An update of the pathogenesis of frontal fibrosing alopecia: What does the current evidence tell us?

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2z4xXHh

Quantitative gingival crevicular fluid proteome in type 2 diabetes mellitus and chronic periodontitis

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


https://ift.tt/2qaGMLJ

Use of calcium hydroxylapatite in the upper third of the face: Retrospective analysis of techniques, dilutions and adverse events

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2EIzQ2g

Adult bilateral idiopathic occlusion of foramina of Monro: is foraminoplasty really safe and effective?

Idiopathic bilateral occlusion of foramina of Monro is an extremely rare condition in adults and only few cases are reported. Currently, foraminoplasty is indicated as first-line treatment. We reported the case of a 52-year-old woman who presented with headache, instability and urinary incontinence. The imaging demonstrated bilateral occlusion of foramina of Monro and consequent biventricular hydrocephalus. A ventriculo-peritoneal shunt allowed to treat the hydrocephalus, but it was necessary to remove it for the appearance of peritonitis from salpingitis. Since the initial symptomatology reappeared, according to the literature, we performed an endoscopic foraminoplasty with septostomy. The patient immediately developed short-term memory impairment and subsequently we observed the hydrocephalus recurrence. The positioning of a ventriculo-atrial shunt allowed to improve the symptoms, but the memory remained impaired. In case of bilateral true stenosis of foramina of Monro, foraminoplasty may lead to severe memory impairment. Therefore, cerebrospinal fluid shunting should be considered as an effective and safer treatment.

https://ift.tt/2O7UaKa

Prenatal diagnosis and management of fetal discordant alpha-thalassaemia in dichorionic diamniotic (DCDA) twins

A 29-year-old nulliparous woman with a dichorionic diamniotic (DCDA) twin pregnancy was referred to our hospital at 16 weeks' gestation for prenatal diagnosis. She was diagnosed of Haemoglobin H Constant Spring (Hb H CS; --^SEA/α^CSα) and her husband of alpha thalassemia-1 trait (--^SEA/αα). Detailed ultrasound showed that left twin had fetal anaemia and early signs of hydrops while the right one was normal. Both twins were female. Amniocentesis in each sac was performed for prenatal diagnosis of thalassemia after a proper counselling with the couple. DNA analysis confirmed that the left fetus was affected with haemoglobin Bart's hydrops fetalis (--^SEA/--^SEA) while the right one was alpha thalassemia-1 trait (--^SEA/αα). Selective feticide with intracardiac injection of KCl was successfully performed on the hydropic fetus. Identification of the affected fetus is crucial for selective termination. Family counselling about the procedure and complications is also necessary.

https://ift.tt/2yAJ3nP

Histologically confirmed case of complete atrioventricular block due to hepatocellular carcinoma

A 72-year-old man, who had been diagnosed as having hepatocellular carcinoma (HCC) with multiple extrahepatic metastasis, complained a general fatigue which appeared 2 weeks before admission. Because bradycardia was detected on physical examination, ECG was performed which revealed the complete atrioventricular (AV) block. We stopped Ca-blocker and β-blocker, but the bradycardia persisted. He was admitted to our hospital for an emergent pacemaker implantation. On admission, he complained dyspnoea. After the surgery, he died due to deterioration of heart failure. The autopsy revealed cardiac metastasis of HCC on AV node, so it was suspected that cardiac metastasis caused the AV block. We thought that the cause of his death was the exacerbation of heart failure associated with bradycardia. It was likely that complete AV block as a very rare complication caused by cardiac metastasis of HCC influenced the prognosis of this patient.

https://ift.tt/2O7U994

Umbilical cord anomalies: antenatal ultrasound findings and postnatal correlation

Umbilical cord anomalies are rare. The differential diagnosis for a cystic structure around the umbilical cord and its insertion include pseudocyst, omphalomesenteric duct cyst, haemangioma, omphalocele or anterior abdominal wall defects. Although cord anomalies can be detected through antenatal ultrasound scans (US), very often a definitive diagnosis cannot be made. This may affect the management of the infant at birth. In cases where antenatal US was not diagnostic, current evidence supports the use of MRI to help in making an accurate diagnosis. We report two cases of umbilical cord anomalies. The first case was diagnosed in antenatal US as an omphalocele, but was found to be an allantoic cyst with hamartoma on postnatal diagnosis. The second case was not detected on antenatal US, and was diagnosed postnatally as a small omphalocele with vitellointestinal duct remnants.

https://ift.tt/2yA32mD

Coronary artery vasospasm in a patient withChurg-Strauss syndrome

Patients with Churg-Strauss syndrome often suffer from unusual cardiac manifestations and sudden cardiac death. This differs from patients with other autoimmune disorders, who typically present with premature ischaemic heart disease. We report the case of a 56-year-old man with recurrent coronary vasospasm, including an inferoposterior ST-elevation myocardial infarction, complicated by bradycardic arrest. There was only minor coronary artery disease on coronary angiography. An elevated eosinophil count was noted. His medical history included allergic rhinitis with polyposis, adult-onset asthma and biopsy-proven eosinophilic oesophagitis. Review of his sinus biopsies demonstrated blood vessels with marked accumulation of eosinophils in extravascular areas. The patient, therefore, met the American College of Rheumatology criteria for Churg-Strauss syndrome. The patient was commenced on immunosuppression, with the return of the eosinophil count to within normal limits, and remains free of cardiovascular events over 24 months.

https://ift.tt/2O7U7xY

Not just another diplopia: neurocysticercosis in a postpartum woman

Description 

A 23-year-old woman with a history of child birth 2 weeks back presented to the outpatient department with binocular diplopia and slight blurring of vision in both eyes (BE) for last 1 week. She also had four bouts of vomiting with associated nausea and hemicranial dull headache for last 3 days. The antenatal and immediate perinatal period was uneventful. Previous history as well as systemic history was not significant. The patient was afebrile. On systemic examination, neck stiffness could be elucidated. The blood pressure was recorded to be 124/74 mm Hg. Ocular examination revealed the visual acuity to be 20/40 in BE. There was restricted abduction of the right eye (figure 1) and diplopia charting revealed isolated sixth cranial nerve palsy. Pupillary reaction was brisk in BE with no evidence of relative afferent pupillary defect. Slit lamp evaluation of the anterior segment showed no abnormality. On fundus evaluation, bilateral disc oedema with ill-defined...

https://ift.tt/2yCktD9

Giant vesicle calculi leading to spontaneous bladder rupture and acute renal failure: an unusual presentation

Spontaneous rupture of the urinary bladder is extremely rare. We report a case of a 70-year-old man with spontaneous bladder rupture secondary to neglected giant vesicle calculi who presented as acute renal failure. The patient was stabilised with per-urethral catheterisation and extravesical drain placement. About 700 mL pus mixed with urine was drained through the per-urethral catheter and approximately 2000 mL of pus was drained through the extravesical drain. Cystolithotomy showed two large calculi which were removed.

https://ift.tt/2O7U5WS

Acute aortic dissection: a missed diagnosis

A 60-year-old man with a history of indigestion and untreated hypertension presented with sudden-onset central chest pain which radiated to his back. Acute coronary syndrome was initially suspected but excluded in the emergency department before the patient was discharged. The pain subsequently abated to mild intermittent episodes and was misdiagnosed as indigestion. A week later the patient developed new shortness of breath and 'flu-like' symptoms with a positive d-dimer test. CT angiography revealed a Stanford type B aortic dissection which was causing hypoperfusion of the right kidney, resulting in an acute kidney injury. Due to uncontrolled hypertension despite rigorous antihypertensive medication and his failing renal function, the patient underwent endovascular repair and made a good recovery postoperatively.

https://ift.tt/2yA30ev

Proximal humerus deformity, in a four-limb amputee following meningococcal septicaemia

We present a challenging case of proximal humerus varus deformity in a four-limb amputee, caused by growth arrest from meningococcal septicaemia. The deformity resulted in a loss of function for our patient with inhibition of activities of daily living, requiring corrective osteotomy to help improve the range of motion of the shoulder. We describe in detail the management of our patient, highlight the importance of the orthopaedic manifestations of meningococcal septicaemia, and demonstrate the importance of monitoring potential deformities from growth arrest in these patients.

https://ift.tt/2O7U4lM

Tuberous sclerosis complex: a clinical case with multiple ophthalmological manifestations

The tuberous sclerosis complex is a rare disease, with autosomal dominant transmission, with multisystemic involvement including ophthalmologic. Retinal hamartomas and retinal achromic patch are the most frequent ocular findings. Other ophthalmic signs and symptoms are relatively rare in this disease.

We describe the case of a young woman with tuberous sclerosis who presented with horizontal binocular diplopia and decreased visual acuity without complaints of nausea, vomiting or headache. She had right abducens nerve palsy, pale oedema of both optic discs and retinal hamartomas. An obstructive hydrocephalus caused by an intraventricular expansive lesion was identified in brain CT.

Observation by the ophthalmologist is indicated in all confirmed or suspected cases of tuberous sclerosis to aid in clinical diagnosis, monitoring of retinal hamartomas or identification of poorly symptomatic papilloedema.

https://ift.tt/2yzfrqS

Chest pain following permanent pacemaker insertion... a case of pneumopericardium due to atrial lead perforation

Permanent pacemaker (PPM) implantation is an increasingly common procedure with complication rate estimated between 3% and 6%. Cardiac perforation by pacemaker lead(s) is rare, but a previous study has shown that it is probably an underdiagnosed complication. We are presenting a case of a patient who presented 5 days after PPM insertion with new-onset pleuritic chest pain. She had a normal chest X-ray (CXR), and acceptable pacing checks. However, a CT scan of the chest showed pneumopericardium and pneumothorax secondary to atrial lead perforation. The pain only settled by replacing the atrial lead. A repeat chest CT scan a few months later showed complete resolution of the pneumopericardium and pneumothorax. We believe that cardiac perforation can be easily missed if associated with normal CXR and acceptable pacing parameters. Unexplained chest pain following PPM insertion might be the only clue for such complication, although it might not always be present.

https://ift.tt/2O7l6JO

Solitary fibrous tumour of caecum wall: an unlikely cause of low gastrointestinal haemorrhage

Solitary fibrous tumour (SFT), previously denominated as haemangiopericytoma, is a rare, spindle cell neoplasm that was first described in the thoracic pleura. It is now known that this tumour may develop from almost any anatomic location. We report a case of SFT, in a 65-year-old man, which was located in the muscularis propria layer of the caecum with involvement of the serosa and the ileocecal appendix, location never described in the literature, and with an uncommon clinical presentation of hematochezia. A radical right hemicolectomy was performed, and the patient was asymptomatic without evidence of metastasis or relapse after 6 months of follow-up.

https://ift.tt/2yA2Xzl

Neck carbuncle associated with methicillin-susceptible Staphylococcus aureus bacteraemia

Description 

A 66-year-old man presented with a 14-day history of painful posterior neck swelling and fever for a week prior to presentation. A restricted neck movements was noted over the last 3 days. Generally, he had a fever of 37.5°C and tachycardia at 121 bpm, whereas the other vital signs were normal. Local physical examination showed large posterior neck swelling with erythema and multiple sinuses discharging pus.

A neck carbuncle was diagnosed (figure 1).1 2 Skin eruptions were noted also on the lower extremities and gluteal region.

Figure 1

Physical examination. (a) A pustule in posterior neck which is surrounded by an extensive erythematous swelling (white dotted circle). (b) The pustules that have the same features were seen at lower extremity and gluteal region.

Laboratory evaluation showed a haemoglobin level of 14.3 g/dL, leucocyte count of 38 800x109/L, sodium of 132 mmol/L, creatinine of...

https://ift.tt/2O7U19A

Multiple yellow nodules in a 13‐year‐old girl

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2OMP2QG

Painful papule on the right arm of a woman

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2O7mYCj

Human papilloma virus infection in the healing thermal‐burn wound in a child

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2OPRtlH

Dead or alive: how the immune system detects microbial viability

Matteo Ugolini | Leif E Sander

https://ift.tt/2PVsLgd

Management of Squamous Cell Carcinoma Involving the Temporal Bone

Abstract

Purpose of Review

To examine contemporary management of squamous cell carcinoma (SCC) involving the temporal bone.

Recent Findings

The modified Pittsburgh criteria have gained acceptance by many institutions for staging, planning treatment and comparing outcomes. Often primary SCC as well as secondary cutaneous SCC involving the temporal bone can be managed in a similar fashion.

Summary

T1 tumours should undergo lateral temporal bone resection (LTBR) due to the higher risk of positive margins and recurrence rates with lesser surgical procedures. T2 tumours require LTBR and superficial parotidectomy. T3 and T4 tumours often require a subtotal resection of the temporal bone (STBR), parotidectomy and cutaneous soft tissues as an en bloc excision. Advanced lesions are associated with a diminished survival especially if margins are involved. Patient outcomes are improved by a combination of surgery and postoperative radiotherapy. Preoperative imaging with high resolution CT and MRI is useful, particularly if there is evidence of large nerve perineural spread and nodal disease.

https://ift.tt/2SjOKPy

Richard Studley Farr, MD

During the early 1960s, I was a postdoctoral fellow under the mentorship of David W. Talmage, MD. The laboratory at the University of Colorado Health Sciences Center was a crossroads for visiting allergists and immunologists from all over the world. Dr. Talmage would arrange for the fellows to meet one-on-one with many of the visitors. For some visitors, a suggestion was made to avoid discussing any work that was not well along the path to publication. When Dr. Richard Farr came to visit, the suggestion was, "you should get Dick Farr's thoughts about this." Very worthwhile advice indeed.

https://ift.tt/2CIdiMO

“Electrochemotherapy – a loco regional therapy with well-established palliative effect in patient with large recurrent lesion of Head and Neck”

Electrochemotherapy (ECT) is a well-established treatment for cutaneous tumors consisting in the combination of electroporation and chemotherapy. Electroporation has been studied for approximately 20 years as a means of facilitating the transport of normally non-permeant molecules into cells. By applying an electric field to the cells, the membrane become permeable, allowing chemotherapic agents such as bleomycin to enter the cell.increasing its toxicity(Mir et al., 1991).

https://ift.tt/2Pk4Hqi

Double Puncture Versus Single Puncture Arthrocentesis For The Management Of Unilateral Temporomandibular Joint Disc Displacement Without Reduction: A Randomized Controlled Trial

To compare the clinical efficacy of the conventional double puncture versus single puncture type 2 arthrocentesis for management of temporomandibular joint disc displacement without reduction (DDWOR).

https://ift.tt/2EKEvAO

Real-time augmented model guidance for mandibular proximal segment repositioning in orthognathic surgery, using electromagnetic tracking

It is essential to reposition the mandibular proximal segment (MPS) as close to its original position as possible during orthognathic surgery. Conventional methods cannot pinpoint the exact position of the condyle in the fossa in real time during repositioning. In this study, based on an improved registration method and a separable electromagnetic tracking tool, we developed a real-time, augmented, model-guided method for MPS surgery to reposition the condyle into its original position more accurately.

https://ift.tt/2EIaPEo

Rural and urban differences in orthognathic surgical patients in the north east of Scotland

We have previously identified differences in the presentation and treatment of cancer between patients who live in rural compared with urban areas, but have not yet seen differences in those treated by orthognathic surgery. We hypothesised that patients from areas further away from the hospital face higher costs to attend and may not present with minor problems as often as those who live nearby. We therefore retrospectively reviewed all those (n=216) who had presented for orthognathic surgery over a six-year period (May 2011 to May 2017).

https://ift.tt/2OS7lEf

Re: Knowledge of final-year medical students about oral and maxillofacial surgery: a two-centre study

As medical students in our clinical years, we read with interest the article by Hamid et al.1 They used a questionnaire to assess students' exposure to oral and maxillofacial surgery (OMFS), their knowledge of oral cancer, and their ability to refer appropriately to OMFS. They concluded that medical students are poorly engaged with OMFS and would benefit from improved awareness and understanding of the specialty.

https://ift.tt/2Rd4iTN

More Press Coverage from the 88th Annual Meeting of the ATA

 From endocrineweb

Combination Immunotherapies to Treat Advanced Thyroid Cancers

Diet for Thyroid Disease: What You Need to Know

Matching Expectations and Guidelines to Treatment-Worthy Thyroid Cancers

Liver Failure: A Turning Point in Graves' Disease Treatment

 

The post More Press Coverage from the 88th Annual Meeting of the ATA appeared first on American Thyroid Association.

https://ift.tt/2RhD8v8

High Thyrotropin Is Associated with Reduced Hippocampal Volume in a Population-Based Study from Germany

Thyroid, Ahead of Print.


https://ift.tt/2OLvdJs

Erosive pustular dermatosis of the scalp: a neutrophilic folliculitis within the spectrum of neutrophilic dermatoses. A clinicopathologic study of thirty cases

Histopathology of primary lesion of erosive pustular dermatosis of the scalp has not been characterized. Biopsy of intact follicular pustules shows spongiotic vesiculo-pustules affecting the follicular infundibula. Erosive pustular dermatosis of the scalp is a neutrophilic superficial folliculitis, with some clinicopathologic similarities with other pathergic neutrophilic dermatoses, such as pyoderma gangrenosum.

https://ift.tt/2PjGMao

Development and Implementation of an Order Set to Improve Value of Care for Patients with Severe Stasis Dermatitis

https://ift.tt/2Jhn1dZ

Considerations on the ‘corseting’ or ‘strangling’ technique to treat large venous malformations

We read with interest the paper entitled "Corseting: a new technique for the management of diffuse venous malformations in the head and neck region" published in the International Journal of Oral & Maxillofacial Surgery1, and found that it deals with a relevant topic.

https://ift.tt/2O52GJK

Apical U-shape splitting technique for undercut areas of the anterior alveolar ridge: a prospective non-randomized controlled study

The aim of this study was to investigate a novel apical U-shape splitting technique for horizontal bone augmentation in undercut areas and to compare its efficacy with that of guided bone regeneration (GBR). This was a prospective non-randomized controlled clinical trial. A total of 36 patients, who presented with a labial undercut that was not able to house a normally inclined implant, underwent the new technique or GBR. Radiographic and clinical data were obtained preoperatively, immediately after surgery, and 12 months after surgery.

https://ift.tt/2yBntQf

‘Corseting’ and ‘strangling’—two techniques sharing similar concepts to treat large venous malformations in the head and neck region

We congratulate Colletti et al. for introducing the 'strangling technique' in a preliminary report of two cases in the journal Head & Neck in October 20141. Although it shares a similar approach with the 'corset technique' in terms of the concept and the exposure of the lesion, it is very different from the corset technique2. The term itself talks about a difference in collapsing the lesion using locked vertical mattress sutures. The following narrative clearly explains the differences between the two techniques.

https://ift.tt/2O52EBC

Dysplastic Nevi: Monitoring and Management

Is it safe to observe moderately dysplastic nevi with positive histologic margins, or is the risk for cutaneous melanoma too high?
Medscape Dermatology

https://ift.tt/2yZ1vWA

MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence

mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and results ach...

https://ift.tt/2O6oaWA

Off-the-shelf cell therapy with induced pluripotent stem cell-derived natural killer cells

Abstract

Cell therapy is emerging as a very promising therapeutic modality against cancer, spearheaded by the clinical success of chimeric antigen receptor (CAR) modified T cells for B cell malignancies. Currently, FDA-approved CAR-T cell products are based on engineering of autologous T cells harvested from the patient, typically using a central manufacturing facility for gene editing before the product can be delivered to the clinic and infused to the patients. For a broader implementation of advanced cell therapy and to reduce costs, it would be advantageous to use allogeneic "universal" cell therapy products that can be stored in cell banks and provided upon request, in a manner analogous to biopharmaceutical drug products. In this review, we outline a roadmap for development of off-the-shelf cell therapy based on natural killer (NK) cells derived from induced pluripotent stem cells (iPSCs). We discuss strategies to engineer iPSC-derived NK (iPSC-NK) cells for enhanced functional potential, persistence, and homing.

https://ift.tt/2D47nm4

Sex differences in autoimmune disorders of the central nervous system

Abstract

Stronger adaptive immune responses in females can be observed in different mammals, resulting in better control of infections compared to males. However, this presumably evolutionary difference likely also drives higher incidence of autoimmune diseases observed in humans. Here, we summarize sex differences in the most common autoimmune diseases of the central nervous system (CNS) and discuss recent advances in the understanding of possible underlying immunological and CNS intrinsic mechanisms. In multiple sclerosis (MS), the most common inflammatory disease of the CNS, but also in rarer conditions, such as neuromyelitis optica spectrum disorders (NMOSD) or neuronal autoantibody–mediated autoimmune encephalitis (AE), sex is one of the top risk factors, with women being more often affected than men. Immunological mechanisms driving the sex bias in autoimmune CNS diseases are complex and include hormonal as well as genetic and epigenetic effects, which could also be exerted indirectly via modulation of the microbiome. Furthermore, CNS intrinsic differences could underlie the sex bias in autoimmunity by differential responses to injury. The strong effects of sex on incidence and possibly also activity and progression of autoimmune CNS disorders suggest that treatments need to be tailored to each sex to optimize efficacy. To date, however, due to a lack of systematic studies on treatment responses in males versus females, evidence in this area is still sparse. We argue that studies taking sex differences into account could pave the way for sex-specific and therefore personalized treatment.

https://ift.tt/2EIvF6I

Sexual dimorphism in solid and hematological malignancies

Abstract

Cancer represents a leading cause of death with continuously increasing incidence worldwide. Many solid cancer types in non-reproductive organs are significantly more frequent and deadly in males compared to females. This sex-biased difference is also present in hematologic malignancies. In this review, we present an overview about sex differences in cancer with a focus on leukemia. We discuss mechanisms potentially underlying the observed sex-biased imbalance in cancer incidence and outcome including sex hormones, sex chromosomes, and immune responses. Besides affecting the pathobiology of cancers, sex differences can also influence drug responses, most notably those to immune checkpoint blockers. Therefore, sex should become a relevant factor in clinical trial design in order to avoid over- or under-treatment of one sex.

https://ift.tt/2D3J5IV

Sex differences in tuberculosis

Abstract

Tuberculosis is the most prevalent bacterial infectious disease in humans and the leading cause of death from a single infectious agent, ranking above HIV/AIDS. The causative agent, Mycobacterium tuberculosis, is carried by an estimated two billion people globally and claims more than 1.5 million lives each year. Tuberculosis rates are significantly higher in men than in women, reflected by a male-to-female ratio for worldwide case notifications of 1.7. This phenomenon is not new and has been reported in various countries and settings over the last century. However, the reasons for the observed gender bias are not clear, potentially highly complex and discussed controversially in the literature. Both gender- (referring to sociocultural roles and behavior) and sex-related factors (referring to biological aspects) likely contribute to higher tuberculosis rates in men and will be discussed.

https://ift.tt/2EIvCb2

The effect of maxillary sinus antrostomy size on the sinus microbiome

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2CERIIO

The role of galactomannan Aspergillus antigen in diagnosing acute invasive fungal sinusitis

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2q9cLM2

Exposure to 3‐methyl‐4‐nitrophenol (MNP) facilitates development of intestinal allergy

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


https://ift.tt/2yz77rs

Audiological and clinical outcomes of a transcutaneous bone conduction hearing implant: 6‐month results from a multicenter study

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2PkPnK0

Methotrexate and melanoma‐specific mortality

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Sj5V3G

First psychodermatology clinic in a Portuguese department of Dermatology

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2z6CrNM

Inherited epidermolysis bullosa: description of clinical and subclinical morphological features with optical coherence tomography

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2ShjbWo

Increased tumour cell PD‐L1‐expression, macrophage and dendritic cell infiltration characterise the tumour microenvironment of ulcerated primary melanomas

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2z1ZE3r

JAK1/3‐inhibition preserves epidermal morphology in full thickness 3D skin models of atopic dermatitis and psoriasis

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Si5ab5

Validation of “ItchApp©” in Poland and in the USA Multicenter validation study of an electronical Diary for the Assessment of pruritus

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2z2Jy9Q

Post‐orf epidermolysis bullosa acquisita

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Shjb8Q

Aggressive-Appearing Intratracheal Mass in an Older Woman

A woman in her early 70s presents with biphasic stridor and a report of dyspnea on mild exertion. Noncontrast computed tomography of the chest shows a lesion protruding into the right side of the tracheal region that appears to be contiguous with the right lobe of the thyroid gland. Examination of a biopsy specimen shows medullary thyroid cancer. What is your diagnosis?

https://ift.tt/2PlrG3Z

Reduction of Opiates for Ambulatory Surgery

According to the US Department of Health and Human Services, 116 people die every day in this country from an opioid-related overdose. That statistic represents more than 42 000 people a year, more than the annual number of deaths due to automobile crashes or homicides. In 2014, 47 055 drug overdose deaths occurred in the United States, and 60.9% of those involved an opioid. The following year, this number grew to 53 000 deaths and the percentage involving at least 1 opioid drug increased to 63.1%. In 1999, only 180 morphine milligram equivalents (MME) per capita were sold in the United States. In 2015, 640 MMEs per capita were sold, representing a 3.6-times increase.

https://ift.tt/2JfRoS9

Opioid Prescribing Practice and Needs in Thyroid and Parathyroid Surgery

This cohort study assesses the opioid prescribing practices and opioid needs for patients undergoing thyroid and parathyroid surgery.

https://ift.tt/2PlrFNt

Characterizing the Normative Voice Tremor Frequency in Essential Vocal Tremor

This cross-sectional observational study characterizes the normative voice tremor frequency in patients with essential vocal tremor.

https://ift.tt/2JfRmK1

The Use of Osteopathic Medical Manipulation to Decrease the Incidence and Severity of Post-Operative Sore Throat

Conditions:   Pharyngitis;   Dysphonia
Interventions:   Procedure: Osteopathic Manipulation Treatment;   Procedure: Sham
Sponsor:   Brooke Army Medical Center
Recruiting

https://ift.tt/2OP7SH2

Early Support in Primary Care for People Starting Treatment for Cancer

Conditions:   Cancer of Pancreas;   Cancer of Stomach;   Cancer of Esophagus
Intervention:   Other: Anticipatory care planning letter
Sponsors:   NHS Lothian;   NHS Fife
Recruiting

https://ift.tt/2RkJQ3x

Safety and Efficacy of Tipifarnib in Head and Neck Cancer With HRAS Mutations and Impact of HRAS on Response to Therapy

Conditions:   HRAS Gene Mutation;   HNSCC
Interventions:   Drug: Tipifarnib;   Device: HRAS Detection Assay
Sponsor:   Kura Oncology, Inc.
Not yet recruiting

https://ift.tt/2OONIgl

Enteral Omega 3 During Radiotherapy to Improve the Quality of Life and Functionality of Head and Neck Cancer Patients

Conditions:   Head and Neck Squamous Cell Carcinoma;   Quality of Life;   Radiotherapy; Complications
Interventions:   Dietary Supplement: Omega 3 Group;   Dietary Supplement: Placebo or Control Group
Sponsor:   Coordinación de Investigación en Salud, Mexico
Recruiting

https://ift.tt/2R9GP5G

Nal-iri/lv5-fu Versus Paclitaxel as Second Line Therapy in Patients With Metastatic Oesophageal Squamous Cell Carcinoma

Condition:   Squamous Cell Carcinoma
Interventions:   Drug: Onivyde;   Drug: Paclitaxel
Sponsors:   Federation Francophone de Cancerologie Digestive;   Shire
Not yet recruiting

https://ift.tt/2OO0cEF

Robot-assisted Approach to Cervical Cancer

Condition:   Cervical Cancer
Interventions:   Procedure: Abdominal radical hysterectomy;   Procedure: Robot-assisted radical hysterectomy;   Diagnostic Test: Sentinel lymph node biopsy
Sponsor:   Karolinska Institutet
Not yet recruiting

https://ift.tt/2RgxvgB

Acute Radiation Oral Mucositis in Nasopharyngeal Carcinoma(NPC) Patients Treated With Combined Radio-Chemotherapy

Condition:   Nasopharyngeal Carcinoma
Interventions:   Drug: Recombinant Human Interleukin-11;   Drug: Saline
Sponsor:   Zhejiang Cancer Hospital
Recruiting

https://ift.tt/2OMlBye

Analysis of tumor-infiltrating CD103 resident memory T-cell content in recurrent laryngeal squamous cell carcinoma

Abstract

Background

Recurrent laryngeal squamous cell carcinomas (LSCCs) are associated with poor outcomes, without reliable biomarkers to identify patients who may benefit from adjuvant therapies. Given the emergence of tumor-infiltrating lymphocytes (TIL) as a biomarker in head and neck squamous cell carcinoma, we generated predictive models to understand the utility of CD4⁺, CD8⁺ and/or CD103⁺ TIL status in patients with advanced LSCC.

Methods

Tissue microarrays were constructed from salvage laryngectomy specimens of 183 patients with recurrent/persistent LSCC and independently stained for CD4⁺, CD8⁺, and CD103⁺ TIL content. Cox proportional hazards regression analysis was employed to assess combinations of CD4⁺, CD8⁺, and CD103⁺ TIL levels for prediction of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) in patients with recurrent/persistent LSCC.

Results

High tumor CD103⁺ TIL content was associated with significantly improved OS, DSS, and DFS and was a stronger predictor of survival in recurrent/persistent LSCC than either high CD8⁺ or CD4⁺ TIL content. On multivariate analysis, an "immune-rich" phenotype, in which tumors were enriched for both CD103⁺ and CD4⁺ TILs, conferred a survival benefit (OS hazard ratio: 0.28, p = 0.0014; DSS hazard ratio: 0.09, p = 0.0015; DFS hazard ratio: 0.18, p = 0.0018) in recurrent/persistent LSCC.

Conclusions

An immune profile driven by CD103⁺ TIL content, alone and in combination with CD4⁺ TIL content, is a prognostic biomarker of survival in patients with recurrent/persistent LSCC. Predictive models described herein may thus prove valuable in prognostic stratification and lead to personalized treatment paradigms for this patient population.

https://ift.tt/2O6kkN6

Non-cystic Sclerosing Polycystic Adenosis: Diagnosis of a Hitherto Undescribed Pattern

Abstract

A case of sclerosing polycystic adenosis without cysts is described. The lesion occurred as a painless slow growing superficial right parotid lump in a 47 years old woman. The tumor measured 14 × 10 mm and displayed extreme well circumscription, sclerotic stroma with scattered hyaline nodules, sprinkling of mononuclear inflammatory cells and islands of mature fat. The epithelial component was predominantly composed of tubules lined by low columnar to cuboidal epithelium with bland nuclear features. Only focal incomplete acinar differentiation with few cells containing small eosinophilic granules was present. The stroma contained a significant fibromyxoid component with increased cellularity. There was no recurrence on follow-up at 14 months.

https://ift.tt/2O3sExn

Combined Growth Factor and Gene Therapy: An Approach for Hair Cell Regeneration and Hearing Recovery

Introduction: Fibroblast growth factor, nerve growth factor neurotrophins, and insulin-like growth factor 1 are considered 3 families of growth factors that can be involved in the process of otic neurogenesis. In this respect, otic neurons can also be connected with mechanoreceptors in the ear, the hair cells (HCs), as well as the central nervous system. As a growth factor is combined with gene transfer technology, it can be used for hair cell regeneration. Gene therapy can be similarly employed to introduce genes into a system in order to induce the expression of genes for therapeutic agents, to replace defective genes, or to re-program supporting or surrounding cells to acquire the phenotype of lost or damaged cells in order to repair or regenerate the damaged tissue. Objective: The purpose of this review article was to investigate the epigenetic and growth factors involved in the differentiation pathway of embryonic stem cells (ESCs) into HCs and auditory neurons (ANs). Methods: To this end, the databases of Directory of Open Access Journals, Google Scholar, PubMed (NLM), LISTA (EBSCO), as well as Web of Science were searched. Results: Given the results available in the related literature, the differentiation efficacy of ESCs toward the ANs and the HCs, the important role of growth factors, and 3 different strategies of application of miRNA, epigenetic regulation, and preparation of three-dimensional (3D) environments were suggested to be taken into consideration in order to improve these studies in the future. Furthermore, the role of epige­netic mechanisms and miRNA in this differentiation process became quite obvious; hence, the utilization of such procedures in the near future would be significant. Conclusion: Combining several techniques with a synergic effect (such as growth factor gene therapy and 3D environments) seemed to lead to obtaining the best results as a therapeutic strategy.
ORL

https://ift.tt/2CEUwpi

Vocal Cord Palsy as a Complication of Epidural Anaesthesia

Cranial nerve palsy is a rare but recognised complication of epidural anaesthesia, most commonly presenting as diplopia secondary to abducens nerve palsy. While upper cranial nerve palsies have been documented on numerous occasions, lower cranial nerve palsies, including recurrent laryngeal nerve palsy, are exceedingly rare. This case describes a 37-year-old female who, following epidural anaesthesia for spontaneous vaginal delivery of her first child, presented with dysphonia. Flexible laryngoscopy confirmed a left vocal cord palsy, and computed tomography ruled out any mass lesions along the course of the recurrent laryngeal nerve. Here, we discuss a case of vocal cord palsy secondary to epidural anaesthesia, an extremely rare complication. We also discuss the proposed etiology, treatment, and outcomes in patients with this condition. Cranial nerve palsy should be an important differential in patients presenting with dysphonia following spinal or epidural anaesthesia.

https://ift.tt/2Sj0AJp

Non-cystic Sclerosing Polycystic Adenosis: Diagnosis of a Hitherto Undescribed Pattern

Abstract

A case of sclerosing polycystic adenosis without cysts is described. The lesion occurred as a painless slow growing superficial right parotid lump in a 47 years old woman. The tumor measured 14 × 10 mm and displayed extreme well circumscription, sclerotic stroma with scattered hyaline nodules, sprinkling of mononuclear inflammatory cells and islands of mature fat. The epithelial component was predominantly composed of tubules lined by low columnar to cuboidal epithelium with bland nuclear features. Only focal incomplete acinar differentiation with few cells containing small eosinophilic granules was present. The stroma contained a significant fibromyxoid component with increased cellularity. There was no recurrence on follow-up at 14 months.

https://ift.tt/2O3sExn

Ungewöhnlicher Tumor der Schädelbasis mit Ausdehnung in die Halsweichteile

https://ift.tt/2z0zr5n

Non-cystic Sclerosing Polycystic Adenosis: Diagnosis of a Hitherto Undescribed Pattern

Abstract

A case of sclerosing polycystic adenosis without cysts is described. The lesion occurred as a painless slow growing superficial right parotid lump in a 47 years old woman. The tumor measured 14 × 10 mm and displayed extreme well circumscription, sclerotic stroma with scattered hyaline nodules, sprinkling of mononuclear inflammatory cells and islands of mature fat. The epithelial component was predominantly composed of tubules lined by low columnar to cuboidal epithelium with bland nuclear features. Only focal incomplete acinar differentiation with few cells containing small eosinophilic granules was present. The stroma contained a significant fibromyxoid component with increased cellularity. There was no recurrence on follow-up at 14 months.

https://ift.tt/2O3sExn

Individualized treatment for allergic rhinitis based on key nasal clinical manifestations combined with histamine and leukotriene D4 levels

Publication date: Available online 24 October 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Congxiang Shen, Fang Chen, Huigang Wang, Xinyu Zhang, Guanxue Li, Zhong Wen

Abstract

Introduction

The types of allergic rhinitis are roughly classified based on the causative antigens, disease types, predilection time, and symptom severity.

Objective

To examine the clinical typing and individualized treatment approach for allergic rhinitis and to determine the optimal treatment method for this disease using various drug combination therapies.

Methods

A total of 108 participants with allergic rhinitis were divided into three groups based on symptoms. Subsequently, each group was further categorized into four subgroups based on the medications received. The efficacy of the treatments was evaluated using the visual analog scale VAS scores of the total and individual nasal symptoms, decline index of the symptom score, histamine and leukotriene levels, and mRNA and protein expression levels of histamine 1 and cysteinyl leukotriene 1 receptors.

Results

Loratadine + mometasone furoate and loratadine + mometasone furoate + montelukast significantly improved the sneezing symptom and reduced the histamine levels compared with the other combination therapies (p < 0.05). Meanwhile, montelukast + mometasone furoate and montelukast + mometasone furoate + loratadine considerably improved the nasal obstruction symptom and decreased the leukotriene D4 levels compared with the other combination therapies (p < 0.05).

Conclusion

Clinical symptom evaluation combined with experimental detection of histamine and leukotriene levels can be an objective and accurate method to clinically classify the allergic rhinitis types. Furthermore, individualized treatment based on allergic rhinitis classification can result in a good treatment efficacy.

Resumo

Introdução

A rinite alérgica é basicamente classificada de acordo com os antígenos causadores, tipos de doença, peridiocidade e gravidade dos sintomas.

Objetivo

Avaliar os tipos clínicos e a abordagem terapêutica individualizada para cada tipo de rinite alérgica, e determinar o método de tratamento ideal utilizando várias terapias de combinação de fármacos.

Método

Um total de 108 participantes com rinite alérgica foram divididos em três grupos com base nos sintomas. Posteriormente, cada grupo foi subsequentemente categorizado em quatro subgrupos com base nos medicamentos recebidos. A eficácia dos tratamentos foi avaliada utilizando os escores da escala visual analógica EVA dos sintomas nasais totais e individualmente, índice de declínio do escore de sintomas, níveis de histamina e leucotrienos e níveis de expressão de mRNA e proteína dos receptores de histamina 1 e cisteinil-leucotrieno 1.

Resultados

As associações entre loratadina + furoato de mometasona, assim como a de loratadina + furoato de mometasona + montelucaste melhoraram significativamente o sintoma de espirros e reduziram os níveis de histamina em comparação às outras terapias combinadas (p < 0,05). Por outro lado, a associação montelucaste + furoato de mometasona, assim como a associação montelucaste + furoato de mometasone + loratadina melhoraram consideravelmente o sintoma de obstrução nasal e diminuíram os níveis de leucotrieno D4 em comparação com as outras combinações (p < 0,05).

Conclusão

A avaliação clínica dos sintomas combinada com a detecção experimental dos níveis de histamina e leucotrieno pode ser um método objetivo e preciso para classificar clinicamente os tipos de rinite alérgica. Além disso, o tratamento individualizado baseado na classificação da rinite alérgica pode resultar no aumento da eficácia do tratamento.

https://ift.tt/2CGnm8H

Regulatory T cell therapy for autoimmune and autoinflammatory diseases: the next frontier

Publication date: Available online 25 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jonathan H. Esensten, Yannick D. Muller, Jeffrey A. Bluestone, Qizhi Tang

Unstructured abstract

FOXP3-expressing regulatory T cells (Tregs) are essential for self-tolerance with an emerging role in tissue repair and regeneration. Their ability to traffic to tissue and perform complex therapeutic tasks in response to the tissue microenvironment make them an attractive candidate for drug development. Early experiences of Treg cell therapy in graft-versus-host disease, type 1 diabetes, and organ transplant have shown that it is feasible, safe, and potentially efficacious in some settings. Many ongoing trials in a wide variety of diseases will further enhance our knowledge about the optimal approaches for Treg manufacturing and dosing. We review the current preclinical rationale supporting Treg therapy in a variety of disease settings ranging from tissue transplantation, autoimmune diseases, and non-immune-mediated inflammatory settings. We point out challenges in development of Treg cell therapy and speculate how synthetic biology may be used to enhance the feasibility and efficacy of Treg therapy for autoimmune and autoinflammatory diseases.

https://ift.tt/2SdpI4m

Analysis of eosinophilic esophagitis in children with repaired congenital esophageal atresia

Publication date: Available online 24 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Usha Krishnan, Chan Lijuan, Gifford J. Andrew, Marc E. Rothenberg, Ting Wen

Background

A high prevalence of eosinophilic esophagitis (EoE) has been preliminarily reported in patients after repair of esophageal atresia (EA), but the basis of this association is unknown.

Objectives

We aimed to (1) characterize the EoE transcriptome in patients with EA, (2) compare the EoE transcriptome in patients with EoE and EA with that in patients with EoE alone, and (3) identify transcripts that could predispose patients with EA to EoE.

Methods

This single-center, population-based, retrospective study identified 4 EoE study cohorts: healthy control subjects, patients with EA and EoE (EA+EoE+), patients with EA without EoE (EA+EoE−), and patients with EoE without EA (EA−EoE+). Molecular signatures were assessed by using the EoE diagnostic panel, a 94-gene expression quantitative PCR array.

Results

In a cohort of 110 pediatric patients with surgically repaired EA, 20 (18%) patients were given a diagnosis of EoE, representing a 364-fold enrichment of EoE in patients with EA compared with the general pediatric population. EoE diagnostic panel analyses revealed a major overlap between the EA+EoE+ and EA−EoE+ cohorts. A proportion (approximately 25%) of EoE signature genes were dysregulated in patients with EA+EoE− compared with healthy control subjects, including those involved in epithelial barrier function and type 2–associated inflammatory responses. Patients with EA+EoE+ exhibit a more severe EoE clinical phenotype than those with EA−EoE+ in terms of dysphagia and dilation need.

Conclusions

Patients with EA have increased risk of EoE. Patients with EoE with EA have a similar molecular profile compared with that of patients with EoE without EA. Dysregulated baseline epithelial barrier and type 2–associated genes in EA monomorbidity might explain the higher EoE prevalence in patients with EA.

Graphical abstract

https://ift.tt/2zbBnrZ

Integrative approach identifies corticosteroid response variant in diverse populations with asthma

Publication date: Available online 24 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Albert M. Levin, Hongsheng Gui, Natalia Hernandez-Pacheco, Mao Yang, Shujie Xiao, James J. Yang, Samantha Hochstadt, Andrea J. Barczak, Walter L. Eckalbar, Dean Rynkowski, Lesly-Anne Samedy, Pui-Yan Kwok, Maria Pino-Yanes, David J. Erle, David E. Lanfear, Esteban G. Burchard, L. Keoki Williams

Abstract

Background

Although inhaled corticosteroid (ICS) medication is considered the cornerstone treatment for patients with persistent asthma, few ICS pharmacogenomic studies have involved non-white populations.

Objective

To identify genetic predictors of ICS response in multiple population groups with asthma.

Methods

The discovery group comprised African American participants from the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE) who underwent 6 weeks of monitored ICS therapy (n=244). A genome-wide scan was performed to identify single nucleotide polymorphism (SNP) variants jointly associated (i.e., the combined effect of the SNP and SNP x ICS treatment interaction) with changes in asthma control. Top associations were validated by assessing the joint association with asthma exacerbations in three additional groups – African Americans (n=803 and n=563) and Latinos (n=1,461). RNA-seq data from 408 asthma cases and 405 controls were used to examine whether genotype was associated with gene expression.

Results

One variant, rs3827907, was significantly associated with ICS-mediated changes in asthma control in the discovery set (P=7.79x10^-8) and was jointly associated with asthma exacerbations in three validation cohorts (P=0.023, P=0.029, and P=0.041). RNA-seq analysis found the rs3827907 C-allele to be associated with lower RNASE2 expression (P=6.10x10-4). RNASE2 encodes eosinophil-derived neurotoxin (EDN), and the rs3827907 C-allele appeared to particularly influence ICS treatment response in the presence of eosinophilic inflammation (i.e., high pre-treatment EDN levels or blood eosinophil counts).

Conclusion

We identified a variant, rs3827907, which appears to influence response to ICS treatment in multiple population groups, and likely mediates its effect through eosinophils.

Clinical Implications

African Americans and Latinos are disproportionately affected by asthma and its complications. Here we identify a pharmacogenomic variant that may assist in identifying individuals from these groups who will respond to ICS treatment.

https://ift.tt/2ShqXQ8

“Evaluating primary endpoints in peanut immunotherapy clinical trials”

Publication date: Available online 24 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Pablo Rodríguez del Río, Carmelo Escudero, Silvia Sánchez-García, María Dolores Ibáñez, Brian P. Vickery

Abstract

Food immunotherapy has been the focus of several allergy research initiatives over the last decade. Though many questions remain unanswered, the evidence suggests that this treatment may be available in the near future outside clinical trials. Additionally, pharmaceutical companies, in light of promising early stage results, have shown interest in developing commercially available products, thus increasing the likelihood that new immunotherapy treatments will be introduced, especially for peanut allergy.

Given this optimistic scenario, and given the prospect of rigorously developed products for peanut allergy treatment, each allergist will need to understand the specificities of these treatments and their expected efficacy and adverse event profiles. It is thus imperative that allergists understand the differences in efficacy between the different management options as well as how the endpoints are measured in the relevant literature. However, given the significant heterogeneity detected among food immunotherapy trials, this task may not be as straightforward as desired.

This article aims to dissect how primary efficacy endpoints are defined and assessed in order to facilitate understanding of the design of these trials and the potential impact that this variation may have on the reported outcomes.

https://ift.tt/2z3p3tF

Effect of “Surgery-first” orthognathic approach on temporomandibular symptoms and function: a comparison with “Orthodontic-first” approach

Publication date: Available online 24 October 2018

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

Author(s): Kensuke Yamauchi, Tetsu Takahashi, Yoshihiro Yamaguchi, Hikari Suzuki, Shinnosuke Nogami, Junji Sugawara

Abstract

Objective

The aim of this study was to comparatively evaluate the effects of the Surgery-first approach (SFA) and Orthodontics-first approach (OFA) on temporomandibular joint (TMJ) function and maximum mouth opening.

Study Design

This retrospective study investigated the outcomes of patients with diagnosed skeletal class III dentofacial deformities. 24 patients were enrolled in the OFA group and 23 patients were enrolled in the SFA group. All patients were examined in the same manner four times: before surgery and at 1, 3, 6 and 12 months after surgery. Range of motion (ROM) was measured between the maxillary and mandibular central incisors. Symptoms were evaluated subjectively using a questionnaire with items pertaining to pain on mandibular movements, TMJ sounds, pain in masticatory muscles region.

Results

No severe complications or relapse occurred in either group during the 12-month follow-up period. Postoperative changes in ROM showed similar tendencies, but there was no significant difference in ROM during the follow-up period between OFA and SFA group (p< .05). The percentage reduction was nearly 45% at 1 month postoperatively and 20% at 3 months postoperatively compared with the preoperative situation. After 6 months postoperatively, the ROM was almost the same as before surgery. The number of patients with such sounds increased with time until 12- month postoperative examinations in the OFA group, but increased slightly during this period in the SFA group. During the first 3 months postoperatively, less than 10 % of patients in both groups had newly detected pain of TMJ and/or muscles. At 6 and 12 months postoperatively, only one patient in the SFA group have pain.

Conclusion

No significant differences in TMJ symptoms or function were observed during a 12-month follow-up period between patients with skeletal class III malocclusion treated with the SFA and those treated with the OFA.

https://ift.tt/2z5PcI3

Comparison of complications with semi-solid versus liquid diet via nasogastric feeding tube after orthognathic surgery

Publication date: Available online 25 October 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Shigeo Ishikawa, Hiroyoshi Matsumura, Sachiko Tomitsuka RB, Kazuyuki Yusa, Yoko Sato, Mitsuyoshi Iino

Abstract

Purpose

The aim of this retrospective study was to compare the effectiveness of nasogastric tube (NGT) feeding of a semi-solid diet versus a liquid diet after orthognathic surgery.

Patients and Methods

Orthognathic surgery patients were relatively young and generally healthy, without severe medical disease. Twenty-six patients received liquid feeding (Liquid group [LG]; administration rate: 100 mL/hour), 30 patients received semi-solid feeding at a high administration rate (Semi-solid rapid administration group [SSRAG]; 200–500 mL/hour), and 33 received semi-solid feeding at a slower rate (Semi-solid with slow administration group [SSSAG]; 100 mL/hour). We retrospectively investigated the complications of NGT feeding in each group.

Results

The incidence of diarrhoea was clearly lower in the SSRAG than in the LG. Among patients with lower gastrointestinal tract symptoms, stool form scale scores and maximum defecation frequency per day were significantly lower in the SSRAG than in the LG (p=0.001 for both). Rapid administration of a semi-solid diet via NGT resulted in fewer complications and shorter feeding times for orthognathic surgery patients.

Conclusions

The rapid administration of a semi-solid diet via NGT should decrease the complications of NGT feeding and improve the quality of the perioperative period for patients. The findings of this study will help clinicians select NGT diets for relatively young, healthy patients, such as orthognathic surgery patients.

https://ift.tt/2O5jO1W

Sialorrhea & aspiration control - A minimally invasive strategy uncomplicated by anticholinergic drug tolerance or tachyphylaxis

Publication date: Available online 24 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Joseph E. Dohar

Abstract

Objective

Sialorrhea complicated by aspiration is a primary source of morbidity and mortality in neurologically impaired children. Anticholinergics are an effective treatment option, but have traditionally been considered only adjuncts due to tachyphylaxis and drug tolerance. Similarly, Botox-A® salivary gland injections are also considered adjunctive due to the need to repeat treatment every 3 months. This retrospective case series assessed these two adjunctive strategies used in combination as definitive minimally invasive primary treatment.

Methods

112 subjects diagnosed with sialorrhea and treated at Children's Hospital of Pittsburgh of UPMC between 2004 and 2011 were identified. Charts were carefully reviewed for pertinent information regarding the treatment of their sialorrhea and related outcomes.

Results

Over half of the subject undergoing BTX-A injections were able to reduce their dosage of anticholinergics after receiving injection (58%, n=28 for glycopyrrolate users and 61%, n=20 for scopolamine users). Subjects experienced a significant reduction in days spent in the hospital in the year following Botox-A® injection (P-Value = 0.03), and the number of pneumonia episodes in the year following injection (P-Value = 0.04).

Conclusion

Patients treated effectively with both BTX-A injections into their salivary glands and anticholinergics neither developed neither tachyphylaxis nor drug tolerance with up to 9.6 years of continuous treatment. During the year following combined therapy, patients' average length hospital stay was reduced by a full week and the number of pneumonia episodes was statistically decreased. The failure rate of combined therapy was below that reported for any other intervention or combination of interventions in the literature. Finally, patients did not require BTX-A re-injection at the reported frequency. We hypothesize that anticholinergic medications competitively block acetylcholine attachment to post-synaptic receptors while BTX-A inhibits acetylcholine release at the pre-synaptic terminal, tachyphylaxis/drug tolerance mechanisms resulting in up-regulation of post-synaptic receptors are disrupted. Although salivary production may increase in the year following BTX-A injection, there is enough remaining activity at a molecular level to inhibit release of acetylcholine allowing salvage with anticholinergic medications at tolerable dosages.

https://ift.tt/2qb4Dek

Kurdish Speech Test: A Validation Study for Children Aged 3-5 Years

Publication date: Available online 24 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Shahla Fatemi Syadar, Talieh Zarifian, Yahya Modarresi, Muhamad Sediq Zahedi, Mona Ebrahimipour, Akbar Biglarian

Abstract

Objectives

Speech disorder in children is the most common disorder reported by speech and language pathologists in all languages and its evaluation and diagnosis requires valid and reliable tools. This study aimed to develop a Kurdish Speech Test for children aged 3-5 years and to determine its psychometric properties.

Methods

The validation included 120 monolingual Kurdish-speaking children aged 3-5 years in the city of Bukan, Iran. Content validity was determined according to expert opinions of Kurdish speech and language pathologists and linguists. Test-retest (one-week interval) and scoring-rescoring by two independent examiners were conducted to determine intra- and inter-rater reliability. The tests ability to discriminate between four age groups (36-60 months) was investigated for construct validity. Differences related to gender were assessed.

Results

Intra- and inter-rater reliability showed no significant difference between the first and second week of administration (p<0.001) and scoring-rescoring by two independent raters confirmed the reliability of the Kurdish Speech Test (P<0.001). Discriminating properties, reflecting construct validity showed higher scores with increasing age. No gender differences were found.

Conclusion

The Kurdish Speech Test is a reliable and valid instrument for evaluation of articulation in three-to-five-year-old children. Results suggest that the test is appropriate for clinical assessment of children with speech sound disorders.

https://ift.tt/2RhiCuB

Why some surgeons no longer systematically operate cases of papillary thyroid carcinoma

Publication date: Available online 25 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): F. Rubin, A. Ait-Boudaoud, Q. Lisan

https://ift.tt/2O5EyH0

Transoral robotic surgery of the tongue base for obstructive sleep apnea: Preliminary results

Publication date: Available online 24 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): G. de Bonnecaze, B. Vairel, A. Dupret-Bories, E. Serrano, S. Vergez

Abstract

Introduction

Obstructive sleep apnea syndrome (OSAS) is a major public health issue. Robotic tongue-base reduction surgery is being developed, but needs assessment. The present study reports clinical and polygraphic results at 6 months' follow-up.

Method

Single-center prospective study of 8 patients undergoing transoral robotic surgery (TORS) for severe OSAS.

Results

Mean age was 47 years. M/F sex ratio was 5:3. Initial body-mass index ranged from 18 to 35 kg/m². Mean Epworth score was 12. Mean preoperative apnea-hypopnea index (AHI) was 47 (range, 36–60). At 6 months, only 1 patient did not meet usual success criteria (AHI < 20 with > 50% decrease); 2 patients had residual AHI between 10 and 20; the other 5 had non-significant event rates.

Conclusion

TORS tongue-base reduction showed promising results, which need confirmation on long-term multicenter studies.

https://ift.tt/2yAOlzN

Effect of Post-Injection Facial Exercise on Time of Onset of Botulinum Toxin for Glabella and Forehead Wrinkles: A Randomized Controlled, Crossover Clinical Trial

https://ift.tt/2Arn7wU

Iris Morphological Features in Patients with 360° Angle-Closure Neovascular Glaucoma: An Anterior Segment Optical Coherence Tomography Study

Purpose: To investigate iris morphological features in 360° angle-closure neovascular glaucoma (NVG) by swept-source anterior segment optical coherence tomography (ASOCT). Patients and Methods: In this retrospective, clinic-based, comparative study, 14 patients with 360° angle-closure NVG and 14 healthy age-matched control subjects were enrolled. All patients enrolled had no prior glaucoma surgery but underwent cataract surgery with intraocular lens implantation. Horizontal scanning images of swept-source ASOCT were analyzed using software calipers in temporal and nasal angle areas. The iris thickness at 1 and 2 mm from the pupil edge, iris length, trabecular meshwork length, peripheral anterior synechia (PAS) length, PAS height ratio (PAS length/trabecular meshwork length), and pupil diameter were measured. Results: Between the groups, there were no statistically significant differences in iris length, trabecular meshwork length, and pupil diameter (p #x3e; 0.05). However, the iris thickness was significantly reduced in the NVG group compared with the control group in the temporal and nasal areas (0.306 vs. 0.563 mm/0.326 vs. 0.645 mm at 1 mm, 0.278 vs. 0.523 mm/0.282 vs. 0.546 mm at 2 mm, respectively) (mean, all p #x3c; 0.001). In the NVG group, PAS height ratios were 1.55 ± 0.45 (mean ± standard deviation) (range, 0.58–2.30) and 1.55 ± 0.78 (range, 0.68–3.68) at the temporal and nasal angles, respectively. Conclusions: In patients with 360° angle-closure NVG, the iris thickness decreased to about 50% of that in healthy subjects, and the PAS length exceeded the trabecular meshwork length by about 1.5 times.
Case Rep Ophthalmol 2018;9:449–456

https://ift.tt/2RcwXIw

Salivary Biomarkers of Inflammation and Oxidative Stress in Healthy Adults

Publication date: Available online 24 October 2018

Source: Archives of Oral Biology

Author(s): Yoon Nam, Yoon-Young Kim, Ji-Youn Chang, Hong-Seop Kho

Abstract

Objectives

Diagnostic value of saliva depends on the reproducibility of data in repeatedly collected samples and predictable correlations between saliva and blood. We aimed to investigate the reliability, blood reflectance, and influence of blood contamination in the analysis of inflammatory and oxidative stress biomarkers in saliva samples.

Design

In total, 37 healthy young male participants (26.7 ± 2.2 years) were included. Unstimulated whole saliva and blood samples were collected on the first visit, and saliva samples were collected again after 2-3 days. The concentrations of total protein and inflammatory [C-reactive protein (CRP), IL-1β, IL-6, and TNF-α] and oxidative stress [8-hydroxy-2'-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and total antioxidant capacity (TAC)] biomarkers in saliva and blood, and as well as blood contamination biomarkers (transferrin and hemoglobin) in saliva were analyzed.

Results

The intra-class correlations of all examined biomarkers except TNF-α were fair to excellent. Significant positive correlations between CRP and IL-6 and between total protein and TAC were stable in the saliva samples collected on different days. Notably, IL-6 was the only biomarker that showed a significant correlation between saliva and blood. As the concentration of salivary transferrin increased, the saliva/blood ratios of total protein and TAC also increased. The concentration of salivary hemoglobin did not affect the saliva/blood ratios of biomarkers.

Conclusions

The findings of this study are limited to healthy young males. For clinical applications, studies on salivary diagnostics should be performed for individual disease and health conditions, demographic characteristics, and biomarkers.

https://ift.tt/2Ji4aPS

Hypogammaglobulinemia with decreased class-switched B-cells and dysregulated T-follicular-helper cells in IPEX syndrome

Publication date: Available online 24 October 2018

Source: Clinical Immunology

Author(s): Oded Shamriz, Kiran Patel, Rebecca A. Marsh, Jacob Bleesing, Avni Y. Joshi, Laura Lucas, Chengyu Prince, Bojana B. Pencheva, Lisa Kobrynski, Shanmuganathan Chandrakasan

Abstract

Early onset multisystem autoimmunity is commonly the defining feature of IPEX. Recurrent sinopulmonary infections and CVID-like phenotype were not previously recognized as a presentation in IPEX. Herein, we describe three extended family members with IPEX. In addition to autoimmunity, all three had a CVID-like presentation consisting of recurrent sinopulmonary infections, hypogammaglobulinemia and B-cell class switching defect. In vitro studies have shown that the B cell class switching defect is not B cell intrinsic. Additionally, a marked increase in circulating T follicular helper (cTFH) cells with high IFN-γ and IL-17 secretion on stimulation was noted in our patients. The dysregulated cTFH cells could contribute to a decreased B cell class switching. However, the exact mechanism of how expanded and dysregulated cTFH lead to B cell class switching defect and hypogammaglobulinemia in our patients is not clear. Our study could extend the clinical spectrum of IPEX to include a CVID-like presentation.

https://ift.tt/2ORJYuj

Salivary Biomarkers of Inflammation and Oxidative Stress in Healthy Adults

Publication date: Available online 24 October 2018

Source: Archives of Oral Biology

Author(s): Yoon Nam, Yoon-Young Kim, Ji-Youn Chang, Hong-Seop Kho

Abstract

Objectives

Diagnostic value of saliva depends on the reproducibility of data in repeatedly collected samples and predictable correlations between saliva and blood. We aimed to investigate the reliability, blood reflectance, and influence of blood contamination in the analysis of inflammatory and oxidative stress biomarkers in saliva samples.

Design

In total, 37 healthy young male participants (26.7 ± 2.2 years) were included. Unstimulated whole saliva and blood samples were collected on the first visit, and saliva samples were collected again after 2-3 days. The concentrations of total protein and inflammatory [C-reactive protein (CRP), IL-1β, IL-6, and TNF-α] and oxidative stress [8-hydroxy-2'-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and total antioxidant capacity (TAC)] biomarkers in saliva and blood, and as well as blood contamination biomarkers (transferrin and hemoglobin) in saliva were analyzed.

Results

The intra-class correlations of all examined biomarkers except TNF-α were fair to excellent. Significant positive correlations between CRP and IL-6 and between total protein and TAC were stable in the saliva samples collected on different days. Notably, IL-6 was the only biomarker that showed a significant correlation between saliva and blood. As the concentration of salivary transferrin increased, the saliva/blood ratios of total protein and TAC also increased. The concentration of salivary hemoglobin did not affect the saliva/blood ratios of biomarkers.

Conclusions

The findings of this study are limited to healthy young males. For clinical applications, studies on salivary diagnostics should be performed for individual disease and health conditions, demographic characteristics, and biomarkers.

https://ift.tt/2Ji4aPS

Oral cancers: Current status

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Anil K. D'Cruz, Richa Vaish, Harsh Dhar

Abstract

Oral cancer is a global disease. Despite a well elucidated tumour progression model, these cancers present late. Attempts at early detection by way of adjunctive diagnostic technologies and screening have not lived up to expectations in spite initial promise. Surgery is the mainstay of treatment. Treatment intensification by way of adjuvant radiation/chemo radiation is warranted for those with high risk features. Recent studies have explored intensification in those with intermediate risk factors in an attempt to improve outcomes. There has been generation of recent robust evidence that has influenced the need and extent of neck dissection. Neoadjuvant chemotherapy (NACT) may have a potential role in organ preservation and borderline resectable oral cancers. Recurrent tumours should be offered surgery whenever feasible while the addition of biological agents to chemotherapy gives best results in the palliative settings.

https://ift.tt/2qayaEV

Malignant transformation to oral cancer by subtype of oral potentially malignant disorder: A prospective cohort study of Taiwanese nationwide oral cancer screening program

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Shu-Lin Chuang, Cheng-Ping Wang, Mu-Kuan Chen, William Wang-Yu Su, Chiu-Wen Su, Sam Li-Sheng Chen, Sherry Yueh-Hsia Chiu, Jean Ching-Yuan Fann, Amy Ming-Fang Yen

Abstract

Objectives

To elucidate the risk of malignant transformation to invasive oral cancer by subtypes of oral potentially malignant disorders (OPMD) and to examine the independent effects of risk factors, particularly alcohol drinking, by subtype based on a nationwide oral cancer screening program targeting at general population with habits of smoking and/or betel quids chewing.

Materials and methods

The total of 8501 subjects diagnosed as different subtypes of OPMDs from the Taiwanese screening program between 2004 and 2009 were followed up over time to ascertain the occurrence of invasive oral cancer. The hazard ratios of malignant transformation were estimated by using Cox proportional hazards regression model.

Results

The overall malignant rate (per 1000 person-years) to oral cancer was 8.4 (407 incident cases with an average of 5.7 years of follow-up). The highest rate was noted in exophytic verrucous hyperplasia (33), followed by erythroplakia (11.8), erythroleukoplakia (10.7), oral submucous fibrosis (OSF) (8.6), and leukoplakia (5.4). After adjusting for confounders, exophytic verrucous hyperplasia still had a 5.69 (4.47–7.24) times risk compared with leukoplakia. The corresponding figures for erythroplakia, erythroleukoplakia, and OSF were 2.25 (1.31–3.89), 2.00 (1.13–3.53), and 1.63 (1.29–2.06), respectively. Alcohol drinking elevated the overall risk of malignant transformation by 23% (1–52% and also triggered a higher risk in OSF (aHR = 1.62 (1.06–2.47)). The higher risk attributed to betel quids chewing was noted for exophytic verrucous hyperplasia (aHR = 4.23 (1.55–11.55)).

Conclusions

The risk of malignant transformation to oral cancer varied with the subtypes of OPMD and was elevated in OSF and verrucous hyperplasia attributed to alcohol drinking and betel quids, respectively.

https://ift.tt/2CDHSXD

Durable response to first-line nivolumab in a patient with oligometastatic PD-L1 positive nasopharyngeal cancer

Publication date: Available online 25 October 2018

Source: Oral Oncology

Author(s): S. Cabezas-Camarero, F. Puebla, A.I. Subhi-Issa, J. Sanz-Ortega, Pedro Pérez-Segura

https://ift.tt/2qayaop

Oral submucous fibrosis – Is it time to modify the definition?

Publication date: Available online 24 October 2018

Source: Oral Oncology

Author(s): R. Shesha Prasad, Anuradha Pai

https://ift.tt/2CCjXrI

A randomized, open-label, multicenter, comparative study of therapeutic efficacy, safety and tolerability of BNO 1030 extract, containing Althea root, Cammomile flowers, horsetail herb, walnut leaves, yarrow herb, oak bark, dandelion herb in the treatment of acute non-bacterial tonsillitis in children aged 6 to 18 years

Publication date: Available online 24 October 2018

Source: American Journal of Otolaryngology

Author(s): V.I. Popovych, I.V. Koshel, A.N. Malofiichuk, L.I. Pyletska, A.A. Semeniuk, O.V. Filippova, R.N. Orlovska

Abstract

Seventy to 95% of acute tonsillitis episodes are caused by viral infection, therefore why antibiotic therapy is not indicated in majority of cases. In such cases, acetaminophen or ibuprofen are used to alleviate the symptoms. The objective of this study was assessment of efficacy of phytoneering extract BNO 1030 (Imupret®) in patients with acute non-bacterial tonsillitis.

Methods

This randomized, open-label, multicenter, comparative study randomised 238 outpatients aged 6–18 years to receive either BNO 1030 (Imupret®) as a supplement to standard symptomatic therapy, or standard therapy. Assessment criteria were as follows: sore throat dynamics at rest and at swallowing, throat irritation associated with cough, general condition, day of withdrawal of antipyretics, the share of treatment responders, as well as assessment of "therapeutic benefit" from the use of BNO 1030.

Results

Decreased intensity of acute tonsillitis symptoms to 1 point and lower, assessed using 4-point scale starting from the day 5 of treatment (p < 0.005), alleviation of local symptoms and general condition starting from day 2 of the disease (р < 0.001), withdrawal of antipyretics starting from day 4 of treatment (p < 0.005), increase of the number of treatment responders to 81.6% (p < 0.005) versus the control were reported. "Therapeutic benefit" was 4.2 days. All patients tolerated phytotherapy well, and no adverse reactions were seen.

Conclusion

BNO 1030 (Imupret®) is a safe and effective product for treatment of acute non-bacterial tonsillitis in children aged 6–18 years, assuring therapeutic benefit when prescribed additionally to the standard symptomatic therapy.

https://ift.tt/2CEsIkT

How the Smartphone Is Changing Allergy Diagnostics

Abstract

Purpose of Review

Evidence-based clinical diagnosis of allergic disorders is increasingly challenging. Clinical decision support systems implemented in mobile applications (apps) are being developed to assist clinicians in diagnostic decisions at the point of care. We reviewed apps for allergic diseases general diagnosis, diagnostic refinement and diagnostic personalisation. Apps designed for specific medical devices are not addressed.

Recent Findings

Apps with potential usefulness in the initial diagnosis and diagnostic refinement of respiratory, food, skin and drug allergies are described. Apps to support diagnostic personalisation are not yet available. There is an urgent need to increase the scientific evidence on the real usefulness of these apps, as well as to develop new scientifically grounded apps designed and validated to support all allergic diseases and diagnostic levels.

Summary

Apps have the potential to change the diagnosis of allergic diseases becoming part of the routine diagnostics toolset, but its usefulness needs to be established.

https://ift.tt/2yxqfWC

Letter to the Authors Concerning the Published Manuscript by Rial and Sastre: Food Allergies Caused by Allergenic Lipid Transfer Proteins: What Is Behind the Geographic Restriction?

https://ift.tt/2O5D7IG

Virus-Like Particles as Carrier Systems to Enhance Immunomodulation in Allergen Immunotherapy

Abstract

Purpose of Review

Utilization of virus-like particles (VLPs) is considered to improve allergen-specific immunotherapy (AIT). AIT aims at the efficient uptake of the target allergen by antigen-presenting cells (APCs) subsequently inducing adaptive allergen-specific immune responses to induce tolerance. The purpose of this review is to describe the immune-modulating properties of VLPs per se and to summarize the application of VLPs as antigen carriers, preferably for Th2 cytokines or allergens, with and without simultaneous administration of adjuvants in order to modulate allergic immune responses.

Recent Findings

Currently, a broad variety of approaches considering the origin of the VLPs, the choice of the adjuvant and antigen, and the coupling of the antigen are under preclinical investigation.

Summary

The data provide evidence that VLPs used as carrier for antigens/allergens strongly increase antigen immunogenicity, and might be suitable to prevent allergies. However, systematic studies in mice showing the immunological mechanism and data from clinical studies are scarce.

https://ift.tt/2yxqbpQ

Laryngeal stroboscopy ‐ normative values for amplitude, open quotient, asymmetry and phase difference in young adults

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2D2ovJ1

Single‐Sided Deafness and cochlear implantation in congenital and acquired hearing loss in children

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2EEnYhQ

New tools for preoperative diagnosis of allergic fungal sinusitis? A prospective study about 71 patients

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2D4dJSv

Postoperative radiotherapy of intermediate‐risk head and neck cancer in 134 patients: Does subset matter?

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2ESmVey

Analysis of inner ear malformations associated with a facial nerve anomaly in 653 children fitted with a cochlear implant

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2D4Hr9M

Copy number variation: a prognostic marker for young patients with squamous cell carcinoma of the oral tongue

Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Je6Deb

Good Clinical Approach: Delphi Consensus for the Use of Betahistine in Menière’s Disease

Menière's disease is a disorder of the inner ear that causes vertigo, tinnitus, fullness, and hearing loss. Several pharmacological treatments are available, but none of them has shown significant results. Betahistine has been largely used but its effect on the main symptoms of Menière's disease remains unclear. In order to improve clinical appropriateness and to reduce the heterogeneity of the therapeutic approaches for Menière's disease, we proposed a European Consensus Conference on Betahistine's prescription. A group of European experts in vestibular disorders completed a questionnaire, prepared by opinion leaders, on the use of betahistine in Menière's disease. The Delphi method was used as an iterative investigation method in order to increase and establish the consensus. While betahistine was considered useful to reduce the number of the vertigo attacks during the intercritical phase of the disease, its use during attacks was considered helpful only when associated with other drugs. Betahistine was not considered useful for preventing hearing loss. The experts support the use of betahistine during the intercritical phase of the disease to reduce the number and severity of vertigo episodes. They also defined the parameters for a good clinical approach to evaluate the efficacy of betahistine treatment for Menière's disease.

https://ift.tt/2O3pYQc

How the Smartphone Is Changing Allergy Diagnostics

Abstract

Purpose of Review

Evidence-based clinical diagnosis of allergic disorders is increasingly challenging. Clinical decision support systems implemented in mobile applications (apps) are being developed to assist clinicians in diagnostic decisions at the point of care. We reviewed apps for allergic diseases general diagnosis, diagnostic refinement and diagnostic personalisation. Apps designed for specific medical devices are not addressed.

Recent Findings

Apps with potential usefulness in the initial diagnosis and diagnostic refinement of respiratory, food, skin and drug allergies are described. Apps to support diagnostic personalisation are not yet available. There is an urgent need to increase the scientific evidence on the real usefulness of these apps, as well as to develop new scientifically grounded apps designed and validated to support all allergic diseases and diagnostic levels.

Summary

Apps have the potential to change the diagnosis of allergic diseases becoming part of the routine diagnostics toolset, but its usefulness needs to be established.

https://ift.tt/2yxqfWC

Letter to the Authors Concerning the Published Manuscript by Rial and Sastre: Food Allergies Caused by Allergenic Lipid Transfer Proteins: What Is Behind the Geographic Restriction?

https://ift.tt/2O5D7IG

Virus-Like Particles as Carrier Systems to Enhance Immunomodulation in Allergen Immunotherapy

Abstract

Purpose of Review

Utilization of virus-like particles (VLPs) is considered to improve allergen-specific immunotherapy (AIT). AIT aims at the efficient uptake of the target allergen by antigen-presenting cells (APCs) subsequently inducing adaptive allergen-specific immune responses to induce tolerance. The purpose of this review is to describe the immune-modulating properties of VLPs per se and to summarize the application of VLPs as antigen carriers, preferably for Th2 cytokines or allergens, with and without simultaneous administration of adjuvants in order to modulate allergic immune responses.

Recent Findings

Currently, a broad variety of approaches considering the origin of the VLPs, the choice of the adjuvant and antigen, and the coupling of the antigen are under preclinical investigation.

Summary

The data provide evidence that VLPs used as carrier for antigens/allergens strongly increase antigen immunogenicity, and might be suitable to prevent allergies. However, systematic studies in mice showing the immunological mechanism and data from clinical studies are scarce.

https://ift.tt/2yxqbpQ

Cryotherapy vs trichloroacetic acid 90% in treatment of common warts

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2Sh9veC

Hypomelanotic melanoma simulating pigmented Bowen's disease and its challenging dermoscopic features

The Journal of Dermatology, EarlyView.


https://ift.tt/2q920JV

Eruptive keratoacanthoma with spontaneous regression arising from a cervical squamous cell carcinoma patient treated with nivolumab

The Journal of Dermatology, EarlyView.


https://ift.tt/2CEeII4

Thrombocytopenia in a psoriatic patient sequentially treated with adalimumab, secukinumab and ustekinumab

The Journal of Dermatology, EarlyView.


https://ift.tt/2qc3cfC

Hitherto unreported involvement pattern of Carvajal phenotype of cardiocutaneous syndrome: evaluation on cardiac MRI

Description 

An 11-year-old boy, born out of a consanguineous marriage, was admitted with gradually progressive dyspnoea, and facial and abdominal swelling for the past 1 year. On physical examination, he had woolly hair and patchy keratosis over the palms and soles (figure 1A,B). Chest radiograph showed gross cardiomegaly (figure 1C). ECG revealed left axis deviation. Transthoracic echocardiogram demonstrated biventricular dilatation with severe left ventricular dysfunction, trabecular configuration of both ventricles along with mild tricuspid and mitral valve regurgitation. Cardiac MRI revealed biventricular dilatation with severe global hypokinesia (left ventricular ejection fraction: 10%) and increased trabeculations in both the ventricles (figure 2A–D). Late gadolinium enhanced images showed extensive transmural enhancement predominantly of septum and lateral wall of left ventricle (figure 2E–F). In addition, enhancement was also seen in the right ventricular wall as well as involving the trabeculations. No genetic study was performed in...

https://ift.tt/2CC7LHs

Superior mesenteric artery syndrome: a vicious cycle

Description 

A middle-aged cachectic woman with significant medical history of quadriplegia, chronic osteomyelitis, chronic obstructive pulmonary disease, kyphoscoliosis and malnutrition presented with 3 days of persistent nausea and vomiting, absolute constipation and increasing abdominal distention. She has had similar episodes in the recent past, which were milder in nature, and were diagnosed as gastroenteritis. She was hypotensive (blood pressure 86/60 mm Hg) and tachycardic (130 bpm) on arrival, with a grossly distended abdomen and active vomiting. Initial blood tests detected hypokalaemia (K+ of 3.0 mmol/L), a raised white cell count of 23.4x10⁹/L and features of acute kidney injury. A nasogastric tube was inserted and over a litre of bilious gastric contents was immediately aspirated.

A non-contrast CT scan of the abdomen and pelvis was performed (as the patient is allergic to iodine contrast), which demonstrated marked distension of the stomach and duodenum terminating abruptly where the third part of the duodenum crosses over the...

https://ift.tt/2AqZQve

Non-uraemic calciphylaxis (NUC) postliver transplantation

Calciphylaxis is a rare and life-threatening disease characterized by cutaneous arteriolar stenosis and vascular thrombosis leading to skin ischaemia and necrosis. While calciphylaxis occurs mostly in patients with end-stage renal disease, the disorder has been described in patients with normal renal function, namely non-uraemic calciphylaxis (NUC). A 41-year-old African-American woman presented with a painful ulcerative rash on her thighs and right buttock 2 months after undergoing an orthotopic liver transplantation. She underwent debridement of the lesions and an excisional biopsy of one of the lesions, which revealed calciphylaxis. She was treated with sodium thiosulfate, cinacalcet and hyperbaric oxygen with complete resolution of the lesions 4–5 months after presentation. While she was treated with a course of high-dose glucocorticoids after the transplant, she did not have other risk factors for calciphylaxis. NUC should be considered in the differential diagnosis of necrotic skin lesions in postliver transplant patients.

https://ift.tt/2CC7ILM

Anterior spinal cord syndrome as a rare complication of acute bacterial meningitis in an adult

Acute bacterial meningitis is not an uncommon central nervous system infection. In severe cases, it can be associated with various neurological or systemic complications. However, acute spinal cord dysfunction rarely occurs. We report a case of bacterial meningitis complicated with spinal cord infarction despite adequate treatment with antibiotics and corticosteroid therapy. He had residual paraplegia and was fully dependent in the activity of daily living.

https://ift.tt/2ArydCf

Rare recurrence of apical ballooning (takotsubo) syndrome in an elderly man

Apical ballooning syndrome (ABS) is an under recognised clinical entity characterised by acute reversible left ventricular systolic dysfunction that mimics acute myocardial infarction in the absence of obstructive coronary artery disease; typically occurring in the setting of profound stress.¹ ABS disproportionately affects older women and recurrences are infrequent. We, hereby, describe a rare phenomenon of recurrent ABS in an elderly male patient, 10 years apart, presenting with the same left ventricular morphological appearance following non-cardiac surgeries. The case illustrates the importance of considering ABS in the differential diagnosis of perioperative acute myocardial infarction in older men undergoing major surgery.

https://ift.tt/2CC7GDE

Retinoblastoma presenting as haemorrhagic choroidal detachment in a 10-year-old girl

To report a case of retinoblastoma presenting as haemorrhagic choroidal detachment in a 10-year-old girl. The patient, apparently well, presented with sudden blurring of vision in the setting of blunt trauma. On examination and ocular ultrasound, haemorrhagic choroidal detachment was suspected. She underwent external drainage via sclerostomies. The haemorrhage resolved ultrasonographically, but the vision did not improve. Five months postoperatively, she presented with sudden eye pain, lid swelling and proptosis. The ancillary workups were consistent with panophthalmitis and was treated as such. Six months postoperatively, the pain and lid swelling persisted; hence, the painful near absolute eye was enucleated. The histopathology revealed small round blue cells with necrosis consistent with retinoblastoma. Immunohistochemistry was positive for synaptophysin and negative for S100 confirming retinoblastoma. Retinoblastoma is the most common intraocular malignancy in children. The importance of increased awareness of its various presentations is of utmost importance to prevent life-threatening and vision-impairing complications.

https://ift.tt/2AqTk7s

Triphasic response of pituitary stalk injury following TBI: a relevant yet uncommonly recognised endocrine phenomenon

The triphasic response of pituitary stalk injury has previously been described in a minority of patients following intracranial surgery, however, this phenomenon can also occur after traumatic brain injury. We present the case of a 20-year-old male who experienced the triphasic response of pituitary stalk injury (central diabetes insipidus, syndrome of inappropriate antidiuretic hormone and central diabetes insipidus again) after striking his head on a concrete curb. His history and presentation highlight the importance of recognising the distinctive symptoms of each individual stage of pituitary stalk injury, and using the appropriate diagnostic tools and therapies to guide further management.

https://ift.tt/2CHMEmS

Trans-Frontal Five-Fluorouracil (TraFFF): a novel technique for the application of adjuvant topical chemotherapeutic agents in sinonasal adenocarcinoma

Sinonasal adenocarcinoma has traditionally been treated with surgery (craniofacial or endoscopic) and adjuvant radiotherapy. Two large series have demonstrated favourable 5-year survival using surgery with adjuvant topical chemotherapy applied repeatedly over several weeks. The authors describe a novel, transnasal application of topical 5-fluorouracil. However, complete coverage of the frontal region of the anterior skull base can be difficult to achieve with a purely transnasal approach in an outpatient setting. We present a novel adjunct method of delivering chemotherapeutic agents into this key area used in a 37-year-old man with T2N0M0 ethmoid adenocarcinoma. The procedure was well tolerated in an outpatient setting and remains disease free at 3 years postoperatively. We suggest that frontal trephination is a useful adjunct to aid accurate placement of adjuvant topical chemotherapeutic agents in the treatment of sinonasal adenocarcinoma.

https://ift.tt/2AsDsl1

Treatment of Grade I and II types of xanthelasma palpebrarum with intralesional heparin sodium

Dermatologic Therapy, EarlyView.


https://ift.tt/2OOs77I

Neoadjuvant intralesional methotrexate in squamous cell carcinoma of the lip

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2Piwqro

Endotypes of chronic rhinitis: a cluster analysis study

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


https://ift.tt/2SmO4ca

Changes of NGF pathway in allergic rhinoconjunctivitis: a conjunctival allergen challenge study

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


https://ift.tt/2yYS35K

Triclosan‐induced Alteration of Gut Microbiome and Aggravation of Asthmatic Airway Response in Aeroallergen‐sensitized mice

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


https://ift.tt/2SknvEz

From basic science to diagnostics – history of a patent on a honeybee venom allergen

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


https://ift.tt/2yZOZGn

Comparing biologicals and small molecule drug therapies for chronic respiratory diseases

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


https://ift.tt/2SjDwu2

Combined administration of anti‐IL‐13 and anti‐IL‐17A at individually sub‐therapeutic doses limits asthma‐like symptoms in a mouse model of Th2/Th17 high asthma

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


https://ift.tt/2yZORGT