Head and Neck Diseases by Alexandros G.Sfakianakis: 01/10/18

Τετάρτη 10 Ιανουαρίου 2018

Surveillance After Endovascular Treatment for Blunt Thoracic Aortic Injury

Publication date: Available online 10 January 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Vladimir Makaloski, Konstantinos Spanos, Jürg Schmidli, Tilo Kölbel

http://ift.tt/2FseDWD

Endometrial Adenocarcinoma With Pulmonary Recurrence

Description

We present the case of an 83-year-old woman with a history of grade 1 stage IB endometrial cancer (endometrial adenocarcinoma) (figure 1) involving the lower uterine segment. She underwent robotic hysterectomy with right salpingo-oophorectomy followed by brachytherapy. A year and a half later, she presented with difficulty in breathing. A chest X-ray showed 8 mm nodular density in the right lower lobe. The above finding was confirmed with CT. Given the concern for a malignant lesion, positron emission tomography/CT scan was performed, which revealed two metabolically active lung nodules, measuring 1.2 cm in the right middle lobe and other in the right lower lobe measuring 1.2 cm (figure 2). Video-assisted thoracoscopic wedge resection of the right lower lobe lung nodule was performed. The frozen section and histopathology revealed papillary adenocarcinoma (figures 3 and 4); nuclear staining was positive for oestrogen receptors and negative for thyroid...

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Cervical ganglioneuroma: clinical and radiological features of a rare tumour

Description

Ganglioneuromas are rare benign tumours of neurogenic origin that most frequently develop in the cervical sympathetic chain,1 2 with genetic associations demonstrated with Neurofibromatosis type 1 (NF-1). We report the case of a 41-year-old woman with a history of cavum neoplasm at the age of 23. This tumour was classified after assessment of extension as T1N0M0 (tumour, node, metastases). Pathological examination of a biopsy concluded to a keratinising squamous cell carcinoma. The patient was then irradiated (2D Cobalt radiotherapy). The patient presented with gait trouble that appeared a few weeks ago. Clinical examination found a Brown-Séquard syndrome with paresis and loss of proprioception on the left side, and loss of pain and temperature sensation on the right side. Medullar MRI (figures 1 and 2) showed an intradural extramedullary well-circumscribed mass with an hourglass shape from C5 to C6 extending through the...

http://ift.tt/2DhvSJE

Rare cause of pulmonary cavitation in a 75-year-old man

A 75-year-old man of Asian descent presented to the acute medical unit with signs and symptoms suggestive of a community-acquired pneumonia. He had multiple comorbidities and was relatively immunocompromised as a result. Initial investigations supported the diagnosis of community-acquired pneumonia complicated by a cavitating lung lesion, and the patient was treated as per hospital guidelines. He continued to deteriorate despite appropriate therapy and developed a hydropneumothorax, requiring the insertion of a chest drain. A diagnosis of pulmonary mucormycosis (Rhizopus microsporus) was made based on microbiology results from pleural aspirate, and patient was treated with intravenous antifungals. The patient was referred to the thoracic team for consideration of surgical intervention but was not suitable due to his multiple comorbidities. This case highlighted the importance of early consideration of fungal infection in patients with multiple risk factors and the need for aggressive therapy to ensure the best outcome.

http://ift.tt/2CQGgac

Intradiploic cephalocele: a rare entity at a rare site

Description

A 52-year-old woman presented with complaints of non-specific headache. The patient had a history of head injury 1 year ago. Clinical neurological examination was nil significant. The skin over the occipital region is normal. No prior investigations were done immediately after the injury. MRI of the brain at present showed small intradiploic cerebrospinal fluid (CSF)-filled defect with herniation of foliae of the right cerebellar hemisphere (figure 1). The rest of the brain parenchyma revealed no abnormality and no skull fracture was seen. Features were suggestive of intradiploic cephalocele involving cerebellar foliae.

Figure 1

Axial Fluid attenuated inversion recovery (A), T2 (B), coronal T2 (C) and sagittal T1 (D) images at the level of the cerebellum showing small calvarial defect in the occipital bone on the right side with intradiploic herniation of the right cerebellar foliae (black arrows).

A cephalocele is...

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Sternocleidomastoid tumour in neonate: fibromatosis colli

Description

We report a case of a 4-week-old female neonate who was admitted to the hospital for a anterior right lump of the neck, perceived by his mother the day before. The mother also noticed a preferential tilting of the head towards right. He was an otherwise full-term healthy baby, with a history of instrumented delivery. There was no fever, trauma or respiratory symptoms/signs. Family history was irrelevant. On examination, the neck swelling was a small firm, partially mobile, no warm on touch and apparently painless mass, with approximately 1.5–2 cm soft tissue mass, attached to the right sternocleidomastoid muscle. There was no restriction of neck movements. Ultrasonography (USG) revealed a 13 mm fusiform thickening of the right sternocleidomastoid muscle, with maintained structure of muscle fibres (figures 1 and 2). No cervical lymphadenopathy, signs of infiltration or other anomalies were found (figures 1 and...

http://ift.tt/2CThuXb

Ninety-year-old man with hypereosinophilia, lymphadenopathies and pruritus

We report a case of a 90-year-old man with hypereosinophilia, lymphadenopathies and skin lesions, namely lichenification and pruritus. An aetiological investigation was performed, and a bone marrow (BM) biopsy and aspirate showed a hypercellular marrow with hypereosinophilia without dysmorphia or abnormal elements, and the BM and inguinal node's immunophenotyping denied any presence of abnormal lymphoid cell population. The inguinal node biopsy revealed a multinodular proliferation of large cells S100 and CD1a⁺, and a diagnosis of Langerhans cell histiocytosis was made. The hypereosinophilia and skin lesions were managed with corticotherapy with substantial improvement of cutaneous lesions and lymphadenopathies and normalisation of eosinophil count. Finally, to define if it is a single or multisystem disease, a skin biopsy will be necessary.

http://ift.tt/2DiXy0W

Degradation of organics extracted from dewatered sludge by alkaline pretreatment in microbial electrolysis cell

Abstract

Waste activated sludge in China are mostly subjected to dewatering process before final disposal without stabilization. This study investigated the feasibility of organics degradation and H₂ production from non-stabilized dewatered sludge (DS) by microbial electrolysis cells (MECs). Alkaline pretreatment was used to disintegrate sludge matrix and solubilize organic matters in DS. Then, the treatment performance of DS supernatant in a single-chamber MEC at various applied voltages was investigated. The COD (chemical oxygen demand) removal rate increased with increasing voltage, which ranged from 26.35 to 44.92% at 0.5–0.9 V. The average coulombic efficiency was 75.6%, while the cathodic hydrogen recovery was not satisfied (15.56–20.05%) with H₂ production rates of 0.027–0.038 m³ H₂/(m³ day). The reasons could be ascribed to the complexity of the substrate, H₂ loss, and the confinement of configuration in scale-up. The organic matter degradation was influenced by the composition of DS. The carbohydrates could be readily used; meanwhile, the major component of the DS supernatant, i.e. proteins, was difficult to be utilized, which resulted from the low biodegradability of the transphilic fractions during the MEC operation.

http://ift.tt/2mpJlrH

Response to ‘Serological diagnostics in the detection of IgG autoantibodies against human collagen VII in epidermolysis bullosa acquisita: a multicentre analysis': reply from authors

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Ticagrelor inhibits platelet–tumor cell interactions and metastasis in human and murine breast cancer

Abstract

Activated platelets promote the proliferation and metastatic potential of cancer cells. Platelet activation is largely mediated through ADP engagement of purinergic P2Y12 receptors on platelets. We examined the potential of the reversible P2Y12 inhibitor ticagrelor, an agent used clinically to prevent cardiovascular and cerebrovascular events, to reduce tumor growth and metastasis. In vitro, MCF-7, MDA-MB-468, and MDA-MB-231 human mammary carcinoma cells exhibited decreased interaction with platelets treated with ticagrelor compared to untreated platelets. Prevention of tumor cell–platelet interactions through pretreatment of platelets with ticagrelor did not improve natural killer cell-mediated tumor cell killing of K562 myelogenous leukemia target cells. Additionally, ticagrelor had no effect on proliferation of 4T1 mouse mammary carcinoma cells co-cultured with platelets, or on primary 4T1 tumor growth. In an orthotopic 4T1 breast cancer model, ticagrelor (10 mg/kg), but not clopidogrel (10 mg/kg) or saline, resulted in reduced metastasis and improved survival. Ticagrelor treatment was associated with a marked reduction in tumor cell–platelet aggregates in the lungs at 10, 30 and 60 min post-intravenous inoculation. These findings suggest a role for P2Y12-mediated platelet activation in promoting metastasis, and provide support for the use of ticagrelor in the prevention of breast cancer spread.

http://ift.tt/2CQ01ii

Relationship between α-melanocyte stimulating hormone levels and therapeutic outcome of melanocyte transplantation and phototherapy in non-segmental patients with vitiligo: A prospective study

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Relationship between α-melanocyte stimulating hormone levels and therapeutic outcome of melanocyte transplantation and phototherapy in non-segmental patients with vitiligo: A prospective study

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Kompetenzbasierte Ausbildung im „geschützten Umfeld“: vom Schonraum zum Realraum

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 12-19
DOI: 10.1055/s-0043-105257

„Lernen im geschützten Umfeld" ist ein häufig gebrauchter, aber unklarer Begriff im Rahmen der anästhesiologischen postgradualen Weiterbildung. Dieser Artikel beleuchtet seine Bedeutung in der Anästhesiologie – einschließlich Lehr- und Lernstrategien, wie kompetenzorientierte und simulationsbasierte Ausbildung. Ein Versuch der Klassifikation von Simulatoren und Unterrichtsmethoden sowie deren Probleme bei der Umsetzung runden den Beitrag ab.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Behandlung im Voraus planen – Bedeutung für die Intensiv- und Notfallmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 62-70
DOI: 10.1055/s-0042-118690

Behandlung im Voraus planen (BVP) – im Englischen Advance Care Planning (ACP) – etabliert sich auch in Deutschland als ein neues Konzept zur Realisierung wirksamer Patientenverfügungen. Das Konzept beinhaltet Prozesse zur Ermittlung, Dokumentation und Umsetzung von Behandlungswünschen für den Fall, dass die Betroffenen nicht (mehr) selbst entscheiden können.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Begünstigt Kaudalanästhesie postoperative Komplikationen nach Hypospadie-OP?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 6-7
DOI: 10.1055/s-0043-123122

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2FoN2Wn

Hyperchlorämie ist mit akutem Nierenversagen nach SAB verbunden

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 7-8
DOI: 10.1055/s-0043-123121

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2FoN2pl

Lernen im geschützten Umfeld

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 10-11
DOI: 10.1055/s-0043-122170

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Simulation als Fortbildungsmethode zur Professionalisierung von Teams

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 20-33
DOI: 10.1055/s-0043-105261

Simulation ist eine Methode, virtuelle Lernumgebungen zu erzeugen. Mittels Simulation können Technical Skills, aber auch Soft Skills wie die Funktionsfähigkeit von Teams sehr gut vermittelt werden. Dieser Team-Aspekt wird nachfolgend vor dem Hintergrund spezifischer Trainingsmethoden näher beleuchtet. Der Artikel bezieht sich dabei auf „Zwischenfalltrainings", die in den Zentren der Autoren einen großen Anteil des Kursangebotes einnehmen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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The Same Procedure As Last Year?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 9-9
DOI: 10.1055/s-0043-123165

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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„Das Kind hat einen Fremdkörper verschluckt“ – was tun?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 48-60
DOI: 10.1055/s-0042-120991

Sowohl Ingestions- als auch Aspirationsunfälle sind häufige Ereignisse bei Kindern. Sie können unmittelbar lebensbedrohlich sein oder bei fehlender direkter Bedrohung dennoch erhebliche langfristige Beeinträchtigungen für die Kinder verursachen. Der Beitrag zeigt die diagnostischen und therapeutischen Möglichkeiten und Notwendigkeiten auf, durch die eine bestmögliche Sicherheit und möglichst geringe Folgeschäden zu gewährleisten sind.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Neurologischer Schaden nach Wirbelsäulen-OP

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 71-75
DOI: 10.1055/s-0043-122628

Schlichtungsstellen für Arzthaftpflichtfragen bieten Patienten, Ärzten und Versicherern eine Möglichkeit, Arzthaftungsstreitigkeiten außergerichtlich zu klären. In der Rubrik „Fälle der Schlichtungsstelle" stellen wir abgeschlossene Fälle aus der Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern vor.
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Georg Thieme Verlag KG Stuttgart · New York

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Entwicklung neuer Antibiotika: Endpunkte klinischer Studien teils ungeeignet

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 5-6
DOI: 10.1055/s-0043-117062

Georg Thieme Verlag KG Stuttgart · New York

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Interventionen zur präoperativen Unterstützung geriatrischer Patienten mit Frailty

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 777-783
DOI: 10.1055/s-0043-104684

Der stetig zu beobachtende demografische Wandel geht mit veränderten Anforderungen an die Patientenbetreuung einher. Ältere Patienten weisen häufig einen erhöhten Behandlungsbedarf und eine höhere Komplexität des klinischen Gesamtbildes auf. Dieser Umstand ist – abgesehen von der Routineversorgung – besonders dann zu beachten, wenn eine angedachte Intervention zu schweren und potenziell lebensbedrohlichen Komplikationen führen kann.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Therapiebegrenzung: DIVI empfiehlt neuen Dokumentationsbogen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 752-753
DOI: 10.1055/s-0043-119947

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2CZufUd

Zervikale Plexusblockaden

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 806-813
DOI: 10.1055/s-0043-115204

Eine vollständige Blockade des Plexus cervicalis ist weder erwünscht noch ausreichend für eine chirurgische Anästhesie in der vorderen Halsregion. Supplementierungen durch Opioide oder topische Lokalanästhetika sind daher häufig. Die Blockade beteiligter Hirnnerven und des Truncus sympathicus verbessert möglicherweise die Anästhesiequalität, führt aber auch zu typischen Nebenwirkungen. Dieser Beitrag liefert anatomisches Hintergrundwissen und stellt Indikationen vor – auch außerhalb der Karotischirurgie.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Warum und wie sollte ich Frailty erfassen? – ein Ansatz für die Anästhesieambulanz

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 765-776
DOI: 10.1055/s-0043-104682

Frailty (Gebrechlichkeit) ist eine Einschränkung der physiologischen Reserve bei älteren Patienten mit schwerwiegenden individuellen und sozioökonomischen Folgen. Multiple Aspekte der Patientenbehandlung sowie das Outcome werden durch Frailty nachhaltig beeinflusst. Obwohl mehr als 60 Messinstrumente existieren, sind die Erfassung und Berücksichtigung funktioneller Assessments in der klinischen Routine unzureichend umgesetzt. Das interdisziplinäre und interprofessionelle Verständnis, warum und wie Frailty beurteilt werden sollte, ist die Grundlage für die dauerhafte Implementierung. Der Artikel zeigt die Auswirkungen von Frailty und Vorteile einer Früherkennung auf und gibt einen Überblick über die wichtigsten Instrumente, die in der Frailty-Erkennung und -Bewertung verwendet werden können. Die frühe präoperative Detektion bietet ein vielfältiges Optimierungspotenzial für die peri- und intraoperative Versorgung. Verschiedene Frailty-Assessment-Tools körperlicher, kognitiver und psychosozialer Domänen werden vorgestellt und diskutiert. Frailty-Assessments variieren immens in Bezug auf die erforderliche Zeit, die Ausrüstung und das Fachwissen zur Durchführung. Wir empfehlen mindestens einen Test für die einzelnen Dimensionen von Frailty, um ein holistisches Bild der geriatrischen Patienten zu erhalten. Die Bewertung von Frailty sollte übergreifend in die interdisziplinären Strukturen der klinischen Routine implementiert werden, um die Patientensicherheit sowie das kurz- und langfristige Outcome zu verbessern.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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http://ift.tt/2D22nik

Vielen Dank!

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 754-754
DOI: 10.1055/s-0043-121256

Georg Thieme Verlag KG Stuttgart · New York

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http://ift.tt/2D22kTG

Die meisten Todesbescheinigungen weisen Fehler auf

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 752-752
DOI: 10.1055/s-0043-121621

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2CZLFQy

Kompetenzbasierte Ausbildung im „geschützten Umfeld“: vom Schonraum zum Realraum

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 12-19
DOI: 10.1055/s-0043-105257

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2FqW0Tc

Behandlung im Voraus planen – Bedeutung für die Intensiv- und Notfallmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 62-70
DOI: 10.1055/s-0042-118690

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2EwIFHs

Begünstigt Kaudalanästhesie postoperative Komplikationen nach Hypospadie-OP?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 6-7
DOI: 10.1055/s-0043-123122

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://ift.tt/2FoN2Wn

„Lernen im geschützten Umfeld“: Implementierung in die Fort- und Weiterbildung

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 35-46
DOI: 10.1055/s-0043-105259

Aktuelle Aus- und Fortbildungskonzepte in der Akut- oder Notfallmedizin beinhalten Simulations- und Skill-Trainings unter Berücksichtigung von Methoden und Mechanismen der Fehler- und Zwischenfallprävention wie Human Factors, Shared mental Models und Closed-Loop-Communication. Immer noch ungeklärt ist die Frage nach der optimalen Kombination der einzelnen Methoden und Inhalte eines Fortbildungsprogramms in Abhängigkeit von individuellen Abteilungen eines Krankenhauses und dem einzelnen Mitarbeiter bzw. seinem individuellen Ausbildungsstand. Ein von uns angebotenes Konzept ist das „Lernen im geschützten Umfeld": Hier werden Teilnehmer und Patient vor den negativen Auswirkungen einer konventionellen klinisch-praktischen Ausbildungssituation beschützt. Gleichzeitig profitieren die Teilnehmer in unserem Fortbildungsprogramm von standardisierten Kursmodellen. Das Ziel der optimalen Vorbereitung auf die klinische Tätigkeit und einer möglichst praktischen bzw. wirklichkeitsnahen Aus- und Fortbildung wird durch eine ständige Re-Evaluation der Inhalte und Methoden komplettiert. Die Implementierung eines solchen multimodalen Teamtrainings ist für jede Institution individuell anzupassen. Die Methoden zur Implementierung sollten standardisiert angewendet werden. Wir empfehlen eine Curriculumsentwicklung auf Grundlage des „Kern-Zyklus". Auf dieser Basis gelingt die Kombination aus „Lernen im geschützten Umfeld" und Zwischenfalltraining zur optimalen Vorbereitung auf eine akutmedizinische, klinische Tätigkeit mit dem Ziel einer höchstmöglichen Patientensicherheit.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2FoMVKr

Hyperchlorämie ist mit akutem Nierenversagen nach SAB verbunden

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 7-8
DOI: 10.1055/s-0043-123121

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://ift.tt/2FoN2pl

Lernen im geschützten Umfeld

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 10-11
DOI: 10.1055/s-0043-122170

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2FqW2ui

Etomidat-Analogon mit verringerter Nebennierensuppression

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 8-8
DOI: 10.1055/s-0043-117029

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2FqW45o

Simulation als Fortbildungsmethode zur Professionalisierung von Teams

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 20-33
DOI: 10.1055/s-0043-105261

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2EwJno6

The Same Procedure As Last Year?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 9-9
DOI: 10.1055/s-0043-123165

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://ift.tt/2FoN1lh

„Das Kind hat einen Fremdkörper verschluckt“ – was tun?

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 48-60
DOI: 10.1055/s-0042-120991

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2EwIHPA

Neurologischer Schaden nach Wirbelsäulen-OP

Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 71-75
DOI: 10.1055/s-0043-122628

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2FqVPHw

Atemübungen schützen ältere Patienten vor gefährlichen Lungenentzündungen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 753-753
DOI: 10.1055/s-0043-121213

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2D2sTbq

Interventionen zur präoperativen Unterstützung geriatrischer Patienten mit Frailty

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 777-783
DOI: 10.1055/s-0043-104684

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2D1zvqv

Therapiebegrenzung: DIVI empfiehlt neuen Dokumentationsbogen

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 752-753
DOI: 10.1055/s-0043-119947

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

http://ift.tt/2CZufUd

Zervikale Plexusblockaden

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 806-813
DOI: 10.1055/s-0043-115204

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2D0SMs5

Warum und wie sollte ich Frailty erfassen? – ein Ansatz für die Anästhesieambulanz

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 765-776
DOI: 10.1055/s-0043-104682

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Abstract | Full text

http://ift.tt/2D22nik

Die meisten Todesbescheinigungen weisen Fehler auf

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 752-752
DOI: 10.1055/s-0043-121621

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2CZLFQy

Patienten mit Frailty: Anästhesiologie in der Verantwortung

Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 756-757
DOI: 10.1055/s-0043-117836

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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http://ift.tt/2CZUV77

Laser treatment of primary axillary hyperhidrosis: a review of the literature

Abstract

Hyperhidrosis o`ccurs when the body produces sweat beyond what is essential to maintain thermal homeostasis. The condition tends to occur in areas marked by high-eccrine density such as the axillae, palms, and soles and less commonly in the craniofacial area. The current standard of care is topical aluminum chloride hexahydrate antiperspirant (10–20%), but other treatments such as anticholinergics, clonidine, propranolol, antiadrenergics, injections with attenuated botulinum toxin, microwave technology, and surgery have been therapeutically implicated as well. Yet, many of these treatments have limited efficacy, systemic side effects, and may be linked with significant surgical morbidity, creating need for the development of new and effective therapies for controlling excessive sweating. In this literature review, we examined the use of lasers, particularly the Neodynium:Yttrium-Aluminum-Garnet (Nd:YAG) and diode lasers, in treating hyperhidrosis. Due to its demonstrated effectiveness and limited side effect profile, our review suggests that Nd:YAG laser may be a promising treatment modality for hyperhidrosis. Nevertheless, additional large, randomized controlled trials are necessary to confirm the safety and efficacy of this treatment option.

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Necrotizing fasciitis. Possible profiles of professional liability with reference to two cases.

Necrotizing fasciitis. Possible profiles of professional liability with reference to two cases.

Ann Ital Chir. 2017 Dec 18;6:

Authors: Marella GL, De Dominicis E, Paliani GB, Santeusanio G, Marsella LT, Potenza S

Abstract
Necrotizing fasciitis is one of the most dangerous complication of an abscess and it is still a disease with a high mortality. In this work, we decided to consider two cases: the first one concerns a male subject, aged 66, deceased because of a fatal necrotizing fasciitis associated to a cervical descending mediastinitis, which evolved from a primary peritonsillar abscess; the second is about a 50-year-old woman with a perineal abscess, then evolved into necrotizing fasciitis associated to a fatal septis shock. After a systematic consideration of necrotizing fasciitis as pathology and an analysis of the possible related risks to a diagnostic or therapeutic delay, we analyzed the particular history of both cases to underline the possible critical issues in professional behavior of the medical staff intervened.
KEY WORDS: Abscess, Medical malpractice, Mortality, Necrotizing fasciitis, Professional liability.

PMID: 29311423 [PubMed - as supplied by publisher]

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Narrow band imaging versus laryngovideostroboscopy in precancerous and malignant vocal fold lesions

Abstract

Background

This is a comparative analysis of the diagnostic accuracy of narrow band imaging (NBI) and laryngovideostroboscopy (LVS) in the assessment of premalignant and malignant vocal fold lesions.

Methods

A prospective analysis was performed on 105 consecutive patients with vocal fold lesions. The NBI and LVS were obtained before the microsurgery.

Results

The NBI and LVS showed no significant differences in identifying premalignant and malignant pathologies. However, in analysis restricted to identification of only malignant lesions, the specificity (88.9% vs 20.6%), accuracy (90.5% vs 51.4%), and positive predictive value (PPV; 84.8% vs 45.1%) were significantly higher for NBI (P value < .001; .015; and .045, respectively). A comparison of LVS scored results relative to each NBI type revealed statistically significant differences (P < .001). A moderate positive correlation between NBI and LVS was demonstrated (P = .54).

Conclusion

The NBI and LVS are useful, complementary tools in evaluating early potential vocal fold malignancies. The NBI was superior to LVS on several statistical analyses.

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Unilaterale Halsschwellung – eine überraschende Differentialdiagnose

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-123651

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents | Full text

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Kartagener’s syndrome: a case report

Kartagener's syndrome is a subset of primary ciliary dyskinesia, an autosomal recessive inherited disorder characterized by the clinical triad of chronic sinusitis, bronchiectasis, and situs inversus. Abnormal...

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Editorial: Special Issue “Effect-related evaluation of anthropogenic trace substances—concepts for genotoxicity, neurotoxicity and endocrine effects”

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Thirty-day readmissions following parathyroidectomy: Evidence from the National Readmissions Database, 2013–2014

Parathyroidectomy is one of the most common procedures performed in the United States, and are increasingly being performed safely in the outpatient setting. However, complications from surgery can be life-threatening, and thus an understanding of who may be at risk is essential. We analyzed and compared the risk factors for patients readmitted within 30 days following inpatient parathyroidectomy for primary or secondary hyperparathyroidism.

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Removal of cadmium in aqueous solution using wheat straw biochar: effect of minerals and mechanism

Abstract

The biochars were produced from wheat straw (WSBC) at different pyrolytic temperatures. Biochars were characterized by multiple instrumental techniques and were applied to remove Cd from aqueous solution. The removal mechanism was explored, and the quantitative information regarding the relative contribution of related mechanisms to Cd sorption on biochars was provided. The results showed that pseudo-second-order kinetic model, TC (two-compartment) model, and Freundlich isotherm could well fit the process of Cd sorption on biochars. The sorption could be divided into fast and slow adsorption stages. The order of the Cd removal capacity by biochar was WSBC700 > WSBC500 > WSBC300. Adsorption amount of Cd by biochar reduced when the biochar was rinsed with 1.0 M HCl, which indicated that acid-soluble minerals in biochar played an important role during the Cd removal process, especially for the biochar obtained at high pyrolytic temperature. Various equipments were used to investigate the interaction mechanism between biochar and Cd. Mineral precipitation, surface complexation, and cation-π interaction were the main mechanisms of Cd sorption on the biochars. The contribution of cation-π mechanism was in the range of 25.42–48.58%, 2.18–19.30% for surface complexation and 32.12–72.41% for mineral precipitation, respectively. The pyrolytic temperature significantly influenced the removal capacity and mechanism of Cd on biochars. The cation-π mechanism was predominant for biochar obtained at lower pyrolytic temperature. However, mineral precipitation mechanism played a crucial role for biochar obtained at high pyrolytic temperature. These results are helpful for the design or screening of "engineered biochar" to act as sorbents to remove or immobilized Cd in polluted soil or water.

Graphical abstract

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Lead, zinc, and cadmium uptake, accumulation, and phytoremediation by plants growing around Tang-e Douzan lead–zinc mine, Iran

Abstract

In the current study, soils of Tang-e Douzan mine, located in Isfahan, Iran, were collected and analyzed for soluble, exchangeable, and total amounts of Pb, Zn, Cd, Ca, and Mg. The maximum Pb, Zn, Cd, Ca, and Mg concentrations in soils were 2500, 1100, 59, 43,800, and 1320 mg/kg for total metals, 86, 83, 6.3, 4650, and 48 mg/kg for their exchangeable fractions, and 59, 3.7, 0.53, 430, and 6.4 mg/kg for their soluble fractions, respectively. All specimens collected, including 69 plant species, were analyzed for Pb, Zn, and Cd. Moreover, their phytoremediation potential was investigated by calculating bioconcentration factors (BCF), translocation factors (TF), and extraction factors (EF) for each heavy metal. Analysis of the leaves for heavy metals showed no metal hyperaccumulation. The highest shoot concentrations of Pb (298 mg/kg) and Zn (740 mg/kg) were found in Roemeria hybrida subsp. dodecandra and Cd (43 mg/kg) in Chenopodium foliosum. Plants having BCFs and TFs > 1 are capable of phytoextraction. Among the analyzed species, four had both TFs and BCFs > 1 for Zn, 13 for Cd, and none for Pb. R. hybrida, Bromus squarrosus, Descurainia sophia, and Poa bulbosa seem to be the best choices for phytoextraction of Zn. Aegilops columnaris, Allium ampeloprasum subsp. iranicum, B. squarrosus, and Cousinia piptocephala are the best choices for phytoextraction of Cd. Plants with BCF > 1 and TF < 1, including Cerastium dichotomum and Muscari neglectum for Pb, Ceratocephala falcata, M. neglectum, Ornithogalum orthophyllum, and Ranunculus arvensis for Zn and C. falcata, M. neglectum, O. orthophyllum, and R. hybrida subsp. dodecandra for Cd, are proposed to be the most efficient species for metal phytostabilization.

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‘Hidden’ occupational allergens such as additives

Purpose of review With the development of innovative technologies, new agents are continually introduced to the workplace. Some of these agents can act as hidden allergens whenever they are not declared in the product labels or whenever their health hazards are unknown. This review article focuses on the identification and description of unusual and/or hidden allergens recently incriminated in occupational diseases. Recent findings Occupational exposure is an important global health issue that can induce respiratory and cutaneous disorders, as well as life-threatening anaphylaxis. Apart from the classic forms of occupational exposure, reports have emerged from nonconventional or newly identified allergens or additives. These compounds are substances added to another in order to alter or improve the general quality or to counteract undesirable properties, and some of them may behave as potent and frequently hidden allergens. These highly uncommon and/or hidden allergens belong to several categories: foods, spices, cosmetics, insects, enzymes, chemicals, drugs, preservatives, and coloring agents, among others. Summary A high level of suspicion and awareness about the potential hidden allergens is necessary to ascertain the allergens implicated. It is of utmost importance to identify the specific eliciting agents of the occupational diseases in order to avoid strictly further exposure to them. Correspondence to Santiago Quirce, MD, PhD, Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain. E-mail: squirce@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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High intraoperative inspiratory oxygen fraction and risk of major respiratory complications

British Journal of Anaesthesia, 2017; 119(1): 140–9, DOI 10.1093/bja/aex128

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Feet in danger: short exposure to contaminated soil causing health damage—an experimental study

Abstract

In this study, hematological and behavioral changes in Wistar rats exposed to soil collected from urban areas next to an industrial complex were investigated. Animals were exposed to soil samples placed at the bottom of cages for 4 days. After this period, behavioral parameters were measured by the open field test and the elevated plus-maze. Blood was collected to measure hematological parameters. The soil from the vicinity of the oil refining industry caused changes in hematological parameters and altered behavioral parameters in both tests. The soil from the vicinity of the petroleum refining industry and fertilizer industries increased the density of white blood cells and decreased exploratory activity in the exposed animals. The results demonstrate that contact with contaminated soils, even for short periods, can cause physiological damage in organisms and that special attention should be given to people who live under constant exposure to these soils.

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Contribution of ammonia-oxidizing archaea and ammonia-oxidizing bacteria to ammonia oxidation in two nitrifying reactors

Abstract

In this study, two laboratory nitrifying reactors (NRI and NRII), which were seeded by sludge from different sources and operated under different operating conditions, were found to possess distinct dominant ammonia-oxidizing microorganisms. Ammonia-oxidizing archaeal (AOA) amoA genes outnumbered ammonia-oxidizing bacterial (AOB) amoA genes in reactor NRI, while only AOB amoA genes were detectable in reactor NRII. The AOA amoA gene sequences retrieved from NRI were characterized within the Nitrososphaera sister cluster of the group 1.1b Thaumarchaeota. Two inhibitors for ammonia oxidation, allylthiourea (ATU) and 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide (PTIO), were applied individually and as a mixture to observe the ammonia-oxidizing activity of both microorganisms in the reactors' sludge. The results indicated that AOA and AOB jointly oxidized ammonia in NRI, while AOB played the main role in ammonia oxidation in NRII. DNA-stable isotope probing with labeled ¹³C–HCO₃⁻ was performed on NRI sludge. Incorporation of ¹³C into AOA and AOB implied that both microorganisms may perform autotrophy during ammonia oxidation. Taken together, the results from this study provide direct evidence demonstrating the contribution of AOA and AOB to ammonia oxidation in the nitrifying reactors.

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Effect of inorganic and organic solutes on zero-valent aluminum-activated hydrogen peroxide and persulfate oxidation of bisphenol A

Abstract

The effect of varying inorganic (chloride, nitrate, sulfate, and phosphate) and organic (represented by humic acid) solutes on the removal of aqueous micropollutant bisphenol A (BPA; 8.8 μM; 2 mg/L) with the oxidizing agents hydrogen peroxide (HP; 0.25 mM) and persulfate (PS; 0.25 mM) activated using zero-valent aluminum (ZVA) nanoparticles (1 g/L) was investigated at a pH of 3. In the absence of the solutes, the PS/ZVA treatment system was superior to the HP/ZVA system in terms of BPA removal rates and kinetics. Further, the HP/ZVA process was not affected by nitrate (50 mg/L) addition, whereas chloride (250 mg/L) exhibited no effect on the PS/ZVA process. The negative effect of inorganic anions on BPA removal generally speaking increased with increasing charge in the following order: NO₃⁻ (no inhibition) < Cl⁻ (250 mg/L) = SO₄²⁻ < PO₄³⁻ for HP/ZVA and Cl⁻ (250 mg/L; no inhibition) < NO₃⁻ < SO₄²⁻ < PO₄³⁻ for PS/ZVA. Upon addition of 20 mg/L humic acid representing natural organic matter, BPA removals decreased from 72 and 100% in the absence of solutes to 24 and 57% for HP/ZVA and PS/ZVA treatments, respectively. The solute mixture containing all inorganic and organic solutes together partly suppressed the inhibitory effects of phosphate and humic acid on BPA removals decreasing to 46 and 43% after HP/ZVA and PS/ZVA treatments, respectively. Dissolved organic carbon removals were obtained in the range of 30 and 47% (the HP/ZVA process), as well as 47 and 57% (the PS/ZVA process) for the experiments in the presence of 20 mg/L humic acid and solute mixture, respectively. The relative Vibrio fischeri photoluminescence inhibition decreased particularly for the PS/ZVA treatment system, which exhibited a higher treatment performance than the HP/ZVA treatment system.

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Association of cord blood ghrelin, leptin and insulin concentrations in term newborns with anthropometric parameters at birth

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print

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EAACI Guidelines on Allergen Immunotherapy – Out With the Old and In With the New

Abstract

Occurring in both developed and developing countries and across all ethnic groups and ages allergic diseases represent a global health problem. During the last few decades, there has been an increase in the prevalence of allergic diseases and it has been predicted that by 2025 half of the entire EU population will be affected [1]. The three major management strategies are avoidance, symptom control by pharmacotherapy and allergen immunotherapy (AIT). By contrast with symptom control by pharmacotherapy AIT aims to modify the immune system via tolerance induction [2] and is potentially able to alter the course of allergic diseases [3]. The potential preventive effect of AIT is currently being explored for pollen [4].

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Cell therapy for severe hemophilia: study has come full circle

No abstract available

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Necessity of interrupted time series analysis in evaluating the impact of PHS risk identification and introduction of direct-acting antiviral therapy and Share 35 implementation

No abstract available

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Design, Synthesis and Fungicidal Evaluation of Novel Pyraclostrobin Analogues

Publication date: Available online 10 January 2018
Source:Bioorganic & Medicinal Chemistry
Author(s): Lili Wang, Shuangshuang Zhao, Xiaotian Kong, Lingling Cao, Sheng Tian, Yonghao Ye, Chunhua Qiao
A series of novel pyraclostrobin derivatives were designed and prepared as antifungal agents. Their antifungal activities were tested in vitro with five important phytopathogenic fungi, namely, Batrylis cinerea, Phytophthora capsici, Fusarium sulphureum, Gloeosporium pestis and Sclerotinia sclerotiorum using the mycelium growth inhibition method. Among these compounds, 5s displayed IC50 value of 0.57 μg/mL against Batrylis cinerea and 5k-II displayed IC50 value of 0.43 μg/mL against Sclerotinia sclerotiorum, which were close to that of the positive control pyraclostrobin (0.18 μg/mL and 0.15 μg/mL). Other compounds 5f, 5k-II, 5j, 5m and 5s also exhibited strong antifungal activity. Further enzymatic assay demonstrated compound 5s inhibited porcine bc1 complex with IC50 value of 0.95 μM. The statistical results from an integrated computational pipeline demonstrated the predicted total binding free energy for compound 5s is the highest. Consequently, compound 5s with the biphenyl-4-methoxyl side chain could serve as a new motif as inhibitors of bc1 complex and deserve to be further investigated.

Graphical abstract

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Clinical and Pathological Features of Plasma Cell-Rich Acute Rejection after Kidney Transplantation

AbstractBackgroundPlasma cell-rich acute rejection (PCAR) is a rare type of allograft rejection characterized by the presence of mature plasma cells. In general the prognosis of PCAR is poor, and its clinical and pathological features remain unclear.MethodsWe performed a retrospective observational study and compared allograft survival between kidney transplant recipients who developed PCAR and those who did not develop PCAR. We further analyzed clinical and pathological risk factors for allograft failure in PCAR patients.ResultsOf 1,956 recipients, 40 developed PCAR. There was a higher prevalence of deceased donor transplants (27.5% vs. 11.7%, P=0.0059), longer median total ischemia time (99 min, interquartile range: 71 – 144, vs. 77 min, interquartile range: 59 – 111, P=0.0309), and lower prevalence of ABO-incompatible transplantation (7.5% vs. 22.5%, P=0.0206) in patients with PCAR than in those without PCAR.Multivariate Cox regression analysis showed that development of PCAR was associated with allograft loss (Hazard Ratio=8.03, 95% Confidence Interval: 3.89 – 14.80, P

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Preserving Treg function: beyond mTOR inhibitors

No abstract available

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Effect of Conversion to CTLA4Ig Treatment on Tacrolimus-Induced Diabetic Rats

ABSTRACTBackgroundThe effect of conversion to cytotoxic T-lymphocyte-associated protein 4 immunoglobulin (CTLA4Ig) treatment on tacrolimus (TAC)-induced renal dysfunction is well known, but its effect on TAC-induced diabetes mellitus (DM) is still undetermined. In the present study, we tested the diabetogenicity of CTLA4Ig and evaluated the effect of conversion to CTLA4Ig treatment on TAC-induced diabetic rats.MethodsWe tested diabetogenicity of CTLA4Ig by escalating doses (0.25, 0.5, 1, 2, and 4 mg/kg weekly) for 4 weeks. In the conversion study, we administered TAC (1.5 mg/kg) for 3 weeks and confirmed TAC-induced DM by intraperitoneal glucose tolerance test (IPGTT). Thereafter, TAC administration was continued, withdrawn, or replaced by CTLA4Ig treatment (1 or 2 mg/kg) for additional 3 weeks. The effect of CTLA4Ig on TAC-induced DM in vivo and in vitro was evaluated by assessing pancreatic islet function, histopathology, oxidative stress, apoptosis, and macrophage infiltration.ResultsIPGTT in the CTLA4Ig groups did not differ from the control group. In addition, plasma insulin level, glucose-induced insulin secretion, and islet viability were not different between the CTLA4Ig and control groups. In the conversion study, TAC withdrawal ameliorated pancreatic islet dysfunction compared to the TAC group, and conversion to CTLA4Ig further improved pancreatic islet function compared to the TAC withdrawal group. TAC-induced oxidative stress, apoptotic cell death, and infiltration of macrophages decreased with TAC withdrawal, and CTLA4Ig conversion further reduced those values. In the in vitro study, CTLA4Ig decreased TAC-induced pancreatic islet cell death and ROS production.ConclusionsCTLA4Ig was not diabetogenic, and conversion to CTLA4Ig reduced TAC-induced pancreatic islet injury. Background The effect of conversion to cytotoxic T-lymphocyte-associated protein 4 immunoglobulin (CTLA4Ig) treatment on tacrolimus (TAC)-induced renal dysfunction is well known, but its effect on TAC-induced diabetes mellitus (DM) is still undetermined. In the present study, we tested the diabetogenicity of CTLA4Ig and evaluated the effect of conversion to CTLA4Ig treatment on TAC-induced diabetic rats. Methods We tested diabetogenicity of CTLA4Ig by escalating doses (0.25, 0.5, 1, 2, and 4 mg/kg weekly) for 4 weeks. In the conversion study, we administered TAC (1.5 mg/kg) for 3 weeks and confirmed TAC-induced DM by intraperitoneal glucose tolerance test (IPGTT). Thereafter, TAC administration was continued, withdrawn, or replaced by CTLA4Ig treatment (1 or 2 mg/kg) for additional 3 weeks. The effect of CTLA4Ig on TAC-induced DM in vivo and in vitro was evaluated by assessing pancreatic islet function, histopathology, oxidative stress, apoptosis, and macrophage infiltration. Results IPGTT in the CTLA4Ig groups did not differ from the control group. In addition, plasma insulin level, glucose-induced insulin secretion, and islet viability were not different between the CTLA4Ig and control groups. In the conversion study, TAC withdrawal ameliorated pancreatic islet dysfunction compared to the TAC group, and conversion to CTLA4Ig further improved pancreatic islet function compared to the TAC withdrawal group. TAC-induced oxidative stress, apoptotic cell death, and infiltration of macrophages decreased with TAC withdrawal, and CTLA4Ig conversion further reduced those values. In the in vitro study, CTLA4Ig decreased TAC-induced pancreatic islet cell death and ROS production. Conclusions CTLA4Ig was not diabetogenic, and conversion to CTLA4Ig reduced TAC-induced pancreatic islet injury. *Corresponding author: Chul Woo Yang, MD, Department of Internal Medicine, Seoul St. Mary's Hospital, 505 Banpo-Dong, Seocho-Ku, 137-040, Seoul, Republic of Korea. Fax: +82-2-536-0323, Phone: +82-2-2258-6037, E-mail: yangch@catholic.ac.kr Author's contributions: LJ contributed to the experimental surgeries, analyzed the data, and co-drafted the manuscript; JJ and KL performed the experiments and analyzed the data; SWL, EJK, BHC, and HLL retrieved and analyzed the data; SWL and CWY designed the study and co-drafted the manuscript. All authors read and approved the final manuscript. Disclosure: The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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History of marijuana use does not affect outcomes on the liver transplant waitlist

AbstractBackgroundData are limited on marijuana use and its impact on liver transplant (LT) waitlist outcomes. We aimed to assess the risk of waitlist mortality/delisting and likelihood of LT among prior marijuana users, and to determine the prevalence and factors associated with marijuana use.MethodsRetrospective cohort of adults evaluated for LT over 2 years at a large LT center. Marijuana use defined by self-report in psychosocial assessment and/or positive urine toxicology. Ongoing marijuana use was not permitted for LT listing during study period.Results884 adults were evaluated and 585 (66%) were listed for LT (median follow up 1.4 years, IQR 0.5-2.0). Prevalence of marijuana use was 48%, with 7% being recent users and 41% prior users. Marijuana use had statistically significant association with alcoholic cirrhosis (IRR=1.9) and hepatitis C (IRR=2.1) vs. hepatitis B, tobacco use (prior IRR=1.4; recent IRR=1.3 vs. never), alcohol use (never IRR 0.1; heavy use/abuse IRR 1.2 vs. social), and illicit drug use (prior IRR=2.3; recent =1.9 vs. never). In adjusted competing risk regression, marijuana use was not associated with the probability of LT (prior HR 0.9; recent HR=0.9 vs. never) or waitlist mortality/delisting (prior HR 1.0; recent HR 1.0 vs. never). However, recent illicit drug use was associated with higher risk of death or delisting (HR 1.8, p=0.004 vs. never).ConclusionsUnlike illicit drug use, marijuana use was not associated with worse outcomes on the LT waitlist. Prospective studies are needed to assess ongoing marijuana use on the LT waitlist and post-LT outcomes. Background Data are limited on marijuana use and its impact on liver transplant (LT) waitlist outcomes. We aimed to assess the risk of waitlist mortality/delisting and likelihood of LT among prior marijuana users, and to determine the prevalence and factors associated with marijuana use. Methods Retrospective cohort of adults evaluated for LT over 2 years at a large LT center. Marijuana use defined by self-report in psychosocial assessment and/or positive urine toxicology. Ongoing marijuana use was not permitted for LT listing during study period. Results 884 adults were evaluated and 585 (66%) were listed for LT (median follow up 1.4 years, IQR 0.5-2.0). Prevalence of marijuana use was 48%, with 7% being recent users and 41% prior users. Marijuana use had statistically significant association with alcoholic cirrhosis (IRR=1.9) and hepatitis C (IRR=2.1) vs. hepatitis B, tobacco use (prior IRR=1.4; recent IRR=1.3 vs. never), alcohol use (never IRR 0.1; heavy use/abuse IRR 1.2 vs. social), and illicit drug use (prior IRR=2.3; recent =1.9 vs. never). In adjusted competing risk regression, marijuana use was not associated with the probability of LT (prior HR 0.9; recent HR=0.9 vs. never) or waitlist mortality/delisting (prior HR 1.0; recent HR 1.0 vs. never). However, recent illicit drug use was associated with higher risk of death or delisting (HR 1.8, p=0.004 vs. never). Conclusions Unlike illicit drug use, marijuana use was not associated with worse outcomes on the LT waitlist. Prospective studies are needed to assess ongoing marijuana use on the LT waitlist and post-LT outcomes. Corresponding Author: Prashant Kotwani, MD, Email – prashant.kotwani@ucsf.edu; prashant.kotwani@gmail.com, 505 Parnassus Avenue, Room 987, San Francisco, CA 94143, Phone: 415-476-1528, Fax: 415-502-1976 Authorship PK - contributed to research design, data collection, data analysis, manuscript preparation VS – contributed to research design, data analysis, manuscript preparation JLD – contributed to data analysis, manuscript preparation JR – contributed to research design, manuscript preparation FY – contributed to research design, manuscript preparation BH – contributed to research design, data analysis, manuscript preparation Conflict of Interest The authors declare no conflicts of interest Funding This work was supported, in part, by the Biostatistics Core of the UCSF Liver Center (P30 DK026743). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Liver transplantation for NASH-related hepatocellular carcinoma versus non-NASH etiologies of hepatocellular carcinoma

AbstractBackgroundLiver Transplant (LT) for Non-Alcoholic Steatohepatitis (NASH) related Hepatocellular Carcinoma (HCC) is not well characterized in the literature. The aim of the study was to examine characteristics and outcomes of patients who had LT for NASH-HCC (NASH) vs. HCC from other liver diseases (non-NASH).MethodsUsing a two-centre retrospective design all patients from 2004-2014 that received LT for HCC were analyzed. Subgroup analysis stratified patients according to Milan criteria.Results929 patients were transplanted for HCC. 60/929 (6.5%) had HCC in the context of NASH. There were no significant differences between groups for pretransplant or explant tumor characteristics. The actuarial 1-, 3- and 5-year overall survival was 98%, 96% and 80% in NASH vs. 95%, 84% and 78% in non-NASH (p=0.1). No differences in tumor recurrence were observed in patients within and beyond Milan in the NASH group. Multivariate Cox Regression demonstrated NASH status to be a protective factor for recurrence among patients with tumors beyond Milan, HR 0.21 (0.05-0.86), p=0.029.ConclusionAfter LT, outcomes are similar between NASH and non-NASH etiologies for HCC. The hypothesis that patients with more advanced HCC tumors in the context of NASH may have more favourable outcomes after LT has been generated, but requires further study. Background Liver Transplant (LT) for Non-Alcoholic Steatohepatitis (NASH) related Hepatocellular Carcinoma (HCC) is not well characterized in the literature. The aim of the study was to examine characteristics and outcomes of patients who had LT for NASH-HCC (NASH) vs. HCC from other liver diseases (non-NASH). Methods Using a two-centre retrospective design all patients from 2004-2014 that received LT for HCC were analyzed. Subgroup analysis stratified patients according to Milan criteria. Results 929 patients were transplanted for HCC. 60/929 (6.5%) had HCC in the context of NASH. There were no significant differences between groups for pretransplant or explant tumor characteristics. The actuarial 1-, 3- and 5-year overall survival was 98%, 96% and 80% in NASH vs. 95%, 84% and 78% in non-NASH (p=0.1). No differences in tumor recurrence were observed in patients within and beyond Milan in the NASH group. Multivariate Cox Regression demonstrated NASH status to be a protective factor for recurrence among patients with tumors beyond Milan, HR 0.21 (0.05-0.86), p=0.029. Conclusion After LT, outcomes are similar between NASH and non-NASH etiologies for HCC. The hypothesis that patients with more advanced HCC tumors in the context of NASH may have more favourable outcomes after LT has been generated, but requires further study. Corresponding Author: Dr. Gonzalo Sapisochin, Multi-Organ Transplant. Division of General Surgery, Department of Surgery, University of Toronto, 585 University Avenue, 11-PMB-184, Toronto, ON M5G 2N2, Canada. gonzalo.sapisochin@uhn.ca. T: +1 416 340 5230, F: +1 416 340 5242 Authorship E.M. Sadler - involved in study design, data collation, data analysis, manuscript preparation. N. Mehta – involved in study design, data collection, data analysis, and manuscript review. M. Bhat – involved in study design, manuscript preparation and review. A. Ghanekar – involved in data collection and manuscript review. P.D. Greig – involved in data collection and manuscript review. D.R. Grant – involved in data collection and manuscript review. F. Yao – involved in study design, data collection, and manuscript review. G. Sapisochin – involved in study design, data collection, data analysis, manuscript review. Disclosure The authors declare no conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Selective CD28 inhibition modulates alloimmunity and cardiac allograft vasculopathy in anti-CD154-treated monkeys

AbstractBackgroundSelective CD28 inhibition is actively pursued as an alternative to B7 blockade using CTLA4-Ig based on the hypothesis that the checkpoint immune regulators CTLA-4 and PD-L1 will induce tolerogenic immune signals. We previously showed that blocking CD28 using a monovalent nonactivating reagent (single chain anti-CD28 Fv fragment linked to alpha-1 anti-trypsin: sc28AT) synergizes with calcineurin inhibitors in nonhuman primate (NHP) kidney and heart transplantation. Here, we explored the efficacy of combining a 3-week 'induction" sc28AT treatment with prolonged CD154 blockade.MethodsCynomolgus monkey heterotopic cardiac allograft recipients received sc28AT (10 mg/kg, d0-20, n=3), hu5C8 (10-30 mg/kg, d0-84, n=4), or combination (n=6). Graft survival was monitored by telemetry. Protocol biopsies and graft explants were graded according to ISHLT AR and CAV scores. Alloantibody, T cell phenotype and Tregs were analyzed by flow cytometry. Immunochemistry and gene expression (Nanostring) characterized intra-graft cellular infiltration.ResultsRelative to modest prolongation of median graft survival time with sc28AT alone (34 days), hu5C8 (133 days) and sc28AT+hu5C8 (141 days) prolonged survival to a similar extent. CD28 blockade at induction, added to hu5C8, significantly attenuated the severity of acute rejection and cardiac allograft vasculopathy (CAV) during the first 3 months after transplantation relative to hu5C8 alone. These findings were associated with decreased proportions of circulating CD8+ and CD3+CD28- T cells, and modulation of inflammatory gene expression within allografts.ConclusionsInduction with sc28AT promotes early cardiac allograft protection in hu5C8-treated NHPs. These results support further investigation of prolonged selective CD28 inhibition with CD40/CD154 blockade in NHP transplants. Background Selective CD28 inhibition is actively pursued as an alternative to B7 blockade using CTLA4-Ig based on the hypothesis that the checkpoint immune regulators CTLA-4 and PD-L1 will induce tolerogenic immune signals. We previously showed that blocking CD28 using a monovalent nonactivating reagent (single chain anti-CD28 Fv fragment linked to alpha-1 anti-trypsin: sc28AT) synergizes with calcineurin inhibitors in nonhuman primate (NHP) kidney and heart transplantation. Here, we explored the efficacy of combining a 3-week 'induction" sc28AT treatment with prolonged CD154 blockade. Methods Cynomolgus monkey heterotopic cardiac allograft recipients received sc28AT (10 mg/kg, d0-20, n=3), hu5C8 (10-30 mg/kg, d0-84, n=4), or combination (n=6). Graft survival was monitored by telemetry. Protocol biopsies and graft explants were graded according to ISHLT AR and CAV scores. Alloantibody, T cell phenotype and Tregs were analyzed by flow cytometry. Immunochemistry and gene expression (Nanostring) characterized intra-graft cellular infiltration. Results Relative to modest prolongation of median graft survival time with sc28AT alone (34 days), hu5C8 (133 days) and sc28AT+hu5C8 (141 days) prolonged survival to a similar extent. CD28 blockade at induction, added to hu5C8, significantly attenuated the severity of acute rejection and cardiac allograft vasculopathy (CAV) during the first 3 months after transplantation relative to hu5C8 alone. These findings were associated with decreased proportions of circulating CD8+ and CD3+CD28- T cells, and modulation of inflammatory gene expression within allografts. Conclusions Induction with sc28AT promotes early cardiac allograft protection in hu5C8-treated NHPs. These results support further investigation of prolonged selective CD28 inhibition with CD40/CD154 blockade in NHP transplants. * T.Z. and A.M.A. contributed equally to the first authorship of this study. #Correspondence: Richard N. Pierson III, MD, Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, 110 South Paca Street 7N-134, Baltimore, MD 21201. E-mail: rpierson@som.umaryland.edu. Phone: 410.328.5842, Fax: 410.328.2750 Authorship Contributions: T.Z., A.M.A., and R.N.P.III designed the experiments, analysed the data, and wrote the article. W.S., N.A.O., E.B., and G.B. performed experiments and analysed data. E.S., L.B., X.C., T.M., S.D., D.H., E.R., E.W., A.K., and C.A. conducted all experiments. Disclosure : The authors declare no conflict of interest. Funding: This work was supported by the NIH (UO1 AI 066719), an ASTS Mid-Career Award, a contract from the DOD ORD (N00014-04-1-0821), and an AHA Grant-in-Aid, all to RNP; by the Other Tobacco Related Diseases research grant from the Maryland Restitution Fund Program, to AA and RNP; and by the NIH Nonhuman Primate Reagent Resource (OD010976 and AI126683). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A high portal venous pressure gradient increases gut-related bacteremia and consequent early mortality after living donor liver transplantation

AbstractBackgroundPortal hypertension (PHT) is defined as a portal venous pressure gradient (PVPG) exceeding 5 mmHg, which results in severe clinical manifestations. However, the validity of intraoperative PVPG monitoring and the association between PHT and bacterial translocation (BT) after liver transplantation remain unclear.MethodsIn this retrospective study, 223 patients who underwent primary adult-to-adult living donor liver transplantation (ALDLT) from 2008 to 2015 were divided into 2 groups based on the PVPG at the end of the operation: high PVPG (>5 mmHg, n=69) and low PVPG (≤5 mmHg, n=154). The clinical factors were compared between the groups, and the association between a high PVPG and posttransplant bacteremia/bacterial infections was investigated.ResultsThe high PVPG group had a significantly higher incidence of bacteremia (46% vs. 24%, p<.001 higher mortality rate vs. p=".002)," and poorer survival the high pvpg group had a particularly incidence of bacteremia caused by bacteria including enterobacteriaceae bacteroides spp. enterococcus multivariate analysis showed that>5 mmHg (odds ratio, 2.55; 95% confidence interval, 1.18–5.55; p=.017) was an independent predictor of bacteremia due to gut bacteria.ConclusionsMonitoring of the PVPG is clinically meaningful for predicting patients' prognosis. In particular, a high PVPG with a threshold of 5 mmHg at the end of ALDLT may increase gut-related bacteremia through the mechanism of BT, resulting in early mortality. Background Portal hypertension (PHT) is defined as a portal venous pressure gradient (PVPG) exceeding 5 mmHg, which results in severe clinical manifestations. However, the validity of intraoperative PVPG monitoring and the association between PHT and bacterial translocation (BT) after liver transplantation remain unclear. Methods In this retrospective study, 223 patients who underwent primary adult-to-adult living donor liver transplantation (ALDLT) from 2008 to 2015 were divided into 2 groups based on the PVPG at the end of the operation: high PVPG (>5 mmHg, n=69) and low PVPG (≤5 mmHg, n=154). The clinical factors were compared between the groups, and the association between a high PVPG and posttransplant bacteremia/bacterial infections was investigated. Results The high PVPG group had a significantly higher incidence of bacteremia (46% vs. 24%, p<.001 higher mortality rate vs. p=".002)," and poorer survival the high pvpg group had a particularly incidence of bacteremia caused by bacteria including enterobacteriaceae bacteroides spp. enterococcus multivariate analysis showed that>5 mmHg (odds ratio, 2.55; 95% confidence interval, 1.18–5.55; p=.017) was an independent predictor of bacteremia due to gut bacteria. Conclusions Monitoring of the PVPG is clinically meaningful for predicting patients' prognosis. In particular, a high PVPG with a threshold of 5 mmHg at the end of ALDLT may increase gut-related bacteremia through the mechanism of BT, resulting in early mortality. Corresponding author: Shintaro Yagi, Ph.D., Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. Telephone: +81-75-751-3242; FAX: +81-75-751-4263; E-mail: shintaro@kuhp.kyoto-u.ac.jp Authorship S.Yao and S.Yagi designed the study and wrote the draft. S.Yao, T.Iida, and Y.Okamura acquired the data. M.Nagao analyzed the data as a specialist of infection prevention. R.Uozumi analyzed the data as a specialist of medical statistician. S. Yagi, T. Iida, Y.Okamura, T.Anazawa, H.Okajima, T.Kaido and S.Uemoto performed living-donor liver transplantations, followed up the patients. M.Nagao, T.Anazawa, H.Okajima, T.Kaido, S.Uemoto contributed to editing the manuscript. S.Uemoto supervised the study design and revised the manuscript. Disclosures The authors have no conflicts of interest or financial ties to disclose. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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B Cells in Transplantation: of rat, mouse and man

No abstract available

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Early Hospital Readmission: The Canary in the Coal Mine?

No abstract available

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Publication Rates of Oral Abstract Presentations at the 2014 International Congress of the Transplantation Society

No abstract available

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Heart Transplantation in a Left Ventricular Assist Device Recipient Following Donor's Extracorporeal Membrane Oxygenation Support: Is it safe?

No abstract available

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Patterns of Discordance Between Pretransplant Imaging Stage of Hepatocellular Carcinoma and Posttransplant Pathologic Stage: A Contemporary Appraisal of the Milan Criteria

AbstractBackgroundPatients with hepatocellular carcinoma (HCC) exceeding Milan criteria on explant pathology are at increased risk of recurrence and death. Discordance between contemporary magnetic resonance imaging (MRI) and explant pathology, and preoperative characteristics predictive of discordance are not well understood.MethodsPatients who underwent orthotopic liver transplantation (OLT) for HCC following preoperative MRI were identified in a prospectively collected institutional database (1/2003-12/2013). Patients were dichotomized to "within" or "outside" Milan criteria by both imaging and explant pathologic evaluation. Binary logistic regression and Kaplan-Meier methodology were utilized to identify independent predictors of imaging/pathologic discordance and its impact on posttransplant survival.ResultsOf 318 patients with HCC meeting Milan criteria by MRI at the time of OLT, 248 (78.0%) remained within a pathological correlate of Milan criteria on explant examination. Understaging was associated with worse median recurrence-free survival (64.0 vs. 140.0 months, p=0.002) and overall survival (96.0 vs. 143.0 months, p=0.005), and did not vary between patients exceeding criteria due to tumor explant >5 cm, >3 tumor foci, or a tumor >3 cm in the setting of multifocality. Discordance was independently associated with an increasing serum AFP level (OR 2.82, 95% CI 1.37-5.79, p=0.005).ConclusionsUnderestimating HCC burden prior to liver transplant remains frequent despite contemporary imaging technologies. Patients with an increasing AFP prior to transplantation may benefit from more frequent testing or novel neoadjuvant therapies. Background Patients with hepatocellular carcinoma (HCC) exceeding Milan criteria on explant pathology are at increased risk of recurrence and death. Discordance between contemporary magnetic resonance imaging (MRI) and explant pathology, and preoperative characteristics predictive of discordance are not well understood. Methods Patients who underwent orthotopic liver transplantation (OLT) for HCC following preoperative MRI were identified in a prospectively collected institutional database (1/2003-12/2013). Patients were dichotomized to "within" or "outside" Milan criteria by both imaging and explant pathologic evaluation. Binary logistic regression and Kaplan-Meier methodology were utilized to identify independent predictors of imaging/pathologic discordance and its impact on posttransplant survival. Results Of 318 patients with HCC meeting Milan criteria by MRI at the time of OLT, 248 (78.0%) remained within a pathological correlate of Milan criteria on explant examination. Understaging was associated with worse median recurrence-free survival (64.0 vs. 140.0 months, p=0.002) and overall survival (96.0 vs. 143.0 months, p=0.005), and did not vary between patients exceeding criteria due to tumor explant >5 cm, >3 tumor foci, or a tumor >3 cm in the setting of multifocality. Discordance was independently associated with an increasing serum AFP level (OR 2.82, 95% CI 1.37-5.79, p=0.005). Conclusions Underestimating HCC burden prior to liver transplant remains frequent despite contemporary imaging technologies. Patients with an increasing AFP prior to transplantation may benefit from more frequent testing or novel neoadjuvant therapies. Corresponding Author: Matthew H. Levine, MD, PhD, 3400 Spruce Street, 1 Founders, University of Pennsylvania, Philadelphia, Pennsylvania 19104, Phone: 215.662.7367. E-mail: matthew.levine@uphs.upenn.edu. Author contributions: 1) conception and design (Ecker, Hoteit, Shaked, Olthoff, Levine), acquisition of data (Ecker), or analysis and interpretation of data (all authors); 2) drafting (Ecker, Levine) or revising (all authors) 3) final approval of the version to be published (all authors) Disclosures: The authors report no conflicts of interest Funding: none Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia

Background and Objectives Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Methods Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Results Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07–0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. Conclusions High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice. Accepted for publication August 20, 2017. Address correspondence to: Santhanam Suresh, MD, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611 (e-mail: ssuresh@luriechildrens.org). Identification of institution(s) where work is attributed: Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University, Chicago, IL; and Department of Anesthesiology at Rhode Island Hospital, Alpert School of Medicine, Brown University, Providence, RI. The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Epidural Hematoma Following Interlaminar Epidural Injection in Patient Taking Aspirin

Objective We present a case report of a patient who developed an epidural hematoma following an interlaminar epidural steroid injection with no risk factors aside from old age and aspirin use for secondary prevention. Case Report A 79-year-old man developed an epidural hematoma requiring surgical treatment following an uncomplicated interlaminar epidural steroid injection performed for neurogenic claudication. In the periprocedural period, he continued aspirin for secondary prophylaxis following a myocardial infarction. Conclusions For patients taking aspirin for primary or secondary prophylaxis, the American Society of Regional Anesthesia and Pain Medicine antiplatelet and anticoagulation guidelines for spine and pain procedures recommend a shared assessment and risk stratification when deciding to hold the medication for intermediate-risk neuraxial procedures. Cases such as this serve to highlight the importance of giving careful consideration to medical optimization of a patient even when a low- or intermediate-risk procedure is planned. Accepted for publication September 2, 2017. Address correspondence to: Rebecca A. Sanders, MD, 200 First Street SW, Rochester, MN 55901 (e-mail: Sanders.rebecca@mayo.edu). The authors declare no conflict of interest. A case abstract was presented at the 2016 Annual Meeting of the American Academy of Pain Medicine; February 18 to 21, 2016; Palm Springs, CA. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Macular Ganglion Cell Complex Reduction Preceding Visual Field Loss in a Patient With Chiasmal Compression With a 21-Month Follow-up: Comment

No abstract available

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An Evaluation of Educational Neurological Eye Movement Disorder Video Posted on Internet Video Sharing Sites: Comment

No abstract available

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Macular Ganglion Cell Complex Reduction Preceding Visual Field Loss in a Patient With Chiasmal Compression With a 21-Month Follow-Up: Response

No abstract available

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HINTS in the Acute Vestibular Syndrome: Pearls and Pitfalls

Abstract: The acute vestibular syndrome (AVS) is characterized by the rapid onset of vertigo, nausea/vomiting, nystagmus, unsteady gait, and head motion intolerance lasting more than 24 hours. We present 4 patients with AVS to illustrate the pearls and pitfalls of the Head Impulse, Nystagmus, Test of Skew (HINTS) examination. Address correspondence to Daniel R. Gold, DO, Division of Neuro-Visual and Vestibular Disorders, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology-Head and Neck Surgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Pathology 2-210, Baltimore, MD 21287; E-mail: dgold7@jhmi.edu G. P. Van Stavern: Research was supported by DOVS Core Grant 5 P30 EY02687, Institute for Clinical and Translational Sciences Grant RR023496, Biostat Core Grant U54 RR023496, an unrestricted grant from Research to Prevent Blindness, and NIH Core Vision Grant P30 EY02687. D. R. Gold: Research was supported by Department of Defense MR141166. The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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Management of Morgellons Disease With Low-Dose Trifluoperazine

This medical record review examines the novel use of low-dose trifluoperazine, a high-potency typical antipsychotic, in a cohort of patients with Morgellons disease.

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Diagnosis of Neurofibromatosis Type 2 From Congenital Skin Plaques

This genetic testing study reports a case of an early diagnosis of neurofibromatosis type 2 (NF2) in a child after genetic analysis of congenital skin plaques, with confirmation of these findings by analysis of skin plaques from 6 unrelated patients with NF2.

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Intertriginous Condyloma-like Plaques and Ulcers

A woman in her 50s with a medical history of hypertension and depression was evaluated by the inpatient dermatology consult service for a 1.5-year history of painful intertriginous wounds; she was previously diagnosed with hidradenitis suppurativa. What is your diagnosis?

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Human Herpesvirus 8–Associated Inflammatory Cytokine Syndrome

This case report describes a patient with human herpesvirus 8–associated inflammatory cytokine syndrome.

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Comorbidity Development in Children With Psoriasis

This cohort study examines the risk ocomorbidities in children with and without psoriasis, after accounting for obesity.

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Allergen Concerns and Popular Skin Care Products

To the Editor We read with great interest the article by Xu et al published in a recent issue of JAMA Dermatology highlighting the high prevalence of contact allergens in common moisturizers. Their data mirror similar results in our recent study investigating contact allergens in pediatric personal care products marketed as hypoallergenic, dermatologist recommended and/or tested, fragrance free, or paraben free. Similar to the study by Xu et al, which found that 88% of common moisturizers contained at least 1 common contact allergen, we found that 167 of 187 of our selection of pediatric products (89%) contained at least 1 allergen.

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Dermatology Practice Consolidation Fueled by Private Equity Investment

This Viewpoint discusses the consolidation of dermatology practices facilitated by private equity investment and the potential consequences for the specialty and patients.

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Dermatology’s Grandest Piano

This is a story about a piano that played a small but special role in dermatology's history. It belonged to Stephen Rothman, MD (1894-1963), one of the most influential dermatologists of the 20th century. He was also an accomplished pianist.

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The Importance of Population-Based Estimates of Melanocytic Pathology

In this issue of JAMA Dermatology, Lott et al describe a novel and innovative approach to estimating the prevalence of different types of melanocytic lesions in all adults undergoing skin biopsies in a population. Using an automated natural language processing tool, they analyzed 80 368 written pathology reports of skin biopsies from 47 529 adult patients drawn from an underlying health system patient population, which was representative of the general adult population. For analysis of each pathology report, the diagnosis was first dichotomized as either a melanocytic or nonmelanocytic lesion. For melanocytic lesions, the cases were then assigned to 1 of 4 diagnostic categories based on the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx), with differing management implications: class I, benign lesion requiring no further treatment; class II, low-risk lesion requiring complete excision with narrow (<5-mm) margins; class III, higher-risk lesion such as melanoma in situ requiring reexcision with 5-mm to 1-cm margins; and class IV/V, invasive melanoma requiring wide reexcision with 1-cm margins or greater. Approximately one-quarter of all skin biopsies were of melanocytic lesions. Of these, over 90% were benign or low risk (class I or II); 4.5% were melanoma in situ or similar-risk lesion (class III); and 4.1% were invasive melanoma (class IV/V).

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Hair Repigmentation With Anti–PD-1 and Anti–PD-L1 Immunotherapy

To the Editor We read with great interest the article by Rivera and colleagues reporting on hair repigmentation in patients receiving immunotherapy with anti–programmed cell death 1 (PD-1) and anti–programmed cell death 1 ligand 1 (PD-L1) immunotherapy.

http://ift.tt/2jMSX1k

Spanish Fly—Cantharidin’s Alter Ego

Cantharidin, derived from the Greek word for beetle, kantharis, is an odorless, colorless terpenoid produced by up to 2000 species of beetles collectively referred to as blister beetles. Male blister beetles synthesize and use cantharidin as a defensive chemical and nuptial gift. Females receive cantharidin during mating and use the compound to coat their eggs to ward off predators. It functions as a potent vesicant on skin contact, but it is also a systemic poison if ingested, with toxic effects comparable with those of strychnine and cyanide. If properly dosed and applied, however, its blistering properties can be used therapeutically.

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Geographic Distribution of Nonphysicians Who Billed Medicare for Dermatologic Services

This study uses Medicare and US Census data to discover which dermatology-related services are independently billed by nonphysician clinicians treating Medicare beneficiaries, and where these clinicians are located.

http://ift.tt/2jRq9ox

Topical Timolol for Paronychia and Pseudopyogenic Granuloma

This study evaluated the efficacy and tolerability of topical timolol, 0.5%, gel as a treatment of paronychia and pseudopyogenic granuloma induced by antineoplastic agents.

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Probiotic Strains for Children With Moderate Atopic Dermatitis

This randomized clinical trial investigates whether a mixture of oral probiotics is safe and effective in the treatment of atopic dermatitis symptoms and evaluates its influence on the use of topical steroids in children.

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Treatment of Refractory Mycosis Fungoides With Brentuximab Vedotin

This case report describes the treatment of CD30-negative refractory mycosis fungoides with brentuximab vedotin.

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Factors Associated With Remission of Skin Disease in Dermatomyositis

This cohort study examines factors associated with clinical remission of skin disease in dermatomyositis.

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Hair Repigmentation With Anti–PD-1 and Anti–PD-L1 Immunotherapy—Reply

In Reply We read with interest the letter by Manson et al. They describe another case of hair repigmentation (HR) in a male patient with concomitant advanced colorectal cancer and Hodgkin lymphoma treated with nivolumab and showing a good response. Interestingly, this new case seems to support the association between a good response and HR.

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Preference-Based QOL Measures for Economic Evaluations in Early Melanoma

This study uses randomized clinical trial data to compare utility scores from the AQoL-8D and the FACT-M and evaluate the sensitivity of both instruments in identifying the influence of fear of cancer recurrence on health-related quality of life in patients with early-stage melanoma.

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Error in Figure Legend

In the article titled "Factors Associated With Clinical Remission of Skin Disease in Dermatomyositis" by Wolstencroft et al, published online November 7, 2017, there was an error in the key for Figure 1B. This article was corrected online.

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Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients

This cohort study addresses whether current skin surveillance intervals and threshold for biopsy of suspicious lesions are adequate for the increased tendency of solid organ transplant recipients to develop potentially aggressive cutaneous squamous cell carcinomas.

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Sporty Spots

During the 2016 summer Olympic Games in Rio de Janeiro, Brazil, many viewers questioned the origins of the purple spots seen on US swimmer Michael Phelps during a relay event. Similarly, in recent years public attention has been drawn to the tell-tale circular markings on various other celebrities' bodies, including Justin Bieber, Jennifer Aniston, and Gwyneth Paltrow. The origin of these markings is an ancient practice called "cupping," which uses suction to attach a cup to skin for purported therapeutic benefit. In recent times, the practice has been popularized in the United States as a form of complementary and alternative medicine (CAM) practice.

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January 2018 Issue Highlights

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Chronisch spontane Urtikaria

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Operative Behandlungsoptionen bei Hidradenitis suppurativa/Acne inversa

Zusammenfassung

Hidradenitis suppurativa/Acne inversa (HS/AI) ist eine chronisch inflammatorische Hauterkrankung, für deren Behandlung konservative und operative Therapieoptionen zur Verfügung stehen. Im Hurley-Stadium II und III stellt die operative Sanierung von irreversibel destruiertem Gewebe die Methode der Wahl dar. Resektionstechniken unterschiedlicher Invasivität werden in der Literatur beschrieben. Bisher herrscht kein allgemein akzeptierter Konsens über den Einsatz verschiedener Resektions- und Rekonstruktionstechniken sowie die postoperative Nachbehandlung. Die Beurteilung von Rezidiven nach chirurgischer Intervention wird durch fehlende Rezidivdefinitionen sowie eine heterogene Studienlage erschwert.

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Panorama Dermatologische Praxis

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Performance of ceramic ultrafiltration and reverse osmosis membranes in treating car wash wastewater for reuse

Abstract

Reusing treated effluents in industries is a great option to conserve freshwater resources. For example, car wash centres all over Australia are estimated to use 17.5 billion litres of water and discharge it as wastewater and spend $75 million a year for both purchasing fresh water and for treating and/or discharging the wastewater. Therefore, it is important to develop simple but reliable systems that can help to treat and reuse car wash wastewater. Significant savings could also be associated with the implementation of such systems. This study evaluates the performance of granular and membrane filtration systems with coagulation/flocculation and sedimentation in treating car wash wastewater for the purpose of reuse. Overall, 99.9% of turbidity, 100% of suspended solids and 96% of COD were removed from the car wash wastewater after treating by coagulation, flocculation, sedimentation, sand filtration, ceramic ultrafiltration and reverse osmosis and the treated water meets the standards required for class A recycled water in Australia and standards imposed in Belgium and China. The treated water can be reused. However, optimisation is required to reduce the sludge produced by this system.

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Authentication of synthetic environmental contaminants and their (bio)transformation products in toxicology: polychlorinated biphenyls as an example

Abstract

Toxicological studies use "specialty chemicals" and, thus, should assess and report both identity and degree of purity (homogeneity) of the chemicals (or toxicants) under investigation to ensure that other scientists can replicate experimental results. Although detailed reporting criteria for the synthesis and characterization of organic compounds have been established by organic chemistry journals, such criteria are inconsistently applied to the chemicals used in toxicological studies. Biologically active trace impurities may lead to incorrect conclusions about the chemical entity responsible for a biological response, which in turn may confound risk assessment. Based on our experience with the synthesis of PCBs and their metabolites, we herein propose guidelines for the "authentication" of synthetic PCBs and, by extension, other organic toxicants, and provide a checklist for documenting the authentication of toxicants reported in the peer-reviewed literature. The objective is to expand guidelines proposed for different types of biomedical and preclinical studies to include a thorough authentication of specialty chemicals, such as PCBs and their derivatives, with the goal of ensuring transparent and open reporting of scientific results in toxicology and the environmental health sciences.

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Identification and functional characterization of type II toxin/antitoxin systems in Aggregatibacter actinomycetemcomitans

Summary

Type II toxin/antitoxin (TA) systems contribute to the formation of persister cells and biofilm formation for many organisms. A. actinomycetemcomitans thrives in the complex oral microbial community subjected to continual environmental flux. Little is known regarding the presence and function of type II TA systems in this organism or their contribution to adaptation and persistence in the biofilm. We identified 11 TA systems that are conserved across all seven serotypes of A. actinomycetemcomitans and represent the RelBE, MazEF and HipAB families of type II TA systems. The systems selectively responded to various environmental conditions that exist in the oral cavity. Two putative RelBE-like TA systems, D11S_1194-1195 and D11S_1718-1719 were induced in response to low pH and deletion of D11S_1718-1719 significantly reduced metabolic activity of stationary phase A. actinomycetemcomitans cells upon prolonged exposure to acidic conditions. The deletion mutant also exhibited reduced biofilm biomass when cultured under acidic conditions. The D11S_1194 and D11S_1718 toxin proteins inhibited in vitro translation of dihydrofolate reductase (DHFR) and degraded ribosome-associated but not free MS2 virus RNA. In contrast, the corresponding antitoxins (D11S_1195 and D11S_1719), or equimolar mixtures of toxin and antitoxin had no effect on DHFR production or RNA degradation. Together, these results suggest that D11S_1194-1195 and D11S_1718-1719 are RelBE-like type II TA systems that are activated under acidic conditions and may function to cleave ribosome-associated mRNA to inhibit translation in A. actinomycetemcomitans. In vivo, these systems may facilitate A. actinomycetemcomitans adaptation and persistence in acidic local environments in the dental biofilm.

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Evaluation of the Thyroid Volume After Radiofrequency Ablation of Thyroid Nodules and Recurrent Thyroid

Condition: Thyroid Nodule
Intervention: Device: Celon Pro Surge
Sponsor: Olympus Surgical Technologies Europe
Recruiting

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Avenir® Cemented Hip Stem - PMCF

Conditions: Primary Osteoarthritis; Post-Traumatic Osteoarthritis of Hip; Femoral Neck Fractures; Femoral Head Necrosis; Sequelae From Previous Hip Surgery; Osteotomies; Congenital Hip Dysplasia
Intervention:
Sponsor: Zimmer Biomet
Recruiting

http://ift.tt/2D0EYNY

Evaluation of the Thyroid Volume After Radiofrequency Ablation of Thyroid Nodules and Recurrent Thyroid

Condition: Thyroid Nodule
Intervention: Device: Celon Pro Surge
Sponsor: Olympus Surgical Technologies Europe
Recruiting

http://ift.tt/2AM3H2N

Avenir® Cemented Hip Stem - PMCF

The Association Between Serum Vaspin and Omentin-1 Levels in Obese Children with Metabolic Syndrome

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

http://ift.tt/2D0KHTc

In Vivo and Ex Vivo Inflammatory Markers of Common Metabolic Phenotypes in Humans

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

http://ift.tt/2mgRL3T

Interaction of Metabolic Health and Obesity on Subclinical Target Organ Damage

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

http://ift.tt/2D0p9Gn

Head circumference - a useful single parameter for skull volume development in cranial growth analysis?

Abstract

Background

The measurement of maximal head circumference is a standard procedure in the examination of childrens' cranial growth and brain development. The objective of the study was to evaluate the validity of maximal head circumference to cranial volume in the first year of life using a new method which includes ear-to-ear over the head distance and maximal cranial length measurement.

Methods

3D surface scans for cranial volume assessment were conducted in this method comparison study of 44 healthy Caucasian children (29 male, 15 female) at the ages of 4 and 12 months.

Results

Cranial volume increased from measurements made at 4 months to 12 months of age by an average of 1174 ± 106 to 1579 ± 79 ml. Maximal cranial circumference increased from 43.4 ± 9 cm to 46.9 ± 7 cm and the ear-to ear measurement increased from 26.3 ± 21 cm to 31.6 ± 18 cm at the same time points. There was a monotone association between maximal head circumference (HC) and increase in volume, yet a backwards inference from maximal circumference to the volume had a predictive value of only 78% (adjusted R²). Including the additional measurement of distance from ear to ear strengthened the ability of the model to predict the true value attained to 90%. The addition of the parameter skull length appeared to be negligible.

Conclusion

The results demonstrate that for a distinct improvement in the evaluation of a physiological cranial volume development, the additional measurement of the ear-to ear distance using a measuring tape is expedient, and, especially for cases with pathological skull changes, such as craniosynostosis, ought to be conducted.

http://ift.tt/2CVnRwp

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τετάρτη 10 Ιανουαρίου 2018

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