Head and Neck Medicine by Alexandros G.Sfakianakis: 11/14/18

Τετάρτη 14 Νοεμβρίου 2018

Basophil Activation Test: Old and New Applications in Allergy

Abstract

Purpose of Review

The basophil activation test (BAT) using flow cytometry has supplanted traditional methods of measuring basophil degranulation using histamine and other mediator release, and can be used for clinical applications as well as to explore the immune mechanisms of effector cell response to allergen. This review discusses the advancements made in clinical, diagnostic and laboratory research of allergy utilizing an ever-evolving BAT.

Recent Findings

Being an in vitro surrogate of the allergic reaction that happens in vivo in the sick patient, the BAT can be used to support the diagnosis of various allergic conditions, such as food, drug, respiratory and insect venom allergies, and the assessment of clinical response to allergen-specific immunotherapy and other immunomodulatory treatments. The BAT can also be used for research purposes to explore the mechanisms of allergy and tolerance at the level of the basophil, for instance by manipulating IgE and IgG and their receptors and by studying intracellular signalling cascade in response to allergen.

Summary

This review covers the applications of the BAT to the clinical management of allergic patients and the increased understanding of the mechanisms of immune response to allergens as well as technological advancements made in recent years.

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Increased salivary AKR1B10 level: association with progression and poor prognosis of oral squamous cell carcinoma

Abstract

Background

Aldo‐keto reductase family 1 member B10 (AKR1B10) expression in oral squamous cell carcinoma (OSCC) tissue specimens is correlated with the progression and prognosis of OSCC.

Methods

Saliva samples were obtained from 35 normal controls and 86 patients with OSCC before cancer surgery. The AKR1B10 levels were determined using enzyme‐linked immunosorbent assay (ELISA).

Results

The mean salivary AKR1B10 levels were significantly higher in the patients with OSCC than in the normal controls (P < .001). Higher salivary AKR1B10 levels were significantly associated with larger tumor size, more advanced clinical stage, and areca quid chewing habit. Patients with OSCC with a higher salivary AKR1B10 level (>646 pg/mL) had a significantly poorer survival than those with a lower (≤646 pg/mL) salivary AKR1B10 level (P = .026).

Conclusion

The salivary AKR1B10 level may be a promising biomarker for screening high‐risk patients with OSCC and monitoring the progression of OSCC.

https://ift.tt/2K3oa9m

Basophil Activation Test: Old and New Applications in Allergy

Abstract

Purpose of Review

Recent Findings

Summary

https://ift.tt/2K4pj0B

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 2018; S 01 Article in Thieme...

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 2018; S 01

Article in Thieme eJournals:
Table of contents | Congress

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Traumatische Verletzungen des zentralen Nervensystems

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 668-681
DOI: 10.1055/s-0043-118969

Traumatische Verletzungen des zentralen Nervensystems stellen die Folge einer äußeren Gewalteinwirkung auf Gehirn oder Rückenmark dar. Sowohl das Schädel-Hirn-Trauma als auch das spinale Trauma sind dynamische Krankheitsbilder, die besondere Anforderungen an Diagnostik und Therapie stellen und somit in spezialisierten Zentren versorgt werden sollten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Gefährliche Verzögerung: Warten erhöht Mortalität bei Sepsis

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 644-645
DOI: 10.1055/a-0727-4782

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Neurointensivmedizin: aneurysmatische Subarachnoidalblutung – State of the Art

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 654-667
DOI: 10.1055/s-0043-118963

Die spontane, nicht traumatische Subarachnoidalblutung ist eine lebensbedrohliche Erkrankung, die mit vielfältigen Komplikationen und einer hohen Morbidität und Mortalität vergesellschaftet ist. In den ersten 24 Stunden hat die Ausschaltung der Blutungsursache Vorrang. Die Patienten sollen intensivmedizinisch überwacht und behandelt werden. Stringente Diagnostik und konsequente Behandlung verbessern das Outcome der Patienten nachweislich.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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ICU: längeres Überleben durch Delirprophylaxe mit Haloperidol?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 645-645
DOI: 10.1055/a-0727-5752

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Geburtshilfliche Anästhesie und postoperative Überwachung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 696-702
DOI: 10.1055/s-0043-111309

Die von ASA (American Society of Anesthesiologists) und SOAP (Society for Obstetric Anesthesia and Perinatology) für das Jahr 2016 aktualisierten Leitlinien sind eine Handlungsempfehlung in erster Linie für Anästhesisten, die auf das anästhesiologische Management Gebärender, nicht operative und operative Entbindung sowie auf die postpartale Versorgung und Analgesie fokussiert.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Mukopolysaccharidose: hohes Anästhesierisiko bei Kindern

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 645-646
DOI: 10.1055/a-0727-6682

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Neurointensivmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 652-653
DOI: 10.1055/a-0668-4925

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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(Über-)Leben nach Lungenversagen: die DACAPO-Studie

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 646-647
DOI: 10.1055/a-0727-6029

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Schmerztherapeutische Aspekte bei Tumoroperationen

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 704-717
DOI: 10.1055/s-0043-104600

Trotz einer Vielzahl von Therapieoptionen wird die Akutschmerztherapie nach onkologischen Operationen häufig als unzureichend beschrieben. Neben einer unzureichenden Akutschmerztherapie können weitere Faktoren eine Hypersensitivierung und Chronifizierung sowie den Verlauf der Tumorerkrankung beeinflussen. Dieser Beitrag erklärt pathophysiologische Hintergründe und erläutert geeignete Therapiemodalitäten.
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Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Herzstillstand nach Infarkt: bessere Ergebnisse mit mechanischer Kreislaufunterstützung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 647-648
DOI: 10.1055/a-0727-6465

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Neuromonitoring und Therapieentscheidungen auf der Intensivstation

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 682-695
DOI: 10.1055/s-0043-118971

Bei Patienten mit einer akuten Hirnschädigung besteht das Risiko einer weiteren neurologischen Verschlechterung aufgrund der Entwicklung eines sekundären Hirnschadens. Ziel des Neuromonitorings ist es frühzeitig pathophysiologische Veränderung des Gehirns zu erkennen um adäquate diagnostische und therapeutische Maßnahmen einzuleiten, um die Entstehung eines sekundären Hirnschadens zu vermeiden. Neben der klassischen Methode des klinischen Neuromonitorings bei wachen Patienten werden invasive Methoden mit Implantation von Messsonden zur Bestimmung des Hirndruckes, des zerebralen Sauerstoffpartialdruckes sowie des Hirnmetabolismus bei komatösen Patienten angewendet. Ein elektrophysiologisches Monitoring mittels Elektrokortikografie oder evozierter Potenziale sowie die Messung des zerebralen Blutflusses liefert ergänzende Informationen. Die Indikationen und die klinische Relevanz der verschiedenen Monitoring-Techniken werden im Hinblick auf eine Optimierung der Behandlung von Patienten mit akuten zerebralen Schädigungen besprochen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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„Ich muss genau hier sein!“

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 650-651
DOI: 10.1055/a-0663-1715

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Metabolische Azidose unter Paracetamol – eine ungewöhnliche Nebenwirkung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 718-722
DOI: 10.1055/a-0636-2595

Die metabolische Azidose ist bei hospitalisierten Patienten keine Rarität. Doch nur selten ist eine metabolische Azidose mit erweiterter Anionenlücke unter chronischer Paracetamol-Therapie und konsekutiver transienter 5-Oxoprolin-Akkumulation (Pyroglutaminsäure) bei Erwachsenen beschrieben 1, 2, 3, 4. Dieser Beitrag stellt einen solchen Fall dar und erläutert die wenig bekannte Pathogenese.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Hematopoietic cell transplantation for asymptomatic X-linked lymphoproliferative syndrome type 1

X-linked lymphoproliferative disease type 1 (XLP1) is a rare primary immune deficiency, which is caused by SH2D1A gene mutations. XLP1 is commonly associated with Epstein–Barr virus (EBV)-associated hemophagocyti...

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Aberrant localization of FOXJ1 correlates with the disease severity and comorbidities in patients with nasal polyps

Upper airway inflammatory diseases are associated with abnormal expression of nasal epithelial forkhead-box J1 (FOXJ1) which regulates motile cilia formation. We sought to investigate whether aberrant FOXJ1 lo...

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Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study

Pyoderma gangrenosum is a painful ulcerating disease. The current evidence base for treatment is limited. In a large prospective study of topical treatments, 44% of patients were healed by 6 months. Ulcer size was a predictor of healing, and 15% of patients with pyoderma gangrenosum had a recurrence. Clobetasol propionate 0.05% is a potentially useful first-line therapy for patients with pyoderma gangrenosum, particularly for patients with small lesions.

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Acquired cold urticaria: Clinical features, particular phenotypes, and disease course in a tertiary care center cohort

Acquired cold urticaria (ACU) is characterized by the development of wheals, angioedema, or both after cold exposure. Age at diagnosis, disease severity, and response to the ice cube challenge test predicted both prognosis and response to therapy. Proper characterization of the type of acquired cold urticaria allows for appropriate counseling and choice of therapy.

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Are alkyl glucosides really allergens?

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Multivariate analysis of potential risk factors for lymph node metastasis in patients with cutaneous squamous cell carcinoma of the head and neck

Risk factors for metastasis from cutaneous squamous cell carcinoma are incorporated in tumor staging by the seventh edition of the American Joint Committee on Cancer Cancer Staging Manual.We confirmed most risk factors, and also identified moderate differentiation as a predictor for lymph node metastasis. Moderate differentiation can be considered in tumor staging.

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Examining the epidemiology of coincident psoriasis and sarcoidosis: An observational cross-sectional study

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Premalignant and Malignant Mucosal lesions: Clinical and Pathological Findings Part II. Premalignant and malignant mucosal lesions

Part 2 of this 2-part continuing medical education series discusses the clinical and histopathologic features of common premalignant and malignant lesions of the oral cavity. It is imperative for dermatologists to be able to recognize suspicious lesions, determine biopsy need, counsel, and refer patients presenting with premalignant or malignant conditions appropriately. Given the higher rates of mortality and morbidity of oral mucosal malignancies due to late diagnosis, appropriate treatment with multidisciplinary care in a timely manner is essential to these neoplasms.

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Benign Oral Mucosal Lesions: Clinical and Pathological Findings Part I- Benign Oral Mucosal lesions

A diverse spectrum of benign oral mucosal lesions exists, presenting as either isolated oral findings or in association with dermatological conditions. Oral lesions can closely resemble one another; therefore, it is important for clinicians to be able to recognize their distinctive features and recognize benign versus malignant disease and when a biopsy is warranted. 1 In this continuing medical education series, we review oral anatomy and the clinical attributes of several benign lesions of the oral cavity along with the appropriate management and therapeutic modalities.

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Screening of thyroid function and autoantibodies in patients with alopecia areata: A systematic review and meta-analysis

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Letter to the Editor: Surgical Smoke: Current Recommendations for Clinical Practice

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About “Surgical smoke: Risk assessment and mitigation strategies” and chemical adsorption by activated carbon N95 masks

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Intralesional Vitamin D3 in Periungual Warts

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The “Rule of 10s” versus the “Rule of 2s”: High complication rates after conventional excision with postoperative margin assessment of specialty site versus trunk and proximal extremity melanomas

The "Rule of 10s" defines the high rate of complications after conventional excision of specialty site melanomas.Segregating melanomas into high- and low-risk categories for local surgical complications is an important step to develop consensus guidelines that specify indications for Mohs surgery or slow Mohs to improve outcomes.

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Anesthetization of the tragus and antitragus to utilize skin hooks for full visualization of the auricular concha

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Mobile Phone Reminders for Onychomycosis Medication Adherence

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Mast cell chymase impairs bronchial epithelium integrity by degrading cell‐junction molecules of epithelial cells

Abstract

Background

An increased degree of mast cell (MC) degranulation and damage to the epithelial lining are prominent features of bronchial asthma. In asthmatic airways, it seems likely that epithelial cells will be exposed to increased concentrations of proteases from MC, though their actions on the epithelium are still not very clear.

Methods

Bronchial rings from human lung tissue or 16HBE cell monolayer were incubated with MC‐chymase in different doses or various inhibitors. The sections of paraffin‐embedded tissue were haematoxylin‐eosin stained and computerized by image analysis for epithelial damage‐scale‐evaluation; the cell viability, proliferation, adhesion, LDH release were assayed; the expressions of gelatinases, cell‐junction molecules and structure proteins of 16HBE were examined.

Results

MC‐Chymase was found to provoke profound changes in the morphology of bronchi epithelial layer. Following incubation with chymase there was 40% reduction of the length of epithelium that was intact, with detachment of columnar epithelial cells and basal cells. Chymase reduced epithelial cell proliferation and induced cell detachment, which were associated with the changes in secretion and activation of matrix metalloproteinase‐2/9. In intact epithelial cell layers, immunocytochemistry study revealed that chymase reduced the expressions of occludin, claudin‐4, ZO‐1, E‐cadherin, focal adhesion kinase and cytokeratin. Overall data of this study indicated that MC‐chymase can influence tissue remodelling, disrupt epithelial cell‐junctions, inhibit wound healing and impair the barrier function of epithelium, resulting in dysfunction of airway wall and ECM remodelling in pathogenesis of asthma.

Conclusions

MC‐chymase plays a key role in inducing the damage to bronchial epithelium in asthma.

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Less exacerbations and sustained asthma control 12 months after high altitude climate treatment (HACT) for severe asthma

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Cord‐serum per‐ and poly‐fluoroalkyl substances (PFAS) and atopy and eczema at 12‐months

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New insights into the origin of mast cells

Abstract

Single‐cell RNA‐sequencing and colony‐forming assays suggest that bone marrow hematopoietic stem and progenitor cells traverse through a differentiation landscape before commitment to the mast cell and other cell lineages.¹ However, the bone marrow contribution for the formation of tissue‐resident mast cells has been questioned, and the prenatal origin of mast cells was recently uncovered.² Through fate mapping experiments Gentek et al² elegantly demonstrated that mast cells arise during two distinct waves of the embryonic development, one from the yolk sac and the other via the aorta‐gonad‐mesonephros.

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Salvage surgery for a locally persistent or recurrent tumour in maxillary cancer patients who have undergone radiotherapy and concomitant intra-arterial cisplatin: implications for surgical margin assessment

Limited information about salvage surgery is available for locally persistent and recurrent maxillary sinus cancers after the completion of chemoradiation therapy. Seventy-six maxillary sinus cancer patients who had undergone chemoradioselection using initial radiotherapy and concomitant intra-arterial cisplatin were screened retrospectively. Twenty-four of these patients who had a locally persistent or recurrent tumour were investigated. The 2-year overall survival rate of patients with maxillary sinus cancer of all types was 39.0% for those who underwent salvage surgery and 10.0% for those who did not.

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Impact of incubation method on the release of growth factors in Non-Ca2+-activated PRP, Ca2+-activated PRP, PRF and A-PRF

The aim of this study was to investigate the influence of different incubation methods on the growth factor content of lysates of platelet-rich fibrin (PRF), advanced-platelet-rich fibrin (A-PRF) and platelet-rich plasma (PRP) products. A comparison of related studies suggests that the method of sample preparation has a significant influence on growth factor content. There are few reports on the comparison of non-Ca2+-activated PRP, Ca2+-activated PRP, A-PRF, and PRF, along with a lack of information on the release of PDGF-BB, TGF-β1, and VEGF among the different incubation methods.

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The Effect of Disc Repositioning and Post-operative Functional Splint for the Treatment of Anterior Disc Displacement in Juvenile Patients with Class II Malocclusion

To evaluate the effect of temporomandibular joint (TMJ) disc repositioning and post-operative functional splint for the treatment of anterior disc displacement (ADD) in juvenile patients with Class II malocclusion.

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Modified bolster dressing with continuous suction improves skin graft survival for an oral cavity wound

Prognostic impact of regression in patients with primary cutaneous melanoma >1 mm in thickness

The impact of histologic regression on sentinel lymph node biopsy (SLNB) status and on clinical outcome is uncertain.

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Management of Complex Arteriovenous Malformations Using a Novel Combination Therapeutic Algorithm

This case series assesses the efficacy and tolerability of sirolimus as an adjuvant therapy for endovascular embolization in the management of complicated extracranial head and neck arteriovenous malformations.

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Machine Learning and Health Care Disparities in Dermatology

This viewpoint discusses the limitations of machine learning in diagnostics involving skin of color.

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Antiphospholipid Syndrome Following Pembrolizumab Treatment of Stage IIIB Unresectable Melanoma

The case report describes the occurrence of antiphospholipid syndrome following pembrolizumab treatment of stage IIIB unresectable melanoma.

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Avoiding and Managing Medicare Fraud and Abuse Investigations of Mohs Surgery

This Viewpoint discusses ways dermatologists can manage and avoid investigations by the US Department of Justice and the Centers for Medicare & Medicaid Services for alleged Medicare fraud and abuse related to Mohs surgery.

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An Atypical Figurate Erythema With Seasonal Recurrences

A woman had a large annular erythematous plaque on her back that had centrifugally expanded. She had mild pruritus that had not responded to antihistamine therapy or topical steroids and reported a 20-year history of the plaques recurring every summer and resolving by autumn. What is your diagnosis?

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Identifying Disparities in Dermatology

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Vasculitis

This Patient Page describes vasculitis, focusing especially on skin vasculitis, how to recognize it, and how it might be treated.

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Predictions, Surprises, and the Future of the Dermatology Workforce

With the debut of managed care in the 1980s, experts in the physician workforce portended an impending surplus of specialist physicians, including dermatologists. Despite these dire predictions, a dermatology workforce shortage was identified in the late 1990s, with an associated geographical imbalance. Since then, the overall shortage has only modestly abated, so it would not be surprising to find that an urban-rural workforce maldistribution has persisted. Indeed, in this issue of JAMA Dermatology, Feng and colleagues present physician data from 1995 to 2013 demonstrating that the maldistribution of dermatologists may well have worsened. They show an overall increase in density of dermatologists but a widening gap between metropolitan vs nonmetropolitan and rural communities. Additionally, the ratio of younger compared with older dermatologists (using a cutoff of age 55 years, the approximate mean physician age in the United States) increased in urban settings and simultaneously decreased in rural settings, a distribution that may cause this gap to grow.

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Complementary and Alternative Medicine Therapies for Psoriasis

This systematic review summarizes the evidence on the efficacy of the most studied complementary and alternative medicine therapies for treatment of plaque psoriasis and discusses those treatments with the most robust available evidence.

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Introducing “Images in Dermatology”

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

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An Atrophic and Spiny Eruption of the Palms

A woman presented with a pruritic and burning hyperpigmented eruption on the bilateral palms; examination revealed well-marginated brown atrophic patches on the bilateral palms extending focally onto the volar aspect of the wrist and surmounted by spiny keratotic pits in the palmar creases. What is your diagnosis?

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Translating Data on Trends in Disease Management to Decisions

Quantifying health care utilization is an important first step in understanding how to efficiently and effectively deliver health care to patients. Actinic keratoses (AKs) are among the most common clinical diagnoses encountered by dermatologists, and treatment aims to reduce patient discomfort and potential for malignant transformation. Given an aging population, disease burden will likely increase, highlighting the need for understanding trends in AK treatment and reimbursement.

https://ift.tt/2PPtpLB

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

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

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Exercise for Leg Ulcers

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

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November 2018 Issue Highlights

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Comparison of Dermatologist Density Between Urban and Rural Counties in the United States

This study analyzes county-level data from nationwide US data to compare dermatologist density between urban and rural areas.

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Glycolic Acid Plus Lovastatin-Cholesterol Combination Cream to Treat Congenital Ichthyoses

This case series evaluates the use of topical glycolic acid plus a lovastatin-cholesterol combination cream to treat autosomal recessive congenital ichthyoses.

https://ift.tt/2MpSj2i

Trajectories of Nevus Development From Age 3 to 16 Years in the Colorado Kids Sun Care Program Cohort

This longitudinal cohort study describes nevus acquisition from the ages of 3 to 16 years among white youths and evaluates variation by sex, Hispanic ethnicity, and body sites that are chronically vs intermittently exposed to the sun.

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Acrodermatitis Continua of Hallopeau

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

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Use of Actinic Keratosis Destruction in the Medicare Part B Fee-for-Service Population

This billing claims analysis uses the Medicare Part B Physician/Supplier Procedure Summary Master Files and National Summary Data to evaluate trends in the use and costs of actinic keratosis destruction.

https://ift.tt/2PPrI0N

Blended learning modules for lectures on oral and maxillofacial surgery

Over the last couple of years, new teaching methods have been developed and implemented in German universities, but only rarely in dental schools. The aim of this project therefore was to implement students' requests for such methods to be used in dental education. In 2012, based on an analysis of both quantitative and qualitative requirements, we designed a questionnaire for quantitative analysis, and evaluated a series of lectures on oral and maxillofacial surgery. Based on our findings, we then designed a blended learning module that was gradually integrated into the series.

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Citation for the 2017 BAOMS Surgery prize – Rajiv Anand

Citation for Rajiv Anand (Reg) DOB 17/1/67.

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Exercise-induced anaphylaxis associated with the use of bee pollen

The use of alternative and complementary medicine, including herbal supplements, is widespread in the United States. Some supplements have been associated with allergic reactions, even anaphylaxis. One such over-the-counter (OTC) supplement is bee pollen. This product is derived from pollen loads collected by honeybees and held together via enzymes secreted in the saliva of the bees. It contains various pollens that can vary based on the path of the individual insect as well the geographical location and associated plant species.

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Too Many Thyroid Ultrasound Exams Lead to an Increase in the Diagnosis of Low-Risk Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 11, Page 519-522, November 2018.

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Randomized, Controlled Trials Show That Treatment of Subclinical Hypothyroidism Does Not Improve Quality of Life, Cognition, Blood Pressure, or BMI

Clinical Thyroidology, Volume 30, Issue 11, Page 496-499, November 2018.

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Which Factors Predict the Outcome of Ablative Radioactive Iodine Treatment of Hyperthyroid Graves' Disease?

Clinical Thyroidology, Volume 30, Issue 11, Page 500-504, November 2018.

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Levothyroxine Treatment Improves Miscarriage Risk, But Not Live Birth Rates, in Women with Subclinical Hypothyroidism or TPO Antibody Positivity Undergoing ART

Clinical Thyroidology, Volume 30, Issue 11, Page 526-528, November 2018.

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A Thyroid Hormone Transporter Mutant Causes Delayed Hypothyroidism Selectively in the Brain

Clinical Thyroidology, Volume 30, Issue 11, Page 505-507, November 2018.

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Vemurafenib Restores Radioiodine Uptake in Some Metastatic Thyroid Cancers

Clinical Thyroidology, Volume 30, Issue 11, Page 516-518, November 2018.

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High-Dose Radioactive Iodine Ablation Decreases Local Recurrence for High-Risk Papillary Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 11, Page 508-510, November 2018.

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Symptoms Strongly Drive the Consideration of Alternative Thyroid Hormone–Replacement Options in Patients with Hypothyroidism

Clinical Thyroidology, Volume 30, Issue 11, Page 523-525, November 2018.

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Low-Dose Radioiodine Ablation Is Equally Effective as High-Dose Ablation in Patients with Low-Risk Thyroid Cancer on Long-Term Follow-up

Clinical Thyroidology, Volume 30, Issue 11, Page 511-515, November 2018.

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CASE REPORT: An Extensively Necrotic Hürthle-Cell Carcinoma Mimicked a Thyroid Abscess

Clinical Thyroidology, Volume 30, Issue 11, Page 529-533, November 2018.

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Confounders of severe asthma: diagnoses to consider when asthma symptoms persist despite optimal therapy

Asthma can often be challenging to diagnose especially when patients present with atypical symptoms. Therefore, it is important to have a broad differential diagnosis for asthma to ensure that other conditions...

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In This Issue

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MM-398 and Ramucirumab in Treating Patients With Gastric Cancer or Gastroesophageal Junction Adenocarcinoma

Conditions: Clinical Stage III Gastric Cancer AJCC v8; Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage IV Gastric Cancer AJCC v8; Clinical Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage IVA Gastric Cancer AJCC v8; Clinical Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8; Clinical Stage IVB Gastric Cancer AJCC v8; Clinical Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8; Locally Advanced Unresectable Gastric Adenocarcinoma; Metastatic Gastroesophageal Junction Adenocarcinoma; Metastatic Unresectable Gastric Adenocarcinoma; Pathologic Stage III Gastric Cancer AJCC v8; Pathologic Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIIA Gastric Cancer AJCC v8; Pathologic Stage IIIA Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIIB Gastric Cancer AJCC v8; Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IIIC Gastric Cancer AJCC v8; Pathologic Stage IV Gastric Cancer AJCC v8; Pathologic Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8; Pathologic Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage III Gastric Cancer AJCC v8; Postneoadjuvant Therapy Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IIIA Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IIIB Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IV Gastric Cancer AJCC v8; Postneoadjuvant Therapy Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IVA Gastroesophageal Junction Adenocarcinoma AJCC v8; Postneoadjuvant Therapy Stage IVB Gastroesophageal Junction Adenocarcinoma AJCC v8; Unresectable Gastroesophageal Junction Adenocarcinoma
Interventions: Drug: Liposomal Irinotecan; Other: Quality-of-Life Assessment; Other: Questionnaire Administration; Biological: Ramucirumab
Sponsors: University of Southern California; National Cancer Institute (NCI); Ipsen
Not yet recruiting

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Study Evaluating Safety and Efficacy of Bimiralisib in Patients With Head and Neck Squameous Cell Carcinoma

Condition: HNSCC
Intervention: Drug: Bimiralisib
Sponsor: PIQUR Therapeutics AG
Not yet recruiting

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Binary Oncolytic Adenovirus in Combination With HER2-Specific CAR VST, Advanced HER2 Positive Solid Tumors (VISTA)

Conditions: Bladder Cancer; Head and Neck Squamous Cell Carcinoma; Cancer of the Salivary Gland; Lung Cancer; Breast Cancer; Gastric Cancer; Esophageal Cancer; Colorectal Cancer; Pancreatic Adenocarcinoma
Intervention: Biological: CAdVEC
Sponsors: Baylor College of Medicine; The Methodist Hospital System; Texas Children's Hospital
Not yet recruiting

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Reduced Itch Associated With Dupilumab Treatment In 4 Patients With Prurigo Nodularis

This case report describes itch reduction in 4 patients with prurigo nodularis following treatment with dupilumab.

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A Meta-analysis of Benefits and Harms of Omalizumab in Patients With Chronic Idiopathic Urticaria

This meta-analysis of 67 observational studies analyzes the effectiveness and adverse event rate of omalizumab therapy in patients with chronic idiopathic urticaria and compares these findings with those of randomized clinical trials conducted among similar patients.

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Coral Dermatitis

This case report describes a cerebriform plaque with sharply demarcated, pink, erythematous borders on the leg of a woman after she came in contact with coral.

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Dupilumab Treatment for Generalized Prurigo Nodularis

This case series report of 3 patients assesses the effectiveness of dupilumab in the treatment of generalized prurigo nodularis.

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Factors Associated With Persistent Atopic Dermatitis in Children

This clinical birth cohort study evaluates the association of genetic, environmental, clinical, and social factors with the persistence of atopic dermatitis at age 13 years among children born to parents with asthma.

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Bilateral Round Scar-like Lesions on the Face of a Young Man

A 26-year-old man presents with a several-year history of persistent round lesions with a scar-like appearance on his face. What is your diagnosis?

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A phase I clinical study of a cocktail vaccine of Wilms’ tumor 1 (WT1) HLA class I and II peptides for recurrent malignant glioma

Abstract

Purpose

The safety and clinical efficacy of WT1 human leukocyte antigen (HLA) class I peptide vaccine have been established, but the safety of a cocktail vaccine of WT1 HLA class I and II peptides has not. To verify its safety, we performed a phase I clinical trial for patients with recurrent malignant gliomas and assessed the immunological responses and survival data.

Patients and methods

Fourteen HLA-A*24:02-positive patients with recurrent malignant glioma (2 with grade 3, 12 with grade 4) were enrolled. Every week, the patients received alternately a vaccine containing 3 mg of WT1 HLA-A*24:02-restricted (HLA class I) peptide and a cocktail vaccine of the HLA class I peptide and one of 0.75, 1.5 or 3 mg of the WT1 HLA class II peptide. For patients who showed no significant adverse effects within 6 weeks, the WT1 vaccine was continued at 2–4-week intervals.

Results

Eleven of the 14 patients completed WT1 vaccination for 6 weeks, while 3 patients dropped out earlier due to disease progression. All patients showed grade I level of skin disorders at the injection sites. No grade III/IV toxicity or dose-limiting toxicity was observed for any dose of WT1 HLA class II peptide. Six of the 14 patients had stable disease at 6 weeks. Median OS and 1-year OS rates were 24.7 weeks and 36%, respectively.

Conclusion

The safety of a cocktail vaccine of WT1 HLA class I and II peptides for malignant gliomas was verified. This vaccine is, therefore, considered promising for patients with recurrent malignant glioma.

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Could Music Minimize Discomfort and Pain During Office-Based ENT Surgery?

Background. Video-assisted endoscopic radiofrequency inferior turbinate volume reduction (RFVTR) is one of the most common surgical therapies for inferior turbinate hypertrophy (ITH). Despite all the technical and surgical advancement, it is advisable to reduce as low as possible the intraoperative discomfort. The aim of this study is to evaluate the role of music in reducing patient discomfort during RFVTR. Materials and Methods. Twenty-three patients with chronic nasal obstruction due to ITH and candidate to RFVTR are included. Before the procedure each patient filled in a completed Italian version of the state anxiety questionnaire (State-Trait Anxiety Inventory), SNOT 22 questionnaire, VAS, and chose their favourite music to be played during RFVTR. All patients evaluate the intraoperative discomfort with a visual analog scale (VAS) and for each patient, vital parameters such as blood pressure and heart rate were recorded 15 minutes before the procedure, during and after RFVTR. Results. The intraoperative VAS scores during listening to music (5.7 ± 2.42 vs 6.7 ± 1.97; p

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Targeting the polarization of tumor-associated macrophages and modulating mir-155 expression might be a new approach to treat diffuse large B-cell lymphoma of the elderly

Abstract

Aging immune deterioration and Epstein–Barr (EBV) intrinsic mechanisms play an essential role in EBV-positive diffuse large B-cell lymphoma (DLBCL) of the elderly (EBV + DLBCLe) pathogenesis, through the expression of viral proteins, interaction with host molecules and epigenetic regulation, such as miR-155, required for induction of M1 phenotype of macrophages. This study aims to evaluate the relationship between macrophage polarization pattern in the tumor microenvironment and relative expression of miR-155 in EBV + DLBCLe and EBV-negative DLBCL patients. We studied 28 EBV + DLBCLe and 65 EBV-negative DLBCL patients. Tumor-associated macrophages (TAM) were evaluated by expression of CD68, CD163 and CD163/CD68 ratio (degree of M2 polarization), using tissue microarray. RNA was extracted from paraffin-embedded tumor samples for miR-155 relative expression study. We found a significantly higher CD163/CD68 ratio in EBV + DLBCLe compared to EBV-negative DLBCL. In EBV-negative DLBCL, CD163/CD68 ratio was higher among advanced-staged/high-tumor burden disease and overexpression of miR-155 was associated with decreased polarization to the M2 phenotype of macrophages. The opposite was observed in EBV + DLBCLe patients: we found a positive association between miR-155 relative expression and CD163/CD68 ratio, which was not significant after outlier exclusion. We believe that the higher CD163/CD68 ratio in this group is probably due to the presence of the EBV since it directly affects macrophage polarization towards M2 phenotype through cytokine secretion in the tumor microenvironment. Therapeutic strategies modulating miR-155 expression or preventing immuno-regulatory and pro-tumor macrophage polarization could be adjuvants in EBV + DLBCLe therapy since this entity has a rich infiltration of M2 macrophages in its tumor microenvironment.

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La relation médecin/malade : d’un tact dermatologique

Publication date: Available online 13 November 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): E. Fiat

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Modified bolster dressing with continuous suction improves skin graft survival for an oral cavity wound

Abstract

Background

Skin engraftment of intraoral defects is known to be inconsistent due to mobility of the oral structure, uneven wounds, and accumulation of saliva under the skin graft. To improve the success rate of oral skin graft, we proposed a novel and simple dressing technique for intraoral skin graft to control saliva accumulation, in comparison with the conventional bolster dressing.

Methods

We retrospectively reviewed 31 patients reconstructed with skin graft in their intraoral defect. The patients were divided into two groups; conventional bolster group (n = 21) and modified bolster group (n = 10). In the modified bolster group, a polyvinyl alcohol sponge was designed to fit the skin graft and a suction drain was inserted with tagging suture to apply continuous suction. We analyzed the success rate, the size of the skin grafts and clinical variables of each method.

Results

The overall success rate of oral skin graft was not different between the two groups (90.0 and 90.5%). However, partial necrosis in the engrafted skin was observed frequently in the control group (57.1% versus 20.0%). The relative engrafted area was significantly higher in the modified bolster group (55.0 ± 11.6% versus 23.0 ± 18.7%, p = 0.015). The duration of bolster dressing and the time to start an oral diet were shorter in the modified bolster group.

Conclusions

Our modified method could be easily applied for removing saliva accumulation under a skin graft and for enhancing skin engraftment of an oral cavity wound.

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Persistent IKKα phosphorylation induced apoptosis in UVB and Poly I:C co-treated HaCaT cells plausibly through pro-apoptotic p73 and abrogation of IκBα

Publication date: December 2018

Source: Molecular Immunology, Volume 104

Author(s): Wuxiyar Otkur, Fang Wang, Weiwei Liu, Toshihiko Hayashi, Shin-ichi Tashiro, Satoshi Onodera, Takashi Ikejima

Abstract

Toll-like receptor 3 (TLR3), a member of pattern recognition receptors, is reported to initiate skin inflammation by recognizing double-strand RNA (dsRNA) released from UVB-irradiated cells. Recently, we have discovered the NF-κB pathway activated by TLR3 is involved in apoptosis of UVB-Poly I:C-treated HaCaT cells. The real culprit for apoptosis has not been precisely identified since the system of NF-κB pathway is complex. In this study, we silenced main transcriptional factors in NF-κB family, RelA, RelB and c-Rel, but to our surprise the results show that none of them participate in apoptosis induction in UVB-Poly I:C-treated HaCaT cells. Therefore, we moved to investigate the apoptosis-associated molecules in the upstream of NF-κB pathway. We firstly checked the expression of IκBα, an NF-κB inhibitor. UVB (4.8 mJ/cm²) and Poly I:C (0.3 μg/mL) co-treatment decreased IκBα expression level in a time-dependent manner. Silencing IκBα with siRNA further enhanced UVB-Poly I:C-induced cell death. We then investigated IκB kinase (IKK) complex that contributes to the degradation of IκBα. IKK is composed of IKKα, IKKβ and NEMO. Treatment with IKK-16, an IKKα/β inhibitor, significantly diminished UVB-Poly I:C-induced IκBα degradation and thus apoptosis. Silencing either IKKα or NEMO but not IKKβ with corresponding siRNA inhibited apoptosis. Tumor repressor p73, a homologue of p53, is reported to mediate IKKα-induced apoptosis in DNA damage response. Silencing p73 reduced cell apoptosis in UVB-Poly I:C-treated HaCaT cells. In summary, UVB and Poly I:C co-treatment activates IKKα and NEMO, which diminishes anti-apoptotic IκBα, resulting in enhancement of apoptosis through p73. The findings partially clarify the possible molecular mechanism of pro-apoptotic NF-κB pathway activated by TLR3 in the fate of UVB-irradiated epidermis.

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Nasal Blowing Induces Subcutaneous Emphysema Post Penetrating Mastoid Tip Trauma

Publication date: Available online 13 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yehuda Schwarz, Ala'a Hamdan, Jean Yves Sichel, Pierre Attal

Abstract

We describe the case of a child with an isolated penetrating trauma to the mastoid tip. Nasal blowing consequently induced air bubbles coming through the mastoid cutaneous fistula and causing extensive subcutaneous neck emphysema. A computed tomography (CT) demonstrated a right mastoid tip bone fracture with extensive cervical subcutaneous emphysema. The patient was treated conservatively with antibiotics and did not require operative intervention. His subsequent course was uncomplicated. This case emphasizes the importance of taking seriously even what seems to be a minor skin laceration.

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Pediatric acquired subglottic stenosis: Associated costs and comorbidities of 7,981 hospitalizations

Publication date: Available online 13 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Khashayar Arianpour, Suzanne N. Forman, Patrick Karabon, Prasad John Thottam

Abstract

Objectives

Numerous risk factors have been characterized for acquired subglottic stenosis (ASGS) in the pediatric population. This analysis explores the comorbidities of hospitalized ASGS patients in the United States and associated costs and length of stay (LOS).

Methods

A retrospective analysis of the Kids' Inpatient Database (KID) from 2009 to 2012 for inpatients ≤ 20 years of age who were diagnosed with ASGS. International Classification of Diseases, Clinical Modification, Version 9 diagnosis codes were used to extract diagnoses of interest from 14, 045, 425 weighted discharges across 4179 hospitals in the United States. An algorithm was created to identify the most common co-diagnoses and subsequently evaluated for total charges and LOS.

Results

ASGS was found in 7981 (0.06%) of total discharges. The mean LOS in discharges with ASGS is 13.11 days while the mean total charge in discharges with ASGS is $114,625; these values are significantly greater in discharges with ASGS than discharges without ASGS. Patients with ASGS have greater odds of being co-diagnosed with gastroesophageal reflux, Trisomy 21, other upper airway anomalies and asthma, while they have lower odds of being diagnosed with prematurity and dehydration. Aside from Trisomy 21 and asthma, hospitalizations of ASGS patients with the aforementioned comorbidities incurred a greater LOS and mean total charge.

Conclusion

Our analysis identifies numerous comorbidities in children with ASGS that are associated with increased resource utilization amongst US hospitalizations. The practicing otolaryngologist should continue to advocate interdisciplinary care and be aware of the need for future controlled studies that investigate the management of such comorbidities.

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Relationship between Obstructive Sleep Apnea and Difficulty of Anesthesia Induction in Children Undergoing Tonsillectomy

Publication date: Available online 13 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Sarah B. Jacob, Guerin M. Smith, Whitney N. Rebholz, Elizabeth D. Cash, Sasi R. Kalathoor, Julie L. Goldman, Swapna K. Chandran

Abstract

OBJECTIVE

To determine whether anesthesiologists need to rely on polysomnography (PSG) when predicting need for airway intervention during induction in patients with sleep-disordered breathing (SDB).

METHODS

Prospective case-control observational study at a tertiary care pediatric hospital. Children between the ages of 2-17 undergoing tonsillectomy were divided into three groups: those presenting with OSA observed by history and/or physical examination alone (SDB; n=33), those with OSA determined by preoperative PSG (OSA; n=32), and a control group (n=35) undergoing tonsillectomy for recurrent tonsillitis. An anesthesiologist ranked each case on the level of intervention required to maintain ventilation.

RESULTS

Age, height and BMI were associated with greater induction difficulty (r's>.225, p's<.025). Compared to controls, induction difficulty was significantly greater for the SDB group (mean difference=-.751, 95% confidence interval [CI]=-1.241, -.261, p=.003), but not for the OSA group (p=.061). No significant difference in induction difficulty was observed between SDB and OSA groups. In a subgroup analysis of the OSA group, an apnea-hypopnea index (AHI) >10 correlated with increased level of intervention during induction (r=.228, p=.022). Race was also associated with AHI >10 (odds ratio=3.859, 95% CI=1.485, 10.03, p=.006).

CONCLUSION

Children with OSA undergoing tonsillectomy require more airway intervention during induction than children with recurrent tonsillitis. Age and BMI were correlated with greater induction difficulty, suggesting that PSG data be considered in light of these clinical characteristics to ensure an optimal postoperative course for children undergoing tonsillectomy.

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Failure to Accurately Disclose Conflicts of Interest in Article Published in JAMA Otolaryngology-Head & Neck Surgery.

Failure to Accurately Disclose Conflicts of Interest in Article Published in JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 26;:

Authors: Baselga J

PMID: 30422229 [PubMed - as supplied by publisher]

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Caries, antemortem tooth loss and tooth wear observed in indigenous peoples and Russian settlers of 16th to 19th century West Siberia

Publication date: Available online 14 November 2018

Source: Archives of Oral Biology

Author(s): Hyejin Lee, Jong Ha Hong, Yeonwoo Hong, Dong Hoon Shin, Sergey Slepchenko

Abstract

Objective

Increased prevalence of dental caries evidently is correlated with increasing intake of sugar and carbohydrate-rich foods. Preceding and accompanying this dietary alteration might have been a shift from a hunting-and-gathering subsistence strategy to one based on agriculture. We corroborated this conjecture by means of a study on the prevalence of caries, antemortem tooth loss (AMTL) and tooth wear among 16^th to 19^th century hunter-gatherers and agriculturalists who co-existed in West Siberia.

Design

Indigenous skeletons (n = 75) exhumed from Tatar, Selkup, Khant, and Nenet graves along with Russian settler skeletons (n = 79) from Izyuk were examined. The prevalence of caries, AMTL and tooth wear among the indigenous peoples were compared with those among the Russian settlers. The resulting statistical inferences were tested using package R.

Results

The agriculturalist Russian settlers showed a significantly higher prevalence of dental caries (11.88%) than did the non-agriculturalist indigenous Siberian people (3.85%). Among the latter, the prevalence was the lowest in the Khanty and the highest in the Tatars, suggesting that caries differently affected each sub-group of indigenous Siberian people. Correspondingly to the case of dental caries, the Russian settlers' AMTL prevalence also was higher than that of the indigenous Siberians, regardless of age. On the other hand, the native Siberians and the Russian settlers did not show statistical differences in tooth wear.

Conclusion

In the study on 16^th to 19^th century West Siberian populations, we were able to corroborate our presumption that agriculturalists ingesting a carbohydrate-rich diet would have higher rates of dental caries and AMTL than would hunter-gatherers.

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Missing Conflict of Interest Disclosure.

Missing Conflict of Interest Disclosure.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 26;:

Authors:

PMID: 30422227 [PubMed - as supplied by publisher]

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Characterizing the Normative Voice Tremor Frequency in Essential Vocal Tremor.

Characterizing the Normative Voice Tremor Frequency in Essential Vocal Tremor.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 25;:

Authors: Paige C, Hopewell BL, Gamsarian V, Myers B, Patel P, Garrett CG, Francis DO

Abstract
Importance: Essential vocal tremor (EVT) is a neurologic voice disorder characterized by periodic fluctuations in pitch and loudness that can hinder intelligibility. Defining the normative range of vocal tremor frequency may assist in diagnosis and provide insight into disease mechanisms.
Objective: To characterize the normative voice tremor frequency in EVT (in hertz).
Design, Setting, and Participants: Cross-sectional observational study of 160 patients with EVT. The setting was a tertiary voice center. Participants were identified from a database of consecutive patients diagnosed as having laryngeal movement disorders between January 1, 1990, and April 1, 2017.
Main Outcomes and Measures: The following 3 methods measured the frequency of tremor experienced by patients with EVT: perceptual method, computerized peak detection method, and laryngeal electromyography method. Within-person and population-level tremor frequencies were compared across modalities to assess measurement reliability and consistency and to characterize the normal distribution of tremor frequencies in this population.
Results: Among 160 participants (median age, 70 years; interquartile range [IQR], 64-77 years; 90.6% female [n = 145]), the median frequency of EVT was consistently between 4 and 5 Hz across all 3 methods (perceptual, 4.8 Hz [IQR, 4.4-5.5 Hz]; computerized peak detection, 4.6 Hz [IQR, 4.2-5.0 Hz]; and laryngeal electromyography, 4.3 Hz [IQR, 3.8-5.0 Hz]). The mean in-person differences between each measurement method were not clinically meaningful (range, 0.1-0.5 Hz). Including all interquartile ranges across measurement modalities, the normative tremor frequency range for EVT was 3.8 to 5.5 Hz.
Conclusions and Relevance: To our knowledge, this is the largest study to date to characterize the normal frequency of tremor in patients with EVT. The normative frequency of EVT (range, 3.8-5.5 Hz) falls within a much narrower range than previously reported. Those whose frequency is outside this range may still have EVT but should be carefully evaluated for potential other causes of vocal tremor. Defining characteristics of EVT may aid appropriate diagnosis and improve understanding of this disease.

PMID: 30422171 [PubMed - as supplied by publisher]

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Opioid Prescribing Practice and Needs in Thyroid and Parathyroid Surgery.

Opioid Prescribing Practice and Needs in Thyroid and Parathyroid Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 25;:

Authors: Shindo M, Lim J, Leon E, Moneta L, Li R, Quintinalla-Diek L

Abstract
Importance: In recent years, the medical community's inadvertent contribution to opioid addiction has been recognized.
Objective: To determine the opioid prescribing practices and opioid needs for patients undergoing thyroid and parathyroid surgery to help reduce postoperative opioid administration.
Design, Setting, and Participants: This retrospective cohort study included 1788 opioid-naive patients who underwent thyroid and parathyroid surgery from January 1, 2012, through December 31, 2017, at the high-volume academic endocrine surgery center at Oregon Health and Sciences University. Patients with long-term opioid treatment and those who underwent other head and neck procedures or robotic thyroidectomy were excluded. For analysis, 1765 procedures were available (723 parathyroidectomy, 400 hemithyroidectomy, and 642 total thyroidectomy).
Main Outcomes and Measures: The quantity of prescribed opioids was determined in morphine milligram equivalents (MME). Opioid refill data after discharge were also analyzed. Patients were then divided into past (1336 in group 1 [January 1, 2012, to September 30, 2016]) and current (429 in group 2 [October 31, 2016, to December 31, 2017]) prescribing practices. For each procedure, the mean quantity prescribed for each group, difference between the means, 95% CI for the difference, and effect size were calculated.
Results: A total of 1702 patients (80.0% female [n = 1361]; mean age, 51.2 years [range, 7-97 years]) undergoing 1765 procedures were included in the analysis. For parathyroidectomy, the mean (SD) opioid quantity prescribed was 176.20 (86.66) MME in group 1 vs 80.08 (74.43) MME in group 2 (effect size, 1.139); for hemithyroidectomy, 204.65 (112.24) MME in group 1 vs 112.24 (102.31) MME in group 2 (effect size, 0.842); and for total thyroidectomy, 214.87 (161.09) MME for group 1 vs 102.29 (87.72) MME for group 2 (effect size, 0.754). In the last quarter of 2017, the numbers of patients discharged without any opioid prescription were 15 of 26 (57.5%) for parathyroidectomy, 12 of 32 (37.5%) for hemithyroidectomy, and 9 of 27 (33.3%) for total thyroidectomy. Patient calls requesting pain medications for group 2 were similar or fewer, depending on the procedure. Those who were prescribed less than 75.0 MME postoperatively did not call for additional opioid prescriptions.
Conclusions and Relevance: Our study suggests that patients undergoing thyroid and parathyroid surgery need little, if any, postoperative opioids.

PMID: 30422170 [PubMed - as supplied by publisher]

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Reduction of Opiates for Ambulatory Surgery-Endocrine Surgeons at the Cutting Edge.

Reduction of Opiates for Ambulatory Surgery-Endocrine Surgeons at the Cutting Edge.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 25;:

Authors: Stack BC, Lide RC

PMID: 30422168 [PubMed - as supplied by publisher]

https://ift.tt/2Ps91og

Aggressive-Appearing Intratracheal Mass in an Older Woman.

Aggressive-Appearing Intratracheal Mass in an Older Woman.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 25;:

Authors: Roche AM, Griffin MJ, Urken ML

PMID: 30422150 [PubMed - as supplied by publisher]

https://ift.tt/2zU5ofU

Caries, antemortem tooth loss and tooth wear observed in indigenous peoples and Russian settlers of 16th to 19th century West Siberia

Publication date: Available online 14 November 2018

Source: Archives of Oral Biology

Author(s): Hyejin Lee, Jong Ha Hong, Yeonwoo Hong, Dong Hoon Shin, Sergey Slepchenko

Abstract

Objective

Design

Results

Conclusion

https://ift.tt/2DHmvWO

Diagnosis, Clinical Trend, and Treatment of Diffuse Lamellar Keratitis after Femtosecond Laser-Assisted in situ Keratomileusis: A Case Report

We report a severe case of diffuse lamellar keratitis (DLK) following femtosecond laser-assisted in situ keratomileusis (femto-LASIK). A 25-year-old man was submitted to 150 kHz iFS® IntraLase-assisted LASIK in both eyes for compound myopic astigmatism. The day after surgery, clinical examination showed a diffuse whitish granular cell reaction particularly in the right eye. High-dose dexamethasone eyedrops with topical antibiotic and artificial tears were prescribed. Five days after surgery, a central corneal opacity with convergent striae was detected at biomicroscopy. The suspicion of DLK was confirmed. Additional therapy based on hyperosmolar ophthalmological solution, oral doxycycline, and topical 10% sodium citrate was prescribed. Treatment was continued and tapered for over 3 months. Improvement in corneal transparency were obtained 2 weeks after the systemic therapy had been started. Uncorrected visual acuity improved from 20/32 to 20/20 at 1-year follow-up. DLK represents an infrequent complication after femto-LASIK. It should resolve without sequelae if promptly diagnosed and treated, without necessity of corneal flap lifting.
Case Rep Ophthalmol 2018;9:457–464

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The role of genetics in the current diagnostic workup of idiopathic non‐histaminergic angioedema

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Novel cytokine and chemokine markers of hidradenitis suppurativa reflect chronic inflammation and itch

https://ift.tt/2DlsFuE

The hyper IgM syndromes: Epidemiology, pathogenesis, clinical manifestations, diagnosis and management

Publication date: Available online 13 November 2018

Source: Clinical Immunology

Author(s): Reza Yazdani, Saba Fekrvand, Sepideh Shahkarami, Gholamreza Azizi, Bobak Moazzami, Hassan Abolhassani, Asghar Aghamohammadi

Abstract

Hyper Immunoglobulin M syndrome (HIGM) is a rare primary immunodeficiency disorder characterized by low or absent levels of serum IgG, IgA, IgE and normal or increased levels of serum IgM. Various X-linked and autosomal recessive/dominant mutations have been reported as the underlying cause of the disease. Based on the underlying genetic defect, the affected patients present a variety of clinical manifestations including pulmonary and gastrointestinal complications, autoimmune disorders, hematologic abnormalities, lymphoproliferation and malignancies which could be controlled by multiple relevant therapeutic approaches. Herein, the epidemiology, pathogenesis, clinical manifestations, diagnosis, management, prognosis and treatment in patients with HIGM syndrome have been reviewed.

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Association of anti-nuclear matrix protein 2 antibody with complications in patients with idiopathic inflammatory myopathies: A meta-analysis of 20 cohorts

Publication date: Available online 13 November 2018

Source: Clinical Immunology

Author(s): Linqing Zhong, Zhongxun Yu, Hongmei Song

Abstract

Background

Several complications like calcinosis, interstitial lung disease (ILD) or malignancy, are primary causes leading to poor outcomes in idiopathic inflammatory myopathies (IIM) patients. Specific antibodies might help to indicate the occurrence or absence of these complications.

Objective

The aim of this study was to evaluate the association of anti-nuclear matrix protein 2 antibody (anti-NXP2) with calcinosis, ILD and malignancy in IIM patients.

Methods

Two investigators independently searched literature about the relation of anti-NXP2 with calcinosis, ILD, malignancy in IIM patients in PubMed, EMBASE, Web of Science databases, then selected eligible articles and extracted data from the included studies. The association between anti-NXP2 and these complications was assessed by odds ratios (OR) and 95% confidence intervals (95% CI). Further quantitative meta-analysis, subgroup analysis, sensitivity analysis and publication bias analysis were conducted with STATA 14.0 software (Stata Corp.; College Station, Texas, USA). A fixed-effects model (the Mantel-Haenszel method) was employed when I² < 25%, otherwise a random-effects model (the Mantel-Haenszel method) was used.

Results

Twenty cohorts with 3064 IIM patients were included in this meta-analysis, among which 9 were about calcinosis in adults, 6 about calcinosis in juvenile patients, 9 about ILD in adults, 3 about ILD in juvenile patients, while 13 about malignancy in adult patients. Anti-NXP2 was more common in patients with calcinosis than those without calcinosis (pooled OR = 4.00, 95% CI: 2.65–6.06 in adults; pooled OR = 1.62, 95% CI: 1.14–2.30 in juvenile patients). On the contrary, this antibody was less common in adult patients with ILD than those without ILD (pooled OR: 0.33, 95% CI: 0.19–0.56). No significant difference concerning the incidence of anti-NXP2 antibody was found in IIM patients between those with and without cancer (pooled OR = 1.42, 95% CI: 0.69–2.91).

Conclusion

The present study indicates that anti-NXP2 autoantibody is a risk factor for development into calcinosis both in adult and juvenile patients, while a protective factor for ILD in adult patients. Anti-NXP2 had no relation with malignancy in adult patients.

https://ift.tt/2DmuNT9

Is there a role for PRF with simvastatin in stage I osteoradionecrosis?

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Mohan Baliga, Subhagata Chakraborty, Thushara Kumari, Dani Mihir Tusharbhai, Souvick Sarkar

https://ift.tt/2RYSMvN

Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): John D. Cramer, Robert L. Ferris, Seungwon Kim, Umamaheswar Duvvuri

Abstract

Objectives

Human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a unique form of head and neck cancer with improved prognosis. We assessed survival for stage I patients with low- or intermediate-risk pathologic features with surgery alone compared with surgery with adjuvant radiation (RT) or chemoradiation (CRT).

Materials and methods

We identified patients with stage I HPV+ OPSCC (after restaging with 8th edition staging system) treated with surgery alone, adjuvant RT or CRT in the National Cancer Data Base from 2010 to 2013. We compared survival for low-risk patients (≤1 metastatic lymph nodes with no adverse features) and intermediate-risk patients (2–4 metastatic lymph nodes, microscopic extranodal extension (ENE) or lymphovascular invasion).

Results

We examined 1677 patients with median follow-up of 43.9 months. In the intermediate-risk group, 4-year overall survival was 94.0% with surgery alone, 91.5% with adjuvant RT and 92.0% with adjuvant CRT (p = 0.72). There were similar rates of overall survival in the low-risk group. In multivariable models accounting for clinicopathologic differences the dose of adjuvant RT was not associated with mortality. On Cox proportional hazard modeling, adjuvant RT (HR 0.94; CI 0.43–2.08) or CRT (HR 0.96; CI 0.45–2.11) did not significantly improved survival compared with surgery alone in the intermediate-risk group (reference). Similar results were seen in the low-risk group. The composite number of pathologic risk features significantly improved risk stratification.

Conclusion

We provide observational evidence that adjuvant RT or CRT does not provide a survival benefit for stage I HPV+ OPSCC with low- or intermediate-risk pathologic features.

https://ift.tt/2DHie5I

Cost-effectiveness of diagnostic algorithms for peanut allergy in children

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Natalia R. Kunst, Helene Lindvik, Kai-Håkon Carlsen, Geir Håland, Eivind Jørgensen, Karin C. Lødrup Carlsen

https://ift.tt/2FhbnBw

Transcriptional and Functional Diversity of Human Macrophage Repolarization

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Sina A. Gharib, Ryan S. McMahan, William E. Eddy, Matthew E. Long, William C. Parks, Moira L. Aitken, Anne M. Manicone

Abstract

Background

Macrophage plasticity allows cells to adopt different phenotypes, a property with important implications in disorders such as cystic fibrosis (CF) and asthma.

Objective

To examine the transcriptional and functional significance of macrophage repolarization from an "M1" towards an "M2" phenotype, and assess the role of a common human genetic disorder (CF) and a prototypical allergic disease (asthma) in this transformation.

Methods

Monocyte-derived macrophages were collected from healthy and CF subjects and polarized to an M2 state using IL-4, IL-10, glucocorticoids, apoptotic PMNs, or azithromycin. We performed transcriptional profiling and pathway analysis for each stimulus. We assessed the ability of M2-repolarized macrophages to respond to LPS re-challenge and clear apoptotic neutrophils, and used murine models to determine conserved functional responses to IL-4 and IL-10. We investigated whether M2 signatures were associated with alveolar macrophage phenotypes in asthma.

Results

We found that macrophages exhibit highly diverse responses to distinct M2-polarizing stimuli. Specifically, IL-10 activated pro-inflammatory pathways and abrogated LPS-tolerance allowing for rapid restoration of LPS responsiveness. In contrast, IL-4 enhanced LPS-tolerance, dampening pro-inflammatory responses after repeat LPS challenge. A common theme observed across all M2 stimuli was suppression of interferon-associated pathways. We found that CF macrophages had intact reparative and transcriptional responses, suggesting that macrophage contributions to CF lung disease are primarily shaped by their environment. Finally, we leveraged in vitro-derived signatures to show that allergen provocation induces distinct M2-state transcriptional patterns in alveolar macrophages.

Conclusion

Our findings highlight the diversity of macrophage polarization, attribute functional consequences to different "M2" stimuli, and provide a framework to phenotype macrophages in disease states.

Graphical abstract

Graphical abstract for this article

https://ift.tt/2qJsUIu

Ordinary vibratory angioedema is not generally associated with ADGRE2-mutation

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Zuotao Zhao, Sascha Reimann, Shan Wang, Yuhan Wang, Torsten Zuberbier

https://ift.tt/2FmOgWk

Histologic similarities in children with eosinophilic esophagitis and PPI-responsive esophageal eosinophilia

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Nathalie Nguyen, Anna Baumgarten, Benjamin L. Wright, Kelley E. Capocelli, Zhaoxing Pan, James J. Lee, Glenn T. Furuta, Joanne C. Masterson

https://ift.tt/2qIutXa

Nasal Allergen Neutralising IgG4 Antibodies Block IgE-mediated Responses: Novel biomarker of Subcutaneous Grass Pollen Immunotherapy

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Mohamed H. Shamji, Jasper Kappen, Hisham Abubakar-Waziri, Jinjin Zhang, Esther Steveling, Shelley Watchman, Lubna Kouser, Aarif Eifan, Amy Switzer, Gilda Varrichi, Gianni Marone, Natália C. Couto-Francisco, Moises Calderon, Stephen R. Durham

Abstract

Background

Grass pollen subcutaneous immunotherapy (SCIT) is associated with induction of serum IgG₄-associated inhibitory antibodies that prevent IgE-facilitated allergen binding to B cells.

Objective

To determine whether SCIT induces nasal allergen-specific IgG₄ antibodies with inhibitory activity that correlate closely with clinical response.

Methods

In a cross-sectional, controlled study, nasal fluid and sera were collected during the grass pollen season from 10 SCIT-treated patients, 13 untreated allergics (SAR) and 12 non-atopic controls (NA). Nasal and serum IgE and IgG₄ to Phleum pratense (Phl p) components were measured by ISAC microarray. Inhibitory activity was measured by IgE-FAB assay. IL-10⁺Breg cells were quantified in peripheral blood by flow cytometry.

Results

Nasal and serum Phl p1 and Phl p5-specific IgE levels were elevated in SAR compared to NA (all, P < .001) and SCIT group. Nasal IgG₄ levels were increased in SCIT compared to SAR group (P < .001) during the pollen season compared to out of season. IgG-associated inhibitory activity in nasal fluid and serum was significantly increased in SCIT compared to SAR group (both, P < .001). The magnitude of the inhibitory activity was 96% in the nasal fluid compared to 66% in serum and was reversed following depletion of IgG in nasal fluid (P = .03) and serum (P = .002). Both nasal fluid (r = -0.67, P = .0011) and serum (r = -0.59, P = .0097) blocking activity correlated global symptom improvement. IL-10⁺Breg cells were increased in season compared to out of season in SCIT group (P < .01).

Conclusion

For the first time, we show that nasal IgG₄-associated inhibitory activity correlate closely with the clinical response to allergen immunotherapy in allergic rhinitis with/without asthma.

Graphical abstract

Graphical abstract for this article

https://ift.tt/2FmqGZT

The Expression and Function of the Ectopic Olfactory Receptor OR10G7 in Atopic Dermatitis

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Elizabeth Huiwen Tham, Nathan Dyjack, Byung Eui Kim, Cydney Rios, Max A. Seibold, Donald YM. Leung, Elena Goleva

Abstract

Background

Ectopic olfactory receptors (OR) are found in the skin but their expression and biological functions in normal skin and atopic dermatitis (AD) are unknown.

Objectives

To characterize the expression of ORs in the skin and assess OR-mediated biological responses of primary human keratinocytes in the presence of odorant ligands.

Methods

OR expression was examined by whole transcriptome sequencing of skin tape strips collected from AD and healthy controls (NC). OR10G7 and FLG-1 expression were analyzed by RT-PCR and immunostaining in AD and NC skin biopsies and primary human keratinocytes. ATP and cyclic AMP production by control and OR10G7 siRNA transfected keratinocytes in response to odorant stimulation with acetophenone and eugenol were assessed.

Results

A total of 381 OR gene transcripts were detected in the skin samples, with the greatest OR expression detected in the skin tape strips, corresponding to the upper granular layer of the skin. OR10G7 expression was significantly increased in AD compared to NC skin biopsies (p=0.01) and inversely correlated with FLG-1 expression (p=0.009). OR10G7 expression was highest in undifferentiated AD keratinocytes and was down-regulated with progressive differentiation. Primary human keratinocytes produced ATP, an essential neurotransmitter in sensory pathways, in response to acetophenone and eugenol, odorants previously identified as potential ligands for this receptor. This response was abolished in OR10G7 siRNA-transfected keratinocytes.

Conclusions

OR10G7 is expressed at significantly higher levels in undifferentiated AD keratinocytes compared to normal controls. OR10G7 is likely involved in the transmission of skin-induced chemosensory responses to odorant stimulation, which may modulate differential nociceptive responses in AD skin.

https://ift.tt/2qIulXG

Selection of house dust mite allergic patients by molecular diagnosis may enhance success of specific immunotherapy

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Kuan-Wei Chen, Petra Zieglmayer, René Zieglmayer, Patrick Lemell, Friedrich Horak, Carmen Panaitescu Bunu, Rudolf Valenta, Susanne Vrtala

Summary

AIT performed with HDM extracts inducing IgG antibodies only to Der p 1 and 2 was beneficial for patients sensitized exclusively to these allergens but not for patients with sensitization to other HDM allergens.

https://ift.tt/2FltBBQ

Shedding light on corticosteroid-resistant Type-2 high severe asthma

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Kian Fan Chung

https://ift.tt/2qN7zOs

Lab-on-a-Chip Technologies for Diagnosis and Monitoring of Airway Inflammation

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Mehdi Javanmard

https://ift.tt/2DBMsan

Immunologic reconstitution following hematopoietic stem cell transplantation despite lymph node paucity in NIK deficiency

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Khaoula Ben Farhat, Mohammed F. Alosaimi, Hiba Shendi, Suleiman Al-Hammadi, Jennifer Jones, Klaus Schwarz, Ansgar Schulz, Laila S. Alawdah, Sandra Burchett, Sultan Albuhairi, Jennifer Whangbo, Neha Kwatra, Hanan E. Shamseldin, Fowzan S. Alkuraya, Janet Chou, Raif S. Geha

https://ift.tt/2RR8lFv

Remission of persistent childhood asthma: early predictors of adult outcomes

Publication date: Available online 14 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Alberta L. Wang, Soma Datta, Scott T. Weiss, Kelan G. Tantisira

Abstract

Background

Few data exist on the predictors of asthma remission by early adulthood in North America.

Objective

The predictors of adult asthma remission were determined in a multiethnic population of mild-to-moderate persistent childhood asthmatics.

Methods

Asthma remission in early adulthood was measured using two definitions, a clinical and a strict definition. Both included normal lung function and the absence of symptoms, exacerbations, and medication use. The strict definition also included normal airways responsiveness. Predictors were identified from 23 baseline measures using multivariate logistic regression. The probability of remission was modeled using decision tree analysis.

Results

In 879 subjects, mean baseline age was 8.8 years (SD ± 2.1), 59.4% were males, and 68.7% were Caucasian. By adulthood, 229 (26.0%) of 879 participants were in clinical remission and 111 (15.0%) of 741 participants were in strict remission. The degree of forced expiratory volume in one second to forced vital capacity (FEV₁/FVC) impairment was the largest predictor of asthma remission. Over half of boys and two-thirds of girls with baseline FEV₁/FVC ≥ 90% were in remission at adulthood. Decreased airways responsiveness was also a predictor for both remission definitions (clinical remission OR 1.23, 95% CI 1.09-1.39; strict remission OR 1.52, 95% CI 1.26-1.84). The combination of normal FEV₁/FVC, airways responsiveness, and serum eosinophil count at baseline yielded > 80% probability of remission by adulthood.

Conclusion

A considerable minority of persistent childhood asthmatics will develop disease remission by adulthood. Clinical prognostic indicators of asthma remission, including baseline lung function, can be seen from an early age.

Graphical abstract

Graphical abstract for this article

https://ift.tt/2DDYLmA

Social Media and Allergy

Abstract

Purpose of Review

Social media services dominate online consumption of information and play an ever expanding role in our lives. They are not only used to connect with friends and family but also to educate and recruit colleagues and patients, and to stay up-to-date with the new developments in the field of allergy and immunology.

Recent Findings

There are known risks to social media user by health care professionals mostly related to breaches of patient confidentiality, professionalism, and privacy. Malpractice and liability risks have been linked to irresponsible use of social media.

Summary

This review provides a comprehensive overview of the current social media tools in allergy. We recommend a pragmatic approach to maximize social media tools for the allergy practice.

https://ift.tt/2RU5DyX

Lebensqualität bei Patientinnen mit Ovarialkarzinom

Zusammenfassung

Fortschritte der chirurgischen und systemischen Therapien des Ovarialkarzinoms haben die Überlebenszeiten von Patientinnen verlängert und den Fokus auf deren Lebensqualität (LQ) erhöht. Die Berücksichtigung von Patient Reported Outcomes (PROs) als primäre oder sekundäre Endpunkte in klinischen Ovarialkarzinomstudien ist in den letzten Jahren deutlich angestiegen. Für die Messung von PROs stehen standardisierte Instrumente zur Verfügung, die speziell für Patientinnen mit Ovarialkarzinom entwickelt wurden. PRO-Instrumente sind mittels internetbasierter Erfassungsmethoden als ePROs verfügbar und weniger zeit- und kostenintensiv. Klinische Studienergebnisse mit PRO-Endpunkten haben in der Behandlung des Ovarialkarzinoms zur Veränderung des international anerkannten Therapiestandards geführt. Auf Grundlage der Daten wurden Carboplatin plus Paclitaxel weltweit als neuer Standard der Primärtherapie des fortgeschrittenen Ovarialkarzinoms festgelegt. Eine weitere Individualisierung der Therapie unter Berücksichtigung der LQ von Patientinnen konnte in der späten Rezidivsituation des Ovarialkarzinoms ermöglicht werden. Neben klinischen Studien finden PROs zunehmend auch in der klinischen Routine Eingang. Die Mehrheit onkologischer Patienten befürwortet die routinemäßige Erfassung der LQ. PRO-Daten geben wichtige Information über die subjektive Auswirkung der Erkrankung und der Therapie auf die LQ der Patientinnen, können für gemeinsame Therapieentscheidungen herangezogen werden und Behandlungsoptionen an die Bedürfnisse der Patientinnen anpassen.

https://ift.tt/2PsDvGr

Neue Behandlungsoptionen bei Gliomen

Zusammenfassung

Hintergrund

Patienten mit Gliomen profitieren bereits jetzt − v. a. in molekular definierten Untergruppen (IDH-Mutation, 1p/19q-Kodeletion; IDH: Isocitrat-Dehydrogenase) − von den Standardtherapien. MGMT (O6-Methylguanin-DNA-Methyltransferase) ist der einzige relevante Biomarker für eine Therapieentscheidung pro oder kontra alkylierende Chemotherapie.

Fragestellung

Im aktuellen Übersichtsartikel sollen neue Konzepte der Immuntherapie der zielgerichteten Therapie und der Tumortherapiefelder für die Gliombehandlung diskutiert werden.

Ergebnisse

In den letzten Jahren sind Studienkonzepte und molekular zielgerichtete Behandlungen in Studien für Patienten mit IDH-Mutationen, Endothelial-Growth-Factor-Receptor(EGFR)-Überexpression, EGFRvIII-Expression, aber auch anderen definierten molekularen Läsionen im Tumorgewebe entwickelt worden. Aktuelle Therapiestudien übertragen diese in auf einzelne Biomarker ausgerichtete Studien in sog. Umbrella-Konzepte. In diesen Umbella-Konzepten werden verschiedene Therapiearme mit jeweils molekular zielgerichteten Therapien basierend auf Biomarkertests untersucht. Hauptergebnisse dieser Studien sollten neben möglicherweise profitierenden Patienten Kenntnisse über Wirk- bzw. Resistenzmechanismen der untersuchten Therapien sein. Ähnliche Untersuchungen werden für Immuntherapie mit noch sehr variablen Ansätzen der Checkpointinhibition auf der einen Seite und verschiedener Vakzinierungsverfahren einschließlich der Nutzung von CAR-Zellen (chimäre Antigenrezeptor-T-Zellen) auf der anderen Seite untersucht.

Schlussfolgerungen

Elektrische Wechselfelder stehen als eine Therapieoption für Patienten mit neu diagnostizierten Glioblastomen nach erfolgreichem Abschluss der Radiochemotherapie zur Verfügung.

https://ift.tt/2QF8trB

Social Media and Allergy

Abstract

Purpose of Review

Recent Findings

Summary

This review provides a comprehensive overview of the current social media tools in allergy. We recommend a pragmatic approach to maximize social media tools for the allergy practice.

https://ift.tt/2RU5DyX

Obstructive sleep apnoea and hypoventilation in an adult with congenital myasthenic syndrome

In this case report, we describe an adult male with congenital myasthenic syndrome due to mutations in muscle-specific receptor tyrosine kinase (MuSK, c.79+2 T>G; IVS1 +2 T>G, c.2368 G>A, Val790Met) presenting with sleep apnoea and hypercapnic respiratory failure. In the intensive care unit, he required intubation followed by tracheostomy which resolved obstructive sleep apnoea. Later, due to persistent sleep-associated hypoventilation, he required nocturnal mechanical ventilation. His case illustrates how respiratory muscle weakness due to mutations in MuSK can lead to various forms of sleep disordered breathing.

https://ift.tt/2QEPE7N

Parry-Romberg syndrome in a patient with scleroderma

Parry-Romberg syndrome (PRS) is characterised by progressive but self-limiting facial hemiatrophy. We describe a 48-year-old woman with a 3-year history of gradually worsening right facial hemiatrophy on a background of scleroderma. Her initial primary concern was alopecia. Within the last year, there was greater prominence of her right zygoma and hyperpigmentation on her forearms and left neck. She also had worsening headaches and neck stiffness in the mornings. A clinical diagnosis of PRS was made and she was subsequently treated with a course of methotrexate. She is due to be followed up by dermatology, rheumatology and maxillofacial surgery with the aim of reconstructive surgery once her symptoms stabilise.

https://ift.tt/2PwEKVq

An atypical presentation of an ovarian lymphoma: a case report

Ovarian lymphoma has a varied clinical presentation and rarely presents with heavy menstrual bleeding. It may occur de novo or secondary to systemic disease and macroscopically appear as solid ovarian tumors.

https://ift.tt/2PVa9A5

Oxygenated UW solution decreases ATP decay and improves survival after transplantation of DCD liver grafts

Background DCD liver grafts are known to be predisposed to primary nonfunction and ischemic cholangiopathy. Many DCD grafts are discarded because of older donor age or long warm ischemia times. Thus, it is critical to improve the quality of DCD liver grafts. Here, we have tested whether an enriched oxygen carrier added to the preservation solution can prolong graft survival and reduce biliary damage. Methods We assessed the ATP content decay of mouse liver grafts after cold ischemia, warm ischemia, and combined warm+cold ischemia. In addition, we used a rat model of liver transplantation to compare survival of DCD grafts preserved in high-oxygen solution (pre-oxygenated PFC+UW solution) vs. lower-oxygen solution (pre-oxygenated UW solution). Results ATP levels under UW preservation fall to less than 10% after 30 min of warm ischemia. Pre-oxygenated UW solution with PFC reached a significantly higher PaO2. After 45min of warm ischemia in oxygenated UW+PFC solution, grafts showed 63% higher levels of ATP (p=0.011). In addition, this was associated with better preservation of morphology when compared to grafts stored in standard UW solution. Animals that received DCD grafts preserved in higher oxygenation solution showed improved survival: 4 out of 6 animals survived long-term whereas all control group animals died within 24 hours. Conclusions The additional oxygen provided by PFC during static cold preservation of DCD livers can better sustain ATP levels, and thereby reduce the severity of ischemic tissue damage. PFC-based preservation solution extends the tolerance to warm ischemia, and may reduce the rate of ischemic cholangiopathy. Corresponding author: James F. Markmann MD, PhD, Transplant Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA, 02114, e-mail: jmarkmann@partners.org Authorship 1. Paulo N. Martins and James F. Markmann participated in research design, performance of the research and writing of the paper. 2. Timothy A. Berendsen, Heidi Yeh, Bote G. Bruinsma, Maria-Louisa Izamis, Sanna Op den Dries, Robert Porte, Martin L. Yarmush, and Korkut Uygun participated in performance of the research and writing of the paper. 3. Andrew R. Gillooly participated in writing of the paper. Disclosure The authors declare no conflicts of interest. Funding Departmental grant Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2B5BmYo

Asian Liver Transplant Network Clinical Guidelines on Immunosuppression in Liver Transplantation

Most management guidelines and much of the available clinical trial evidence for immunosuppressants in liver transplantation pertain to Western practice. While evidence from Western studies may not translate to Asian settings, there is a paucity of Asian randomized controlled trials of immunosuppression in liver recipients. Nonetheless, there are notable differences in the indications and procedures for liver transplantation between Western and Asian settings. The Asian Liver Transplant Network (ALTN) held its inaugural meeting in Singapore in November 2016 and aimed to provide an Asian perspective on aspects of immunosuppression following liver transplantation. Because of their importance to outcome following liver transplantation, the meeting focused on: (1) reducing the impact of renal toxicity, (2) hepatocellular carcinoma recurrence and (3) nonadherence with immunosuppressant therapy. Corresponding author: Poh Seng TAN, Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, 1E Kent Ridge Road Tower Block, Level 10, Singapore 119228, DID (+65) 6772-4354; Fax (+65) 6775-1518, Email: poh_seng_tan@nuhs.edu.sg Authorship page Authorship P.S.T., M.D.M., and T.K. are co-first authors with equal contribution to writing the draft of the article. J.F., and K.L. are co-senior authors with equal contribution leading the project. All authors reviewed the draft, provided expertise for critical revisions, and approved the final version of the article. Disclosure P.S.T is a PI of a Novartis sponsored clinical trial (H2307). The other authors declare no conflict of interest. Funding The consensus meeting was supported by the educational grant provided by Novartis and Astellas. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2K1amfP

Αρχειοθήκη ιστολογίου

Τετάρτη 14 Νοεμβρίου 2018

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