Biology of Bone Formation, Fracture Healing, and Distraction Osteogenesis.

Distraction osteogenesis is a bone-regenerative process in which an osteotomy is followed by distraction of the surrounding vascularized bone segments, with formation of new bone within the distraction gap. Distraction osteogenesis is efficacious for reconstructing critical sized bony defects in the appendicular and craniofacial skeleton. To provide opportunity to expand applications of distraction osteogenesis, it is important to have a thorough understanding of the underlying molecular biology and physiology of bone development and fracture healing. To accomplish these objectives a review of the literature was performed using search terms "endochondral ossification, intramembranous ossification, craniofacial skeleton, appendicular skeleton, fracture healing, bone development, and distraction osteogenesis." Bones of the craniofacial and appendicular skeleton have distinct mechanisms of embryonic development. The former develops from growth centers of mesenchymal precursors through intramembranous ossification. The latter forms though endochondral ossification in growth plates. However, both endochondral and intramembranous bone share similar master regulatory transcription factors and downstream growth factors. Fracture healing mirrors the pathway by which these bones developed embryonically. In contrast, bone formed by distraction osteogenesis does so by intramembranous ossification, regardless of whether it occurs within the appendicular or craniofacial skeleton. Understanding molecular pathway differences between bone formation by these mechanisms may allow for optimization and expansion of skeletal reconstruction by distraction osteogenesis (C) 2017 by Mutaz B. Habal, MD.

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Patient-reported outcomes (PROs) in chronic urticaria

Abstract

Chronic urticaria is an itching skin disease which persists for more than 6 weeks. Chronic urticaria has great impact on the daily life of the patient, and the fluctuating nature of the symptoms complicates the monitoring and treatment of the disease. Currently, there are no reliable biomarkers to identify and measure disease activity in chronic spontaneous urticaria. Consequently, use of patient-reported outcomes (PROs) is crucial when evaluating and monitoring different aspects of chronic urticaria such as disease activity/severity, disease control, and quality of life. We present an overview of seven different PROs used in chronic urticaria and highlight their strengths, limitations, and use in clinical practice and research.

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Lipid resuscitation in acute poisoning: after a decade of publications, what have we really learned?.

Purpose of review: The decision to provide intravenous lipid emulsion (ILE) therapy as a treatment modality for the reversal of various drug toxicity was discovered in the last decade. Numerous publications, in both human and animals attested to its clinical use, but current supporting evidence supporting inconsistent. Recent findings: A recent systematic review reported evidence for benefit of ILE in bupivacaine toxicity. Human randomized trials and large observational studies as well as animal models of orogastric poisoning failed to report a clear benefit of ILE for nonlocal anesthetics poisoning. Summary: ILE can be used to resuscitate local anesthetics especially bupivacaine. The impact of ILE on oral overdoses is controversial and clear evidence on benefit is lacking. A thorough risk benefit assessment with consideration of alternative options is warranted to minimize the risk of adverse effects. Evidence supports using bolus doses of ILE, while infusion rates are still debatable Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Neurotoxicity of anesthetic drugs: an update.

Purpose of review: This article reviews the most recently published evidence that investigated anesthesia-induced neurotoxicity in both animals and humans, especially as it pertains to the perinatal period. Recent findings: Several recent studies have focused on better understanding the complex mechanisms that underlie intravenous and volatile anesthesia-induced neurotoxicity in animals. Adjuvant agents that target these pathways have been investigated for their effectiveness in attenuating the neuroapoptosis and neurocognitive deficits that result from anesthesia exposure, including dexmedetomidine, rutin, vitamin C, tumor necrosis factor [alpha], lithium, apocynin, carreic acid phenethyl ester. Five clinical studies, including one randomized control trial, provided inconsistent evidence on anesthesia-induced neurotoxicity in humans. Summary: Despite a growing body of preclinical studies that have demonstrated anesthesia-induced neurotoxic effects in the developing and aging brain, their effects on the human brain remains to be determined. The performance of large-scale human studies is limited by several important factors, and noninvasive biomarkers and neuroimaging modalities should be employed to define the injury phenotypes that reflect anesthesia-induced neurotoxicity. Ultimately, the use of these modalities may provide new insights into whether the concerns of anesthetics are justified in humans. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Procedural sedation in the ICU and emergency department.

Purpose of review: Procedures are increasingly being performed in the acute care setting, outside of the operating rooms (OR). This article aims to review the current literature on out-of-OR procedural sedation with a focus on the ICU and emergency department, highlighting the following topics: multidisciplinary team approach, choice of pharmacologic agent, sedation scales, current safety guidelines, anticipating complications, appropriate monitoring and necessary resources. Recent findings: Subjective assessment of sedation using sedation scales is controversial. Addition of ketamine and dexmedetomidine to propofol for sedation improves patient and proceduralist satisfaction. The short-acting benzodiazepine remimazolam shows promise in initial phase 2 trials. Use of capnography for monitoring during sedation is being challenged by new literature from the emergency department setting. Hypoxia is the most common adverse event with procedural sedation, and the risk of pulmonary aspiration is low. Summary: Multimodal/synergistic sedation under a multidisciplinary team provides the best patient satisfaction. Collection and analysis of physiological data and outcomes of patients undergoing procedural sedation is necessary to maintain compliance with regulatory bodies. There is a paucity of comprehensive guidelines for conducting research in procedural sedation; therefore, it is being currently addressed by the Sedation Consortium. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Patch testing in patients with suspected cosmetic dermatitis: A retrospective study

Summary

Background

Growing use of cosmetics has led to an increase in the incidence of allergic contact dermatitis (ACD) to cosmetics. Patch testing helps to confirm allergy to cosmetics and pinpoint the exact offending allergens.

Aims and Objectives

The study aimed to find the frequency of positive patch test reactions in cases with suspected ACD to cosmetics, and the common allergens responsible for it.

Methods

This is a retrospective record-based study of 58 patients, with suspected ACD to cosmetics, who had undergone patch testing with Indian standard series and Indian cosmetic and fragrance series from January 2013 to December 2015.

Results

The majority of patients (60.34%) belonged to the age group of 20-40 years. The most common site of involvement was face (94.8%) followed by neck (22.4%). The most commonly implicated cosmetics in history were soaps (53.4%), and face creams (24.1%). The most common allergens detected on patch testing were cetrimide (20.7%) and thimerosal (15.5%) followed by paraphenylenediamine (6.9%), and fragrance mix (5.2). Positive allergic reactions were obtained in 2.12% of the patches.

Conclusion

Most common cosmetic products implicated for causing ACD were face creams, soaps, and hair dyes. The principal culprit allergens were cetrimide and thimerosal.

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Transient ischemic attacks on turning the head to one side, with immediate remission of symptoms when the head returned to the neutral position.

http://medicine-greece.blogspot.com/2017/05/transient-ischemic-attacks-on-turning.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com