Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Τρίτη 4 Δεκεμβρίου 2018

Epidermolysis bullosa simplex–generalized severe type due to keratin 5 p.Glu477Lys mutation: Genotype‐phenotype correlation and in silico modeling analysis

Abstract

Background/Objectives

Epidermolysis bullosa is a group of diseases caused by mutations in skin structural proteins. Availability of genetic sequencing makes identification of causative mutations easier, and genotype‐phenotype description and correlation are important. We describe six patients with a keratin 5 mutation resulting in a glutamic acid to lysine substitution at position 477 (p.Glu477Lys) who have a distinctive, severe and sometimes fatal phenotype. We also perform in silico modeling to show protein structural changes resulting in instability.

Methods

In this case series, we collected clinical data from six patients with this mutation identified from their national or local epidermolysis bullosa databases. We performed in silico modeling of the keratin 5‐keratin 14 coil 2B complex using CCBuilder and rendered with Pymol (Schrodinger, LLC, New York, NY).

Results

Features include aplasia cutis congenita, generalized blistering, palmoplantar keratoderma, onychodystrophy, airway and developmental abnormalities, and a distinctive reticulated skin pattern. Our in silico model of the keratin 5 p.Glu477Lys mutation predicts conformational change and modification of the surface charge of the keratin heterodimer, severely impairing filament stability.

Conclusions

Early recognition of the features of this genotype will improve care. In silico analysis of mutated keratin structures provides useful insights into structural instability.



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An original procedure for orbitonasal cutaneous infiltrative tumor repair, using combined forehead and melolabial propeller flaps

Abstract

Introduction

Resections of cutaneous tumors in the medial orbitonasal region can be transfixing. Repairs using a single local flap run the risk of failure and that of secondary sinonasal fistula, especially in cases of surgery on a radiated field. We propose an original and reliable repair procedure using two pedicled regional flaps vascularized by two distinct arterial systems clinched together to reconstruct the mucosal and cutaneous planes.

Materials and methods

A first melolabial propeller flap (MPF) with a superior perforating pedicle was elevated and the cutaneous side was sutured to the deep plane of the loss of substance (mucosal lining). A second homolateral or contralateral paramedian forehead flap (PFF) was then lifted and sutured over the first flap (superficial plane). The forehead pedicle flap was divided at 1 month.

Results

No trophic complication or failure was recorded on two patients. The 7-year carcinologic, aesthetic, and functional results were satisfying.

Conclusion

This technique involving the superimposition of two local flaps, vascularized by two different arterial systems, appears to offer a simple and reliable repair technique for transfixing cutaneous losses of substance in the medial orbitonasal region. It could be used in the first-line treatment, particularly if an additional radiotherapy is to be performed.



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IL‐27 Signaling Deficiency Develops Th17‐enhanced Th2‐dominant Inflammation in Murine Allergic Conjunctivitis Model

Abstract

Background

While most studies focus on pro‐allergic cytokines, the protective role of immunosuppressive cytokines in allergic inflammation is not well elucidated. This study was to explore a novel anti‐inflammatory role and cellular/molecular mechanism of IL‐27 in allergic inflammation.

Methods

A murine model of experimental allergic conjunctivitis (EAC) was induced in BALB/c, C57BL/6 or IL‐27Rα deficient (WSX‐1 ‐/‐) mice by short ragweed pollen, with untreated or PBS‐treated mice as controls. The serum, eyeballs, conjunctiva, cervical lymph nodes (CLNs) were used for study. Gene expression was determined by RT‐qPCR, protein production and activation were evaluated by immunostaining, ELISA and Western blotting.

Results

Typical allergic manifestations and stimulated TSLP signaling and Th2 responses were observed in ocular surface of EAC models in BALB/c and C57BL/6 mice. The decrease of IL‐27 at mRNA (IL‐27/EBI3) and protein levels were detected in serum, conjunctiva and CLN, as evaluated by RT‐qPCR, immunofluorescent staining, ELISA and Western blotting. EAC induced in WSX‐1 ‐/‐ mice showed aggravated allergic signs with higher TSLP‐driven Th2‐dominant inflammation, accompanied by stimulated Th17 responses, including IL‐17A, IL‐17F, and transcription factor RORγt. In contrast, Th1 cytokine IFNγ and Treg marker IL‐10, with their respective transcription factors T‐bet and foxp3 were largely suppressed. Interestingly, imbalanced activation between reduced phosphor (P)‐STAT1 and stimulated P‐STAT6 were revealed in EAC, especially WSX‐1 ‐/‐ ‐EAC mice.

Conclusion

These findings demonstrated a natural protective mechanism by IL‐27, of which signaling deficiency develops a Th17‐type hyper‐response that further aggravates Th2‐dominant Allergic Inflammation.

This article is protected by copyright. All rights reserved.



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Emerging concepts and challenges in implementing the exposome paradigm in allergic diseases and asthma

Abstract

Exposome research can improve the understanding of the mechanistic connections between exposures and health to help mitigate adverse health outcomes across the lifespan. The exposomic approach provides a risk profile instead of single predictors and thus is particularly applicable to allergic diseases and asthma. Under the PRACTALL collaboration between the European Academy of Allergy and Clinical Immunology (EAACI) and the American Academy of Allergy, Asthma and Immunology (AAAAI) we evaluated the current concepts and the unmet needs on the role of the exposome in allergic diseases and asthma.

This article is protected by copyright. All rights reserved.



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Ertapenem – a potent treatment for clinical and quality of life improvement in patients with hidradenitis suppurativa— Reply



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Thick nails, plantar keratoderma, follicular hyperkeratosis, and leukokeratosis associated with a novel mutation in KRT6A gene



https://ift.tt/2KVLyX5

Soft tissue reactions following cochlear implantation

Abstract

Introduction

Cochlear implantation is a boon to children with hearing loss. Rarely, it can be associated with complications. Soft tissue reaction can be a particularly distressing complication.

Materials and methods

The study was conducted on all patients presenting with soft tissue reaction post-cochlear implant in a tertiary care referral institute from March 2011 to June 2018. We graded the severity of soft tissue reaction as per the severity and then managed these patients accordingly.

Results

Thirty-five patients were included in this study. Grade 1 had 12 patients, grade 2 had 9, grade 3 had 4 and grade 4 had 9 patients. Grade 1, 2 and 3 reactions were managed conservatively, while grade 4 required surgery. The incidence of explantations increased with the grade severity.

Conclusion

Soft tissue reaction post-cochlear implant is a rare, but distressing complication. Grading and analyzing them can help us manage them in a better way.



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Longitudinal Characterization of Autoantibodies to the Thyrotropin Receptor During Alemtuzumab Therapy: Evidence that the Thyrotropin Receptor May Precede Thyroid Dysfunction by Many Years

Thyroid, Ahead of Print.


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Urticaria control test might misevaluate disease control in particular patients treated with omalizumab

Since its effectiveness in H1-antihistamine refractory chronic spontaneous urticaria (CSU) was shown, omalizumab has been increasingly used across the world. Omalizumab is licensed at a dose of 300 mg subcutaneously every 4 weeks in Turkey and in the European Union[1, 2]. The urticaria activity, control and response to treatment should be assessed by a reliable and easily applicable tool during this 4 week-interval. Urticaria activity score (UAS) and urticaria control test (UCT) are two well-developed and validated patient reported outcome measures (PRO).

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Part II - Emerging Imaging Technologies in Dermatology: Applications and Limitations

•There are emerging technologies in dermatology for use in clinical research, diagnosis, and monitoring therapeutic response. Currently, adjunctive imaging technologies are most frequently used for diagnosis and surgical planning for non-melanoma and melanoma skin cancer.•With improving technology and usability, imaging devices will become important tools for clinicians.

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Part I - Emerging Imaging Technologies in Dermatology: Basic Principles

• Dermoscopy and digital clinical imaging improve clinical diagnosis and document changing lesions.• New emerging technologies include confocal microscopy, optical coherence tomography, high frequency ultrasound, Raman spectroscopy, and fluorescence imaging, which may become integrated into clinical practice to aid in patient diagnosis and management.

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Impact of Nasalis Muscle Repair in Unilateral Cleft Lip Patients

Although the role of nasalis muscle in the establishment of nasal deformity is well recognized; its abnormal anatomy and role in the correction of alar deformity in cleft lip patients have not been adequately studied. This work aimed to study the effect of nasalis muscle repair on the postoperative nasal symmetry.

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Does vertical incomitance predict the diplopia outcome in orbital fracture patients? A prospective study of 188 patients

To determine the predictive value of vertical incomitance for diplopia outcome in orbital fracture patients.

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Managing pitted keratolysis: consider topical glycopyrrolate



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Efficacy and safety of oral atenolol for the treatment of infantile haemangioma: A systematic review

Abstract

Recently, several studies have reported their experience in using oral atenolol in patients with infantile haemangioma (IH), especially as an alternative to propranolol, but the efficacy and safety of oral atenolol has not been evaluated. We searched PubMed (Medline), Central, Embase, Web of Science and EBSCOhost (until May 2018) for the eligible studies reporting more than 10 IH patients who were treated with oral atenolol with detailed original data, including outcomes, regimens and adverse events (AEs). The data was standardised and analysed by using R software with meta‐package. A total of 9 of 141 identified articles, including 341 infantile haemangioma patients treated with oral atenolol therapy, were included. The pooled response rate of atenolol was 0.90 (95% CI: 0.85–0.93), and the rebound rate was 0.11 (95% CI: 0.08–0.16). Among the 341 patients, 44 patients were switched to atenolol therapy from propranolol due to adverse events. The response rate of subsequent atenolol treatment was 90.9% (40/44). Regarding AEs, 141 patients reported 177 episodes of AEs, and the pooled rate was 0.26 (95% CI: 0.12–0.47). Gastrointestinal symptoms (e.g. constipation, diarrhoea and vomiting) were the most frequent AEs (22.6%). Widely known propranolol‐related AEs, including hypoglycaemia, bronchospasm, bradycardia and hypotension, were not recorded. Overall, atenolol appears to be an effective and safe therapy for the treatment of IH and may be a promising alternative to propranolol.



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Antimicrobial susceptibility patterns of bacteria isolated from patients with ear discharge in Jimma Town, Southwest, Ethiopia

Abstract

Background

Otitis media is among the leading causes of childhood illnesses although it can also affect the adults resulting in frequent physician visits, drug prescription and a key contributor to antibiotic resistance. The aim of this study was to determine the risk factors, bacterial profile, and the antimicrobial susceptibility pattern of the isolates from patients with discharging ears which clinically equates to draining otitis media in developing countries with limited medical resources such as otoscope.

Methods

A prospective cross-sectional study was conducted on 173 patients with draining otitis media. The ear discharge specimens were collected and analyzed by standard microbial techniques. The antibiotic susceptibility profiles were determined for 19 different antibiotics by the standard disk diffusion method. Data was analyzed by SPSS version 22 and the P value of less than 0.05 was considered as statistically significant.

Results

Among 173 otitis media patients participated in the study; majority, 102(63%) were pediatrics, out of which 72 (41.61%) were in the age group of less than 4 years. Ear infection was bilateral in 39 (22.54%) and chronic in 100 (57.8%) of the patients. Pathogens were isolated from 160 (92.5%) of the patients with a total of 179 isolates. The predominant isolate was Staphylococcus aureus (30.72%) followed by Proteus spp. (17.89%). The result of this study showed that adult age (p = 0.031), rural residence (p = 0.005), previous history of health care visit and treatment (p = 0.000), upper respiratory tract infection (p = 0.018) and presence of cigarette smoker in the house (p = 0.022) had statistically significant association with chronic otitis media. Most of the isolated bacteria showed high level of resistance to ampicillin/amoxicillin (88.3%), penicillin G (79.5%) followed by trimethoprim /sulfamethoxazole (73.8%). Conversely, the majority of bacterial isolates showed moderate susceptibility to ciprofloxacin (72.9%), gentamicin (70.4%), and amikacin (69.3%). Bacterial isolates identified in this study showed trend of multiple drug resistance, majority (67%) being resistant to three or more antimicrobials.

Conclusions

Majority of the bacterial isolates were multidrug resistant, hence, efforts to isolate microorganisms and determine the susceptibility pattern should be strengthened to improve the treatment outcome of otitis media instead of the usual trend of empirical treatment.



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Chemical analysis of in vivo –irradiated dentine of head and neck cancer patients by ATR-FTIR and Raman spectroscopy

Abstract

Objectives

To evaluate the effect of in vivo radiotherapy on the chemical properties of human dentine by Fourier-transform infrared spectroscopy (FTIR) and Raman analysis.

Materials and methods

Chemical composition was evaluated comparing control and irradiated group (n = 8). Irradiated teeth were obtained from radiotherapy patients subjected to fractionated X-ray radiation of 1.8 Gy daily totaling 72 Gy. The teeth were sectioned according to the type of dentine (crown or root dentine), obtaining 3-mm dentine cervical slices. The analyzed parameters by FTIR and Raman spectroscopies were mineral/matrix ratio (M:M), carbonate/mineral ratio (C:M), amide I/amide III ratio, and amide I/CH2 ratio. Raman also calculated the phosphate and carbonate crystallinity.

Results

FTIR revealed that M:M had a decrease in both factors (p = 0.008; p = 0.043, respectively) and root dentine showed a lower C:M in the irradiated group (p = 0.003). Raman revealed a higher phosphate crystallinity and a lower carbonate crystallinity in crown dentine of irradiated group (p = 0.021; p = 0.039). For amide I/amide III, the irradiated showed a lower ratio when compared to the control group (FTIR p = 0.002; Raman p = 0.017). For amide I/CH2, the root dentine showed a higher ratio than the crown dentine in both methods (p < 0.001).

Conclusions

Radiotherapy altered the chemical composition of human dentine. The exchange of phosphate-carbonate ions in the hydroxyapatite and higher concentration of organic components was found after radiotherapy.

Clinical relevance

The increased risk of radiation-related caries in patients undergoing head and neck radiotherapy is due not only to salivary, dietary, and microbiological changes but also to changes in tooth chemical composition.



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Nasal nitric oxide in the inferior turbinate surface decreases with intranasal steroids in allergic rhinitis: A prospective study

It remains controversial whether nasal nitric oxide (NO) serves as a reliable parameter to evaluate treatment efficacy in patients with allergic rhinitis (AR). The measurement of local nasal NO levels has been shown to be a sensitive marker for the diagnosis of symptomatic AR patients. Here we assessed the applicability of nasal NO to evaluations of the efficacy of intranasal steroids (INS) in a prospective design.

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Case of steroid-resistant Crohns-associated bronchiolitis in the setting of quiescent gastrointestinal disease treated with infliximab

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Cher Shiong Chuah<br />Nov 28, 2018; 11:e226934-e226934<br />

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Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection

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John G Skedros<br />Nov 28, 2018; 11:e226598-e226598<br />

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A dogs dinner: an interesting case presenting as gastroenteritis

Caroline Elliott<br />Nov 28, 2018; 11:e226131-e226131<br />

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Toxic shock syndrome: the great masquerader

Sagnik Biswas<br />Nov 28, 2018; 11:e226123-e226123<br />

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'Hearing hooves, finding zebras: the differential diagnosis of cardiac arrest precipitated by chest pain in the postpartum woman

Gareth Squire<br />Nov 28, 2018; 11:e227048-e227048<br />

https://ift.tt/2UgT031

Recognising the return of nutritional deficiencies: a modern pellagra puzzle

Elisabeth Ng<br />Nov 28, 2018; 11:e227454-e227454<br />

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Augmented reality game-related injury

Kate Gemma Richards<br />Nov 28, 2018; 11:e224012-e224012<br />

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Inflammatory fibroid polyp of the duodenum: is endoscopic resection a feasible therapeutic choice?

Faisal Inayat<br />Nov 28, 2018; 11:e226972-e226972<br />

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Tumour lysis syndrome: a rare side effect of imatinib therapy for GIST

Juliann Ondecker<br />Nov 28, 2018; 11:e226647-e226647<br />

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Skull base aspergillosis in an immunocompetent elderly man with early response to steroid

Pamela Sarkar<br />Nov 28, 2018; 11:e226998-e226998<br />

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Eagles syndrome: a piercing matter

Matthew Zammit<br />Nov 28, 2018; 11:e226611-e226611<br />

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Traumatic rosette cataract

Rohan Bir Singh<br />Nov 28, 2018; 11:e227465-e227465<br />

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Successful outcome after spontaneous first trimester intra-amniotic haematoma and early preterm premature rupture of membranes

Spyros Bakalis<br />Nov 28, 2018; 11:e224596-e224596<br />

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Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistant Staphylococcus aureus (MRSA) in a young healthy man

Cong Ran<br />Nov 28, 2018; 11:e226975-e226975<br />

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Unusual presentation of a life-threatening intraperitoneal haemorrhage after elective inguinal hernia repair

Kenrick Kai Chi Chan<br />Nov 28, 2018; 11:e226676-e226676<br />

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Chronic meningoencephalitis with mixed pathology mimics progressive supranuclear palsy

Marian L Dale<br />Nov 28, 2018; 11:e227119-e227119<br />

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Unusual case of Lemierres syndrome

Issrah I Jawad<br />Nov 28, 2018; 11:e226948-e226948<br />

https://ift.tt/2UfIY2k

Acute subretinal abscess in Staphylococcus aureus septicaemia with endophthalmitis showcased by multimodal retinal imaging and with 2-year follow-up

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Rita Prajapati<br />Nov 28, 2018; 11:e227288-e227288<br />

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Dysphagia due to massive retropharyngeal and pre-vertebral abscess

Thomas Hendriks<br />Nov 28, 2018; 11:e228162-e228162<br />

https://ift.tt/2Ugfh19

Meropenem-induced liver injury and beta-lactam cross-reactivity

Timothy Tattersall<br />Nov 28, 2018; 11:e227124-e227124<br />

https://ift.tt/2AOGzmd

Comparison of clinical outcomes of treatment of dysfunction of the temporomandibular joint between conventional and ultrasound-guided arthrocentesis

Patients with disorders of the temporomandibular joint (TMJ) who do not respond to non-operative treatment may require invasive procedures such as arthrocentesis and arthroscopy. We divided 80 patients with dysfunction of the TMJ into two groups: a control group who were treated by conventional arthrocentesis, and an experimental group who were treated by ultrasound-guided arthrocentesis. Both groups were monitored three days, one week, and one month postoperatively and the clinical outcomes compared.

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Comparison of retroauricular and small transcervical approaches for endoscopic-assisted selective neck dissection: a cadaveric study

Advances in endoscopic-assisted neck surgery have allowed surgeons to conceal the scars via various approaches. However, studies comparing the approaches are still rare. The aim of this study was to comparatively analyze the feasibility and oncological outcomes of the retroauricular approach (RA) and the small transcervical approach (STC) for endoscopic-assisted selective neck dissection (EASND). Five fresh cadavers were recruited. EASND was performed via RA on one side and via STC on the contralateral side of each of the cadavers.

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Analysis of an in-house technique for temporary mandibulotomy and its impact on postoperative radiotherapy

The purpose of this study was to describe a newly developed procedure for temporary mandibulotomy and subsequent osteosynthesis. Clinical outcomes were evaluated, including complications and the impact on postoperative treatment, particularly postoperative radiotherapy. Twenty-four patients underwent temporary mandibulotomies for the surgical resection of malignancies located in the posterior oral or oropharyngeal region. All were treated with postoperative radiotherapy. An angulated median mandibulotomy was followed by osteosynthesis with three anchor screws directed towards the inferior aspect of the mandible.

https://ift.tt/2E2CePp

Antimicrobial susceptibility patterns of bacteria isolated from patients with ear discharge in Jimma Town, Southwest, Ethiopia

Otitis media is among the leading causes of childhood illnesses although it can also affect the adults resulting in frequent physician visits, drug prescription and a key contributor to antibiotic resistance. ...

https://ift.tt/2FUF23M

Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap

Abstract

Background

The scapular tip free flap (STFF) is becoming more popular for oromandibular reconstruction. This article reviewed the early and late outcomes in a larger series over 9 years.

Methods

We conducted a retrospective review of all consecutive patients who underwent oromandibular reconstruction using the STFF at London Health Sciences Centre. Demographic information, surgical data, and complications were collected and analyzed.

Results

From April 2008 to March 2017, 81 STFFs were performed in 80 patients. The average bony reconstruction measured 5.4 cm. Bone‐only flaps were utilized in 24 cases (29.6%). Five cases (6.2%) required a single osteotomy. There were 3 (3.7%) flap failures. There were 7 plate extrusions and 11 cases of radiographic nonunion.

Conclusion

The STFF is a reliable option with acceptable early and long‐term results. The STFF may be considered as a first line option especially for shorter bone defects or in conjunction with complex soft tissue requirements.



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Multimodal Imaging in a Case of Idiopathic Neuroretinitis

A 37-year-old woman presented with painful visual loss in the left eye for 2 weeks. The best-corrected visual acuity was 20/200. Ophthalmic examination of the left eye revealed vitreous cells, optic disc swelling, serous retinal detachment, and macular star-figure hard exudates. Swept-source optical coherence tomography showed both inner and outer retinas were swollen, the choroid was thickened, and the corresponding retinal pigment epithelium was elevated. Wide-field indocyanine green angiography disclosed multiple hypofluorescent spots in the mid-periphery. Taken together, an involvement of optic disc, entire retina, and choroid was considered in the current case.
Case Rep Ophthalmol 2018;9:487–492

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Postoperative Late-Onset Endophthalmitis Caused by Leishmania donovani: A Case Report

Leishmania donovani is a human blood parasite that belongs to the genus Leishmania. We would like to present a case of late Leishmania donovani endophthalmitis in one eye of a patient that underwent simultaneous bilateral grade 3 cataract surgery.
Case Rep Ophthalmol 2018;9:484–486

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Electronic Nicotine Delivery Systems: Oral Health Implications and Oral Cancer Risk

Abstract

There is a paucity of evidence surrounding the potential detrimental effects of electronic nicotine delivery systems (ENDS) for both systemic and oral health. The effects of conventional cigarettes on the development of oral cancer are well known, however the role of ENDS in oral carcinogenesis is yet to be elucidated. Furthermore, the exponential rise of the use of ENDS by the general public means that dental healthcare providers are more likely to encounter questions on their safety in the oral cavity, and on their effectiveness as a smoking cessation aid. Herein, we review the most up to date literature on the systemic and oral health complications of ENDS. Moreover, evidence‐based recommendations on the use of ENDS as a smoking cessation tool within the dental setting are discussed.

This article is protected by copyright. All rights reserved.



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Assessment of taste functions in allergic rhinitis patients undergoing allergen-specific immunotherapy

Abstract

Background

We evaluated taste functions of patients with perennial allergic rhinitis (AR) before and after allergen-specific immunotherapy (AIT).

Methods

The study was designed as a prospective clinical study in our tertiary care hospital. Patients (n = 21) who were diagnosed with perennial AR on the basis of physical examination, skin prick test of at least 3* for HDM allergen and treated with AIT were enrolled in this study. A control group (n = 21) was selected from patients who were given intranasal steroids (INS) for perennial AR. Both groups had self-reported hyposmia and subjective loss of the sense of taste before treatment. Taste strips (Burghart, Wedel, Germany) were used for the taste identification scores before and after 6 months treatment.

Results

A total of 42 subjects were included, with a mean age of 24.1 ± 7.9 years (range 15–43 years). Overall, the AIT group showed more of an improvement of taste function, observed in the total average test scores, compared to the INS group (p < 0.05), but no change was detected between the groups before treatment. No difference was found for the bitter taste scores between the study groups (p = 0.053).

Conclusion

Subcutaneous allergen immunotherapy resulted in more of an improvement in taste function than intranasal steroids. Further studies are needed.



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Issue Information



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Defining quality in chronic rhinosinusitis management



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Science in endoscopic cranial base, rhinology, and allergy



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Atypical nasal mass

Publication date: Available online 4 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): E. Drapier, M. Makeieff, X. Dubernard



https://ift.tt/2FXylOv

HLA testing in the molecular diagnostic laboratory

Abstract

The human leukocyte antigen (HLA) system is a highly polymorphic family of genes involved in immunity and responsible for identifying self versus non-self. HLA typing is essential for solid organ and bone marrow transplantation as well as in non-transplant settings such as disease association and pharmacogenomics. Typing of HLA genes differs from most molecular testing as, rather than evaluating differences from an accepted "wild-type" gene, it must distinguish between thousands of similar, but distinct alleles. This article will describe the HLA system and nomenclature. We will then discuss clinical uses of HLA typing including solid organ transplantation, hematopoietic stem cell transplantation, evaluation of platelet refractory patients, disease association, and pharmacogenetics. Finally, we describe common molecular methods of HLA typing.



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Intake of a fermented plant product attenuates allergic symptoms without changing systemic immune responses in a mouse model of Japanese cedar pollinosis

Japanese cedar pollinosis (JCP) is one of the most prevalent allergies in Japan. Within the past few decades, many food factors have been demonstrated to suppress symptoms of pollinosis and mast cell degranula...

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Biomechanically stimulated chondrocytes promote osteoclastic bone resorption in the mandibular condyle

Publication date: Available online 3 December 2018

Source: Archives of Oral Biology

Author(s): Bin Kuang, Zhaobin Zeng, Qing Qin

Abstract
Objective

Chondrocyte signaling is important in osteoclastic bone resorption in mice tibiae. The present study aimed to test whether biomechanically stimulated chondrocytes promote osteoclastic bone resorption in the mandibular condyle.

Methods

Primary chondrocytes isolated from rat condylar cartilage were stimulated by fluid flow shear stress (FSS) for 30, 60, 120 min at intensities of 10, 20, or 30 dynes/cm2. The levels of pro-osteoclastic factors and pro-osteoclastic function of FSS-stimulated chondrocytes were tested. Abnormal molar occlusion was established in rats, and the relationship between cartilage degeneration and osteoclastogenesis in the subchondral bone of the mandibular condyle, and the expression of pro-osteoclastic factors in condylar cartilage, were evaluated.

Results

The mRNA and protein levels of SDF-1 and TGFβ-1 increased significantly in all FSS-treated groups; the levels of RANKL and RANKL:OPG increased in all intensities and in 60 and 120 min of FSS; and those of Wnt5 A increased in all time-points and in 20 and 30 dynes/cm2 of FSS-treated groups (all compared with their levels the controls; P < 0.05). The percent area of degenerative cartilage changes correlated positively with osteoclast number and osteoclast surface/bone surface in the mandibular condyles of abnormal occlusion rats (P < 0.05). Abnormal occlusion increased the immune-positive area and the mRNA expression levels of Sdf1, Tgfb1, Rankl, Wnt5a and the RANKL:OPG ratio in rat condylar cartilage compared with those in the controls (all P < 0.05).

Conclusion

Chondrocytes under mechanical stimulation could express higher levels of pro-osteoclastic factors and induced condylar subchondral bone resorption by promoting osteoclastogenesis.



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Methylation status of SFRP1, SFRP2, RASSF1A, RARβ and DAPK1 genes in patients with oral squamous cell carcinoma

Publication date: Available online 3 December 2018

Source: Archives of Oral Biology

Author(s): Joanna Katarzyna Strzelczyk, Łukasz Krakowczyk, Aleksander Jerzy Owczarek

Abstract

Our study assessed the methylation status of the SFRP1, SFRP2, RASSF1 A, RARβ and DAPK1 genes, which are associated with epigenetic silencing in cancers. In a group of 75 patients with oral squamous cell carcinoma, aberrant methylation was detected using methylation-specific PCR in tumours and matched margins. Our results showed significantly higher methylation frequency in tumours than in surgical margin of SFRP2 (26.6% vs 11.9%, p < 0.05) and DAPK1 (65.3% vs 41.3%, p < 0.01) genes. Moreover, methylation of the SFRP1 and DAPK1 genes was associated with older age. Advanced tumour stages were associated with lower rates of SFRP1 gene methylation. Decreased methylation levels of the SFRP2 and RASSF1 A genes were associated with positive N stage. On the contrary, lymph node metastasis were associated with higher methylation rates of RARβ and DAPK1 genes. Patients with a familial history of cancer were associated with more frequently methylated SFRP1, SFRP2 and DAPK1 genes. Hypermethylation of DAPK1 was associated with decreased risk of death in patients. Our results are suggestive, although not conclusive, that some epigenetic changes, especially frequent hypermethylation of SFRP2 and DAPK1 genes, can be useful as potential diagnostic biomarkers of oral cavity cancer. Moreover, estimating the methylation status in surgical margins could become an additional strategy for more accurate treatment methods. Further efforts are needed to identify and validate this finding on a larger patient group and using new advanced methylation testing methods.



https://ift.tt/2BPtxXr

18F-Fluorocholine for the Detection of Parathyroid Adenomas

Condition:   Hyperparathyroidism, Primary
Intervention:   Drug: Fluorocholine PET
Sponsor:   University of California, San Francisco
Recruiting

https://ift.tt/2zKaoof

Biomechanically stimulated chondrocytes promote osteoclastic bone resorption in the mandibular condyle

Publication date: Available online 3 December 2018

Source: Archives of Oral Biology

Author(s): Bin Kuang, Zhaobin Zeng, Qing Qin

Abstract
Objective

Chondrocyte signaling is important in osteoclastic bone resorption in mice tibiae. The present study aimed to test whether biomechanically stimulated chondrocytes promote osteoclastic bone resorption in the mandibular condyle.

Methods

Primary chondrocytes isolated from rat condylar cartilage were stimulated by fluid flow shear stress (FSS) for 30, 60, 120 min at intensities of 10, 20, or 30 dynes/cm2. The levels of pro-osteoclastic factors and pro-osteoclastic function of FSS-stimulated chondrocytes were tested. Abnormal molar occlusion was established in rats, and the relationship between cartilage degeneration and osteoclastogenesis in the subchondral bone of the mandibular condyle, and the expression of pro-osteoclastic factors in condylar cartilage, were evaluated.

Results

The mRNA and protein levels of SDF-1 and TGFβ-1 increased significantly in all FSS-treated groups; the levels of RANKL and RANKL:OPG increased in all intensities and in 60 and 120 min of FSS; and those of Wnt5 A increased in all time-points and in 20 and 30 dynes/cm2 of FSS-treated groups (all compared with their levels the controls; P < 0.05). The percent area of degenerative cartilage changes correlated positively with osteoclast number and osteoclast surface/bone surface in the mandibular condyles of abnormal occlusion rats (P < 0.05). Abnormal occlusion increased the immune-positive area and the mRNA expression levels of Sdf1, Tgfb1, Rankl, Wnt5a and the RANKL:OPG ratio in rat condylar cartilage compared with those in the controls (all P < 0.05).

Conclusion

Chondrocytes under mechanical stimulation could express higher levels of pro-osteoclastic factors and induced condylar subchondral bone resorption by promoting osteoclastogenesis.



https://ift.tt/2KTbNgx

Methylation status of SFRP1, SFRP2, RASSF1A, RARβ and DAPK1 genes in patients with oral squamous cell carcinoma

Publication date: Available online 3 December 2018

Source: Archives of Oral Biology

Author(s): Joanna Katarzyna Strzelczyk, Łukasz Krakowczyk, Aleksander Jerzy Owczarek

Abstract

Our study assessed the methylation status of the SFRP1, SFRP2, RASSF1 A, RARβ and DAPK1 genes, which are associated with epigenetic silencing in cancers. In a group of 75 patients with oral squamous cell carcinoma, aberrant methylation was detected using methylation-specific PCR in tumours and matched margins. Our results showed significantly higher methylation frequency in tumours than in surgical margin of SFRP2 (26.6% vs 11.9%, p < 0.05) and DAPK1 (65.3% vs 41.3%, p < 0.01) genes. Moreover, methylation of the SFRP1 and DAPK1 genes was associated with older age. Advanced tumour stages were associated with lower rates of SFRP1 gene methylation. Decreased methylation levels of the SFRP2 and RASSF1 A genes were associated with positive N stage. On the contrary, lymph node metastasis were associated with higher methylation rates of RARβ and DAPK1 genes. Patients with a familial history of cancer were associated with more frequently methylated SFRP1, SFRP2 and DAPK1 genes. Hypermethylation of DAPK1 was associated with decreased risk of death in patients. Our results are suggestive, although not conclusive, that some epigenetic changes, especially frequent hypermethylation of SFRP2 and DAPK1 genes, can be useful as potential diagnostic biomarkers of oral cavity cancer. Moreover, estimating the methylation status in surgical margins could become an additional strategy for more accurate treatment methods. Further efforts are needed to identify and validate this finding on a larger patient group and using new advanced methylation testing methods.



https://ift.tt/2BPtxXr

Relationship between vitamin D and chronic spontaneous urticaria: a systematic review

Vitamin D has been reported to be associated with many allergic diseases. There are a limited number of the studies of vitamin D supplementation in patients with chronic spontaneous urticaria (CSU). This study...

https://ift.tt/2KS88zG

Orthognathic Surgery in “Older” Adults with Hemi-Mandibular Elongation: Long-Term Occlusion Outcomes

Publication date: Available online 3 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Jeffrey C. Posnick, Anish Chavda, Brian E. Kinard

Summary
Purpose

The purpose of this study was to describe a consecutive series of subjects with HME who underwent orthognathic correction after 26 years of age. The investigators hypothesized that for this group of HME subjects, bimaxillary orthognathic correction would result in a favorable initial and long-term occlusion.

Materials and Methods

A retrospective cohort study was implemented. The sample included a consecutive series of HME subjects > 26 years of age undergoing bimaxillary osteotomies. The outcome variables were the achievement and maintenance of a corrected occlusion after surgery. We compared the occlusion at intervals before surgery (T1), 5 weeks postoperatively (T2), >2 years after surgery (T3). Descriptive and bivariate statistics were calculated. P<0.05 was considered significant.

Results

13 subjects met inclusion criteria with a mean age of 36 years. All subjects underwent maxillary advancement. All subjects underwent mandibular surgery with 92% receiving advancement. Sixty-nine percent of subjects had a maxillary occlusal cant. In 12 of 13 subjects, a favorable occlusion was maintained long-term (T3) after surgery.

Conclusion

We confirmed that bimaxillary orthognathic surgery in HME subjects >26 years of age results in a favorable initial occlusion which is maintained long-term. These findings are similar to that previously reported in HME subjects <26 years of age.



https://ift.tt/2Q9rF4o

Development process of traumatic heterotopic ossification of the temporomandibular joint in mice

Publication date: Available online 3 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Yan Zhao, Pengchao Liu, Qiming Chen, Ningjuan Ouyang, Yuheng Lin, Wenbin Zhang, Jiewen Dai, Guofang Shen



https://ift.tt/2RAx2GA

Coincidence of craniocerebral and craniofacial injuries

Publication date: Available online 3 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Bartłomiej Błaszczyk, Maciej Studziński, Piotr Ładziński

Abstract
Purpose

To determine the incidence of craniocerebral injuries in patients who experienced upper facial or midfacial traumas associated with the disorders of consciousness. To find which types of craniofacial traumas predisposed to craniocerebral injuries. To analyze a relationship between the site of the force application and the type of resultant craniocerebral injury.

Materials and methods

The study included 3,481 patients with upper facial and midfacial traumas. All 425 patients with craniofacial traumas and disorders of consciousness at the time of the event or hospital admission, were qualified for computed tomography (CT) of the head.

Results

In 85/425 patients (20%), 70 men and 15 women (age 14-71 years), craniofacial trauma coincided with a craniocerebral injury. Upper facial dislocation and zygomatic-orbital-maxillary complex fracture significantly more often co-existed with skull, dura mater or cranial nerve injuries, and zygomatico-orbital fracture with the injuries of the brain. Application of force both centrally and laterally to the horizontal plane predisposed to skull, dura mater and cranial nerve injuries.

Conclusion

The recommendation to perform head CT in each patient with craniofacial trauma who experienced the disorders of consciousness is as simple as possible, yet provides high diagnostic sensitivity, facilitating proper management at initial stages post-injury.



https://ift.tt/2Q9rypu

Thieme Teaching Award 2018 für interprofessionelles Video-Lerntool

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 734-734
DOI: 10.1055/a-0751-3830



Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2QZRArQ

Metaanalyse kombinierter Spinal-Epidural- vs. Spinalanästhesie bei Sectio

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 728-729
DOI: 10.1055/a-0763-0199



Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2QZwoCe

Leitlinien: Ketamin hilft bei akuten Schmerzen

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 732-733
DOI: 10.1055/a-0763-0647



Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2R0o3hN

Ketamin i. v. bei chronischen Schmerzen: Was sagen die neuen Leitlinien?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 729-730
DOI: 10.1055/a-0763-0502



Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2PDUupv

Präoperative Bolusgabe von Ringer-Laktat kann hämodynamischer Instabilität vorbeugen

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 731-732
DOI: 10.1055/a-0762-9494



Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2PGO09l

Unterer Atemwegsinfekt: Procalcitonin-Messung reduziert Antibiotikaverbrauch nicht

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 730-731
DOI: 10.1055/a-0763-0387



Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2QZy8vl

ECMO – High-Tech-Verfahren bei Lungenversagen

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 734-735
DOI: 10.1055/a-0741-9860



Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2PGNZlN

„Klug-entscheiden-Empfehlungen“ für die Notaufnahme

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 735-735
DOI: 10.1055/a-0741-9837



Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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https://ift.tt/2PIgHCW

Kinderanästhesie mit Sicherheit: Update Medikamentensicherheit

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 741-752
DOI: 10.1055/a-0575-0536

Medikamentenfehler kommen in allen Versorgungsbereichen vor. Bei Kindern steigt die Fehlerwahrscheinlichkeit im Vergleich zu Erwachsenen aufgrund altersgruppenspezifischer Besonderheiten und der erforderlichen Dosisberechnung. Wesentliche Aspekte sind: die Erkenntnis, dass jeder Versorger fehlbar ist, und die Akzeptanz von Sicherheitsstrukturen. Dieser Beitrag beschreibt einen Katalog alltagstauglicher Maßnahmen zur Medikamentensicherheit.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2QZRBMq

Vielen Dank!

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 736-736
DOI: 10.1055/a-0766-9283



Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2R0aQFx

Sichere Kinderanästhesie – von der Evidenz zur Praxis!

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 738-740
DOI: 10.1055/a-0750-2786



Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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https://ift.tt/2PIGyKI

Atemwegsmanagement in der Kinderanästhesie: Anwendung von Materialien und Methoden

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 754-765
DOI: 10.1055/a-0575-0557

Das Atemwegsmanagement stellt eine Kernkompetenz des klinisch tätigen Anästhesisten dar. Insbesondere bei der Versorgung von pädiatrischen Patienten ist die sichere Anwendung entsprechender Materialien, Methoden und Abläufe für die Atemwegssicherung essenziell. Der wissenschaftliche Arbeitskreis Kinderanästhesie der DGAI (WAKKA) hat 2011 eine Handlungsempfehlung für das Management des unerwartet schwierigen Atemweges herausgegeben. Die Handlungsempfehlung für den erwartet schwierigen Atemweg ist aktuell als Entwurf auf der Seite des WAKKA abrufbar. Für die richtige Anwendung von Materialien und Methoden des Atemwegsmanagements benötigt man Kenntnisse über verfügbare Hilfsmittel und deren korrekte Verwendung, sowie Übung in ihrer Anwendung. Diese Übersichtsarbeit stellt eine Auswahl von Materialien und Methoden vor, die in den Handlungsempfehlungen zum Atemwegsmanagement empfohlen werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2PEsYIq

Drama im Aufwachraum: pädiatrisches Emergence-Delir

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 766-776
DOI: 10.1055/a-0575-0473

Das pädiatrische Emergence Delir rückt aufgrund der Debatte um Neurotoxizität von Anästhetika bei kleinen Kindern erneut in den Fokus. Die 2017 von der Europäischen Gesellschaft für Anästhesiologie (ESA) publizierte Leitlinie zu Prävention und Therapie kann eine sinnvolle Unterstützung der klinischen Tätigkeit sein. Insbesondere die zügige und konsequente Behandlung von Schmerzen bei kleinen Kindern und die konsequente Diagnose eines pädED mittels validierter Skale ermöglicht es- dank der Verbreitung von patient data management systemen- in Zukunft eine reelle Inzidenz des pädEDs anzugeben. In der Prävention des pädED liegt der Schwerpunkt auf der Reduktion der präoperativen Angst der Kinder, egal, ob dies durch ein auf das Kind fokussierte Kinderanästhesieteam zusammen mit den Eltern, Musik, Clowns, smartphones/tablets oder eine medikamentöse Prämedikation erzielt wird. Medikamentöse pädED-Prophylaxe durch perioperative Anwendung von alpha-2-Agonisten und die Verwendung von Propofol als Ausleitungsbolus oder TIVA erscheint gleichzeitg sinnvoll. Postoperativ ermöglicht eine ruhige Aufwachumgebung ein entspanntes delirfreies Aufwachen. Postanästhesiologische Visiten mit strukturiertem Erfassen von Veränderungen des kindlichen Verhaltens respektive schriftliche Fragebögen werden in Zukunft Auskunft über das pädED auf den Normalstationen geben. Strukturierte Nachbefragungen im Verlauf werden auch die Erfassung postoperativen unerwünschten Verhaltensänderungen und deren möglichen Zusammenhang zum pädED ermöglichen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2R4Hsy8

Echokardiografie bei akuter Rechtsherzinsuffizienz

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 778-786
DOI: 10.1055/a-0575-7156

Die akute Rechtsherzinsuffizienz wird als Ursache einer kardiopulmonalen Insuffizienz häufig übersehen und kann vital bedrohlich sein. Die verschiedenen Krankheitsbilder, die der Rechtsherzinsuffizienz ätiologisch auf Ebene der Nachlast, Vorlast und Kontraktilität zugrunde liegen, können mittels zielgerichteter Diagnostik abgeklärt werden. Neben klinischen Symptomen ist vor allem die Echokardiografie für die Diagnosestellung relevant.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2PIxd5K

Betablocker im septischen Schock

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 787-792
DOI: 10.1055/s-0043-124906

Die Therapie von Patienten im septischen Schock birgt große Herausforderungen. Die adrenerg vermittelte Stressantwort im Körper ist komplex reguliert – ob Betablocker die Hämodynamik in der Sepsis verbessern können, ist noch offen. Dieser Beitrag gibt einen Überblick über die Pharmakologie des betaadrenergen Systems, die pathophysiologische Rationale und die aktuelle Literatur zum Betablocker-Einsatz in der Sepsis und im septischen Schock.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2R0o31h

3D-CAM: Delir-Testinstrument für deutschsprachigen Raum übersetzt

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 793-796
DOI: 10.1055/a-0627-4601

Das postoperative Delir (POD) ist eine häufige und schwerwiegende Komplikation nach chirurgischen Eingriffen. Darum müssen Patienten postoperativ gezielt auf die Entwicklung eines POD untersucht werden. Hierfür steht die Weiterentwicklung des bekannten Delir-Testinstruments CAM, das 3D-CAM, nun auch in deutscher Fassung zur Verfügung.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2PJCeLu

Tetraplegie nach radikaler Zystektomie

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 797-799
DOI: 10.1055/a-0749-7258

Schlichtungsstellen für Arzthaftpflichtfragen bieten Patienten, Ärzten und Versicherern eine Möglichkeit, Arzthaftungsstreitigkeiten außergerichtlich zu klären. In der Rubrik „Fälle der Schlichtungsstelle" stellen wir abgeschlossene Fälle aus der Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern vor.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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https://ift.tt/2QZRBvU

Expression levels of miR-34-family microRNAs are associated with TP53 mutation status in head and neck squamous cell carcinoma

Abstract

Purpose

The majority of head and neck squamous cell carcinoma (HNSCC) cases in developing countries are associated with cigarette smoking and TP53 mutations. p53 is a transcription factor that activates downstream genes, including the hsa-miR-34a and hsa-miR-34b/c loci, to achieve cell-cycle arrest, senescence, and/or apoptosis. This study examined the differences in expression levels of miR-34 in HNSCC with or without TP53 mutations.

Methods

We examined surgically resected tumor samples and normal adjacent tissues from HNSCC in oral cavity, larynx, and hypopharynx for TP53 mutations (exons 5–8) and miR-34 expression levels.

Results

miR-34a, miR-34b, miR-34b*, and miR-34c are significantly up-regulated in tumors with wild-type TP53 genes (n = 23); while such up-regulation is not observed in tumors with mutant TP53 (n = 19). Although expression levels of miR-34-family miRNAs do not correlate with gender, age, or tumor staging, interestingly they are correlated with smoking status and tumor sites. miR-34b/b*/c are up-regulated in tumors from those who ever smoked or recently smoked (quit smoking less than 15 years ago); but such up-regulation was not seen in those who never smoked or quit smoking for at least 15 years. HNSCC of the oral cavity also up-regulated miR-34b/b*/c while no such overexpression was observed in HNSCC of the larynx and hypopharynx.

Conclusions

Surgically resected HNSCC samples with no TP53 mutations have elevated levels of miR-34a and miR-34b/b*/c, while those with TP53 mutations show no such up-regulation. miR-34b/b*/c expression is also correlated with smoking status and tumor sites.



https://ift.tt/2ARFqdP

Swept-source optical coherence tomography and optical coherence tomography angiography in acquired toxoplasmic chorioretinitis: a case report

To describe swept-source optical coherence tomography and optical coherence tomography angiography retinal changes in a case of acute toxoplasmic chorioretinitis both at the time of diagnosis and after healing.

https://ift.tt/2QdQEno

Does metformin usage improve survival in head and neck squamous cell carcinoma? A population-based study

We sought to expand upon preliminary data suggesting that metformin confers a survival benefit to patients with head and neck squamous cell carcinoma (HNSCC).

https://ift.tt/2KRYixG

Empfindliche Kopfhaut bei androgenetischer Alopezie



https://ift.tt/2QxgP7P

The effect of passive smoking on bacterial colonisation of the upper airways and selected laboratory parameters in children.

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The effect of passive smoking on bacterial colonisation of the upper airways and selected laboratory parameters in children.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):431-438

Authors: Bugova G, Janickova M, Uhliarova B, Babela R, Jesenak M

Abstract
Exposure to tobacco smoke is associated with a higher risk of respiratory tract diseases. The aim of this study was to determine the influence of passive smoking on selected characteristics of children with adenoid hypertrophy. Sixty-one children with adenoid hypertrophy were enrolled in the prospective study. Differences in bacterial colonisation of middle nasal meatus and nasopharynx and changes in selected laboratory immune and inflammatory markers according to the tobacco smoke exposure were analysed. Exposure to tobacco smoke was associated with significantly higher colonisation of pathogenic bacteria and polymicrobial growth of pathogenic bacteria (≥ 2 bacteria) in middle nasal meatus compared to non-exposed children (P = 0.045, P = 0.032, respectively). Identification of pathogenic bacteria in the middle nasal meatus did not correlate with isolation of pathogenic bacteria in the nasopharynx in either group of children. Parameters of humoral immunity in serum, IgA and IgG, were detected at higher concentrations in children exposed to tobacco smoke (P = 0.047, P = 0.031, respectively). Differences in selected parameters of cellular immunity in peripheral blood according to passive smoking were not observed. Tobacco smoke exposure is related to increased colonisation by pathogenic bacteria in middle nasal meatus and elevation of IgA and IgG in peripheral blood, but does not seem to influence markers of cellular immunity parameters in children with adenoid hypertrophy. Avoidance of passive smoking could be recommended as a universal preventive strategy against microbial colonisation of the upper airways and development of various inflammatory diseases in children, e.g. adenoid hypertrophy.

PMID: 30498271 [PubMed - in process]



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Praxisaufgaben übergeben — am besten gut strukturiert



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Mit mehr Elan und Ellbogen in das neue Jahr



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Weitergabe von Daten und Datenübertragung — nur mit Einwilligung?

Durch die Datenschutzgrundverordnung (DSGVO) ist in der Ärzteschaft Verunsicherung darüber entstanden, unter welchen Voraussetzungen Patientendaten an Dritte weitergegeben werden dürfen. Es besteht oftmals die Sorge, für jede Weitergabe von Patientendaten eine schriftliche Einwilligung des Patienten zu benötigen und so im Papierwust zu ersticken. Im Fokus steht dabei die Weitergabe von Daten an weiter- oder nachbehandelnde Ärzte, an Labore sowie an Abrechnungsgesellschaften. Doch auch außerhalb des Praxisalltags ist der Thematik Beachtung zu schenken.



https://ift.tt/2DZZ1LN

The prognostic significance of E-cadherin expression in laryngeal squamous-cell carcinoma: a systematic review.

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The prognostic significance of E-cadherin expression in laryngeal squamous-cell carcinoma: a systematic review.

Acta Otorhinolaryngol Ital. 2018 Nov 09;:

Authors: Re M, Gioacchini FM, Scarpa A, Cassandro C, Tulli M, Cassandro E

Abstract
The aim of this study was to systematically review publications that investigated the prognostic role of E-cadherin immunostaining in patients affected by laryngeal squamous cell carcinoma. An appropriate string was run on PubMed to retrieve articles dealing with this topic. A double cross-check was performed on citations and full-text articles by two authors independently to analyse all manuscripts and perform a comprehensive quality assessment. Among 89 abstracts identified, 13 articles were included. These studies reported on 1,121 patients with histologically confirmed diagnosis of laryngeal squamous cell carcinoma. Overall, there were 10 studies that showed a significant correlation between E-cadherin immunohistochemical expression and at least one of the clinical and histopathological parameters considered by the authors. In particular E-cadherin expression was significantly associated with N stage (five studies), grading (four studies) and disease-free survival/disease-specific survival (six studies). In conclusion, the findings of our review appear similar to the results published by other authors on the putative role of E-cadherin in progression of malignancy. In fact, for laryngeal squamous cell carcinoma it seems that lower levels of E-cadherin correlate with increased tumoural aggressiveness and worse prognosis. Nevertheless, further high-quality prospective studies should be carried out to clarify if E-cadherin expression may be considered as an independent prognostic factor for patients affected by laryngeal cancer.

PMID: 30499566 [PubMed - as supplied by publisher]



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Treatment-emergent central sleep apnoea after surgery for obstructive sleep apnoea.

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Treatment-emergent central sleep apnoea after surgery for obstructive sleep apnoea.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):476-479

Authors: Testani E, De Corso E, Losurdo A, Fiorita A, Vollono C, Marca GD, Scarano E

Abstract
Central sleep apnoea (CSA) is a lack of drive to breathe during sleep, which can occur in physiologic as well as in pathologic conditions. A particular type of CSA, defined treatment-emergent CSA (TECSA), may occur after the treatment of obstructive sleep apnoea syndrome (OSAS), either with CPAP or surgery. TECSA is transitory and seems to be related to the severity of OSAS. We describe a 51-year-old man affected by severe OSAS who developed severe, transient CSA immediately after upper airways surgery. We believe that CSA was triggered by the sudden variation in nocturnal arterial PCO2, which decreased from 52.3 mmHg before surgery to 42.0 mmHg after surgery. It is conceivable that, due to long-lasting severe OSAS, our patient lowered his chemosensitivity to PCO2. Consequently, the resolution of obstructive apnoeas and the restoration of normal nocturnal values of PCO2 may have reduced the nocturnal PCO2 to the point of being inadequate to stimulate ventilation.

PMID: 30498277 [PubMed - in process]



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Lichtschutzberatung: Wofür gibt es Evidenz?



https://ift.tt/2QyZonk

Radiologic measurement of cochlea and hearing preservation rate using slim straight electrode (CI422) and round window approach.

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Radiologic measurement of cochlea and hearing preservation rate using slim straight electrode (CI422) and round window approach.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):468-475

Authors: Skarzynski H, Matusiak M, Furmanek M, Pilka A, Wlodarczyk E, Oldak M, Skarzynski PH

Abstract
Hearing preservation surgery constitutes a considerable branch of cochlear implantation surgery and is being steadily developed and perfected. The aim of the study was to verify if insertion of a cochlear implant electrode according to individually calculated linear insertion depth improves hearing preservation. We evaluated the relations between the size of a cochlea, insertion depth angle, linear insertion depth and hearing preservation rate (HP) according to Hearing Preservation Classification in a retrospective case review of 54 patients implanted with a slim straight electrode Nucleus CI422 in 2008-2011. Group HP was 0.75 at activation, 0.67 at 12 months (for 53 patients) and 0.60 at 24 months. In 53 cases, the mean insertion depth angle was 375° (SD 17°); mean calculated cochlear duct length 35.87 mm (SD 1.95); mean calculated linear insertion depth 23.14 mm (SD 1.68). There was no significantly relevant relation between HP values and angular insertion depth or insertion depth. Preoperative measurements of cochlea and specific parameters such as linear insertion depth have no effect on hearing preservation. Poor hearing preservation in some deep insertion cases cannot be explained entirely by the electrode position.

PMID: 30498276 [PubMed - in process]



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Minimalinvasive nachweislich wirksame Verbesserung von Cellulite und Falten



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Report from a Consensus Conference on the treatment of Ménière's disease with betahistine: rationale, methodology and results.

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Report from a Consensus Conference on the treatment of Ménière's disease with betahistine: rationale, methodology and results.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):460-467

Authors: Casani AP, Guidetti G, Schoenhuber R, Consensus Conference Group

Abstract
Ménière's disease is a disorder of the inner ear that causes vertigo, tinnitus, fullness and hearing loss. Although several treatments are available, the success rate is reported to be around 70%, similar to placebo. Betahistine, a weak H1 receptor agonist and an effective H3 receptor antagonist, is frequently prescribed for Ménière's disease, especially to reduce recurrent vertigo attacks. The effects of this drug on hearing and other audiological symptoms remains unclear. Given the inconclusive reports in the literature, we proposed a consensus conference on the use of betahistine in Ménière's disease. The aim was to define best practice criteria for therapy for Ménière's disease, improve clinical suitability and reduce heterogeneity of the therapeutic approach. The consensus conference on betahistine for Ménière's disease involved a group of Italian experts in vestibular disorders who were asked a series of questions prepared by opinion leaders. The Delphi method, an iterative investigation method, was used to increase consensus. Via a tele-voting system, each participant anonymously evaluated all statements using a Likert 5-point scale. Betahistine was considered useful for the treatment of dizziness and vertigo during the intercritical phase of the disease (87% agreeing answers). However, during the acute phase of the disease betahistine was considered less effective and useful only when associated with other drugs (71% agreement). Similarly, the efficacy of the drug was considered low when used to reduce progressive hearing loss, tinnitus, and ear fullness. The experts advocated the use of betahistine during the intercritical phase of Ménière's disease to reduce the number and severity of vertigo attacks. Its use seems to be at low risk of major side effects.

PMID: 30498275 [PubMed - in process]



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Prediction of hearing recovery in sudden deafness treated with intratympanic steroids.

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Prediction of hearing recovery in sudden deafness treated with intratympanic steroids.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):453-459

Authors: Attanasio G, Russo FY, Di Porto E, Cagnoni L, Masci E, Ralli M, Greco A, De Vincentiis M

Abstract
The present study aims to obtain a probability model allowing prediction of auditory recovery in patients affected by sudden sensorineural hearing loss treated exclusively with intratympanic steroids. A monocentric retrospective chart review of 381 patients has been performed. A Probit model was used to investigate the correlation between the success of treatment (marked or total recovery according to Furuashi's criteria) and the delay between onset of disease and beginning of therapy. The age of patients and audiometric curve shapes were included in the analysis. The results show that delay is negatively correlated with variable success. Considering the entire sample, each day of delay decreases the probability of success by 3%. The prediction model shows that for each day that passes from the onset of the disease the probability of success declines in absence of the medical treatment, hence we conclude that early treatment is strongly recommended.

PMID: 30498274 [PubMed - in process]



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MVZ, Teilzulassung, Jobsharing: Für wen eignet sich welches Modell?

Ob Berufsausübungsgemeinschaft, Teilzulassung, Entlastungsassistent, MVZ oder Jobsharing-Modelle: Die Auswahl möglicher Versorgungsformen bei einer Existenzgründung war für Mediziner nie größer als heutzutage. Je nach ihrer individuellen Lebenssituation können sich Ärzte für eine höhere oder weniger hohe Flexibilität bei der Berufsausübung entscheiden.



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Cochlear implantation in far-advanced otosclerosis: hearing results and complications.

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Cochlear implantation in far-advanced otosclerosis: hearing results and complications.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):445-452

Authors: Dumas AR, Schwalje AT, Franco-Vidal V, Bébéar JP, Darrouzet V, Bonnard D

Abstract
Severe forms of otosclerosis known as far-advanced otosclerosis (FAO) can lead to severe to profound sensorineural hearing loss and can justify cochlear implantation. Because of the pathophysiology of otosclerosis, patients implanted for FAO may experience an increased rate of complications, such as facial nerve stimulation or electrode dislocation, and may have poorer hearing outcomes than expected. This retrospective study aimed to compare cochlear implantation hearing outcomes, surgical difficulties and complications in FAO patients versus non-FAO patients. Moreover, we evaluated whether high resolution computed tomography (CT scan) findings were predictive of perioperative problems, complications and hearing outcomes. FAO patients were diagnosed based on medical history, examination and CT scan. Thirty-five ears from FAO patients were compared to 38 control ears. Audiometric results were assessed at least 12 months after implantation by pure tone average, speech reception threshold, monosyllabic and disyllabic word recognition score (WRS) and Central Institute for the Deaf (CID) sentences test. Complications and surgical difficulties were compiled. CT scan findings were categorised within 3 grades of otosclerotic extension. No significant difference was found between FAO and non-FAO hearing outcomes, except that monosyllabic WRS were lower for FAO patients, especially those who underwent previous stapedotomy. Facial nerve symptomatology occurred in 8.6% of FAO patients; among these, one required explantation-reimplantation surgery. 86% of FAO implanted patients had retrofenestral extension on CT. These were associated with poorer disyllabic WRS (51% vs 68%, p < 0.05) than those with only fenestral involvement. Although not significant, high grade of severity on CT tended to be associated with surgical difficulties and complications. Cochlear implantation in FAO patients is an effective treatment technique. Though the overall complication rate is low, it tends to be higher in cases of severe extension on CT. Patient counselling should be adjusted accordingly.

PMID: 30498273 [PubMed - in process]



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Trans-nasal endoscopic and intra-oral combined approach for odontogenic cysts.

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Trans-nasal endoscopic and intra-oral combined approach for odontogenic cysts.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):439-444

Authors: Procacci P, Lanaro L, Molteni G, Marchioni D, Lonardi F, Fusetti S, Nocini PF, Albanese M

Abstract
Maxillary cysts are a common finding in maxillofacial surgery, dentistry and otolaryngology. Treatment is surgical; a traditional approach includes Caldwell-Luc and other intra-oral approaches. In this article, we analyse the outcomes of 9 patients operated on using a combined intra-oral and trans-nasal approach to the aforementioned disease. Although the number of patients is small, the good results of this study suggest that the combined approach might be a reliable treatment option.

PMID: 30498272 [PubMed - in process]



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Die besten Innovationen 2018

Im Rahmen einer Gala in Berlin ist der von Springer Medizin gestiftete Galenus-von-Pergamon-Preis für pharmazeutische Innovationen verliehen worden. Mit dem CharityAward wurde außerdem ehrenamtliches Engagement gewürdigt.



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Relationship between socio-demographic characteristics and vocal fold nodules, polyps and oedema.

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Relationship between socio-demographic characteristics and vocal fold nodules, polyps and oedema.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):424-430

Authors: Milovanovic J, Vukasinovic M, Jotic A, Vlajinac H, Milovanovic A, Pavlovic B, Banko B, Maksimovic J

Abstract
The aim of our study was to compare socio-demographic characteristics of vocal fold nodules, polyps and oedema. The study included patients diagnosed for the first time with vocal fold nodules, polyps and oedema at the Communication Disorders Care Center of Clinic for Otorhinolaryngology and Maxillofacial Surgery in Clinical Center of Serbia, Belgrade. Diagnosis was made on the basis of symptoms, clinical otorhinolaryngological and phoniatric examination and endovideolaryngostroboscopic findings. A self-administered questionnaire was used to collect the following data: socio-demographic status, exposure to occupational noise and air pollution, occupational voice demands, health habits, symptoms of the present voice problems and voice problems in the family. By multivariate logistic regression analyses, nodules and oedema were more frequent in women than men in comparison with polyps (p < 0.001). Patients with nodules and polyps were younger than those with oedema (p < 0.001). Patients with nodules were more frequently lecturers, singers and actors compared with polyp patients (p = 0.006), had occupational voice demands more frequently than patients with oedema (p = 0.037) and were less frequently smokers than patients with polyps (p = 0.043) and those with oedema (p < 0.001). Patients with oedema were more frequently current smokers than patients with nodules and those with polyps (p < 0.001). Hoarseness as the main symptom was more frequent among patients with nodules than among patients with polyps (p = 0.040) and those with oedema (p = 0.001).Voice problems in the family was more frequently reported by oedema patients than by patients with polyps (p = 0.005). These findings are in agreement with majority of previous studies and may be of help in investigations on the aetiology of the disease.

PMID: 30498270 [PubMed - in process]



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Predictors of recurrence after surgical treatment of idiopathic progressive subglottic stenosis.

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Predictors of recurrence after surgical treatment of idiopathic progressive subglottic stenosis.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):417-423

Authors: Fiz I, Koelmel JC, Piazza C, Fiz F, Di Dio D, Bittar Z, Peretti G, Sittel C

Abstract
Idiopathic progressive subglottic stenosis is a rare cause of tracheal narrowing. Partial cricotracheal resection and anastomosis can cure idiopathic stenosis, even if some patients may require multiple interventions and experience voice and swallowing deterioration. We investigated risk factors for retreatment and assessed the impact of crico-tracheal resection on functional parameters. We conducted a retrospective multicentric study on 44 female patients (mean age 52.6 ± 13.1 years) affected by idiopathic stenosis and treated by crico-tracheal resection between 2002 and 2016. Functional outcomes after crico-tracheal resection were assessed by the airway-dyspnoea-voice-swallowing score (range 1-5, with "1" expressing normal and "5" completely altered function). Previous treatments, grade of stenosis, site, airway comorbidities, age and resection length were tested as predictors of postoperative complications and number of additional treatments, using bivariate and multivariate analysis. The overall decannulation rate was 97.3%. The dyspnoea score improved (mean variation 1.4 ± 1.0; p < 0.001), while voice and swallowing were negatively affected (mean variation 1.6 ± 0.9 and 0.5 ± 0.7, respectively; p < 0.001). Airway comorbidities were associated with a higher rate of complications (p < 0.05). Retreatments were more frequent in patients with postoperative complications (p < 0.05). The length of resection correlated with the number of subsequent treatments (R = 0.52; p < 0.01). At multivariate analysis, post-operative complications were predicted by comorbidities and disease stage (p < 0.05); number of retreatments was linked to the length of resection (p < 0.05) as well as with the application of mitomycin C (p < 0.001). Crico-tracheal resection for idiopathic progressive subglottic stenosis offers good functional results in terms of airway patency. These data suggest that a higher complication rate can be expected in patients affected by comorbidities. Moreover, more extensive surgical resection seems to be associated with the occurrence and number of subsequent retreatments. On the contrary, the local application of an anti-proliferative drug does not seem to be of use in preventing recurrences.

PMID: 30498269 [PubMed - in process]



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Three-dimensional stereophotogrammetric analysis of nasolabial soft tissue effects of rapid maxillary expansion: a systematic review of clinical trials.

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Three-dimensional stereophotogrammetric analysis of nasolabial soft tissue effects of rapid maxillary expansion: a systematic review of clinical trials.

Acta Otorhinolaryngol Ital. 2018 Oct;38(5):399-408

Authors: Staderini E, Patini R, De Luca M, Gallenzi P

Abstract
The aim of this systematic review is to analyse the quality and clinical evidence in the literature analysing, through 3D stereophotogrammetry, the nasolabial soft tissue modifications that may occur after rapid maxillary expansion (RME). This systematic literature review was based on the PRISMA-P statement and was registered in the PROSPERO database with the following protocol ID: CRD42017079875. Pubmed, Cochrane, EBSCO, Scopus, Web of Science databases were searched with no restriction of year or publication status. Selection criteria were: randomised clinical trials, controlled clinical trials, cohort studies, cross-sectional studies, case-control studies on patients with unilateral/bilateral crossbite, transverse maxillary deficiency and crowding, treated with RME and monitored by 3D stereophotogrammetry. 652 articles were retrieved in the initial search. After the review process, 11 full-text articles met inclusion criteria. After the evaluation process, 4 publications were included for the present literature review. Due to the heterogeneous methodology meta-analysis was not possible; consequently, a systematic assessment of the studies and summary of the findings from the available evidence were used to answer the research question. The maximum widening of the alar cartilage is 1.41 ± 0.95 mm, whose clinical significance is open to question. The effect of RME on the mouth width remains controversial. In Altindis et al., the difference between pre-treatment and post-treatment mouth width (1.80 mm increment in the banded RME group) was statistically significant, while in Baysal 1.86 mm was considered a non-significant value. Inconsistencies and limitations in the study population and measurement protocols were detected between studies. These data underline the necessity for updated guidelines that allow to standardise, for this type of study, sample selection, measurement methods and collection of results.

PMID: 30498268 [PubMed - in process]



https://ift.tt/2Qt7mOR

Incidence of Thyroid Cancer Among Children and Young Adults in Fukushima, Japan, Screened With 2 Rounds of Ultrasonography Within 5 Years of the 2011 Fukushima Daiichi Nuclear Power Station Accident.

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Incidence of Thyroid Cancer Among Children and Young Adults in Fukushima, Japan, Screened With 2 Rounds of Ultrasonography Within 5 Years of the 2011 Fukushima Daiichi Nuclear Power Station Accident.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 29;:

Authors: Ohtsuru A, Midorikawa S, Ohira T, Suzuki S, Takahashi H, Murakami M, Shimura H, Matsuzuka T, Yasumura S, Suzuki SI, Yokoya S, Hashimoto Y, Sakai A, Ohto H, Yamashita S, Tanigawa K, Kamiya K

Abstract
Importance: Ultrasonographic (US) screening for thyroid cancer was performed in the Fukushima Health Management Survey after the 2011 Fukushima Daiichi nuclear power station accident. Clinical characteristics of thyroid cancers screened by US among children and young adults during the first 5 years after the accident were analyzed.
Objectives: To evaluate the number of detected thyroid cancers by age group within 5 years of the Fukushima Daiichi nuclear power station accident and to compare the basic clinical characteristics and demographic patterns in first- and second-round examinations.
Design, Setting, and Participants: In this observational study, 324 301 individuals 18 years or younger at the time of accident were included. Patients received a cytologic diagnosis of malignant or suspected malignant thyroid cancer during the first (fiscal years 2011-2013) or second round (fiscal years 2014-2015) of screening. Number of detected cases of cancer was evaluated, correcting for the number of examinees by age group at the time of the accident and for the incidence of detected cancers according to age group at the time of the screening (age groups were divided into 3-year intervals). Results were compared using the age-specific incidence of unscreened cancers from a national cancer registry.
Main Outcomes and Measures: Clinical baseline characteristics of the patients and the age-specific number and incidence of thyroid cancers detected during the second round.
Results: Among 299 905 individuals screened in the first round (50.5% male; mean [SD] age at screening, 14.9 [2.6] years), malignant or suspected thyroid cancer was diagnosed in 116. Among 271 083 individuals screened in the second round (50.4% male; age at screening, 12.6 [3.2] years), malignant or suspected thyroid cancer was diagnosed in 71. The most common pathologic diagnosis in surgical cases was papillary thyroid cancer (149 of 152 [98.0%]). The distribution pattern by age group at the time of the accident, where the number of detected thyroid cancer cases was corrected by the number of examinees, increased with older age in both screening rounds. This demographic pattern was similar between the first and second examinations. The distribution pattern of the incidence rate by age group at the time of screening in the second round also increased with older age. The incidence rate detected by screening was 29 cases per 100 000 person-years for those aged 15 to 17 years, 48 cases per 100 000 person-years for those aged 18 to 20 years, and 64 cases per 100 000 person-years for those aged 21 to 22 years.
Conclusions and Relevance: Large-scale mass US screening of young people resulted in the diagnosis of a number of thyroid cancers, with no major changes in overall characteristics within 5 years of the 2011 Fukushima nuclear power station accident. These results suggest that US screening can identify many detectable cancers from a large pool of nonclinical and subclinical thyroid cancers among individuals of a relatively young age, in an age-dependent manner.

PMID: 30489622 [PubMed - as supplied by publisher]



https://ift.tt/2PaPoM8

Association of Preoperative Anemia With 30-Day Morbidity and Mortality Among Patients With Thyroid Cancer Who Undergo Thyroidectomy.

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Association of Preoperative Anemia With 30-Day Morbidity and Mortality Among Patients With Thyroid Cancer Who Undergo Thyroidectomy.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 29;:

Authors: Burton BN, Okwuegbuna O, Jafari A, Califano J, Brumund KT, Gabriel RA

Abstract
Importance: Despite the ease of preoperative anemia diagnosis and the availability of treatment options, the morbidity and mortality associated with this condition remain unacceptably high, and the literature describing the association of preoperative anemia with postoperative outcomes following thyroid surgery in patients with thyroid cancer remain sparse. Reporting outcomes in this patient population may help to facilitate preoperative optimization.
Objective: To assess whether an association exists between preoperative anemia and outcomes following thyroid surgery in patients with thyroid cancer.
Design, Setting, and Participants: This retrospective, cross-sectional, cohort study used the American College of Surgeons National Surgical Quality Improvement Program database to identify 32 166 patients between 2007 and 2016 with Current Procedural Terminology codes for thyroid surgery and with the International Classification of Diseases, Ninth Revision code of malignant thyroid cancer.
Exposures: Preoperative anemia as defined using the World Health Organization criteria of hematocrit less than 36% in nonpregnant females and less than 39% in males.
Main Outcomes and Measures: Multivariable logistic regression analysis was conducted to assess the association of preoperative anemia with the following 30-day postoperative outcomes: pulmonary, infectious, and cardiac complications, overall and serious morbidity (surgical site infection and medical complications), prolonged hospital length of stay (≥75th percentile for the cohort), and mortality.
Results: Among the 24 912 patients with thyroid cancer who underwent thyroidectomy included in the final analysis, the median (interquartile range) age was 51 (40-62) years and the majority were women (18 705 [75.1%]). The prevalence of preoperative anemia was 12.5% (n = 3108). Within the overall study population, hypertension (9242 patients [37.1%]) followed by active smoking (2992 patients [12.0%]) were the most prevalent comorbidities. The unadjusted odds of anemia vs no anemia were significantly higher for every 10-year increase in age (odds ratio [OR], 1.10; 95% CI, 1.08-1.13) and for black vs white patients (OR, 2.82; 95% CI, 2.51-3.17). The adjusted odds of postoperative overall morbidity (OR, 1.68; 95% CI, 1.29-2.17), mortality (OR, 3.36; 95% CI, 1.37-8.28), and pulmonary (OR, 2.36; 95% CI, 1.65-3.34) and infectious (OR, 1.62; 95% CI, 1.12-2.29) complications were higher in patients with preoperative anemia than in those without preoperative anemia.
Conclusions and Relevance: The findings from this study suggest that preoperative anemia may not only be associated with racial differences and a higher comorbidity burden but may also increase the likelihood of postoperative morbidity and mortality. These results may provide a basis for further risk reduction strategies and preoperative optimization.

PMID: 30489623 [PubMed - as supplied by publisher]



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Melasmen: Liposomales Hydrochinon nicht besser als konventionelles?

Hydrochinon kann Melasmen effektiv lindern. Dabei scheint es keine Rolle zu spielen, ob der Wirkstoff in Liposomen verpackt wird oder nicht — sowohl die konventionelle Creme, als auch eine liposomale Formulierung reduzierten in einer Studie Melasmen effektiv.



https://ift.tt/2QAztM7

Sklerotherapie besitzt großes therapeutisches Potenzial



https://ift.tt/2E4mSdB

App im Wartezimmer fördert Bewusstsein für Sonnenschutz

Gebräunte Haut verbinden viele Menschen mit Attraktivität. Jedoch wird diese häufig auf ungesunde Weise erreicht. Fehlender Sonnenschutz und Solarienbesuche sorgen zwar für Bräune, sie erhöhen aber zugleich das Hautkrebsrisiko und fördern Photoaging. Eine App soll dabei helfen, Patienten zu verdeutlichen, wie wichtig der richtige, auf die individuelle Haut abgestimmte Sonnenschutz ist.



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Effect of Total Intravenous Anesthesia vs Volatile Induction With Maintenance Anesthesia on Emergence Agitation After Nasal Surgery: A Randomized Clinical Trial.

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Effect of Total Intravenous Anesthesia vs Volatile Induction With Maintenance Anesthesia on Emergence Agitation After Nasal Surgery: A Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 29;:

Authors: Jo JY, Jung KW, Kim HJ, Park SU, Park H, Ku S, Choi SS

Abstract
Importance: Emergence agitation is common after nasal surgery under general anesthesia and may lead to serious consequences for the patient, including an increased risk of injury, pain, hemorrhage, and self-extubation. Despite decades of research, studies on the incidence, risk factors, and prevention of emergence agitation in adult patients are ongoing, and opinions differ on the different effects of inhalation and intravenous anesthesia.
Objective: To investigate the effect of anesthetic method on the occurrence of emergence agitation after nasal surgery.
Design, Setting, and Participants: This prospective, randomized, single-blind, clinical trial included 80 patients undergoing open rhinoplasty, septoplasty, turbinoplasty, endoscopic sinus surgery, and functional endoscopic sinus surgery under general anesthesia who were randomized to receive total intravenous anesthesia (TIVA) with remifentanil hydrochloride and propofol (n = 40) or volatile induction and maintenance of anesthesia (VIMA) with sevoflurane and nitrous oxide (n = 40) in Asan Medical Center, a tertiary referral center in Seoul, Republic of Korea. Data were collected from August 24 through October 14, 2016, and analyzed from October 26, 2016, through September 14, 2017.
Main Outcomes and Measures: The occurrence of emergence agitation defined by the following 2 individual criteria: a Richmond Agitation-Sedation Scale score of at least 1 and a Riker Sedation-Agitation Scale score of at least 5 immediately after extubation.
Results: Among the 80 patients included in the analysis (68.8% men [n = 55]; mean [SD] age, 41.6 [17.9] years), emergence agitation measured by the Richmond Agitation Sedation Scale occurred in 8 of 40 patients (20.0%) in the VIMA group and 1 of 40 (2.5%) in the TIVA group. The risk difference was 17.5 (95% CI, 3.6-31.4). Emergence agitation measured by the Riker Sedation-Agitation Scale score occurred in 10 of 40 patients (25.0%) in the VIMA group and 1 of 40 (2.5%) in the TIVA group. The risk difference was 22.5 (95% CI, 7.3-37.7).
Conclusions and Relevance: The occurrence of emergence agitation after nasal surgery under general anesthesia can be significantly reduced by using TIVA rather than VIMA.
Trial Registration: CRIS identifier: KCT0002145.

PMID: 30489620 [PubMed - as supplied by publisher]



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Topische Behandlung unterstützt Regeneration der Haut



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Thyroid Cancer Screening After Nuclear Accidents.

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Thyroid Cancer Screening After Nuclear Accidents.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 29;:

Authors: Morris LGT

PMID: 30489617 [PubMed - as supplied by publisher]



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Wo investieren im Digital-Health-Markt?



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Why the Data From the Fukushima Health Management Survey After the Daiichi Nuclear Power Station Accident Are Important.

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Why the Data From the Fukushima Health Management Survey After the Daiichi Nuclear Power Station Accident Are Important.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 29;:

Authors: Bauer AJ, Davies L

PMID: 30489616 [PubMed - as supplied by publisher]



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Pilz und Spore nachhaltig bekämpfen



https://ift.tt/2DYZlKR

Introducing New Section Editor and Clinical Focus: Care of Patients With Endocrine Conditions.

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Introducing New Section Editor and Clinical Focus: Care of Patients With Endocrine Conditions.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 29;:

Authors: Piccirillo JF

PMID: 30489615 [PubMed - as supplied by publisher]



https://ift.tt/2Svk8Kb

Nicht nur einfach schön sein ...

Wer sich einer kosmetischen Korrektur unterzieht, erhofft sich als Resultat seines erfrischten Auftritts häufig psychisches Wohlbefinden, Glücksgefühle, Attraktivität, eine bessere Lebensqualität, aber auch mehr Chancen im täglichen Gerangel in Job und Privatleben.



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An Indolent Middle Ear Mass.

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An Indolent Middle Ear Mass.

JAMA Otolaryngol Head Neck Surg. 2018 Nov 29;:

Authors: D'Oto A, Tolisano AM, Isaacson B

PMID: 30489613 [PubMed - as supplied by publisher]



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Keloide: Welche Therapie ist die beste?

Eine gute Therapie sollte nicht nur wirksam, sondern auch nebenwirkungsarm sein. Mit Blick auf die Behandlung von Keloiden scheint die Injektion von Triamcinolon plus Hyaluronsäure diese Kriterien am besten zu erfüllen.



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Phase II Trial of Paclitaxel +/- Ramucirumab in Patients With Squamous-cell Carcinoma of the Esophagus After Prior Therapy

Condition:   Squamous Cell Carcinoma of the Esophagus
Interventions:   Drug: Ramucirumab;   Drug: Paclitaxel
Sponsors:   IKF Klinische Krebsforschung GmbH at Krankenhaus Nordwest;   Eli Lilly and Company;   Trium Analysis Online GmbH
Not yet recruiting

https://ift.tt/2KTKbbp

Prognostiziertes Marktpotenzial weckt Fantasie bei Anlegern

Die Digitalisierung des Gesundheitswesens wird immer wieder mit Chancen für ein effizientes Gesundheitswesen verknüpft. Doch bietet sie auch ökonomisch ein enormes Potenzial. Davon können Ärzte als Anleger profitieren.



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Second-Line Chemotherapy With Ramucirumab +/- Paclitaxel in Elderly Advanced Gastric or Gastroesophageal Junction Cancer Patients

Conditions:   Stomach Cancer;   Stomach Neoplasm;   Gastric Cancer;   Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Ramucirumab;   Drug: Ramucirumab + Paclitaxel
Sponsors:   Federation Francophone de Cancerologie Digestive;   Eli Lilly and Company
Recruiting

https://ift.tt/2BR5l6Z

Individuelle Gesundheitsleistungen in der dermatologischen Praxis

Zwar gibt es inzwischen einen „offiziellen" Katalog mit individuellen Gesundheitsleistungen und durch den medizinischen Fortschritt etablieren sich weitere Leistungen, die nicht im Rahmen der gesetzlichen Krankenversicherung erbracht werden dürfen. Dennoch bricht die Diskussion um die Berechtigung dieser Leistungen nicht ab. Zumindest bezüglich der Abrechnung herrschen aber eindeutige Vorgaben seitens des Gesetzgebers, die die Anbieter dieser Leistungen kennen sollten.



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Inhaltsverzeichnis



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„ästhetik am Sonntag fand beeindruckend großes Interesse“



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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.

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Influence of Immunological Maturity on Respiratory Syncytial Virus-Induced Morbidity in Young Children

Viral Immunology, Ahead of Print.


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Association of Single Nucleotide Polymorphisms in TNFA and IL10 Genes with Disease Severity in Influenza A/H1N1pdm09 Virus Infections: A Study from Western India

Viral Immunology, Ahead of Print.


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Clinical Significance of B7-H3 Expression During the Progression of Hepatitis B Virus Infection

Viral Immunology, Ahead of Print.


https://ift.tt/2SqPAJj

Contribution of Vaccination to Human Health

Viral Immunology, Ahead of Print.


https://ift.tt/2EdJjxF

Anti-Bovine Podoplanin Monoclonal Antibody PMab-44 Detects Goat Podoplanin in Immunohistochemistry

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


https://ift.tt/2KTJH55