Purpose of review Against the background of increasing healthcare costs and diminishing budgets, this review aims to present clinicians with ethically viable options to overcome budgetary restraints when seeking to introduce novel products. Recent findings Healthcare administrators and primary healthcare providers are not unlikely to have different opinions when discussing the introduction of novel products. However, rather than taking a 'no' for an answer, doctors may be able to argue for a change – even if this may seem to come at a higher cost. The recent introduction of the reversal agent sugammadex may provide a timely example for the possibility of success 'against all financial odds'. Summary Health professionals have the responsibility to deliver high-quality care while acknowledging the financial budget constraints. However, evidence (vs. perception) for outcome benefits of novel drugs or devices should stimulate a robust desire for their timely introduction. Demonstrating actual benefits understandable to administrators, seeking alliances with other medical specialties or patient groups, as well as negotiations with the healthcare industry may all represent viable options. Simply waiting for patents to expire should remain a measure of last resort. Correspondence to Professor Thomas Ledowski, Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia 6000, Australia. Tel: +61 8 92242244; e-mail: Thomas.ledowski@health.wa.gov.au Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2QLERfD
Πέμπτη 6 Δεκεμβρίου 2018
Role of anesthesiologists in managing perioperative anemia
Purpose of review Anemia can contribute negatively to a patient's morbidity and mortality. Which treatment options do exist and what role do anesthesiologists play in management of perioperative anemia treatment? This review gives an overview about recent findings. Recent findings Patient Blood Management and standards for the management and treatment of anemia have been established worldwide. Various logistic settings and approaches are possible. With a special focus on cardiovascular anesthesia, intravenous iron is a therapeutic option in the preoperative setting. Autologous blood salvage is a standard procedure during surgery. Restrictive transfusion triggers in adult cardiac surgery have been shown to be beneficial in the majority of studies. Elderly patients and defined comorbidities might require higher transfusion triggers. Both, intravenous and oral iron increase hemoglobin values when given prior to surgery. Oral iron is effective when given several weeks prior to elective surgery. Erythropoietin is a treatment decision individualized to each patient. Summary Within the previous 18 months, important publications have demonstrated the established role of anesthesiologists in managing perioperative anemia. A substantial pillar for anemia treatment is the implementation of Patient Blood Management worldwide. Correspondence to Andrea U. Steinbicker, MD, MPH, Westfalische Wilhelms-Universitat Munster, Muenster; Muenster University Hospital, Albert-SChweitzer Campus 1, Building A1, 48149 Muenster, Germany. Tel: +0049 251 83 47898; e-mail: andrea.steinbicker@ukmuenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2SwyUAg
https://ift.tt/2SwyUAg
Withholding or withdrawing life support versus physician-assisted death: a distinction with a difference?
Purpose of review Withholding or withdrawing life-sustaining therapy is generally differentiated from physician-assisted suicide or euthanasia based on the distinction between intention and foresight. We reviewed the literature surrounding the validity of this distinction. Recent findings Many physicians from different specialties express a perceived distinction between intention and foresight. The distinction between intention and foresight differs from the morally irrelevant distinction between doing and allowing. Intention and foresight may be distinguished by their opposing directions of fit between world and mind. Intention is held to be of greater moral significance than foresight because it guides and constrains our actions, determines the moral quality of our actions, and expresses the moral character of the agent. Opponents of the distinction argue that it undermines moral accountability for foreseen consequences of our actions and is overly concerned with the physician's state of mind rather than the patient's experience. They also argue that intentions may be vague and difficult to express or ascertain. Summary Several reasons may be given in favor of the distinction between intention and foresight. Given this distinction, the moral permissibility of withholding or withdrawing life-sustaining therapy does not necessarily entail the moral permissibility of physician-assisted suicide or euthanasia. Correspondence to Ewan C. Goligher, MD, PhD, Toronto General Hospital, 585 University Ave., Peter Munk Building, 11-192, Toronto, ON M5G 2N2, Canada. Tel: +1 416 340 4800 ext. 6810; e-mail: ewan.goligher@utoronto.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2SxLM9f
https://ift.tt/2SxLM9f
Preoperative rehabilitation for thoracic surgery
Purpose of review Lung resection provides the best outcome for patients with early stage lung cancer. However, lung cancer surgery carries a significant risk of perioperative complications. Patient risk may be reduced by addressing modifiable risk factors in the preoperative period. We review how this can be achieved through preoperative rehabilitation pathways. Recent findings Cardiorespiratory fitness is an independent predictor of survival for nonsmall cell cancer. Preoperative exercise programmes may improve cardiorespiratory reserve and reduce perioperative complications. Additional benefits may be achieved through interventions such as smoking cessation programmes, correction of anaemia, improvement of nutritional status and improved oral hygiene. These interventions may also have the additional benefit of enabling high-risk patients previously deemed unsuitable for surgery to be optimized to such a degree that they can undergo surgery. These interventions will achieve maximal benefit when delivered early in lung cancer pathways; this requires close collaboration amongst multidisciplinary teams. Summary Lung cancer surgery carries significant risk of postoperative pulmonary complications. Through integrating prehabilitation interventions into lung cancer pathways, there are opportunities to improve long-term outcomes for patients. Correspondence to Richard Templeton, MB.ChB, FRCA, Wythenshawe Hospital, Manchester Foundation Trust, Southmoor Road, Manchester M23 9LT, UK. Tel: +441612914514; e-mail: rtempleton7@doctors.org.uk Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2QJPBes
https://ift.tt/2QJPBes
Sodium-glucose cotransporter-2 inhibitors: an overview and perioperative implications
Purpose of review Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are a relatively new class of drugs used in the management of diabetes mellitus. This review will highlight key pharmacologic characteristics of this class of drugs; discuss their potential role in management of patients with cardiac disease; and raise several perioperative concerns for anesthesiologists caring for patients on SGLT-2 inhibitors. Recent findings Recent trials have shown a strong mortality benefit in diabetic patients on SGLT 2 inhibitors especially in patients with a high cardiovascular burden. In addition, there is a reduction in HbA1c levels, blood pressure, weight and readmissions secondary to heart failure in this patient population. However, these drugs have been also associated with an increased incidence of adverse events, such as euglycemic ketoacidosis, urinary tract infections, acute kidney injury and limb amputations. Summary SGLT 2 inhibitors are being increasingly prescribed secondary to their significant salutatory effect in patients with type II diabetes mellitus. Although there are no perioperative consensus guidelines for management of patients on SGLT2 inhibitors, they should be discontinued at least 24–48 h prior to major surgeries. Their overall management in the perioperative period should be carried out on a case-to-case basis using a multidisciplinary approach. Correspondence to Amit Bardia, MBBS, Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06515, USA. E-mail: amit.bardia@yale.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2Sw3D0c
https://ift.tt/2Sw3D0c
Ethical lessons learned and to be learned from mass casualty events by terrorism
Purpose of review The world has seen a major upturn in international terror awareness. Medicine has had to respond. In addition to the unique physical and mental injuries caused by terror which require special clinical attention, so too terror represents a challenge for medicine from an ethics perspective. Recent findings Several responses in the literature over the past few years have attempted to reflect where the battlefront of ethical dilemmas falls. These include issues of resource allocation, triage, bioterror, the therapeutic relationship with terrorists, dual loyalty, and challenges in the role in the promotion of virtuous behavior as a physician under difficult conditions. Summary Although many challenges exist, physicians need to be prepared for ethical response to terror. With their associated unique status, providing legitimacy and specialized ability in the management and approach to terror situations, physicians are held to a higher standard and need to rise to the occasion. This is required in order to promote ethical behavior under trying conditions and ethical sensitivity of the medical profession by means of being attuned to the reality around. Correspondence to Rael D. Strous, MD, MHA, Mayanei Hayeshua Medical Center, 17 HaRav Povarski Street, Bnei Brak, Israel. Tel: +972 73 3398015; fax: +972 73 3398003; e-mail: raels@post.tau.ac.il Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2QCDXSj
https://ift.tt/2QCDXSj
The ethics of treating family members
Purpose of review Many medical professionals receive requests from family and friends asking for medical advice and treatment. But should medics treat their family? Ethically can we treat, or refuse to treat, family members? This is a common ethical challenge that most doctors face during their career and there is limited evidence available. By examining ethical principles, we aim to answer these questions and provide a framework that will guide decision making in this area. Recent findings There is a paucity of evidence available. Many ethical systems exist and have been discussed since ancient Greece but in recent years, bioethics has become more prominent in medical thinking and debate. Summary We examine ethical systems such as virtue ethics, utilitarianism, deontology and principlism and how they relate to treating family members. We then look at cases in different contexts and describe a system for approaching such cases, allowing doctors to conform to moral standards, and consider ethical arguments, prior to embarking upon any treatment course with a relative. Correspondence to Paul C. McConnell, MB, ChB (Hons), FRCA, EDIC, FFICM, Consultant Intensive Care Medicine, Royal Alexandra Hospital, Paisley PA2 9PJ, Scotland. Tel: +0141 314 6609; e-mail: paulmcconnell@nhs.net Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2QDCb3j
https://ift.tt/2QDCb3j
Resource allocation in ICU: ethical considerations
Purpose of review Increasing scarcity of resources on the background of ever improving medical care and prolonged life expectancy has placed a burden on all aspects of health care. In this article we examine the current problems with resource allocation in intensive care and question whether we can find guidance on appropriate resource allocation through ethical models. Recent findings The problem of fair and ethical resource allocation has perpetually plagued health care. Recent work has looked at value for money, benefits of therapies and how we define futility, but these still fall victim to the same problems that classical schools of ethical thought have tried to tackle. Summary Many ethical principles provide a framework on which to allocate resources to certain cohorts of patients, however, most appear too rigid to be fully and primarily utilized for intensive care admission. We suggest a collaboration of principles be applied to achieve a moral, ethical and common sense approach to this issue. Over resourcing and under resourcing is also suggested to be problematic for patients and healthcare workers alike. Correspondence to Paul C. McConnell, MB ChB (Hons) FRCA EDIC FFICM, Royal Alexandra Hospital, Corsebar Road, Paisley PA2 9QF, UK. Tel: +0141 314 6609; e-mail: paulmcconnell@nhs.net Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2SwRZlJ
https://ift.tt/2SwRZlJ
Nonstandard do-not-resuscitate orders
Purpose of review Tattoos and medallions are examples of nonstandard do-not-resuscitate (DNR) orders that some people use to convey end-of-life wishes. These DNR orders are neither universally accepted nor understood for reasons discussed within this manuscript. Recent findings Studies show both providers and patients confuse the meaning and implication of DNR orders. In the United States, out-of-hospital DNR orders are legislated at the state level. Most states standardized out-of-hospital DNR orders so caregivers can immediately recognize and accept the order and act on its behalf. These out-of-hospital orders are complicated by the need to be printed on paper that does not always accompany the individual. Oregon created an online system whereby individuals recorded their end-of-life wishes that medical personnel can access with an Internet connection. This system improved communication of end-of-life wishes in patients who selected comfort care only. Summary To improve conveyance of an individual's wishes for end-of-life care, the authors discuss nationwide adoption of Oregon's online registry where a person's account could comprehensively document end-of-life wishes, be universally available in all healthcare institutions, and be searchable by common patient identifiers. Facial recognition software could identify unconscious patients who present without identification. Correspondence to Gregory E. Holt, MD, PhD, University of Miami School of Medicine, Miami, FL 33136, USA. E-mail: gholt@miami.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2SwRW9x
https://ift.tt/2SwRW9x
Effect of brightness and contrast variation for detectability of root resorption lesions in digital intraoral radiographs
Abstract
Objectives
To evaluate the performance of periapical radiography assessed under different radiographic brightness and contrast variations in the detection of simulated internal (IRR) and external (ERR) root resorption lesions. Additionally, observers' preferences related to image quality for these diagnostic tasks were evaluated.
Methods
Thirty single-root teeth were divided into two groups (n = 15): IRR, in which lesions were simulated using mechanical and biochemical processes; and ERR, in which cavities standardized with drills of different sizes were performed on the root surfaces. Digital radiographs were obtained and subsequently adjusted in 4 additional combinations, resulting in 5 brightness/contrast variations (V1–V5). Five radiologists evaluated the radiographs. The observers' preference on the image quality was also recorded.
Results
For both conditions, there were no differences in the accuracy and specificity between the five brightness/contrast variations (p > 0.05), but the sensitivity for ERR was significantly lower in V4 (+ 15% brightness/−15% contrast) in the large size (p < 0.05). The observers classified V2 (− 15% brightness/+15% contrast) as the "best" image quality for IRR and ERR evaluation.
Conclusions
For IRR and ERR lesions, brightness and contrast variation does not affect the diagnostic performance of digital intraoral radiography within the tested range. The observers prefer images with a reasonable decrease in brightness and increase in contrast.
Clinical relevance
Brightness and contrast enhancement tools are commonly applied in digital radiographic assessment. The use of these tools for detection of root resorptions can be applied according to the observer preference without influence on diagnostic accuracy.
https://ift.tt/2G46aNY
Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review
Abstract
Background
Biofilm management and infection control are essential after periodontal and implant surgery. In this context, chlorhexidine (CHX) mouth-rinses are frequently recommended post-surgically. Despite its common use and many studies in this field, a systematic evaluation of the benefits after periodontal or implant surgery is—surprisingly—still missing.
Objectives
To evaluate the benefits of chlorhexidine rinsing after periodontal or implant surgery in terms of plaque and inflammation reduction potential. Furthermore, to screen whether the concentration changes or additives in CHX solutions reduce side effects associated with its use.
Materials and methods
A systematic literature search was performed for clinical trials, which compared CHX rinsing after periodontal or implant surgery with rinsing using placebo, non-staining formulations, or solutions with reduced concentrations of the active compound. Four databases (Medline, PubMed, Embase, Cochrane) were searched up to June 2018. Two reviewers independently identified and screened the literature.
Results
From 691 titles identified, only eleven publications met the inclusion criteria and were finally included. Mainly early publications assessed the benefits of CHX over placebo rinsing, whereas more recent publications focused more on the evaluation of new formulations with regard to effectiveness and side effects. The use of CHX after surgery showed in general significant reduction in plaque (means of 29–86% after 1 week) and bleeding (up to 73%) as compared to placebo. No consensus, however, was found regarding the most beneficial CHX formulation avoiding side effects.
Conclusion
Chlorhexidine rinsing helps to reduce biofilm formation and gingival inflammation after surgery. However, no additional reduction of periodontal probing depth over any given placebo or control solution could be found irrespective of whether CHX was used or not. The use of additives such as antidiscoloration systems (ADS) or herbal extracts may reduce side effects while retaining efficacy.
Clinical relevance
Within the limitations of this review, it can be concluded that CHX may represent a valuable chemo-preventive tool immediately after surgery, during the time period in which oral hygiene capacity is compromised. To reduce the side effects of CHX and maintain comparable clinical effects, rinsing with less concentrated formulations (e.g., 0.12%) showed the most promising results so far.
https://ift.tt/2rlbwKy
CD8‐positive lymphomatoid papulosis (type D): Some lesions may lack CD30 expression and overlap histologically with mycosis fungoides
Abstract
Background
CD8+ lymphomatoid papulosis is frequently indistinguishable histopathologically from primary cutaneous aggressive epidermotropic CD8+ T‐cell lymphoma except for the expression of CD30. However, absent or weak expression of CD30 has been rarely reported in cases of CD8+ LyP.
Objective
We aim to study the clinical and pathologic features of cases of CD8+ LyP with no or minimal expression of CD30.
Material and Methods
We identified all cases of CD8+ LyP diagnosed in our institution over a period of 10 years. Blinded comparison of clinical and histopathologic features of cases with and without CD30 expression was performed.
Results
Among seven cases (four patients) with definitive clinical and histopathologic diagnosis of CD8+ LyP, two cases (29%) had no expression of CD30. These two cases had more prominent epidermotropism, less epidermal ulceration, and less vascular damage relative to cases with CD30 expression and therefore resembled mycosis fungoides and type B LyP. CD5 and CD7 were frequently lost regardless of the CD30 status. Expression of cytotoxic markers was not different between the two groups. In the two cases with lack of CD30 expression, subsequent biopsies showed classic features of CD8+ LyP with strong expression of CD30.
Conclusion
CD8+ LyP with lack of expression of CD30 may have distinct histopathologic features that resemble mycosis fungoides and LyP type B. Clinically, they are indistinguishable from their CD30+ counterparts, signifying the importance of clinical correlation to avoid the erroneous diagnosis of lymphoma. Interval biopsies may be needed to establish a definitive diagnosis.
https://ift.tt/2SARYNV
The effect of pectoral block type II on persistent pain: Follow up of a randomised trial and hypotheses for further analyses
No abstract availablehttps://ift.tt/2rqJ8Xw
Prediction of bilateral cerebral oxygen desaturation from a single sensor in adult cardiac surgery
No abstract availablehttps://ift.tt/2G1q6Ba
Low-dose ketamine infusion reduces postoperative hydromorphone requirements in opioid-tolerant patients following spinal fusion: A randomised controlled trial
BACKGROUND The current opioid epidemic highlights the urgent need for effective adjuvant therapies to complement postoperative opioid analgesia. Intra-operative ketamine infusion has been shown to reduce postoperative opioid consumption and improve pain control in opioid-tolerant patients after spinal fusion surgery. Its efficacy for opioid-naïve patients, however, remains controversial. OBJECTIVE We hypothesised that low-dose ketamine infusion after major spinal surgery reduces opioid requirements in opioid-tolerant patients, but not in opioid-naïve patients. DESIGN Randomised placebo-controlled study. SETTING Single-centre, tertiary care hospital, November 2012 until November 2014. PATIENTS A total of 129 patients were classified as either opioid-tolerant (daily use of opioid medications during 2 weeks preceding the surgery) or opioid-naïve group, then randomised to receive either ketamine or placebo; there were thus four groups of patients. All patients received intravenous hydromorphone patient-controlled analgesia postoperatively. INTERVENTION Patients in the ketamine groups received a ketamine infusion (bolus 0.2 mg kg−1 over 30 min followed by 0.12 mg kg−1 h−1 for 24 h). Patients in the placebo groups received 0.9% saline. MAIN OUTCOME MEASURES The primary outcome was opioid consumption during the first 24 h postoperatively. The secondary outcome was numerical pain scores during the first 24 h and central nervous system side effects. RESULTS Postoperative hydromorphone consumption was significantly reduced in the opioid-tolerant ketamine group, compared with the opioid-tolerant placebo group [0.007 (95% CI 0.006 to 0.008) versus 0.011 (95% CI 0.010 to 0.011) mg kg−1 h−1, Bonferroni corrected P https://ift.tt/2rqLjtU
Effects of a single subanaesthetic dose of ketamine on pain and mood after laparoscopic bariatric surgery: A randomised double-blind placebo controlled study
BACKGROUND When administered as a continuous infusion, ketamine is known to be a potent analgesic and general anaesthetic. Recent studies suggest that a single low-dose administration of ketamine can provide a long-lasting effect on mood, but its effects when given in the postoperative period have not been studied. OBJECTIVE We hypothesised that a single low-dose administration of ketamine after bariatric surgery can improve pain and mood scores in the immediate postoperative period. DESIGN We performed a randomised, double-blind, placebo-controlled study to compare a single subanaesthetic dose of ketamine (0.4 mg kg−1) with a normal saline placebo in the postanaesthesia care unit after laparoscopic gastric bypass and gastrectomy. SETTING Single-centre, tertiary care hospital, October 2014 to January 2018. PATIENTS A total of 100 patients were randomised into the ketamine and saline groups. INTERVENTION Patients in the ketamine group received a single dose of ketamine infusion (0.4 mg kg−1) in the postanaesthesia care unit. Patients in the placebo groups received 0.9% saline. OUTCOME MEASURES The primary outcome was the visual analogue pain score. A secondary outcome was performance on the short-form McGill's Pain Questionnaire (SF-MPQ). RESULTS There were no significant differences in visual analogue pain scores between groups (group-by-time interaction P = 0.966; marginal group effect P = 0.137). However, scores on the affective scale of SF-MPQ (secondary outcome) significantly decreased in the ketamine group as early as postoperative day (POD) 2 [mean difference = −2.2 (95% bootstrap CI −2.9 to 1.6), Bonferroni adjusted P https://ift.tt/2rqLdm2
Shared decision-making for postoperative analgesia: A semistructured qualitative study
BACKGROUND Shared decision-making (SDM) and decision-support tools have attracted broad support in healthcare as they improve medical decision-making. Experts disagree on how these can help patients evaluate their present situation and possible outcomes of therapy, and how they might reduce decisional conflict. Little is known about their implementation, especially in anaesthesiology. OBJECTIVE To obtain a more fundamental understanding of pre-operative SDM and evaluate the use of a decision-support tool for postoperative analgesia after major thoracic and abdominal surgery. DESIGN A qualitative study with semistructured, in-depth interviews of patients and professionals. SETTING Patient recruitment took place at the Radboud University Medical Centre in Nijmegen and the Canisius Wilhelmina Hospital in Nijmegen, a nonacademic teaching centre. Professionals of the Radboud University Medical Centre were invited to participate in the interviews. PARTICIPANTS Interviews were performed with 10 individual patients and two focus groups both consisting of eight different professionals. MAIN OUTCOME MEASURES To gain insight into the provision of pre-operative information, decision-making processes and the clarity and usability of a prototype decision-support tool. RESULTS Professionals seemed to provide their patients with information directed towards the application of epidural analgesia, providing little attention to its negative effects. For many patients, the information was not tailored to their needs. Patients' involvement in decision-making was minimal, but they did not feel a need for more involvement. They were positive about the decision-support tool, although they indicated that it would not have influenced their treatment decision. Professionals expressed their doubt about the capacity of their patients to fully understand the decisions involved and about the clinical usability of the decision-support tool, because patients might misinterpret the information provided. CONCLUSION The results of this study suggest that both patients and professionals did not adhere to some 'self-evident' principles of SDM when postoperative analgesia after major thoracic and abdominal surgery was discussed.https://ift.tt/2rqL7uG
Short- and long-term impact of remifentanil on thermal detection and pain thresholds after cardiac surgery: A randomised controlled trial
BACKGROUND The clinical relevance of the suggested hyperalgesic effects of remifentanil is still unclear, especially in the long term. OBJECTIVE The current study evaluated the impact of remifentanil on thermal thresholds 3 days and 12 months after surgery, measured with Quantitative Sensory Testing. DESIGN A single-blind, randomised controlled trial. SETTING A tertiary care teaching hospital in The Netherlands, from 2014 to 2016. PATIENTS A total of 126 patients aged between 18 and 85 years, undergoing cardiothoracic surgery via sternotomy (coronary artery bypass grafts and/or valve replacement) were included. Exclusion criteria were BMI above 35 kg m−2, history of cardiac surgery, chronic pain conditions, neurological conditions, allergy to opioids or paracetamol, language barrier and pregnancy. INTERVENTIONS Patients were allocated randomly to receive intra-operatively either a continuous remifentanil infusion or intermittent intra-operative fentanyl as needed in addition to standardised anaesthesia with propofol and intermittent intravenous fentanyl at predetermined time points. MAIN OUTCOME MEASURES Warm and cold detection and pain thresholds 3 days and 12 months after surgery. In addition the use of remifentanil, presence of postoperative chronic pain, age, opioid consumption and pre-operative quality of life were tested as a predictor for altered pain sensitivity 12 months after surgery. RESULTS Both warm and cold detection, and pain thresholds, were not significantly different between the remifentanil and fentanyl groups 3 days and 12 months after surgery (P > 0.05). No significant predictors for altered pain sensitivity were identified. CONCLUSION Earlier reports of increased pain sensitivity 1 year after the use of remifentanil could not be confirmed in this randomised study using Quantitative Sensory Testing. This indicates that remifentanil plays a minor role in the development of chronic thoracic pain. Still, the relatively high incidence of chronic thoracic pain and its accompanying impact on quality of life remain challenging problems. TRIAL REGISTRATION The study was registered at EudraCT (ref: 2013-000201-23) and ClinicalTrials.gov (https://ift.tt/2Mq69Sn).https://ift.tt/2rqL4Pw
Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: A double-blind, randomised study
BACKGROUND Cleft defects are common craniofacial malformations which require early surgical repair. These patients are at high risk of postoperative airway obstruction and respiratory failure. Cleft surgery may require high doses of opioids which may contribute to these complications. OBJECTIVES To compare the effectiveness of proximal and distal approaches to blocking the maxillary nerve in patients undergoing cleft lip or cleft palate surgery. DESIGN Randomised, controlled and double-blind study. SETTING The current study was carried out in Guwahati (Assam, India) between April 2014 and June 2014. PATIENTS A total of 114 patients older than 6 months who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included coagulation disorders, peripheral neuropathy or chronic pain syndrome, infection in the puncture site, allergy to local anaesthetics, lack of consent and language problems or other barriers that could impede the assessment of postoperative pain. INTERVENTIONS Patients were randomly assigned to one of two groups: proximal group (bilateral suprazygomatic maxillary nerve blocks) and distal group (bilateral infraorbital nerve blocks for cleft lip repair and bilateral greater and lesser palatine nerve blocks and nasopalatine nerve block for cleft palate surgery). MAIN OUTCOME MEASURE The primary endpoint was the percentage of patients requiring extra doses of opioids. Secondary endpoints included pain scores, respiratory and nerve block-related complications during the first 24 h. RESULTS In the intra-operative period, there was a significant reduction of nalbuphine consumption in the proximal group (9.1 vs. 25.4%, P = 0.02). The percentage of patients requiring intra-operative fentanyl was lower in the proximal group (16.4 vs. 30.5%, P = 0.07). There were no differences in either postoperative pain scores or in postoperative complications. No technical failure or block-related complications were reported. CONCLUSION Bilateral suprazygomatic maxillary nerve block is an effective and safe alternative to the traditional peripheral nerve blocks for cleft lip and cleft palate surgery, in a mixed paediatric and adult population.https://ift.tt/2G59594
Fluid therapy for critical haemorrhage during elective noncardiac surgery
No abstract availablehttps://ift.tt/2rpSzGp
Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial
BACKGROUND Axillary and infraclavicular brachial plexus blocks are commonly used for upper limb surgery. Clinicians require information on the relative benefits of each to make a rational selection for specific patients and procedures. OBJECTIVES The main objective of the study was to compare axillary and infraclavicular brachial plexus block in terms of the incidence and severity of tourniquet pain. DESIGN Single blinded, randomised trial. SETTING University affiliated hospital, level-1 trauma centre. PATIENTS Age more than 18 years, ASAI-III patients undergoing orthopaedic surgery distal to the elbow, with an anticipated tourniquet duration of more than 45 min were recruited. INTERVENTIONS Patients underwent either ultrasound guided axillary brachial plexus block or infraclavicular block (ICB). MAIN OUTCOME MEASURES Incidence of tourniquet pain (onset, severity, associated haemodynamic changes) and block characteristics (block performance/onset times, distribution, incidence of adverse events, patient satisfaction) were recorded. RESULTS Eighty two patients (40 in the axillary block and 42 in the ICB group) were recruited. The incidence (5/36 and 3/35; P = 0.71), onset time (73.0 ± 14.8 and 86.6 ± 5.7 min; P = 0.18) and severity (mild/moderate; 4/1 and 1/2; P = 0.51) of tourniquet pain were similar in the two groups. The incidence of paraesthesia during block performance, and block performance time were greater in the axillary block group (P = 0.0054 and 0.012, respectively). The volume of local anaesthetic administered was greater in the ICB group (P https://ift.tt/2G2I1XT
Incidence of peri-operative paediatric cardiac arrest and the influence of a specialised paediatric anaesthesia team: Retrospective cohort study
BACKGROUND Peri-operative critical events are still a major problem in paediatric anaesthesia care. Access to more experienced healthcare teams might reduce the adverse event rate and improve outcomes. OBJECTIVE The current study analysed incidences of peri-operative paediatric cardiac arrest before and after implementation of a specialised paediatric anaesthesia team and training programme. DESIGN Retrospective cohort study with before-and-after analysis. SETTING Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. PATIENTS A total of 36 243 paediatric anaesthetics (0 to 18 years) were administered between 2008 and 2016. INTERVENTION Implementation of a specialised paediatric anaesthesia team and training programme occurred in 2014 This included hands-on supervised training in all fields of paediatric anaesthesia, double staffing for critical paediatric cases and a 24/7 emergency team. A logistic regression analysis with risk factors (age, ASA physical status, emergency) was used to evaluate the impact of implementation of the specialised paediatric anaesthesia team. MAIN OUTCOME MEASURES Incidences of peri-operative paediatric cardiac arrest and anaesthesia-attributable cardiac arrest before and after the intervention. RESULTS Twelve of 25 paediatric cardiac arrests were classified as anaesthesia-attributable. The incidence of overall peri-operative paediatric cardiac arrest was 8.1/10 000 (95% CI 5.2 to 12.7) in the period 2008 to 2013 and decreased to 4.6/10 000 (95% CI 2.1 to 10.2) in 2014 to 2016. Likewise, the incidence of anaesthesia-attributable cardiac arrest was lower after 2013 [1.6/10 000 (95% CI 0.3 to 5.7) vs. 4.3/10 000 (95% CI 2.3 to 7.9)]. Using logistic regression, children anaesthetised after 2013 had nearly a 70% lower probability of anaesthesia-attributable cardiac arrest (odds ratio 0.306, 95% CI 0.067 to 1.397; P = 0.1263). For anaesthesia-attributable cardiac arrest, young age was the most contributory risk factor, whereas in overall paediatric cardiac arrest, ASA physical statuses 3 to 5 played a more important role. CONCLUSION In this study on incidences of peri-operative paediatric cardiac arrest from a European tertiary care university hospital, implementation of a specialised paediatric anaesthesia team and training programme was associated with lower incidences of peri-operative paediatric cardiac arrest and a reduced probability of anaesthesia-attributable cardiac arrest.https://ift.tt/2G0oNlF
Dentin isotopic reconstruction of individual life histories reveals millet consumption during weaning and childhood at the Late Neolithic (4500 bp) Gaoshan site in southwestern China
Abstract
Here, we present results of a pilot project that measured δ13C and δ15N values in bone collagen (ribs and femora) as well as dentin serial sections to examine individual dietary life histories at a Late Neolithic (4500 bp) site known as Gaoshan Ancient City (高山古城) located on the Chengdu Plain in Sichuan Province, China. The isotopic data of the bones indicate that humans consumed C3‐based foods, which corresponds to the dominance of rice agriculture in this region. However, the isotopic data of the dentin serial sections of five individuals display much more positive δ13C values than those of the bones, strongly suggesting that millets (a C4 crop) contributed substantially to human diets during the weaning process and early childhood. Furthermore, the isotopic profiles of dentin sections of the first molars and canines demonstrate that the cession of weaning was individually variable and completed between ~2.5 and 4 years of age. Although limited in scope, this pilot study offers new evidence of millet consumption during human growth and development even though individuals relied on rice exclusively as adults. Moreover, our study provides another perspective with which to rethink the role that millets played during the development and spread of millet agriculture to the south of China in terms of cultural exchange and migration.
https://ift.tt/2roeFcp
Auditory exostosis: Exploring the daily life at an early sedentary population (Körtik Tepe, Turkey)
Abstract
Auditory exostosis (AE) is a bony anomaly located on the tympanic portion of the temporal bone. Cold water, wind chill, and the effects of temperature are considered to be contributors to the development of AE. It is frequently encountered among surfers, lifeguards, whitewater kayakers, swimmers, and divers. Accordingly, there is a strong relationship between prolonged exposure to cold water and the frequency and grade of AE. For this reason, AE can be accepted as an occupational anomaly.
In this study, AE from Körtik Tepe, Turkey, were analysed to understand the lifestyle of early hunter gatherer populations from Anatolia. One hundred twenty‐eight individuals and 174 temporal bones from Körtik Tepe were examined for the frequency and severity (graded) of AE. Forty‐five individuals (35.2%) have exostosis of various sizes. Half of 40 male individuals and 42.5% of females (n: 40) have AE with no statistically significant difference between the sexes. First observed in individuals 7 years of age, severity and frequency of AE increase with age. Besides increasing in frequency, the increase in size of AE suggest a continuous and prolonged exposure to cold water.
The people of Körtik Tepe, which is surrounded by numerous freshwater sources, must have been subjected to cold water through activities such as bathing, cleaning, swimming, and playing in the water, as well as fishing. Our results suggest that the lifestyle of early sedentary people in Körtik Tepe was rather egalitarian with little or no gender differences and was closely connected to aquatic sources. Bioarchaeological data suggest that Körtik Tepe can be accepted as a community of hunter‐gatherer‐fishermen.
https://ift.tt/2rqsfvY
Over 4,500 years of trepanation in Poland: From the unknown to therapeutic advisability
Abstract
This paper discusses 6 trepanned skulls from central Poland, dating from the late Neolithic (3,000–2,800 BC) to early modern times (18th century AD). Four of them come from a small area in and around the town of Brześć Kujawski in Kujawy, a region of long‐lasting and intense human settlement in Poland. The analysed skulls provide striking evidence for the long history of trepanation in this part of Europe. Three surgical techniques were used: sawing, scraping, and drilling, either on their own or in combination with one another. Regardless of the method, all the trepanations were fully healed, which proves long‐term survival of the patients. All skulls belonged to adult males, who were generally at a higher risk of trauma in the populations from which 4 of the specimens derive. The studied skulls demonstrate a marked evolution in trepanation practices over time. Trepanations from the late medieval and early modern times tend to be smaller, less life threatening, and clearly made for therapeutic purposes to remedy cranial injuries. The remarkable skills of the surgeons who performed them could be linked to the influence of the renowned Danzig Anatomical School in Gdańsk, which was one of the leading centres of medical and anatomical research in northern and central Europe in the 17th and 18th centuries.
https://ift.tt/2G4GqRp
Genetic profiling of basal cell carcinomas detects postzygotic mosaicism in basal cell naevus syndrome
Summary
Basal cell naevus syndrome (BCNS) is associated with germline mutations in the PTCH1 gene. Postzygotic mosaicism can also cause BCNS. Here we describe two patients, one with multiple basal cell carcinomas (BCCs) and one with clinical BCNS, who had no PTCH1 mutation in DNA extracted from blood. In both patients, we performed genetic analysis on different BCCs, revealing the presence of a shared PTCH1 mutation in all tumours. Our findings show that in patients with symptoms of BCNS and initial absence of a PTCH1 mutation in blood, genetic profiling of BCCs can detect postzygotic mosaicism.
https://ift.tt/2QinG5N
Evaluation of biochemical variables in patients with trigeminal neuralgia
The aim of this study was to evaluate the calcium, sodium, potassium, serum iron, vitamin B12, and albumin concentrations, and alkaline phosphatase (ALP) activity, in samples of serum from patients with primary trigeminal neuralgia (TN), and investigate the associations between them. Results from 73 patients who had been diagnosed with primary TN between December 2015 and 2017 were compared with those of 70 healthy subjects. Calcium (p=0.013), iron (p=0.004), and albumin (p=0.001) concentrations in the primary TN group were significantly lower than those in the control group, whereas the ALP activity was significantly higher in the TN group than in the control group (p=0.007).
https://ift.tt/2E5q74n
Seldinger technique in repair of the parotid duct
Injuries to the parotid ducts are difficult to locate, assess, and repair, and traditionally, solid metal dilators and soft plastic tubes have had only limited success. We describe the Seldinger technique with a central venous catheter, which makes repair easier.
https://ift.tt/2E5qdsL
Qualitative study to identify issues affecting quality of life in adults with craniofacial anomalies
Our objective was to identify key issues that affect the quality of life (QoL) of adult patients with craniofacial anomalies. This was a qualitative prospective study using in-depth, semi-structured interviews. Ten patients who fulfilled the inclusion criteria were recruited during their attendance at the Adult Craniofacial Clinic at the Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust. Interviews ceased when no new themes arose. A framework method of analysis was used to identify themes that related to QoL.
https://ift.tt/2QBYYfV
Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study
In the last years endoscopic sinus surgery (ESS) is improved with the introduction of computer assisted navigation (CAN). In this retrospective study we evaluated the usefulness of CAN in endoscopic sinus surgery and studied its advantages over conventional endoscopic sinus surgery.
https://ift.tt/2EiYaGW
Quantitative analysis of carotid arterial calcification using airway CT in obstructive sleep apnea
To evaluate the relationship between obstructive sleep apnea (OSA) severity and carotid arterial calcification by quantitative analysis using airway computed tomography (CT).
https://ift.tt/2SwJneO
Publication Bias and Systematic Reviews in Top-Ranked Otolaryngology Journals
This study analyzes whether 324 systematic reviews that contain at least 1 meta-analysis with 10 or more primary studies published in top otolaryngology journals that do not evaluate for publication bias show evidence of such bias.
https://ift.tt/2PmNh8o
https://ift.tt/2PmNh8o
Whatever Happened to Local Otolaryngology Societies?
This essay describes the importance of, and decline of membership in, specialty medical societies.
https://ift.tt/2PoHvmH
https://ift.tt/2PoHvmH
Pretreatment Hearing Level—Another Prognostic Factor in Sudden Sensorineural Hearing Loss—Reply
In Reply We thank Dr Wu and colleagues for their interest and comments on our research. Various factors may affect hearing recovery after SSHL, such as age, degree of hearing loss, type of hearing loss, interval from onset of symptoms to treatment, tinnitus, type 2 diabetes, cardiovascular disease, and the presence of vertigo. We were unable to include the hearing level at onset into our analyses owing to the lack of corresponding data in the included studies. Moreover, only 1 of the included studies assessed the possible association between the presence of vertigo and hearing recovery in patients with severe sudden sensorineural hearing loss (≥60 dB). We also think that the opinion by Dr Wu et al that the presence of vertigo is significantly correlated only with hearing recovery in the group with profound SSHL may have implications for the understanding of the mechanisms of SSHL with vertigo, but we were unable to retrieve the raw data. At present, the pathogenesis, clinical manifestations, optimal treatments, and prognostic factors of SSHL are not clear. We are in the process of validating the occurrence of vertigo and its possible role in SSHL. A complete analysis of this role will require more unbiased studies with prospectively gathered data in a large sample size to estimate the precise association of vertigo with the clinical manifestation and prognosis of SSHL.
https://ift.tt/2zNmYTN
https://ift.tt/2zNmYTN
Pretreatment Hearing Level—Another Prognostic Factor in Sudden Sensorineural Hearing Loss
To the Editor We read with great interest the article titled "Association of Vertigo With Hearing Outcomes in Patients With Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis" by Yu et al. The authors concluded that vertigo may be negatively associated with hearing recovery in patients with sudden sensorineural hearing loss (SSHL).
https://ift.tt/2PoLJdO
https://ift.tt/2PoLJdO
Association of Audiometric Age-Related Hearing Loss With Depressive Symptoms in Hispanic Individuals
This multicenter, cross-sectional study uses Community Health Study/Study of Latinos data collected from 4 US communities to assess whether an association exists between age-related, audiometrically measured hearing loss and clinically relevant depressive symptoms in Hispanic adults 50 years or older.
https://ift.tt/2zOweqJ
https://ift.tt/2zOweqJ
Anterior Nasal Cavity Mass in a Neonate
A newborn twin girl was evaluated for a left-sided nasal mass causing nasal obstruction and difficulty breathing; physical examination showed a firm, pedunculated polypoid mass in the anterior nasal cavity at the vestibule with no fluid in the mass. What is your diagnosis?
https://ift.tt/2zJiyNS
https://ift.tt/2zJiyNS
Evaluation of the Serum Levels of Galectin‐3 in Patients with Oral Lichen Planus Disease
Abstract
Objectives
Galectin‐3, a member of beta‐galactoside‐binding proteins, can be found in cytoplasm and nucleus as well as extracellularly in various tissues and involved in many physiological and pathological processes. We aimed to measure the serum levels of galectin‐3 in oral lichen planus (OLP) disease and compare the result with that observed in healthy ones.
Materials and Methods
In this cross‐sectional study, the serum levels of galectin‐3 were measured in 56 healthy individuals and 53 pathologically proven OLP patients including those with atrophic/erosive (33 cases) or reticular (20 cases) lesions, using enzyme‐linked immunosorbent assay (ELISA).
Results
Compared with healthy individuals (1.1±0.4 ng/ml), galectin‐3 serum levels in patients with OLP (3.1±1.1 ng/ml) were significantly elevated (p < 0.0001). Serum galectin‐3 levels were elevated significantly in patients with atrophic/erosive lesions compared to those of reticular (3.9±2.1 ng/ml vs. 1.9±1.4 ng/ml, p = 0.001), but it has not associated with age and gender.
Conclusions
The elevation of galectin‐3 in OLP is a future tool to increase the knowledge about the possible etiology of the disease and may be helpful to differentiate atrophic/erosive lesions from reticular ones. To the best of our knowledge, this is the first study evaluated the serum galectin‐3 levels in OLP.
This article is protected by copyright. All rights reserved.
https://ift.tt/2zKPFAR
Benefit of cetuximab addition to a platinum–fluorouracil-based chemotherapy according to KRAS-LCS6 variant in an unselected population of recurrent and/or metastatic head and neck cancers
Abstract
Objectives
To evaluate the benefit of cetuximab (Cx) addition to platinum-based and 5-fluorouracil chemotherapy (PFU) in unselected recurrent and/or metastatic head and neck cancer patients (R/MHNC) according to KRAS-LCS6 variant status.
Methods
All patients who received at least two PFU ± Cx cycles from 2004 to 2014 were retrospectively included into to two distinct study periods according to Cx implementation: patients treated by PFU alone before 2009 and those treated by PFU + Cx from 2009. Primary objective was to evaluate the progression-free survival (PFS) between the two groups. Secondary objectives were to analyze the overall survival (OS) between the two groups and the prognostic impact of KRAS-LCS6 variant. Factors associated with survival were determined by a Cox multivariate analysis including age, WHO performance status (PS), type of treatment, KRAS-LCS6 variant, Charlson's score and p16 status.
Results
Overall, 134 patients were included: 59 (44%) in PFU group and 75 (56%) in PFU + Cx group. Baseline characteristics were well balanced including 30% of patients with 2–3 PS. Median PFS was significantly improved in PFU + Cx group compared to PFU group (6.1 vs 4.4 months, respectively, HR 0.68, p = 0.02) and with a trend for better OS. A KRAS-LCS6 variant was found in 27 (25%) of samples without prognostic impact neither in whole population nor according to treatment. In multivariate analysis, addition of Cx to PFU was the only factor significantly associated with a better PFS (p = 0.01, HR 0.6).
Conclusion
Our results suggest that PFU + Cx combination may be effective in unselected population of R/MHNC regardless the KRAS-LCS6 variant status.
https://ift.tt/2L3wPte
Efficacy of abdominal peripheral nerve block and caudal block during robot-assisted laparoscopic surgery: a retrospective clinical study
Abstract
Purpose
We retrospectively analyzed the efficacy of abdominal peripheral nerve block (PNB) and caudal block (CB) in patients undergoing robot-assisted laparoscopic radical prostatectomy (RARP).
Methods
Patients who underwent elective RARP at our hospital (Jan. 2015–Sept. 2016) were enrolled. We reviewed the 188 patients' anesthesia charts and medical records and divided the patients into three groups based on the anesthesia used in their cases: 76 patients in the total intravenous anesthesia (TIVA) group, 51 patients in the TIVA + abdominal PNB group (TI-PB group), and 61 patients in the TIVA + abdominal PNB + CB (TI-PB-CB group). We compared the groups' amounts of anesthetic drug usage, anesthesia times, and the presence/absence of additional opioid administration in the recovery room.
Results
The perioperative opioid use during anesthesia was significantly greater in the TIVA group than in the TI-PB-CB group. The total amount of muscle relaxant was significantly higher (p < 0.001) in the TIVA group than the TI-PB-CB group: 60.0 (50.0–70.0) mg vs. 50.0 (40.0–60.0) mg. Although there were no significant differences in the operation time, the frequency of the use of additional opioid administration was significantly higher (p < 0.01) in the TIVA group than the TI-PB group: 23.7% vs. 2.0%, respectively.
Conclusions
Although there was no influence on the anesthesia time, the muscle relaxant dose and the perioperative amount of opioid use were significantly less in the combined PNB + CB group. Our analyses suggest that not only PNB but also CB was useful for perioperative management in RARP.
Clinical trial registration
2016-1059.
https://ift.tt/2zOpUzo
Utility of first positron emission tomography‐computed tomography scan as a prognostic tool following treatment of sinonasal and skull base malignancies
Abstract
Background
The prognostic value of the first posttreatment whole body integrated positron emission tomography‐computed tomography (PET/CT) scanning in patients with sinonasal/skull base malignancies is undetermined.
Methods
We retrospectively reviewed the data of all patients that underwent surgery for sinonasal/skull base malignancies in 2000‐2015. The results of the pretreatment and posttreatment PET/CT findings and the clinical course were retrieved.
Results
Thirty‐eight patients (average age 60.6 years, 20 males) were included. Sensitivity and specificity, positive predictive value, and negative predictive value of the first PET/CT scan for predicting persistent/recurrent disease were 85.7%, 87.5%, 80%, and 91.3%, respectively. Overall 5‐year survival was significantly lower in the first posttreatment PET/CT‐positive group (35%) compared to the PET/CT‐negative group (93%) (P = .0008).
Conclusion
Posttreatment PET/CT findings are highly prognostic in patients with sinonasal/skull base malignancies. Negative findings on the first posttreatment PET/CT scan predict a significantly better overall survival.
https://ift.tt/2UiYpXD
Crystalloid coloading vs. colloid coloading in elective Caesarean section: postspinal hypotension and vasopressor consumption, a prospective, observational clinical trial
Abstract
Background
Maternal hypotension is a common side effect of spinal anaesthesia for Caesarean section. The combination of colloid coloading and vasopressors was considered our standard for its prevention and treatment. As the safety of hydroxyethyl starch is under debate, we replaced colloid with crystalloid coloading.
Objective
We hypothesize that the mean blood pressure drop is greater when coloading with crystalloids.
Design
Prospective, observational clinical trial.
Setting
Two-centre study conducted in Berlin, Germany.
Patients
Parturients scheduled for a Caesarean section were screened for eligibility.
Intervention
The study protocol and patient monitoring were based on the standard operating procedure for Caesarean section in both centres. The data from the crystalloid group were prospectively collected between November 2014 and July 2015.
Main outcome measures
The primary endpoint was the median drop in mean blood pressure after induction of spinal anaesthesia. Secondary endpoints were incidence of hypotension (drop > 20% of baseline systolic pressure /drop < 100 mmHg), vasopressor and additional fluid requirements (mL), incidence of bradycardia (heart rate < 60 beats per minute), blood loss, Apgar score, and umbilical artery pH. In case of hypotension, patients received phenylephrine or cafedrine/theodrenaline according to their heart rate. A p < 0.05 was considered significant.
Results
345 prospectively enrolled patients (n = 193 crystalloid group vs. n = 152 colloid group) were analysed. The median drop in mean blood pressure was greater in the crystalloid group [34 mmHg (25; 42 mmHg) vs. 21 mmHg (13; 29 mmHg), p < 0.001]. Incidences of hypotension [93.3% vs. 83.6%, p: 0.004] and bradycardia [19.7% vs. 9.9%, p: 0.012] were also significantly greater in the crystalloid group. Vasopressor requirements, blood loss and neonatal outcome were not different between the groups.
Conclusions
Crystalloid coloading was associated with a greater drop in mean blood pressure and a higher incidence of hypotension when compared with colloid coloading. Neonatal outcome was, however, unaffected by the type of fluid.
Trial registration
DRKS00006783 (http://www.drks.de).
https://ift.tt/2PmSkWc
Study of Anti-PD-1 Antibody SHR-1210 Plus Nimotuzumab in the Treatment of Advanced Esophageal Squamous Cell Carcinoma
Condition: Esophageal Squamous Cell Carcinoma
Intervention: Drug: Nimotuzumab + SHR-1210
Sponsor: The First Affiliated Hospital of Zhengzhou University
Not yet recruiting
https://ift.tt/2EiiWGG
Intervention: Drug: Nimotuzumab + SHR-1210
Sponsor: The First Affiliated Hospital of Zhengzhou University
Not yet recruiting
https://ift.tt/2EiiWGG
Non-Keratinizing Nasopharyngeal Carcinoma with Adenomatous Differentiation
Abstract
A case of non-keratinizing, EBV-positive (EBER-in situ hybridization), carcinoma with adenomatous differentiation is presented. The patient is a 40 year old male with T2N2M0 disease who received standard combined chemo- and radiotherapy with complete resolution of all tumor. The tumor cells were strongly positive for low-molecular weight cytokeratins (AE1–3) and scattered cells expressed cytokeratin 20. No expression of cytokeratin 5/6, 7, p63, TTF-1, CDX2 or androgen receptor was detected. There was no evidence of recurrence or disease progression on follow-up after 19 months, which included post treatment MRI and PET–CT scans.
https://ift.tt/2E1lpV4
Non-Keratinizing Nasopharyngeal Carcinoma with Adenomatous Differentiation
Abstract
A case of non-keratinizing, EBV-positive (EBER-in situ hybridization), carcinoma with adenomatous differentiation is presented. The patient is a 40 year old male with T2N2M0 disease who received standard combined chemo- and radiotherapy with complete resolution of all tumor. The tumor cells were strongly positive for low-molecular weight cytokeratins (AE1–3) and scattered cells expressed cytokeratin 20. No expression of cytokeratin 5/6, 7, p63, TTF-1, CDX2 or androgen receptor was detected. There was no evidence of recurrence or disease progression on follow-up after 19 months, which included post treatment MRI and PET–CT scans.
https://ift.tt/2E1lpV4
Correction to: Giant nonfunctioning adrenal tumors: two case reports and review of the literature
In the publication of this article [1], there is an error in the Family Name and Given Name of the authors since these were interchanged.
https://ift.tt/2Ees9A9
Giant prolactinoma, germline BRCA1 mutation, and depression: a case report
Giant prolactinomas are very rare pituitary tumors that may exhibit an aggressive behavior and present with a life-threatening condition.
https://ift.tt/2SuOwEk
The Hidden Agenda
Laser-Assisted Drug Delivery
Guidelines for Diagnosis and Treatment of Cutaneous Sarcomas: Dermatofibrosarcoma Protuberans
Kaposi Sarcoma and Cutaneous Angiosarcoma: Guidelines for Diagnosis and Treatment
Acral Metastasis of the Fingers: Report of 2 Cases
Difficulties Coding Dermatological Disorders Using the ICD-10: The DIADERM Study
Fibroepithelioma of Pinkus: A Basal Cell Carcinoma With Distinctive Dermoscopic Features
Using a “Mutaf Triangular Flap” for Lower Eyelid Reconstruction
Behçet Disease
Induction of Light Tolerance Using Narrowband UV-B in Solar Urticaria
Inpatient Dermatology Consultations in Renal Transplant Recipients
Annular Pigmented Plaque Under the Chin
Narrowband UV-B Phototherapy in the Treatment of Generalized Hailey-Hailey Disease
Asymptomatic Hyperkeratotic Plaque on the Glans in a Middle-Aged Man
RF-Topical Rapamycin as an Adjuvant to Laser Treatment in Capillary Malformations
Pemphigus Vegetans in the Inguinal Folds
The Effectiveness of a Twice-weekly Narrowband Ultraviolet B Phototherapy Schedule in Early-stage Mycosis Fungoides in a Cohort of 18 Argentinian Patients
Simultaneous Disappearance of Various Nevi in a Patient with Autoimmune Disorders
Identification of key genes and pathways in chronic rhinosinusitis with nasal polyps using bioinformatics analysis
Publication date: Available online 5 December 2018
Source: American Journal of Otolaryngology
Author(s): Yao Yao, Shaobing Xie, Fengjun Wang
Abstract
Purpose
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent inflammatory disease of yet unknown etiology. The purpose of this study was to uncover key genes and pathways related to the pathogenesis of CRSwNP via bioinformatics approaches.
Materials and methods
The gene expression profile of GSE36830 extracted from Gene Expression Omnibus database was used to screen differentially expressed genes (DEGs) between nasal polyp samples and control samples. Furthermore, functional and pathway enrichment analysis was performed using the clusterProfiler package in R language. In addition, protein-protein interaction (PPI) network was constructed by STRING database and functional modules were detected using Molecular Complex Detection algorithm.
Results
A total of 538 DEGs (326 up-regulated and 212 down-regulated) were identified. The most significantly enriched pathways for up-regulated and down-regulated genes were hematopoietic cell lineage and salivary secretion, respectively. Moreover, twenty hub genes with high connectivity degrees were selected from the PPI network, such as TYRO protein tyrosine kinase binding protein (TYROBP), G protein subunit gamma 2 (GNG2), CCR7, and CCR3. Besides, six important modules were obtained, which were highly associated with chemokine signaling pathway, Th1 and Th2 cell differentiation, complement and coagulation cascades, cell cycle, systemic lupus erythematosus, and Staphylococcus aureus infection.
Conclusions
The results of this study may provide new insights into potential molecular mechanisms of CRSwNP. Nevertheless, further experiments are needed to confirm these findings.
https://ift.tt/2KY6D35
Computational fluid dynamics analysis of H-uvulopalatopharyngoplasty in obstructive sleep apnea syndrome
Publication date: Available online 6 December 2018
Source: American Journal of Otolaryngology
Author(s): Lei Zhu, Haibo Liu, Zhongying Fu, Jianmei Yin
Abstract
Purpose
To explore the impact of H-uvulopalatopharyngoplasty (H-UPPP) in obstructive sleep apnea syndrome (OSAS) and gain insights into the potential mechanism underlying improvement by H-UPPP.
Methods
In a cohort of 11 OSAS patients, computational fluid dynamics (CFD) models of the upper airway were obtained using commercial software from computed tomography (CT) datasets before and after H-UPPP. Morphological and numerical parameters were respectively computed and compared during the peak tidal inspiratory flow. The correlations among polysomnography endpoints, airway dimensions, and pre- and post-operative airflow properties were analyzed with Spearman's rank correlation.
Results
The preoperative minimum cross-sectional area was significantly increased by 89.56% (p < .05), with a positive correlation to the apnea hypoapnea index (AHI) (r = 0.974). However, the capacity of all pharyngeal regions was not significantly altered (p > .05). Following H-UPPP, we observed a significant increase in pressure and reduction of velocity (p < .05) in the previously constricted areas. The change in pressure and velocity were significantly correlated with AHI (r = 0.922 and r = 0.946, respectively). In addition, the pressure drop in the constricted area, oropharynx, and hypopharynx were also significantly decreased (p < .05).
Conclusions
H-UPPP is capable of expanding the constricted region of the velopharynx and can decrease the airway resistance which will in turn decrease the workload necessary for breathing and facilitate inspiration.
https://ift.tt/2BUhk3D
Monte Carlo simulation of reasons for early failure of implants: effects of two risk factors
Publication date: Available online 6 December 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): O. Buhara, S. Pehlivan
Abstract
We have estimated the joint effects of two important risk factors on early failure of implants and then ranked all quoted risks by importance. We made a systematic search of published papers listed in PubMed, Web of Knowledge, Scopus, and Cochrane Central up to March 2018, and identified a total of 437 records. Eight studies met the inclusion criteria, in which seven significant risk factors for early failure were selected and used to build a conceptual simulation model. Selected risk factors were: "male sex", "smoking", "quality of bone", "short implants", "wide implants", "adjacent teeth", and "periodontitis". Based on these risk factors, all two-factor combinations that accounted for a total of 21 areas of greatest risk were created. We made a Monte Carlo simulation with 10 000 iterations and a sensitivity analysis to evaluate the estimates of these risks and to identify those that had the most influence on the model of early failure. The outcomes of the Monte Carlo simulation model showed that the SRS values of the combinations of these risks had different ranges of effects and probabilities of the early risk of failure. As a result, the most sensitive areas of greatest risk were "smoking and periodontitis", the second "short implants and periodontitis", and the third "smoking and short implants". The least sensitive combination of risks for early failure was "wide implants and male sex". This is to our knowledge the first study that has illustrated the contributions of various combinations of risk factors to early failure of implants. "Smoking and periodontitis" was thought to be associated with the greatest risk of early failure.
https://ift.tt/2rjR38W
Day-case bilateral sagittal split osteotomy
Publication date: Available online 6 December 2018
Source: British Journal of Oral and Maxillofacial Surgery
Author(s): L.A Davies, E.M.S. Crawford, J.L. Jones, S.D. Jones
Abstract
In the UK, patients who have bilateral sagittal split osteotomy (BSSO) have generally been thought to require inpatient admission and an overnight hospital stay. However, since the introduction of national standards on day case surgery in the UK in 2011, patients at the Royal Gwent Hospital, Newport, have been treated as day cases, and have been pleased with the results. The aim of this paper was to show that these procedures conform to current national standards, and can be done successfully and safely. We retrospectively reviewed all patients who had isolated BSSO planned as day cases between March 2015 and February 2017. Thirty-four were eligible. Of them, 32 were discharged on the day of operation and two were admitted postoperatively: one because of severe nausea and vomiting and the other because of bleeding. No patients were readmitted within 48 hours of the procedure. BSSO can be done successfully and routinely as a day-case procedure. However, to reduce the rate of unplanned admissions, we recommended that operations start early in the morning.
https://ift.tt/2G0Bnl9
Non-Keratinizing Nasopharyngeal Carcinoma with Adenomatous Differentiation
Abstract
A case of non-keratinizing, EBV-positive (EBER-in situ hybridization), carcinoma with adenomatous differentiation is presented. The patient is a 40 year old male with T2N2M0 disease who received standard combined chemo- and radiotherapy with complete resolution of all tumor. The tumor cells were strongly positive for low-molecular weight cytokeratins (AE1–3) and scattered cells expressed cytokeratin 20. No expression of cytokeratin 5/6, 7, p63, TTF-1, CDX2 or androgen receptor was detected. There was no evidence of recurrence or disease progression on follow-up after 19 months, which included post treatment MRI and PET–CT scans.
https://ift.tt/2E1lpV4
Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study
Publication date: Available online 6 December 2018
Source: Auris Nasus Larynx
Author(s): Bruno Galletti, Francesco Gazia, Francesco Freni, Federico Sireci, Francesco Galletti
Abstract
Objective
In the last years endoscopic sinus surgery (ESS) is improved with the introduction of computer assisted navigation (CAN). In this retrospective study we evaluated the usefulness of CAN in endoscopic sinus surgery and studied its advantages over conventional endoscopic sinus surgery.
Methods
We retrospectively reviewed the records of 96 patients with chronic rhinosinusitis (CRS). 48 patients undergoing endoscopic sinus surgery with surgical navigation (A group) and other 48 without navigation (B group). Data about percentage of complications, olfactory function (Visual Analogue Scale), Sino-nasal Outcomes Test (SNOT-22), Rhinosinusitis Quality of Life (RhinoQoL), recurrence (CT Lund–Mackay score), total nasal resistance (rhinomanometry) and duration of the intervention were collected and analyzed.
Results
A group evidenced a decrease of recurrence rate (p = 0.009), a reduction of total nasal resistance (p = 0.007), of frontal recess stenosis (p = 0.04) and of nasal symptomatology (p = 0.008). QoL had a better improvement in group A. Rate of other complications and olfactory function did not show statistically significant differences between the two groups. The average calibration time was approximately 11 min in the A group. Total time of surgical procedure does not evidenced statistically significant difference between the two groups (p > 0.05) but if it is considered only the time of the surgical intervention, the difference of duration is significant reduced statistically (p < 0.05) in CAN surgery.
Conclusion
Computer assisted navigation in ESS can be useful for the most experienced surgeons, especially in the frontal recess surgery, decreasing the recurrence rate and reducing the total nasal resistance.
https://ift.tt/2KXtBXU
Risk factors and distribution features of level IB lymph nodes metastasis in nasopharyngeal carcinoma
Publication date: Available online 6 December 2018
Source: Auris Nasus Larynx
Author(s): Lei Zeng, Qin Zhang, Fan Ao, Chun-Ling Jiang, Yun Xiao, Hong-Hui Xie, Yi-Qiang Tang, Xiao-Chang Gong, Jin-Gao Li
Abstract
Objective
The objective of this study is to investigate the risk factors and distribution features for level IB metastasis in nasopharyngeal carcinoma (NPC) and provide clinical evidence for defining the indications and clinical target volume (CTV) of prophylactic level IB irradiation.
Methods
We retrospectively analyzed 798 patients with newly-diagnosed, non-metastatic and histologically confirmed NPC underwent intensity-modulated radiation therapy (IMRT). Two sides of neck in each patient have been analyzed separately. The correlations of level IB metastasis and the clinical risk factors were analyzed with Chi-square test and logistic regression model. The risk score model (RSM) of level IB metastasis was calculated by totaling up the scores of each independent variable. We divided level IB into three areas, including anterolateral space of submandibular glands, medial space of the submandibular glands and submandibular glands.
Results
Maximal axial diameter (MAD) of level IIA nodes >20 mm or extra capsular spread (ES) of level IIA nodes, anterior half of nasal cavity involvement and submandibular gland involvement/compression were independently significantly risk factors for level IB lymph nodes (LNs) metastasis at diagnosis. Two groups based on RSM were obtained: low risk (total score = 0–2.5); high risk (4–8.5). The incidence of IB LNs metastasis at diagnosis of the two groups were 0.9% and 6.3%, respectively (P < 0.001). The cervical lymph nodes of level IB were distributed in the anterolateral space of submandibular glands. There was no positive/negative LNs inside or medial space of the submandibular glands.
Conclusion
Level IB LNs metastasis is associated with MAD of level IIA nodes >20 mm or ES of level IIA nodes, anterior half of nasal cavity involvement and submandibular gland involvement/compression in NPC patients. Omission of level IB irradiation may be feasible for patients with low-risk IB LNs metastasis at diagnosis. The submandibular gland should not be included in level IB.
https://ift.tt/2BSQw3F
CRISPR/Cas9-mediated PD-1 disruption enhances human mesothelin-targeted CAR T cell effector functions
Abstract
The interaction between programmed cell death protein 1 (PD-1) on activated T cells and its ligands on a target tumour may limit the capacity of chimeric antigen receptor (CAR) T cells to eradicate solid tumours. PD-1 blockade could potentially enhance CAR T cell function. Here, we show that mesothelin is overexpressed in human triple-negative breast cancer cells and can be targeted by CAR T cells. To overcome the suppressive effect of PD-1 on CAR T cells, we utilized CRISPR/Cas9 ribonucleoprotein-mediated editing to disrupt the programmed cell death-1 (PD-1) gene locus in human primary T cells, resulting in a significantly reduced PD-1hi population. This reduction had little effect on CAR T cell proliferation but strongly augmented CAR T cell cytokine production and cytotoxicity towards PD-L1-expressing cancer cells in vitro. CAR T cells with PD-1 disruption show enhanced tumour control and relapse prevention in vivo when compared with CAR T cells with or without αPD-1 antibody blockade. Our study demonstrates a potential advantage of integrated immune checkpoint blockade with CAR T cells in controlling solid tumours and provides an alternative CAR T cell strategy for adoptive transfer therapy.
https://ift.tt/2AUSSh2
The North-Western Italian experience with anti IL-5 therapy amd comparison with regulatory trials
The severe forms of asthma represent a major burden, because of severity of symptoms, costs and impact on everyday life. Recently, Mepolizumab (MEP) was approved and marketed for the treatment of hypereosinoph...
https://ift.tt/2AVDcdh
Test for Respiratory and Asthma Control in Kids (TRACK): validation of the Portuguese version
TRACK (Test for Respiratory and Asthma Control in Kids) questionnaire is an instrument developed and validated in English to evaluate the control of respiratory symptoms in children under 5 years of age.
https://ift.tt/2UldMyH
Chondrosarcoma of the jaw bones: a review of 224 cases reported to date and an analysis of prognostic factors
Publication date: Available online 6 December 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): L.L. de Souza, F.S.C. Pontes, F.P. Fonseca, D.S. da Mata Rezende, V.C.S. Vasconcelos, H.A.R. Pontes
Abstract
The objective was to integrate the available published data on chondrosarcoma (CHS) of the jaw bones into a comprehensive analysis of its clinical and histological features, treatment, and prognostic factors. An electronic search was undertaken in October 2017. To be eligible, the publication had to provide sufficient clinical/histological data to confirm the diagnosis. One hundred and ten publications (224 cases of CHS) were identified and included. There was a slightly higher prevalence of CHS in males than in females. Most subjects with CHS were in the second to fifth decades of life. The most common symptom was swelling and the most commonly observed location was the maxilla. Histologically, most tumours were of the conventional type and were low grade tumours. The treatment of choice was tumour resection. Histological grade, treatment with chemotherapy alone, and the presentation of recurrence or metastasis were found to be significant independent prognostic factors: patients who presented high-grade tumours, who received chemotherapy alone as the treatment of choice, and those who presented recurrence or metastasis were more likely to have a worse prognosis. In addition, radical surgery associated with radiotherapy as the treatment protocol showed a better prognosis.
https://ift.tt/2E4bWfJ
Maxillary sinus floor augmentation using low-crystalline carbonate apatite granules with simultaneous implant installation: First-in-human clinical trial
Publication date: Available online 6 December 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Keiko Kudoh, Naoyuki Fukuda, Shohei Kasugai, Noriko Tachikawa, Kiyoshi Koyano, Yasuyuki Matsushita, Yoichiro Ogino, Kunio Ishikawa, Youji Miyamoto
Abstract
Purpose
Carbonate apatite (CO3Ap), an inorganic component of human bone, can be fabricated in chemically pure form from calcium carbonate block via dissolution-precipitation. A first-in-human clinical trial was conducted in which low-crystalline CO3Ap granules were evaluated for safety and efficacy in sinus floor augmentation and simultaneous implant installation.
Materials and Methods
Procedures were performed on 8 patients (9 implants) with two granule sizes: S (300–600 μm) and M (600–1000 μm). Panoramic radiographic assessment was performed immediately after and 7 ± 2 months after augmentation, and 6 ± 2 months and 12 ± 2 months after prosthetic loading.
Results
Postoperative healing was uniformly uneventful, with no abnormal bleeding, pain or swelling, and all implants achieved successful osseointegration. The mean preoperative residual maxillary molar bone height of 5.2 ± 0.8 mm increased to 14.0 ± 1.9 mm after augmentation. Implants 9.0 -11.5 mm in length were placed. Post-augmentation heights decreased to 12.4 ± 1.3 mm at 7 ± 2 months, and after prosthetic loading to 11.9 ± 0.8 mm at 6 ± 2 months and 11.7 ± 0.6 mm at 12 ± 2 months. No abnormal bone resorption of the augmented areas was observed, and bone height supporting the implants was maintained. The overall implant survival rate was 100%, with no implant failure or complications during the first year.
Conclusions
Low-crystalline CO3Ap granules were useful and safe for sinus floor augmentation and simultaneous implant installation, providing a promising bone substitute for dental implant surgery.
https://ift.tt/2rmNLl5
Morphological evaluation of the nasopalatine canal in patients with different facial profiles and ages
Publication date: Available online 6 December 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Eliana Dantas da Costa, Yuri Nejaim, Luciano Augusto Cano Martins, Priscila Dias Peyneau, Gláucia Maria Bovi Ambrosano, Matheus Lima Oliveira
Abstract
Purpose
To evaluate the influence of the facial profile and age on the morphology of the nasopalatine canal.
Methods
132 volumes of cone-beam computed tomography (CBCT) were classified according to the facial profile – mesofacial, brachyfacial and dolichofacial – and divided into the following age groups: 21-30, 31-40, 41-50 and 51-60 years. Measurements were obtained from the opening of the incisive and nasopalatine foramina, alveolar bone thickness, and full length, most constricted region and volume of the nasopalatine canal. Intra- and inter-examiner agreement was calculated using the intraclass correlation coefficient. After the exploratory and descriptive analysis, data were subjected to two-way analysis of variance (ANOVA) and Tukey's test for comparisons between the facial profiles and age groups. The significance level was 5% (α=0.05).
Results
Intra- and inter-examiner reproducibility was excellent for all measurements. Patients older than 51 years presented significantly greater volume of the nasopalatine canal than patients aged between 21 and 30 years, for all facial profiles (p≤0.05). Linear measurements obtained from the nasopalatine canal showed no significant difference between facial profiles and age groups (p>0.05).
Conclusion
The nasopalatine canal proved not to be influenced by the facial profile, but showed increased volume with aging, particularly after 50 years of age.
https://ift.tt/2G0dZ76
Down-regulation and nuclear localization of survivin by sodium butyrate induces caspase-dependent apoptosis in human oral mucoepidermoid carcinoma
Publication date: January 2019
Source: Oral Oncology, Volume 88
Author(s): Boonsil Jang, In-Hyoung Yang, Nam-Pyo Cho, Bohwan Jin, WonWoo Lee, Yun Chan Jung, Seong Doo Hong, Ji-Ae Shin, Sung-Dae Cho
Abstract
Objective
Sodium butyrate (NaBu) is a histone deacetylase inhibitor that possesses an apoptotic ability. However, the molecular mechanism by which NaBu induces apoptosis in human oral mucoepidermoid carcinoma (MEC), a type of salivary gland tumor, remains unclear.
Materials and methods
The anticancer effects of NaBu and its related molecular mechanisms were determined by trypan blue exclusion assay, 4′-6-diamidino-2-phenylindole staining, live/dead assay, human apoptosis array, RT-PCR, western blotting, immunocytochemistry, preparation of nuclear fractions, and nude mice tumor xenograft.
Results
In this study, we found that NaBu inhibited growth and induced apoptosis in the human oral MEC cell lines MC3 and YD15 with acetylation of histone proteins H2A and H3. NaBu apparently down-regulated survivin protein, as evidenced by the results of the human apoptosis antibody array, and modulated it at the post-translational process. Interestingly, NaBu caused nuclear translocation of survivin protein in both cell lines. NaBu also resulted in decreased expression levels of Bcl-xL mRNA and protein, leading to induction of caspase-dependent apoptosis in human oral MEC cell lines. In addition, NaBu administration inhibited tumor growth in vivo at a dosage of 500 mg/kg/day, but it did not cause any hepatic or renal toxicity.
Conclusion
This study provides new insights into the molecular mechanism of apoptotic actions by NaBu in human oral MEC and the basis of its clinical application for the treatment of human oral MEC.
Graphical abstract
https://ift.tt/2QhRWgW
Utility of a repeat PET/CT scan in HPV-associated Oropharyngeal Cancer following incomplete nodal response from (chemo)radiotherapy
Publication date: January 2019
Source: Oral Oncology, Volume 88
Author(s): Howard Yu-hao Liu, Robin Milne, Gregory Lock, Benedict James Panizza, Anne Bernard, Matthew Foote, Margaret McGrath, Elizabeth Brown, Mitesh Gandhi, Sandro Virgilio Porceddu
Abstract
Objectives
To assess the utility of a repeat positron emission tomography/computed tomography (PET/CT) instead of immediate neck dissection (ND) for incomplete nodal response (IR) in Human Papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPC) following chemoradiotherapy/radiotherapy [(chemo)RT].
Materials and methods
Patients with non-distant metastatic, node positive (N+) disease treated between Jan/2005 to Jan/2016, achieved complete response at the primary with no distant relapse on a 12-week re-staging PET/CT were evaluated. Patients underwent surveillance after complete nodal response (CR). Patients with IR underwent repeat PET/CT at 16 weeks to direct neck management. Primary endpoints were CR conversion rate and subsequent regional failure following a 16-week PET/CT directed ND. Secondary endpoints were predictive values (PV) of the 12- and 16-week PET/CT for residual nodal disease, predictors for requiring the 16-week PET/CT, 5 year regional, locoregional failure free survival (FFS) and overall survival (OS).
Results
235 patients were evaluated. Median follow up was 56 (range 19–60) months. 41 patients underwent 16-week re-staging PET/CT, 29 (71%) converted to CR. No subsequent regional failures occurred following a 16-week PET/CT directed ND. Positive and negative PV of the 12- and 16-week PET/CT for residual nodal disease was 12% & 98%, and 33% & 97%, respectively. N-category (AJCC/UICC 7th edition) predicted for requiring a 16-week PET/CT on univariate analysis (P-value 0.02). 5 year regional, locoregional FFS and OS was 95.8%, 93.4% and 90.8%, respectively.
Conclusion
For N+ HPV-associated OPC achieving IR on the 12-week re-staging PET/CT following (chemo)RT, a repeat 16-week PET/CT can spare patients from unnecessary surgery.
https://ift.tt/2RD7pVL
Identification and prospective stability of eNose derived inflammatory phenotypes in severe asthma
Publication date: Available online 6 December 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): P. Brinkman, A.H. Wagener, P.P. Hekking, A.T. Bansal, A.H. Maitland-van der Zee, Y. Wang, H. Weda, H.H. Knobel, T.J. Vink, N.J. Rattray, A. D'Amico, G. Pennazza, M. Santonico, D. Lefaudeux, B. De Meulder, C. Auffray, P.S. Bakke, M. Caruso, P. Chanez, K.F. Chung
Abstract
Background
Severe asthma is a heterogeneous condition as shown by independent cluster analyses based on demographic, clinical and inflammatory characteristics. A next step is to identify molecular driven phenotypes using 'omics'-technologies. Molecular fingerprints of exhaled breath are associated with inflammation and may qualify as non-invasive assessment of severe asthma phenotypes.
Objectives
We aimed: 1) to identify severe asthma phenotypes by exhaled metabolomic fingerprints obtained from a composite of electronic noses (eNoses); 2) to assess stability of eNose derived phenotypes in relation to within-patient clinical and inflammatory changes.
Methods
In this longitudinal multicenter study exhaled breath samples were taken from an unselected subset of adult severe asthma subjects from the U-BIOPRED cohort. Exhaled metabolites were centrally analyzed by an assembly of eNoses. Unsupervised Ward clustering enhanced by Similarity Profile Analysis (SPA) together with K-Means clustering was performed. For internal validation Partitioning Around Medoids (PAM) and topological data analysis (TDA) were applied. Samples at 12-18 months of prospective follow-up were used to assess longitudinal within-patient stability.
Results
Data were available for 78 subjects (age 55 [IQR: 45-64] years, 41% male). Three eNose-driven clusters (n=26/33/19) were revealed, showing differences in circulating eosinophil- (p=0.045) and neutrophil percentages (p=0.017) and ratio of patients using oral corticosteroids (p=0.035). Longitudinal within-patient cluster stability was associated to changes in sputum eosinophils (p=0.045).
Conclusions
We have identified and followed-up exhaled molecular phenotypes of severe asthma, which were associated with changing inflammatory profile and oral steroid usage. This suggests that breath analysis might contribute to the management of severe asthma.
https://ift.tt/2EgsamX
A computerized decision support tool to implement asthma guidelines for children and adolescents
Publication date: Available online 5 December 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Carolyn M. Kercsmar, Christine A. Sorkness, Agustin Calatroni, Peter J. Gergen, Gordon R. Bloomberg, Rebecca S. Gruchalla, Meyer Kattan, Andrew H. Liu, George T. O'Connor, Jacqueline A. Pongracic, Stanley J. Szefler, Stephen J. Teach, Jeremy J. Wildfire, Robert A. Wood, Edward M. Zoratti, William W. Busse, NIAID-sponsored Inner-City Asthma Consortium
Abstract
Background
Multi-center randomized controlled trials (RCTs) for asthma management that incorporate usual care regimens could benefit from standardized application of evidence-based guidelines.
Objective
To evaluate performance of a computerized decision support tool, Asthma Control Evaluation and Treatment (ACET) Program, to standardize usual care regimens for asthma management in RCTs.
Methods
Children and adolescents with persistent, uncontrolled asthma, living in urban census tracts were recruited into 3 multi-center RCTs (each with a usual care arm) between 2004 and 2014. A computerized decision support tool scored asthma control and assigned an appropriate treatment step based on published guidelines. Control level determinants (symptoms, rescue medication use, pulmonary function measure, adherence estimates) were collected at visits and entered into the ACET Program. Changes in control level and treatment steps were examined during the trials.
Results
At screening, over half the participants were rated as not or poorly controlled. The proportion of participants who gained good control between screening and randomization increased significantly in all three trials. Between 51% and 70% were well-controlled by randomization. The proportion of well-controlled participants remained constant or improved slightly from randomization until the last post-treatment visit. Night symptoms were the most common control level determinant; there were few (<1%) instances of complete overlap of factors. FEV1 was the driver of control level assignment in 30% of determinations.
Conclusion
The ACET decision support tool facilitated standardized asthma assessment and treatment in multicenter RCTs and was associated with attaining and maintaining good asthma control in most participants.
Graphical abstract
https://ift.tt/2Sy7Alk
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