen, Sandra de Bruin - Versteeg, Alberto Orfao, Jacques J.M. van Dongen, Jos J.A.M. van Raay

Abstract

Leukocyte populations quickly respond to tissue damage, but most leukocyte kinetic studies are not based on multiparameter flow cytometry. We systematically investigated several blood leukocyte populations after controlled tissue damage. 48 patients were assigned to either an anterior or posterolateral total hip arthroplasty. Peripheral blood was collected pre-operatively and at 2 h, 24 h, 48 h, 2 and 6 weeks postoperatively and assessed by flow cytometry for absolute counts of multiple leukocyte populations using standardized EuroFlow protocols. Absolute counts of leukocyte subsets differed significantly between consecutive time points. Neutrophils increased instantly after surgery, while most leukocyte subsets initially decreased, followed by increasing cell counts until 48 h. At two weeks all leukocyte counts were restored to pre-operative counts. Immune cell kinetics upon acute tissue damage exhibit reproducible patterns, which differ between the leukocyte subsets and with "opposite kinetics" among monocyte subsets. Flow cytometric leukocyte monitoring can be used to minimally invasively monitor tissue damage.

https://ift.tt/2O1QvlW

Surgical Excision with Rotational Flap Reconstruction for Basosquamous Cell Carcinoma in Xeroderma Pigmentosa: A Case Report

Abstract

Xeroderma pigmentosa (XP) is a rare autosomal recessive disorder which is characterized by a defect in nucleotide excision repair of DNA following exposure to UV radiation. This leads to hypersensitivity to sunlight causing pigmented skin lesions, photophobia and a 1000-fold increase in risk of developing cutaneous malignancies like basal cell carcinomas, squamous cell carcinomas and melanomas of head and neck. We present an interesting case of a 28 year old man with basosquamous cell carcinoma secondary to XP treated successfully with surgical excision and reconstruction with rotational flap technique.

https://ift.tt/2P7ugYj

A Case–Control Study on the Association Between Endoscopic ACE Grade of Adenoid Hypertrophy and Hearing Loss in Children and Its Impact on Speech and Language Development

Abstract

To establish an association between adenoid hypertrophy and hearing loss and its impact on speech and language in pediatric age group. A prospective case control study done in a tertiary hospital in South India. Twenty children with hearing loss were recruited in the study group and twenty-four children as controls. These groups underwent at detailed otorhinolaryngologic examination, hearing and speech evaluation. The size of the adenoids was graded endoscopically. Findings between the two groups were compared and analysed. Our study found statistically significant association between adenoid hypertrophy with choanal obstruction and abutment of eustachian tube opening seen on endoscopy with hearing loss (p = 0.025). The children with hearing loss also had speech and language delay (p = 0.004). Children with enlarged adenoids obstructing the > 50% of the choanae or abutting the eustachian tube opening are more likely to have hearing loss and may develop speech and language delay. The ACE endoscopic adenoid grading system is consistent and reliable in evaluation of adenoids.

https://ift.tt/2IzyBkj

Geriatric Dysphonia: Etiological Analysis in a Rural Hospital in India

Abstract

To establish the prevalence of etiological factors for dysphonia in elderly individuals in rural India. Hundred adults aged ≥ 65 years, who presented with dysphonia for ≥ 4 weeks and underwent detailed clinical evaluation including videolaryngoscopic assessment and other appropriate investigations/evaluation, were included in a retrospective cohort clinical study. Patients were classified into eight groups for further descriptive statistical analysis based on standard diagnostic criteria/guidelines i.e. benign vocal cord lesions, inflammatory disorders of the larynx, laryngeal and hypopharyngeal neoplasms, isolated vocal cord palsy/paresis, presbylaryngis, central neurological disorders affecting laryngeal function, impaired pulmonary function and non specific dysphonia. Mean age was 70.73 ± 4.29 years. 58% were aged between 65 and 69 years. Overall, the common causes for dysphonia were laryngopharyngeal reflux disease (23%), carcinoma larynx (12%) and presbylaryngis (8%). Inflammatory disorders of the larynx, benign vocal cord lesions and laryngeal/hypopharyngeal malignancies were the commonest causes for dysphonia in individuals aged between 65 and 74 years. Presbylaryngis and systemic causes were the commonest among individuals aged 75–89 years. 63 males and 37 females met the inclusion criteria. The most common cause for dysphonia among females was laryngopharyngeal reflux disease (17%), followed by vocal palsy (5%) and spasmodic dysphonia (4%). Carcinoma larynx (12%) was the most common cause for dysphonia among males, followed by laryngopharyngeal reflux (6%) and presbylaryngis (6%). Geriatric dysphonia is an often overlooked symptom of greater underlying disease as evidenced in this study. With its impact on the quality of life in this age group and life expectancy in the rural population, dysphonia requires early detection, prompt evaluation and appropriate management.

https://ift.tt/2Rire4O

Surgical Excision with Rotational Flap Reconstruction for Basosquamous Cell Carcinoma in Xeroderma Pigmentosa: A Case Report

Abstract

Xeroderma pigmentosa (XP) is a rare autosomal recessive disorder which is characterized by a defect in nucleotide excision repair of DNA following exposure to UV radiation. This leads to hypersensitivity to sunlight causing pigmented skin lesions, photophobia and a 1000-fold increase in risk of developing cutaneous malignancies like basal cell carcinomas, squamous cell carcinomas and melanomas of head and neck. We present an interesting case of a 28 year old man with basosquamous cell carcinoma secondary to XP treated successfully with surgical excision and reconstruction with rotational flap technique.

https://ift.tt/2P7ugYj

A Case–Control Study on the Association Between Endoscopic ACE Grade of Adenoid Hypertrophy and Hearing Loss in Children and Its Impact on Speech and Language Development

Abstract

To establish an association between adenoid hypertrophy and hearing loss and its impact on speech and language in pediatric age group. A prospective case control study done in a tertiary hospital in South India. Twenty children with hearing loss were recruited in the study group and twenty-four children as controls. These groups underwent at detailed otorhinolaryngologic examination, hearing and speech evaluation. The size of the adenoids was graded endoscopically. Findings between the two groups were compared and analysed. Our study found statistically significant association between adenoid hypertrophy with choanal obstruction and abutment of eustachian tube opening seen on endoscopy with hearing loss (p = 0.025). The children with hearing loss also had speech and language delay (p = 0.004). Children with enlarged adenoids obstructing the > 50% of the choanae or abutting the eustachian tube opening are more likely to have hearing loss and may develop speech and language delay. The ACE endoscopic adenoid grading system is consistent and reliable in evaluation of adenoids.

https://ift.tt/2IzyBkj

Geriatric Dysphonia: Etiological Analysis in a Rural Hospital in India

Abstract

To establish the prevalence of etiological factors for dysphonia in elderly individuals in rural India. Hundred adults aged ≥ 65 years, who presented with dysphonia for ≥ 4 weeks and underwent detailed clinical evaluation including videolaryngoscopic assessment and other appropriate investigations/evaluation, were included in a retrospective cohort clinical study. Patients were classified into eight groups for further descriptive statistical analysis based on standard diagnostic criteria/guidelines i.e. benign vocal cord lesions, inflammatory disorders of the larynx, laryngeal and hypopharyngeal neoplasms, isolated vocal cord palsy/paresis, presbylaryngis, central neurological disorders affecting laryngeal function, impaired pulmonary function and non specific dysphonia. Mean age was 70.73 ± 4.29 years. 58% were aged between 65 and 69 years. Overall, the common causes for dysphonia were laryngopharyngeal reflux disease (23%), carcinoma larynx (12%) and presbylaryngis (8%). Inflammatory disorders of the larynx, benign vocal cord lesions and laryngeal/hypopharyngeal malignancies were the commonest causes for dysphonia in individuals aged between 65 and 74 years. Presbylaryngis and systemic causes were the commonest among individuals aged 75–89 years. 63 males and 37 females met the inclusion criteria. The most common cause for dysphonia among females was laryngopharyngeal reflux disease (17%), followed by vocal palsy (5%) and spasmodic dysphonia (4%). Carcinoma larynx (12%) was the most common cause for dysphonia among males, followed by laryngopharyngeal reflux (6%) and presbylaryngis (6%). Geriatric dysphonia is an often overlooked symptom of greater underlying disease as evidenced in this study. With its impact on the quality of life in this age group and life expectancy in the rural population, dysphonia requires early detection, prompt evaluation and appropriate management.

https://ift.tt/2Rire4O

Label-free Identification of Antibody-mediated Rejection in Cardiac Allograft Biopsies Using Infrared Spectroscopic Imaging

BACKGROUND Antibody-mediated rejection (AMR) in cardiac allograft recipients remains less well-understood than acute cellular rejection, is associated with worse outcomes, and portends a greater risk of developing chronic allograft vasculopathy. Diffuse immunohistochemical (IHC) C4d staining of capillary endothelia in formalin-fixed, paraffin-embedded (FFPE) right ventricular (RV) endomyocardial biopsies is diagnostic of immunopathologic AMR but serves more as a late-stage marker. Infrared (IR) spectroscopy may be a useful tool in earlier detection of rejection. We performed mid-IR spectroscopy to identify a unique biochemical signature for AMR. METHODS A total of 30 posttransplant FFPE RV tissue biopsies (14 positive for C4d and 16 negative for C4d) and 14 native heart biopsies were sectioned for IR analysis. IR images of entire sections were acquired and regions of interest (ROI) from cardiomyocytes were identified. Extracted spectra were averaged across many pixels within each ROI. Principal component analysis coupled with linear discriminant analysis (PCA-LDA) and predictive classifiers were applied to the data. RESULTS Comparison of averaged mid-IR spectra revealed unique features among C4d-positive, C4d-negative, and native heart biopsies. PCA-LDA and classification models demonstrated that spectral features from the mid-IR fingerprint region of these 3 groups permitted accurate automated classification into each group. CONCLUSIONS In cardiac allograft biopsies with immunopathologic AMR, IR spectroscopy reveals a biochemical signature unique to AMR compared to that of nonrejecting cardiac allografts and native hearts. Future study will focus on the predictive capabilities of this IR signature. Correspondence Information: Michael John Walsh. 840 S Wood St, Rm 130 CSN (MC847), 909 S Wolcott Ave, Chicago, Illinois. 606012. Email: walshm@uic.edu. Equal contribution, Vishal K Varma PhD Joint corresponding author, Aliya Husain MD, Michael J Walsh PhD AUTHORSHIP Imran Uraizee – Participated in research design, identifying patients, analyzing data and writing manuscript. Vishal K Varma - Participated in research design, collecting spectral data, analyzing spectral data and writing manuscript. Hari Sreedhar - Participated in analyzing spectral data and writing manuscript. Francesca Gambacorta – Participated in collecting spectral data Shaiju Nazeer - Participated in analyzing spectral data and writing manuscript. Aliya Husain - Participated in research design, identifying patients, and writing manuscript. Michael Walsh - Participated in research design, analyzing data and writing manuscript. DISCLOSURES The authors have no conflicts of interest to disclose. FUNDING This work was funded by the Chicago Biomedical Consortium with support from the Searle Funds at The Chicago Community Trust (Husain and Walsh joint PIs). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2IydAX9

Congenital Cleft Earlobe: Technique for Repair of a Triple-Lobe Type Defect

Congenital cleft earlobe is a rare clinical entity that results from failure of fusion during embryologic development. In contrast to acquired earlobe clefts, congenital defects are usually associated with tissue loss, thereby complicating surgical repair. The authors present the case of a 22-year-old female with a triple-lobe type of congenital cleft earlobe and discuss their technique for repair. Address correspondence and reprint requests to Seth R. Thaller, MD, DMD, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL; E-mail: sthaller@med.miami.edu Received 4 December, 2017 Accepted 31 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2DZWL8S

Anthropometric Evaluation of Periorbital Region and Facial Projection Using Three-Dimensional Photogrammetry

Introduction: Direct anthropometric and three-dimensional (3D) photogrammetry measurements have been used extensively in cleft/craniofacial surgery to assess morphological changes and surgical outcomes. Craniofacial procedures alter the sagittal projection of periorbital bony prominences. Mulliken described a method of measuring their projection relative to the corneal plane but is impractical in clinical practice. Three-dimensional photogrammetry may offer a solution; however, the cornea is not visualized on this. The authors propose to develop new normative measurements of facial projection relative to the pupil. Methods: Five 3D photographs were taken of 5 individuals using Vectra M5 camera. Facial projection measurements were taken of the sagittal projection of the bilateral periorbital landmarks and nasal radix relative to the pupil using Mirror 3D analysis. Standard deviations (SD) were determined for each subject and laterality. Chi-square tests confirmed all SD

https://ift.tt/2DTzu8E

Study on Hair Distribution in Healthy Males for Hair Restoration Design

Background: The incidence of hair loss among Chinese male has increased to 21.3 per hundred. Hair restoration has been an effective technique. Detailed hair distribution has a tremendous impact on the surgery design. Objective: To investigate the pattern of hair distribution in Chinese young adult males. Methods: A total of 1000 males without hair disease were enrolled. We evaluated the locations of the main anatomical marks at different sites on the scalp and analyzed the hair density and follicular unit structure using the standard photographs and trichoscope. Results: The hairline shapes were classified as: linear (48.7%), linear with central protrusion (27.9%), round (9.8%), round with central protrusion (13.7%). The average height of the median line was 6.78 ± 0.75 cm, the ratio of the median line and the forehead height was 0.333. The average distance from the parietal whorl to the vertical bimeatal line was 7.05 ± 3.32 cm, and most of the PWs were on the right (51.4%) and had a clockwise pattern (73.3%). The hair density was 171.12 ± 18.32 hairs/cm2 in the vertex. 1-hair follicular units were (75.90% and 56.39%) in anterior hairline and temporal area. Conclusion: Our study clearly assisted understanding of scalp anatomy and hair distribution in Chinese young adult males. Address correspondence and reprint requests to Wenyu Wu, MD, PhD, Huashan Hospital Affiliated of Fudan University, Shanghai 200040, China; E-mail: william88888@139.com Received 25 April, 2018 Accepted 23 May, 2018 YB and KW contributed equally to this work. The study was permitted by the constituted Ethical Committee of Huashan Hospital, Fudan University. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2zOo1TV

Epithelioid Hemangioma of The Face

An epithelioid hemangioma is a very rare lesion arising from vascular structures. We encountered 2 cases in atypical locations, one in the orbital and the other in the nasal region. We performed preoperative angiography in addition to the diagnostic imaging recommended in the literature. Angiography highlighted the lesions well, and in one case, it was possible to embolize the arterial trunk of a high-flow lesion. Angiography underscored how such lesions may differ from the vascular perspective, emphasizing the importance of histology in correct diagnosis. Management of both hemangiomas yielded good functional and cosmetic outcomes with no disease recurrence. Address correspondence and reprint requests to Dr. Luca Sedran, MD, Corso Bramante 88/90, Torino, Italia; E-mail: luca.sedran@gmail.com Received 4 February, 2018 Accepted 7 April, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2DS7VNa

Optic Disc Deformation and Orbital Bone Erosion Secondary to a Huge Neglected Orbital Cavernous Hemangioma

Cavernous hemangioma (CH) is the most common benign tumor of the orbit which can expand the bony orbit by gradual growth of a large tumor. In this article, the authors report a 28-year-old man presented with a longstanding unilateral proptosis secondary to a huge orbital CH which also caused optic disc deformation and bone erosions in the adjacent orbital walls. The optic disc deformities resolved after the tumor removal. Address correspondence and reprint requests to Abbas Bagheri, MD, Labbafinejad Medical Center, Boostan 9 St, Pasdaran Avenue, Tehran 16666, Iran; E-mail: abbasbagheri@yahoo.com Received 4 May, 2018 Accepted 28 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2zNR89I

Osteotomy in Genioplasty by Piezosurgery

Background: The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips. The authors present the application of piezoelectric scalpel for the correction of different chin deformities. The distinctive characteristics of this device allow the authors to avoid or reduce the immediate genioplasty complications. Methods: Fifty-five patients of defective chin have been treated from January 2006 to April 2008. Intraoral genioplasty was performed during the correction of dentofacial dysmorphisms or associated with nasal surgery. The authors used a piezoelectric cutting device to perform different osteotomies and if necessary, interpositional graft was used to stabilize bony segments. Results: Piezosurgery has been associated with a fewer number of postoperative complications, especially as regard intraoperative bleeding, nerve injuries (immediate and late), hematomas and seromas, asymmetry (immediate and early). The mean time for completing the complete procedure of genioplasty with piezosurgery was almost the same compared with the saw and drill. Conclusion: Genioplasty represents one of the most common ancillary procedures and may be associated with corrective surgery of dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cut of mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect). In the authors' experience, piezoelectric scalpel, compared with saw and drill, enables them to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients' satisfaction. Address correspondence and reprint requests to Dario Bertossi, MD, Department of Maxillofacial Surgery and Dentistry, University of Verona, University Hospital of Verona, Piazzale L.A. Scuro 10 – 37134 Verona, Italy; E-mail: Dario.bertossi@univr.it Received 25 January, 2018 Accepted 13 May, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2DRedN5

Intracorporeal Septorhinoplasty: Technique and Outcome

Objective: Septal deformities usually associated with functional and aesthetic nasal consequences. Multiple techniques were described to correct these deformities. Using less invasive and at the same time competent technique with loge standing results is important. This study aimed to assess intracorporeal correction for septal deviation with assessment of its competence in managing deferent degrees of deviation and to show concomitant patient-dependant internal valve manipulation used. Methods: Intracorporeal correction of septal deviation was used in 35 patients which was performed at plastic surgery departments of Menoufia University Hospital and Mawada Privet Hospital, Egypt. The study was carried out between July 2014 and July 2017. Results: Thirty-five patients with variable types of septal deformities, 16 of them were females and 19 were males, were included in the study. Age of patients was between 18 and 55 years (mean 24.9, standard deviation 7.9). Etiology was found as follows: 15 (about 43%) posttraumatic septal deviation, 8 (about 23%) patients had postcleft septal deviation, and the remaining 12 had idiopathic septal deviation. Spreader graft was in 22 (about 63%) patients. Septal hematoma followed by septal perforation occurred in 1 patient (2.8%), while dorsal irregularities were found in 3 (8.4%) patients. Recurrent septal deviation occurred in 2 (5.6%) patients. Concerning functional outcome, no residual nasal obstruction was found in all patients with negative Cottle sign postoperative. Conclusion: Intracorporeal correction of septal deformities in open rhinoplasty technique is still found to be effective and less invasive option even with sever septal deviation. Address correspondence and reprint requests to Ahmed Tharwat Nassar, MD, Plastic Surgery Department, Menoufia University, Egypt 32111; E-mail: dr_ahmedtharwat79@yahoo.com Received 29 November, 2017 Accepted 29 May, 2018 The author reports no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2zNjctO

A New Technique for Sagittal Synostosis: A Plurality of Small Incisions Minimally Invasive Technique Used on Infants and Young Patients

Objectiv: The authors devised a multiple small incisions minimally invasive technique for use in isolated nonsyndromic sagittal synostosis to achieve better esthetic effect and satisfactory reshaping of the calvarial vault. The purpose of this study is to provide clinicians with new and feasible solution. Methods: From April 2016 to January 2017, 5 male patients were successfully treated with minimally invasive surgery. The age ranges from 1.5 to 3.3 years. The authors designed 9 short skin linear incisions (2–3 cm long) strategically to disperse in the scalp. The patient was assessed in a series including sex, age of surgery, blood loss, blood transfusion, duration of surgery, postoperative complications, preoperative and postoperative cephalic index (CI), length of stay (LOS), esthetic outcomes, and intellectual developmental quotient (DQ). Results: The shortest operation time is 1.5 hours. The shortest hospital stay is 6 days. The blood loss ranged from 135 to 280 mL. No serious complications occurred during the follow-up time. Postoperative 3-dimensional CT scan showed that the extensive floating bone formed well. Preoperative CI ranged from 64.2 to 68 and postoperatively 69.4 to 74.3. Mental development was tested by children heath care practioners, significantly improving DQ from 67 to 81 preoperatively and 76 to 90 postoperatively. All children receive good esthetic results. Conclusion: The new technique is safe and effective. The advantages are satisfactory: calvarial fornix remodeling, less visible appearance of scars, shorter length of surgery, lower mental and financial stress, optimal age for surgery, no endoscopic adjuvant and postoperative helmet are needed. Address correspondence and reprint requests to Shuo Gu, MD, Department of Neurosurgery, The Maternal and Child Health Hospital of Hainan Province, Haikou, Hainan 570206, China; E-mail: gushuo@shsmu.edu.cn Received 27 January, 2018 Accepted 31 May, 2018 T-JL and S-HW contributed equally to this study. Disclosure: Any experimental investigation with human subjects reported in the manuscript was performed with informed consent and following all the guidelines for experimental investigation with human subjects required by our institutions. The authors report no conflict of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2zNgowS

Evaluation of a Sample of Patients With Unilateral Cleft Lip and Palate Treated With a Two-Stage Protocol

The aim of this paper was to assess growth, speech, and aesthetic results at the completion of growth in patients with unilateral cleft lip and palate treated with the 2 stages Milan surgical protocol. Craniofacial growth was evaluated with cephalometric analysis and a theoretical need for orthognathic surgery. Nasolabial appearance was qualitatively assessed using the Asher McDade Aesthetic Index. Speech was assessed using the Gos.Sp.Ass '98 modified for Italian language scoring system. Burden of care was recorded in terms of number of secondary surgical procedures. All of the patients were treated and evaluated at San Paolo Hospital, Smile House, Milan. Fifty-two consecutive patients treated by the same surgeon were recalled, 12 patients did not come for assessment. The first surgical step (average age of 6 months) was cheilorhinoplasty (Millard modified Delaire technique) and soft palate rapair (Pigott). The second step (average age of 35 months) was hard palate and alveolar repair performed simultaneously with an early secondary gengivo alveolo plasty. Fifty-six percent of the patients did not need further surgery after the 2-stage surgery protocol. The 2-stage surgical protocol of Milano, Smile House, seems to be effective for treatment of unilateral cleft lip and palate, with good results in terms of speech, labial appearance, and alveolar cleft management. Nevertheless, maxillary growth was moderately impaired by the protocol. Address correspondence and reprint requests to Valeria Marinella Augusta Battista, MD, via De Predis 2, 20100 Milano, Italy; E-mail: vma.battista@gmail.com Received 14 January, 2018 Accepted 31 May, 2018 A case series of 20 patients, part of this paper, was presented during the 10th European Craniofacial Congress in Göteborg, Sweden, in 2015. No funding was received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s). The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2DP4MO5