Cartoon Analgesia in the Pediatric Plastic Surgery Population

No abstract available

http://ift.tt/2zTvoYg

Topographic Analysis of the Supratrochlear Artery and the Supraorbital Artery: Implication for Improving the Safety of Forehead Augmentation

No abstract available

http://ift.tt/2xseG0B

Do Bacteria and Biofilm Play a Role in Double-Capsule Formation around Macrotextured Implants?

Background: The double capsule is a complication mostly described in aggressive macrotextured implants. Mechanical shear stress applied onto an immature periprosthetic capsule has been linked to their formation. The authors aim to demonstrate the role of bacterial phenotype and biofilm in the development of the double capsule. Methods: Seven double capsules formed at the interface of macrotextured breast expander implants were studied using scanning electron microscopy. Two samples for each surface of the inner capsule layer (the prosthesis interface and the intercapsular space) were analyzed for bacteria cell size, bacterial density, and biofilm deposition. Results: Although all routine bacterial cultures were negative, the prosthesis interface had both higher bacteria load and biofilm deposition compared with the intercapsular space (Mann-Whitney U test, p = 0.004 and p = 0.008, respectively). Moreover, bacteria cell sizes were significantly smaller at the prosthesis interface in six of seven samples. Comparison of bacteria density and biofilm dispersion showed an increase of biofilm extracellular matrix deposition over 2000 cells/mm2 (linear regression, p = 0.0025). These results indicate a common trend among bacteria species. Conclusions: Bacterial expression between the different surfaces of the double capsule displays significant differences; bacteria at the prosthesis interface are mostly in a biofilm state, whereas they demonstrate a planktonic phenotype at the intercapsular space. When a sufficient amount of bacteria are present at a specific location, quorum sensing may trigger a biofilm phenotypic switch in planktonic bacteria cells. Biofilm formation may alter capsule formation through immune response, thereby weakening capsule strength and facilitating extracellular matrix delamination and double-capsule formation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

http://ift.tt/2yNtlal

Subfascial Primary Breast Augmentation with Fat Grafting: A Review of 156 Cases: Correction

No abstract available

http://ift.tt/2zSHdOl

Five Steps to Internal Mammary Vessel Preparation in Less than 15 Minutes

Background: Modern breast reconstruction often involves microvascular reconstruction. The most common recipient vessels are the internal mammary artery and vein. Recently, there has been great focus on efficiency, but much of this emphasis has been directed to faster flap harvest or recovery protocols for expeditious discharge. An equally important aspect is internal mammary vessel preparation. Methods: Breast reconstruction was performed in 415 patients (715 breasts) using autologous tissue (850 flaps) from 2012 to 2016. In 97.6 percent of these breast reconstructions, the internal mammary vessels were used. The preparation of these vessels was routinely performed using the five-step technique described here. Results: Internal mammary preparation time ranged from 7 to 45 minutes (median, 15 minutes). The procedure involves five simplified steps, as follows: step 1, the rib is exposed by splitting the pectoralis major muscle; step 2, the perichondrium anterior to the cartilage is incised and dissected away from the cartilage; step 3, the cartilage is removed with a rongeur; step 4, laterally the perichondrium is elevated and incised (under direct vision, this perichondrium is then split directly over the vessels and the cranial and caudal flaps are resected); and step 5, careful dissection is performed on the artery and vein. Conclusions: Safe preparation of recipient vessels in microvascular reconstruction is essential for success. In modern breast reconstruction, the internal mammary artery and vein are typically used. Exposure of these vessels should be predictable and efficient. The authors have found that a systematic approach using the above five steps accomplishes these goals.

http://ift.tt/2yO5303

Establishment of an Acquired Lymphedema Model in the Mouse Hindlimb: Technical Refinement and Molecular Characteristics

No abstract available

http://ift.tt/2xrvt3M

Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction with DIEP or Pedicled TRAM Abdominal Flaps

Summary: The American Society of Plastic Surgeons commissioned a multistakeholder Work Group to develop recommendations for autologous breast reconstruction with abdominal flaps. A systematic literature review was performed and a stringent appraisal process was used to rate the quality of relevant scientific research. The Work Group assigned to draft this guideline was unable to find evidence of superiority of one technique over the other (deep inferior epigastric perforator versus pedicled transverse rectus abdominis musculocutaneous flap) in autologous tissue reconstruction of the breast after mastectomy. Presently, based on the evidence reported here, the Work Group recommends that surgeons contemplating breast reconstruction on their next patient consider the following: the patient's preferences and risk factors, the setting in which the surgeon works (academic versus community practice), resources available, the evidence shown in this guideline, and, equally important, the surgeon's technical expertise. Although theoretical superiority of one technique may exist, this remains to be reported in the literature, and future methodologically robust studies are needed.

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Discussion: Mixed Reality with HoloLens: Where Virtual Reality Meets Augmented Reality in the Operating Room

No abstract available

http://ift.tt/2zTvdw4

Fat Grafting in Hollow Upper Eyelids and Volumetric Upper Blepharoplasty

Background: Periorbital volume loss creates a shadow frame, and traditional excisional blepharoplasties may aggravate the situation. Divergence in filling treatments establishes a demand for simple and reproducible techniques to achieve consistent results. Here, the author's hollow upper eyelid evaluation and treatment approach are presented. Methods: A retrospective photographic analysis was conducted of 32 women who underwent fat grafting for hollow upper eyelids between 2012 and 2016. Preoperative and postoperative evaluations of upper eyelid ratios at the medial and lateral corneal limbus, together with lateral contour modifications, were used to determine the efficacy of the technique to restore youthful proportions and contours. Results: Preoperative analysis showed 20 eyelids with an inner shadow, or A-pattern; and 44 eyelids with the complete extension of the hollow, or C-pattern. Three patients presented mild blepharoptosis, and eight patients had undergone a previous upper blepharoplasty. Mean grafting volume was 0.4 cc in the deep plane and 2.8 cc in the superficial plane. Fat grafting exclusively was performed in six patients, improving all ratios and correcting the A-pattern deformity. Volumetric upper blepharoplasty combining fat grafting in two levels and orbicularis oculi muscle imbrication was performed in 26 patients, correcting every inverted ratio (p

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Reply: Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

No abstract available

http://ift.tt/2xseGh7

Breast Cleavage Remodeling with Fat Grafting: A Safe Way to Optimize Symmetry and to Reduce Intermammary Distance

Background: In their descriptions of the ideal breast, most studies have focused primarily on the dimensions, shape, and proportions. The distance between the breasts has only very rarely been considered. The intermammary distance and the medial symmetry between the breasts are important parts of the outcome of surgery and have a strong bearing on patient satisfaction. However, the control surgeons have over these factors is only relative, and depends heavily on the underlying anatomical characteristics of the patients. Methods: Eighty-six patients undergoing breast augmentation, breast reduction, or mastopexy and breast reconstruction with separated or asymmetric breasts underwent fat grafting in the medial quadrants. Intermammary distances were measured before fat grafting and 12 months later. Complications were also recorded. Results: This technique obtained a statistically significant reduction in the mean intermammary distance (p

http://ift.tt/2yOCQpN

Evidence-Based Medicine: Face Lift

No abstract available

http://ift.tt/2zQFTLX

Impact of Patient Subtype and Surgical Variables on Abdominoplasty Outcomes: A 12-Year Massachusetts General Hospital Experience

Background: The traditional abdominoplasty is one of the most common surgical procedures performed. This study evaluates the impact of different surgical techniques and clinical patient factors on abdominoplasty outcomes. Methods: A retrospective review of consecutive patients undergoing abdominoplasty was performed. Results: Seven hundred seventy-nine patients with a mean age of 43.7 years and a body mass index of 27 kg/m2 underwent abdominoplasty. The majority were women (92.9 percent), and massive weight loss was present in 34.8 percent. Abdominoplasty techniques included traditional (59.4 percent), belt lipectomy (17.9 percent), fleur-de-lis (16.4 percent), umbilical float (9.2 percent), and mini-abdominoplasty (2.8 percent). Half of the study population [n = 384 (49.3 percent)] had concurrent surgical procedures. Total complications (23.0 percent) consisted primarily of wound- and scar-related complications (15.3 percent). Approximately 60 percent of patients received heparin chemoprophylaxis, with overall thromboembolic and hematoma rates less than 1 percent. Univariate analysis revealed that massive weight loss (p = 0.04), fleur-de-lis (p = 0.03) or belt lipectomy (p = 0.05) techniques, and concurrent medial thigh lift (p

http://ift.tt/2yOOelK

Optimizing Outcomes in Pharyngoesophageal Reconstruction and Neck Resurfacing: 10-Year Experience of 294 Cases

No abstract available

http://ift.tt/2xsc2YE

Injection of Compressed Diced Cartilage in the Correction of Secondary and Primary Rhinoplasty: A New Technique with 12 Years’ Experience

Background: There are instances where small or large pockets are filled with diced cartilage in the nose, without use of wrapping materials. For this purpose, 1-cc commercial syringes were used. The obtained results were partial and incomplete. For better and improved results, the author designed new syringes, with two different sizes, which compress the diced cartilage for injection. Methods: The author presents his experience accrued over the past 12 years with 2366 primary, 749 secondary, 67 cleft lip and nose, and a total of 3182 rhinoplasties, using his new syringe design, which compresses diced cartilage and injects the diced cartilages as a conglutinate mass, simulating carved costal cartilage, but a malleable one. Results: In 3125 patients, the take of cartilage graft was complete (98.2 percent) and a smooth surface was obtained, giving them a natural appearance. In 21 patients (0.65 percent), there was partial resorption of cartilage. Correction was performed with touch-up surgery by reinjection of a small amount of diced cartilage. In 36 patients (1.13 percent), there was overcorrection that, 1 year later, was treated by simple rasping. Conclusions: Compared with diced cartilage wrapped with Surgicel or fascia, the amount of injected cartilage graft is predictable because it consists purely of cartilage. The injected diced cartilage, because it is compressed and becomes a conglutinated mass, resembles a wood chip and simulates carved cartilage. It is superior to carved cartilage in that it is moldable, time saving, and gives a good result with no late show or warping. The injection takes only a few minutes.

http://ift.tt/2yQGeQS

ASPS/PSF Sponsored Symposia and Workshops

No abstract available

http://ift.tt/2zQFMA1

Managing Alar Flare in Rhinoplasty

Summary: Alar flare is a common feature that contributes to the width of the lower third of the nose. In the right patient, alar flare reduction can improve nasal harmony and facial aesthetic balance; however, it is also difficult to correct if conducted inappropriately or overzealously. The unique anatomy and diverse morphologies of the alar lobule, and the dynamic relationship between flare and changes in tip projection, must be considered. The authors provide guidelines for flare reduction: when it is appropriate and how to tailor the excision pattern to safely and effectively refine nasal width. Alar flare is classified into three types according to alar rim shape on basal view analysis. By designing the excision pattern based on specific flare type, the lower third of the nose is narrowed without creating an operated appearance. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

http://ift.tt/2yQGdMO

Gender Affirmation: Medical & Surgical Perspectives

No abstract available

http://ift.tt/2zQFHfH

The Evolution of Chemical Peeling and Modern-Day Applications

Summary: Despite the growth of technically more sophisticated skin resurfacing modalities, such as those based on light, radiofrequency, and ultrasound, chemical peel procedures have risen 5 to 25 percent over the past year alone. Chemexfoliation carries historical significance and has markedly evolved since its inception in ancient times. As a result of plastic surgery and dermatologic advancements, modern-day chemexfoliation offers plastic surgeons additional safe and effective options for patients with rhytides, dyschromias, and other signs of light- and environment-induced skin damage. This review discusses the historical evolution of chemexfoliation procedures, highlights modern-day practice habits, and touches on the clinically relevant applications of chemical peels.

http://ift.tt/2yOOcu8

Reply: The Anterior Intercostal Artery Flap: Anatomical and Radiologic Study

No abstract available

http://ift.tt/2zQFB7P

Denosumab-induced cutaneous hypersensitivity reaction with distinct clinical and histopathologic findings

Targeted biologic agents are increasingly approved for the treatment of a wide range of medical conditions. Cutaneous drug reactions are seen to varying degrees with these agents, and postmarketing surveillance is critical to identifying adverse and uncommon events. Denosumab is a monoclonal antibody to receptor activator of nuclear factor kappa-B ligand (RANKL) that results in decreased osteoclast activation.

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Copyright

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6





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Contributors

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6





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Contents

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6





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Forthcoming Issues

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6





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Hematology/Oncology Emergencies

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): John C. Perkins, Jonathan E. Davis




http://ift.tt/2z9xc1X

Hematology/Oncology Emergencies

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): John C. Perkins, Jonathan E. Davis




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Oncologic Mechanical Emergencies

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Umar A. Khan, Carl B. Shanholtz, Michael T. McCurdy

Teaser

Prevalence of cancer and its various related complications continues to rise. Increasingly these life-threatening complications are initially managed in the emergency department, making a prompt and accurate diagnosis crucial to effectively institute the proper treatment and establish goals of care. The following oncologic emergencies are reviewed in this article: pericardial tamponade, superior vena cava syndrome, brain metastasis, malignant spinal cord compression, and hyperviscosity syndrome.


http://ift.tt/2z9xbuV

Oncologic Metabolic Emergencies

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Jonathan Wagner, Sanjay Arora

Teaser

Cancer and its therapies may lead to several metabolic emergencies that emergency providers (EPs) should be well-versed in identifying and managing. With prompt recognition and treatment initiation in the emergency department, lives can be saved and quality of life maintained. Most oncologic metabolic emergencies occur in advanced cancer states, but some follow initiation of treatment or may be the presenting syndrome that leads to the cancer diagnosis. This article reviews the 2 most emergent oncologic metabolic diagnoses: tumor lysis syndrome and hypercalcemia of malignancy. A discussion on associated cancers and conditions, pathogenesis and pathophysiology, and management recommendations is included.


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Pediatric Oncologic Emergencies

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Melanie K. Prusakowski, Daniel Cannone

Teaser

The overall prognosis for most pediatric cancers is good. Mortality for all childhood cancers combined is approximately half what it was in 1975, and the survival rates of many malignancies continue to improve. However, the incidence of childhood cancer is significant and the related emergencies that develop acutely carry significant morbidity and mortality. Emergency providers who can identify and manage oncologic emergencies can contribute significantly to an improved prognosis. Effective care of pediatric malignancies requires an age-appropriate approach to patients and compassionate understanding of family dynamics.


http://ift.tt/2z9x96h

Neutropenic Fever

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Lindsey White, Michael Ybarra

Teaser

Fever is a common presenting complaint among adult or pediatric patients in the emergency department setting. Although fever in healthy individuals does not necessarily indicate severe illness, fever in patients with neutropenia may herald a life-threatening infection. Therefore, prompt recognition of patients with neutropenic fever is imperative. Serious bacterial illness is a significant cause of morbidity and mortality for neutropenic patients. Neutropenic fever should trigger the initiation of a rapid work-up and the administration of empiric systemic antibiotic therapy to attenuate or avoid the progression along the spectrum of sepsis, severe sepsis, septic shock syndrome, and death.


http://ift.tt/2xryPDE

Chemotherapeutic Medications and Their Emergent Complications

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Janet S. Young, Jennifer W. Simmons

Teaser

Patients with complications of chemotherapy, either acute or chronic, are frequently encountered in the emergency department (ED). Some patients present with complaints immediately after chemotherapy administration, whereas others may show subtle, secondary signs or may have no signs or symptoms of chemotoxicity. An increased index of suspicion prompts early recognition, diagnosis, and prevention of further iatrogenic injury. This article reviews characteristic hypersensitivity reactions, typical organ system dysfunction, and treatment strategies for adult patients who present to the ED with complications after chemotherapy.


http://ift.tt/2zaU0P1

Acute Leukemia

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Hayley Rose-Inman, Damon Kuehl

Teaser

Although great progress has been made in the understanding and treatment of acute leukemia, this disease has not been conquered. For emergency providers (EPs), the presentation of these patients to an emergency department presents a host of challenges. A patient may present with a new diagnosis of leukemia or with complications of the disease process or associated chemotherapy. It is incumbent on EPs to be familiar with the manifestations of leukemia in its various stages and maintain some suspicion for this diagnosis, given the nebulous and insidious manner in which leukemia can present.


http://ift.tt/2xrEEkz

Myeloproliferative Disorders

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Brian Meier, John H. Burton

Teaser

The emergency providers generally encounters myeloproliferative disorders (MPNs) in 1 of 2 ways: as striking laboratory abnormalities of seeming unknown consequence, or in previously diagnosed patients presenting with complications. The course of patients with MPNs is highly variable, but major complications can arise. Emergent conditions related to hyperviscosity need to be recognized early and treated aggressively. Rapid hydration, transfusion, cytoreduction, and early hematology consultation can be lifesaving. Likewise, although management is not altered, a high index of suspicion for thrombotic complications is required in patients with known MPNs as these are a significant cause of morbidity and mortality.


http://ift.tt/2zaU01t

Anemia

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Julie T. Vieth, David R. Lane

Teaser

Patients with anemia are frequently encountered in the emergency department (ED); emergency physicians (EPs) often play an important role in the evaluation and management of anemia. Although many patients have findings consistent with anemia on routine laboratory tests, only a small percentage will require acute intervention. An understanding of the broader types of anemia and how to manage such patients is important in the practice of an EP, as the presence of anemia will impact treatment plans for a variety of other disorders. This article reviews the evaluation and management of adult patients presenting to the ED with anemia.


http://ift.tt/2xrECJt

Sickle Cell Disease in the Emergency Department

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Paris B. Lovett, Harsh P. Sule, Bernard L. Lopez

Teaser

Acute painful episodes are the most common reason for emergency department visits among patients with sickle cell disease (SCD). Early and aggressive pain management is a priority. Emergency providers (EPs) must also diagnose other emergent diagnoses in patients with SCD and differentiate them from vaso-occlusive crisis. EPs should be aware of cognitive biases that may misdirect the diagnostic process. Administration of intravenous fluids should be used judiciously. Blood transfusion may be considered. Coordination of care with hematology is an important part of the effective emergency department and long-term management of patients with SCD.


http://ift.tt/2z9x3LX

Thrombotic Microangiopathies (TTP, HUS, HELLP)

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Shane Kappler, Sarah Ronan-Bentle, Autumn Graham

Teaser

Thrombocytopenia, strictly defined as a platelet count less than 150,000, is common in the emergency department. Recognition, diagnostic investigation, and proper disposition of a thrombocytopenic patient are imperative. One group of disorders leading to thrombocytopenia is the thrombotic microangiopathies, hallmarked by platelet destruction. These thrombotic microangiopathies include thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS) and hemolysis, elevated liver enzyme levels, low platelet count (HELLP), which should be distinguished from similar disease processes such as immune thrombocytopenia (ITP), disseminated intravascular coagulation (DIC) and heparin induced thrombocytopenia (HIT). In this article, clinical presentations, pathophysiology, diagnostic workup, management plans, complications, and dispositions are addressed for this complex group of platelet disorders.


http://ift.tt/2xqMwTB

Evaluation and Management of Congenital Bleeding Disorders

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Rahul Bhat, Whitney Cabey

Teaser

Patients presenting to the emergency department with acute bleeding and a history of clotting or platelet disorder present a unique challenge to the emergency physician. The severity of bleeding presentation is based on mechanism as well as factor levels: patients with factor levels greater than 5% can respond to most minor hemostatic challenges, whereas those with factor levels less than 1% bleed with minor trauma or even spontaneously. Treatment should be initiated in consultation with the patient's hematologist using medications and specific factor replacement, except in rare, life-threatening, resource-poor situations, when cryoprecipitate or activated prothrombin complex may be considerations.


http://ift.tt/2z9x1DP

Acquired Bleeding Disorders

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Alisheba Hurwitz, Richard Massone, Bernard L. Lopez

Teaser

Emergency medicine practitioners treat bleeding patients on a regular basis. Disorders of hemostasis are an additional challenge in these patients but can be assessed and managed in a systematic fashion. Of particular importance to the emergency clinician are the iatrogenic causes of abnormal hemostasis. Other acquired causes of abnormal hemostasis include renal disease, immune thrombocytopenia, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, acquired coagulation factor inhibitors, acute traumatic coagulopathy, liver disease, and disseminated intravascular coagulopathy.


http://ift.tt/2xqNFuc

Antithrombotic Reversal Agents

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Matthew D. Wilson, Jonathan E. Davis

Teaser

The actively bleeding anticoagulated patient presenting to the emergency department requires rapid evaluation and treatment, which is made increasingly complicated by the ever-evolving antithrombotic treatment options used in medicine. Even with excellent supportive care, the timeliness with which reversal decisions need to be made continues to demand of the emergency practitioner a familiarity with the properties and general characteristics of a variety of antithrombotic agents. Reversal options vary and may include vitamin K, FFP, PCC, rFVIIa, platelets, and desmopressin, among others.


http://ift.tt/2z9wZMd

Blood Product Transfusions and Reactions

Publication date: December 2017
Source:Hematology/Oncology Clinics of North America, Volume 31, Issue 6
Author(s): Jessica L. Osterman, Sanjay Arora

Teaser

Blood product transfusions are an essential component of the practice of emergency medicine. From acute traumatic hemorrhage to chronic blood loss necessitating transfusion for symptomatic anemia, familiarity with individual blood products and their indications for transfusion is an essential tool for every emergency physician (EP). Although the focus of this article is primarily on the transfusion of red blood cells, many of the concepts are applicable to the transfusion of all blood products. EPs must be fully familiar with both the individual blood components and the potential reactions and complications of these transfusions.


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Adolescent Tuning of Association Cortex in Human Structural Brain Networks

Abstract

Motivated by prior data on local cortical shrinkage and intracortical myelination, we predicted age-related changes in topological organization of cortical structural networks during adolescence. We estimated structural correlation from magnetic resonance imaging measures of cortical thickness at 308 regions in a sample of N = 297 healthy participants, aged 14–24 years. We used a novel sliding-window analysis to measure age-related changes in network attributes globally, locally and in the context of several community partitions of the network. We found that the strength of structural correlation generally decreased as a function of age. Association cortical regions demonstrated a sharp decrease in nodal degree (hubness) from 14 years, reaching a minimum at approximately 19 years, and then levelling off or even slightly increasing until 24 years. Greater and more prolonged age-related changes in degree of cortical regions within the brain network were associated with faster rates of adolescent cortical myelination and shrinkage. The brain regions that demonstrated the greatest age-related changes were concentrated within prefrontal modules. We conclude that human adolescence is associated with biologically plausible changes in structural imaging markers of brain network organization, consistent with the concept of tuning or consolidating anatomical connectivity between frontal cortex and the rest of the connectome.

http://ift.tt/2gN2dkR

Network Structure and Function in Parkinson’s Disease

Abstract

Little is known of the structural and functional properties of abnormal brain networks associated with neurological disorders. We used a social network approach to characterize the properties of the Parkinson's disease (PD) metabolic topography in 4 independent patient samples and in an experimental non-human primate model. The PD network exhibited distinct features. Dense, mutually facilitating functional connections linked the putamen, globus pallidus, and thalamus to form a metabolically active core. The periphery was formed by weaker connections linking less active cortical regions. Notably, the network contained a separate module defined by interconnected, metabolically active nodes in the cerebellum, pons, frontal cortex, and limbic regions. Exaggeration of the small-world property was a consistent feature of disease networks in parkinsonian humans and in the non-human primate model; this abnormality was only partly corrected by dopaminergic treatment. The findings point to disease-related alterations in network structure and function as the basis for faulty information processing in this disorder.

http://ift.tt/2yPNmxf

Neural Encoding of Auditory Features during Music Perception and Imagery

Abstract

Despite many behavioral and neuroimaging investigations, it remains unclear how the human cortex represents spectrotemporal sound features during auditory imagery, and how this representation compares to auditory perception. To assess this, we recorded electrocorticographic signals from an epileptic patient with proficient music ability in 2 conditions. First, the participant played 2 piano pieces on an electronic piano with the sound volume of the digital keyboard on. Second, the participant replayed the same piano pieces, but without auditory feedback, and the participant was asked to imagine hearing the music in his mind. In both conditions, the sound output of the keyboard was recorded, thus allowing precise time-locking between the neural activity and the spectrotemporal content of the music imagery. This novel task design provided a unique opportunity to apply receptive field modeling techniques to quantitatively study neural encoding during auditory mental imagery. In both conditions, we built encoding models to predict high gamma neural activity (70–150 Hz) from the spectrogram representation of the recorded sound. We found robust spectrotemporal receptive fields during auditory imagery with substantial, but not complete overlap in frequency tuning and cortical location compared to receptive fields measured during auditory perception.

http://ift.tt/2gLt2WA

Large-Scale Network Topology Reveals Heterogeneity in Individuals With at Risk Mental State for Psychosis: Findings From the Longitudinal Youth-at-Risk Study

Abstract

Emerging evidence demonstrates heterogeneity in clinical outcomes of prodromal psychosis that only a small percentage of at-risk individuals eventually progress to full-blown psychosis. To examine the neurobiological underpinnings of this heterogeneity from a network perspective, we tested whether the early patterns of large-scale brain network topology were associated with risk of developing clinical psychosis. Task-free functional MRI data were acquired from subjects with At Risk Mental State (ARMS) for psychosis and healthy controls (HC). All individuals had no history of drug abuse and were not on antipsychotics. We performed functional connectomics analysis to identify patterns of system-level functional brain dysconnectivity associated with ARMS individuals with different outcomes. In comparison to HC and ARMS who did not transition to psychosis at follow-up (ARMS-NT), ARMS individuals who did (ARMS-T) showed marked brain functional dysconnectivity, characterized by loss of network segregation and disruption of network communities, especially the salience, default, dorsal attention, sensorimotor and limbic networks (P < 0.05 FWE-corrected, Cohen's d > 1.00), and was associated with baseline symptom severity. In contrast, we did not observe connectivity differences between ARMS-NT and HC individuals. Taken together, these results suggest a possible large-scale functional brain network topology phenotype related to risk of psychosis transition in ARMS individuals.

http://ift.tt/2yQtUjQ

Clinical and radiographic evaluation of pulpectomy in primary teeth: a 18-months clinical randomized controlled trial

To avoid untoward changes when primary teeth are replaced by permanent teeth, resorption of the material used in primary teeth root canal filling should occur at the same rate as root resorption. The Aim of th...

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The Arthur Prophet Memorial Lecture

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Reflection

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Paediatric dentistry: A multidisciplinary approach

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Stress and burnout research project

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Dental notation: Mental gymnastics

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Fracture resistance of zirconia-based all-ceramic crowns after bur adjustment

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Identifying teeth correctly

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Community dental team screen factory workers for mouth cancer

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Dental education: A gentle touch

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Interview: Say no more... An insight into the Behavioural Insights Team

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Patient benefits: Incorrect advice

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Oral surgery II: Part 3. Cysts of the mouth and jaws and their management

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From the archive: Sydney turns 100

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An estimated carbon footprint of NHS primary dental care within England. How can dentistry be more environmentally sustainable?

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Primary dental care: You're not serious

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Eavesdroppers and nosey neighbours required

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Alternative sugars: Syrup

Elaine Gardner, British Dietetic Association (BDA) Spokesperson, discusses the sugar content in syrup and provides related oral health advice.

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Is it time to digitally enable dentistry with the rest of healthcare?

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How Was Your Otology Training? A Survey of Recent Otolaryngology Residents.

Objective: To survey graduating residents or recent graduates of otolaryngology residency programs to evaluate their Otology/Neurotology (ON) experience in residency and discern if they had received adequate training in time to decide whether to pursue a fellowship in Otology or Neurotology. Study Design: Internet-based survey. Methods: A survey was distributed to all US otolaryngology residency programs to distribute to 5th year residents and recent graduates in last 4 years. The survey assessed satisfaction in ON experience, presence of ON fellows, adequacy of experience to decide on ON fellowship, post-graduate year (PGY) year at which residents observed, performed, and proficiently performed five procedures (tympanoplasty, mastoidectomy, ossiculoplasty, stapedectomy, and cochlear implant), and plan for performing these surgeries in practice. Results: 89/106 (84%) of respondents felt they had adequate training in Otology in time to decide whether or not to pursue a fellowship and were found to observe and perform surgeries significantly earlier in training by PGY including: mastoidectomy (observed PGY 1.9 versus PGY 2.3, performed PGY 2.9 versus PGY 3.5), ossiculoplasty (observed 2.1 versus 3.0, performed 3.6 versus 4.3), stapedectomy (observed 2.3 versus 3.0, performed 3.9 versus 4.5), and cochlear implant (observed 2.1 versus 2.8, performed 3.4 versus 4.1) all p

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Spreading the word about a devastating disease

http://ift.tt/2lktXyR

Bone-conducted Vestibular-evoked Myogenic Potentials Before and After Stapes Surgery.

Objective: To identify whether stapes surgery causes otolith dysfunction using bone-conducted vestibular-evoked myogenic potentials (VEMPs). Study Design: Prospective study. Setting: Hyogo College of Medicine Hospital. Patients: Twenty primary ears (19 otosclerosis, 1 congenital stapes fixation) in 17 patients (2 men, 15 women; mean age 51 yr, range 20-68 yr) who had normal cervical VEMP (cVEMP) and ocular VEMP (oVEMP) results with bone-conducted stimulation were included. Intervention: Stapes surgery. Main Outcome Measure: Both VEMP tests with bone-conducted stimulation were performed before and after stapes surgery. The normalized p13-n23 amplitude of cVEMPs and the nI-pI amplitude of oVEMPs were measured within 3 months after stapes surgery. Then, the asymmetry ratio (AR) was calculated to examine the effect of surgery on otolith function. Results: Seven patients complained of temporary dizziness postoperatively, but their symptoms disappeared within approximately a week. Deterioration of VEMPs of the operated ear was not seen in any ears. Significantly greater amplitude compared with the opposite ear was found for cVEMP in one ear and oVEMP in two ears after the surgery. Their VEMP results recovered to the normal range at 6 months postoperatively. Conclusions: These findings suggest that stapes surgery causes no or undetectably small otolith dysfunction from the perspective of VEMP evaluation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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BDA AGM

http://ift.tt/2y8BXc0

Abscess with osteomyelitis of the clivus after adenoidectomy: An uncommon complication of a common procedure

Publication date: Available online 26 October 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Moreddu, C. Le Treut, J.-M. Triglia, R. Nicollas




http://ift.tt/2y8Rj09

OR004 Safe and effective implementation of chemotherapy outpatient desensitizations

Hypersensitivity reactions (HSRs) to platinum-based chemotherapies are increasing as cancer rates are rising. Desensitization protocols allow patients to receive first-line therapy despite HSRs, but are often performed in the inpatient setting for close monitoring by trained personnel and to mitigate risk. We aimed to evaluate a safe and effective strategy for performing desensitizations in the outpatient setting, with a focus on decreasing delays in medication administration, patient inconvenience, and overall treatment time.

http://ift.tt/2zbfw6e

P275 Refractory hypereosinophilia manifesting as nodular sclerosis classical hodgkin lymphoma—a case presentation

The differential of hypereosinophilia is broad and includes atopy, infection, malignancy, and in rare cases of exclusion, hypereosinophilic syndrome (HES). Thorough evaluation is necessary to elucidate the cause and prevent sequelae of hypereosinophilia.

http://ift.tt/2iDiB7S

P283 Pneumococcal osteomyelitis: a rare diagnosis suggestive of immune deficiency

Despite routine immunization with pneumococcal conjugate vaccines, Streptococcus pneumoniae is still a significant cause of bacteremia, pneumonia and meningitis. Osteoarticular pneumococcal infections are very rare, accounting for less than 5% of all invasive pneumococcal diseases (IPD).

http://ift.tt/2zaosJ3

P282 Recurrent candidal esophagitis in an otherwise healthy host

Candida Albicans is a yeast that naturally colonizes the skin and mucosa. Chronic Mucocutaneous Candidiasis Syndrome (CMCS) presents with recurrent superficial candida infection, and is associated with other clinical manifestations such as autoimmunity or bacterial infections. Chronic Mucocutaneous Candidaisis Disease (CMCD) is a new entity in which patients present solely with superficial candidiasis. Here we present an interesting case of CMCD.

http://ift.tt/2iDkQIs

P337 Remission of cow’s milk allergy during rituximab therapy: a case report

Food allergy has no known treatment. However, novel therapies are being studied in the hope of promoting tolerance. This case report describes the remission of food allergy during rituximab therapy.

http://ift.tt/2zaon8d

P222 Effects of immunoglobulin e concentration, eosinophil concentration, and atopy status on benralizumab efficacy in asthma

We investigated the efficacy of the anti-eosinophilic monoclonal antibody benralizumab for patients with severe, uncontrolled asthma by high versus low serum IgE concentrations and atopy status.

http://ift.tt/2iBx1p9

OR001 Drug rash eosinophilia and systemic symptoms (DRESS) syndrome identified in electronic health record allergy module

Drug rash eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe hypersensitivity reaction. Due to challenges in case identification, DRESS epidemiology remains poorly characterized in the US. We used the electronic health record (EHR) allergy module to identify and describe DRESS syndrome cases in an integrated US healthcare system.

http://ift.tt/2zaoeBH

P280 Severe combined immunodeficiency in cartilage hair hypoplasia

Cartilage Hair Hypoplasia (CHH) is associated with immune deficiency, which is a leading cause of mortality in these patients. Newborn screening (NBS) utilizing T-cell receptor excision circles (TRECs) is critical for early diagnosis of severe combined immunodeficiency (SCID), enabling prompt treatment and decreased morbidity/mortality.

http://ift.tt/2iDieKw

OR002 Testing strategies for immediate and delayed reactions to cephalosporins

Similar to penicillin allergy up to 8% of the general population are labeled as cephalosporin allergic; however, specific and validated testing strategies to manage immediate and delayed cephalosporin hypersensitivities are not well defined.

http://ift.tt/2zaPhwL

P206 Effect of inhaled corticosteroid use on weight (BMI) in moderate to severe asthmatic pediatric patients

The effect of inhaled corticosteroids (ICS) on weight (BMI) in moderate to severe asthmatic pediatric patients has not been established. Obesity has been shown to decrease response to ICS as well as increase the risk of worse asthma symptoms.

http://ift.tt/2iGjXiA

OR003 Common misconceptions in the recognition and treatment of anaphylaxis in community hospital based medical professionals

Intramuscular epinephrine is the primary treatment for anaphylaxis. Delays in administration of epinephrine have been associated with increased mortality in anaphylaxis. Despite numerous publications regarding this topic, interdisciplinary recognition, primary treatment and epinephrine administration route choices remain inconsistent. We hypothesize that a multidisciplinary quality improvement project is required to address common misconceptions in order to facilitate the preparedness to recognize and treat anaphylaxis appropriately.

http://ift.tt/2zanYTf

P296 Hypogammaglobulinemia in a patient with Turner’s Syndrome (TS) and celiac disease

Turner's syndrome (TS), a rare chromosomal disorder that affects females, is characterized by loss of one of the X chromosomes. This case report demonstrates a patient with TS who has hypogammaglobulinemia and celiac disease.

http://ift.tt/2iBRhHc

P275 Refractory hypereosinophilia manifesting as nodular sclerosis classical hodgkin lymphoma—a case presentation

The differential of hypereosinophilia is broad and includes atopy, infection, malignancy, and in rare cases of exclusion, hypereosinophilic syndrome (HES). Thorough evaluation is necessary to elucidate the cause and prevent sequelae of hypereosinophilia.

http://ift.tt/2iDiB7S

P283 Pneumococcal osteomyelitis: a rare diagnosis suggestive of immune deficiency

Despite routine immunization with pneumococcal conjugate vaccines, Streptococcus pneumoniae is still a significant cause of bacteremia, pneumonia and meningitis. Osteoarticular pneumococcal infections are very rare, accounting for less than 5% of all invasive pneumococcal diseases (IPD).

http://ift.tt/2zaosJ3

P230 Long-term assessment of the burden of atopic sensitization in patients with severe/difficult-to-treat asthma

Analyses of data from TENOR II demonstrated that approximately 50% of patients had uncontrolled asthma based on NHLBI impairment category. Here we report the long-term burden of disease in patients relative to aeroallergen sensitization from the TENOR II cohort.

http://ift.tt/2iE14N9

P282 Recurrent candidal esophagitis in an otherwise healthy host

Candida Albicans is a yeast that naturally colonizes the skin and mucosa. Chronic Mucocutaneous Candidiasis Syndrome (CMCS) presents with recurrent superficial candida infection, and is associated with other clinical manifestations such as autoimmunity or bacterial infections. Chronic Mucocutaneous Candidaisis Disease (CMCD) is a new entity in which patients present solely with superficial candidiasis. Here we present an interesting case of CMCD.

http://ift.tt/2iDkQIs

P345 New onset concurrent eosinophilic gastritis in patients with eosinophilic esophagitis: a case series

Eosinophilic Esophagitis (EoE) is thought to be a disease limited to the esophagus.

http://ift.tt/2iCY4ka

OR005 A penicillin skin testing initiative in an outpatient allergy practice

The penicillin allergy label has significant clinical implications and there is renewed interest in penicillin allergy de-labeling. We identified the clinical characteristics of all penicillin-allergic patients presenting to an outpatient allergy practice, and offered all qualifying patients penicillin skin testing (PST).

http://ift.tt/2zbpVP9

P337 Remission of cow’s milk allergy during rituximab therapy: a case report

Food allergy has no known treatment. However, novel therapies are being studied in the hope of promoting tolerance. This case report describes the remission of food allergy during rituximab therapy.

http://ift.tt/2zaon8d

P222 Effects of immunoglobulin e concentration, eosinophil concentration, and atopy status on benralizumab efficacy in asthma

We investigated the efficacy of the anti-eosinophilic monoclonal antibody benralizumab for patients with severe, uncontrolled asthma by high versus low serum IgE concentrations and atopy status.

http://ift.tt/2iBx1p9

P214 Mepolizumab induction therapy for eosinophilic granulomatosis with polyangiitis (EGPA)

Mepolizumab has been used as an adjuvant therapy for refractory EGPA. We report biopsy confirmed EGPA using conventional doses of Mepolizumab for induction treatment.

http://ift.tt/2iE62tc

OR001 Drug rash eosinophilia and systemic symptoms (DRESS) syndrome identified in electronic health record allergy module

Drug rash eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe hypersensitivity reaction. Due to challenges in case identification, DRESS epidemiology remains poorly characterized in the US. We used the electronic health record (EHR) allergy module to identify and describe DRESS syndrome cases in an integrated US healthcare system.

http://ift.tt/2zaoeBH

OR006 Usability and comprehension of an illustrated Canadian Anaphylaxis Action Plan for Kids (Kids’ CAP study)

We designed a written plan called Canadian Anaphylaxis Action Plan for Kids (Kids' CAP) which incorporate validated pictograms with written instructions. Using a patient-centered approach, we aimed to assess the impact of the Kids' CAP on anaphylaxis recognition and treatment and to determine its perceived usefulness.

http://ift.tt/2zc4vkY

P280 Severe combined immunodeficiency in cartilage hair hypoplasia

Cartilage Hair Hypoplasia (CHH) is associated with immune deficiency, which is a leading cause of mortality in these patients. Newborn screening (NBS) utilizing T-cell receptor excision circles (TRECs) is critical for early diagnosis of severe combined immunodeficiency (SCID), enabling prompt treatment and decreased morbidity/mortality.

http://ift.tt/2iDieKw

OR002 Testing strategies for immediate and delayed reactions to cephalosporins

Similar to penicillin allergy up to 8% of the general population are labeled as cephalosporin allergic; however, specific and validated testing strategies to manage immediate and delayed cephalosporin hypersensitivities are not well defined.

http://ift.tt/2zaPhwL

P206 Effect of inhaled corticosteroid use on weight (BMI) in moderate to severe asthmatic pediatric patients

The effect of inhaled corticosteroids (ICS) on weight (BMI) in moderate to severe asthmatic pediatric patients has not been established. Obesity has been shown to decrease response to ICS as well as increase the risk of worse asthma symptoms.

http://ift.tt/2iGjXiA

OR101 Outcomes of patients with aspirin-exacerbated respiratory disease on omalizumab

The current treatment for patients with aspirin-exacerbated respiratory disease (AERD) who have uncontrolled asthma or chronic rhinosinusitis is aspirin desensitization. However, some patients are unable to undergo or fail desensitization, and treatment with omalizumab is an option although efficacy data is scarce.

http://ift.tt/2zbpMez

OR003 Common misconceptions in the recognition and treatment of anaphylaxis in community hospital based medical professionals

Intramuscular epinephrine is the primary treatment for anaphylaxis. Delays in administration of epinephrine have been associated with increased mortality in anaphylaxis. Despite numerous publications regarding this topic, interdisciplinary recognition, primary treatment and epinephrine administration route choices remain inconsistent. We hypothesize that a multidisciplinary quality improvement project is required to address common misconceptions in order to facilitate the preparedness to recognize and treat anaphylaxis appropriately.

http://ift.tt/2zanYTf

P296 Hypogammaglobulinemia in a patient with Turner’s Syndrome (TS) and celiac disease

Turner's syndrome (TS), a rare chromosomal disorder that affects females, is characterized by loss of one of the X chromosomes. This case report demonstrates a patient with TS who has hypogammaglobulinemia and celiac disease.

http://ift.tt/2iBRhHc

P329 Utility and safety of the intermittent oral immunotherapy, step-up method, for severe food allergy patients

Although Oral Immunotherapy (OIT) is a hopeful treatment for severe food allergy patients, its usefulness and safeness is still unclear. We evaluated the utility and safety of our intermittent OIT protocol, Step-up method.

http://ift.tt/2iCY3N8

OR004 Safe and effective implementation of chemotherapy outpatient desensitizations

Hypersensitivity reactions (HSRs) to platinum-based chemotherapies are increasing as cancer rates are rising. Desensitization protocols allow patients to receive first-line therapy despite HSRs, but are often performed in the inpatient setting for close monitoring by trained personnel and to mitigate risk. We aimed to evaluate a safe and effective strategy for performing desensitizations in the outpatient setting, with a focus on decreasing delays in medication administration, patient inconvenience, and overall treatment time.

http://ift.tt/2zbfw6e

OR011 Safety of multi-dose immunotherapy vials after routine use

Recent proposed changes to US Pharmaceutical General Chapter <797> (USP <797>) have prompted discussion regarding the safety of multi-dose immunotherapy extract vials after routine use. We present evidence to support the argument that currently accepted aseptic protocols for handling and administration of multi-dose immunotherapy extract maintenance vials during routine patient care does not result in risk of microbial growth and that changes as suggested by the proposed USP <797> guidelines are not needed.

http://ift.tt/2zbpGDJ

P230 Long-term assessment of the burden of atopic sensitization in patients with severe/difficult-to-treat asthma

Analyses of data from TENOR II demonstrated that approximately 50% of patients had uncontrolled asthma based on NHLBI impairment category. Here we report the long-term burden of disease in patients relative to aeroallergen sensitization from the TENOR II cohort.

http://ift.tt/2iE14N9

OR005 A penicillin skin testing initiative in an outpatient allergy practice

The penicillin allergy label has significant clinical implications and there is renewed interest in penicillin allergy de-labeling. We identified the clinical characteristics of all penicillin-allergic patients presenting to an outpatient allergy practice, and offered all qualifying patients penicillin skin testing (PST).

http://ift.tt/2zbpVP9

P214 Mepolizumab induction therapy for eosinophilic granulomatosis with polyangiitis (EGPA)

Mepolizumab has been used as an adjuvant therapy for refractory EGPA. We report biopsy confirmed EGPA using conventional doses of Mepolizumab for induction treatment.

http://ift.tt/2iE62tc

OR006 Usability and comprehension of an illustrated Canadian Anaphylaxis Action Plan for Kids (Kids’ CAP study)

We designed a written plan called Canadian Anaphylaxis Action Plan for Kids (Kids' CAP) which incorporate validated pictograms with written instructions. Using a patient-centered approach, we aimed to assess the impact of the Kids' CAP on anaphylaxis recognition and treatment and to determine its perceived usefulness.

http://ift.tt/2zc4vkY

P345 New onset concurrent eosinophilic gastritis in patients with eosinophilic esophagitis: a case series

Eosinophilic Esophagitis (EoE) is thought to be a disease limited to the esophagus.

http://ift.tt/2iCY4ka

OR101 Outcomes of patients with aspirin-exacerbated respiratory disease on omalizumab

The current treatment for patients with aspirin-exacerbated respiratory disease (AERD) who have uncontrolled asthma or chronic rhinosinusitis is aspirin desensitization. However, some patients are unable to undergo or fail desensitization, and treatment with omalizumab is an option although efficacy data is scarce.

http://ift.tt/2zbpMez

P329 Utility and safety of the intermittent oral immunotherapy, step-up method, for severe food allergy patients

Although Oral Immunotherapy (OIT) is a hopeful treatment for severe food allergy patients, its usefulness and safeness is still unclear. We evaluated the utility and safety of our intermittent OIT protocol, Step-up method.

http://ift.tt/2iCY3N8

OR011 Safety of multi-dose immunotherapy vials after routine use

Recent proposed changes to US Pharmaceutical General Chapter <797> (USP <797>) have prompted discussion regarding the safety of multi-dose immunotherapy extract vials after routine use. We present evidence to support the argument that currently accepted aseptic protocols for handling and administration of multi-dose immunotherapy extract maintenance vials during routine patient care does not result in risk of microbial growth and that changes as suggested by the proposed USP <797> guidelines are not needed.

http://ift.tt/2zbpGDJ

Editorial Board

Publication date: October 2017
Source:Artificial Intelligence in Medicine, Volume 82





http://ift.tt/2zTod23

A matched-filter algorithm to detect amperometric spikes resulting from quantal secretion

Publication date: 1 January 2018
Source:Journal of Neuroscience Methods, Volume 293
Author(s): Supriya Balaji Ramachandran, Kevin D. Gillis
BackgroundElectrochemical microelectrodes located immediately adjacent to the cell surface can detect spikes of amperometric current during exocytosis as the transmitter released from a single vesicle is oxidized on the electrode surface. Automated techniques to detect spikes are needed in order to quantify the spike rate as a measure of the rate of exocytosis.New methodWe have developed a Matched Filter (MF) detection algorithm that scans the data set with a library of prototype spike templates while performing a least-squares fit to determine the amplitude and standard error. The ratio of the fit amplitude to the standard error constitutes a criterion score that is assigned for each time point and for each template. A spike is detected when the criterion score exceeds a threshold and the highest-scoring template and the time of peak score is identified. The search for the next spike commences only after the score falls below a second, lower threshold to reduce false positives. The approach was extended to detect spikes with double-exponential decays with the sum of two templates.ResultsReceiver Operating Characteristic plots (ROCs) demonstrate that the algorithm detects >95% of manually identified spikes with a false-positive rate of ∼2%.Comparison with existing methodsROCs demonstrate that the MF algorithm performs better than algorithms that detect spikes based on a derivative-threshold approach.ConclusionsThe MF approach performs well and leads into approaches to identify spike parameters.



http://ift.tt/2xrnFiu

Widespread optogenetic expression in macaque cortex obtained with MR-guided, convection enhanced delivery (CED) of AAV vector to the thalamus

Publication date: 1 January 2018
Source:Journal of Neuroscience Methods, Volume 293
Author(s): Azadeh Yazdan-Shahmorad, Nan Tian, Viktor Kharazia, Lluis Samaranch, Adrian Kells, John Bringas, Jiwei He, Krystof Bankiewicz, Philip N. Sabes
BackgroundIn non-human primate (NHP) optogenetics, infecting large cortical areas with viral vectors is often a difficult and time-consuming task. Previous work has shown that parenchymal delivery of adeno-associated virus (AAV) in the thalamus by convection-enhanced delivery (CED) can lead to large-scale transduction via axonal transport in distal areas including cortex. We used this approach to obtain widespread cortical expression of light-sensitive ion channels.New methodAAV vectors co-expressing channelrhodopsin-2 (ChR2) and yellow fluorescent protein (YFP) genes were infused into thalamus of three rhesus macaques under MR-guided CED. After six to twelve weeks recovery, in vivo optical stimulation and single cell recording in the cortex was carried out using an optrode in anesthetized animals. Post-mortem immunostaining against YFP was used to estimate the distribution and level of expression of ChR2 in thalamus and cortex.ResultsHistological analysis revealed high levels of transduction in cortical layers. The patterns of expression were consistent with known thalamo-cortico-thalamic circuits. Dense expression was seen in thalamocortiocal axonal fibers in layers III, IV and VI and in pyramidal neurons in layers V and VI, presumably corticothalamic neurons. In addition we obtained reliable in vivo light-evoked responses in cortical areas with high levels of expression.Comparison with existing methodsThalamic CED is very efficient in achieving large expressing areas in comparison to convectional techniques both in minimizing infusion time and in minimizing damage to the brain.ConclusionMR-guided CED infusion into thalamus provides a simplified approach to transduce large cortical areas by thalamo-cortico-thalamic projections in primate brain.



http://ift.tt/2zT87pf

A solitary reddish nodule on the lower leg

http://ift.tt/2zSOnC2

The association of HLA B*15:02 allele and Stevens–Johnson syndrome/toxic epidermal necrolysis induced by aromatic anticonvulsant drugs in a South Indian population

Abstract

Background

The presence of HLA-B*15:02 allele is considered a risk factor for development of Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in patients taking aromatic anticonvulsant drugs like carbamazepine and phenytoin. The genetic association is ethnicity specific. Testing for HLA-B*15:02 allele is suggested as a prerequisite before starting carbamazepine in certain ethnic groups. There are only a few/no studies from south India on HLA association of SJS/TEN.

Aims

To identify any association between HLA-B*15:02 allele and SJS/TEN induced by carbamazepine/phenytoin among native population.

Methods (including settings, design, and statistical analysis used)

A case–control study done in a tertiary care center at Kottayam in Kerala state of south India. Cases were 12 native patients who developed SJS/TEN owing to aromatic anticonvulsant drugs (phenytoin – 8; carbamazepine – 4), and controls were 11 persons tolerant to these drugs from unrelated families of the same ethnic group. HLA-B typing was done by PCR SSP method.

Results

There was only one HLA-B*15:02 carrier among cases and controls. He/she had SJS/TEN induced by carbamazepine.

Conclusions

Association of HLA-B*15:02 with phenytoin-induced SJS/TEN is rare in the population studied. The one limitation of the study was the small sample size.

http://ift.tt/2xtoRSf

Lichen planus pigmentosus and its variants: review and update

Abstract

Lichen planus pigmentosus (LPP) is considered a rare variant of lichen planus (LP). It is characterized by acquired dark brown to gray macular pigmentation located on sun-exposed areas of the face, neck, and flexures, commonly found in dark-skinned patients. In patients with LPP, an inflammatory lichenoid response results in marked pigmentary incontinence. It has been associated with hepatitis C virus, sun exposure, and contactants such as mustard oil and nickel. LPP-inversus affects fair and dark skin, predominantly involving flexural and intertriginous areas, while sun-exposed areas are spared; friction is an associated trigger. LPP along Blaschko's lines has been associated with susceptibility to genetic mosaicisms. LPP can present concomitantly with other variants of LP such as frontal fibrosing alopecia, as well as endocrinopathies, and autoimmune diseases. Treatment is difficult and consists of avoidance of triggers and topical and systemic medications in order to stop the inflammatory reaction and reduce pigmentation, improving aesthetic appearance and quality of life.

http://ift.tt/2zSOltU

Exacerbation of Darier disease by peg-interferon beta-1a in a patient suffering from multiple sclerosis

http://ift.tt/2xqeq1Z

Clinical and radiological improvement in idiopathic calcinosis cutis with topical 25% sodium metabisulfite

http://ift.tt/2zTeXee

Bullous eruption in a patient with B-cell chronic lymphocytic leukemia: a diagnostic challenge

http://ift.tt/2i9m9ej

Dermoscopy in vitiligo: diagnosis and beyond

Abstract

Background

Vitiligo is essentially a clinical diagnosis, and dermoscopy may aid in noninvasive confirmation of diagnosis by excluding other clinically simulating hypopigmentary conditions. More importantly, dermoscopy is rapidly gaining ground as an important adjunct tool to evaluate disease activity.

Aim

To study the dermoscopic features of vitiligo and ascertain their correlation with disease activity.

Methods

Retrospective analysis of dermoscopy of 60 cases suffering from vitiligo was undertaken. Dermoscopy was performed using Dermlite II hybrid m dermatoscope at 10× magnification in polarized mode, and photographs were captured by Apple iphone 6. Variables assessed in the dermoscopic evaluation included perifollicular changes, perilesional changes, altered pigmentary network, and presence of specific features such as the starburst appearance, comet tail appearance, leukotrichia, telangiectasia, and any new findings.

Results

Sixty patients with stable, progressive, or repigmenting vitiligo were retrospectively studied. While perifollicular depigmentation (PFD) was predictive of stable vitiligo, perifollicular pigmentation (PFP) was characteristic of active disease. Starburst appearance, altered pigment network, and comet tail appearance, were also noted, and these were typical of progressive vitiligo. A new dermoscopic feature, the 'tapioca sago' appearance (sabudana), was observed in the skin adjacent to the vitiligo lesion only in patients with progressive vitiligo.

Conclusion

Dermoscopy is useful in assessing the stage of evolution and the status of disease activity in vitiligo. The most useful dermoscopic clues are observed in the perifollicular region, since progressive lesions display perifollicular pigmentation and stable/remitting lesions display perifolliclar depigmentation.

http://ift.tt/2gGPEnu

The effect of plasma rich in growth factors combined with follicular unit extraction surgery for the treatment of hair loss: A pilot study

Summary

Background

Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss. Blood-derived autologous growth factors have also proved to promote hair regeneration in patients with different types of alopecia.

Aims

The aim of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGF) technology as an adjuvant therapy for FUE surgery in hair loss affected patients.

Methods

The biologic potential of PRGF was firstly in vitro evaluated over follicular germinal matrix and dermal papilla cells. Afterward, fifteen patients were subjected to routine FUE procedure while 15 patients underwent FUE+PRGF therapy. PRGF group included intradermal injections of growth factors and follicular transfer unit (FTU) preservation in an autologous fibrin clot. Postsurgical patient satisfaction and clinical improvement were evaluated, and PRGF or saline-preserved hair grafts were histomorphometrically analyzed.

Results

Follicular cell proliferation and migration was induced after autologous growth factors treatment. PRGF-preserved FTUs presented higher bioactivity signals and improved integrity of perifollicular structures and extracellular matrix proteins such as collagen and elastic fibers. PRGF not only reduced the postsurgical crust healing and hair fixation period, but also decreased the inflammatory pain and itching sensation.

Conclusions

This preliminary data demonstrate that PRGF is able to minimize the postsurgical follicle loss and potentiate the performance of grafted hairs. The fibrin clot not only acts as a protective barrier against environmental factors, but also provides a biologically active scaffold that induces resident cell proliferation and maintains an optimal integrity of the grafted hair.

http://ift.tt/2iDcXCI

The effect of plasma rich in growth factors combined with follicular unit extraction surgery for the treatment of hair loss: A pilot study

Summary

Background

Hair transplant surgery using follicular unit extraction technique (FUE) is a common surgical procedure for the treatment of severe hair loss. Blood-derived autologous growth factors have also proved to promote hair regeneration in patients with different types of alopecia.

Aims

The aim of this study was to evaluate the safety and clinical efficacy of plasma rich in growth factors (PRGF) technology as an adjuvant therapy for FUE surgery in hair loss affected patients.

Methods

The biologic potential of PRGF was firstly in vitro evaluated over follicular germinal matrix and dermal papilla cells. Afterward, fifteen patients were subjected to routine FUE procedure while 15 patients underwent FUE+PRGF therapy. PRGF group included intradermal injections of growth factors and follicular transfer unit (FTU) preservation in an autologous fibrin clot. Postsurgical patient satisfaction and clinical improvement were evaluated, and PRGF or saline-preserved hair grafts were histomorphometrically analyzed.

Results

Follicular cell proliferation and migration was induced after autologous growth factors treatment. PRGF-preserved FTUs presented higher bioactivity signals and improved integrity of perifollicular structures and extracellular matrix proteins such as collagen and elastic fibers. PRGF not only reduced the postsurgical crust healing and hair fixation period, but also decreased the inflammatory pain and itching sensation.

Conclusions

This preliminary data demonstrate that PRGF is able to minimize the postsurgical follicle loss and potentiate the performance of grafted hairs. The fibrin clot not only acts as a protective barrier against environmental factors, but also provides a biologically active scaffold that induces resident cell proliferation and maintains an optimal integrity of the grafted hair.

http://ift.tt/2iDcXCI

Exogenous pigmentation of skin and nail caused by a millipede in a patient with plantar psoriasis

http://ift.tt/2yVDgKA

Exogenous pigmentation of skin and nail caused by a millipede in a patient with plantar psoriasis

http://ift.tt/2yVDgKA

Colonic strictures in children and young adults with Crohn's disease: Recognition on MR enterography

Publication date: March–April 2018
Source:Clinical Imaging, Volume 48
Author(s): David M. Biko, Petar Mamula, Nancy A. Chauvin, Sudha A. Anupindi
ObjectivesIdentify MRE features of colonic strictures in children/young adults with Crohn's disease.MethodsIncluded are patients with colonic strictures on colonoscopy imaged with MRE. Bowel wall thickening (BWT) with luminal narrowing, pre-stenotic dilatation (PSD), bowel wall enhancement, and diffusion restriction were evaluated.ResultsAll potential strictures (n=12) had BWT with luminal narrowing on MRE. 8/12 had PSD, meeting our MRE stricture criteria. MRE diagnosed 8/12 colonic strictures compared to colonoscopy but was concordant with findings in all surgical patients.ConclusionStrictures on MRE did not always agree with colonoscopy, but when correlating with surgery, MRE findings were all concordant.



http://ift.tt/2hd30IY

Intertwined control of the cell cycle and nucleocytoplasmic transport by the cyclin-dependent kinase Pho85 and RanGTPase Gsp1 in Saccharomyces cerevisiae

Publication date: Available online 26 October 2017
Source:Microbiological Research
Author(s): Oriol Mirallas, Elisabet Ballega, Bàrbara Samper-Martín, Sergio García-Márquez, Reyes Carballar, Natalia Ricco, Javier Jiménez, Josep Clotet
Deciphering the molecular mechanisms that connect cell cycle progression and nucleocytoplasmic transport is of particular interest: this intertwined relationship, once understood, may provide useful insight on the diseases resulting from the malfunction of these processes. In the present study we report on findings that indicate a biochemical connection between the cell cycle regulator CDK Pho85 and Ran-GTPase Gsp1, an essential nucleocytoplasmic transport component. When Gsp1 cannot be phosphorylated by Pho85, the cell cycle progression is impaired. Accordingly, a nonphosphorylatable version of Gsp1 abnormally localizes to the nucleus, which impairs the nuclear transport of molecules, including key components of cell cycle progression. Furthermore, our results suggest that the physical interaction of Gsp1 and the Kap95 karyopherin, essential to the release of nuclear cargoes, is altered. Altogether, the present findings point to the involvement of a biochemical mechanism in the interlocked regulation of the cell cycle and nuclear transport.



http://ift.tt/2xrps6W

Isolation, purification, structural elucidation and antimicrobial activities of kocumarin, a novel antibiotic isolated from actinobacterium Kocuria marina CMG S2 associated with the brown seaweed Pelvetia canaliculata

Publication date: Available online 26 October 2017
Source:Microbiological Research
Author(s): Bushra Uzair, Farid Menaa, Barkat Ali Khan, Faryal Vali Mohammad, Viqar Uddin Ahmad, Ryad Djeribi, Bouzid Menaa
AimsScreening of seaweed-associated bacteria capable of producing antimicrobials.Methods and resultsFifteen microbial strains, associated to the brown seaweed Pelvetia canaliculata (Linnaeus) attached to the rocks of Sonmiani Beach (Karachi, Pakistan), were screened. Crude extract filtrates of CMG S2 strain grew on Zobell marine agar (ZMA) had the most remarkable antimicrobial activity. Based on its phenotypic aspects (e.g. Gram-positive, microccoid form), biochemical characteristics (e.g. halotolerance) and genetic analyses, CMG S2 is identified as a putatively new Kocuria marina type strain belonging to the actinobacteria's class and micrococcaceae family. Thereby, the nucleotide sequence analysis of its full-length 16S ribosomal ribonucleic acid (rRNA) gene (GenBank accession number EU073966.1) displayed highest identity (i.e. 99%) and score (2630) with K. marina KMM 3905. Phylogenic trees analysis using the neighbor-joining method showed closest evolutionary distance of CMG S2 with KMM 3905 strain and K. carniphila (DC2201) specie. Interestingly, a unique ultraviolet (UV)-bioactive compound was purified from CMG S2 crude extracts by flash silica gel column and thin-layer chromatography techniques (TLC). Its chemical structure was unraveled as 4-[(Z)-2 phenyl ethenyl] benzoic acid (PEBA, later named kocumarin) by nuclear magnetic resonance (NMR) spectroscopy techniques. Importantly, kocumarin demonstrated prominent and rapid growth inhibition against all tested fungi and pathogenic bacteria including methicillin-resistant Staphylococcus aureus (MRSA), with a minimal fungal inhibitory concentration (MFC) of 15–25μg/mL and a minimal (bacterial) inhibitory concentration (MIC) of 10–15μg/mL.Significance and impact of the studyKocumarin represents a new promising natural antibiotic for in vivo and environmental applications.

Graphical abstract

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Cover 2 -- Editorial Board

Publication date: December 2017
Source:Magnetic Resonance Imaging, Volume 44





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fm iii and iv -- Contents/Barcode

Publication date: December 2017
Source:Magnetic Resonance Imaging, Volume 44





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Assessing the role of immune system in cancer progression from minimal residual disease

The immune system plays a major role in resisting the development and progression of cancer. Analysis of the molecular mechanisms of immune resistance to cancer has led to the formulation of several immunotherapeutic strategies. Although the immune system is portrayed in the literature as an effective tool for primary cancer control, its role in the development of recurrent tumors was relatively unexplored. It is well established that most cancers contain a subpopulation of cancer cells, that possess an inherent survival instinct which aids them to adopt a dormant state when subjected to stress [1–4].

http://ift.tt/2gHjA33

A review of electrocatalyst characterization by transmission electron microscopy

Publication date: Available online 26 October 2017
Source:Journal of Energy Chemistry
Author(s): Liyun Zhang, Wen Shi, Bingsen Zhang
At present, the development of highly efficient electrocatalysts with more rational control of microstructures (e.g. particle size, morphology, surface structure, and electronic structure) and chemical composition is needed and remained great challenges. Transmission electron microscopy (TEM) can offer the information about the microstructures and chemical compositions of the electrocatalysts on nano and atomic scale, which enables us to establish the synthesis-structure-performance relationship and further direct the design of new electrocatalysts with high performance. In this minireview paper, a brief introduction on the basic characterization of electrocatalysts with TEM, followed by the studying of dynamic evolution of the electrocatalysts in electrochemical reactions with identical location-TEM, is discussed.

Graphical abstract

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Degradation of Diphenhydramine by the Photocatalysts of ZnO/Fe2O3 and TiO2/Fe2O3 Based on Clinoptilolite: Structural and Operational Comparison

Publication date: Available online 26 October 2017
Source:Journal of Environmental Chemical Engineering
Author(s): Nila Davari, Mehrdad Farhadian, Ali Reza Solaimany Nazar, Maryam Homayoonfal
The photocatalysts of TiO2/Fe2O3 and ZnO/Fe2O3 based on clinoptilolite natural zeolite were synthesized by impregnation route and sol-gel methods The synthesized photocatalysts were characterized by XRD, XRF, EDX, FE-SEM, FT-IR, BET and UV–vis DRS analyses. The results of XRD, FT-IR, and EDX confirmed the presence of Fe2O3, TiO2, and ZnO nanoparticles on the surface of clinoptilolite. The FE-SEM results confirmed deposition of TiO2/Fe2O3 and ZnO/Fe2O3 on the surface of zeolite. The approximate particle size of TiO2/Fe2O3 and ZnO/Fe2O3 was 47 and 34nm, respectively. According to the XRF results, the synthesized nanoparticles had Fe³⁺/TiO2 and Fe³⁺/ZnO molar ratios of 0.06 in TiO2/Fe2O3/Zeolite and ZnO/Fe2O3/Zeolite, respectively. Based on BET analysis, the surface area of TiO2/Fe2O3/Zeolite and ZnO/Fe2O3/Zeolite was about 112 and 289m²/g, respectively. UV–vis DRS analysis confirmed that both TiO2/Fe2O3/Zeolite and ZnO/Fe2O3/Zeolite have high absorbtion capacity at visible light region. The performance of these two photocatalysts in degradation of diphenhydramine (DPH) from contaminated water was evaluated by investigating the effects of operational factors such as concentration of the contaminant (1–100mg/l), photocatalysts (0.5–2g/l), irradiation time (45–180min), and pH (4-10). The results of the photocatalytic experiments revealed that the ZnO/Fe2O3/Zeolite had a more effective performance in degrading DPH, compared to TiO2/Fe2O3/Zeolite. Under the optimal conditions, the efficiency of DPH degradation with TiO2/Fe2O3/Zeolite (DPH: 50mg/l, hydrogen peroxide: 50mg/l, irradiation time: 120min, photocatalyst: 0.5g/l, pH=5) and ZnO/Fe2O3/Zeolite (DPH: 50mg/l, hydrogen peroxide: 50mg/l, irradiation time: 100min, photocatalyst: 0.5g/l, pH=10) was 80 and 95%, respectively.

Graphical abstract

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Book review: beyond a shadow of a diet

http://ift.tt/2xrFv4N

Adipose Triglyceride Lipase Gene Polymorphisms is Not Associated with Free Fatty Acid Levels in Chinese Han Population

Metabolic Syndrome and Related Disorders Nov 2017, Vol. 15, No. 9: 474-479.


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Cardiovascular Effects Of Oral Appliance Therapy In Obstructive Sleep Apnea: A Systematic Review And Meta-Analysis

Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. This study systematically reviews the effects of oral appliance therapy (OAT) on a broad spectrum of cardiovascular outcomes.A literature search was performed up to December 31st 2016. Twenty-five relevant full-text articles were retrieved. Sixteen articles were considered methodologically sufficient, including 11 randomized controlled trials.Pooled data of the RCTs showed significant reductions in daytime systolic and diastolic blood pressure compared to baseline, but no significant reductions in heart rate, except for daytime heart rate when compared to inactive/placebo OAT.

http://ift.tt/2iCYVkw

Forced expiratory values in 1 second corresponding to Pediatric Respiratory Assessment Measure and Acute Asthma Intensity Research Score values during pediatric acute asthma exacerbations

Acute asthma exacerbations are one of the most frequent reasons for emergency department (ED) visits and hospitalizations. Expert panel guidelines recommend measurement of percent-predicted forced expiratory volume in 1 second (FEV1) or peak expiratory flow for exacerbation severity assessment and treatment decision making.1 These guidelines categorize exacerbation severity according to percent-predicted FEV1 as mild to moderate (FEV1 ≥40%) and severe (FEV1 <40%), but acute care facilities that treat pediatric exacerbations generally do not have the equipment or personnel for such measures of lung function.

http://ift.tt/2gFZK83

Paternal gonadal mosaicism as cause of a puzzling inheritance pattern of activated PI3-kinase delta syndrome

Birth defects caused by de novo chromosomal abnormalities resulting in single-gene defects occur in approximately 5% of all live births.1 Affected offspring have a broad range of illnesses, including primary immunodeficiency diseases, a genetically heterogeneous group of disorders presenting with a clinical spectrum of mild to severe infections, often complicated by autoimmunity and malignancies.2 Most primary immunodeficiency diseases are monogenic diseases with a Mendelian inheritance pattern.

http://ift.tt/2i8A706

Bee moth (Galleria mellonella) allergy

We present a case of bee moth (Galleria mellonella) allergy with new clinical and immunologic features. While taking part in trout fishing games during the past year, a 34-year-old amateur fisherman with no personal history of allergic diseases experienced several attacks of rhinoconjunctivitis and late asthmatic reactions. Symptoms of rhinoconjunctivitis began when starting to fish and persisted during the day. This was followed by mild wheezing and dyspnea during the following night. Symptoms worsened during the most recent fishing excursion, and mild breathing difficulty tends to last until the night of the next day.

http://ift.tt/2gGNSD2

Bee moth (Galleria mellonella) allergy

We present a case of bee moth (Galleria mellonella) allergy with new clinical and immunologic features. While taking part in trout fishing games during the past year, a 34-year-old amateur fisherman with no personal history of allergic diseases experienced several attacks of rhinoconjunctivitis and late asthmatic reactions. Symptoms of rhinoconjunctivitis began when starting to fish and persisted during the day. This was followed by mild wheezing and dyspnea during the following night. Symptoms worsened during the most recent fishing excursion, and mild breathing difficulty tends to last until the night of the next day.

http://ift.tt/2gGNSD2

Association of consistently suboptimal quality of life with consistently poor asthma control in children with asthma

Asthma is one of the most prevalent chronic conditions in children, affecting 8.4% of American children and adolescents (approximately 6.2 million) in 2015.1 Although previous studies have found that poor asthma control is associated with impaired physical, psychological, and social aspects of health-related quality of life (HRQoL),2 some studies have suggested that impaired psychological aspects of HRQoL (ie, anxiety and depressive symptoms) cause poor asthma control.3 The effects of impaired HRQoL domains (eg, fatigue, pain, mobility, and peer relationships) in addition to anxiety and depressive symptoms on subsequent asthma outcomes in pediatric populations have been inadequately studied.

http://ift.tt/2i7OpxZ

Association of consistently suboptimal quality of life with consistently poor asthma control in children with asthma

Asthma is one of the most prevalent chronic conditions in children, affecting 8.4% of American children and adolescents (approximately 6.2 million) in 2015.1 Although previous studies have found that poor asthma control is associated with impaired physical, psychological, and social aspects of health-related quality of life (HRQoL),2 some studies have suggested that impaired psychological aspects of HRQoL (ie, anxiety and depressive symptoms) cause poor asthma control.3 The effects of impaired HRQoL domains (eg, fatigue, pain, mobility, and peer relationships) in addition to anxiety and depressive symptoms on subsequent asthma outcomes in pediatric populations have been inadequately studied.

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Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications

To determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone.

http://ift.tt/2zIa4nu

Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Current grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children.

http://ift.tt/2hcDV0A

Pediatric airway study: Endoscopic grading system for quantifying tonsillar size in comparison to standard adenotonsillar grading systems

Current grading systems may not allow clinicians to reliably document and communicate adenotonsillar size in the clinical setting. A validated endoscopic grading system may be useful for reporting tonsillar size in future clinical outcome studies. This is especially important as tonsillar enlargement is the cause of a substantial health care burden on children.

http://ift.tt/2hcDV0A

Interferon response to RSV by bronchial epithelium from children with asthma is inversely correlated with pulmonary function

RSV-infected bronchial epithelial cells from children with asthma and obstructive physiology demonstrate greater expression of type I and III IFN-associated genes than cells from children without airway obstruction. Furthermore expression of IFN-associated genes inversely correlate with lung function.

http://ift.tt/2zb0lK7

Anti-apoptotic Serine Protease Inhibitors contribute towards the survival of allergenic Th2 cells

The mechanisms regulating the maintenance of persistent Th2 cells that potentiate allergic inflammation are not well understood.

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Chronic Rhinosinusitis: Endotypes, Biomarkers and Treatment Response

It is increasingly recognized that chronic rhinosinusitis (CRS) comprises a spectrum of different diseases with distinct clinical presentations and pathogenic mechanisms. Defining the distinct phenotypes and endotypes of CRS impacts prognosis and most importantly is necessary as the basis for making therapeutic decisions. The need for individualized defining of pathogenic mechanisms prior to initiating therapy extends to virtually all therapeutic considerations. This is clearly crucial with antibiotics where, barring an influence from their off-target anti-inflammatory pharmacological effects, an understanding of the role of individual biome predicts likelihood of therapeutic benefit.

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Lower Plasma Choline Levels are Associated with Sleepiness Symptoms

Sleepiness and cardiovascular disease share common molecular pathways; thus, metabolic risk factors for sleepiness may also predict cardiovascular disease risk. Daytime sleepiness predicts mortality and cardiovascular disease, although the mechanism is unidentified. This study explored the associations between subjective sleepiness and metabolite concentrations in human blood plasma within the oxidative and inflammatory pathways, in order to identify mechanisms that may contribute to sleepiness and cardiovascular disease risk.

http://ift.tt/2yUswMC

Women’s Perceptions of Usefulness and Ease of Use of Four Healthy Eating Blog Characteristics: A Qualitative Study of 33 French-Canadian Women

Publication date: Available online 26 October 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Véronique Bissonnette-Maheux, Audrée-Anne Dumas, Véronique Provencher, Annie Lapointe, Marilyn Dugrenier, Sharon Straus, Marie-Pierre Gagnon, Sophie Desroches
BackgroundHealthy eating blogs are knowledge translation tools used by nutrition and dietetics practitioners for helping people improve their health behaviors and food choices.ObjectiveOur aim was to explore women's perceptions of the usefulness and ease of use of healthy eating blog (HEB) characteristics that might increase potential users' intention to use them as tools to improve their dietary habits.DesignWe conducted qualitative research using semi-structured individual interviews.ParticipantsThirty-three women (mean age of 44 years; range=27 to 61 years) living in the Quebec City, Canada, metropolitan area were studied.InterventionFour existing HEBs, written by French-Canadian registered dietitians (RDs) whose main objective was the promotion of a healthy diet, were explored by women during individual interviews. A standardized open-ended interview questionnaire based on the Technology Acceptance Model was used to identify women's perceptions about characteristics of type of blog content delivery, RD blogger's delivery of information, blog layout, and blog design.Main outcome measuresWomen's perceptions toward the contribution of HEB characteristics to the usefulness and ease of use of those tools to improve their dietary habits were measured.Analyses performedInterviews were audiorecorded, transcribed verbatim, coded, and analyzed through an inductive content analysis using NVivo software.ResultsThe most useful characteristics of type of blog content delivery identified by women were recipes, hyperlinks, and references. Among characteristics of RD blogger's delivery of information, most women reported that interaction between blog readers and the RD blogger created a sense of proximity and of connection that was helpful for improving their dietary behaviors. Women's perceptions toward various characteristics of blog layout and design were also discussed.ConclusionsIncorporating specific characteristics when designing HEBs should be considered by RDs and future research to promote the use of those tools to support dietary behavior change efforts of internet users.



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Clinicopathologic features of 28 cases of nail matrix nevi (NMNs) in Asians: Comparison between children and adults

Clinical distinction between nail matrix nevus (NMN) and subungual melanoma (SUM) can be challenging. More precise delineation of the clinicodermoscopic characteristics specific for NMNs is needed.

http://ift.tt/2xpYcpx

Prevalence and clinicopathologic characteristics of multiple myeloma with cutaneous involvement: A case series from Korea

Multiple myeloma (MM) is a plasma cell dyscrasia characterized by the presence of a clonal proliferation of tumor cells. Cutaneous involvement of MM is very rare and remains poorly understood.

http://ift.tt/2zT2V4W

Comorbidities in rosacea: A systematic review and update

Rosacea is linked to abnormalities of cutaneous vasculature and dysregulation of the inflammatory response. Recent reports on rosacea have shown a significant association with cardiovascular, gastrointestinal, and psychiatric diseases, all of which may affect morbidity and mortality among these patients.

http://ift.tt/2zT2YOa

Sweet syndrome in patients with and without malignancy: A retrospective analysis of 83 patients from a tertiary academic referral center

Sweet syndrome is a neutrophilic dermatosis that may be categorized into classic, malignancy-associated, and drug-induced subtypes. Few studies have systematically analyzed this rare disorder.

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Langerhans cell histiocytosis: A neoplastic disorder driven by Ras-ERK pathway mutations

Langerhans cell histiocytosis (LCH) is a disorder of myeloid neoplasia of dendritic cells that affects 1 in 200,000 children <15 years of age and even fewer adults. LCH presents with a spectrum of clinical manifestations. High-risk stratification is reserved for infiltration of blood, spleen, liver, and lungs. After decades of debate on the disease pathogenesis, a neoplastic mechanism is now favored on the basis of LCH cell clonality, rare cases of familial clustering, and recent evidence of mutations involving the Ras/Raf/MEK (mitogen-activated protein kinase kinase)/ERK (extracellular signal-regulated kinase) pathway in lesional biopsy specimens.

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Designing a tissue-engineered tracheal scaffold for preclinical evaluation

Recent efforts to tissue engineer long-segment tracheal grafts have been complicated by stenosis and malacia. It has been proposed that both the mechanical characteristics and cell seeding capacity of TETG scaffolds are integral to graft performance. Our aim was to design a tracheal construct that approximates the biomechanical properties of native sheep trachea and optimizes seeding with bone marrow derived mononuclear cells prior preclinical evaluation in an ovine model.

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Branchial anomalies in children: A report of 105 surgical cases

Branchial anomalies (BAs) account for 20% of all congenital masses in children. We sought to review the incidence of involvement of individual anomalies, diagnostic methods, surgical treatment, and complications of BAs in children. In addition, we also classified our study and analyzed a congenital lower neck cutaneous fistula near the sternoclavicular joint that was thought to be the skin-side remnant of the fourth BAs.

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The Effect of Low Level Laser Therapy on Bone Healing After Rapid Maxillary Expansion: A Systematic Review

Photomedicine and Laser Surgery , Vol. 0, No. 0.


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Autologous dermis - fat grafts as primary and secondary orbital transplants before rehabilitation with artificial eyes

The aim of this study was to examine the role of autologous dermis-fat grafts in the reconstruction of orbital soft-tissue defects.

http://ift.tt/2i79EA4

Acoustics of Clear and Noise-Adapted Speech in Children, Young, and Older Adults

Purpose

This study investigated acoustic–phonetic modifications produced in noise-adapted speech (NAS) and clear speech (CS) by children, young adults, and older adults.

Method

Ten children (11–13 years of age), 10 young adults (18–29 years of age), and 10 older adults (60–84 years of age) read sentences in conversational and clear speaking style in quiet and in noise. A number of acoustic measurements were obtained.

Results

NAS and CS were characterized by a decrease in speaking rate and an increase in 1–3 kHz energy, sound pressure level (SPL), vowel space area (VSA), and harmonics-to-noise ratio. NAS increased fundamental frequency (F0) mean and decreased jitter and shimmer. CS increased frequency and duration of pauses. Older adults produced the slowest speaking rate, longest pauses, and smallest increase in F0 mean, 1–3 kHz energy, and SPL when speaking clearly. They produced the smallest increases in VSA in NAS and CS. Children slowed down less, increased the VSA least, increased harmonics-to-noise ratio, and decreased jitter and shimmer most in CS. Children increased mean F0 and F1 most in noise.

Conclusions

Findings have implications for a model of speech production in healthy speakers as well as the potential to aid in clinical decision making for individuals with speech disorders, particularly dysarthria.

http://article/doi/10.1044/2017_JSLHR-S-16-0130/2660931/Acoustics-of-Clear-and-NoiseAdapted-Speech-in

Generalized Adaptation to Dysarthric Speech

Purpose

Generalization of perceptual learning has received limited attention in listener adaptation studies with dysarthric speech. This study investigated whether adaptation to a talker with dysarthria could be predicted by the nature of the listener's prior familiarization experience, specifically similarity of perceptual features, and level of intelligibility.

Method

Following an intelligibility pretest involving a talker with ataxic dysarthria, 160 listeners were familiarized with 1 of 7 talkers with dysarthria—who differed from the test talker in terms of perceptual similarity (same, similar, dissimilar) and level of intelligibility (low, mid, high)—or a talker with no neurological impairment (control). Listeners then completed an intelligibility posttest on the test talker.

Results

All listeners benefited from familiarization with a talker with dysarthria; however, adaptation to the test talker was superior when the familiarization talker had similar perceptual features and reduced when the familiarization talker had low intelligibility.

Conclusion

Evidence for both generalization and specificity of learning highlights the differential value of listeners' prior experiences for adaptation to, and improved understanding of, a talker with dysarthria. These findings broaden our theoretical knowledge of adaptation to degraded speech, as well as the clinical application of training paradigms that exploit perceptual processes for therapeutic gain.

http://article/doi/10.1044/2017_JSLHR-S-17-0127/2660935/Generalized-Adaptation-to-Dysarthric-Speech

Intelligibility of Noise-Adapted and Clear Speech in Child, Young Adult, and Older Adult Talkers

Purpose

This study examined intelligibility of conversational and clear speech sentences produced in quiet and in noise by children, young adults, and older adults. Relative talker intelligibility was assessed across speaking styles.

Method

Sixty-one young adult participants listened to sentences mixed with speech-shaped noise at −5 dB signal-to-noise ratio. The analyses examined percent correct scores across conversational, clear, and noise-adapted conditions and the three talker groups. Correlation analyses examined whether talker intelligibility is consistent across speaking style adaptations.

Results

Noise-adapted and clear speech significantly enhanced intelligibility for young adult listeners. The intelligibility improvement varied across the three talker groups. Notably, intelligibility benefit was smallest for children's speaking style modifications. Listeners also perceived speech produced in noise by older adults to be less intelligible compared to the younger talkers. Talker intelligibility was correlated strongly between conversational and clear speech in quiet, but not for conversational speech produced in quiet and in noise.

Conclusions

Results provide evidence that intelligibility variation related to age and communicative barrier has the potential to aid clinical decision making for individuals with speech disorders, particularly dysarthria.

http://article/doi/10.1044/2017_JSLHR-S-16-0165/2660932/Intelligibility-of-NoiseAdapted-and-Clear-Speech

Influence of Altered Auditory Feedback on Oral–Nasal Balance in Speech

Purpose

This study explored the role of auditory feedback in the regulation of oral–nasal balance in speech.

Method

Twenty typical female speakers wore a Nasometer 6450 (KayPentax) headset and headphones while continuously repeating a sentence with oral and nasal sounds. Oral–nasal balance was quantified with nasalance scores. The signals from 2 additional oral and nasal microphones were played back to the participants through the headphones. The relative loudness of the nasal channel in the mix was gradually changed so that the speakers heard themselves as more or less nasal. An additional amplitude control group of 9 female speakers completed the same task while hearing themselves louder or softer in the headphones.

Results

A repeated-measures analysis of variance of the mean nasalance scores of the stimulus sentence at baseline, minimum, and maximum nasal feedback conditions demonstrated a significant effect of the nasal feedback condition. Post hoc analyses found that the mean nasalance scores were lowest for the maximum nasal feedback condition. The scores of the minimum nasal feedback condition were significantly higher than 2 of the 3 baseline feedback conditions. The amplitude control group did not show any effects of volume changes on nasalance scores.

Conclusions

Increased nasal feedback led to a compensatory adjustment in the opposite direction, confirming that oral–nasal balance is regulated by auditory feedback. However, a lack of nasal feedback did not lead to a consistent compensatory response of similar magnitude.

http://article/doi/10.1044/2017_JSLHR-S-16-0390/2660934/Influence-of-Altered-Auditory-Feedback-on

Verbal Working Memory in Children With Cochlear Implants

Purpose

Verbal working memory in children with cochlear implants and children with normal hearing was examined.

Participants

Ninety-three fourth graders (47 with normal hearing, 46 with cochlear implants) participated, all of whom were in a longitudinal study and had working memory assessed 2 years earlier.

Method

A dual-component model of working memory was adopted, and a serial recall task measured storage and processing. Potential predictor variables were phonological awareness, vocabulary knowledge, nonverbal IQ, and several treatment variables. Potential dependent functions were literacy, expressive language, and speech-in-noise recognition.

Results

Children with cochlear implants showed deficits in storage and processing, similar in size to those at second grade. Predictors of verbal working memory differed across groups: Phonological awareness explained the most variance in children with normal hearing; vocabulary explained the most variance in children with cochlear implants. Treatment variables explained little of the variance. Where potentially dependent functions were concerned, verbal working memory accounted for little variance once the variance explained by other predictors was removed.

Conclusions

The verbal working memory deficits of children with cochlear implants arise due to signal degradation, which limits their abilities to acquire phonological awareness. That hinders their abilities to store items using a phonological code.

http://article/doi/10.1044/2017_JSLHR-H-16-0474/2660933/Verbal-Working-Memory-in-Children-With-Cochlear

Validation of a Paediatric Speech and Language Screening (RALF)

Background/Aims: This study aims to analyse psychometric characteristics of the Portuguese Paediatric Speech and Language Screening (RALF) test. Methods: 202 Portuguese children aged 3; 0–5; 11 were recruited from 4 kindergartens participating in this study. Reliability and validity (sensitivity and specificity) data were obtained and analysed. Results: Content validity, analysed by an expert panel (general practitioner, kindergarten, teacher, nurse, and speech and language pathologist) revealed that the items were representative and relevant for the content the instrument intends to measure. Sensitivity values were 95, 96, and 83% and specificity values were 85, 84, and 71% for the age groups 3; 0–3; 11, 4; 0–4; 11, and 5; 0–5; 11, respectively. Internal consistency, calculated through Cronbach's alpha, was 0.7, 0.8, and 0.7, respectively. The inter-judge reliability (interclass correlation coefficient) was 0.951. The results ensure the content validity of RALF. Sensitivity and specificity values revealed that RALF could discriminate typical from disordered speech-language developing children. RALF also presented good internal consistency and excellent reliability. Conclusion: RALF is a reliable and valid screening instrument that health and educational professionals can use in Portuguese children to identify children who may need a speech-language diagnosis for consideration or referral to speech therapy services.
Folia Phoniatr Logop 2017;68:247–251

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WEBINAR: Receive Hundreds of Sleep Patients From Hospitals Thanks to Project Rose

OBJECTIVE

The American Sleep and Breathing Academy (ASBA) recently partnered with NFL greats Earl Campbell and Gary Baxter in Tyler, Texas to ensure the highest quality sleep program for the community. ASBA Executive Directors David Gergen and Alan Hickey were among the special guests invited to the grand opening of their first facility. We are looking for qualified sleep dentists to join the ASBA/Project Rose team and work in their new hospitals and clinics that are open across the country. Don't miss out on your opportunity to be a part of this! Register for the webinar and find out more.

 

SCHEDULE

Review Benefits of Joining Project Rose
Hundreds of patients in your chair without having to pay for marketing
Higher reimbursements because the hospital will bill for you
Work with the best equipment in the industry
Be a part of the winning team

Review Special Staff Training – Sleep Coordinator Specialist 

"Certification"Improve office productivity with expert staff training and special certification

 

DON'T MISS OUT

REGISTER NOW

 

 

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Adult hippocampal neurogenesis in neuropathic pain and alkyl glycerol ethers treatment

Publication date: Available online 26 October 2017
Source:Acta Histochemica
Author(s): Anna A. Tyrtyshnaia, Igor V. Manzhulo, Ruslan M. Sultanov, Ekaterina V. Ermolenko
Neuropathic pain manifested by a number of sensory symptoms is often accompanied by disorders of higher nervous activity, such as memory impairment, depression, anxiety, anhedonia, etc. This emphasizes the involvement of supraspinal structures including the hippocampus in neuropathic pain pathogenesis. In the present study, we focused on the impact of chronic neuropathic pain on hippocampal neurogenesis and microglial state. In addition, we test the effect of alkyl glycerol ethers on hippocampal neuronal and microglial plasticity as well as behavioral parameters. Neuropathic pain was induced using the model of sciatic nerve chronic constriction injury. We found an impairment of working memory and locomotor activity in animals with neuropathic pain, which was prevented by alkyl glycerol ethers treatment. Sciatic nerve ligation in mice contributed to the decrease in hippocampal neurogenesis intensity. Alkyl glycerol ethers administration significantly reduced this effect. Neuropathic pain-associated neurogenesis reduction was accompanied by an increased percentage of Iba1-labeled area in the CA1 hippocampal region on the 14th and 28th days after surgery. In addition, we observed a decrease in hippocampal pro-inflammatory microglia marker CD86 immunostaining on day 28 after surgery in alkyl glycerol ethers-treated mice with sciatic nerve ligation. These results are consistent with data on pro- and anti-inflammatory cytokines expression in the hippocampus. Alkyl glycerol ethers administration increased IL-10 and decreased IL-1β hippocampal expression in animals with neuropathic pain. Taken together, these data suggest that neuropathic pain-behavior in rodents is accompanied by changes in microglia polarization, thereby contributing to neurogenesis impairment and cognitive disturbances. Alkyl glycerol ethers prevented M1 microglial activation, contributing to the maintenance of normal neurogenesis levels within the hippocampus and normalizing working memory.

Graphical abstract

http://ift.tt/2yNDIeb