Background Ex situ normothermic machine perfusion (NMP) can be used to assess viability of suboptimal donor livers prior to implantation. Our aim was to assess the diagnostic accuracy of bile biochemistry for the assessment of bile duct injury (BDI). Methods In a preclinical study, 23 human donor livers underwent 6 hours of end-ischemic NMP to determine biomarkers of BDI. Livers were divided into groups with low or high BDI, based on a clinically relevant histological grading system. During NMP, bile was analyzed biochemically and potential biomarkers were correlated with the degree of BDI. Receiver operating characteristics curves were generated to determine optimal cut-off values. For clinical validation, identified biomarkers were subsequently included as viability criteria in a clinical trial (n=6) to identify transplantable liver grafts with low BDI. Results Biliary bicarbonate and pH were significantly higher and biliary glucose was significantly lower in livers with low BDI, compared to high BDI. The following cut-off values were associated with low BDI: biliary bicarbonate >18 mmol/L (P=0.002), biliary pH >7.48 (P=0.019), biliary glucose
https://ift.tt/2Pa4BCp
Παρασκευή 2 Νοεμβρίου 2018
Proliferating Trichilemmal Tumor of the Auricula: A Very Rare Locus
Abstract
Proliferating trichilemmal tumor (PTT) is a rare but morphologically characteristic tumor, derived from the external root sheath. They are commonly localized as a solitary lesion on the scalp. They rarely occur in other regions. PTTs generally behave in a benign fashion, up to 20% of the lesions may undergo malignant transformation into squamous carcinoma. We present an elderly woman with a cystic swelling on the crus of auricular helix diagnosed as PTT. To our knowledge, this is the first case in the English literature, of PTT of the auricula.
https://ift.tt/2JzjF6p
Proliferating Trichilemmal Tumor of the Auricula: A Very Rare Locus
Abstract
Proliferating trichilemmal tumor (PTT) is a rare but morphologically characteristic tumor, derived from the external root sheath. They are commonly localized as a solitary lesion on the scalp. They rarely occur in other regions. PTTs generally behave in a benign fashion, up to 20% of the lesions may undergo malignant transformation into squamous carcinoma. We present an elderly woman with a cystic swelling on the crus of auricular helix diagnosed as PTT. To our knowledge, this is the first case in the English literature, of PTT of the auricula.
https://ift.tt/2JzjF6p
The long and the short of it: insights into the cellular source of autoantibodies as revealed by B cell depletion therapy
Malika Hale | David J Rawlings | Shaun W Jackson
https://ift.tt/2FcMfft
Familial congenital choanal atresia with GATA3 associated hypoparathyroidism-deafness-renal dysplasia syndrome unidentified on auditory brainstem response
Hypoparathyroidism-deafness-renal dysplasia (HDR) syndrome is a rare autosomal dominant disorder primarily caused by GATA3 haploinsufficiency and is challenging to diagnose in early childhood. We report a Japanese family with HDR syndrome and congenital choanal atresia. The 6-year-old female proband was diagnosed with epilepsy at the age of three. Under carbamazepine monotherapy, the patient presented hypoparathyroidism accompanied by severe hypocalcemia. Subsequently, renal ultrasound analysis revealed bilateral multicystic dysplastic kidneys.
https://ift.tt/2F9WD7k
A nomogram to identify high-risk melanoma patients with a negative sentinel node biopsy
Melanoma may recur even after a negative sentinel node biopsy, A nomogram identifies patients without nodal disease who are at a higher risk of recurrent melanoma, who deserve more strict surveillance and adjuvant treatments.
https://ift.tt/2zt46s6
Insect Repellents: An Updated Review for the Clinician
Malaria, Zika virus, West Nile virus, Dengue fever, and Lyme disease are common causes of morbidity and mortality around the world. While arthropod bites may cause local inflammation and discomfort, a greater concern is the potential to develop deadly systemic infection. The use of insect repellents (IR) to prevent systemic infections constitutes a fundamental public health effort. Cost-effectiveness, availability, and high-efficacy against arthropod vectors are key characteristics of an ideal IR.
https://ift.tt/2zpZwuL
Rhytidectomy in Patients with Cochlear Implants
Facial plast Surg
DOI: 10.1055/s-0038-1666872
As the incidence of rhytidectomy and cochlear implantation increases, so does the likelihood that an individual patient will undergo both procedures over their lifetime. This is particularly relevant as the US population not only ages but ages well. The purpose of this paper is to describe cochlear implants and to characterize pre-, intra-, and postoperative considerations of rhytidectomy in patients with cochlear implants. A thorough understanding of the relevant anatomy and physiology is crucial to the avoidance of potentially serious complications in patients with cochlear implants.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2RxPTBQ
A New Technique for Augmentation Rhinoplasty Using Hybrid Autologous Grafts with Septal Extension Grafts in Asian Patients
Facial plast Surg
DOI: 10.1055/s-0038-1666992
Augmentation rhinoplasty is commonly performed to raise the nasal dorsum in Asian individuals. However, materials used for dorsal augmentation are associated with various surgical challenges and complications. In this article, the authors present a novel dorsal augmentation technique combining hybrid autologous costal grafts with septal extension grafts. The records of 28 patients (19 women and 9 men; mean age: 27 years; range: 18–43 years) who underwent augmentation rhinoplasty (primary or revision) with our novel technique from December 2007 to December 2016 were retrospectively reviewed. Our technique included septal extension grafts for nasal tip projection and hybrid costal cartilage grafts, with a solid boat-shaped portion for bony dorsum augmentation and a fascia-wrapped diced cartilage graft for cartilaginous dorsum augmentation. Objective and subjective outcomes and complications were evaluated. Anthropometric parameters were measured on facial photographs to evaluate surgical outcomes in the 15 primary cases. Objective anthropometric measurements revealed successful augmentation of all nasal parameters. The nasal tip was mobile and comfortable in all patients. Among the 28 patients, 12 (42.9%) were very satisfied, 10 (35.7%) were satisfied, and 6 (21.4%) were unsatisfied with surgical results and required revision surgery. No immediate postoperative complications occurred. Ten (35.7%) patients experienced graft-related complications, including visibility or warping of the solid graft, supratip depression, and caudal deviation of the septal extension graft. None of these complications was serious. Augmentation rhinoplasty using hybrid autologous costal grafts with septal extension grafts allows dorsal augmentation with suitable graft material for each recipient site and can achieve successful outcomes in Asian patients.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2PB0qP3
Nasal challenges in allergen immunotherapy trials
Purpose of review The nasal allergen challenge (NAC) model can be a valuable diagnostic tool for allergic rhinitis. Alongside its clinical use, NACs can be used as primary and secondary endpoints in studies evaluating allergen immunotherapy (AIT) products for allergic rhinitis treatment. This review will discuss the technical aspects of the NAC model and provide a summary of recent studies using NACs to assess existing and new AIT treatments. Recent findings Over the last 2 years, both titrated and single-dose nasal challenge protocols have been used to evaluate immunotherapies targeting grass, birch, house dust mite, and cat allergens. Early efficacy and dose-finding trials showed improvements in allergic symptoms and nasal tolerance to allergens after AIT treatment with standardized extracts or modified forms of whole allergen. NACs were also used in two proof-of-concept studies to illustrate the efficacy of intralymphatic immunotherapy with two concomitant allergens and subcutaneous immunotherapy with Fel d 1-specific IgG-blocking antibodies. Summary Along with existing therapies, nasal challenges are useful in evaluating AIT treatments in the very early stages of clinical development. However, because of the variety in challenge techniques and symptom assessments available, special attention must be placed in the protocol design in order to compare the study results with existing NAC publications.https://ift.tt/2qroBBi
What is new in HIES? Recent insights from the interface of primary immune deficiency and atopy
Purpose of review Understanding the pathophysiology of monogenic primary immunodeficiency (PID) with atopic presentation has pivotal implications for intervention strategies and potentially wider polygenic atopic-related traits. This review will discuss advances in gene discovery arising from monogenic defects at the interface between PID and atopy, notably the hyper-IgE syndromes. Recent findings Key molecular pathways underlying development of primary atopic diseases have recently been proposed. We test this classification through reviewing novel genes reported in the last 2 years and compare insights from pathway-analysis of genome-wide association studies (GWAS) of atopic-related traits. Growing access to next-generation sequencing (NGS) has resulted in a surge in gene discovery, highlighting the utility and some pitfalls of this approach in clinical practice. The variability of presenting phenotypes reveals important gene-dosage effects. This has important implications for therapeutic strategies such as protein stabilization and modulators of JAK-STAT or TH2-cytokine signalling. We also consider the therapeutic implications raised by CARD11 deficiency, and wider applications of NGS including polygenic risk score in atopy. Summary Disorders presenting at the interface between PID and allergy are often difficult to diagnose, with serious consequences if missed. Application of NGS has already provided critical insights to pathways enabling targeted therapeutic interventions, and potential wider translation to polygenic disorders.https://ift.tt/2qoaa0S
Allergen immunotherapy as add-on to biologic agents
Purpose of review In this review, we sought to outline many of the recent evidences about the available clinical trials in which biologic agents [i.e. omalizumab (OMA)] were associated as add-on to allergen-specific immunotherapy (AIT). Recent findings The available literature shows that OMA may be a valuable option as add-on to AIT for respiratory allergy, or food desensitization, especially in the escalation or build-up phases, in which adverse events are more commonly expected. The encouraging data for hymenoptera venom allergy remain limited to case reports, and no structured clinical trial is available. Summary Over the past decade, studies of OMA used with AIT have shown promising results. Today, big randomized, double-blind, placebo-controlled trials are needed to better select those patients who would benefit from the addition of OMA (or other biologic agents) to AIT, as well as optimal dosing schedules, optimal duration of treatments and, finally, adequate evaluation about pharmacoeconomic aspects.https://ift.tt/2QfY0CN
Advances in site-specific gene editing for primary immune deficiencies
Purpose of review Conventional gene therapy has been a successful, curative treatment modality for many primary immune deficiencies with significant improvements in the last decade. However, the risk of leukemic transformation with viral-mediated gene addition still remains, and unregulated gene addition is not an option for certain diseases in which the target gene is closely controlled. The recent bloom in genome modification platforms has created the opportunity to site-specifically correct mutated DNA base pairs or insert a corrective cDNA minigene while maintaining gene expression under control of endogenous regulatory elements. Recent findings There is an abundance of ongoing research utilizing programmable nucleases to facilitate site-specific gene correction of many primary immune deficiencies including X-linked severe combined immune deficiency, X-linked chronic granulomatous disease, Wiskott–Aldrich syndrome, X-linked hyper-IgM syndrome, X-linked agammaglobulinemia, and immune dysregulation, polyendocrinopathy, enteropathy, X-linked. In all, these studies have demonstrated the ability to integrate corrective DNA sequences at a precise location in the genome at rates likely to either cure or ameliorate disease. Summary Gene editing for primary immune deficiency (PID) has advanced to the point to that translation to clinical trials is likely to occur in the next several years. At the current pace of research in DNA repair mechanisms, stem cell biology, and genome-editing technology, targeted genome modification represents the next chapter of gene therapy for PID.https://ift.tt/2qoa75c
Secondary antibody deficiency in neurology
Purpose of review Induction of lymphocyte depletion is increasingly used as a therapeutic strategy for central and peripheral neuroinflammatory disease. However, there is also a growing recognition of the treatment-related complication of secondary antibody deficiency (SAD). Although the occurrence of hypogammaglobulinaemia is a recognized phenomenon during immunomodulation, robust data on the coexistence of impaired responses to immunization, and significant and/or atypical infections is scarce. Here we review the literature on SAD in anti-CD20 therapy. Recent findings Several factors that may increase the incidence of SAD have now been identified, including low levels of immunoglobulins prior to the commencement of B-cell ablation therapy, duration of maintenance therapy, and concurrent or prior use of other immunosuppressing agents such as cyclophosphamide and steroids. Measurement of disease-specific antibodies and vaccine response are likely to be helpful adjuncts to measurement of serum immunoglobulin levels during B-cell depleting therapy. Supportive treatment may include amending the treatment schedule to limit cumulative dose. Summary B-cell depleting agents offer considerable therapeutic benefit in neurology. We propose modifications in current practice that include risk stratification and early identification of SAD, with the aim of minimising morbidity and mortality related to this underappreciated condition.https://ift.tt/2QgmtIb
Very early-onset inflammatory bowel disease: an integrated approach
Purpose of review Immune dysregulation disorders are among the most rapidly growing set of inborn errors of immunity. One particular subset is the category where early-onset inflammatory bowel disease (IBD) is the most common manifestation. These disorders are being increasingly appreciated although there has been minimal effort to articulate a unified approach to their diagnosis and management. This review will cover current thinking and strategies related to diagnosis and management of very early-onset IBD. Recent findings There is an expanding set of monogenic causes of early-onset IBD. In many cases, the precise genetic cause dictates management. Lessons learned from the management of these monogenic conditions can sometimes be extrapolated to other refractory cases of IBD. Summary An integrated approach to diagnosis, risk analysis, and management can include diagnostic approaches not often utilized for traditional IBD such as whole exome sequencing. Management can also include nontraditional approaches such as targeted biologics or hematopoietic cell transplantation.https://ift.tt/2qroIgc
Role of allergen-specific T-follicular helper cells in immunotherapy
Purpose of review The discovery of novel T-cell subsets including follicular helper T (Tfh) cells has broadened our knowledge on the complex immune networks in allergic diseases. This review summarizes the evidence for Tfh cells in controlling immune responses to allergens with a particular focus on immunoglobulin E (IgE) production and discusses the implication of such regulation in allergen-specific immunotherapy. Recent findings Tfh cells support the production of IgE in animal models for allergic diseases. Among Tfh cells, the type 2 subset (Tfh2) is considered as the major player that secretes IL-4 and promotes the isotype switching to IgE. In human inflammatory airway diseases, including allergic rhinitis, asthma, and nasal polyps, the increased frequencies of circulating or tissue Tfh2 cells have been reported. Notably, the frequencies of Dermatophagoides pteronyssinus group 1 (Der p 1)-specific IL-4+ Tfh cells in blood positively correlated with serum Der p-specific IgE levels in allergic rhinitis patients. After allergen immunotherapy (AIT), Der p 1-specific IL-4+ Tfh cells declined in allergic rhinitis patients, which associated with the remission of clinical symptoms. Summary Allergen-specific IL-4+ Tfh cells contribute to the production of allergen-specific IgE and correlate with clinical efficacy of AIT in allergic rhinitis patients, which suggest allergen-specific Tfh cells as a promising therapeutic target and biomarker for AIT in allergic rhinitis.https://ift.tt/2Qebj6x
Very early onset IBD: novel genetic aetiologies
Purpose of review To summarize the current understanding and recent advances on the genetic aetiology in the pathogenesis of very early onset inflammatory bowel disease (VEO-IBD). Recent findings IBD is a chronic disorder of the gastrointestinal tract whose manifestation is a result of complex interactions between genetics, environment, immune system and microbial flora. Over 230 IBD risk loci have been reported in genome wide association studies but the genetic contribution of the majority of these loci in the manifestation of IBD is very low. Patients with VEO-IBD present with a more severe disease than older patients, characterized by poor prognosis and failure of conventional therapy. Recent studies have reported several monogenic diseases with high penetrance that present with IBD and IBD-like intestinal manifestations and overlap with primary immunodeficiencies. Increasing body of evidence supports a prominent role of genetics in the onset of VEO-IBD. New genetic variants and diagnoses in VEO-IBD are reviewed and current challenges in therapy with potential strategy to manage the disease are discussed. Summary Functional analysis of the genes implicated in monogenic IBD has increased the understanding of the underlying pathobiological mechanism of the disease. This knowledge can be used to personalize medicine for specific patients, improving the standard of care and quality of life.https://ift.tt/2qro0zy
Biological treatments for severe asthma: where do we stand?
Purpose of review For patients with severe asthma, disease control is not achieved resulting in persistent morbidity and risks for exacerbations. The advent of biologics is providing a new form of treatment for many with severe asthma. Recent findings Four mAb biologics are approved for clinical use: omalizumab (anti-IgE) and three antieosinophilic interventions (mepolizumab, reslizumab, and benralizumab). These four biologics target components of the type 2-inflammatory pathway which is reflected by biomarkers: peripheral blood eosinophils and exhaled nitric oxide. In severe asthma, biologics have reduced asthma exacerbations. The antieosinophilic biologics have also improved lung function. The safety profile of these biologics has been good. Summary For patients with severe asthma and biomarkers indicating a type 2 inflammatory pathway, the addition of biologics has proven to be an effective approach to achieve disease control and is an appropriate next step treatment.https://ift.tt/2QhmETl
Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin
Suleiman Furmli<br />Oct 9, 2018; 2018:bcr-2017-221854-bcr-2017-221854<br />Myth exploded
https://ift.tt/2yNLDXJ
Alpha 1 antitrypsin distribution in an allergic asthmatic population sensitized to house dust mites
Severe alpha1 antitrypsin deficiency has been clearly associated with pulmonary emphysema, but its relationship with bronchial asthma remains controversial. Some deficient alpha 1 antitrypsin (AAT) genotypes s...
https://ift.tt/2QeJ7Ax
Expression of PTEN, Androgen Receptor, HER2/ neu , Cytokeratin 5/6, Estrogen Receptor-Beta, HMGA2, and PLAG1 in Salivary Duct Carcinoma
Abstract
Salivary duct carcinoma (SDC) is an aggressive neoplasm that resembles high-grade invasive ductal carcinoma of the breast. It can develop de novo or from the malignant transformation of pleomorphic adenoma (PA). We performed immunohistochemical stains for phosphatase and tensin homologue [PTEN androgen receptor (AR)], HER2/neu, cytokeratin 5/6, estrogen receptor-beta, high-mobility group AT-hook 2 (HMGA2), and pleomorphic adenoma gene 1 (PLAG1) on tissue microarray samples of 75 SDCs and 31 adenocarcinomas, not otherwise specified (NOS). Our data showed the following in SDC samples: loss of PTEN was found in 17 of 60 (28.3%); AR was expressed in 43 of 62 (69.4%); HER2/neu was overexpressed in 25 of 58 (43.1%); cytokeratin 5/6 was expressed in 14 of 54 (25.9%); estrogen receptor-beta was expressed in 37 of 56 (66.1%); HMGA2 was expressed in 29 of 63 (46.0%); and PLAG1 was expressed in 0 of 62 (0%). In addition, there was no statistically significant difference in the age at onset between patients with HMGA2-positive SDCs (range 32–85 years; mean: 64.3 years; median: 64.5 years) and those with HMGA2-negative SDCs (range 41–79 years; mean: 62.5 years; median: 64.5 years). There was also no statistically significant difference in overall survival between patients with HMGA2-positive and HMGA2-negative SDCs (follow-up period range 3–201 months; mean: 49.8 months; median: 30 months). Among 10 patients with a definite PA component (SDC ex-PA), 6 were positive and 4 were negative for HMGA2. Our data were consistent with previous findings that AR and estrogen receptor-beta are expressed in most SDCs, whereas HER2/neu overexpression and loss of PTEN are expressed in a subset of SDCs. In our cohort of patients, HMGA2 was expressed in approximately half of SDCs. HMGA2 and PTEN are promising therapeutic targets for salivary gland tumors.
https://ift.tt/2zqTU3h
Reticular Oral Lichen Planus
Abstract
Reticular oral lichen planus is a common clinical finding, often found incidentally on routine oral examination. Patients rarely complain of symptoms and the condition does not require treatment, as a result, biopsies and ancillary laboratory evaluation are seldom performed. We present a case of reticular oral lichen planus with a classic clinical presentation and characteristic histologic findings.
https://ift.tt/2SDK9I1
Expression of PTEN, Androgen Receptor, HER2/ neu , Cytokeratin 5/6, Estrogen Receptor-Beta, HMGA2, and PLAG1 in Salivary Duct Carcinoma
Abstract
Salivary duct carcinoma (SDC) is an aggressive neoplasm that resembles high-grade invasive ductal carcinoma of the breast. It can develop de novo or from the malignant transformation of pleomorphic adenoma (PA). We performed immunohistochemical stains for phosphatase and tensin homologue [PTEN androgen receptor (AR)], HER2/neu, cytokeratin 5/6, estrogen receptor-beta, high-mobility group AT-hook 2 (HMGA2), and pleomorphic adenoma gene 1 (PLAG1) on tissue microarray samples of 75 SDCs and 31 adenocarcinomas, not otherwise specified (NOS). Our data showed the following in SDC samples: loss of PTEN was found in 17 of 60 (28.3%); AR was expressed in 43 of 62 (69.4%); HER2/neu was overexpressed in 25 of 58 (43.1%); cytokeratin 5/6 was expressed in 14 of 54 (25.9%); estrogen receptor-beta was expressed in 37 of 56 (66.1%); HMGA2 was expressed in 29 of 63 (46.0%); and PLAG1 was expressed in 0 of 62 (0%). In addition, there was no statistically significant difference in the age at onset between patients with HMGA2-positive SDCs (range 32–85 years; mean: 64.3 years; median: 64.5 years) and those with HMGA2-negative SDCs (range 41–79 years; mean: 62.5 years; median: 64.5 years). There was also no statistically significant difference in overall survival between patients with HMGA2-positive and HMGA2-negative SDCs (follow-up period range 3–201 months; mean: 49.8 months; median: 30 months). Among 10 patients with a definite PA component (SDC ex-PA), 6 were positive and 4 were negative for HMGA2. Our data were consistent with previous findings that AR and estrogen receptor-beta are expressed in most SDCs, whereas HER2/neu overexpression and loss of PTEN are expressed in a subset of SDCs. In our cohort of patients, HMGA2 was expressed in approximately half of SDCs. HMGA2 and PTEN are promising therapeutic targets for salivary gland tumors.
https://ift.tt/2zqTU3h
Reticular Oral Lichen Planus
Abstract
Reticular oral lichen planus is a common clinical finding, often found incidentally on routine oral examination. Patients rarely complain of symptoms and the condition does not require treatment, as a result, biopsies and ancillary laboratory evaluation are seldom performed. We present a case of reticular oral lichen planus with a classic clinical presentation and characteristic histologic findings.
https://ift.tt/2SDK9I1
Expression of PTEN, Androgen Receptor, HER2/ neu , Cytokeratin 5/6, Estrogen Receptor-Beta, HMGA2, and PLAG1 in Salivary Duct Carcinoma
Abstract
Salivary duct carcinoma (SDC) is an aggressive neoplasm that resembles high-grade invasive ductal carcinoma of the breast. It can develop de novo or from the malignant transformation of pleomorphic adenoma (PA). We performed immunohistochemical stains for phosphatase and tensin homologue [PTEN androgen receptor (AR)], HER2/neu, cytokeratin 5/6, estrogen receptor-beta, high-mobility group AT-hook 2 (HMGA2), and pleomorphic adenoma gene 1 (PLAG1) on tissue microarray samples of 75 SDCs and 31 adenocarcinomas, not otherwise specified (NOS). Our data showed the following in SDC samples: loss of PTEN was found in 17 of 60 (28.3%); AR was expressed in 43 of 62 (69.4%); HER2/neu was overexpressed in 25 of 58 (43.1%); cytokeratin 5/6 was expressed in 14 of 54 (25.9%); estrogen receptor-beta was expressed in 37 of 56 (66.1%); HMGA2 was expressed in 29 of 63 (46.0%); and PLAG1 was expressed in 0 of 62 (0%). In addition, there was no statistically significant difference in the age at onset between patients with HMGA2-positive SDCs (range 32–85 years; mean: 64.3 years; median: 64.5 years) and those with HMGA2-negative SDCs (range 41–79 years; mean: 62.5 years; median: 64.5 years). There was also no statistically significant difference in overall survival between patients with HMGA2-positive and HMGA2-negative SDCs (follow-up period range 3–201 months; mean: 49.8 months; median: 30 months). Among 10 patients with a definite PA component (SDC ex-PA), 6 were positive and 4 were negative for HMGA2. Our data were consistent with previous findings that AR and estrogen receptor-beta are expressed in most SDCs, whereas HER2/neu overexpression and loss of PTEN are expressed in a subset of SDCs. In our cohort of patients, HMGA2 was expressed in approximately half of SDCs. HMGA2 and PTEN are promising therapeutic targets for salivary gland tumors.
https://ift.tt/2zqTU3h
Reticular Oral Lichen Planus
Abstract
Reticular oral lichen planus is a common clinical finding, often found incidentally on routine oral examination. Patients rarely complain of symptoms and the condition does not require treatment, as a result, biopsies and ancillary laboratory evaluation are seldom performed. We present a case of reticular oral lichen planus with a classic clinical presentation and characteristic histologic findings.
https://ift.tt/2SDK9I1
Cabozantinib in Advanced Salivary Gland Cancer Patients
Condition: Salivary Gland Cancer
Intervention: Drug: Cabozantinib
Sponsors: Radboud University; Ipsen
Recruiting
https://ift.tt/2JAhTC7
Intervention: Drug: Cabozantinib
Sponsors: Radboud University; Ipsen
Recruiting
https://ift.tt/2JAhTC7
TORS De-Intensification Protocol Version 2.0: Dose and Volume Reduction in the Neck
Conditions: Oropharyngeal Cancer; Squamous Cell Carcinoma; Human Papilloma Virus
Intervention: Radiation: Radiation Therapy (IMRT or IMPT)
Sponsor: Abramson Cancer Center of the University of Pennsylvania
Recruiting
https://ift.tt/2Dj45vu
Intervention: Radiation: Radiation Therapy (IMRT or IMPT)
Sponsor: Abramson Cancer Center of the University of Pennsylvania
Recruiting
https://ift.tt/2Dj45vu
Add-on Low Dose Dextromethorphan and Memantine in Patients With Amphetamine-type Stimulants Use Disorder
Condition: Stimulants Use Disorder
Interventions: Drug: dextromethorphan and memantine (DM+MM); Drug: Placebos
Sponsors: Tzu-Yun Wang; Ministry of Science and Technology, Taiwan
Recruiting
https://ift.tt/2JxdtM5
Interventions: Drug: dextromethorphan and memantine (DM+MM); Drug: Placebos
Sponsors: Tzu-Yun Wang; Ministry of Science and Technology, Taiwan
Recruiting
https://ift.tt/2JxdtM5
Preoperative Vascular Interventions to Improve Donor Leg Perfusion: a Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction
Publication date: Available online 1 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Roderick Y. Kim, Jason N. Burkes, Harshal S. Broker, Fayette C. Williams
Abstract
Purpose
For the reconstruction of head and neck defects, the fibula free flap is the first choice at many institutions. The main contraindication for fibula harvest is the lack of three vessel run-off leading to post-operative vascular compromise of the lower extremity. Atherosclerosis is the most common disease which can limit the use of this donor site. In general, vascular interventions, which includes angioplasty, atherectomy, and stenting, have been utilized to fix the arterial supplies using endovascular methods. The purpose of this study was to report the outcome of preliminary cohort of patients following vascular interventions to re-establish vessel patency to allow safe use of the free fibula free flap in head and neck reconstruction.
Materials and Methods
We designed a single institution retrospective case review, obtained from electronic medical records. The study population was composed of patients that received fibula free flap for head and neck reconstruction from 2015-2017. Inclusion criteria was patients that obtained conventional angiography and required vascular interventions. There were no specific exclusion criteria. Primary outcome of interest was vascular compromise of the donor site. Additional variables of interest included success of the reconstruction, and perioperative donor or recipient site complications.
Results
We identified 2 subjects who underwent preoperative vascular interventions of the superficial femoral artery and posterior tibial artery. The mean age was 65, and both patients underwent resection and reconstruction for mandibular carcinoma. Both fibula flaps were from the left lower extremity and included skin paddles. The fibula flaps survived and the donor feet maintained adequate perfusion. One patient had poor take of their split thickness skin graft. No long-term functional deficit was noted.
Conclusions
Vascular interventions may be a safe method to re-establish vascular flow and three-vessel run-off for select patients initially unable to undergo fibula free flap harvest.
https://ift.tt/2SFxzb5
AAOMS Elects Officers, Trustees
Publication date: Available online 1 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s):
https://ift.tt/2zwP30T
Bone regeneration of canine peri-implant defects using cell sheets of adipose-derived mesenchymal stem cells and platelet-rich fibrin membranes
Publication date: Available online 1 November 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Lidan Ding, Shijun Tang, Panpan Liang, Chao Wang, Peng fei Zhou, Leilei Zheng
Abstract
Purpose
Insufficient bone volume compromises the success rate and osseointegration of immediate implantation. The objective of the present study was to engineer bone tissue by using adipose-derived stem cell (ASC) sheets and autologous platelet-rich fibrin (PRF) to enhance new bone formation and osseointegration around dental implants.
Material and Methods
The proliferation and osteogenic potential of ASCs treated with autologous PRF were evaluated with CCK-8 assays, alkaline phosphatase (ALP) staining, and real-time quantitative PCR. A three-wall bone defect around each immediate implant was generated in the mandible and randomly treated with one of the following four groups: A, ASC sheets/PRF complex; B, ASC sheets only; C, PRF only; and D, no treatment. Micro-CT, biomechanical tests, fluorescent bone labeling and histological assessments were performed to evaluate bone regeneration capacity.
Results
The proliferation and osteogenic potential of canine ASCs were significantly enhanced by PRF. Group A exhibited significantly more new bone formation and a higher reosseointegration percentage (41.17+ 1.44%, 55.06+ 0.06%) than that of the other three groups. Fluorescent labeling revealed that the most rapid bone remodeling activity occurred in group A. (P<0.05).
Conclusion
These results suggest that sheets of ASC combined with autologous PRF may be a promising tissue-engineering strategy for bone formation in immediate implantation.
https://ift.tt/2SDeYwp
Lymphomes cutanés : avancées et perspectives en 2018
Publication date: Available online 1 November 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): M. Beylot-Barry
https://ift.tt/2QeuHAx
Short-Term Swallowing Outcomes Following Type 1 Laryngeal Cleft Injection
Publication date: Available online 1 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Ashley. L. Miller, Cheryl. J. Hersh, Kaalan. E. Johnson, Christopher. J. Hartnick
Abstract
Introduction
Interarytenoid injection augmentation at the time of initial diagnostic endoscopy for aspiration and dysphagia may result in near-immediate improvement in swallowing function, potentially obviating the need for future formal endoscopic repair of type 1 laryngeal cleft. Interarytenoid injection augmentation may also address physiologic aspiration. Early treatment of type 1 laryngeal cleft may allow for expedited liberalization of feedings. The objective of this study was to evaluate the effect of interarytenoid injection augmentation (IIA) for type 1 laryngeal clefts (LC-1) on short-term swallowing function assessed by videofluoroscopic swallowing study (VFSS).
Methods
This was a retrospective cohort study of patients age ≤24 months with dysphagia on preoperative VFSS who underwent IIA with calcium hydroxyapatite for LC-1 during direct laryngoscopy and bronchoscopy from June to October 2017 at a tertiary care academic subspecialty hospital. Exclusion criteria included prior endoscopic or open LC repair (n=1), gastrostomy tube dependence (n=1), additional procedures at the time of IIA (supraglottoplasty, frenulectomy, n=1). Children without postoperative VFSS within 30 days of injection were excluded (n=2). Fifteen children met inclusion criteria for analysis. The primary endpoint was improvement in safely swallowed consistency as defined by recommendation to liberalize diet by at least a half-consistency (e.g. half-honey to nectar thick liquid). Secondary endpoints included clinical assessment of dysphagia and postoperative respiratory events.
Results
Median [range] age at injection was 15.2 [7.7-24.3] months and 67% of patients were female (n=10). The majority (13/15) of patients were full-term and 80% of patients (n=12) had documented gastroesophageal reflux disease (GERD). Median time from injection to VFSS was 16 [9-29] days. Improvement in safely swallowed consistency was noted in 60% (n=9) of patients. Aspiration completely resolved in two patients. Swallow function was unchanged in 40% of patients (n=6); no patients experienced worsening dysphagia. No respiratory complications were documented during inpatient observation.
Conclusion
IIA is a safe procedure that may result in immediate improvement in dysphagia in select patients with LC-1. IIA does not address neurologic, developmental, or other anatomic etiologies of dysphagia. Additional studies are required to determine long-term efficacy of IIA on dysphagia and pulmonary complications, as well as the patient- and caregiver-related outcome measures.
https://ift.tt/2CSXMh7
Genotyping and audiological characteristics of infants with a single-allele SLC26A4 mutation
Publication date: Available online 1 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Xuelei Zhao, Lihui Huang, Xueyao Wang, Xianlei Wang, Liping Zhao, Xiaohua Cheng, Yu Ruan
Abstract
Objectives
To identify second-allele variant in infants with a known single-allele mutation of the SLC26A4 gene and to determine the frequency of their occurrence; and to investigate the clinical audiological characteristics of infants with bi-allelic mutations in SLC26A4.
Methods
The study subjects were 371 patients with a single-allele SLC26A4 mutation detected by neonatal deafness gene screening (4 genes and 9 pathogenic variants) who were treated at the otology outpatient department of Beijing Tongren Hospital. The exonic and flanking splice site regions of the SLC26A4 gene were sequenced for all patients. All patients with bi-allelic SLC26A4 mutations underwent audiological evaluation, and some also underwent temporal bone computed tomography and/or inner ear magnetic resonance imaging.
Results
Of the 371 patients, 314 (84.64%) had an c.919-2A>G heterozygous mutation and 57 (15.36%) had a c.2168A>G (p.H723R) heterozygous mutation. 13 patients (3.50%) had a second-allele variant, including 11 (2.96%) with pathogenic mutations and 1 (0.27%) with a likely benign variant. Of the 13 patients with bi-allelic mutations, 11 had hearing loss and 2 had normal hearing, the latter of whom had c.919-2A>G/c.1766A>G and c.919-2A>G/c.757A>G compound heterozygous mutations, respectively. Four of the 13 patients with bi-allelic mutations had passed the universal newborn hearing screening, including 2 cases (15.38%) with hearing loss. The most prevalent degree of hearing loss was profound (40.91%), followed by severe (36.36%). The most prevalent audiometric configuration was sloping hearing loss (50.00%), followed by flat-type hearing loss (40.91%).
Conclusions
This is the first report in China of the frequency of occurrence of second-allele variant in infants with a known single-allele mutation of the SLC26A4 gene; the frequency was 3.50% for any type of variant and 2.96% for pathogenic mutations. A novel variant, c.1766A>G (p.Q589R), which is likely benign, was identified. The pathogenicity of c.757A>G (p.I253V) mutation deserves more in-depth research. For infants with bi-allelic SLC26A4 mutations, the degree of hearing loss was mainly severe-to-profound and the audiometric configuration was mainly sloping.
https://ift.tt/2P3CrbX
Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: A systematic review and meta-analysis
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Ho-Ryun Won, Jae Won Chang, Yea Eun Kang, Jae Yoon Kang, Bon Seok Koo
Abstract
The purpose of this systematic review and meta-analysis was to determine the optimal extent of lateral neck dissection in patients with well-differentiated thyroid carcinoma with clinically confirmed lateral neck lymph node metastases. All studies reporting the distribution of metastatic lymph nodes in level IIb or level V, complication rate, recurrence rate, or clinical outcomes according to the extent of lateral neck dissection were collected from MEDLINE and Embase databases. Two reviewers independently retrieved articles, extracted data, and assessed the quality of the studies. A total of 40 criteria-meeting studies were included in the systematic review and meta-analysis, representing a total of 6 027 patients. The distribution of metastatic lymph nodes was 13.7% (95% confidence interval [CI]: 8.2–21.9%) in level IIb and 22.1% (95% CI: 18.6–26.1%) in level V. Shoulder syndrome complication showed a tendency to increase when comprehensive neck dissection was performed. The recurrence rate was 11.2% (95% CI: 8.4–14.9%) in the comprehensive neck dissection group and 11.0% (95% CI: 4.2–26.1%) in the selective neck dissection group. Clinical outcomes showed no difference between groups. In conclusion, selective neck dissection may be considered in patients with well-differentiated thyroid carcinoma with lateral neck lymph node metastases without any other risk factors.
https://ift.tt/2SCXctb
High Molecular Weight Hyaluronic Acid Regulates P. gingivalis–induced Inflammation and Migration in Human Gingival Fibroblasts via MAPK and NF-κB Signaling Pathway
Publication date: Available online 1 November 2018
Source: Archives of Oral Biology
Author(s): Minshan Chen, Lin Li, Zhenshi Wang, Ping Li, Feng Feng, Xi Zheng
Abstract
Chronic periodontitis is associated with Porphyromonas gingivalis (P. gingivalis) infection. Hyaluronic Acid (HA), a critical component of the extracellular matrix, exhibits anti-inflammatory and wound-healing properties. This study aimed to investigate the effect of various molecular weights of HA (30, 300 and 1300 kDa) on P. gingivalis-induced inflammatory and wound-healing responses in human gingival fibroblasts (HGFs). Cell cytotoxicity and proliferation were assessed by Lactate dehydrogenase and MTT assays, respectively. An enzyme linked immunosorbent assay was used to detect the levels of interleukin (IL) -1β, IL-6, IL-8, IL-4 and IL-10. Cell migration was evaluated with a scratch wound healing assay. The expression of nuclear factor kappa B (NF-кB), IкBα, p38 and extracellular signal-regulated kinase (ERK) were analyzed with Western blotting. The results showed that P. gingivalis (1.6 × 106 CFU/mL) and HA (1, 2, 5 and 10 mg/mL) exhibited no toxicity to the HGFs. The 1300 kDa HA inhibited P. gingivalis-induced IL-1β, IL-6, IL-8, IL-4 and IL-10 production in a dose-dependent manner, while the 30 and 300 kDa HA did not have an effect. Meanwhile, cell migration was significantly promoted by the 30 and 1300 kDa HA. Furthermore, the 1300 kDa HA inhibited NF-κB expression, IκBα degradation and P. gingivalis-induced ERK and P38 activation. Therefore, our study suggests that high molecular weight HA may have beneficial effects on periodontal inflammation and oral wounds.
https://ift.tt/2P2bJ3s
MMP-3 and MMP-8 in Rat Mandibular Condylar Cartilage Associated with Dietary Loading, Estrogen Level, and Aging
Publication date: Available online 1 November 2018
Source: Archives of Oral Biology
Author(s): Jia Yu, Eerika Mursu, Matleena Typpo, Sakari Laaksonen, Hanna-Marja Voipio, Paula Pesonen, Aune Raustia, Pertti Pirttiniemi
Abstract
Objectives
The structure of the mandibular condylar cartilage (MCC) is regulated by dynamic and multifactorial processes. The aim of this study was to examine the effects of altered dietary loading, estrogen level, and aging on the structure of the condylar cartilage and the expressions of matrix metalloproteinase (MMP) -3 and MMP-8 of rat MCC.
Methods
In this study, Crl:CD (SD) female rats were randomly divided into 3 groups according to dietary hardness: hard diet (diet board), normal diet (pellet), and soft diet (powder). In each group, the rats were further divided into 2 subgroups by ovariectomy at the age of 7 weeks. The rats were sacrificed at 5- and 14-month-old. Histomorphometric analysis of the MCC thickness was performed after toluidine blue staining. Immunochemical staining was done for MMP-3 and MMP-8. A linear mixed model was used to assess the effects of dietary loading, estrogen level, and aging. Results: Increased dietary loading was the main factor to increase the MMP-3 expression and the anterior and central thickness of the MCC. Lack of estrogen was the main factor associated with decreased MMP-8. Aging was associated with the thickness changes of the whole condylar cartilage and the reduced expression of MMP-8.
Conclusion
The condylar cartilage structure and metabolism of the female rats are sensitive to dietary loading changes, estrogen level as well as aging. The proper balance of these factors seems to be essential for the maintenance of the condylar cartilage.
https://ift.tt/2CXyxu3
Preoperative Evaluation of the Pediatric Patient
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Allison Basel, Dusica Bajic
https://ift.tt/2PvZxrl
Preoperative Management of Medications
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Zdravka Zafirova, Karina G. Vázquez-Narváez, Delia Borunda
https://ift.tt/2RuuNEf
Creating a Pathway for Multidisciplinary Shared Decision-Making to Improve Communication During Preoperative Assessment
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Timothy D. Quinn, Piotr Wolczynski, Raymond Sroka, Richard D. Urman
https://ift.tt/2PGhtj6
Diabetes Mellitus: Preoperative Concerns and Evaluation
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Roshni Sreedharan, Basem Abdelmalak
https://ift.tt/2RxVMyZ
Surgical Prehabilitation: Nutrition and Exercise
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): John Whittle, Paul E. Wischmeyer, Michael P.W. Grocott, Timothy E. Miller
https://ift.tt/2PEaqHq
Preoperative Cardiac Evaluation for Noncardiac Surgery
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Vahé S. Tateosian, Deborah C. Richman
https://ift.tt/2Rx5wJQ
Designing and Running a Preoperative Clinic
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Jeanna D. Blitz, Christian Mabry
https://ift.tt/2Pwq6N1
Forthcoming Issues
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s):
https://ift.tt/2Rvxqpf
Contents
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s):
https://ift.tt/2PCdPXl
Contributors
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s):
https://ift.tt/2RvUZhF
Copyright
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s):
https://ift.tt/2PyHEYO
Preoperative Patient Evaluation
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Zdravka Zafirova, Richard D. Urman
https://ift.tt/2RuQfZJ
High Molecular Weight Hyaluronic Acid Regulates P. gingivalis–induced Inflammation and Migration in Human Gingival Fibroblasts via MAPK and NF-κB Signaling Pathway
Publication date: Available online 1 November 2018
Source: Archives of Oral Biology
Author(s): Minshan Chen, Lin Li, Zhenshi Wang, Ping Li, Feng Feng, Xi Zheng
Abstract
Chronic periodontitis is associated with Porphyromonas gingivalis (P. gingivalis) infection. Hyaluronic Acid (HA), a critical component of the extracellular matrix, exhibits anti-inflammatory and wound-healing properties. This study aimed to investigate the effect of various molecular weights of HA (30, 300 and 1300 kDa) on P. gingivalis-induced inflammatory and wound-healing responses in human gingival fibroblasts (HGFs). Cell cytotoxicity and proliferation were assessed by Lactate dehydrogenase and MTT assays, respectively. An enzyme linked immunosorbent assay was used to detect the levels of interleukin (IL) -1β, IL-6, IL-8, IL-4 and IL-10. Cell migration was evaluated with a scratch wound healing assay. The expression of nuclear factor kappa B (NF-кB), IкBα, p38 and extracellular signal-regulated kinase (ERK) were analyzed with Western blotting. The results showed that P. gingivalis (1.6 × 106 CFU/mL) and HA (1, 2, 5 and 10 mg/mL) exhibited no toxicity to the HGFs. The 1300 kDa HA inhibited P. gingivalis-induced IL-1β, IL-6, IL-8, IL-4 and IL-10 production in a dose-dependent manner, while the 30 and 300 kDa HA did not have an effect. Meanwhile, cell migration was significantly promoted by the 30 and 1300 kDa HA. Furthermore, the 1300 kDa HA inhibited NF-κB expression, IκBα degradation and P. gingivalis-induced ERK and P38 activation. Therefore, our study suggests that high molecular weight HA may have beneficial effects on periodontal inflammation and oral wounds.
https://ift.tt/2P2bJ3s
MMP-3 and MMP-8 in Rat Mandibular Condylar Cartilage Associated with Dietary Loading, Estrogen Level, and Aging
Publication date: Available online 1 November 2018
Source: Archives of Oral Biology
Author(s): Jia Yu, Eerika Mursu, Matleena Typpo, Sakari Laaksonen, Hanna-Marja Voipio, Paula Pesonen, Aune Raustia, Pertti Pirttiniemi
Abstract
Objectives
The structure of the mandibular condylar cartilage (MCC) is regulated by dynamic and multifactorial processes. The aim of this study was to examine the effects of altered dietary loading, estrogen level, and aging on the structure of the condylar cartilage and the expressions of matrix metalloproteinase (MMP) -3 and MMP-8 of rat MCC.
Methods
In this study, Crl:CD (SD) female rats were randomly divided into 3 groups according to dietary hardness: hard diet (diet board), normal diet (pellet), and soft diet (powder). In each group, the rats were further divided into 2 subgroups by ovariectomy at the age of 7 weeks. The rats were sacrificed at 5- and 14-month-old. Histomorphometric analysis of the MCC thickness was performed after toluidine blue staining. Immunochemical staining was done for MMP-3 and MMP-8. A linear mixed model was used to assess the effects of dietary loading, estrogen level, and aging. Results: Increased dietary loading was the main factor to increase the MMP-3 expression and the anterior and central thickness of the MCC. Lack of estrogen was the main factor associated with decreased MMP-8. Aging was associated with the thickness changes of the whole condylar cartilage and the reduced expression of MMP-8.
Conclusion
The condylar cartilage structure and metabolism of the female rats are sensitive to dietary loading changes, estrogen level as well as aging. The proper balance of these factors seems to be essential for the maintenance of the condylar cartilage.
https://ift.tt/2CXyxu3
Determination of IgE and IgG reactivity to more than 170 allergen molecules in paper-dried blood spots
Publication date: Available online 1 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Victoria Garib, Eva Rigler, Felix Gastager, Raffaela Campana, Yulia Dorofeeva, Pia Gattinger, Yury Zhernov, Musa Khaitov, Rudolf Valenta
https://ift.tt/2RBishR
Reply
Publication date: Available online 1 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Ana Olivera, Dean D. Metcalfe
https://ift.tt/2PxmxpT
Effect of IL-33 on de novo synthesized mediators from human mast cells
Publication date: Available online 1 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Theoharis C. Theoharides, Susan E. Leeman
https://ift.tt/2RvVwAm
Targeting CTCFL/BORIS for the immunotherapy of cancer
Abstract
Cancer vaccines have great potential in the fight against metastatic malignancies. Current anti-tumor immunotherapy is hindered by existing tolerance to tumor-associated antigens (TAA) and tumor escape using various mechanisms, highlighting the need for improved targets for immunotherapy. The cancer–testis antigen CTCFL/BORIS was discovered 16 years ago and possesses all features necessary for an ideal TAA. Recently CTCFL/BORIS has received additional attention as a target expressed in cancer stem cells (CSC). These cells drive tumor growth recurrence, metastasis, and treatment resistance. CTCFL/BORIS silencing leads to senescence and death of CSC. Therefore, an immunotherapeutic strategy that targets CTCFL/BORIS may lead to the selective destruction of CSC and potential eradication of metastatic disease. The high immunotherapeutic potential of CTCFL/BORIS antigen was shown in a stringent 4T1 mouse model of breast cancer. Using these highly metastatic, poorly immunogenic carcinoma cells inoculated into T-helper2 prone mice, we showed that DC fed with recombinant CTCFL/BORIS as an immunogen inhibited tumor growth and reduced the number of metastases in distant organs. About 20% of CTCFL/BORIS immunized animals were tumor free. 50% of animals remained metastasis free. Those having metastasis showed at least tenfold fewer metastases compared to controls. In a rat model of breast cancer, we showed that alphavirus-based CTCFL/BORIS immunotherapy was capable of cancer elimination as we were able to cure 50% of animals. Based on the above data, we believe that translation of CTCFL/BORIS-targeting immunotherapeutic strategies to the clinic will provide new avenues for improving survival of breast cancer patients with advanced metastatic disease.
https://ift.tt/2Qf8OkC
Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis.
Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Carpenter DJ, Ferrante S, Bakos SR, Clary MS, Gelbard AH, Daniero JJ
Abstract
Importance: Because of the recurrent nature of idiopathic subglottic stenosis, routine follow-up is necessary for monitoring progression of stenosis. However, no easily accessible, standardized objective measure exists to monitor disease progression.
Objective: To determine whether peak expiratory flow (PEF) can be used as a reliable and easily accessible biometric indicator of disease progression relative to other validated spirometry measures in patients with idiopathic subglottic stenosis.
Design, Setting, and Participants: Prospectively collected data on PEF, expiratory disproportion index (EDI), and total peak flow (TPF) from 42 women with idiopathic subglottic stenosis without comorbid lower airway or parenchymal lung disease who were treated at a single tertiary referral center between 2014 and 2018 were analyzed. The mean follow-up period was 18.2 months (range, 2-40 months). Ten patients initially screened were not included in the analysis owing to comorbid glottic or supraglottic stenosis or nonidiopathic etiology.
Main Outcomes and Measures: Measurements of PEF, EDI, and TPF were taken at preoperative visits and at all other visits.
Results: Forty-two women (mean age, 51.5 years; 98% white [n = 41]) met the inclusion criteria. The area under the curve for PEF was 0.855 (95% CI, 0.784-0.926). The optimal cutoff value was 4.4 liters per second (264 L/min), with a sensitivity and specificity of 84.4% and 82.0%, respectively. The area under the curve for EDI was 0.853 (95% CI, 0.782-0.925). For TPF, this was 0.836 (95% CI, 0.757-0.916).
Conclusions and Relevance: This study provides evidence supporting the use of PEF as a simple, efficient, and accessible way of monitoring progression of idiopathic subglottic stenosis and predicting receipt of surgical intervention. Sensitivity and specificity of PEF were comparable to those of the more complex measures of TPF and EDI.
PMID: 30383170 [PubMed - as supplied by publisher]
https://ift.tt/2On7URg
A Destructive Sinonasal Process Leading to Sudden Blindness.
A Destructive Sinonasal Process Leading to Sudden Blindness.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Weber MH, Stein AP, D'Anza BD
PMID: 30383156 [PubMed - as supplied by publisher]
https://ift.tt/2SCKISl
Iodine Deficiency and Hearing Impairment-Reply.
Iodine Deficiency and Hearing Impairment-Reply.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Scinicariello F, Buser MC
PMID: 30383151 [PubMed - as supplied by publisher]
https://ift.tt/2zmRi6N
Iodine Deficiency and Hearing Impairment.
Iodine Deficiency and Hearing Impairment.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Millon-Ramirez C, García-Fuentes E, Soriguer F
PMID: 30383149 [PubMed - as supplied by publisher]
https://ift.tt/2CX6vPa
Defining Optimal Treatment Times in Head and Neck Cancer Care: What Are We Waiting For?
Defining Optimal Treatment Times in Head and Neck Cancer Care: What Are We Waiting For?
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Houlton JJ
PMID: 30383147 [PubMed - as supplied by publisher]
https://ift.tt/2P21AE1
Association of Treatment Delays With Survival for Patients With Head and Neck Cancer: A Systematic Review.
Association of Treatment Delays With Survival for Patients With Head and Neck Cancer: A Systematic Review.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Graboyes EM, Kompelli AR, Neskey DM, Brennan E, Nguyen S, Sterba KR, Warren GW, Hughes-Halbert C, Nussenbaum B, Day TA
Abstract
Importance: Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target.
Objective: To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes.
Evidence Review: A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies.
Findings: A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days.
Conclusions and Relevance: Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.
PMID: 30383146 [PubMed - as supplied by publisher]
https://ift.tt/2CXnIYT
Maternal Perception of Self-Efficacy and Involvement in Young Children with Prelingual Hearing Loss
Abstract
Appropriate intervention needs to support families and consider them as a part of rehabilitation program. Parents who have high self-efficacy are more likely to put their knowledge and skills into action and have positive interactions with their children. In addition, there has been a positive relation between parental involvement and child educational success. The aim of present study was evaluating maternal perception of both self-efficacy and involvement between mothers of children with hearing aid and cochlear implant via Scale of Parental Involvement and Self Efficacy (SPISE) and exploring relationship between maternal self-efficacy and parental involvement and child factors. 100 mothers of children with hearing loss were available. 49 mothers participated in study, filled SPISE, and return it on time. SPISE consisted of three sections (1) demographic information, (2) maternal self-efficacy, (3) parental involvement. All cases had received at least 6 months auditory training and speech therapy. Participants included 30 (61.2%) mothers of children with hearing aid, 19 (38.8%) mothers of children with cochlear implant. ANOVA analysis showed that there is no significant difference between hearing aid (HA) and cochlear implant (CI) groups in term of self-efficacy and parent-involvement except for question 21 (comfortable in participating in individualized program) that score in HA group was significantly higher than CI group. Results of present study has practical implications for early interventionists working with families. Every early intervention program should consider families to reach maximum outcome. Early interventionists can use SPISE to evaluate parental selfefficacy and involvement and work on parents with low score to achieve the best results.
https://ift.tt/2qqnwtI
Correlation of Eustachian Tube Dysfunction with Results of Tympanoplasty in Mucosal Type of Chronic Suppurative Otitis Media
Abstract
To Assess the relation between eustachian tube function and outcome of tympanoplasty in mucosal type of chronic suppurative otitis media, a prospective study was carried out over a period of one and half years (January 2016–July 2017) at a tertiary referral centre (Gujarat Cancer Society Medical College and Research Institute, Ahmedabad). Total 90 Patients of any age and sex and with Mucosal type of chronic suppurative otitis media and Patients with follow up of 12 months were selected. The Eustachian Tube function was assessed preoperatively by pressure swallow equalization test and impedance audiometry. All patients were categorized based on function of eustachian tube. All patients were operated by type 1 tympanoplasty with or without mastoidectomy. We measure the Graft uptake rate after type 1 tympanoplasty (with or without mastoidectomy) in patients with or without eustachian tube dysfunction. Graft uptake rate is higher in patients with normal or mild eustachian dysfunction compared to severe eustachian tube dysfunction. In our study we found 87% success rate in patients with normal Eustachian tube function, 80% in partially impaired Eustachian tube function, and 70% in totally impaired Eustachian tube. So, pre-operative planning in tympanoplasty surgery eustachian tube function assessment is must to increase graft uptake rate by preoperative utilization of decongestant. It is also important to comment outcome of surgery.
https://ift.tt/2Qe0kKB
Adenoid Cystic Carcinoma of the Nasopharynx: A Case Series
Abstract
Adenoid cystic carcinomas are tumors that are more commonly seen in the salivary glands than in the nasopharynx. Nasopharyngeal adenoid cystic carcinomas are rare and cases that are reported in the literatures are few. Treatment is mainly by surgical resection. Here, we report 2 cases of nasopharyngeal adenoid cystic carcinoma.
https://ift.tt/2CV2ESW
Maternal Perception of Self-Efficacy and Involvement in Young Children with Prelingual Hearing Loss
Abstract
Appropriate intervention needs to support families and consider them as a part of rehabilitation program. Parents who have high self-efficacy are more likely to put their knowledge and skills into action and have positive interactions with their children. In addition, there has been a positive relation between parental involvement and child educational success. The aim of present study was evaluating maternal perception of both self-efficacy and involvement between mothers of children with hearing aid and cochlear implant via Scale of Parental Involvement and Self Efficacy (SPISE) and exploring relationship between maternal self-efficacy and parental involvement and child factors. 100 mothers of children with hearing loss were available. 49 mothers participated in study, filled SPISE, and return it on time. SPISE consisted of three sections (1) demographic information, (2) maternal self-efficacy, (3) parental involvement. All cases had received at least 6 months auditory training and speech therapy. Participants included 30 (61.2%) mothers of children with hearing aid, 19 (38.8%) mothers of children with cochlear implant. ANOVA analysis showed that there is no significant difference between hearing aid (HA) and cochlear implant (CI) groups in term of self-efficacy and parent-involvement except for question 21 (comfortable in participating in individualized program) that score in HA group was significantly higher than CI group. Results of present study has practical implications for early interventionists working with families. Every early intervention program should consider families to reach maximum outcome. Early interventionists can use SPISE to evaluate parental selfefficacy and involvement and work on parents with low score to achieve the best results.
https://ift.tt/2qqnwtI
Correlation of Eustachian Tube Dysfunction with Results of Tympanoplasty in Mucosal Type of Chronic Suppurative Otitis Media
Abstract
To Assess the relation between eustachian tube function and outcome of tympanoplasty in mucosal type of chronic suppurative otitis media, a prospective study was carried out over a period of one and half years (January 2016–July 2017) at a tertiary referral centre (Gujarat Cancer Society Medical College and Research Institute, Ahmedabad). Total 90 Patients of any age and sex and with Mucosal type of chronic suppurative otitis media and Patients with follow up of 12 months were selected. The Eustachian Tube function was assessed preoperatively by pressure swallow equalization test and impedance audiometry. All patients were categorized based on function of eustachian tube. All patients were operated by type 1 tympanoplasty with or without mastoidectomy. We measure the Graft uptake rate after type 1 tympanoplasty (with or without mastoidectomy) in patients with or without eustachian tube dysfunction. Graft uptake rate is higher in patients with normal or mild eustachian dysfunction compared to severe eustachian tube dysfunction. In our study we found 87% success rate in patients with normal Eustachian tube function, 80% in partially impaired Eustachian tube function, and 70% in totally impaired Eustachian tube. So, pre-operative planning in tympanoplasty surgery eustachian tube function assessment is must to increase graft uptake rate by preoperative utilization of decongestant. It is also important to comment outcome of surgery.
https://ift.tt/2Qe0kKB
Oral ulceration with bone sequestration: retrospective study of 8 cases and literature review
Oral Diseases, Volume 0, Issue ja, -Not available-.
https://ift.tt/2QeqqNp
Bilateral Pneumothorax Post Emergency Airway Intervention
Abstract
A patient with diffuse axonal injury, with compound type 2 fracture of left tibia and fat embolism, post road traffic accident, was taken up for tracheostomy. He was diagnosed to have developed bilateral pneumothorax following the procedure, which according to literature has been of rare incidence. The causes of the pneumothorax following the procedure could be attributed to a tear or trauma in the posterior tracheal wall while inserting the tube or due to the rupture of alveolar bullae or bleb.
https://ift.tt/2P4PGcr
Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature
Pulmonary cryptococcosis is a common fungal infection frequently seen in immunocompromised patients. Owing to its nonspecific clinical and radiographic features, the differential diagnosis with secondary tuber...
https://ift.tt/2Qe1llA
Blocking antibodies induced by peanut oral and sublingual immunotherapy suppress basophil activation and are associated with sustained unresponsiveness
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2P5O2r8
Low expression of pRB predicts disease relapse in early glottic cancer treated with transoral laser microsurgery
The Laryngoscope, EarlyView.
https://ift.tt/2CYexYk
Exploring the association between parental psychiatric disease and childhood atopic dermatitis: a matched case‐control study
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2qrq1Mp
Dermoscopy of patch test reactions. Study of applicability in differential diagnosis between allergic and irritant reactions
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PD5wdC
Loss of function desmoplakin I and II mutations underlie dominant arrhythmogenic cardiomyopathy with a hair and skin phenotype
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Rt82kg
Adenoid Cystic Carcinoma of the Nasopharynx: A Case Series
Abstract
Adenoid cystic carcinomas are tumors that are more commonly seen in the salivary glands than in the nasopharynx. Nasopharyngeal adenoid cystic carcinomas are rare and cases that are reported in the literatures are few. Treatment is mainly by surgical resection. Here, we report 2 cases of nasopharyngeal adenoid cystic carcinoma.
https://ift.tt/2CV2ESW
Bilateral Pneumothorax Post Emergency Airway Intervention
Abstract
A patient with diffuse axonal injury, with compound type 2 fracture of left tibia and fat embolism, post road traffic accident, was taken up for tracheostomy. He was diagnosed to have developed bilateral pneumothorax following the procedure, which according to literature has been of rare incidence. The causes of the pneumothorax following the procedure could be attributed to a tear or trauma in the posterior tracheal wall while inserting the tube or due to the rupture of alveolar bullae or bleb.
https://ift.tt/2P4PGcr
Hyper IgE recurrent infection syndrome in South Asia: is there a different outcome?
Hyper IgE recurrent infection syndrome (HIES) is a rare immune deficiency, characterized by recurrent staphylococcal skin and lung abscesses, pneumonia and increased IgE levels. The majority of autosomal domin...
https://ift.tt/2CVGz6y
Chronic cutaneous miliary tuberculosis – a forgotten entity
International Journal of Dermatology, EarlyView.
https://ift.tt/2qpcR2h
An unusual deep fungal infection with Nigrospora sphaerica in HIV positive patient
International Journal of Dermatology, EarlyView.
https://ift.tt/2Q8RPAi
Issue Information
The Journal of Dermatology, Volume 45, Issue 11, Page i, 1233-1234, November 2018.
https://ift.tt/2PDmvwG
Issue Information
The Journal of Dermatology, Volume 45, Issue 11, Page 1367-1367, November 2018.
https://ift.tt/2Rvsp02
Improvement of patient-reported outcomes in severe allergic asthma by omalizumab treatment: the real life observational PROXIMA study
Data on the prevalence of perennial versus seasonal allergic asthma in Italy are lacking; moreover, there is limited evidence on the effect of omalizumab on patient-reported outcomes in Italian patients with s...
https://ift.tt/2CWDAuA
Near-infrared spectroscopy in vegetables and humans: An observational study
BACKGROUND Cerebral near-infrared spectroscopy (NIRS) of tissue oxygen saturation is claimed to be a surrogate marker for global cerebral perfusion. Increasingly, NIRS target-based therapy has been used during cardiac surgery in the hope of decreasing the incidence of adverse neurological outcome. OBJECTIVES We report NIRS values for some common vegetables and faculty at a world-class medical institution. DESIGN Observational nonblinded study. SETTING Single tertiary care institution and local urban vegetable market. PARTICIPANTS Five yams (Dioscorea cayenensis), five courgettes (Cucurbita pepo) and five butternut squashes (Cucurbita moschata) were studied. Five cardiothoracic surgeons and anaesthesiologists were the control group. INTERVENTIONS None. MAIN OUTCOME MEASURES NIRS value of each species. RESULTS Mean NIRS value for the control group was 71% [95% confidence interval (CI) 68 to 74] and was similar to that of the yellow squashes [75% (95% CI 74 to 76)]. These values were significantly greater than the NIRS measurements of both the butternut squash and yam [63% (95% CI 62 to 64) and 64% (95% CI 63 to 65), respectively, P https://ift.tt/2P1IEVQ
Peri-operative oral caffeine does not prevent postoperative atrial fibrillation after heart valve surgery with cardiopulmonary bypass: A randomised controlled clinical trial
BACKGROUND Raised plasma levels of endogenous adenosine after cardiac surgery using cardiopulmonary bypass (CPB) have been related to the incidence of postoperative atrial fibrillation (POAF). OBJECTIVE We wished to assess if caffeine, an adenosine receptor antagonist could have a beneficial effect on the incidence of POAF. DESIGN A randomised controlled study. SETTING Single University Hospital. PATIENTS One hundred and ten patients scheduled for heart valve surgery with CPB. INTERVENTIONS We randomly assigned patients to receive peri-operative oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma concentrations and caffeine pharmacokinetic profile were evaluated in a subgroup of 50 patients. MAIN OUTCOME MEASURES The primary endpoint was the rate of atrial fibrillation during postoperative hospital stay. RESULTS The current study was stopped for futility by the data monitoring board after an interim analysis. The incidence of atrial fibrillation was similar in the caffeine and in the placebo group during hospital stay (33 vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P = 0.60). Basal and postoperative adenosine plasma levels were significantly associated with the primary outcome. Adenosine plasma levels were similar in the two treatment groups. Caffeine administration was associated with a higher incidence of postoperative nausea and vomiting (27 vs. 7%, P = 0.005). CONCLUSION Oral caffeine does not prevent POAF after heart valve surgery with CPB but increased the incidence of postoperative nausea and vomiting. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, no.: NCT01999829.https://ift.tt/2P6ch8s
Incidence of akathisia after postoperative nausea and vomiting prophylaxis with droperidol and ondansetron in outpatient surgery: A multicentre controlled randomised trial
BACKGROUND Akathisia, a distressing movement disorder induced by butyrophenones, has been described with low doses of droperidol used for postoperative nausea and vomiting (PONV) prophylaxis, but the incidence remains unclear. OBJECTIVES To determine the incidence of akathisia after PONV prophylaxis with two doses of droperidol in comparison with ondansetron, in patients undergoing ambulatory surgery. We hypothesised that the incidence of akathisia is higher with droperidol than that with ondansetron. DESIGN Randomised controlled double blind trial. SETTING Two University Hospital Centres and two private Clinics from January to September 2014. PATIENTS Patients (n=297) undergoing general anaesthesia for ambulatory surgery were randomly allocated to receive PONV prophylaxis with droperidol (0.625 or 1.25 mg) or ondansetron 4 mg; patients of the three groups also received 4 mg of dexamethasone. Exclusion criteria were contraindication to droperidol and ondansetron, use of psychotropic medications or benzodiazepines or history of psychotic illness. INTERVENTIONS Participants received droperidol (0.625 or 1.25 mg) or ondansetron 4 mg during general anaesthesia. After discharge from the postanaesthesia care unit presence and severity of akathisia were assessed using the Barnes Akathisia Rating Scale at 4 h postoperatively. MAIN OUTCOME MEASURES Score of the Global Clinical Assessment of Akathisia of Barnes Akathisia Rating Scale. RESULTS The number of akathisia observed was 1/118 (0.8%) in the ondansetron group, 1/84 (1.2%) in droperidol 0.625 mg group, and 3/87 (3.4%) in droperidol 1.25 mg group. The akathisia rate difference among the three groups was not significant (P = 0.52). We could not demonstrate significant differences in the incidence of akathisia between the two doses of droperidol. The only case of marked akathisia treated with benzodiazepines was observed after droperidol 1.25 mg. CONCLUSION The use of droperidol or ondansetron for PONV prophylaxis is associated to a low incidence of akathisia (0.8 to 3.4%) after general anaesthesia for ambulatory surgery. TRIAL REGISTRATION Clinicaltrials.gov: NCT01942343.https://ift.tt/2CX1ciH
Peri-operative respiratory adverse events in children with upper respiratory tract infections allowed to proceed with anaesthesia: A French national cohort study
BACKGROUND Peri-operative respiratory adverse events (PRAEs) in paediatric patients with upper respiratory tract infections (URTIs) remain inadequately explored in patients allowed to proceed to anaesthesia and surgery. OBJECTIVE To determine the incidence and risk factors of PRAE in children with URTI allowed to proceed to anaesthesia. DESIGN Multicentre cohort study performed over 6 months in France. SETTING Sixteen centres with dedicated paediatric anaesthetists. PATIENTS Eligible patients were aged from 0 to 18 years with URTI symptoms on admission or a history of such over the preceding 4 weeks. MAIN OUTCOMES The primary outcome of the study was to determine predictors of PRAE. Secondary outcomes were: predictors of peri-operative arterial desaturation and of the decision to proceed with anaesthesia and surgery in children with URTI. RESULTS Overall, 621 children were included and 489 (78.7%) anaesthetised. Of those anaesthetised, 165 (33.5%) and 97 (19.8%) experienced PRAE and arterial desaturation, respectively. Factors predictive of PRAE included patient age, tracheal intubation and the absence of midazolam premedication. Factors predictive of peri-operative arterial desaturation included patient age, anaesthetist experience, endoscopic procedures and the presence of other PRAE. Factors predicting proceeding to anaesthesia in the context of URTI included anaesthetist experience, emergency procedures and the absence of severe URTI symptoms. CONCLUSION The risk of PRAE in patients anaesthetised in the presence of URTI was similar to previous publications – close to 30%. In the light of our findings, first, current rescheduling indications should be questioned, and second, further medical and organisational strategies should be investigated to reduce PRAE in children with URTI. TRIAL REGISTRATION The study was registered in the European Networks of Centers for Pharmacoepidemiology and Pharmacovigilance (EUPAS16436).https://ift.tt/2P6OuW4
Green blood plasma from a patient with breast cancer after sentinel lymph node biopsy
No abstract availablehttps://ift.tt/2CX0T7x
Emergence delirium in children is related to epileptiform discharges during anaesthesia induction: An observational study
BACKGROUND Epileptiform discharges frequently occur in children during induction of anaesthesia. However, studies analysing the impact of epileptiform discharges on postoperative emergence delirium in children are still scarce. The aim of this study is to correlate the incidence of epileptiform activity during anaesthesia induction with the occurrence of emergence delirium during stay in the recovery room. OBJECTIVES Prospective, observational cohort study in children 0.5 to 8 years old undergoing planned surgery. Bifrontal electroencephalogram electrodes were placed before induction of anaesthesia. Visual electroencephalogram analysis was performed from start of anaesthetic agent administration until intubation with regard to epileptiform patterns: rhythmic polyspikes; periodic epileptiform discharges; delta with spikes; and suppression with spikes. Emergence delirium was assessed during stay in the recovery room using the Pediatric Assessment of Emergence Delirium Score. DESIGN Prospective, observational cohort study. SETTING University hospital – Germany/Berlin. Children were included between September 2015 and February 2017. PATIENTS A total of 62 Children, aged 0.5 to 8 years old undergoing planned surgery were included. MAIN OUTCOME MEASURES Primary outcome was emergence delirium. Secondary outcomes, peri-operative Electroencephalography (EEG) data analysis. The presented study analysed an association between emergence delirium and the occurrence of epileptiform discharges during anaesthesia induction. RESULTS A total of 43.5% of the children developed emergence delirium and 56.5% did not. Epileptiform discharges were observed more often in children developing emergence delirium (63%) compared with children not developing emergence delirium (43%). But only the occurrence of interictal spike events – such as rhythmic polyspikes; periodic epileptiform discharges and delta with spikes – were significantly related to emergence delirium (emergence delirium-group 48% vs. nonemergence delirium-group 14%, OR = 5.6 [95% CI: 1.7 to 18.7]; P = 0.004). CONCLUSION Emergence delirium in children is significantly related to interictal spike events occurring during induction of anaesthesia. CLINICAL TRIAL NCT02481999.https://ift.tt/2P87eEv
Ultrasound assessment of gastric emptying time after a standardised light breakfast in healthy children: A prospective observational study
OBJECTIVES Current guidelines recommend 6 h of fasting for solids before anaesthesia. However, prolonged fasting may lead to discomfort, hunger, thirst, misbehaviour and lipolysis. To prevent this, a more liberal fasting regimen has been empirically implemented in our children's hospital, allowing a shorter fasting time of 4 h for a standardised light breakfast. AIM The aim of this study was to determine the gastric emptying time after a standardised light breakfast in healthy children. DESIGN A prospective observational noninterventional study. METHODS After fasting overnight, the children had a standardised light breakfast. Before and afterwards, ultrasound examinations of the gastric antrum were performed hourly to determine the gastric antral area (GAA), which is a surrogate parameter for gastric volume in children in the right lateral position (RLP). Demographic data and fasting times are presented as mean ± SD (range) and GAA as median (interquartile range). RESULTS Twenty-two children aged 7.8 (2.5 to 13.6) years volunteered for this study. After fasting overnight [735 ± 120 (467 to 930) min], the initial GAA was 3.06 (2.35 to 4.03) cm2 in RLP. After the light breakfast, GAA in RLP initially increased and decreased subsequently. After 4 h, GAA in RLP was lower than the initial value (median of differences −0.54, 95% confidence interval −1.00 to −0.07, P https://ift.tt/2P5ng1R
How current transfusion practices in geriatric patients with hip fracture still differ from current guidelines and the effects on outcome: A retrospective observational study
BACKGROUND Transfusion guidelines have become increasingly restrictive. We investigated actual transfusion practices in geriatric hip fracture patients, why they differ from current guidelines and how this affects outcome. OBJECTIVES The primary aim was to examine transfusion timing, evaluate how many red blood cell (RBC) transfusions are in keeping with guidelines and how this affects morbidity (infection, cardiac events and delirium), mortality and length of stay (LOS). Our secondary aim was to test the hypothesis that guidelines were more likely to be deviated from shortly before discharge and with consecutive transfusions. DESIGN A retrospective observational study. SETTING The Luzerner Kantonsspital, a major trauma centre, over a 12-month period from 1 February 2015 to 31 January 2016. PATIENTS All patients over 70 years of age admitted to the Luzerner Kantonsspital with hip fractures over a 12-month period in 2015 to 2016 were included. RESULTS 156 patients were included, to which 141 units of RBCs were transfused. All pre and intra-operative transfusions were according to guidelines; 110 transfusions were postoperative and 37 of these were not according to guidelines. Patients who were transfused had longer LOS in hospital (P = 0.002) and an odds ratio (OR) of 2.7 of contracting an infection (P = 0.04) in comparison with patients who were not transfused. No significant differences in mortality, LOS or morbidity were found between patients transfused according to guidelines and more liberal thresholds. Guidelines were more likely to be deviated from within the last 2 days before discharge than prior to this (58 vs. 24%, P = 0.03). Furthermore, 24 stable patients received two consecutive RBC units resulting in posttransfusion haemoglobin values of between 83 and 124 g l−1. CONCLUSION Most RBC transfusions occur postoperatively, many still according to liberal transfusion thresholds, in particular shortly before discharge and as part of consecutive transfusions. Transfused patients had longer LOS and more infections than patients not transfused, but there was no difference in mortality, LOS or morbidity between patients transfused according to current guidelines and those where guidelines were deviated from.https://ift.tt/2CU3S0u
The degree of adherence to CONSORT reporting guidelines for the abstracts of randomised clinical trials published in anaesthesia journals: A cross-sectional study of reporting adherence in 2010 and 2016
BACKGROUND Abstracts are intended to be concise summaries of the entire randomised clinical trial (RCT). Despite their importance, few studies have examined the reporting quality of abstracts in the anaesthesiology literature. OBJECTIVES To examine the quality of RCT abstract reporting according to the CONSORT for Abstracts guidelines and determine whether recommended items omitted from the abstract were present in the body of the article. DESIGN A cross-sectional study of RCTs. SETTING This study was performed at the University of Western Ontario and University Hospital, London Health Sciences Centre. PARTICIPANTS All RCTs meeting inclusion criteria that were published in 2010 or 2016 in six general anaesthesiology journals (Anaesthesia, Anesthesia & Analgesia, Anesthesiology, British Journal of Anaesthesia, Canadian Journal of Anesthesia and European Journal of Anaesthesiology). MAIN OUTCOME MEASURES The 16 checklist items from the CONSORT for Abstracts statement were used to create a convenience score as a proxy for RCT abstract reporting quality, with each criterion measured as being reported in abstract, not reported in abstract but reported in full-text article, or not reported in abstract or full-text article. RESULTS Of the 395 RCTs identified, 219 were published in 2010 and 176 were published in 2016. Out of the maximum possible score of 16, the median abstract score increased from 4 points [interquartile range (IQR): 3 to 5] in 2010 to 6 points [IQR: 5 to 8] in 2016. Although most checklist items showed improvement from 2010 to 2016, around 75% of RCTs in 2016 met fewer than half of the 16 items with no RCTs reporting all 16 items in the abstract. A majority of the RCTs had the information present in the full-text. In 2016, only 71 out of 176 (40%) of RCTs reported outcomes conforming to the CONSORT guidelines (with an effect size and a confidence interval around the effect size) in the Abstract. CONCLUSION Abstracts for many anaesthesiology RCTs are incomplete selective summaries of the entire article.https://ift.tt/2P4GHYU
Intra-osseous-access-associated lower limb compartment syndrome in a critically injured paediatric patient
No abstract availablehttps://ift.tt/2CUYjPE
ICU mortality and variables associated with ICU survival in Poland: A nationwide database study
BACKGROUND Recently published international comparison data across European countries revealed high mortality rates in Polish ICUs. OBJECTIVES Estimation of the rate of ICU mortality and identification of variables associated with ICU survival in Poland. DESIGN Retrospective analyses of a database reporting ICU stays in Poland. SETTINGS AND PATIENTS The study included data from all adult patients admitted to an ICU in Poland from 1 January 2012 to 31 December 2012. MAIN OUTCOME MEASURES ICU mortality and variables associated with ICU survival. RESULTS A total of 48 282 patients were treated in 347 ICUs (mean age 63.1 ± 16.8 years, 59% men) with 20 278 deaths (42.0%). Variables associated with ICU survival were: tertiary level of hospital care [relative risk (RR) 0.86, 95% confidence interval (CI) 0.80 to 0.92, P https://ift.tt/2P5GIvE
Comparison of the peripheral antinociceptive effect of somatostatin with bupivacaine and morphine in the rodent postoperative pain model
BACKGROUND AND OBJECTIVES Infiltration of surgical wound with local anaesthetics attenuate postoperative pain. However, side effects can also occur. Somatostatin (SST) and its analogues like octreotide reportedly reduce peripheral sensitisation. The current study evaluates peripherally mediated antinociceptive effect of SST in a rat model of postoperative pain. This was compared with bupivacaine and morphine under identical experimental conditions. DESIGN Randomised vehicle-controlled blind study. SETTING Pain research laboratory, All India Institute of Medical Sciences, New Delhi from February 2014 to July 2017. EXPERIMENTAL SUBJECT Rodent hind paw incision model. INTERVENTIONS Sprague-Dawley rats were subjected to incision and one of the following drugs administered into the open wound once by a micropipette: SST (10, 30 or 100 μg), bupivacaine (3, 10, 30, 50 or 100 μg) or morphine (100 μg). Antinociceptive effect of SST was further evaluated for its reversibility, site of action, effect on spinal c-fos expression and blood glucose level. The site of action of morphine was also investigated. MAIN OUTCOME MEASURE Nociception was estimated by nonevoked (guarding behaviour) and evoked (mechanical allodynia and thermal hyperalgesia) pain behaviours between 2 h and days 4 to 7. RESULTS Nociception was maximum 2 h after incision. SST (10 to 100 μg) significantly attenuated guarding behaviour between 2 h and day 2. A delayed inhibitory effect was observed on allodynia. Bupivacaine (10 to 100 μg doses) similarly decreased guarding score up to day 2 though evoked pain behaviours were relatively unaffected. In contrast, morphine produced a potent but transient inhibitory effect on guarding score at 2 h, which was mediated by both peripheral and central opioid receptors. The antinociceptive effect of SST was peripherally mediated by type 2 receptors and was associated with decreased c-fos staining. Blood glucose level was unaltered. CONCLUSION Guarding behaviour, which likely represents pain-at-rest following surgery, was attenuated by both bupivacaine and SST to comparable extents. This novel peripherally mediated antinociceptive effect of SST needs further evaluation.https://ift.tt/2P46MHq
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