Head and Neck Diseases by Alexandros G.Sfakianakis: 01/15/18

Δευτέρα 15 Ιανουαρίου 2018

Denosumab or oral bisphosphonates in primary osteoporosis: a “real-life” study

Abstract

Purpose

To compare the response to denosumab (DMAb) therapy with that of oral bisphosphonate (BISPH) treatment in postmenopausal women with primary osteoporosis (PO).

Methods

In this retrospective study, we compared data of 75 PO female patients treated for 24 months with DMab (DMAb Group, age 72.6 ± 8.9 years) with those of 75 PO patients treated with oral bisphosphonates (BISPH Group), matched for age, body mass index, femoral bone mineral density (BMD), prevalent fragility fractures and familiar history of hip fracture. In all subjects at baseline and after 24 months we assessed the calcium–phosphorous metabolism parameters, BMD at lumbar spine (LS-BMD) and femoral neck (FN-BMD) by dual X-ray absorptiometry and the morphometric vertebral fractures by radiograph. The patients were considered inadequate responders in the presence of ≥ 2 incident fragility fractures and/or a decrease in BMD greater than the least significant change (LS 2.8%, FN 5.9%).

Results

After 24 months, the DMab Group showed a greater ALP decrease (− 22.8 ± 18.2%), a higher LS-BMD and FN-BMD increase (6.6 ± 6.9 and 4.4 ± 8.2%, respectively) and a lower number of patients with an incident fracture (8%) and with an inadequate response (6.7%) than BISPH Group (− 14.9 ± 15.3, 2.5 ± 4.3, 1.9 ± 4.5, 21.3 and 22.7%, respectively, p < 0.05 for all comparisons). The inadequate response was 4.5-fold more likely in BISPH Group than in DMab one (p = 0.027), regardless of possible confounders.

Conclusions

In postmenopausal PO females, denosumab was more effective than oral bisphosphonates in increasing BMD and reducing bone turnover and the number of inadequate responder patients.

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Systematic review of atopic dermatitis disease definition in studies using routinely-collected health data

Abstract

Background

Routinely collected electronic health data (RCD) obtained for administrative and clinical purposes are increasingly used to study atopic dermatitis (AD). Methods for identifying AD patients in RCD differ, and it is unknown how this might affect study results.

Objectives

We sought to evaluate how AD patients have been identified in studies using RCD, to determine whether these methods were validated, and to estimate how the method for identifying AD patients affected variability in prevalence estimates.

Methods

We systematically searched PubMed, EMBASE, and Web of Science for studies utilizing RCD that reported on AD as a primary outcome. Studies of localized AD and other types of dermatitis were excluded. The protocol for this review was registered in PROSPERO (CRD42016037968).

Results

59 studies met eligibility criteria. Medical diagnosis codes for inclusion and exclusion, number of occasions of a code, type of provider associated with a code, and prescription data were used to identify AD patients. Only two studies described validation of their methods and no study reported on disease severity. Prevalence estimates ranged from 0.18%-38.33% (median 4.91%) and up to 3-fold variation in prevalence was introduced by differences in the method for identifying AD patients.

Conclusions

This systematic review highlights the need for clear reporting of methods for identifying AD patients in routinely collected electronic health data to allow for meaningful interpretation and comparison of results.

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Dermatology Training Across the Globe

Abstract

Dermatology residency program rankings often stem from assessments by practicing physicians or evaluations of scholarly achievements such as grants and publicatons.^1-3 Such rankings, however, are continuously changing, and fail to account for the specific missions of dermatology training programs.² Additionally, a global comparison of dermatology training requirements and a worldwide understanding of the ideal dermatology curriculum remains missing from the literature. Therefore, this study aims to compare and contrast accreditation requirements for dermatology training programs across the world. As a secondary objective, it attempts to identify the different missions of dermatology training programs around the world to create a global vision of what constitutes an ideal dermatology training program.

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Computerized planimetry to assess clinical responsiveness in a phase II randomized trial of topical R333 for discoid lupus erythematosus

Abstract

Background

R333 is a topical janus kinase and spleen tyrosine kinase inhibitor being evaluated for discoid lupus erythematosus (DLE) treatment. There is no validated measure to assess area of active DLE lesions.

Objectives

To evaluate R333 efficacy and assess a technique to measure responsiveness.

Methods

54 DLE patients were randomized in a double blind design to R333 or placebo. The primary endpoint was the proportion of patients achieving ≥50% decrease in erythema and scale based on lesional CLASI for all treated lesions at week 4. Two-dimensional area measurements for each lesion were recorded at baseline and week 1-6. 88 photographs (44 pre- and 44 post-treatment) were obtained from the trial and change in size of active areas was analyzed by computerized planimetry and physician assessed area change.

Results

36 patients were randomized to R333 and 18 patients were randomized to placebo. The primary endpoint was not achieved. There was a strong association between lesion activity and physician global assessment, a measure of activity of all treated lesions (p<10^-6). Photos of 42 patients assessed by computerized planimetry demonstrated excellent inter-rater and intra-rater reliability. Area change by computerized planimetry showed a strong correlation with physician assessed area change (Spearman r=0.72). Area change by two-dimensional measurements showed a weak correlation with physician assessed area change (Spearman r=0.29)

Conclusion

Four weeks of R333 treatment did not result in significant improvement in lesion activity. Lesion activity and area change using computerized planimetry are better determinants of responsiveness as compared to area change using two-dimensional measurements.

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Systematic review of atopic dermatitis disease definition in studies using routinely-collected health data

Abstract

Background

Objectives

Methods

Results

Conclusions

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Dermatology Training Across the Globe

Abstract

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Computerized planimetry to assess clinical responsiveness in a phase II randomized trial of topical R333 for discoid lupus erythematosus

Abstract

Background

Objectives

To evaluate R333 efficacy and assess a technique to measure responsiveness.

Methods

Results

Conclusion

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Vulvo-vaginal rejuvenation: Fact or fiction? Fractional carbon dioxide laser for genitourinary syndrome of menopause

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Vulvo-vaginal rejuvenation: Fact or fiction? Fractional carbon dioxide laser for genitourinary syndrome of menopause

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Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit

Abstract

Background

Incidences of pharyngocutaneous fistulization (PCF) after total laryngectomy (TL) reported in the literature vary widely, ranging from 2.6 to 65.5%. Comparison between different centers might identify risk factors, but also might enable improvements in quality of care. To enable this on a national level, an audit in the 8 principle Dutch Head and Neck Centers (DHNC) was initiated.

Methods

A retrospective chart review of all 324 patients undergoing laryngectomy in a 2-year (2012 and 2013) period was performed. Overall PCF%, PCF% per center and factors predictive for PCF were identified. Furthermore, a prognostic model predicting the PCF% per center was developed. To provide additional data, a survey among the head and neck surgeons of the participating centers was carried out.

Results

Overall PCF% was 25.9. The multivariable prediction model revealed that previous treatment with (chemo)radiotherapy in combination with a long interval between primary treatment and TL, previous tracheotomy, near total pharyngectomy, neck dissection, and BMI < 18 were the best predictors for PCF. Early oral intake did not influence PCF rate. PCF% varied quite widely between centers, but for a large extend this could be explained with the prediction model. PCF performance rate (difference between the PCF% and the predicted PCF%) per DHNC, though, shows that not all differences are explained by factors established in the prediction model. However, these factors explain enough of the differences that, compensating for these factors, hospital is no longer independently predictive for PCF.

Conclusions

This nationwide audit has provided valid comparative PCF data confirming the known risk factors from the literature which are important for counseling on PCF risks. Data show that variations in PCF% in the DHNCs (in part) are explainable by the variations in these predictive factors. Since elective neck dissection is a major risk factor for PCF, it only should be performed on well funded indication.

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Issue Information

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Future Meetings

Thyroid Jan 2018, Vol. 28, No. 1: 151-151.

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Breast-Milk Iodine Concentrations and Iodine Levels of Infants According to the Iodine Status of the Country of Residence: A Systematic Review and Meta-Analysis

Thyroid Jan 2018, Vol. 28, No. 1: 124-138.

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Thyroid-Related Research in Japan A Spotlight on Recent Important Contributions

Thyroid Jan 2018, Vol. 28, No. 1: 1-3.

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Genotype-Based Epigenetic Differences in Monozygotic Twins Discordant for Positive Antithyroglobulin Autoantibodies

Thyroid Jan 2018, Vol. 28, No. 1: 110-123.

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Treatment of allergic rhinitis using mobile technology with real world data: The MASK observational pilot study

Abstract

Background

Large observational implementation studies are needed to triangulate the findings from randomized control trials (RCTs) as they reflect "real world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real life treatment of allergic rhinitis using mobile technology.

Methods

A mobile phone app (Allergy Diary, freely available Google Play and Apple App stores) collects the data of daily visual analogue scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries.

Results

A total of 2,871 users filled in 17,091 days of VAS in 2015 and 2016. Medications were reported for 9,634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single or multiple treatments (worst control).

Conclusions

The present study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in allergic rhinitis. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings and generates new hypotheses.

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The EAACI/GA²LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update

Abstract

This evidence and consensus-based guideline was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. The conference was held on December 1st, 2016. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).

Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria are disabling, impair quality of life, and affect performance at work and school. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

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Body composition and circulating estradiol are the main bone density predictors in healthy young and middle-aged men

Abstract

Purpose

Current fracture risk assessment options in men call for improved evaluation strategies. Recent research directed towards non-classic bone mass determinants have often yielded scarce and conflicting results. We aimed at investigating the impact of novel potential bone mass regulators together with classic determinants of bone status in healthy young and middle-aged men.

Methods

Anthropometric measurements, all-site bone mineral density (BMD) and body composition parameters assessed by dual-energy X-ray absorptiometry and also serum concentrations of (1) the adipokines leptin and resistin, (2) vitamin D and parathormone (PTH), (3) sex hormone binding globulin (SHBG), total testosterone and estradiol (free testosterone was also calculated) and (4) C-terminal telopeptide of type I collagen (CTx) were obtained from 30 apparently healthy male volunteers aged 20–65 years enrolled in this cross-sectional study.

Results

Only lean mass (LM) and total estradiol independently predicted BMD in men in multiple regression analysis, together explaining 49% (p ≤ 0.001) of whole-body BMD variance. Hierarchical regression analysis with whole-body BMD as outcome variable demonstrated that the body mass index (BMI) beta coefficient became nonsignificant when LM was added to the model. Adipokines, fat parameters, testosterone (total and free), SHBG, PTH and vitamin D were not independently associated with BMD or CTx.

Conclusions

The present study shows that LM and sex hormones—namely estradiol—are the main determinants of bone mass in young and middle-aged men. The effects of BMI upon BMD seem to be largely mediated by LM. Lifestyle interventions should focus on preserving LM in men for improved bone outcomes.

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Efficacy and safety of fezakinumab (an anti-IL-22 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by conventional treatments - A randomized, double-blind, phase 2a trial

IL-22 promotes epidermal hyperplasia and inhibits skin barrier function.

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Efficacy and safety of lebrikizumab (an anti-IL-13 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical corticosteroids: A randomized, placebo-controlled phase II trial (TREBLE)

Interleukin (IL)-13 plays a key role in type 2 inflammation and is an emerging pathogenic mediator in atopic dermatitis.

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Editorial Board

Publication date: February 2018
Source:Medical Image Analysis, Volume 44

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Reviewers -- An acknowledgement

Publication date: February 2018
Source:Medical Image Analysis, Volume 44

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Acrodermatitis acidaemica

Summary

Methylmalonic acidaemia (MMA) is an inborn error of amino acid metabolism that may be associated with cutaneous manifestations mimicking other diagnoses, including staphylococcal scalded skin syndrome (SSSS), psoriasis and acrodermatitis enteropathica. Whether this is due to the underlying metabolic disorder itself or occurs as a consequence of dietary restriction has yet to be elucidated. Skin biopsies typically show histological features shared by a number of other metabolic disorders and nutritional deficiency-associated diseases. Some presentations, especially SSSS-like eruptions, may be associated with acute metabolic decompensation. An underlying metabolic disorder, such as MMA, should be considered in a diagnosed adult or undiagnosed child presenting with skin eruptions that resemble those listed above, so that specialist management may be initiated early.

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Acrodermatitis acidaemica

Summary

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Seasonal variation and source apportionment of PM 2.5 -bound trace elements at a coastal area in southwestern Taiwan

Abstract

The aim of this study is to investigate the seasonal variations and source apportionment on atmospheric fine particulate matter (PM_2.5) mass and associated trace element concentrations at a coastal area, in Chiayi County of southwestern Taiwan. Particle measurements were conducted in 2015. Twenty-three trace elements in PM_2.5 were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Multiple approaches of the enrichment factor (EF) analysis and positive matrix fraction (PMF) model were used to identify potential sources of PM_2.5-bound trace elements. Daily mean concentration of PM_2.5 in cold season (25.41 μg m⁻³) was higher than that in hot season (13.10 μg m⁻³). The trace elements contributed 11.02 and 10.74% in total PM_2.5 mass concentrations in cold season and hot season, respectively. The results of EF analysis confirmed that Sb, Mo, and Cd were the top three anthropogenic trace elements in the PM_2.5; furthermore, carcinogenic elements (Cr, Ni, and As) and other trace elements (Na, K, V, Cu, Zn, Sr, Sn, Ba, and Pb) were attributable to anthropogenic emissions in both cold and hot seasons; however, highly enriched Li and Mn were observed only in cold season. The PMF model identified four main sources: iron and steel industry, soil and road dust, coal combustion, and traffic-related emission. Each of these sources has an annual mean contribution of 8.2, 27.5, 11.2, and 53.1%, respectively, to PM_2.5. The relative dominance of each identified source varies with changing seasons. The highest contributions occurred in cold season for iron and steel industry (66.2%), in hot season for traffic-related emission (58.4%), soil and road dust (22.0%), and coal combustion (2.8%). These findings revealed that the PM_2.5 mass concentration, PM_2.5-bound trace element concentrations, and their contributions were various by seasons.

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Issue Information - Instructions for Authors

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Issue Information

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Is there an association of ABO blood groups and Rhesus factor with alopecia areata?

Summary

Background/Objectives

Alopecia areata (AA) is an autoimmune disease characterized by noncicatricial hair loss localized on hair, beard, mustache, eyebrow, eyelash, and sometimes on the body. Although etiopathogenesis is not fully understood, many studies show remarkable associations between various diseases and ABO blood groups. However, there is no study with AA and blood groups.

Methods

Healthy people and patients with AA were included in this study. A total of 155 patients with AA and 299 healthy controls were included in the study.

Results

ABO blood group distribution in patients with AA and distribution of healthy donors were similar. However, Rhesus factor positivity in the AA group was significantly higher than in healthy donors. The relationship between stress and AA was high as known. But, ABO blood group and Rhesus factor were not in a significant connection with stress.

Conclusion

We conclude that there was no association between ABO blood group and AA, but the observed distribution of Rhesus blood group differed slightly but significantly from that of the healthy population. The result of the study shows a small but statistically significant difference in the Rh blood group between patients with AA and the healthy population blood groups. This result is important because it suggests that genetic factors may influence the development of AA. The role of blood groups in the development of AA remains to be determined. We believe that the studies which will be carried out in other centers with wider series will be more valuable to support this hypothesis.

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Is there an association of ABO blood groups and Rhesus factor with alopecia areata?

Summary

Background/Objectives

Methods

Healthy people and patients with AA were included in this study. A total of 155 patients with AA and 299 healthy controls were included in the study.

Results

Conclusion

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Abscopal effects of radiotherapy and combined mRNA-based immunotherapy in a syngeneic, OVA-expressing thymoma mouse model

Abstract

Background

Tumor metastasis and immune evasion present major challenges of cancer treatment. Radiotherapy can overcome immunosuppressive tumor microenvironments. Anecdotal reports suggest abscopal anti-tumor immune responses. This study assesses abscopal effects of radiotherapy in combination with mRNA-based cancer vaccination (RNActive^®).

Methods

C57BL/6 mice were injected with ovalbumin-expressing thymoma cells into the right hind leg (primary tumor) and left flank (secondary tumor) with a delay of 4 days. Primary tumors were irradiated with 3 × 2 Gy, while secondary tumors were shielded. RNA and combined treatment groups received mRNA-based RNActive^® vaccination.

Results

Radiotherapy and combined radioimmunotherapy significantly delayed primary tumor growth with a tumor control in 15 and 53% of mice, respectively. In small secondary tumors, radioimmunotherapy significantly slowed growth rate compared to vaccination (p = 0.002) and control groups (p = 0.01). Cytokine microarray analysis of secondary tumors showed changes in the cytokine microenvironment, even in the non-irradiated contralateral tumors after combination treatment.

Conclusion

Combined irradiation and immunotherapy is able to induce abscopal responses, even with low, normofractionated radiation doses. Thus, the combination of mRNA-based vaccination with irradiation might be an effective regimen to induce systemic anti-tumor immunity.

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Implications of Antimicrobial Usage to Prevent Bacteremia for Periodontal Therapy

Abstract

Purpose of Review

This review examines the current literature on periodontal treatment, bacteremia and prophylactic antibiotic usage to prevent the systemic adverse outcomes.

Recent Findings

Currently, it is not clear whether prophylactic antibiotic administration prevents bacterial endocarditis in patients with high risk.

Summary

Recent publications have resulted in significant changes in the concept of antibiotic prophylaxis. Available evidence does not support the previously published guidelines recommending prophylactic antibiotic usage prior to dental treatment. Potential harms and costs of antibiotic administration should be weighed against expected benefits. Clinicians are advised to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before prescription.

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The role of T2*-weighted gradient echo in the diagnosis of tumefactive intrahepatic extramedullary hematopoiesis in myelodysplastic syndrome and diffuse hepatic iron overload: a case report and review of the literature

Extramedullary hematopoiesis is the proliferation of hematopoietic cells outside bone marrow secondary to marrow hematopoiesis failure. Extramedullary hematopoiesis rarely presents as a mass-forming hepatic le...

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Could conjunctivitis in dupilumab treated atopic dermatitis patients be caused by colonization with Demodex and increased IL-17 levels? Reply from authors

Abstract

In studies in atopic dermatitis (AD), dupilumab has been associated with higher rates of conjunctivitis compared with placebo. Consistent with previous studies, in LIBERTY AD CAFÉ (NCT02755649), all cases but one were mild or moderate, most (62–89%) were recovered/resolved or recovering/resolving by end of treatment, and no patients permanently discontinued study treatment because of conjunctivitis.¹ No patients reported atopic keratoconjunctivitis in this study.

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Treatment of Subclinical Atrial Fibrillation: Does One Plus One Always Equal Two?.

Author: Gold, Michael R. MD, PhD

Page: 217-218

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Confusion Around Therapeutic Temperature Management Hypothermia After In-Hospital Cardiac Arrest?.

Author: Polderman, Kees H. MD, PhD; Varon, Joseph MD, PhD

Page: 219-221

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Phenotypic Consequences of a Genetic Predisposition to Enhanced Nitric Oxide Signaling.

Author: Emdin, Connor A. DPhil; Khera, Amit V. MD; Klarin, Derek MD; Natarajan, Pradeep MD; Zekavat, Seyedeh M. BSc; Nomura, Akihiro MD; Haas, Mary PhD; Aragam, Krishna MD; Ardissino, Diego MD; Wilson, James G. MD; Schunkert, Heribert MD; McPherson, Ruth MD; Watkins, Hugh MD, PhD; Elosua, Roberto MD, PhD; Bown, Matthew J. MD; Samani, Nilesh J. FRCP; Baber, Usman MD; Erdmann, Jeanette PhD; Gormley, Padhraig PhD; Palotie, Aarno MD, PhD; Stitziel, Nathan O. MD, PhD; Gupta, Namrata PhD; Danesh, John DPhil; Saleheen, Danish MBBS, PhD; Gabriel, Stacey PhD; Kathiresan, Sekar MD

Page: 222-232

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Nitric Oxide Signaling and Atherothrombosis Redux: Evidence From Experiments of Nature and Implications for Therapy.

Author: Loscalzo, Joseph MD, PhD

Page: 233-236

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Association Between Urinary Sodium and Potassium Excretion and Blood Pressure Among Adults in the United States: National Health and Nutrition Examination Survey, 2014.

Author: Jackson, Sandra L. PhD; Cogswell, Mary E. DrPH; Zhao, Lixia PhD; Terry, Ana L. MS; Wang, Chia-Yih PhD; Wright, Jacqueline DrPH; Coleman King, Sallyann M. MD; Bowman, Barbara PhD; Chen, Te-Ching PhD; Merritt, Robert MS; Loria, Catherine M. PhD

Page: 237-246

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Sodium and Potassium Intake in US Adults.

Author: Whelton, Paul K. MB, MD, MSc

Page: 247-249

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Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study.

Author: Nazerian, Peiman MD; Mueller, Christian MD; Soeiro, Alexandre de Matos MD; Leidel, Bernd A. MD; Salvadeo, Sibilla Anna Teresa MD; Giachino, Francesca MD; Vanni, Simone MD, PhD; Grimm, Karin MD; Oliveira, Mucio Tavares Jr MD, PhD; Pivetta, Emanuele MD, MSc; Lupia, Enrico MD, PhD; Grifoni, Stefano MD; Morello, Fulvio MD, PhD; for the ADvISED Investigators; Capretti, Elisa; Castelli, Matteo; Gualtieri, Simona; Trausi, Federica; Battista, Stefania; Bima, Paolo; Carbone, Federica; Tizzani, Maria; Veglio, Maria G.; Badertscher, Patrick; Boeddinghaus, Jasper; Nestelberger, Thomas; Twerenbold, Raphael

Page: 250-258

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Magnitude of Soluble ST2 as a Novel Biomarker for Acute Aortic Dissection.

Author: Wang, Yuan PhD, MD; Tan, Xin PhD; Gao, Hai PhD, MD; Yuan, Hui MD; Hu, Rong PhD, MD; Jia, Lixin PhD, MD; Zhu, Junming MD; Sun, Lizhong MD; Zhang, Hongjia MD; Huang, Lianjun MD; Zhao, Dong PhD, MD; Gao, Pei PhD *,; Du, Jie PhD *,,

Page: 259-269

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Biomarker-Assisted Diagnosis of Acute Aortic Dissection.

Author: Suzuki, Toru MD, PhD; Eagle, Kim A. MD

Page: 270-272

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Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients Without ST-Segment-Elevation Myocardial Infarction After Cardiac Arrest.

Author: Bascom, Karen E. MBChB; Dziodzio, John BA; Vasaiwala, Samip MD, MSc; Mooney, Michael MD; Patel, Nainesh MD; McPherson, John MD; McMullan, Paul MD; Unger, Barbara RN; Nielsen, Niklas MD, PhD; Friberg, Hans MD, PhD; Riker, Richard R. MD; Kern, Karl B. MD; Duarte, Christine W. PhD; Seder, David B. MD; for the International Cardiac Arrest Registry (INTCAR); May, Teresa DO; Sunde, Kjetil MD; Rubertsson, Sten MD; Smid, Ondrej MD; Soreide, Eldar MD; Hand, Robert MD; Rundgren, Malin MD; Valsson, Felix MD; Sadaka, Farid MD; Bekkers, Bas MD; Wanscher, Michael MD; Lindell, Eva-Lotta MD; Guldbrand, Pehr MD; Torstensson, Anders MD; Dybkowska, Krystyna MD; Israelsson, Johan MD; Skram, Ulrik MD; Guzowski, Michelle MD; Hopf, Hans-Bernd MD; Persson, Stefan MD; Chang, Ira MD; Samuelsson, Line MD; Oddby, Eva MD; Savolainen, Kristina MD; Zatterman, Richard MD; Rodriguez, Daniel MD; Mayer, Stephan MD; Fodisch, Markus MD; Oscarsson, Beata MD; Scheer, Hakan MD; Sarbinowski, Roman MD; Hyddmark, Ulf MD; Deye, Nicolas MD; Lindbom, Anna MD; Armani, Claudia MD; Forsberg, Sune MD; Ericsson, Anders B. MD

Page: 273-282

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Identifying Candidates for Advanced Hemodynamic Support After Cardiac Arrest.

Author: Bartos, Jason A. MD, PhD; Doonan, Aaron L. MD; Yannopoulos, Demetris MD

Page: 283-285

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Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure: An Individual Patient Data Meta-Analysis.

Author: Aimo, Alberto MD; Januzzi, James L. Jr MD; Vergaro, Giuseppe MD, PhD; Ripoli, Andrea EngD; Latini, Roberto MD; Masson, Serge PhD; Magnoli, Michela BSc; Anand, Inder S. MD, PhD; Cohn, Jay N. MD; Tavazzi, Luigi MD; Tognoni, Gianni MD; Gravning, Jorgen MD, PhD; Ueland, Thor PhD; Nymo, Stale H. MD; Brunner-La Rocca, Hans-Peter MD; Genis, Antoni Bayes MD, PhD; Lupon, Josep MD; de Boer, Rudolf A. MD; Yoshihisa, Akiomi MD, PhD; Takeishi, Yasuchika MD; Egstrup, Michael MD, PhD; Gustafsson, Ida MD, PhD; Gaggin, Hanna K. MD, MPH; Eggers, Kai M. MD, PhD; Huber, Kurt MD; Tentzeris, Ioannis MD; Tang, Wai H.W. MD; Grodin, Justin BSc; Passino, Claudio MD; Emdin, Michele MD, PhD

Page: 286-297

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Costly Medications Add Urgency to Physician-Patient Affordability Discussions.

Author: Kuehn, Bridget M.

Page: 298-299

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Young Male With Incessantly Wide Complex Tachycardia: What Is the Substrate of the Arrhythmia?.

Author: Miranda-Arboleda, Andres F. MD; Correa, Rafael MD; Saenz, Gloria MD; Agudelo, Juan F. MD; Ramirez, Juan D. MD

Page: 300-302

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Electronic Cigarette Smoking Increases Arterial Stiffness and Oxidative Stress to a Lesser Extent Than a Single Conventional Cigarette: An Acute and Chronic Study.

Author: Ikonomidis, Ignatios MD, PhD; Vlastos, Dimitrios MD; Kourea, Kallirrhoe MD, PhD; Kostelli, Gavriela MD; Varoudi, Maria MD; Pavlidis, George MD, PhD; Efentakis, Panagiotis MD; Triantafyllidi, Helen MD, PhD; Parissis, John MD, PhD; Andreadou, Ioanna PhD; Iliodromitis, Efstathios MD, PhD; Lekakis, John MD, PhD

Page: 303-306

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Effect of Intravenous Fentanyl on Ticagrelor Absorption and Platelet Inhibition Among Patients Undergoing Percutaneous Coronary Intervention: The PACIFY Randomized Clinical Trial (Platelet Aggregation With Ticagrelor Inhibition and Fentanyl).

Author: McEvoy, John W. MBBCh, MEHP, MHS; Ibrahim, Khalil MD; Kickler, Thomas S. MD; Clarke, William A. PhD; Hasan, Rani K. MD, MHS; Czarny, Matthew J. MD; Keramati, Ali R. MD; Goli, Rakesh R. BA; Gratton, Travis P. MD; Brinker, Jeffrey A. MD; Chacko, Matthews MD; Hwang, Chao-Wei MD, PhD; Johnston, Peter V. MD; Miller, Julie M. MD; Trost, Jeffrey C. MD; Herzog, William R. MD; Blumenthal, Roger S. MD; Thiemann, David R. MD; Resar, Jon R. MD; Schulman, Steven P. MD

Page: 307-309

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Letter by Madias Regarding Article, "Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement".

Author: Madias, John E. MD

Page: 310-311

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Response by Glaser et al to Letter Regarding Article, "Prosthetic Valve Endocarditis After Surgical Aortic Valve Replacement".

Author: Glaser, Natalie MD; Jackson, Veronica MD, PhD; Holzmann, Martin J. MD, PhD; Franco-Cereceda, Anders MD, PhD; Sartipy, Ulrik MD, PhD

Page: 312-313

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Letter by Jin-shan and Xue-bin Regarding Article, "Prospective Study of Adenosine on Atrioventricular Nodal Conduction in Pediatric and Young Adult Patients After Heart Transplantation".

Author: Jin-shan, He MD; Xue-bin, Li MD

Page: 314

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Letter by Ye et al Regarding Article, "Prospective Study of Adenosine on Atrioventricular Nodal Conduction in Pediatric and Young Adult Patients After Heart Transplantation".

Author: Ye, Ziliang MD; Su, Qiang MD, PhD; Li, Lang MD, PhD

Page: 315-316

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Could conjunctivitis in dupilumab treated atopic dermatitis patients be caused by colonization with Demodex and increased IL-17 levels? Reply from authors

Abstract

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"J BUON"[jour]; +46 new citations

46 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"J BUON"[jour]

These pubmed results were generated on 2018/01/15

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Clinical Thyroidology for the Public – Highlighted Article

From Clinical Thyroidology for the Public: Severe thyroid disease is associated with cognitive deficits that could be misdiagnosed as dementia. The association of milder forms of these thyroid conditions and cognitive deficits is less well understood. Read More….

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Clinical Thyroidology for the Public – Highlighted Article

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology for the Public – Highlighted Article appeared first on American Thyroid Association.

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Mass balance of arsenic fluxes in rivers impacted by gold mining activities in Paracatu (Minas Gerais State, Brazil)

Abstract

Arsenic (As) is a dangerous and carcinogenic element and drinking water is its main pathway of human exposure. Gold mines are widely recognized as important sources of As pollution. This work proposes the assessment of As distribution along watersheds surrounding "Morro do Ouro" gold mine (Paracatu, southeastern Brazil). A balance approach between filtered As fluxes (As < 0.45 μm) and suspended particulate material (AsSPM) in different river segments was applied. Ultrafiltration procedure was used to categorize As into the following classes: particulate > 0.1 μm, colloidal < 0.1 μm to > 10 kDa, dissolved < 10 kDa to > 1 kDa, and truly dissolved < 1 kDa. By applying this approach, arsenic contributions from mining facilities were quantified in order to identify critical fluvial segments and support decision makers in actions of remediation. The mass balance indicated the occurrence of a decreasing gradient from upstream to downstream: (i) of the As concentrations higher than the limit established by Brazilian law (10 μg L⁻¹); (ii) of the ratio between specific fluxes (g As km⁻² day⁻¹) and those determined using an uncontaminated watershed (a proxy for estimating the anthropic contribution), from 103 to 101; (iii) of the specific fluxes As < 0.45 μm and AsSPM from 102 to 100; and (iv) of the negative balance output minus input for each river segment that suggests As accumulation in sediments along the rivers in both urban and rural areas, mainly due to SPM sedimentation and sorption by Fe oxyhydroxides. Ultrafiltration shattering showed concentrations of decreasing As with particle size; the SPM load (> 0.1 μm) was almost one order higher to dissolved load (< 1 kDa).

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A Significant Treatable Cause of Hearing Loss in Our Time

Otosclerosis is often called the disease in which the patient hears nothing and the physician sees nothing. This alludes to the often significant degree of hearing loss experienced by the patient and the regular lack of visible physical findings in this disorder.

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Silicone Migration after Buttock Augmentation

Summary: We present the case of a 30-year-old woman who presented with enlarged inguinal lymph nodes and sacral hyperpigmentation 4 months after gluteal augmentation with silicone implants. Inguinal lymph node biopsy revealed granulomatous lymphadenitis due to foreign material. Upon right buttock implant revision, a 1.5-cm-thick capsule was noted with the absence of peri-implant inflammatory fluid and no macroscopic implant defects. Analysis of the implant by the manufacturer revealed a microscopic silicone leak. The patient's recovery was uneventful, and her symptoms resolved shortly after her reoperation.

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Cardiovascular Mortality Reduction With Empagliflozin in Patients With Type 2 Diabetes and Cardiovascular Disease

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Imaging the Intersection of Oxidative Stress, Lipids, and Inflammation: Progress Toward Personalized Care of Atherosclerosis

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Myocardial Inflammation Predicts Remodeling and Neuroinflammation After Myocardial Infarction

AbstractBackground

The local inflammatory tissue response after acute myocardial infarction (MI) determines subsequent healing. Systemic interaction may induce neuroinflammation as a precursor to neurodegeneration.

Objectives

This study sought to assess the influence of MI on cardiac and brain inflammation using noninvasive positron emission tomography (PET) of the heart-brain axis.

Methods

After coronary artery ligation or sham surgery, mice (n = 49) underwent serial whole-body PET imaging of the mitochondrial translocator protein (TSPO) as a marker of activated macrophages and microglia. Patients after acute MI (n = 3) were also compared to healthy controls (n = 9).

Results

Infarct mice exhibited elevated myocardial TSPO signal at 1 week versus sham (percent injected dose per gram: 8.0 ± 1.6 vs. 4.8 ± 0.9; p < 0.001), localized to activated CD68⁺ inflammatory cells in the infarct. Early TSPO signal predicted subsequent left ventricular remodeling at 8 weeks (r_partial = –0.687; p = 0.001). In parallel, brain TSPO signal was elevated at 1 week (1.7 ± 0.2 vs. 1.4 ± 0.2 for sham; p = 0.017), localized to activated microglia. After interval decline at 4 weeks, progressive heart failure precipitated a second wave of neuroinflammation (1.8 ± 0.2; p = 0.005). TSPO was concurrently up-regulated in remote cardiomyocytes at 8 weeks (8.8 ± 1.7, p < 0.001) without inflammatory cell infiltration, suggesting mitochondrial impairment. Angiotensin-converting enzyme inhibitor treatment lowered acute inflammation in the heart (p = 0.003) and brain (p = 0.06) and improved late cardiac function (p = 0.05). Patients also demonstrated elevation of cardiac TSPO signal in the infarct territory, paralleled by neuroinflammation versus controls.

Conclusions

The brain is susceptible to acute MI and chronic heart failure. Immune activation may interconnect heart and brain dysfunction, a finding that provides a foundation for strategies to improve heart and brain outcomes.

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JACC Instructions for Authors

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Imaging Dynamic Heart-Brain Interactions: Getting to the Heart of the Matter, Gray and White

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Antithrombotic Therapy in Peripheral Artery Disease: Generating and Translating Evidence Into Practice

Abstract

Atherosclerotic cardiovascular (CV) disease remains a major health concern affecting more than 200 million adults worldwide, and lower extremity peripheral artery disease (PAD) is associated with significant morbidity and mortality. Treatment strategies to reduce the burden of major adverse CV events and limb events have mainly involved the use of antiplatelet and statin medications. Unlike other types of atherosclerotic CV disease, the evidence base is not well developed for therapies in patients with PAD. Recently, studies from subgroups of patients with PAD and a large clinical trial of PAD patients have been published, signaling a burgeoning interest in studying this higher risk population. This review outlines the inherent CV risks of patients with PAD, risk reduction strategies, emerging clinical trial data, and opportunities for the CV community to generate evidence in real-world settings and translate evidence into practice as new therapies become available.

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Autosomal Recessive Hypercholesterolemia: Long-Term Cardiovascular Outcomes

AbstractBackground

Autosomal recessive hypercholesterolemia (ARH) is a rare lipid disorder characterized by premature atherosclerotic cardiovascular disease (ASCVD). There are sparse data for clinical management and cardiovascular outcomes in ARH.

Objectives

Evaluation of changes in lipid management, achievement of low-density lipoprotein cholesterol (LDL-C) goals and cardiovascular outcomes in ARH.

Methods

Published ARH cases were identified by electronic search. All corresponding authors and physicians known to treat these patients were asked to provide follow-up information, using a standardized protocol.

Results

We collected data for 52 patients (28 females, 24 males; 31.1 ± 17.1 years of age; baseline LDL-C: 571.9 ± 171.7 mg/dl). During a mean follow-up of 14.1 ± 7.3 years, there was a significant increase in the use of high-intensity statin and ezetimibe in combination with lipoprotein apheresis; in 6 patients, lomitapide was also added. Mean LDL-C achieved at nadir was 164.0 ± 85.1 mg/dl (–69.6% from baseline), with a better response in patients taking lomitapide (–88.3%). Overall, 23.1% of ARH patients reached LDL-C of <100 mg/dl. During follow-up, 26.9% of patients had incident ASCVD, and 11.5% had a new diagnosis of aortic valve stenosis (absolute risk per year of 1.9% and 0.8%, respectively). No incident stroke was observed. Age (≥30 years) and the presence of coronary artery disease at diagnosis were the major predictors of incident ASCVD.

Conclusions

Despite intensive treatment, LDL-C in ARH patients remains far from targets, and this translates into a poor long-term cardiovascular prognosis. Our data highlight the importance of an early diagnosis and treatment and confirm the fact that an effective treatment protocol for ARH is still lacking.

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Myocardial Dysfunction Following Brain Death

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Learning From Patients With Ultrarare Conditions: Cholesterol Hoof Beats

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PET/MR Imaging of Malondialdehyde-Acetaldehyde Epitopes With a Human Antibody Detects Clinically Relevant Atherothrombosis

AbstractBackground

Oxidation-specific epitopes (OSEs) are proinflammatory, and elevated levels in plasma predict cardiovascular events.

Objectives

The purpose of this study was to develop novel positron emission tomography (PET) probes to noninvasively image OSE-rich lesions.

Methods

An antigen-binding fragment (Fab) antibody library was constructed from human fetal cord blood. After multiple rounds of screening against malondialdehyde-acetaldehyde (MAA) epitopes, the Fab LA25 containing minimal nontemplated insertions in the CDR3 region was identified and characterized. In mice, pharmacokinetics, biodistribution, and plaque specificity studies were performed with Zirconium-89 (⁸⁹Zr)-labeled LA25. In rabbits, ⁸⁹Zr-LA25 was used in combination with an integrated clinical PET/magnetic resonance (MR) system. ¹⁸F-fluorodeoxyglucose PET and dynamic contrast-enhanced MR imaging were used to evaluate vessel wall inflammation and plaque neovascularization, respectively. Extensive ex vivo validation was carried out through a combination of gamma counting, near infrared fluorescence, autoradiography, immunohistochemistry, and immunofluorescence.

Results

LA25 bound specifically to MAA epitopes in advanced and ruptured human atherosclerotic plaques with accompanying thrombi and in debris from distal protection devices. PET/MR imaging 24 h after injection of ⁸⁹Zr-LA25 showed increased uptake in the abdominal aorta of atherosclerotic rabbits compared with nonatherosclerotic control rabbits, confirmed by ex vivo gamma counting and autoradiography. ¹⁸F-fluorodeoxyglucose PET, dynamic contrast-enhanced MR imaging, and near-infrared fluorescence signals were also significantly higher in atherosclerotic rabbit aortas compared with control aortas. Enhanced liver uptake was also noted in atherosclerotic animals, confirmed by the presence of MAA epitopes by immunostaining.

Conclusions

⁸⁹Zr-LA25 is a novel PET radiotracer that may allow noninvasive phenotyping of high-risk OSE-rich lesions.

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Cardiovascular Risk and Statin Eligibility of Young Adults After an MI: Partners YOUNG-MI Registry

AbstractBackground

Despite significant progress in primary prevention, the rate of MI has not declined in young adults.

Objectives

The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age.

Methods

The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation.

Results

Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001).

Conclusions

The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.

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Implications of Underlying Mechanisms for the Recognition and Management of Diabetic Cardiomyopathy

Abstract

Heart failure is a complex clinical syndrome, the incidence and prevalence of which is increased in diabetes mellitus, pre-diabetes, and obesity. Although this may arise from underlying coronary artery disease, it often occurs in the absence of significant major epicardial coronary disease, and most commonly manifests as heart failure with preserved ejection fraction. Despite epidemiological evidence linking diabetes to heart failure incidence and outcome, the presence of a distinct primary "diabetic" cardiomyopathy has been difficult to prove, because the link between diabetes and heart failure is confounded by hypertension, microvascular dysfunction, and autonomic neuropathy. Nonetheless, several mechanistic associations at systemic, cardiac, and cellular/molecular levels explain different aspects of myocardial dysfunction, including impaired cardiac relaxation, compliance, and contractility. This review seeks to describe recent advances and limitations pertinent to integrating molecular mechanisms, clinical screening, and potential therapeutic avenues for this condition.

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Identifying and Treating Young Patients at Risk for Cardiovascular Events

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Inorganic Nitrite Selectively Dilates Epicardial Coronary Arteries

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Impaired Recovery of Left Ventricular Function in Patients With Cardiomyopathy and Left Bundle Branch Block

AbstractBackground

Patients with left bundle branch block (LBBB) often respond to cardiac resynchronization therapy (CRT) with left ventricular ejection fraction (LVEF) improvement. Guideline-directed medical therapy (GDMT), not CRT, is first-line therapy for patients with reduced LVEF with LBBB. However, there are little data on how patients with reduced LVEF and LBBB respond to GDMT.

Objectives

This study examined patients with cardiomyopathy and sought to assess rates of LVEF improvement for patients with LBBB compared to other QRS morphologies.

Methods

Using data from the Duke Echocardiography Laboratory Database, the study identified patients with baseline electrocardiography and LVEF ≤35% who had a follow-up LVEF 3 to 6 months later. The study excluded patients with severe valve disease, a cardiac device, left ventricular assist device, or heart transplant. QRS morphology was classified as LBBB, QRS duration <120 ms (narrow QRS duration), or a wide QRS duration ≥120 ms but not LBBB. Analysis of variance testing compared mean change in LVEF among the 3 groups with adjustment for significant comorbidities and GDMT.

Results

There were 659 patients that met the criteria: 111 LBBB (17%), 59 wide QRS duration ≥120 ms but not LBBB (9%), and 489 narrow QRS duration (74%). Adjusted mean increase in LVEF over 3 to 6 months in the 3 groups was 2.03%, 5.28%, and 8.00%, respectively (p < 0.0001). Results were similar when adjusted for interim revascularization and myocardial infarction. Comparison of mean LVEF improvement between patients with LBBB on GDMT and those not on GDMT showed virtually no difference (3.50% vs. 3.44%). The combined endpoint of heart failure hospitalization or mortality was highest for patients with LBBB.

Conclusions

LBBB is associated with a smaller degree of LVEF improvement compared with other QRS morphologies, even with GDMT. Some patients with LBBB may benefit from CRT earlier than guidelines currently recommend.

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Left Ventricular Systolic Dysfunction in Transplantation Donor Hearts: Another Takotsubo Phenotype?

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Cardiomyopathy and Left Bundle Branch Block: A Farewell to Drugs?

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Reply: Transient Wall Motion Abnormalities in Donor Hearts With Improved Left Ventricular Systolic Dysfunction: Takotsubo Revisited?

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Improved Long-term Volume Retention of SVF-gel Grafting with Enhanced Angiogenesis and Adipogenesis

Background The apoptosis of mature adipocytes after fat grafting can result in chronic inflammation, absorption, and fibrosis, leading to unpredictable outcomes. Selective elimination of mature adipocytes may result in better outcomes and a different underlying retention mode. We previously developed a mature-adipocyte-free product, SVF-gel, derived from lipoaspirate, which eliminates adipocytes while preserving the stromal vascular fraction. This study investigated the retention and regeneration mode of SVF-gel grafting. Methods Nude mice were grafted with human-derived SVF-gel or Coleman fat. Detailed cellular events over 3 months were investigated histologically and immunohistochemically. Results The retention rate 90 days after grafting was significantly higher for SVF-gel grafts than for standard Coleman fat (82% ± 15% vs. 42% ± 9%, P

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Measurement of warping angle in human rib graft; Experimental study

To determine the warping angle of the costal cartilage in vivo. A nasal framework reconstruction with a rib graft was performed in a total of 130 patients. After the cartilage specimens were prepared, the remaining grafts were used for the experimental study. The angle of warping in all grafts was measured at 0, 30, and 60 minutes, after 24 hours and after one week. In this study, 8 subgroups of graft thicknesses from central and peripheral groups, which were determined according to the perichondral distance of the grafts, were evaluated, and the warping angles of a total of 48 osteochondral and chondral grafts were individually measured. Three-way analysis of variance was used to compare the change in warping over time to detect differences in the grafts. Significant differences were not observed in the 1-3 mm thick grafts of peripheral and central origin before 30 minutes(P>0.05), although significant differences were observed in these groups for all time periods after 30 minutes(P0.05). In the central origin grafts thinner than 1 mm, significant differences were not observed in the warping angle for all time periods(P>0.05), although significant differences were observed in the same grafts of peripheral origin(P

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Cheek Volumization and Nasolabial folds

The impression that cheek filling results in longitudinal shortening ("lift") of the skin and elevation of the nasolabial crease(NLC) or nasolabial fold (NLF) has become common within the facial injection community, but remains unsubstantiated. In this study, seventy-seven patients were evaluated pre and post-injection injection of the cheeks with an Hyaluronic Acid filler using a 3-dimensional camera system. A constant pattern of skin expansion away from the center of the injection and perpendicular to the surface of the skin was observed. A subgroup of 37 patients without differences in their pre and post-injection facial expression were analyzed by direct comparison and failed to demonstrate lateral traction (or "pull") on the intervening skin from the cheek injection site to the nasolabial crease. Further, there was no photographic difference in the nasolabial fold or nasolabial crease. The only patients who demonstrated photographic improvement of the medial face were those who had filler placed directly in the transition between the lateral nasolabial fold and cheek (nasojugal crease). It is likely that expanding the nasojugal crease is the direct visual cue that leads to perceived improvement in the nasolabial fold. No disclosures Corresponding author Val Lambros, MD , Clinical professor of Plastic Surgery, University of California Irvine, 2121 E Coast Highway #200, Corona Del Mar Ca 92925, Lambrosone@aol.com ©2018American Society of Plastic Surgeons

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Consequences of the F.D.A. Directed Moratorium on Silicone Gel Breast Implants – 1992-2006

The FDA silicone gel breast implant moratorium occurred 25 years ago. The immediate and long-term consequences of the moratorium are reviewed and assessed. Financial Disclosure Statement: Nothing to disclose. Corresponding Author: Norman M. Cole, M.D., 2208 Lake Ridge Drive, Belmont, NC 28012 USA ©2018American Society of Plastic Surgeons

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Commentary on Norm Cole’s “Moratorium Consequences.”

No abstract available

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“A fresh cadaver study on indocyanine green fluorescence lymphography: A new whole body imaging technique for investigating the superficial lymphatics.”

Background: Identification of the lymphatic system in cadavers is painstaking because lymphatic vessels have very thin walls and are transparent. Selection of appropriate contrast agents is a key factor for successfully visualizing the lymphatics. In this study, we introduce a new imaging technique of lymphatic mapping in whole body of fresh cadavers. Methods: Ten fresh human cadavers were used for this study. We injected 0.1 mL of indocyanine green fluorescence (ICG) solution subcutaneously at multiple spots along the watershed lines between lymphatic territories and hand and foot regions. After the body was scanned by the near infrared camera system, fluorescent tissues were harvested and histological examination was performed under the microscope equipped with the infrared camera system to confirm they were the lymphatics. Results: Subcutaneously injected ICG was immediately transported into the lymphatic vessels after gentle massage on the injection points. Sweeping massage along the lymphatic vessels facilitated ICG transport inside the lymphatic vessel to move towards the lymph nodes. The lymphatic system was visualized well in the whole body. Histological examinations confirmed that ICG was detected in the lymphatic lumens specifically, even when located far from the injected points. Conclusions: The lymphatic system could be visualized in whole body fresh cadavers, as in living bodies, using ICG fluorescence lymphography. Compatibility of ICG lymphography would be open to use cadaveric specimens for macro and microscopical analysis. Financial Disclosure Statement: The authors have no financial interest to declare in relation to the content of this article. Acknowledgments: This work was supported by the Japan Society for the Promotion of Science via Grants-in-Aid for Scientific Research (KAKENHI Award Number: 16K20358) and Research Foundation for the Electrotechnology of Chubu. Corresponding author: Akira Shinaoka, Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, 700-8558, Japan. Email: a-shinaoka@okayama-u.ac.jp ©2018American Society of Plastic Surgeons

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Antegrade Arterial and Portal Flushing Versus Portal Flushing Only for Right Lobe Live Donor Liver Transplantation - A Randomized Control Trial

AbstractIntroductionIn live donor liver transplantation (LDLT) portal flush only of the graft is done on the bench. There is no data on antegrade arterial flush along with portal flush of the graft.MethodsConsecutive patients undergoing elective right lobe LDLT were block-randomized to receive either portal flush only or both portal and antegrade arterial flush. The primary objectives were safety, rate of early allograft dysfunction (EAD), and impact on vascular and biliary complicationsResultsAfter randomization there were 40 patients in each group. Both groups had comparable preoperative, intra operative and donor variables. There were no adverse events related to arterial flushing. The portal and antegrade arterial flush group had significantly lower postoperative - bilirubin on days 7, 14 and 21(all p

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Midterm Outcome of Kidney Transplantation from Donors with Thin Basement Membrane Nephropathy

AbstractBackgroundThin basement membrane nephropathy (TBMN) is the most common cause of persistent glomerular hematuria. Most individuals with TBMN show a benign course, although it can be difficult to distinguish it from early stages of progressive renal diseases. However, only limited studies address the prognosis of donors with TBMN and their recipients.MethodsFrom 2007 to 2016, 11 recipients received kidney grafts from donors with TBMN, and their clinical data were analyzed retrospectively. Follow-up protocol kidney biopsies were given to the recipients at 10 days and 1 year after transplantation. The donors were also received a follow-up evaluation of their renal function and were interviewed via telephone survey.ResultsAll donors were living, and their kidney grafts showed TBMN on pre-transplantation biopsy. The recipients were followed for 57.4 ± 28.6 months posttransplantation. Seven recipients showed acute rejection by a median of 9.7 months and all recipients recovered their renal function after treatment. Although 1 kidney failed due to graft arterial occlusion, the functions of the others were preserved during the follow-up period. The donors were followed for 41.0 ± 39.1 months and additionally contacted via telephone survey (in total, 56.8 ± 32.0 months). All the donors maintained their renal function upon clinical follow-up without significant complications and denied any discomfort at the time of the telephone interview.ConclusionsKidney transplant donors with TBMN and their recipients maintained their renal function through midterm follow-up without significant complications. Therefore, kidney transplantation from donors with TBMN could be a safe option. Background Thin basement membrane nephropathy (TBMN) is the most common cause of persistent glomerular hematuria. Most individuals with TBMN show a benign course, although it can be difficult to distinguish it from early stages of progressive renal diseases. However, only limited studies address the prognosis of donors with TBMN and their recipients. Methods From 2007 to 2016, 11 recipients received kidney grafts from donors with TBMN, and their clinical data were analyzed retrospectively. Follow-up protocol kidney biopsies were given to the recipients at 10 days and 1 year after transplantation. The donors were also received a follow-up evaluation of their renal function and were interviewed via telephone survey. Results All donors were living, and their kidney grafts showed TBMN on pre-transplantation biopsy. The recipients were followed for 57.4 ± 28.6 months posttransplantation. Seven recipients showed acute rejection by a median of 9.7 months and all recipients recovered their renal function after treatment. Although 1 kidney failed due to graft arterial occlusion, the functions of the others were preserved during the follow-up period. The donors were followed for 41.0 ± 39.1 months and additionally contacted via telephone survey (in total, 56.8 ± 32.0 months). All the donors maintained their renal function upon clinical follow-up without significant complications and denied any discomfort at the time of the telephone interview. Conclusions Kidney transplant donors with TBMN and their recipients maintained their renal function through midterm follow-up without significant complications. Therefore, kidney transplantation from donors with TBMN could be a safe option. Corresponding author: Sang-il Min, Division of Transplantation and Vascular Surgery, Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Rep. of Korea (surgeonmsi@gmail.com) Authorship C.C. participated in study design, data acquisition, data analysis, interpretation, and writing of the article. S.A. participated in study design, data analysis, and interpretation. S-K.M. participated in study design, data analysis, and interpretation. J.H. participated in study design, interpretation, and writing of the article. C.A. participated in study design, data acquisition, and interpretation. Y.K. participated in study design, data acquisition, and interpretation. H.L. participated in study design, data acquisition, and interpretation. S-i.M. participated in study design, data acquisition, data analysis, interpretation, and writing of the article. Disclosure The authors declare no conflicts of interest. Funding None Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Beyond JAAD April 2018

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The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics

Background: Eye pain is a common complaint, but no previous studies have determined the most common causes of this presenting symptom. Our objective was to determine the most common causes of eye pain in 2 ophthalmology and neurology departments at academic medical centers. Methods: This was a retrospective cross-sectional analysis and chart review at the departments of ophthalmology and neurology at the University Hospital Zurich (USZ), University of Zürich, Switzerland, and the University of Utah (UU), USA. Data were analyzed from January 2012 to December 2013. We included patients aged 18 years or older presenting with eye pain as a major complaint. Results: Two thousand six hundred three patient charts met inclusion criteria; 742 were included from USZ and 1,861 were included from UU. Of these, 2,407 had been seen in an ophthalmology clinic and 196 had been seen in a neurology clinic. Inflammatory eye disease (conjunctivitis, blepharitis, keratitis, uveitis, dry eye, chalazion, and scleritis) was the underlying cause of eye pain in 1,801 (69.1%) of all patients analyzed. Although only 71 (3%) of 2,407 patients had migraine diagnosed in an ophthalmology clinic as the cause of eye pain, migraine was the predominant cause of eye pain in the neurology clinics (100/196; 51%). Other causes of eye pain in the neurology clinics included optic neuritis (44 patients), trigeminal neuralgia, and other cranial nerve disorders (8 patients). Conclusions: Eye pain may be associated with a number of different causes, some benign and others sight- or life-threatening. Because patients with eye pain may present to either a neurology or an ophthalmology clinic and because the causes of eye pain may be primarily ophthalmic or neurologic, the diagnosis and management of these patients often requires collaboration and consultation between the 2 specialties. Address correspondence to Kathleen B. Digre, MD, Johan A Moran Eye Center, University of Utah Health Sciences Center, 65 N Mario Capecchi Drive, Salt Lake City, UT 84132; E-mail: Kathleen.digre@hsc.utah.edu This investigation was supported by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah. Presented at the Annual Meeting of the North American Neuro-Ophthalmology Society, March 1, 2016, Tucson, AZ; Annual Scientific Meeting of the American Headache Society, June 11, 2016, San Diego, CA. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text and PDF versions of this article on the journal's Web site (http://ift.tt/2BFTkP1). R. C. Bowen and J. Koeppel contributed equally to the manuscript and should both be recognized as first authors. © 2018 by North American Neuro-Ophthalmology Society

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Invited Commentary: Evaluation of Horner Syndrome in the MRI Era

This Invited Commentary discusses the following article: Sadaka A, Schockman SL, Golnik KC. Evaluation of Horner syndrome in the MRI era. J Neuroophthalmol. 2017;37:268–272. Background: To identify the etiologies of adult Horner syndrome (HS) in the MRI era using a targeted evaluation approach and to assess the value and yield of targeted imaging. Methods: A retrospective chart review was performed of 200 adult outpatients with HS, confirmed with cocaine eyedrop testing. Patients were divided into subgroups based on the presence or absence of symptoms and those who did or did not receive additional testing with hydroxyamphetamine drops. Imaging was obtained based on pharmacologic localization and/or clinical evaluation. The etiology of HS and the yield of imaging were determined in all subgroups. Results: Imaging showed causative lesions in 24 of 179 (12.84%) imaged patients with HS, and 13 (69.0%) were determined "idiopathic." Of the patients who underwent testing with hydroxyamphetamine drops (132 patients), 86 had a postganglionic localization with an imaging yield of 8.1%, and 46 had preganglionic cause with an imaging yield of 21.7%. Fifty-three patients (26.5%) never noticed ptosis/anisocoria before examination, and the imaging yield in this subgroup was 2.8%. Eighteen of the 200 patients (9.0%) had serious pathology, including carotid artery dissection, brain, or neck mass, and 6 of these (31.6%) had acute symptoms and/or pain. Conclusion: HS is most often idiopathic with serious pathology being relatively infrequent. When determining etiology, the absence of symptoms is not predictive of the pathology. However, acute onset of symptoms and/or pain are possible indicators for serious pathology. Localizing the lesion using hydroxyamphetamine drops whenever obtainable and available is still an efficient way to target imaging evaluation. Address correspondence to Aki Kawasaki, MD, Department of Neuro-Ophthalmology, University of Lausanne, Hôpital Ophtalmique Jules Gonin, Avenue de France 15, Lausanne, 1004, Lausanne, Switzerland; E-mail: aki.kawasaki@fa2.ch The author reports no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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Evaluation of recombinant factor VIIa, tranexamic acid and desmopressin to reduce prasugrel-related bleeding: A randomised, placebo-controlled study in a rabbit model

BACKGROUND Prasugrel is a thienopyridine that inhibits platelet aggregation more rapidly and effectively than clopidogrel, with an increased bleeding risk. OBJECTIVE The current study aimed to evaluate the efficacy of three nonspecific haemostatic drugs – recombinant activated factor VII (rFVIIa), tranexamic acid and desmopressin (DDAVP) – to limit blood loss after administration of prasugrel in a rabbit model of bleeding while also evaluating any prothrombotic effects. DESIGN Randomised, placebo-controlled study. SETTING Faculty of Medicine, University of Geneva, Switzerland, in 2013. ANIMALS Anaesthetised and artificially ventilated rabbits (n=56). INTERVENTIONS Animals were randomly allocated to one of five groups: control (placebo–placebo), prasugrel–placebo, rFVIIa (prasugrel–rFVIIa 150 μg kg−1), tranexamic acid (prasugrel–tranexamic acid 20 mg kg−1) or DDAVP (prasugrel–DDAVP 1 μg kg−1). Two hours after an oral prasugrel loading dose (4 mg kg−1), a stenosis and an injury were inflicted on the carotid artery to induce cyclic flow reductions (CFRs) due to thrombosis. Haemostatic drugs were administered during the ensuing observation period. MAIN OUTCOME MEASURES Standardised hepatosplenic sections were performed to evaluate the primary endpoint of blood loss, monitored for 15 min. Ear-immersion bleeding time and incidence of CFRs were secondary endpoints. RESULTS Prasugrel decreased ADP-induced platelet aggregation (light transmission method) from 66 ± 4% (mean ± SD) to 41 ± 7% (P

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Comparing peri-operative complications of paediatric and adult anaesthesia: A retrospective cohort study of 81 267 cases

BACKGROUND Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved. OBJECTIVE The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery. DESIGN Retrospective cohort study. SETTING The study was performed at the University Medical Centre Groningen in the 4 years between 1 January 2010 and the 31 December 2013. MAIN OUTCOME MEASURES Complications and their severity were graded according to the standard complication score (20 items) of the Dutch Society of Anaesthesia. Univariate and multivariate regression analysis was used to identify independent risk factors for the reported complications. RESULTS A total of 81 267 anaesthetic cases were included. In the paediatric cohort, there were 410 (2.9%) complications and 1675 (2.5%) in the adults. In both cohorts age, American Society of Anaesthesiologists classification and emergency treatment were independent risk factors for complications. With respect to age, infants less than 1 year were at the highest risk, whereas in the adult cohort, increased age was related to a greater number of complications. The incidences of the specific complications were different between both cohorts. Upper airway obstruction was more frequently observed in paediatric patients (26%), whereas in the adults, complications with the highest incidence concerned conversion of regional-to-general anaesthesia (25%) and hypotension (17%). CONCLUSION Risk factors for all peri-operative complications were similar for paediatric and adult anaesthesia. However, the incidence of specific complications differed between both age categories. Correspondence to Andrie C. Westerkamp, MD, PhD, Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Box 30.001, 9700 RB Groningen, The Netherlands Tel: +31 50 3613155; fax: +31 50 3613763; e-mail: ac.westerkamp@umcg.nl © 2018 European Society of Anaesthesiology

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Evaluation of recombinant factor VIIa, tranexamic acid and desmopressin to reduce prasugrel-related bleeding: A randomised, placebo-controlled study in a rabbit model

Comparing peri-operative complications of paediatric and adult anaesthesia: A retrospective cohort study of 81 267 cases

Chronological Progression of an Enlarged Styloid Process: A Case Report of Eagle Syndrome

Eagle syndrome is characterized by an elongated styloid process. However, the time frame over which the styloid process becomes elongated and extends is unknown. How the condition worsens over time is also unclear. To date, there has been no report describing the chronologic change that occurs in the styloid process in Eagle syndrome. We describe a 53-year-old patient with Eagle syndrome in whom the styloid process enlarged progressively over time and the elongated styloid process fused with the hyoid bone. The styloid process was resected via a transcervical approach, and the patient's subjective symptoms improved. This is the first report showing how the styloid process can enlarge over a few years in a patient with Eagle syndrome. Surgical resection via a transcervical approach is an appropriate treatment for a patient in whom the styloid process has become excessively enlarged and elongated.

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The ethics of interventional procedures for patients too ill for surgery

Purpose of review Minimally invasive interventional procedures are increasingly popular options for patients who are high-risk candidates for open surgical procedures. It is unclear how to proceed in the rare circumstance of a complication during an interventional procedure, where addressing the complication would require exposing the patient to the full risk that was being avoided with the minimally invasive technique. This review provides recommendations on how to approach this paradoxical scenario. Recent findings Risk stratification, communication frameworks, and advanced care planning can facilitate shared decision-making between physicians and patients. Risk stratification may include mortality predictive models, disability and frailty scores, and patient-centered outcome studies. In the event of procedural complication or failure, aggressive surgical treatment or limited repair should be guided by patient preferences to best ensure value concordant care. Summary Interventional procedures, and emergent open surgery, should be offered as long as patients are fully informed about the benefits and risks, including the implications of potential life-sustaining treatments, and whether their respective goals of treatment are consistent with the intervention. Implementing this framework will require a cultural shift in physician attitudes to recognize that in some cases, nonintervention or less aggressive treatment may be a reasonable alternative to surgical intervention. Correspondence to Michael Nurok, Cedars-Sinai Heart Institute, 127 S. San Vicente Blvd., A3100, Los Angeles, CA, 90048, USA. Tel: +1 310 248 7369; e-mail: michael.nurok@cshs.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Oxygen in the critically ill: friend or foe?

Purpose of review To examine the potential harmful effects of hyperoxia and summarize the results of most recent clinical studies evaluating oxygen therapy in critically ill patients. Recent findings Excessive oxygen supplementation may have detrimental pulmonary and systemic effects because of enhanced oxidative stress and inflammation. Hyperoxia-induced lung injury includes altered surfactant protein composition, reduced mucociliary clearance and histological damage, resulting in atelectasis, reduced lung compliance and increased risk of infections. Hyperoxemia causes vasoconstriction, reduction in coronary blood flow and cardiac output and may alter microvascular perfusion. Observational studies showed a close relationship between hyperoxemia and increased mortality in several subsets of critically ill patients. In absence of hypoxemia, the routine use of oxygen therapy in patients with myocardial infarction, stroke, traumatic brain injury, cardiac arrest and sepsis, showed no benefit but rather it seems to be harmful. In patients admitted to intensive care unit, a conservative oxygen therapy aimed to maintain arterial oxygenation within physiological range has been proved to be well tolerated and may improve outcome. Summary Liberal O2 use and unnecessary hyperoxia may be detrimental in critically ill patients. The current evidence supports the use of a conservative strategy in O2 therapy to avoid patient exposure to unnecessary hyperoxemia. Correspondence to Professor Massimo Girardis, Anesthesia and Intensive Care Unit, Department of Anaesthesia and Intensive Care, University Hospital of Modena, Via del Pozzo 71, 41124 Modena, Italy. E-mail: girardis.massimo@unimo.it Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Deep vein thrombosis and venous thromboembolism in trauma

Purpose of review Deep vein thrombosis (DVT) and pulmonary embolus are major causes of hospital-related morbidity and mortality, and are recognized as complications in patients with traumatic injury. Despite the significant morbidity and mortality associated with DVTs, prophylaxis and treatment are still not well understood and remain the subject of research and debate. Recent findings Elements of the patient's history and physical examination, along with thromboelastography, can be used to predict patients who are at greatest risk of DVT and venous thromboembolism (VTE). Novel assays and biomarkers hold promise for more accurate evaluation of coagulation status. Patients with traumatic injury are routinely treated with either mechanical or pharmacological treatments to prevent DVT, and a growing body of evidence suggests that DVT prophylaxis should be initiated as early as possible in a patient's hospital course. Summary In trauma patients with traumatic injury, early identification and targeted VTE prophylaxis in trauma patients may prevent this life-threatening complication. Correspondence to Keith J. Ruskin, MD, Department of Anesthesia and Critical Care, University of Chicago School of Medicine, 5841 S Maryland Avenue, MC4028, Chicago, IL 60637, USA. Tel: +1 773 834 2369; e-mail: ruskin@uchicago.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Activation state of circulating eosinophils in nasal polyposis

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common disease with an uncertain pathophysiology. It is characterized by polyps rich in eosinophils, with an activation status already investigated at the tissue level. In a group of CRSwNP patients, we assessed the activation status of circulating eosinophils in the blood before migration into tissues.

Methods

Thirteen patients with CRSwNP and 16 healthy volunteers were enrolled. Several biologic parameters were studied: blood count of eosinophils; plasma eosinophil cationic protein; oxidative metabolism by chemiluminescence at baseline or when activated by phorbol 12-myristate 13-acetate or platelet-activating factor, with or without interleukin-5 (IL-5); percent of granulosar cells; and mean fluorescence intensity (MFI) by flow cytometry.

Results

The mean number of eosinophils was significantly higher in patients with CRSwNP, whose eosinophils showed increased oxidative metabolism in the basal or activated state significantly decreasing in the presence of IL-5. There was also a higher percentage of CD49d⁺, CD25⁺, and CCR3⁺ cells in patients, and a nonsignificant decrease in descending order in MFI between the control group, patients with normal eosinophil levels, patients with hypereosinophilia, and patients with aspirin-exacerbated respiratory disease.

Conclusion

This study demonstrates a priming state of circulating eosinophils in CRSwNP patients when compared with healthy controls, as evidenced by the extent of oxidative metabolism, with increased sensitivity to IL-5 and by the observed variations of percent and MFI of CD49d, CCR3, and CD25. This priming is thus found at the peripheral level and occurs before the migration of eosinophils to polyps, reflecting the systemic and not just local nature of abnormalities in CRSwNP.

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Preclinical therapeutic efficacy of the ciprofloxacin-eluting sinus stent for Pseudomonas aeruginosa sinusitis

Background

The ciprofloxacin-coated sinus stent (CSS) has unique therapeutic potential to deliver antibiotics to the sinuses. The objective of this study is to evaluate the efficacy of the CSS stent in eliminating Pseudomonas aeruginosa infection in a rabbit model of sinusitis.

Methods

A ciprofloxacin-eluting sinus stent was created by coating ciprofloxacin/Eudragit RS100 on biodegradable poly-D/L-lactic acid (2 mg). After analyzing in-vitro inhibition of P aeruginosa (PAO-1 strain) biofilm formation, a total of 8 stents (4 shams, 4 CSSs) were placed unilaterally in rabbit maxillary sinuses via dorsal sinusotomy after inducing infection for 1 week with PAO-1. Animals were assessed 2 weeks after stent insertion with nasal endoscopy, sinus culture, computed tomography (CT) scan, histopathology, and scanning electron microscopy (SEM).

Results

PAO-1 biofilm formation was significantly reduced in vitro with exposure to the CSS (p < 0.0001). Insertion of the stent in PAO-1–infected rabbits for 2 weeks resulted in significant improvement in sinusitis according to endoscopy scoring (p < 0.0001) and CT scoring (p < 0.002). Histology and SEM revealed marked improvement in the structure of the mucosa and submucosa with no detection of biofilm structures in the CSS cohort.

Conclusion

Although this study had a small sample size, we identified robust therapeutic efficacy of the CSS by reducing bacterial load and biofilm formation of P aeruginosa in a preclinical model of sinusitis after placement for 2 weeks.

http://ift.tt/2myqtWS

Antibiotic use patterns in endoscopic sinus surgery: a survey of the American Rhinologic Society membership

Background

There is a paucity of data supporting antibiotic use in endoscopic sinus surgery (ESS). The objective of this study is to determine perioperative antibiotic use patterns and factors which influence use in ESS.

Methods

An online-based survey was distributed to members of the American Rhinologic Society (ARS). Outcomes included timing of perioperative antibiotic use, practice environment, years of experience, and patient factors that influenced antibiotic use.

Results

There were 204 responses (response rate 18.3%); 36.8% of respondents were in academic positions, 32.8% were in private practice, and 30.4% were in academic-affiliated private practice; 20.6% routinely gave preoperative antibiotics, most commonly to reduce bacterial burden (59.5%) and mucosal inflammation (59.5%); 54.4% routinely gave intraoperative antibiotics, most commonly to reduce the risk of postoperative infection (63.1%); 62.3% routinely gave postoperative antibiotics, citing the need to reduce the risk of postoperative infection (75.6%). Diagnosis influenced postoperative antibiotic use in 63.0%. Preoperative antibiotics were more likely to be prescribed by respondents with more than 5 years of experience (odds ratio [OR] 2.97; 95% confidence interval [CI], 1.04 to 8.54; p = 0.043). Compared to private practitioners, academicians were more likely to give intraoperative antibiotics (OR 2.68; 95% CI, 1.39 to 5.17; p = 0.003), but not preoperative or postoperative antibiotics. Use of nonabsorbable packing was significantly associated with use of postoperative antibiotics (OR 2.01; 95% CI, 1.07 to 3.77; p = 0.031).

Conclusion

This study demonstrates the significant variation in perioperative antibiotic use among otolaryngologists. These results provide support for the establishment of evidence-based practice guidelines for perioperative antibiotic use in ESS.

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Prevalence of metabolic syndrome in children with moderate to severe psoriasis treated with TNF inhibitors in comparison to conventional agents

Abstract

Association of childhood psoriasis with metabolic syndrome has not been studied well. TNF-alfa contributes to the inflammation seen in metabolic syndrome, and recently etanercept has shown to reduce the levels of inflammatory markers. Assessment of prevalence of metabolic syndrome in juvenile psoriasis patients in Kuwait. We included 236 patients with moderate to severe psoriasis below 18 years treated for at least 24 weeks with TNF inhibitors (Group A), and equal number of age and sex matched cases treated with conventional medications (Group B). The metabolic syndrome (MBS) was defined according to the International Diabetes Foundation (IDF 2007 criteria for children). Increased waist circumference was seen in 56.77% of cases in Group A. Triglyceridemia was less frequent in Group A. MBS was higher in Group B [41·52% vs. 50·42%, odds ratio (OR) 1·76, 95% CI 1.19–2.41; p = .005]. Psoriasis is associated with higher prevalence of metabolic syndrome in children. Six months of anti TNF treatment showed lesser association with metabolic syndrome. With fasting blood glucose, and serum TG seen in significantly lesser number of patients in this group.

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Clinical evaluation of a novel fractional radiofrequency device for hair growth: Fractional radiofrequency for hair growth stimulation

Abstract

AGA is a common disorder. Different treatments are available to prevent hair loss and achieve hair growth with variable results. The purpose of the present study was to evaluate the efficacy and safety of a novel fractional radiofrequency (RF) device (HairLux, Innogen Technologies Ltd., Yokneam, Israel), to prevent hair loss and induce hair growth. Twenty-five patients received 10 fractional RF treatments every 2 weeks, and were followed up 2 months after the last treatment. All patients were evaluated by global photography. In 10 patients, blinded manual hair counts were performed. Patients demonstrated less hair shedding, fuller hair, and faster hair growth. There was an average increase of 31.6% in hair density (based on hair counts) and 18% increase in hair shaft thickness. All subjects tolerated the treatments well. The HairLux device is effective and safe for hair growth stimulation in AGA. Ten treatment sessions are recommended to maximize results.

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Prevalence of metabolic syndrome in children with moderate to severe psoriasis treated with TNF inhibitors in comparison to conventional agents

Abstract

http://ift.tt/2FE0vtH

Clinical evaluation of a novel fractional radiofrequency device for hair growth: Fractional radiofrequency for hair growth stimulation

Abstract

http://ift.tt/2EILOEs

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Δευτέρα 15 Ιανουαρίου 2018

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