Preoperative continuation of aspirin administration in patients undergoing major abdominal malignancy surgery

Abstract

Purpose

In contrast to that in a nonoperative setting, it has been shown that perioperative administration of aspirin did not decrease the rate of death or myocardial infarction but increased major bleeding risk. Since these conflicting results might be due to concurrent use of anticoagulants and a lower thrombotic risk of patients, this cohort study was carried out for patients at a high thrombotic risk without concurrent use of anticoagulants.

Methods

Medical records for patients who underwent major abdominal malignancy surgery and who were on a preoperative antiplatelet regimen were reviewed. The patients were divided into two groups according to perioperative antiplatelet management: administration of all preoperative antiplatelet agent-suspended (no aspirin) group and only aspirin administration-continued (aspirin) group. The incidence of symptomatic thromboembolic events, frequency of exogenous blood transfusion within 30 days after surgery and the amount of intraoperative bleeding were compared between the two groups.

Results

After propensity score matching, 105 patients of each group were matched. The incidence of perioperative thromboembolic events in the no-aspirin group was significantly higher than that in the aspirin group [7/105 (6.7%) vs 0/105 (0%), 95% CI 1.44–∞, P = 0.016]. In contrast, neither the frequency of exogenous transfusion [21.0% vs 11.4%, 95% CI 0.88–4.38 P = 0.110] nor the amount of intraoperative bleeding [median (interquartile range), ml: 230 (70–500) vs 208 (50–500), P = 0.325] was different between the two groups.

Conclusion

Although the sample size is relatively small, our findings suggest that continuation of aspirin administration is likely to reduce the thrombotic risk but unlikely to increase the bleeding risk of patients who undergo major abdominal surgery for malignancy.

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Impact of big data on oral health outcomes

Abstract

Biomedical big data amasses from different sources such as electronic health records, health research, wearable devices and social media. Recent advances in data capturing, storage and analysis techniques have facilitated conversion of a wealth of knowledge in biomedical big data into evidence‐based actionable plans to enhance population health and wellbeing. The delay in reaping the benefits of biomedical big data in dentistry is mainly due to the slow adoption of electronic health record systems, unstructured clinical records, tattered communication between data silos and perceiving oral health as a separate entity from general health. Recent recognition of the complex interplay between oral and general health has acknowledged the power of oral health big data to glean new insights on disease prevention and management. This review paper summarizes recent advances, limitations and challenges in biomedical big data in health care with emphasis on oral health and discusses the potential future applications of oral health big data to improve the quality and efficiency of personalized health care.

This article is protected by copyright. All rights reserved.

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Amputation for osteomyelitis in a patient with spina bifida

Abstract

We describe a case of osteomyelitis in a patient with spina bifida presenting to the vascular surgeon and highlight the complex challenges encountered. We review the literature and demonstrate how good multidisciplinary care and early consideration for surgical amputation may benefit this unique group of patients.

https://ift.tt/2FGcN8U

Syphilis as an atypical cause of perianal fissure

Abstract

We present the case of a 29-year-old woman who attended a surgical outpatient clinic with symptoms of perianal fissure due to syphilitic infection. This uncommon aetiology of a common condition is often alluded to in textbooks, but little information exists in the scientific literature regarding the pathogenesis, presentation and treatment of fissure-in-ano secondary to syphilis. We present the case and an overview of the topic aimed at surgeons and clinicians who manage patients with perianal pathology. Syphilis is far from a disease of antiquity; in patients presenting with fissure-in-ano a thorough sexual history and sexually transmissible infection screening in at-risk groups may avoid mis-diagnosis, community transmission and unnecessary procedures.

https://ift.tt/2r8SrLv

Effects of equibiaxial mechanical stretch on extracellular matrix‐related gene expression in human calvarial osteoblasts

Mechanical stretch commonly promotes craniofacial suture remodeling during interceptive orthodontics. The mechanical responses of osteoblasts in craniofacial sutures play a role in suture remodeling. Moreover, the extracellular matrix (ECM) produced by osteoblasts is crucial for the transduction of mechanical signals that promote cell differentiation. Therefore, we aimed to investigate the effect of mechanical stretch on cell viability and ECM‐related gene‐expression changes in human osteoblasts. Human calvarial osteoblasts (HCObs) were subjected to 2% deformation. Caspase activity, MTT, and cell viability assays were used to estimate osteoblast apoptosis, proliferation, and viability, respectively. Real‐time RT‐PCR (RT²‐PCR) arrays were used to assess expression of cytoskeletal‐, apoptosis‐, osteogenesis‐, and ECM‐related genes. We found that mechanical stretch significantly increased osteoblast viability and cell proliferation, and decreased the activities of caspases 3 and 7. Moreover, the expression of 18 genes related to osteoblast differentiation, apoptosis, and ECM remodeling changed by more than two‐fold in a time‐dependent manner. Therefore, mechanical stretch promotes HCOb viability and alters expression of genes that are closely related to suture remodeling under mechanical stretch.

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Risky Social Media Behaviors and the Potential for Victimization: A Descriptive Look at College Students Victimized by Someone Met Online

Violence and Gender, Ahead of Print.


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Molecular Classification of Thyroid Nodules with Indeterminate Cytology: Development and Validation of a Highly Sensitive and Specific New miRNA-Based Classifier Test Using Fine-Needle Aspiration Smear Slides

Thyroid, Ahead of Print.


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Innominate artery bifurcation pseudoaneurysm repair by “kissing stent-grafts technique”: a case report

We introduce the "kissing stent-grafts technique" for a patient who suffered from a pseudoaneurysm in bifurcation of innominate artery. This technique repaired an innominate artery bifurcation pseudoaneurysm; ...

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Case reports: old-timers and evergreens

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Ergonomic hazards in otolaryngology

Objectives/Hypothesis

To evaluate the presence of postural‐related strain and musculoskeletal discomfort, along with the level of ergonomics training and the availability of ergonomic equipment among otolaryngology surgeons.

Study Design

Intraoperative observations and survey study.

Methods

Using the Rapid Entire Body Assessment score system to identify ergonomic hazards, we conducted intraoperative observations assessing operating room personnel during different otolaryngological subspecialty procedures. Based on these findings, otolaryngology surgeons at a single academic institution in the United States were sent a survey that evaluated ergonomic practice, environmental infrastructure, and prior ergonomic training or education.

Results

A response rate of 69% was obtained from 70 surgeons, with 72.9% of responding surgeons suffering from some level of back pain, with cervical spine pain being the most common. Interestingly, residents were equally affected when compared to more senior surgeons both in subjective survey reports and from observational risk analysis. Furthermore, 43.8% of surgeons reported suffering from the highest level of pain when standing, whereas only 12.5% experienced pain when sitting. Importantly, 10% stated that pain impacted their work. Only 24% of surgeons had any prior ergonomic training or education.

Conclusions

Our data suggest that pain and disability induced by poor ergonomics are widespread among the otolaryngology community and confirm that surgeons rarely receive ergonomic training in the surgical context. Additionally, intraoperative observational findings identified that the majority of observed surgeons display poor posture, particularly a poor cervical angle and use of ergonomic setups, both of which increase ergonomic risk hazard. These data provide guidance for future interventional studies.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2KDt8dy

Isolated Paresis of Laryngeal Adduction: What Are the Laryngoscopic and Stroboscopic Findings?

Objectives/Hypothesis

This study aimed to describe the videolaryngostroboscopic (VLS) findings in a cohort of patients with isolated paresis of laryngeal adduction and identify predictive variables that may be related to voice recovery.

Study Design

Chart review and VLS analysis of dysphonic patients diagnosed with isolated paresis of laryngeal adduction by laryngeal electromyography (LEMG).

Methods

Demographic, clinical, VLS, and LEMG findings were analyzed according to the outcome of dysphonia.

Results

There were 17 patients, 12 males (70.6%), mean age of 46.6 years, with median dysphonia duration of 4 months (range, 1–60 months) included in the study. In all patients, gross movement of both vocal folds were normal. Laryngoscopy showed limited adduction of the ipsilateral ventricular fold, contralateral interarytenoid region deviation, and vocal fold atrophy in 100%, 94.1%, and 76.5% of patients, respectively. VLS findings included: impairment of glottic closure (94.1%), phase asymmetry (94.1%), and reduced mucosal wave on the affected side (76.5%). Predictors of good voice outcome were sudden onset (P = .012), duration of dysphonia on presentation shorter than 5 months (P = .005), and absence of polyphasic potentials on LEMG (P = .041).

Conclusions

Findings on VLS as described suggest isolated paresis of laryngeal adduction and should warrant indication of LEMG for definite diagnosis. Voice improvement may be related to clinical and LEMG findings.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2BA2LC8

Presentation and eustachian tube function test results in children evaluated at a specialty clinic

Objectives/Hypothesis

Interest in eustachian tube (ET) dysfunction (ETD) has increased with the recent Food and Drug Administration approval of a new device for balloon dilation of the ET (BDET) in adults. However, children have been receiving BDET treatment with ET‐specific or sinus balloons around the world and off‐label in the United States for years. It is important, therefore, to understand the manifestations of and methods to verify ETD in children.

Study Design

Retrospective cross‐sectional study.

Methods

This is a retrospective study of clinical presentations and results of ET function (ETF) tests in children referred to the ETD clinic. An otorhinolaryngology exam, nasopharyngeal videoendoscopy of the ET orifices during swallow and maneuvers, and ETF tests, including inflation deflation, forced response test, and pressure chamber tests, were performed as applicable.

Results

Data for 30 children aged 6.2 to 17.3 years (mean = 12.9 ± 2.8 years) were analyzed. Of 60 ears, 19 (31.7%) had an intact tympanic membrane (TM), 16 (26.7%) had a patent and two had a blocked ventilation tube, and 23 (38.3%) had a TM perforation. Endoscopy of the nasopharynx revealed a large amount of secretions in 19/45 (42.2%); ET orifices and mucosal inflammation in 22/45 (48.8%); a large amount of adenoid tissue in the fossa of Rosenmuller was noted in 21/45 (46.7%). ETF tests revealed abnormal active function in 43/54 ears (79.6%) and abnormal passive function in 40/54 ears (74.1%).

Conclusions

ETD in children is often associated with residual or regrowth of adenoids and inflammation. Caution should be taken assigning a uniform phenotype and treatment prior to thorough evaluation and testing.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2KAzpGL

The shifting relationship between weight and pediatric obstructive sleep apnea: A historical review

Objectives

For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment.

Results

We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid‐2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways—adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure—can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity.

Conclusions

We may need new and different treatments for obesity‐associated OSA as adenotonsillectomy—which is effective at reversing failure to thrive in OSA—is not as effective at treating OSA in children with obesity. One option is drug‐induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 2018

https://ift.tt/2BAyRhd

CCR10+ ILC2s with ILC1‐like properties exhibit a protective function in severe allergic asthma

Abstract

Background

We previously showed that patients with severe allergic asthma have high numbers of circulating ILC2s expressing CCR10.

Method

Herein, CCR10⁺ ILC2s were further analyzed in the blood of healthy individuals or patients with allergic and non−allergic asthma. Characteristics of human CCR10⁺ and CCR10⁻ ILC2s were assessed by flow cytometry as well as single‐cell multiplex RT‐qPCR. The role of CCR10⁺ ILC2s in asthma pathophysiology was studied in allergen‐treated mice.

Results

When compared to healthy controls, CCR10⁺ ILC2s are enriched in the blood of both allergic and non‐allergic severe asthmatic patients, and these cells are recruited to the lungs. Plasma concentrations of the CCR10 ligand CCL27 are significantly increased in severe asthmatics when compared to non‐asthmatic patients. CCR10⁺ ILC2s secrete little T_H2 cytokines, but exhibit ILC1‐like properties, including a capacity to produce IFN‐γ. Also, single cell analysis reveals that the CCR10⁺ ILC2 subset is enriched in cells expressing Amphiregulin. CCR10⁺ ILC2s depletion, as well as blocking of IFN‐γ activity, exacerbates airway hyperreactivity in allergen‐challenged mice, providing evidence for a protective role of these cells in allergic inflammation.

Conclusions

Frequencies of circulating CCR10⁺ ILC2s and CCL27 plasma concentrations represent candidate markers of asthma severity. The characterization of CCR10⁺ ILC2s in human samples and in mouse asthma models suggests that these cells downregulate allergic inflammation through IFN‐γ production.

This article is protected by copyright. All rights reserved.

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RNA is taking its Toll – Impact of RNA‐specific Toll‐like receptors on health and disease

Abstract

RNA‐sensing Toll‐like receptors (TLRs) are often described as anti‐viral receptors of the innate immune system. However, the past decade has shown that the function and importance of these receptors is far more complex. These receptors were found to be relevant for the detection of various bacterial, archaeal, and eukaryotic microorganisms and facilitate the discrimination between dead and living microbes. The cytokine and interferon response profile that is triggered has the potential to improve the efficacy of next‐generation vaccines and may prevent the development of asthma and allergy. Nevertheless, the ability to recognize foreign RNA comes with a cost as also damaged host cells can release nucleic acids that might induce an inappropriate immune response. Thus, it is not surprising that RNA‐sensing TLRs play a key role in various autoimmune diseases. However, promising new inhibitors and antagonists are on the horizon to improve their treatment.

This article is protected by copyright. All rights reserved.

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All items of the Food Allergy Quality of Life Questionnaires are relevant for peanut‐allergic patients

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Case 36-2018: A 29-Year-Old Man with an Incidentally Discovered Renal Mass

Presentation of Case. Dr. Keyan Salari (Urology): A 29-year-old man was seen at this hospital because of an incidentally discovered renal mass. The patient had been well until 6 weeks before this evaluation, when he identified a painless lump above his left testicle during a monthly…

https://ift.tt/2KzDPxt

Pigmented villonodular synovitis occurring in the temporomandibular joint

Pigmented villonodular synovitis occurring in the region of the temporomandibular joint is a rare disease, requiring a review of the treatment method, follow-up period.

https://ift.tt/2PYqO6I

Are antithrombotic agents necessary for head and neck microvascular surgery?

The aim of this prospective study was to determine the effect of antithrombotic agents in preventing thrombosis after head and neck reconstructive surgery. A randomized clinical trial of referred patients undergoing free flap surgery between February 2015 and July 2017 was conducted. Four hundred and fifty-four patients were randomly assigned to group A (n=153), administered aspirin and low molecular weight dextran; group B (n=150), administered low molecular weight heparin; and group C (n=151), not administered any antithrombotic agent.

https://ift.tt/2DMbjas

Assessing staining resistance of a CAD/CAM interpenetrating network composite material

Color change of dental materials over time because of staining agents has important effects on the long-term prognosis of dental esthetic treatments. In the present study, staining resistance of an interpenetr...

https://ift.tt/2KyPdtr

A Case Report of Scrotal Rejuvenation: Laser Treatment of Angiokeratomas of the Scrotum

Abstract

Scrotal rejuvenation encompasses not only the functional quality but also the aesthetic appearance of the scrotum. It includes medical therapy and procedural interventions to improve scrotal conditions that require morphologic restoration and/or aesthetic alteration. Rejuvenation of the scrotum may be appropriate for aging-related and non-aging-related changes concerning the hair (alopecia and hypertrichosis), the morphology (laxity and wrinkles), and/or the vascularity (angiokeratoma) of the scrotum. Angiokeratomas—typically small, asymptomatic, purple papules—may occur on the scrotum. However, these benign vascular lesions may be of cosmetic concern to the affected individuals; in addition, the angiokeratomas can become an issue of medical importance if they begin to bleed. Multiple locally destructive modalities are available for the treatment of scrotal angiokeratomas; indeed, several lasers have effectively been used to treat angiokeratomas of the scrotum. A 70-year-old man with numerous scrotal angiokeratomas experienced scrotal bleeding in the absence of prior trauma to the area or sexual activity. He presented for treatment to prevent future episodes of spontaneous bleeding from his scrotal angiokeratomas, but he also had not liked the aesthetic appearance of the previously asymptomatic angiokeratomas on his scrotum. His angiokeratomas were successfully treated with three sequential 532-nm potassium titanyl phosphate (KTP) laser sessions, which led to not only functional but also cosmetic improvement of his scrotum. In conclusion, men can develop scrotal changes due to either intrinsic (aging) or extrinsic (trauma) causes, but nonsurgical interventions and surgical procedures are available for the management of these conditions in individuals who desire to rejuvenate their scrotum.

https://ift.tt/2P3GX5g

Postoperative radiotherapy for T1/2N0M0 mucoepidermoid carcinoma positive for CRTC1/3‐MAML2 fusions

Abstract

Background

The National Comprehensive Cancer Network (NCCN) guidelines recommend considering postoperative radiotherapy (PORT) for completely resected T1/2N0M0 salivary mucoepidermoid carcinomas when they show tumor spillage, perineural invasion, or intermediate/high‐grade histology. CRTC1/3‐MAML2 fusions have been associated with a favorable clinical outcome.

Methods

Forty‐seven T1/2N0M0 mucoepidermoid carcinoma cases positive for CRTC1/3‐MAML2 fusions were completely resected and were not treated with PORT.

Results

Pathologically, none of the cases showed tumor spillage or perineural invasion. Cases with intermediate/high‐grade histology numbered 9 (19%) to 26 (55%) with the currently used 3 different grading systems. During the follow‐up (median 60 months), locoregional tumor recurrence occurred in 4 cases, which were treated with surgery alone. At the last follow‐up (median 60 months; 7‐160), all patients were alive with no evidence of disease.

Conclusion

An excellent prognosis may be achieved without PORT in T1/2N0M0 mucoepidermoid carcinoma patients positive for CRTC1/3‐MAML2 fusions when the tumors are completely resected without tumor spillage.

https://ift.tt/2BxtzCW

Operative technique: Lateral neck dissection

https://ift.tt/2KDez9O

Neonatal gut colonisation by Staphylococcus aureus strains with certain adhesins and superantigens is negatively associated with subsequent development of atopic eczema

Abstract

Background

Insufficient early immune stimulation may predispose to atopic disease. Staphylococcus aureus, a skin and gut colonizer, produces the B‐cell mitogen protein A and T‐cell activating superantigens. Early gut colonization by S. aureus strains that possess the superantigens encoded by enterotoxin gene (egc) cluster and the elastin‐binding protein, is negatively associated with development of atopic eczema.

Objectives

To investigate whether these findings could be replicated in a second birth‐cohort, FARMFLORA and, secondly, whether nasal colonization by S. aureus also relates to subsequent atopic eczema development.

Methods

Faecal samples and nasal swabs from infants in the FARMFLORA birth‐cohort (N=65) were cultured for S. aureus. Individual strains were distinguished by RAPD (random amplified polymorphic DNA) and assessed for adhesin and superantigen gene carriage by PCR. Atopic eczema at 18 months of age was related to nasal and gut S. aureus colonisation patterns during the first 2 months of life (well before onset of eczema).

Results

S. aureus colonisation per se was unrelated to subsequent eczema development. However, gut S. aureus strains from the infants who subsequently developed atopic eczema less frequently carried the ebp gene, encoding elastin‐binding protein, and superantigen genes encoded by the egc, as compared to strains from children who remained healthy. Nasal colonization by S. aureus was less clearly related to subsequent eczema development.

Conclusion

The results precisely replicate our previous observations and may suggest that mucosal colonisation by certain S. aureus strains provides immune stimulation that strengthens the epithelial barrier and counteracts the development of atopic eczema.

This article is protected by copyright. All rights reserved.

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Social media and psoriasis treatment: What are people saying on Twitter?

Abstract

Almost half of households use the internet for seeking health related information. Because there is no regulation over the accuracy of this information, disease myths and unconventional remedies may be perpetuated. There are few studies that have used social media as a tool to assess people's perception of psoriasis or its treatment. Our aim was to evaluate commonly discussed psoriasis treatments on the social media site Twitter.

This article is protected by copyright. All rights reserved.

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Gene expression profiling in aggressive digital papillary adenocarcinoma sheds light on the architecture of a rare sweat gland carcinoma

Abstract

Background

Sweat gland carcinomas are rare cutaneous adnexal malignancies. Aggressive digital papillary adenocarcinoma (ADPA) represents a very rare sub‐entity, thought to arise almost exclusively from sweat glands of the fingers and toes. The aetiology of sweat gland carcinomas and ADPA is largely unknown. ADPAs are most likely driven by somatic mutations. However, somatic mutation patterns are largely unexplored, creating barriers to the development of effective therapeutic approaches to the treatment of ADPA.

Objective

To investigate the transcriptome profile of ADPA using a sample of eight formalin‐fixed, paraffin embedded (FFPE) tissue samples of ADPA and healthy control tissue.

Methods

Transcriptome profiling was performed using the Affymetrix PrimeView Human Gene Expression Microarray and findings were validated via reverse‐transcription of RNA and real‐time qPCR.

Results

Transcriptome analyses showed increased tumour expression of 2,266 genes, with significant involvement of cell cycle, ribosomal and crucial cancer pathways. Our results furthermore point to tumour‐overexpression of FGFR2 (p = 0.001).

Conclusions

Our results indicate the involvement of crucial oncogenic driver pathways, highlighting cell cycle and ribosomal pathways in the aetiology of ADPA. Suggested tumour‐overexpression of FGFR2 raises the hope that targeting the FGF/FGFR axis might be a promising treatment for ADPA and probably for the overall group of sweat gland carcinomas.

This article is protected by copyright. All rights reserved.

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Histologie bei Adenoiden

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Nachruf auf Herrn Prof. Dr. med. Henning Bier (1957–2018)

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Vitamin D receptor ApaI, TaqI, BsmI, and FokI polymorphisms and psoriasis susceptibility: an updated meta‐analysis

Summary

Background

Vitamin D is considered a regulator of the immune system, and its polymorphisms have been associated with psoriasis in some but not all reports.

Aim

To explore whether vitamin D receptor (VDR) polymorphisms are associated with susceptibility to psoriasis.

Methods

Meta‐analyses were conducted to determine the associations between psoriasis and the VDR ApaI, TaqI, BsmI and FokI polymorphisms in all participants, and stratified by ethnic group.

Results

In total, 16 studies on VDR polymorphisms and psoriasis were included in this meta‐analysis, which involved 2086 patients and 2182 controls. The meta‐analysis indicated an association between psoriasis and the VDR TaqI TT genotype in Caucasian (OR = 1.29, 95% CI = 1.00–1.66, P < 0.05), but not in Asian (OR = 1.32, 95% CI = 0.89–1.96, P = 0.16) populations. However, no association was found between psoriasis and the VDR TaqI polymorphism using dominant, allele contrast or homozygous contrast models. No association was found between psoriasis and either the VDR ApaI, BsmI or FokI polymorphisms by meta‐analyses of the allele contrast, recessive, or dominant models or homozygous contrast models in the overall, Caucasian or Asian populations.

Conclusion

This meta‐analysis showed that polymorphisms in VDR ApaI, BsmI and FokI are not associated with psoriasis susceptibility in overall, Caucasian or Asian populations. However, the VDR TaqI polymorphism is associated with psoriasis susceptibility in Caucasian populations.

https://ift.tt/2RjUKXH

Assessing staining resistance of a CAD/CAM interpenetrating network composite material

Abstract

Background

Color change of dental materials over time because of staining agents has important effects on the long-term prognosis of dental esthetic treatments. In the present study, staining resistance of an interpenetrating network composite material with different translucency levels (translucent and high translucent) and various surface procedures for finishing were investigated.

Methods

Same shade CAD/CAM interpenetrating network composite specimens having two different translucency levels were prepared using by a water cooling cutting saw. Specimens were grouped and different finishing procedures were performed. Then, specimens were kept in distilled water, red wine and coffee for different periods. Color was evaluated before and after exposure to staining liquids using a clinical spectrophotometer.

Results

In the 7 days Glaze group (ΔE₀₀ > 2.2), color difference was only perceivable in the specimens kept in red wine. In the 28 days red wine high translucent groups, only the high translucent Clinical group showed a clinically acceptable (ΔE₀₀ < 2.2) color change. In the translucent groups kept in red wine, only the translucent Glaze group showed a clinically perceivable color change (ΔE₀₀ > 2.2). In the 28 day measurements, all the translucent groups showed a clinically perceivable color change (ΔE₀₀ > 2.2). Of the translucent groups kept in coffee for 28 days, it was observed that only the translucent Clinical group demonstrated a clinically non-perceivable color change (ΔE₀₀ < 2.2).

Conclusions

All the translucent groups kept in red wine showed a clinically perceivable color change after 28 days. Only the high translucent Clinical Kit group showed a clinically acceptable color change. Among high translucent and translucent specimens kept in coffee only the translucent Clinical group showed a clinically acceptable color change after 28 days.

https://ift.tt/2BzgEkh

Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian center

Abstract

Background

Frontal fibrosing alopecia (FFA) is increasing in prevalence worldwide and several series from different countries have been published, in order to detect possible causes of the disease outbreak.

Objective

To analyze the epidemiological, clinical and trichoscopic features of FFA seen in an Italian Dermatology Unit.

Methods

Clinical, trichoscopy, histopathology and medical details of all patients were compared with literature and general population data.

Results

From 2005 to 2017 we diagnosed FFA in 65 Caucasian females, with the number of diagnoses per year progressively rising. Premenopausal onset was detected in 21%. Frontal hair line recession was associated with parietal involvement in 80% of cases, occipital in 12.3% and eyebrows alopecia in 86.1%. In 6 cases eyebrow alopecia preceded hair loss. Non‐inflammatory facial papules were detected in 1/3 of the patients. Itching was reported by 2/3 of the patients and was indicative of disease progression. Trichoscopy showed empty follicles/yellow dots, absence of follicular ostia, mild follicular hyperkeratosis, perifollicular erythema and "lonely hair". Scalp lichen plano pilaris was seen in 15 patients, female pattern hair loss in 22. Therapy included short‐term treatment with systemic or intralesional corticosteroids followed by therapy with 5α‐reductase inhibitors of hydroxychloroquine and topical drugs. Arrest of FFA progression was seen in 75% of the patients, while 16 experienced worsening of the hairline despite therapy.

Conclusions

FFA not rarely starts before menopause, loss of the eyebrows can be the first sign of the disease, about 50% of the patients have other autoimmune conditions, FFA severity is not related to its duration, itching, follicular hyperkeratosis and erythema at trichoscopy are signs of disease progression, 25% of the patients show progression of hairline recession despite therapy.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PYPewL

Managing adverse effects by dose reduction during routine treatment of locally advanced basal cell carcinoma with the hedgehog inhibitor vismodegib: a single center experience

Abstract

Locally advanced basal cell carcinoma (laBCC) represents an uncommon, difficult to treat form of skin cancer (1,2). The approval of hedgehog inhibitor (HHI) vismodegib in 2012 opened a novel therapeutic option (2–10). "Drug holidays" have been proposed to increase patients' compliance and adherence which is poor due to the high frequency of adverse effects (AE's) of HHI (3–5), however, up to date, the effect of dose reduction during HHI treatment has not been reported. Herein we report the data of a single center's experience in dose adjustment in 13 patients with laBCC treated with vismodegib.

This article is protected by copyright. All rights reserved.

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Calcipotriol plus betamethasone dipropionate aerosol foam versus apremilast, methotrexate, acitretin, or fumaric acid esters for the treatment of plaque psoriasis: A matching‐adjusted indirect comparison

Abstract

Background

Plaque psoriasis has significant impact on patients' quality of life. Topical therapy is considered the treatment mainstay for mild‐to‐moderate disease according to guidelines. Calcipotriol/betamethasone dipropionate (Cal/BD) [0.005%/0.05%] aerosol foam is indicated for psoriasis vulgaris treatment in adults. Cal/BD foam trials demonstrated improved efficacy and similar safety in this population. Psoriasis treatment is complicated by the broad range of disease presentation, variability, and therapeutic options; particularly decisions on transition from topical to non‐biologic systemic treatment are difficult. Assessing comparative effectiveness of treatment options provides meaningful value to treatment decisions.

Objective

To compare efficacy of Cal/BD foam individual patient data from pooled trials with efficacy of non‐biologic systemic treatments based on aggregated patient characteristics and treatment outcomes.

Methods

Individual data from 4 Cal/BD foam trials in 749 psoriasis patients were pooled to conduct matching‐adjusted indirect comparisons. Literature review identified non‐biologic systemic treatment trials where methods, populations, and outcomes align with Cal/BD foam trials. Of 3,090 screened publications, 4 studies of apremilast, methotrexate, acitretin, or Fumaric Acid Esters (FAE) were included.

Results

After baseline matching, patients treated with 4 weeks of Cal/BD foam had greater Physician's Global Assessment 0/1 response compared to those treated with 16 weeks of apremilast (52.7% vs. 30.4%; P<0.001). Patients treated with Cal/BD foam had significantly greater Psoriasis Area and Severity Index (PASI) 75 response at Week 4 compared to 16 weeks of apremilast treatment (51.1% vs. 21.6%; P<0.001). Cal/BD foam patients demonstrated significantly greater PASI 75 response improvements at Week 4 versus 12 weeks of methotrexate (50.8% vs. 33.5%; P<0.001) or acitretin (50.9% vs. 31.7%; P=0.009), and comparable response to FAE (42.4% vs. 47.0%; P=0.451).

Conclusions

Despite recent treatment advances, unmet needs for psoriasis patients remain. Cal/BD foam offers improved efficacy in baseline matched psoriasis patients compared to apremilast, methotrexate, or acitretin, and comparable efficacy to FAE.

This article is protected by copyright. All rights reserved.

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Impact of Resident Autonomy Clinics in a Dermatology Residency: Improving Residents’ Perception of Autonomy

Abstract

Over recent years, concerns have been raised by residents within the Harvard Combined Dermatology Residency Program regarding lack of autonomy, including not being viewed by patients as the primary provider and lack of independence when formulating plans under the "apprenticeship" model. Literature from both surgical and medical specialties suggests a gradual decline in resident autonomy over time with ramifications on resident satisfaction and preparedness for future practice. Here we describe the actualization of resident‐run autonomy clinics within our program and compare two years of survey data to assess resident perception of autonomy before and after implementation.

This article is protected by copyright. All rights reserved.

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Abnormal lipid storage related to adipocyte shrinkage in acquired partial lipodystrophy (Barraquer‐Simons syndrome)

Abstract

Background

Acquired partial lipodystrophy (APL) is characterized by the gradual symmetrical loss of subcutaneous fat starting from the face, spreading towards the upper part of the body and sparing the lower extremities.

Objective

We report a 33‐ year‐old woman with facial lipodystrophy, loss of buccal fat pads, and breast fat tissue. The subcutaneous fat was preserved in other anatomic regions, and we noted some excess of fat accumulation in the lower abdomen and thighs. She had a low serum level of C3 was positive for a polyclonal immunoglobulin C3NeF in the serum. She was diagnosed with APL.

Methods

We examined fat from lipoatrophic and healthy areas and compared it to subcutaneous fat samples from a healthy control.

Results

Using scanning electron microscopy, we saw shrunken adipocytes with numerous small lipid droplets detaching from the surface of the adipocytes as compared to the classic aspect of adipose tissue in the control subject where the cytoplasm is occupied by one big lipid droplet. A loss of contact between adipocytes was observed in the APL patient when compared to the normal network of adipocytes in the control subject. The healthy fat seemed not affected by lipoatrophy; we observed normal sized adipocytes, though their surface was not as regular as in the control samples.

Conclusion

The significance and mechanism of the electron microscopic findings are unknown, but they suggest adipocyte shrinkage related to a defect in the retaining triglycerides, which could contribute to the pathogenesis of this disorder.

This article is protected by copyright. All rights reserved.

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Correlation between disease severity and quality of life in patients with epidermolysis bullosa

Abstract

There is an increased interest of medical staff to have a more objective evidence of the severity of clinical picture of the patient with epidermolysis bullosa (EB), but also about the patient's quality of life. The goal of these studies is to develop a personalized treatment, based on the patients' needs.

The aims of our study were to develop a validated and reliable quality of life questionnaire (QOLEB) in Romania, to assess the health‐related quality of life (HRQoL) in Romanian EB patients, and to perform an objective evaluation of the clinical features of patients with EB. This study was observational, analytical, prospective, transversal, cohort type.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Rdb0JH

Spiky follicular Mycosis Fungoides : A trichoscopic feature

Abstract

We have read with great interest a case report published by Slawinka et al describing trichoscopic spectrum of folliculotropic mycosis fungoides (FMF) [1]. Different trichoscopic aspects were reported by authors as the presence of milky white globules, yellow dots, short hair with split or triangle‐shaped end, broken hair and pigtail appearance hair.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PYXU6B

Preliminary experience of the Q‐switched 1064‐nm neodymium:yttrium aluminum garnet laser in the treatment of Café‐au‐lait macules

Abstract

Solitary CALMs are a common finding and they occur in 10‐20% of the normal polulation. Although benign, CALMs in exposed parts of the body(face, forearms, neck et al) are cosmetically distressing to patients. Various types of laser devices have been utilized to remove CALMs over the years with high rates of recurrence and adverse events. Based on the theory of selective photothermolysis, the Q‐switched lasers were most accepted modality to remove CALMs with higher efficacy and minimal adverse effects.

This article is protected by copyright. All rights reserved.

https://ift.tt/2RdwXIM

Gastrointestinal bleeding with severe mucosal involvement in a patient with generalized pustular psoriasis without IL36RN mutation

Abstract

Generalized pustular psoriasis (GPP) is a systemic inflammatory disease that presents with erythema and sterile pustules, pathologically characterized by Kogoj's spongiform pustules. GPP is sometimes accompanied by mucosal involvement, and the most common lesion is on the tongue. IL36RN mutation was found to contribute to the pathogenesis of GPP especially in patients who develop GPP without a past medical history of psoriasis vulgaris. The association of IL36RN mutation with mucosal involvement in GPP is controversial. We herein report a 60‐year‐old male GPP patient with no past history of plaque psoriasis presenting with not only severe skin lesions and arthritis but also severe mucosal involvements of pharyngeal and gastrointestinal lesions, which led to gastrointestinal bleeding. Our case did not have any mutation in the IL36RN gene. We should be aware that severe GPP can cause gastrointestinal bleeding. The relevancy of IL36RN mutation with mucosal involvement in GPP remains to be elucidated.

https://ift.tt/2TGhKSd

Can benign lymphoid tissue changes in 18 F-FDG PET/CT predict response to immunotherapy in metastatic melanoma?

Abstract

Background

An association between immune-related adverse events (irAEs) caused by immunotherapeutic agents and the clinical benefit of immunotherapy has been suggested. We retrospectively evaluated by means of ¹⁸F-FDG PET/CT lymphoid tissue changes in the mediastinal/hilar lymph nodes and the spleen in response to ipilimumab administration in metastatic melanoma.

Methods

A total of 41 patients with unresectable metastatic melanoma underwent ¹⁸F-FDG PET/CT before the start of ipilimumab (baseline PET/CT), after two cycles (interim PET/CT) and at the end of treatment (late PET/CT). Data analysis was focused on the mediastinal/hilar lymph nodes and the spleen. The patients' best clinical response (BCR) was used as reference.

Results

According to the BCR reference, 31 patients showed disease control (DC) and 10 patients showed progressive disease (PD). Mediastinal/hilar lymph node evaluation revealed that in total 4 patients in the interim or late PET/CT (10%) demonstrated a 'sarcoid-like lymphadenopathy' as response to treatment (LN-positive). All LN-positive patients responded to ipilimumab with DC. On the other hand, no significant differences between the DC and PD groups regarding both semi-quantitative and quantitative ¹⁸F-FDG PET spleen-related parameters at baseline and as response to treatment were detected.

Conclusion

Based on our findings, 10% patients in the interim or late PET/CT showed 'sarcoid-like lymphadenopathy' as response to treatment. All these patients showed disease control, implying a relation between the appearance of sarcoid-like lymphadenopathy and the clinical benefit of anti-CTLA-4 therapy. On the other hand, quantitative ¹⁸F-FDG PET analysis of the spleen showed a poor performance in predicting clinical benefit to ipilimumab.

https://ift.tt/2TRqGUW

Treatment of oral manifestations of toxic epidermal necrolysis with low‐level laser therapy in a pediatric patient

Abstract

Drug‐induced reactions are complications associated with high mortality and significant morbidity. Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of these conditions, which are characterized by skin and mucous lesions. Here, we report a case of a 9‐year‐old girl who presented with blisters associated with an extensive vesicular rash and multiple ulcerations on the lips and oral cavity. A drug‐induced hypersensitivity reaction to antibiotics was suspected, and a diagnosis of TEN was made. The patient was managed with withdrawal of the suspected causative agent, and the oral lesions were treated with low‐level laser therapy (LLLT) and oral hygiene. This case highlights that TEN requires interdisciplinary intervention with dental assistance and follow‐up to improve symptoms, nutrition, systemic condition, and quality of life.

https://ift.tt/2Qm7Q9w

Dramatic effect of nivolumab against melanoma and immune‐related liver toxicity: A detailed histopathological and immunohistochemical analysis of nivolumab‐induced liver toxicity

https://ift.tt/2r2DDOo

Metabolic syndrome and psoriatic arthritis among patients with psoriasis vulgaris: Quality of life and prevalence

Abstract

Interest has increased in comorbidities associated with psoriasis and their effects on health‐related quality of life (HRQoL). This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and psoriatic arthritis (PsA) and to investigate HRQoL and the prevalence of hypertension, type 2 diabetes mellitus (T2DM), obesity and dyslipidemia. In a cross‐sectional design, patients diagnosed with plaque psoriasis answered an interview and standardized questionnaires (Dermatology Life Quality Index questionnaire [DLQI], 36‐Item Short Form Health Survey [SF‐36] and EuroQol Five‐Dimension Questionnaire Three‐Level version [EQ‐5D‐3L]). Physical examination and several tests to assess desired outcomes were performed by a dermatologist and a rheumatologist during three visits. The prevalence of MetS and PsA was 50.0% and 41.8%, respectively. Dyslipidemia was the most prevalent (74.5%) secondary comorbidity, followed by hypertension (61.8%), obesity (52.5%) and T2DM (30.9%). The mean (standard deviation) DLQI score was 6.5 (6.9), and mean physical and mental SF‐36 measures were 45.2 (10.4) and 45.5 (12.3), respectively, and for EQ‐5D‐3L, mean utility index and EQ‐VAS scores were 0.68 (0.27) and 72.7 (19.7), respectively. PsA and MetS are important comorbidities; a reduced HRQoL is noted among plaque psoriasis patients with these comorbidities, emphasizing the relevance of diagnosis and treatment beyond the care of skin lesions.

https://ift.tt/2FH7Ooy

Low-grade intraductal carcinoma of salivary glands: A systematic review of this rare entity

Publication date: Available online 25 November 2018

Source: Journal of Oral Biology and Craniofacial Research

Author(s): Francesco Giovacchini, Caterina Bensi, Stefano Belli, Maria Elena Laurenti, Martina Mandarano, Daniele Paradiso, Michele Giansanti, Antonio Tullio

Abstract

Background

Low-grade intraductal carcinomas are rare, malign tumors of salivary glands most commonly affecting parotid gland. It is a slow-growing tumor considered with a favourable prognosis after surgical excision.

Methods

To define the characteristics and management of low-grade intraductal carcinoma a systematic review was performed using the electronic databases Pubmed, Cochrane and Scopus. A new case report was also described.

Results

Including this case the review of literature identified only 54 cases reported thus far. Demographics, clinical presentation, diagnostic tools, treatment, follow-up and recurrence rate, histological and immunohistochemical patterns of this kind of tumor were summarized.

Conclusion

Low-grade intraductal carcinoma has already been well defined but is important to focus on the fact that in few cases component of high-grade infiltrations have been reported: this may modify surgical approach because a simple tumorectomy may not be enough.

https://ift.tt/2BxCcxC

Asthma, obesity and targeted interventions: an update

Purpose of review Obese asthma is now widely recognized as a phenotype of difficult asthma that is common and less responsive to traditional asthma treatments, so identifying specific treatments is increasingly important. Recent findings Obesity can lead to asthma through a complex relationship of causes including mechanical, inflammatory, metabolic and genetic factors. Exercise programmes including pulmonary rehabilitation, weight loss via dietary restriction, exercise and bariatric surgery, or combinations of all of these can improve quality of life, symptoms, and exercise capacity, with reductions in medication use and exacerbations, and represent tailored treatment for this phenotype of severe difficult to treat asthmatic patients. Summary Exercise programmes and pulmonary rehabilitation, weight loss programmes targeting 5–10% weight loss and bariatric surgery are effective treatments for the obese asthma phenotype. Correspondence to Douglas C. Cowan, Room 17, 4th Floor Walton Building, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK. Tel: +1 412115451; e-mails: Douglas.cowan@ggc.scot.nhs.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2DJe0tu

Keimbahnmutationen beim malignen Mesotheliom

https://ift.tt/2AoU2RB

Aktuelle Aspekte der Diagnostik von Ovarialtumoren

Zusammenfassung

Hintergrund

Der Artikel gibt eine Übersicht über die Diagnostik des Ovarialkarzinoms, eine seltene, aber häufig letale Erkrankung. Die jüngste Entwicklung auf dem Gebiet hat gezeigt, dass es sich beim Ovarialkarzinom tumorbiologisch nicht um eine Erkrankung, sondern vielmehr um verschiedene Subtypen mit jeweils spezifischer Pathogenese, Morphologie, Molekularpathologie und Prognose handelt.

Methode

Der Artikel basiert auf selektiver Literaturrecherche in PubMed und gängigen pathologischen Standardwerken sowie eigener Erfahrung in Diagnostik und konsiliarpathologischer Tätigkeit am Institut für Pathologie – Charité – Universitätsmedizin Berlin.

Ergebnisse

Der häufigste histologische Subtyp ist das seröse High-grade-Ovarialkarzinom; daneben gibt es die selteneren serösen Low-grade- sowie die endometrioiden, klarzelligen und muzinösen Ovarialkarzinome. Das seröse High-grade-Adenokarzinom entsteht nach aktueller Lehrmeinung auf dem Boden eines serösen tubaren intraepithelialen Karzinoms (STIC) und ist durch eine hohe Rate an p53-Mutationen und Defekte in der homologen Rekombination gekennzeichnet.

Das seröse Low-grade-Adenokarzinom entsteht hingegen über ein Borderline-Karzinom-Kontinuum und ist molekular durch pathologische Genmutationen von KRAS oder BRAF charakterisiert. Endometrioide und klarzellige Adenokarzinome entstehen am ehesten in Zusammenhang mit einer Endometriose und weisen daher entsprechende molekulare Aberrationen der Gene wie PI3KCA, CTNNB1 und ARID1A auf. Weiterhin ist das endometrioide Adenokarzinom mit einer Mikrosatelliteninstabilität assoziiert. Der Ursprung muzinöser Ovarialtumoren ist weitestgehend unbekannt. Auch wenn ein Primarius im Gastrointestinaltrakt ausgeschlossen wird, ähneln sie morphologisch und molekular den kolorektalen Karzinomen.

Schlussfolgerung

Die molekularen Eigenheiten beeinflussen entscheidend die Prognose, den klinischen Verlauf, die Chemosensititvität und die Rezidivneigung. Translationale und klinische Studien dieses spannenden Gebiets sind notwendig, um tumorbiologische Besonderheiten herauszukristallisieren und multimodale innovative Therapiestrategien zu entwickeln.

https://ift.tt/2TKfjOA

Interdisziplinäre Handlungsempfehlung bei Dupilumab-assoziierten entzündlichen Augenerkrankungen

https://ift.tt/2ApiZvY

Digitales papilläres Adenokarzinom

Zusammenfassung

Das digitale papilläre Adenokarzinom ist ein seltenes, aber charakteristisches Schweißdrüsenkarzinom, das bis auf sehr wenige ungewöhnliche Ausnahmefälle nur in akraler Lokalisation auftritt. Dieser Typ eines Schweißdrüsenkarzinoms neigt zur Ausbildung von Lokalrezidiven und führt in wenigen Fällen zu einer späten, zeitlich oft verzögerten Metastasierung. Das klinisch typische und histologisch breite Spektrum dieses Adnexkarzinoms stellen wir anhand von 4 Fällen dar und geben einen zusammenfassenden kurzen Literaturüberblick.

https://ift.tt/2TIuMym