Accumulating evidence suggests that the gut microbiota shapes developmental processes within the immune system. Early life antibiotic use is one factor which may contribute to immune dysfunction and the recent...
https://ift.tt/2DeWKwQ
Τετάρτη 31 Οκτωβρίου 2018
Perinatal antibiotic exposure alters composition of murine gut microbiota and may influence later responses to peanut antigen
Anaphylactic reaction in patient allergic to mango
An allergy to mango is extremely rare. The antigenic composition of the fruit is not fully known. Profilin from mango has a structure similar to birch tree profiling: it is responsible for cross-reactions betw...
https://ift.tt/2Jvgmgv
Inequalities in healthcare access: how a man with exstrophy in rural India coped
We report a case of a 22-year-old man with adult exstrophy. The patient made a self-made urine collection device, which helped him to lead a normal life, carrying out his routine as well as occupational activities smoothly. This patient is a prime example of inequalities in healthcare distribution in low-income and middle-income countries. He was never taken to a proper medical centre to correct his condition nor was his mother ever given proper antenatal healthcare access. His background of being a poor person from rural India highlights the problems of inequalities in healthcare access.
https://ift.tt/2SyH5g9
Self-Reported Benefit and Satisfaction with a Beamforming Body-Worn Hearing Aid for Elderly Adults
Hearing impairment is a leading cause of disability globally and is particularly prevalent in elderly populations. Hearing aids are commonly recommended to mitigate the adverse effects on communication associated with hearing loss. However, the acceptability of hearing aids to elderly individuals is low and the majority of potential users do not wear hearing aids. Most hearing aids are designed with a discreet form factor in mind, to minimize device visibility. Given the range of comorbidities associated with hearing loss in the elderly, this conventional form factor may not always be optimal. The present study examined the experiences of elderly individuals with a recently developed, unconventional, body-worn hearing instrument, the EasyHear™ Grand (Logital Co. Ltd., Hong Kong). The bilaterally fitted instrument incorporates large controls, a color display, beamforming sound processing, and Bluetooth capabilities. Forty-three elderly participants (mean age=71; range 46-88 years) were surveyed to gauge level of benefit and satisfaction with the device and opinions regarding the hearing aid. They were assessed using three standardized questionnaires (the International Outcome Inventory-Hearing Aids, the Profile of Hearing Aid Benefit, and the Client Oriented Scale of Improvement) and through open-ended, structured interviews. Participants rated their EasyHear device fitting highly for hours of use and improved quality of life and rated the device favorably for improved communication and benefit in background noise. A majority of users felt the device improved listening ability in their expressed area of greatest need, and also for their second highest prioritized area of greatest need. Less than 10% of users felt their listening was only occasionally or hardly ever improved when using the body-worn device. Benefit and satisfaction ratings with the EasyHear Grand were comparable to those in studies involving conventional form factor devices. Interviews highlighted areas where users felt the device could be improved—extra noise reduction, changes to device dimensions, receiver/eartip fit, and cableless technology were among the areas mentioned. Many participants valued smartphone linkage and Bluetooth capability. The EasyHear Grand, with its body-worn design and large, simple controls, was well accepted by the majority of participants. Hearing aids that break from conventional design formats may benefit many elderly individuals with hearing impairment and promote increased user acceptability.
https://ift.tt/2Jtdi4l
Clinical Indices to Drive Quality Improvement in Otolaryngology
A Pediatric Tracheostomy Care Index (PTCI) was developed by the authors to standardize care and drive quality improvement efforts at their institution. The PTCI comprises 9 elements deemed essential for safe care of children with a tracheostomy tube. Based on the PTCI scores, the number of missed opportunities per patient was tracked, and interventions through a "Plan-Do-Study-Act" approach were performed. The establishment of the PTCI has been successful at standardizing, quantifying, and monitoring the consistency and documentation of care provided at the authors' institution.
https://ift.tt/2OiSA8m
Patient Engagement in Otolaryngology
Patient engagement, which involves incorporating the patient and family as partners in their care, is a growing focus in otolaryngology and surgery. Attention to patient and family centeredness, shared decision making, and patient experience together improves the overall tenor of patient engagement. Patient engagement promotes safety through improving quality of electronic health record data, error detection, and treatment decisions and adherence. In this article, we review specific areas of importance for patient engagement in otolaryngology as well as areas needing more research and development.
https://ift.tt/2yLfwrN
Patient Safety and Quality Improvement
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA
https://ift.tt/2yHAuba
Regional Node Distribution in Papillary Thyroid Cancer with Microscopic Metastasis
Background. Optimal neck lymphadenectomy in patients with papillary thyroid cancer (PTC) and microscopic lymph node metastasis needs to be defined in order to aid surgeons in their decision about the best way to proceed in these cases. Methods. Patients who underwent total thyroidectomy and lymphadenectomy at levels IIa to VI were divided into two groups: Group 1 (G1) with macroscopic metastasis detected before surgery and Group 2 (G2) with microscopic metastasis detected in sentinel node during surgery. Odds ratio (OR) was computed for age, sex, tumor size, multicentricity, capsular invasion, vascular/lymphatic permeation, and nodes with metastasis. Results. Primary tumor size was (G1 versus G2, respectively) 3.8 cm versus 1.98 cm (P
https://ift.tt/2OfYOpj
Case 33-2018: A 57-Year-Old Man with Confusion, Fever, Malaise, and Weight Loss
Presentation of Case. Dr. Joshua A. Cohen (Medicine): A 57-year-old man presented to this hospital with confusion, cough, fever, and unintentional weight loss. The patient had been in his usual state of health until approximately 7 weeks before this presentation, when malaise and anorexia…
https://ift.tt/2qmn1kd
Morphological study of the changes after sagittal split ramus osteotomy in patients with facial asymmetry: measurements of 3-dimensional modelling
The effects of bilateral sagittal split ramus osteotomy (BSSRO) on the temporomandibular joint (TMJ) are still not well understood. The aim of this study was to compare the morphological differences among unaffected subjects on the one hand, and patients with facial asymmetry before and after BSSRO on the other. Ten Chinese patients (preoperative and postoperative groups, mean (SD) age 25 (5) years) diagnosed with facial asymmetry and 10 unaffected subjects (control group, mean (SD) age 27 (5) years) were recruited prospectively.
https://ift.tt/2Ohmae5
How do you stop unwanted hair growth?
Unwanted hair growth on the body or face has a range of causes linked to hormones. Some growth is typical and has no links to conditions that cause hirsutism. Natural treatments include diet changes and weight management. Medical treatments can also help. Learn more about excessive or unwanted hair in women here.
https://ift.tt/2RpyE5G
Evaluation of Prevention Interventions for Taxane-Induced Dermatologic Adverse Events
This systematic review summarizes evidence on the effectiveness and safety of current cryotherapy methods to prevent hair, skin, and nail changes associated with chemotherapy.
https://ift.tt/2RoVsSU
https://ift.tt/2RoVsSU
Necrotizing Neutrophilic Dermatitis, an Often-Misdiagnosed Entity With Potentially Severe Consequences
I first became aware of the diagnosis of pyoderma gangrenosum (PG) early in my dermatology residency when I encountered a patient diagnosed with ulcerative colitis who presented with fever and hundreds of vesiculopustular lesions on her face, trunk, and extremities, several of which developed into typical lesions of classic PG. Within weeks of seeing that patient, I cared for another patient with a known diagnosis of agnogenic myeloid metaplasia with an atypical, superficial variant of PG that has been described more frequently on the upper extremities and face in association with a myeloid preleukemic process. This rare ulcerative disease, first described in 1930 by Brunsting et al, was something I heard little of during medical school or my medicine residency. However, within the initial year of my dermatology residency I had become involved with multiple cases of PG and I was hooked on investigating the literature, writing about my experiences with misdiagnoses and management of patients beyond the use of systemic corticosteroids. From 1977, when my first publication on this entity appeared in this journal, until today, I have been an author or coauthor on 28 publications about PG. The most recent publication is part of a Delphi project to develop improved diagnostic criteria that went beyond the statement by Perry in 1969 that "the diagnosis of a skin lesion as pyoderma gangrenosum (PG) is dependent entirely upon the clinical evaluation of the lesion. Unfortunately, there are no characteristic histopathologic changes or abnormalities on laboratory tests."(p899)
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https://ift.tt/2PsTDan
Clinical Features of Neutrophilic Dermatosis Variants Resembling Necrotizing Fasciitis
This case series examines 6 previously unreported patients and published reports of 48 patients with necrotizing neutrophilic dermatosis to identify the traits and infection-mimicking features of a new subset of necrotizing neutrophilic dermatosis.
https://ift.tt/2Rxaer1
https://ift.tt/2Rxaer1
Lipoid Proteinosis
This case report describes a classic presentation of lipoid proteinosis.
https://ift.tt/2PzF6JK
https://ift.tt/2PzF6JK
Assessment of Response to B-Cell Depletion Using Rituximab in Cutaneous Lupus Erythematosus
This cohort study evaluates outcomes of rituximab treatment in patients with different clinical subtypes of cutaneous lupus erythematosus and associated systemic disease.
https://ift.tt/2RsT51y
https://ift.tt/2RsT51y
Early Diagnosis of Skin Melanoma Metastasis by Means of Dermoscopy and Confocal Microscopy
This case report describes the early diagnosis of skin melanoma metastasis by means of dermoscopy and confocal microscopy.
https://ift.tt/2PvU43x
https://ift.tt/2PvU43x
Pityriasis Rosea
This Patient Page provides information on pityriasis rosea, a common cutaneous erruption that is more prevelent in older children and young adults.
https://ift.tt/2RqF7Nt
https://ift.tt/2RqF7Nt
Association Between Market Competition and Prices of Generic Topical Dermatology Drugs
This cost analysis uses National Average Drug Acquisition Cost data and US Food and Drug Administration Orange Book data to assess whether an association exists between changes in drug prices and the number of approved manufacturers for the most commonly prescribed topical dermatologic generic drugs.
https://ift.tt/2PymUAr
https://ift.tt/2PymUAr
Case of extranodal natural killer/T‐cell lymphoma, nasal type, accompanied by Epstein–Barr virus‐positive nasopharyngeal carcinoma
The Journal of Dermatology, EarlyView.
https://onlinelibrary.wiley.com/doi/abs/10.1111/1346-8138.14701?af=R
Arterial Stiffness in a Toddler with Neurofibromatosis Type 1 and Refractory Hypertension
Arterial hypertension is a common finding in patients with neurofibromatosis (NF) type 1. Renovascular hypertension due to renal artery stenosis or midaortic syndrome could be the underlying cause. We report the case of a 4-year-old girl with NF type 1 and midaortic syndrome whose changes in blood pressure and pulse wave velocity suggested the evolution of vasculopathy, diagnosis of renovascular hypertension, and provided insights of response to treatment. Hypertension persisted after percutaneous transluminal angioplasty in the abdominal aorta, requiring escalation of antihypertensive treatment, while arterial stiffness demonstrated a mild decrease. Regular assessment of blood pressure using ambulatory blood pressure monitoring and noninvasive assessment of arterial stiffness may enhance the medical care of patients with NF type 1.
https://ift.tt/2qmz8xI
Trial Evaluating the Tolerance and Safety of Durvalumab - RT Combination for Treatment in SCCHN
Condition: HNSCC
Intervention: Drug: Durvalumab
Sponsors: Groupe Oncologie Radiotherapie Tete et Cou; UNICANCER; Center Eugene Marquis
Not yet recruiting
https://ift.tt/2Jtt9zY
Intervention: Drug: Durvalumab
Sponsors: Groupe Oncologie Radiotherapie Tete et Cou; UNICANCER; Center Eugene Marquis
Not yet recruiting
https://ift.tt/2Jtt9zY
Sialendoscopy for Definitive Management of a Submandibular Abscess following Radiotherapy for Oropharyngeal Squamous Cell Carcinoma
ORL
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Posttraumatic sigmoid sinus thrombosis secondary to transmastoid foreign body
Publication date: Available online 30 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Badidi, S. Chabrier, J.M. Prades, A. Karkas
https://ift.tt/2PEjnAN
Orbit, zygoma, and maxilla growth patterns in Crouzon syndrome
Publication date: Available online 30 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): X. Lu, A.J. Forte, R. Sawh-Martinez, R. Wu, R. Cabrejo, D.M. Steinbacher, M. Alperovich, N. Alonso, J.A. Persing
Abstract
The facial malformations of Crouzon syndrome involve the entire cranio-orbito-zygomatic region. The detailed sequence of changes in orbit, zygoma, and maxilla over time, the mutual influence among these three anatomical structures, and their relationship with the cranial base were studied to determine the sequence and timing of deformity. Preoperative CT scans of 36 patients with Crouzon syndrome (mean age 10.84 ± 14.70 years; 14 male, 22 female) and CT scans of 54 control subjects (mean age 8.53 ± 13.22 years; 29 male, 25 female) were divided into five subgroups by age: 0–6 months, 6 months–2 years, 2–6 years, 6–18 years, and 18–62 years. Craniofacial morphometric cephalometrics were analyzed using Materialise software. Crouzon orbit anteroposterior length was shorter before 6 months (P = 0.021) and remained shorter into adulthood (P < 0.001). Globe projection was greater across all age subgroups (P < 0.001), reaching a peak at 6 months to 2 years (P < 0.001). The increased medial orbital width was the most remarkable and persistent secondary deformity (P < 0.001). The zygoma anterior protrusion was retruded before 6 months of age (P < 0.001), but then improved gradually. The width of maxilla was greater by 24% in the Crouzon cohort (P < 0.001), with a difference of 16% before 6 months (P = 0.024), and was developed earlier than the shortened anteroposterior length. Crouzon high and shallow orbital walls are distinctive. Maxillary widening developed before the malformation of sphenoid. The anteroposterior position of zygoma is likely a principal deformity, rather than a reflection of the intrinsic shape of the bone.
Level of Evidence: II
https://ift.tt/2PvvcZH
Sentinel lymph node biopsy for early stage tongue cancer—a 14-year single-centre experience
Publication date: Available online 30 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): L. Hingsammer, T. Seier, D. Zweifel, G. Huber, M. Rücker, M. Bredell, M. Lanzer
Abstract
This study was performed to report the usage of sentinel lymph node biopsy (SLNB) in clinical stage I or II tongue cancer patients with cN0 necks seen over a 14-year period. Data were collected prospectively, and a retrospective analysis was performed of 41 patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Sentinel lymph node (SLN)-positive patients underwent elective neck dissection, whereas SLN-negative patients were kept under careful observation. Seven of the 41 (17%) patients enrolled in the study were found to have occult metastases. The patients were followed up for a mean duration of 92 months (range 60–144 months). The neck recurrence rate for SLN-positive patients was 0% and for SLN-negative patients was 3%. The authors recommend the routine use of SLNB in patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Furthermore, special focus should be placed on isolated tumour cells, as their presence is of high clinical relevance.
https://ift.tt/2RtISC3
Regarding “Impact of crack cocaine use on the occurrence of oral lesions and micronuclei”
Publication date: Available online 30 October 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): M.E. Suarez Alpire, D.A. Ribeiro
https://ift.tt/2PvxpEp
New role for the modern allergist in drug allergy: Assess, diagnose, and de-label
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): Mariana Castells
https://ift.tt/2qkEFEY
Authors’ response
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): Sten Dreborg, Harold Kim
https://ift.tt/2Q96P0Y
Clarification of epicutaneous immunotherapy trial phase 3 results and methods for qualitative survey design
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): John G. Matthews, Rezi Zawadzki, Tmirah Haselkorn, Karin Rosén
https://ift.tt/2qlHMMX
Qualitative evaluation of caregiver preferences for peanut immunotherapy products: Methods and timing count
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): Stephen A. Tilles
https://ift.tt/2Q96NWU
Penicillin allergy
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): David Lang, Chitra Dinakar, John J. Oppenheimer, Vivian Hernandez-Trujillio
https://ift.tt/2qkDXYk
High-risk drug rashes
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): Sasha A. Alvarado, Diana Muñoz-Mendoza, Sami L. Bahna
Abstract
Objective
To provide a brief overview of the clinical presentation, common offending agents, management, prognosis, and mortality of 6 selected high-risk drug rashes, namely, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, multiple drug hypersensitivity (MDH) syndrome, acute generalized exanthematous pustulosis (AGEP), and drug-induced bullous pemphigoid (DIBP).
Data Sources
A review of the published literature was performed with PubMed and supplemented with our clinical experience.
Study Selections
The most recent clinically relevant studies and older seminal works were selected.
Results
Most of the published data on these uncommon rashes were based on small observational series or case reports. SJS and TEN have specific genotypes association with certain drugs, have high morbidity and mortality, and require aggressive management by a team of multiple specialists. DRESS syndrome is a severe, prolonged multiorgan reaction, yet it has a better prognosis than TEN. MDH is a syndrome of repeated reactions to unrelated drugs that often imposes diagnostic and management difficulties. AGEP consists of generalized sterile small pustules, usually mistaken for infection with subsequent inappropriate treatment. Bullous pemphigoid presents with tense pruritic bullae and characteristic linear basement membrane deposition of IgG and C3. DIBP has much better prognosis than the autoimmune variety.
Conclusion
In such high-risk drug rashes, early recognition, immediate withdrawal of the suspected drug(s), prompt individualized management, and monitoring of vital organs function are mandatory for reducing morbidity and mortality. The lack of reliable tests for identification of the causative agent imposes difficulty, particularly in patients receiving multiple medications.
https://ift.tt/2Q96M5i
Systematic review of professional liability when prescribing β-lactams for patients with a known penicillin allergy
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): Meghan N. Jeffres, Elizabeth A. Hall-Lipsy, S. Travis King, John D. Cleary
Abstract
Objective
To describe medical negligence and malpractice cases in which a patient with a known penicillin allergy received a β-lactam and experienced an adverse reaction related to the β-lactam.
Data Sources
Lexis-Nexus, Westlaw, and Google Scholar were searched.
Study Selections
Medical negligence and malpractice cases were eligible for inclusion if they met the following criteria: the plaintiff had a known penicillin allergy, received a β-lactam, and experienced an adverse event. All United States federal and state cases were eligible.
Results
Twenty-seven unique cases met the inclusion criteria. Eighteen cases involved the receipt of a penicillin-based antibiotic; of these cases with a known legal outcome, the plaintiff (patient or representative) prevailed or settled in 3 cases and defendants (providers) prevailed in 7 cases. Seven cases involved the receipt of a cephalosporin; of these cases with a known legal outcome, the plaintiff settled with physicians before trial in 1 case and defendants prevailed in 3 cases. Two cases involved the receipt of a carbapenem. Defendants prevailed in one case and the legal outcome of the other case is unknown. In cases in which the defense successfully moved for summary judgment, judges cited a lack of scientific evidence demonstrating a cephalosporin or carbapenem was contraindicated for a patient with a penicillin allergy.
Conclusion
The cases with published legal outcomes found limited professional liability for clinicians who prescribed cephalosporins or carbapenems to a patient with a known penicillin allergy. These results may decrease the litigation fears of practitioners and risk managers within health care systems.
https://ift.tt/2qkECZO
Penicillin allergy and the law
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): Roland Solensky
https://ift.tt/2Q96Kuc
Authors’ response
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): Matthew Greenhawt, Rebekah Marsh, Hannah Gilbert, Daniel Matlock
https://ift.tt/2qgZS2O
Editorial Board
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s):
https://ift.tt/2QcF9IV
Information for Authors
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s):
https://ift.tt/2qm7RM6
Table of Contents
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s):
https://ift.tt/2Q9hgBZ
Information for Readers
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s):
https://ift.tt/2qkExFu
Pressure, trigger forces, and epinephrine auto-injectors
Publication date: November 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5
Author(s): Julie Brown
https://ift.tt/2Q9W0vK
Syndrome de Griscelli de type 3 : un nouveau cas
Publication date: Available online 30 October 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): H. Kassem Youssef, C. Ramstein, E. Ginglinger, F. Chouta Ngaha, H. Nojavan, C. Michel
Résumé
Introduction
Le syndrome de Griscelli (SG) est une maladie génétique autosomique récessive rare, caractérisée par une dilution pigmentaire des cheveux et de la peau. Nous rapportons un cas de syndrome de Griscelli de type 3 diagnostiqué à un âge tardif.
Observation
Une femme de 31 ans présentait depuis l'enfance une dépigmentation des cheveux et des sourcils avec une discrète leucodermie diffuse. L'étude microscopique du cheveu mettait en évidence des agrégats de mélanine irrégulièrement distribués le long de la tige pilaire. Le séquençage de l'ADN montrait une mutation homozygote C103T (R35W) dans l'exon 1 du gène MLPH, correspondant au syndrome de Griscelli type 3.
Discussion
Trois phénotypes cliniques de SG ont été décrits selon le défaut moléculaire sous-jacent. Les SG types 1 et 2 sont associés respectivement à un dysfonctionnement du système nerveux central et à un déficit immunitaire. Le SG type 3 est une forme cutanée isolée. L'examen microscopique des cheveux permet de poser le diagnostic. Seuls 15 cas de SG type 3 ont été décrits dans la littérature, neuf de sexe masculin et six de sexe féminin. L'âge moyen au diagnostic est de 12 ans. Dix des cas sont d'origine arabe, quatre d'origine turque et un d'origine indienne. La mutation R35W a été observée dans neuf cas et les mutations E98X et R35Q chacune dans un cas.
Conclusion
Le syndrome de Griscelli doit être évoqué devant tout aspect de cheveux gris argentés, plus particulièrement chez des patients d'origine arabe ou turque.
Summary
Introduction
Griscelli syndrome (GS) is a rare autosomal-recessive genetic disease characterized by hypopigmentation of skin and hair. We report a case of GS type 3 with late diagnosis.
Observation
A 31-year-old female patient had presented depigmentation of the hair and eyebrows as well as diffuse skin hypopigmentation during childhood. Microscopic analysis of a hair shaft revealed irregularly distributed clumps of melanin. DNA sequencing showed a homozygous C103T (R35W) transition in exon 1 of MLPH, confirming Griscelli syndrome type 3.
Discussion
Three clinical phenotypes of GS have been described based on the underlying genetic defect. GS type 1 and 2 are associated respectively with a central nervous system dysfunction and an immune defect. GS type 3 is an isolated cutaneous form. Diagnosis is confirmed on microscopic examination of hair shafts. 15 cases of GS type 3 have been reported: 9 in males and 6 in females. Mean age at diagnosis is around 12 years. Nine of the reported patients were of Arab origin, four of Turkish origin, and one of Indian origin. R35W mutation was described in 9 cases and E98X and R35Q mutations were each found in one case.
Conclusion
GS should be suspected in patients presenting gray silvery hair, particularly when these patients are of Arab or Turkish origin.
https://ift.tt/2JteQeB
Parent Perspectives on Multidisciplinary Pediatric Hearing Healthcare
Publication date: Available online 31 October 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Ursula M. Findlen, Prashant S. Malhotra, Oliver F. Adunka
Abstract
Introduction
Family-centered healthcare demands that families provide input regarding the care of their children. Very little is known, however, about how families perceive their experience in different types of multidisciplinary team models, and specifically, in the multidisciplinary setting currently utilized in many pediatric hearing clinics.
Methods
Quantitative and qualitative parent survey responses were collected and analyzed in a tertiary care pediatric medical center after a one-day multidisciplinary assessment clinical appointment. Questions pertained to information across five domains, including overall experience, diagnosis, treatment plan formulation, additional testing, and resources. Quantitative responses were analyzed descriptively while qualitative responses were evaluated using content analysis to derive themes. Quantitative and qualitative data were evaluated separately and then compared to delineate themes for strengths and weaknesses.
Results
Overall, high satisfaction was evident in both quantitative and qualitative responses. Results suggested that a one-day multidisciplinary assessment appointment may contribute to parents feeling overwhelmed by information shared and not fully understanding which disciplines are providing care. Analysis revealed a specific area of weakness in our particular setting was inadequate provision of information about functional hearing (e.g., listening socially and academically). Results contributed to a change from a multidisciplinary team model to an interdisciplinary care coordination approach to pediatric hearing healthcare.
Conclusions
Understanding parent perspectives and expectations is the corner stone of family-centered care and may ultimately influence a child's developmental outcome. A systematic way of evaluating parent perspectives on the clinical process can influence service delivery and help children with hearing loss meet their potential.
https://ift.tt/2CU530d
Characteristics of Children with Refractory Acute Otitis Media Treated at the Pediatric Emergency Department
Publication date: Available online 31 October 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Jacob Pitaro, Sofia Waissbluth, Marie-Claude Quintal, Anthony Abela, Annie Lapointe
https://ift.tt/2qlGGRl
Cost-effectiveness of nivolumab in the treatment of head and neck cancer
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): A. Hirschmann, J.E. Lupatsch, M. Schwenkglenks, C.M. Panje, K. Matter-Walstra, V. Espeli, K.J. Dedes, M. Siano, for the Swiss Group of Clinical Cancer Research (SAKK)
Abstract
Background
Until recently, no second-line treatment for recurrent and/or metastatic head and neck squamous cell cancer (r/mHNSCC) was able to improve overall survival (OS). Nivolumab has become a promising treatment for r/mHNSCC. The CheckMate-141 trial showed that nivolumab improves OS compared to investigator's choice (IC) (cetuximab, methotrexate, docetaxel). Treatment with immune checkpoint inhibitors is however expensive. The aim of this analysis was to assess the cost-effectiveness of nivolumab as second-line treatment for r/mHNSCC in Switzerland.
Methods
Based on the CheckMate-141 trial, we constructed a Markov model comparing nivolumab to IC, including follow-up data up to 24 months. We assessed costs for treatments from the perspective of the Swiss health system with a 60 months' time horizon. PD-L1 and p16 testing were considered in scenarios. Incremental cost-effectiveness ratios (ICER) were compared to an informal willingness-to-pay of CHF (Swiss Francs) 100,000 per QALY gained.
Results
For the base case we estimated an incremental effectiveness of 0.35 QALYs and incremental costs of CHF 35,562 with nivolumab, resulting in an ICER of CHF 102,957 per QALY gained. Most influential drivers for the ICER were the price of nivolumab and the progressive disease state utility weights. In 45.5% of probabilistic sensitivity analysis simulations nivolumab was estimated below 100,000 CHF/QALY. Reducing the price of nivolumab according to a consented payback by 4.75%, resulted in an ICER of CHF 98,325/QALY gained.
Conclusions
At current prices nivolumab has an ICER of around CHF 100,000 per QALY gained in the second line treatment of r/mHNSCC patients in Switzerland.
https://ift.tt/2P0WQ1v
IVIG induces apoptotic cell death in CD56dim NK cells resulting in inhibition of ADCC effector activity of human PBMC
Publication date: Available online 31 October 2018
Source: Clinical Immunology
Author(s): Sebastian Bunk, Padmapriya Ponnuswamy, Azra Trbic, Mantas Malisauskas, Heinz Anderle, Alfred Weber, Josenato Ilas, Anna M. Winkler, H. Arno Butterweck, Wolfgang Teschner, Friedrich Scheiflinger, Corinna Hermann, Birgit M. Reipert
Abstract
The mechanism of the efficacy of Intravenous immunoglobulins (IVIG) in autoimmune and inflammatory diseases is not well understood. This study aimed at understanding mechanisms of IVIG-mediated suppression of effector cell activities of peripheral blood mononuclear cells (PBMC) in antibody-dependent cellular cytotoxicity (ADCC). We were particularly interested in CD56dim NK cells, the main ADCC effector cells in PBMC. Exposure of PBMC to IVIG for at least 48 h induced a caspase-3-dependent apoptotic cell death of CD56dim NK cells without affecting CD56bright NK cells. Induction of apoptosis in CD56dim NK cells and concomitant suppression of ADCC effector activities of PBMC was associated with the monomer fraction of IVIG. Moreover, it was independent of IgG sialyation, did not depend on engagement of FcγRIII and could not be mimicked by IVIG (Fab')2 or IVIG Fc preparations. The described effect could contribute to the reduction of peripheral NK cells observed during IVIG therapy in patients.
https://ift.tt/2Dei1H1
Migraine increases the proportion of sudden sensorineural hearing loss: A longitudinal follow-up study
Publication date: Available online 30 October 2018
Source: Auris Nasus Larynx
Author(s): So Young Kim, Mi Kyung Kim, Jae-Sung Lim, Il Gyu Kong, Hyo Geun Choi
Abstract
Objective
The aim of the present study was to investigate the proportion of sudden sensorineural hearing loss (SSNHL) patients in a representative population cohort with migraine.
Methods
The Korean National Health Insurance Service-National Sample Cohort was collected from 2002 to 2013. A total of 45,114 migraine participants (the migraine group) were matched according to age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 180,456 controls (the control group). The migraine group included participants diagnosed with migraine (International Classification of Disease [ICD]-10: G43) who underwent treatment ≥2 times. The SSNHL was investigated based on the ICD-10 (H912) code and confirmed by an audiometry exam and steroid treatment. Histories of hypertension, diabetes, dyslipidemia, ischemic heart disease, stroke, depression, Meniere's disease, and tinnitus were evaluated using ICD-10 codes. Crude (simple) and adjusted hazard ratios (HRs) of SSNHL associated with migraine were analyzed using the Cox proportional hazards model. Subgroup analyses were conducted according to age and sex.
Results
In total, 0.9% (399/44,714) of the migraine patients and 0.6% (1,169/179,287) of the controls were diagnosed with SSNHL (P < 0.001). The adjusted HR of migraine for SSNHL was 1.34 (95% confidence interval [CI] = 1.19–1.50, P < 0.001). Both patient age subgroups (20–59 years old and ≥60 years old) showed high adjusted HRs for SSNHL. Both the men and women presented an elevated proportion of SSNHL cases.
Conclusion
Migraine patients had a higher likelihood of SSNHL. All age and sex migraine subgroups showed an elevated proportion of SSNHL cases.
https://ift.tt/2AC2PAN
Evaluation of folded amniotic membrane and injectable amniotic membrane pieces as soft tissue filler materials
Publication date: Available online 30 October 2018
Source: Auris Nasus Larynx
Author(s): Mustafa Caglar Buday, Murat Ozturk
Abstract
Objective
The search for safe and effective tissue fillers has been an ongoing effort for many years. Obtaining biological materials from patients can require additional incisions and brings surgical and cosmetic risks as a major disadvantage. The aim of this experimental study was, therefore, to evaluate the efficacy of folded amniotic membrane as a soft tissue filler and to assess its volume, and to investigate the possible usage of injectable amniotic membrane for augmentation.
Methods
Multi-layer amniotic membranes are transplanted to the subcutaneous tunnels created in the rat's back, and the amniotic membrane transformed into the injection material is inoculated transcutaneously under the rat's skin. At the end of two months, the amount of volume loss and histopathological changes in the grafts were examined under light microscope.
Results
The multi-layer amniotic membrane grafts maintain its volume around 92%. It has been shown that the injectable amniotic membrane maintains its presence in the tissue, can augment it, and can be used as a soft tissue filler. The availability of using amniotic membrane for injection material is shown. No foreign body reaction to the amnion grafts, fibrosis, and necrosis were observed in our study.
Conclusion
According to our study results, multi-layer amnion graft and amnion injection seem to be used as camouflage grafts and soft tissue augmentation materials. Although further clinical trials are mandatory before considering the use of amniotic membrane as a tissue filler material in humans, we are hopeful about its long-term safety and efficacy.
https://ift.tt/2EShYC9
Stapes hypermobility as a possible cause of hyperacusis
Publication date: Available online 31 October 2018
Source: American Journal of Otolaryngology
Author(s): Herbert Silverstein, Joshua Smith, Brian Kellermeyer
Abstract
Objective
Hyperacusis is a reduction of normal tolerances for everyday sounds. Although several publications have been produced demonstrating that minimally invasive surgical procedures may improve patient symptoms, the precise etiology of hyperacusis often remains elusive. This study describes 21 patients, 7 of whom stapes hypermobility is believed to be a mechanical genesis of their hyperacusis symptoms.
Study design
A prospective, repeated-measure single-arm design was used for this study.
Setting
All patients were evaluated and treated at a tertiary level otologic referral center.
Subjects and methods
21 patients (Cohort A) with severe hyperacusis underwent oval and round window reinforcement. Seven patients (Cohort B) intraoperatively appeared to have subjective hypermobility of the stapes. Additional reinforcement of the stapes superstructure was performed in these patients.
Results
In Cohort A, loudness discomfort level (LDL) values improved on average from 72.7 dB to 81.9 dB. Hyperacusis questionnaire (HQ) scores improved from 30.1 to 14.7. Numeric Rating Scale scores (0−10) decreased from 8.5 to 4.0. In Cohort B, values similarly improved from an average of 72.4 dB to 88.2 dB. HQ scores improved from 35.8 to 18.9. Numeric Rating Scale scores fell from 10.0 to 3.7. Postoperatively there were no complaints of hearing loss. Sixteen out of 21(76%) reported improved quality of life and diminished symptoms of hyperacusis.
Conclusion
It is possible that patients suffering from hyperacusis may have a mechanical cause for their symptoms. Further research is necessary to clarify stapes mobility in patients with these symptoms. Excess temporalis tissue reinforcement of the stapes along with round window reinforcement shows promise as a minimally invasive surgical option for patients suffering from hyperacusis.
https://ift.tt/2OgqFFL
Roles of functional strain and capsule compression on mandibular cyst expansion and cortication
Publication date: Available online 30 October 2018
Source: Archives of Oral Biology
Author(s): Babak Sarrafpour, Charbel El-Bacha, Qing Li, Hans Zoellner
Abstract
Objective
Cyst expansion in bone involves bone resorption but is often accompanied by adjacent bone formation with cortication. The mechanisms for these two apparently opposite processes remain unclear. From a mechanobiological perspective, functional strain drives bone remodeling, which involves both bone apposition and resorption. In this study, we explore the role of functional strain in cyst growth.
Design
Using a three-dimensional finite element analysis model of a simulated cyst at the of right first mandibular molar mesial apex, we examined three loading conditions, representing biting on the right molar, left molar and incisors, respectively. Comparison was made with an identical finite element model without the simulated cyst.
Results
Under all loading conditions, finite element analysis revealed higher strain energy density within the bone lining the cyst compared with the non-cyst model, which is consistent with bone formation and cortication observed clinically. Further analysis demonstrated overall compression of the simulated cyst capsule under all loading conditions.We interpret compression of the capsule as indicating resorption of the adjacent bone surface.
Conclusions
We conclude that functional stress results in dominant compression of the soft tissue capsules of bony cysts, contributing to cyst expansion. Also, functional strain becomes elevated in the bone immediately adjacent to the soft tissue cyst capsule, which may drive bone formation and cortication.
https://ift.tt/2F2LhSy
Roles of functional strain and capsule compression on mandibular cyst expansion and cortication
Publication date: Available online 30 October 2018
Source: Archives of Oral Biology
Author(s): Babak Sarrafpour, Charbel El-Bacha, Qing Li, Hans Zoellner
Abstract
Objective
Cyst expansion in bone involves bone resorption but is often accompanied by adjacent bone formation with cortication. The mechanisms for these two apparently opposite processes remain unclear. From a mechanobiological perspective, functional strain drives bone remodeling, which involves both bone apposition and resorption. In this study, we explore the role of functional strain in cyst growth.
Design
Using a three-dimensional finite element analysis model of a simulated cyst at the of right first mandibular molar mesial apex, we examined three loading conditions, representing biting on the right molar, left molar and incisors, respectively. Comparison was made with an identical finite element model without the simulated cyst.
Results
Under all loading conditions, finite element analysis revealed higher strain energy density within the bone lining the cyst compared with the non-cyst model, which is consistent with bone formation and cortication observed clinically. Further analysis demonstrated overall compression of the simulated cyst capsule under all loading conditions.We interpret compression of the capsule as indicating resorption of the adjacent bone surface.
Conclusions
We conclude that functional stress results in dominant compression of the soft tissue capsules of bony cysts, contributing to cyst expansion. Also, functional strain becomes elevated in the bone immediately adjacent to the soft tissue cyst capsule, which may drive bone formation and cortication.
https://ift.tt/2F2LhSy
Epicutaneous immunotherapy for peanut allergy modifies IgG4 responses to major peanut allergens
Publication date: Available online 31 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Stef J. Koppelman, Aurélie Peillon, Wenceslas Agbotounou, Hugh A. Sampson, Laurent Martin
https://ift.tt/2zgIm2H
Multicenter, randomized, double-blind, placebo-controlled clinical trial of vital wheat gluten oral immunotherapy
Publication date: Available online 30 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Anna Nowak-Węgrzyn, Robert A. Wood, Kari C. Nadeau, Jacqueline A. Pongracic, Alice K. Henning, Robert W. Lindblad, Kirsten Beyer, Hugh A. Sampson
Background
Wheat is a common food allergen that can cause anaphylaxis.
Objective
We sought to determine the efficacy and safety of vital wheat gluten (VWG) oral immunotherapy (OIT).
Methods
After baseline double-blind, placebo-controlled food challenge (DBPCFC), 46 patients with wheat allergy (median age, 8.7 years; range, 4.2-22.3 years) were randomized 1:1 to low-dose VWG OIT or placebo, with biweekly escalation to 1445 mg of wheat protein (WP). After a year 1 DBPCFC, active subjects continued low-dose VWG OIT for another year and underwent a year 2 DBPCFC and, if passed, a subsequent off-therapy DBPCFC. Placebo-treated subjects crossed over to high-dose VWG OIT (maximum, 2748 mg of WP).
Results
The median baseline successfully consumed dose (SCD) was 43 mg of WP in both groups. At year 1, 12 (52.2%) of 23 low-dose VWG OIT–treated and 0 (0%) of 23 placebo-treated subjects achieved the primary end point of an SCD of 4443 mg of WP or greater (P < .0001); median SCDs were 4443 and 143 mg, respectively. At year 2, 7 (30.4%) of 23 low-dose VWG OIT–treated subjects were desensitized to an SCD of 7443 mg of WP; 3 (13%) achieved sustained unresponsiveness 8 to 10 weeks off therapy. Among placebo-treated subjects who crossed over to high-dose VWG OIT, 12 (57.1%) of 21 were desensitized after 1 year (median SCD, 7443 mg of WP; nonsignificant vs low-dose VWG OIT). At year 1, skin prick test responses and wheat- and omega-5 gliadin–specific IgE levels did not differ between groups; the low-dose VWG OIT median specific IgG4 level was greater than placebo (wheat, P = .0005; omega-5 gliadin, P = .0001). Year 1 SCDs correlated with wheat-specific (rho = 0.55, P = .0003) and omega-5 gliadin–specific (rho = 0.51, P = .001) IgG4 levels in all subjects. Among 7822 low-dose VWG OIT doses in year 1, 15.4% were associated with adverse reactions: 0.04% were severe, and 0.08% subjects received epinephrine. Among 7921 placebo doses, 5.8% were associated with adverse reactions; none were severe.
Conclusions
Low- and high-dose VWG OIT induced desensitization in about one half of the subjects after 1 year of treatment. Two years of low-dose VWG OIT resulted in 30% desensitization, and 13% had sustained unresponsiveness.
Graphical abstract
https://ift.tt/2SyrzB4
Non-operative management of isolated spontaneous superior mesenteric artery dissection
Abstract
Isolated spontaneous superior mesenteric artery (SMA) dissection is a rare differential for patients presenting with abdominal pain. Due to limited cases reported, management strategies have been poorly defined. We present the case of a 49-year-old male with history of hypertension and ischemic colitis, presenting with abdominal pain. CT imaging demonstrated a thrombosed dissection of the SMA extending into second and third order braches. He was managed conservatively with therapeutic anticoagulation. His symptoms improved and upon discharge he was transitioned to aspirin and warfarin. Repeat CT imaging continued to show the dissection with resolution of the SMA thrombus. Spontaneous SMA dissection is exceedingly rare with no universally agreed upon standard of care for treatment. Operative intervention should be reserved for failed conservative management or vascular compromise. Understanding the current treatment options helps ensure a favorable patient outcome.https://ift.tt/2Q6fcKM
Malignant proliferating trichilemmal tumor of the forearm: a case report of an unusual location of a rare cutaneous adnexal tumor
Abstract
Proliferating trichilemmal tumor (PTT) is a rare cutaneous adnexal neoplasm of the hair follicle that undergoes outer root sheath differentiation in the isthmus. Histological hallmarks include trichilemmal keratinization, lack of granular layer and lobular proliferation of squamous epithelium with glycogenated clear cells. It affects predominantly elderly women, especially over the scalp. In some cases, malignant transformation can occur. However, only a few cases are reported in the literature. We hereby describe the case of a patient diagnosed with malignant PTT (MPTT) in the dorsal forearm, 2 years after undergoing surgical excision of a squamous cell carcinoma in the same topography. Thus, providing a thorough description of the clinical presentation of MPTT will assist surgeons in diagnosing and treating this rare tumor.https://ift.tt/2qiDgPn
Resection of a mature cystic teratoma of the liver harboring a carcinoid tumor
Abstract
Cystic teratomas are rare pluripotent embryonic tumors which most commonly originate in gonadal organs. Extra-gonadal cystic teratomas are exceedingly uncommon, accounting for only 1% of all cystic teratomas, and have been reported in unusual locations including the kidney, mediastinum and liver. These extra-ovarian cystic teratomas have also been known to harbor other neoplasms including carcinoid tumors. In this report, we describe a unique case of a hepatic cystic teratoma occurring as a combined tumor with a carcinoid in a young female. The patient underwent elective laparoscopic resection of her tumor after extensive radiographic and endoscopic work-up for chronic, non-localizable abdominal pain. We believe the carcinoid tumor arose de novofrom committed differentiation of a cell line within the teratoma, and not metastatic spread.https://ift.tt/2Q6f1iA
Decompressive laparotomy for a patient on VA-ECMO for massive pulmonary embolism that suffered traumatic liver laceration after mechanical CPR
Abstract
Massive pulmonary embolism (PE) is an embolus sufficiently obstructing pulmonary blood flow to cause right ventricular (RV) failure and hemodynamic instability. We have utilized veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for early and aggressive intervention for massive PE patients. We present a case of a 61-year-old female placed on VA-ECMO for a massive PE while presenting in cardiac arrest and receiving mechanical cardiopulmonary resuscitation (CPR) via the LUCAS 2.0 device (Physio-Control Inc., Lund, Sweden). The patient suffered a severe liver laceration secondary to mechanical CPR and required a decompressive laparotomy. This case highlights that mechanical CPR during other interventions can lead to malposition of the device and could result in solid organ injury.https://ift.tt/2qnr5k9
Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of
Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency.
https://ift.tt/2zgpm4h
Cover Image
Clinical &Experimental Allergy, Volume 48, Issue 11, Page i-i, November 2018.
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Presented at the 2018 Annual Meeting of the British Society for Allergy and Clinical Immunology
Clinical &Experimental Allergy, Volume 48, Issue 11, Page 1524-1574, November 2018.
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Issue Information
Clinical &Experimental Allergy, Volume 48, Issue 11, Page 1373-1375, November 2018.
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Forthcoming Meetings
Clinical &Experimental Allergy, Volume 48, Issue 11, Page 1575-1575, November 2018.
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Fatal anaphylaxis to food allergens: Learning from tragedies
Clinical &Experimental Allergy, Volume 48, Issue 11, Page 1376-1377, November 2018.
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Best of the Other Journals
Clinical &Experimental Allergy, Volume 48, Issue 11, Page 1576-1577, November 2018.
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Independent predictive factors for the persistence and tolerance of cow's milk allergy
International Forum of Allergy &Rhinology, EarlyView.
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Surgical simulation of a catastrophic internal carotid artery injury: a laser‐sintered model
International Forum of Allergy &Rhinology, EarlyView.
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Fibrous dysplasia of the jaws: Integrating molecular pathogenesis with clinical, radiological and histopathological features
Journal of Oral Pathology &Medicine, Volume 0, Issue ja, -Not available-.
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Glucose metabolism in patients with psoriasis
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
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Risk factors for treatment failure in scabies: a cohort study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
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Characteristics and Outcomes of Liver Transplantation for Primary Biliary Cholangitis (PBC) in Young patients: Analysis of the United Network for Organ Sharing Database
Background Primary biliary cholangitis (PBC) in younger patients has been suggested to require liver transplantation (LT) in early adulthood, but data is limited on its outcomes. We aimed to evaluate the characteristics and outcome of LT in young patients with PBC in comparison with older adults. Methods The United Network for Organ Sharing (UNOS) database was analyzed for all patients with PBC who underwent LT between 2000 and 2012. Based on age at the time of LT subjects were divided into two groups: young patients (≤ 40 years) and older adults (≥ 41 years). Baseline demographics, clinical parameters, and outcomes of LT were then compared between the two groups. Univariable and multivariable analyses were performed to assess the factors associated with outcomes of LT. Results A total of 2,084 patients with PBC were included in the analysis with 158 young patients. Compared to older adults, younger patients were more likely to be male (27.2% vs. 15.4%) and non-white (43.7% vs. 21.5%) but they were less likely to have obesity, diabetes, or hypertension (p
https://ift.tt/2P0GhTm
https://ift.tt/2P0GhTm
Antiphospholipid Syndrome And Renal Allograft Thrombosis
Renal allograft thrombosis is the most frequent and devastating complication in the early postrenal transplantation period. Several risk factors to develop graft thrombosis depending on donors and recipients are well known. Antiphospholipid syndrome (APS) is well recognized as an important cause of kidney injury, with specific clinical and histological features that may lead to renal injury caused by thrombosis at any location within the renal vasculature. There are 3 forms of APS, primary (the most common form), associated to other systemic autoimmune diseases (SAD-APS) and catastrophic. Nevertheless, patients with SAD-APS and renal failure only represent 2-5% in hemodialysis or transplantation. The presence of pretransplant antiphospholipid antibodies (APL) increases risk of graft thrombosis. A new form of APS based on IgA anti-Beta-2-Glycoprotein-I(B2GPI) antibodies, representing up to 30% of patients in ESRD and renal transplantation, is the main independent risk factor for graft thrombosis and early graft loss after renal transplantation. In addition, B2GP1 bound to IgA aB2GP1 immunocomplexes have been described as a marker to predict thrombosis after renal transplantation in patients with antiphospholipid antibodies. Anticoagulation remains the main treatment to prevent renal allograft thrombosis, although new preventive strategies are coming. Future studies may help to identify better therapeutic targets. Correspondence to: Jose M Morales, Prof. of Medicine. Consultant Investigator, Healthcare Research Institute Hospital 12 de Octubre, 28041 Madrid, Spain, E-Mail: jmorales@h12o.es Phone: 34-607469173 Authors: JMM, MS and AS designed the structure of the review, discussed the relevant literature and wrote the manuscript. JAMF and DP worked in the pathophysiology of renal allograft thrombosis. Finally all authors discussed the complete manuscript and all agree with the final text. JMM and MS collaborated equally to this work. The authors declare no conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2CUZu1B
Favorable outcome of an exclusively posttransplant prophylactic strategy after heart transplantation in recipients with high immunological risk
Background Management of the increasing number of sensitised heart transplant candidates has become a recurrent issue. Rather than using pretransplant desensitisation therapies, we used a posttransplant prophylactic strategy. Our aim was to describe outcomes in transplant recipients with preformed donor-specific anti-HLA antibodies (pfDSA) managed with this strategy. Methods A posttransplant protocol was applied to patients transplanted with pfDSA, consisting of perioperative management of DSA (polyvalent immunoglobulins +/- perioperative plasmapheresis sessions, according to DSA level, as well as induction therapy) and systematic treatment of subsequent antibody-mediated rejection (ABMR), even when subclinical. We performed a retrospective analysis of this prospective protocol. The study included all consecutive first recipients of a noncombined heart transplant performed between 2009 and 2015 at our centre. The primary endpoint was all-cause mortality. Secondary endpoints included primary graft dysfunction, early posttransplant bleeding, rejection and cardiac allograft vasculopathy-free survival. Results A total of 523 patients were studied, including 88 (17%) and 194 (37%) transplanted with DSA mean fluorescence intensity (MFI) of 500–1000 and >1000, respectively. The median follow-up period was 4.06 years. Survival was not significantly different between groups. Rejection-free survival was worse in patients with pfDSA MFI >1000, evidenced by a fourfold increase in the risk of ABMR. The incidence of primary graft dysfunction and cardiac allograft vasculopathy-free survival did not significantly differ between groups. Perioperative plasmapheresis increased the risk for transfusion of packed red blood cells. Conclusions This exclusively posttransplant prophylactic strategy achieved favourable outcomes in heart transplant recipients with pfDSA. Institute of cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP). Paris, France. Corresponding author: Dr Guillaume Coutance, Service de Chirurgie Thoracique et Cardio-Vasculaire, Institut de Cardiologie - Groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital - 75651 Paris Cedex 13. Tel: +33 1/42-16-56-08, Fax: +33 1/42-16-55-76. Mail: guillaume.coutance@gmail.com Authorship page Guillaume Coutance participated in the performance of the research, in data analysis and in the writing of the paper. Virginie d'Orio participated in the performance of the research and in data analysis. Lisa Belin participated in data analysis and in the writing of the paper. Nicolas Bréchot participated in research design and in the performance of the research. Samir Saheb participated in research design and in the performance of the research. Guillaume Lebreton participated in research design and in the writing of the paper. Adrien Bouglé participated in the performance of the research and in the writing of the paper. Philippe Rouvier participated in the performance of the research and in the writing of the paper. Chantal Gautreau participated in the performance of the research and in the writing of the paper. Salima Ouldammar participated in the performance of the research. Xavier Chamillard participated in the performance of the research. Mélanie Huot participated in the performance of the research. Julien Amour participated in research design and in the writing of the paper. Alain Combes participated in research design and in the writing of the paper. Pascal Leprince participated in research design and in the writing of the paper. Shaida Varnous participated in research design and in the writing of the paper. Disclosure: The authors declare no conflicts of interest. Funding Source: Guillaume Coutance received research grants from the ADICARE association (2017). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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https://ift.tt/2OZ8ytw
Development of CDX-1140, an agonist CD40 antibody for cancer immunotherapy
Abstract
Limitations of immunotherapy include poorly functioning events early in the immune response cycle, such as efficient antigen presentation and T cell priming. CD40 signaling in dendritic cells leads to upregulation of cell surface costimulatory and MHC molecules and the generation of cytokines, which promotes effective priming of CD8+ effector T cells while minimizing T cell anergy and the generation of regulatory T cells. This naturally occurs through interaction with CD40 ligand (CD40L) expressed on CD4+ T-helper cells. CD40 signaling can also be achieved using specific antibodies, leading to several agonist CD40 antibodies entering clinical development. Our approach to select a CD40 agonist antibody was to define a balanced profile between sufficiently strong immune stimulation and the untoward effects of systemic immune activation. CDX-1140 is a human IgG2 antibody that activates DCs and B cells and drives NFkB stimulation in a CD40-expressing reporter cell line. These activities are Fc-independent and are maintained using an F(ab′)2 fragment of the antibody. CDX-1140 binds outside of the CD40L binding site, and addition of recombinant CD40L greatly enhances DC and B activation by CDX-1140, suggesting that CDX-1140 may act synergistically with naturally expressed CD40L. CDX-1140 also has both direct and immune-mediated anti-tumor activity in xenograft models. CDX-1140 does not promote cytokine production in whole blood assays and has good pharmacodynamic and safety profiles in cynomolgus macaques. These data support the potential of CDX-1140 as part of a cancer therapy regimen, and a phase 1 trial has recently commenced.
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Multiple myeloma presenting as cutaneous leukocytoclastic vasculitis and eosinophilia disclosing a T helper type 1/T helper type 2 imbalance: a case report
Multiple myeloma is a very heterogeneous disease comprising a number of genetic entities that differ from each other in their evolution, mode of presentation, response to therapy, and prognosis. Due to its mor...
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Low frequency of acetyl salicylic acid hypersensitivity in mastocytosis: The results of a double‐blind, placebo‐controlled challenge study
Allergy, Volume 73, Issue 10, Page 2055-2062, October 2018.
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Langerhans and inflammatory dendritic epidermal cells in atopic dermatitis are tolerized toward TLR2 activation
Allergy, EarlyView.
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Modulation of allergic responses by mitochondrial STAT3 inhibitors
Allergy, EarlyView.
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Reduction in polyamine catabolism leads to spermine‐mediated airway epithelial injury and induces asthma features
Allergy, Volume 73, Issue 10, Page 2033-2045, October 2018.
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Issue Information ‐ TOC
Allergy, Volume 73, Issue 10, Page 1933-1934, October 2018.
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Multiple drug intolerance syndrome and multiple drug allergy syndrome: Epidemiology and associations with anxiety and depression
Allergy, Volume 73, Issue 10, Page 2012-2023, October 2018.
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Issue Information ‐ Cover and Editorial Board
Allergy, Volume 73, Issue 10, Page 1931-1931, October 2018.
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In this Issue: Graphical Abstracts
Allergy, Volume 73, Issue 10, Page 1935-1938, October 2018.
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16th Indonesian Society of Dermatology and Venereology Annual Meeting Together with the 23rd Asian–Australasian Regional Conference of Dermatology, Surabaya, Indonesia
Dermatologic Therapy, EarlyView.
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Head positioning in a cone beam computed tomography unit and the effect on accuracy of the three‐dimensional surface mode
European Journal of Oral Sciences, EarlyView.
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Improved Quality of Life for Children With Beckwith–Wiedemann Syndrome Following Tongue Reduction Surgery
Macroglossia is observed in the majority of patients with Beckwith–Wiedemann syndrome (BWS), a congenital condition with characteristic anomalies. In addition, sleep disordered breathing (SDB) associated with macroglossia has occasionally been noted in BWS patients, for which tongue reduction surgery is generally performed. However, macroglossia is related to various health problems, such as eating and articulation disorders, attention deficit disorder, enuresis, and thorax deformation, as well as aesthetic issues. Therefore, in addition to treating airway obstruction, tongue reduction surgery can also exert favorable effects on the overall quality of life (QOL) of patients. However, surgical indications for tongue reduction have yet to be established and reports on QOL assessments after surgery are rare. The OSA-18 questionnaire is used for screening SDB and is also useful for assessing the effect of tongue reduction surgery on QOL. We report a patient whose QOL was improved by tongue reduction surgery. On the basis of our patient's results, we recommend tongue reduction surgery in early childhood not only to treat SDB but also to improve QOL. Address correspondence and reprint requests to Takeshi Harada, DDS, PhD, 840, Murodo-cho, Izumi, Osaka 594-1101, Japan; E-mail: t-harada@dent.osaka-u.ac.jp Received 8 June, 2017 Accepted 13 June, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2zfepjE
https://ift.tt/2zfepjE
Treatment of the Prominent Ear: A Standardized Approach Without Intraoperative Measurements
Background: Candidates for otoplasty have variable anatomy that may result in an aesthetically suboptimal appearance. The authors describe an algorithm to obtain ideal aesthetic position of the ear using a standardized suturing only technique. Methods: A retrospective review was conducted at a major children's hospital. Pre- and postoperative distances from the mastoid to the posterior lateral helical rim were measured at 3 consistent points (upper helix, mid helix, and lobule). Cosmetic outcomes were determined by visual analog cosmetic score (VACS), assigned by 3 independent reviewers. Results: A total of 26 patients underwent otoplasty for prominent ear (average age 8.2 years). Duration of follow-up was an average of 32 weeks postoperatively. Pre- and postoperative VACSs were determined for all patients: overall-appearance, 25.8 versus 71.3; overall-ear appearance, 25.7 versus 70.0; shape, 24.4 versus 72.6; and projection, 23.7 versus 73.9 (P
https://ift.tt/2SwjTiJ
https://ift.tt/2SwjTiJ
Strategies for Complex Scalp Reconstruction in Patients With Poor Recipient Vessels
Complex scalp defects with poor recipient vessels represent a challenge for plastic surgeons. In these cases, free flaps are the last resort for solving the problem. The authors present 5 difficult cases with complex large scalp and calvarium defects with unsuitable small recipient vessels for anastomoses. For these cases, the lesser saphenous vein was harvested and used as an interposition graft between the external carotid artery, the jugular vein, and the flap. Latissimus Dorsi, Anterolateral Thigh, and serratus anterior were the flaps used for reconstruction. Cranioplasty was simultaneously performed in 4 cases. The scalp defects varied from 83 to 288 cm2. All flaps survived. In 1 case (extended Latissimus Dorsi) there was local infection and wound dehiscence with marginal flap necrosis that required flap readvancement. In conclusion, end-to-end anastomosis to the external carotid artery offers strong outflow through the vein graft and flap. A large vein graft allows good outflow and is more resistant to the pressure of the skin envelope. Anastomosis to large neck vessels (internal or external jugular) facilitates drainage since there is also an aspiration effect due to the venous flow circulation through it. Address correspondence and reprint requests to Dr Marius Fodor, MD, PhD, Emergency District Hospital, Street Clinicilor 2-4, 400006 Cluj-Napoca, Romania; E-mail: drfodor@yahoo.com Received 20 March, 2018 Accepted 3 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
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https://ift.tt/2zdY6U8
Endoscopic Approach to Remove a Dental Implant With Simultaneous Laser-Cystectomy
Background: Removal of dental implants from the maxillary sinus may require surgical treatment of comorbidities. Method: Canine fossa endoscopy with an additional laterobasal access originally has been used for flapless sinus floor augmentation. The combined technique is presented to remove a titanium screw from the maxillary sinus. The same portals served for dissection of a mucocele using a diode laser. Conclusions: The combination of canine fossa endoscopy and laterobasal access allows an appropriate instrumentation and triangulation of the scope for the endoscopically assisted implant removal and dissection of the mucocele. Address correspondence and reprint requests to Víctor Beltrán, DDS, MSc, PhD, Dental School, Universidad de La Frontera, Manuel Montt N° 112, Temuco 4781176, Chile; E-mail: victor.beltran@ufrontera.cl Received 5 February, 2018 Accepted 3 July, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2SrgG41
https://ift.tt/2SrgG41
A Standardized Perioperative Clinical Pathway for Uncomplicated Craniosynostosis Repair Is Associated With Reduced Hospital Resource Utilization
Background: Hospital resource overutilization can significantly disrupt patient treatment such as cancelling surgical patients due to a lack of intensive care unit (ICU) space. The authors describe a clinical pathway (CP) designed to reduce ICU length of stay (LOS) for nonsyndromic single-suture craniosynostosis (nsSSC) patients undergoing cranial vault reconstruction (CVR) in order to minimize surgical disruptions and improve patient outcomes. Methods: A multidisciplinary team implemented a perioperative CP including scheduled laboratory testing to decrease ICU LOS. Hospital and ICU LOS, interventions, and perioperative morbidity—infection rate, cerebrospinal fluid (CSF) leaks, and unplanned return to the operating room (OR)—were compared using Mann–Whitney U, Fisher exact, and t tests. Results: Fifty-one ICU admissions were managed with the standardized CP and compared to 49 admissions in the 12 months prior to pathway implementation. There was a significant reduction in ICU LOS (control: mean 1.84 ± 0.93, median 1.89 ± 0.94; CP: mean 1.15 ± 0.34, median 1.03 ± 0.34 days; P
https://ift.tt/2zfhe45
https://ift.tt/2zfhe45
Postsurgical Changes in Osseous Dysmorphology of the Midface and Mandible in Unilateral Coronal Craniosynostosis
Background: Early management of unilateral coronal synostosis (UCS) aims to treat the cranial abnormality with the hope of improving middle and lower facial morphology. This study analyzed osseous volume and 3-dimensional distances in the midface and mandible of patients with UCS to assess changes in facial symmetry following a cranial vault procedure. Methods: Patients who underwent fronto-orbital advancement for UCS repair between 1981 and 2012 with follow-up of at least 3 years were included. Computed tomography-based 3-dimensional reconstructions of the mandible and LeFort III midface were divided by 3 midline osseous landmarks and measured for volume. Distances between 11 osseous landmarks were measured in the midface and mandible. Ratios between the measurements on synostotic and nonsynostotic sides were calculated. Presurgical to postsurgical changes were evaluated with paired samples t tests. The study was powered to detect differences between preoperative and postoperative ratios of at least 3%. Results: Eleven patients were included. Mean age at initial imaging was 4.7 ± 3.2 months (range, 0.4–9.2 months) with postoperative follow-up of 9.0 ± 5.3 years (range, 3.3–17.0 years). Midfacial symmetry of osseous volume improved following surgery (synostotic to nonsynostotic ratio, 94.1% vs 98.9%, P = 0.044). The width (P
https://ift.tt/2Syro8D
https://ift.tt/2Syro8D
Endoscopic Removal of an Epithelial Cyst of the Zygoma
This study elaborates a brief overview of epithelial cysts in the bones of the skull and describes an unusual patient with an epidermoid cyst of the zygoma. This report focuses on an endoscopic preauricular infratemporal fossa approach for resection of a left epidermoid cyst of the zygoma. Preoperative magnetic resonance imaging and computed tomography imaging as well as intraoperative endoscopic images and movie were demonstrated. The epithelial cyst was successfully removed from the patient using a minimally invasive approach utilizing endoscopes. No complications were encountered. The possible causes of this rare presentation and minimal surgical removal utilizing endoscopes were discussed in this study. According to the authors, this is the first reported study of endoscopic removal of an epidermoid cyst from the zygomatic root. The patient's previous surgical history of a tympanoplasty could have contributed to the unusual location of the lesion. Address correspondence and reprint requests to Joe Walter Kutz Jr, MD, FACS, Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9035; E-mail: Walter.Kutz@utsouthwestern.edu Received 15 May, 2018 Accepted 18 June, 2018 Dr Kutz is a consultant for Achaogen and Eloxx. The remaining authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2iuFjMi). © 2018 by Mutaz B. Habal, MD.
https://ift.tt/2zjJx19
https://ift.tt/2zjJx19
Aesthetic and Functional Evaluation of Large Full-Thickness Vermilion and Lower Lip Defects Reconstruction
Background: It is hardly to reconstruct a huge defect of lower lip by using of partial flap which brings no mouth closing functional problem. In this study, we would like to introduce our experience in large full-thickness vermilion and lower lip/chin defects reconstruction, and also focus on the evaluation of the surgery effects. Methods: The large lower lip and chin (include vermilion) reconstruction were performed in Sichuan Provincial People's Hospital (2012–2015). The surgery experience was introduced in this study first. In the following section, after a statement of these basic problems, various situations involving are investigated, such as the surgical effects of aesthetic and function that were evaluated through a visual analogue scale (VAS) by doctors and patients separately. The VAS score assessments of 2 kinds of surgery were collected and compared. Results: A total of 7 patients use the tongue flap alone. Four patients use the combination of the free forearm flap and the anterior ventral tongue flap (COMBO flap). The VAS score of doctors group was significantly lower than the patients group (P 90 points). Language features were not affected (>90 points). Slight mouth opening problems exist on these patients who were used COMBO flaps (>80 points;
https://ift.tt/2zcr5aS
https://ift.tt/2zcr5aS
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