A Chronic Glottic Foreign Body Diagnosed by Radiograph after 9 Months of Symptoms

A six-year-old girl presented to an emergency room after describing choking on a rubber band. She was in no distress and was discharged. Over the course of the next 9 months, she had numerous outpatient and emergency room visits due to intermittent stridor, difficulty breathing, and hoarseness. Eventually, dedicated airway films revealed a laryngeal foreign body. During rigid bronchoscopy, a two-centimeter rubber band was discovered in the larynx. It extended from the supraglottis, through the glottis, and into the subglottis. It was successfully removed. The patient was asymptomatic 24 hours later. This case highlights the appropriate evaluation and management of a child with stridor.

https://ift.tt/2ICRI0d

MRI as an Alternative to Second Look Mastoid Surgery

Abstract

The main goal of surgery of cholesteatoma is eradication of the disease and revision surgery is indicated when a dry and safe ear has not been achieved. Residual cholesteatoma usually occurs at the sites that are difficult to reach with an operating microscope, such as posterior tympanum and anterior epitympanic recess. Computed tomography can be performed to delineate the extent of disease. High-resolution computed tomography scanning is important for planning for surgery and is indicated for all revision mastoid operations. Magnetic resonance imaging is superior to computed tomography in tissue characterization for diagnosis of recurrent cholesteatoma. To evaluate the cases of recurrent cholesteatoma comparing the intraoperative surgical findings with the preoperative MRI radiological findings and if the preoperative MRI can replace the second look surgery for cholesteatoma. This study was applied on 60 patients that have a recurrent cholesteatoma after previous mastoid surgery. A preoperative radiological evaluation was done by Magnetic resonance, surgical management was done by canal wall up or canal wall down mastoidectomy to exclude residual disease. Then, radiological, and surgical findings correlation was done. Diffusion-weighted MRI successfully detected 42 cases out of the 45 cases of surgically proved cholesteatoma, it has accuracy 95%, sensitivity 93.33%, specificity 100%, PPV 100% and NPV 83.33%. MRI is better than CT in tissue characterization for diagnosis of recurrent cholesteatoma, and can replace the unnecessary second look surgery of cholesteatoma

https://ift.tt/2KLPS9P

Efficacy of Tinnitus Retraining Therapy, A Modish Management of Tinnitus: Our Experience

Abstract

Tinnitus retraining therapy involves masking of tinnitus at sound perception level in combination with structured counselling sessions. To assess efficacy of Tinnitus retraining therapy (TRT) in Patients of Tinnitus with Sensori Neural Hearing loss. Prospective study was carried out on patients who presented with Tinnitus in ENT OPD from December 2015 to December 2016. Severity of tinnitus was documented using Tinnitus handicap inventory scale. Response to tinnitus is evaluated at the end of 3 months. In our study 57 patients in age group 21–78 years were selected and Tinnitus retraining therapy was administered. Most of patients had moderate (75.43%) perception of tinnitus before initiation of therapy. After completion of therapy tinnitus completely disappeared in 34 (59.65%) patients. Improvement in Tinnitus perception was observed in total of 49 (85.96%) patients. There was no improvement in Tinnitus perception in 8 (14.03%) patients. TRT aims in reducing the tinnitus perception by inducing habituation of tinnitus-induced reactions allowing patients to achieve control over their tinnitus, live a normal life, and participate in everyday activities.

https://ift.tt/2s2hAbA

Post-operative Sensorineural Hearing Loss After Middle Ear Surgery

Abstract

Chronic suppurative otitis media is managed by tympanomastoid surgery often requires mastoid drilling. Sometimes patients develop sensorineural hearing loss after middle ear surgery. Objective of the study was to compare pre and post operative bone conduction thresholds after middle ear surgeries. The study was conducted on 90 patients who had undergone middle ear surgeries, 30 patients of tympanoplasty (group I), modified intact canal wall mastoidectomy and tympanoplasty type-I (group II) and modified radical mastoidectomy (group III) each ware included. Demographic and clinical data were reviewed. Duration of surgery, ossicular and middle ear status and drilling time noted. Pre operative and post operative (after 3–4 months) bone conduction thresholds were compared statistically. A value of p < 0.05 was considered statistical significant. The average pre-operative hearing loss of study group was 43.78 ± 14.22 dB. Though postoperatively mean air conduction threshold improved to 36.07 ± 13.05 dB, six patients presented with deterioration of hearing. Mastoidectomy has been performed in all six. Post-operative worsening of bone conduction was seen in three patients (13.75–21.5 dB), one patient of group II and two patients of group III developed postoperative worsening of bone conduction thresholds. Significant hearing losses may occur after tympanomastoid surgery in few patients. While we are evaluating the results besides reporting average results such individual patient should be identified.

https://ift.tt/2IGhvAz

Micro-scale pollution mechanism of dust diffusion in a blasting driving face based on CFD-DEM coupled model

Abstract

In order to investigate the diffuse pollution mechanisms of high-concentration dusts in the blasting driving face, the airflow-dust coupled model was constructed based on CFD-DEM coupled model; the diffusion rules of the dusts with different diameters at microscopic scale were analyzed in combination with the field measured results. The simulation results demonstrate that single-exhaust ventilation exhibited more favorable dust suppression performance than single-forced ventilation. Under single-exhaust ventilation condition, the motion trajectories of the dusts with the diameter smaller than 20 μm were close to the airflow streamline and these dusts were mainly distributed near the footway walls; by contrast, under single-forced ventilation condition, the motion trajectories of the dust particles with a diameter range of 20~40 μm were close to the airflow streamlines, and a large number of dusts with the diameter smaller than 20 μm accumulated in the regions 5 m and 17~25 m away from the head-on section. Moreover, under the single-exhaust ventilation, the relationship between dust diameter D and negative-pressured-induced dust emission ratio P can be expressed as P = − 25.03ln(D) + 110.39, and the dust emission ratio was up to 74.36% for 7-μm dusts, and the path-dependent settling behaviors of the dusts mainly occurred around the head-on section; under single-forced ventilation condition, the z value of the dusts with the diameter over 20 μm decreased and the dusts with a diameter smaller than 7 μm are particularly harmful to human health, but their settling ratios were below 22.36%.

Graphical abstract

The airflow-dust CFD-DEM coupling model was established. The numerical simulation results were verified. The migration laws of airflow field were obtained in a blasting driving face. The diffusion laws of dusts were obtained after blasting.

https://ift.tt/2J34wfC

Preterm Birth Changes Networks of Newborn Cortical Activity

https://ift.tt/2GI5tol

MRI as an Alternative to Second Look Mastoid Surgery

Abstract

The main goal of surgery of cholesteatoma is eradication of the disease and revision surgery is indicated when a dry and safe ear has not been achieved. Residual cholesteatoma usually occurs at the sites that are difficult to reach with an operating microscope, such as posterior tympanum and anterior epitympanic recess. Computed tomography can be performed to delineate the extent of disease. High-resolution computed tomography scanning is important for planning for surgery and is indicated for all revision mastoid operations. Magnetic resonance imaging is superior to computed tomography in tissue characterization for diagnosis of recurrent cholesteatoma. To evaluate the cases of recurrent cholesteatoma comparing the intraoperative surgical findings with the preoperative MRI radiological findings and if the preoperative MRI can replace the second look surgery for cholesteatoma. This study was applied on 60 patients that have a recurrent cholesteatoma after previous mastoid surgery. A preoperative radiological evaluation was done by Magnetic resonance, surgical management was done by canal wall up or canal wall down mastoidectomy to exclude residual disease. Then, radiological, and surgical findings correlation was done. Diffusion-weighted MRI successfully detected 42 cases out of the 45 cases of surgically proved cholesteatoma, it has accuracy 95%, sensitivity 93.33%, specificity 100%, PPV 100% and NPV 83.33%. MRI is better than CT in tissue characterization for diagnosis of recurrent cholesteatoma, and can replace the unnecessary second look surgery of cholesteatoma

https://ift.tt/2KLPS9P

Efficacy of Tinnitus Retraining Therapy, A Modish Management of Tinnitus: Our Experience

Abstract

Tinnitus retraining therapy involves masking of tinnitus at sound perception level in combination with structured counselling sessions. To assess efficacy of Tinnitus retraining therapy (TRT) in Patients of Tinnitus with Sensori Neural Hearing loss. Prospective study was carried out on patients who presented with Tinnitus in ENT OPD from December 2015 to December 2016. Severity of tinnitus was documented using Tinnitus handicap inventory scale. Response to tinnitus is evaluated at the end of 3 months. In our study 57 patients in age group 21–78 years were selected and Tinnitus retraining therapy was administered. Most of patients had moderate (75.43%) perception of tinnitus before initiation of therapy. After completion of therapy tinnitus completely disappeared in 34 (59.65%) patients. Improvement in Tinnitus perception was observed in total of 49 (85.96%) patients. There was no improvement in Tinnitus perception in 8 (14.03%) patients. TRT aims in reducing the tinnitus perception by inducing habituation of tinnitus-induced reactions allowing patients to achieve control over their tinnitus, live a normal life, and participate in everyday activities.

https://ift.tt/2s2hAbA

Post-operative Sensorineural Hearing Loss After Middle Ear Surgery

Abstract

Chronic suppurative otitis media is managed by tympanomastoid surgery often requires mastoid drilling. Sometimes patients develop sensorineural hearing loss after middle ear surgery. Objective of the study was to compare pre and post operative bone conduction thresholds after middle ear surgeries. The study was conducted on 90 patients who had undergone middle ear surgeries, 30 patients of tympanoplasty (group I), modified intact canal wall mastoidectomy and tympanoplasty type-I (group II) and modified radical mastoidectomy (group III) each ware included. Demographic and clinical data were reviewed. Duration of surgery, ossicular and middle ear status and drilling time noted. Pre operative and post operative (after 3–4 months) bone conduction thresholds were compared statistically. A value of p < 0.05 was considered statistical significant. The average pre-operative hearing loss of study group was 43.78 ± 14.22 dB. Though postoperatively mean air conduction threshold improved to 36.07 ± 13.05 dB, six patients presented with deterioration of hearing. Mastoidectomy has been performed in all six. Post-operative worsening of bone conduction was seen in three patients (13.75–21.5 dB), one patient of group II and two patients of group III developed postoperative worsening of bone conduction thresholds. Significant hearing losses may occur after tympanomastoid surgery in few patients. While we are evaluating the results besides reporting average results such individual patient should be identified.

https://ift.tt/2IGhvAz

Cu-based nanocatalysts for electrochemical reduction of CO2

Publication date: Available online 21 May 2018
Source:Nano Today
Author(s): Huan Xie, Tanyuan Wang, Jiashun Liang, Qing Li, Shouheng Sun
Understanding CO2 reduction reaction (CO2RR) and developing robust catalysts for selective CO2RR is key to closing carbon cycle and to achieving energy sustainability with desired environmental remediation. Electrochemical CO2RR on a catalyst surface is an attractive method to realize high reaction activity and selectivity under mild reaction conditions. Among various catalysts studied thus far, metallic Cu-based nanocatalysts have demonstrated to be promising for selective CO2RR to HCOOH, CO or, more importantly, to CH4, C2H4 and C2H6 with relatively high efficiency. This review summarizes recent progresses made on these Cu-based nanocatalysts for CO2RR, including fundamental of electrochemical CO2RR, representative approaches to Cu-based nanocatalysts via nanoporous structure, nanoparticle size, composition, surface, support and morphology controls. The review should offer readers some important insights on Cu-catalyzed CO2RR, and will further help readers in their efforts to design and develop robust catalysts for active and selective CO2RR.

Graphical abstract

https://ift.tt/2s2cpsa

Detection of plasma MMP-9 within minutes. Unveiling some of the clues to develop fast and simple electrochemical magneto-immunosensors

Publication date: 15 September 2018
Source:Biosensors and Bioelectronics, Volume 115
Author(s): Gisela Ruiz-Vega, Alicia García-Robaina, Manel Ben Ismail, Helena Pasamar, Teresa García-Berrocoso, Joan Montaner, Mohammed Zourob, Ali Othmane, F. Javier del Campo, Eva Baldrich
Magnetic beads (MB) have been extensively used to produce sensitive and efficient electrochemical magneto-immunosensors. However, MB effective handling requires training, and MB washing after each incubation step is time consuming and contributes to raise result variability. Consequently, most of the electrochemical magneto-immunosensors reported to date, which entailed relatively long and complex multi-step procedures, would be difficult to carry out at point-of-care (POC) settings or by laypersons. For this reason, here we targeted the development of a simplified detection path, which is fast and simple enough to be operated at a POC setting, sufficiently efficient to provide analyte quantitation comparable to classical diagnostic methods, and dependent on minimal technical requirements to facilitate method global exploitation. As a proof-of-concept, we optimized an extremely simple, fast and efficient electrochemical magneto-immunosensor for detection of matrix metalloproteinase 9 (MMP-9). To accomplish this, we optimized MB immunomodification, produced an immunomodified Poly-HRP signal amplifier, developed a single-step magneto-immunoassay, and optimized electrochemical detection using a multiplexed magnetic holder and a ready-to-use commercial substrate solution. The sensor was finally calibrated by detecting MMP-9 in clinical samples. This electrochemical magneto-immunosensor detected MMP-9 in just 12–15 min, displaying linear response between 0.03 and 2 ng mL⁻¹ of MMP-9, limits of detection (LOD) and quantification (LOQ) of 13 pg mL⁻¹ and 70 pg mL⁻¹, respectively, %CV< 6%, and accurate quantification of MMP-9 in patient plasma samples. These results were comparable to those afforded by a 5-h reference ELISA that used the same antibodies, confirming the applicability of our simplified method.



https://ift.tt/2J4o57D

Direct electrochemical reduction of hematite decorated graphene oxide (α-Fe2O3@erGO) nanocomposite for selective detection of Parkinson's disease biomarker

Publication date: 15 September 2018
Source:Biosensors and Bioelectronics, Volume 115
Author(s): Georgeena Mathew, Parama Dey, Rituparna Das, Sreemayee Dutta Chowdhury, Merina Paul Das, Pandiyarasan Veluswamy, Bernaurdshaw Neppolian, Jayabrata Das
An unusual approach is reported herein to fabricate magnetic hematite (α-Fe2O3) decorated electrochemically reduced graphene oxide (α-Fe2O3@erGO) nanocomposite. The method utilizes direct electrochemical reduction of self-assembled, ex-situ synthesized α-Fe2O3 anchored GO to erGO (α-Fe2O3@erGO) on glassy carbon electrode (GCE) for selective detection dopamine (DA), an important biomarker of Parkinson's disease. The formation of α-Fe2O3@erGO/GCE has been confirmed by XPS and Raman spectroscopy. α-Fe2O3@erGO modified GCE exhibits synergistic catalytic activity nearly 2.2 and 5 fold higher than α-Fe2O3@GO and other modified electrodes, respectively towards oxidation of DA. The fabricated sensor exhibited linear dynamic ranges over 0.25 − 100 µM in response to DA with a LOD of 0.024 µM (S/N = 3), LOQ of 0.08 µM (S/N = 10), and a sensitivity of 12.56 µA µM^–1 cm^–2. Finally, the practical analytical application of the proposed α-Fe2O3@erGO/GCE was investigated for the determination of DA in commercially available pharmaceutical formulation and human serum samples, and showed satisfactory recovery results towards DA.



https://ift.tt/2xdQjrR

Autoimmune Th17 Cells Induced Synovial Stromal and Innate Lymphoid Cell Secretion of the Cytokine GM-CSF to Initiate and Augment Autoimmune Arthritis

Publication date: Available online 22 May 2018
Source:Immunity
Author(s): Keiji Hirota, Motomu Hashimoto, Yoshinaga Ito, Mayumi Matsuura, Hiromu Ito, Masao Tanaka, Hitomi Watanabe, Gen Kondoh, Atsushi Tanaka, Keiko Yasuda, Manfred Kopf, Alexandre J. Potocnik, Brigitta Stockinger, Noriko Sakaguchi, Shimon Sakaguchi
Despite the importance of Th17 cells in autoimmune diseases, it remains unclear how they control other inflammatory cells in autoimmune tissue damage. Using a model of spontaneous autoimmune arthritis, we showed that arthritogenic Th17 cells stimulated fibroblast-like synoviocytes via interleukin-17 (IL-17) to secrete the cytokine GM-CSF and also expanded synovial-resident innate lymphoid cells (ILCs) in inflamed joints. Activated synovial ILCs, which expressed CD25, IL-33Ra, and TLR9, produced abundant GM-CSF upon stimulation by IL-2, IL-33, or CpG DNA. Loss of GM-CSF production by either ILCs or radio-resistant stromal cells prevented Th17 cell-mediated arthritis. GM-CSF production by Th17 cells augmented chronic inflammation but was dispensable for the initiation of arthritis. We showed that GM-CSF-producing ILCs were present in inflamed joints of rheumatoid arthritis patients. Thus, a cellular cascade of autoimmune Th17 cells, ILCs, and stromal cells, via IL-17 and GM-CSF, mediates chronic joint inflammation and can be a target for therapeutic intervention.

Graphical abstract

Teaser

It remains obscure how joint inflammation in rheumatoid arthritis is initiated and progressing. In this study, Hirota et al. identified in an animal model of rheumatoid arthritis an inflammatory cellular cascade instigated by an arthritogenic T helper subset and enhanced by GM-CSF-producing synovial-resident innate lymphoid cells.


https://ift.tt/2LlHlLX

Anti-apoptotic Protein BIRC5 Maintains Survival of HIV-1-Infected CD4+ T Cells

Publication date: Available online 22 May 2018
Source:Immunity
Author(s): Hsiao-Hsuan Kuo, Rushdy Ahmad, Guinevere Q. Lee, Ce Gao, Hsiao-Rong Chen, Zhengyu Ouyang, Matthew J. Szucs, Dhohyung Kim, Athe Tsibris, Tae-Wook Chun, Emilie Battivelli, Eric Verdin, Eric S. Rosenberg, Steven A. Carr, Xu G. Yu, Mathias Lichterfeld
HIV-1 infection of CD4⁺ T cells leads to cytopathic effects and cell demise, which is counter to the observation that certain HIV-1-infected cells possess a remarkable long-term stability and can persist lifelong in infected individuals treated with suppressive antiretroviral therapy (ART). Using quantitative mass spectrometry-based proteomics, we showed that HIV-1 infection activated cellular survival programs that were governed by BIRC5, a molecular inhibitor of cell apoptosis that is frequently overexpressed in malignant cells. BIRC5 and its upstream regulator OX40 were upregulated in productively and latently infected CD4⁺ T cells and were functionally involved in maintaining their viability. Moreover, OX40-expressing CD4⁺ T cells from ART-treated patients were enriched for clonally expanded HIV-1 sequences, and pharmacological inhibition of BIRC5 resulted in a selective decrease of HIV-1-infected cells in vitro. Together, these findings suggest that BIRC5 supports long-term survival of HIV-1-infected cells and may lead to clinical strategies to reduce persisting viral reservoirs.

Graphical abstract

Teaser

The host factors that promote the survival and persistence of HIV-infected CD4⁺ T cells are not clear. Kuo et al. demonstrate that the anti-apoptotic protein BIRC5 and its upstream regulator OX40 can promote survival of HIV-1-infected reservoir CD4⁺ T cells, specifically during clonal proliferation. These findings point to clinical strategies that may reduce persisting viral reservoirs.


https://ift.tt/2IFO8OG

Correction to: The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer

Two corrections were made to the above publication following its original online publication on 4th May 2018.

https://ift.tt/2x6uzhk

Perioperative Chemotherapy for Urothelial Carcinoma of the Upper Urinary Tract: A Systematic Review and Meta-Anaysis

Publication date: Available online 22 May 2018
Source:Critical Reviews in Oncology/Hematology
Author(s): Richard W. Gregg, Francisco E. Vera-Badillo, Christopher M. Booth, Aamer Mahmud, Michael Brundage, Michael J. Leveridge, Timothy P. Hanna
IntroductionUpper tract urothelial carcinomas are rare malignancies with differences in anatomy and biology requiring therapeutic strategies that differ from bladder cancer. The role of perioperative systemic therapy in this disease remains uncertain with limited data to support its use. A systematic review of the literature and meta-analysis was therefore undertaken to provide more information and guide clinical practiceMethodsA Literature search was performed using Embase and Medline databases with additional searches performed manually using terms associated with upper tract urothelial malignancies. Data was extracted from studies of patients that underwent nephrouretectomy for the management of upper tract urothelial carcinoma and received either neoadjuvant or adjuvant systemic therapy. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were summated and analyzed using Cochrane Revman software Version 5.3.ResultsThere were 13 comparative studies and no randomized studies identified for data extraction; 11 adjuvant and 2 neoadjuvant with 1260 patients receiving perioperative systemic therapy and 3567 controls that did not. Perioperative chemotherapy was associated with improved OS (HR 0.75, 95%CI 0.57-0.99), DFS (HR 0.54, 95%CI 0.32-0.92), and CSS (HR 0.6, 95%CI 0.42-1.15).ConclusionsThe available data suggests that perioperative systemic therapy is associated with improved survival in patients with upper tract urothelial cancer.



https://ift.tt/2x3urPI

Innovative sludge pretreatment technology for impurity separation using micromesh

Abstract

In order to reduce the impacts on sludge treatment facilities caused by impurities such as fibers, hairs, plastic debris, and coarse sand, an innovative primary sludge pretreatment technology, sludge impurity separator (SIS), was proposed in this study. Non-woven micromesh with pore size of 0.40 mm was used to remove the impurities from primary sludge. Results of lab-scale tests showed that impurity concentration, aeration intensity, and channel gap were the key operation parameters, of which the optimized values were below 25 g/L, 0.8 m³/(m² min), and 2.5 cm, respectively. In the full-scale SIS with treatment capacity of 300 m³/day, over 88% of impurities could be removed from influent and the cleaning cycle of micromesh was more than 16 days. Economic analysis revealed that the average energy consumption was 1.06 kWh/m³ treated sludge and operation cost was 0.6 yuan/m³ treated sludge.

https://ift.tt/2s1tXne

Removal of cobalt and lead ions from wastewater samples using an insoluble nanosponge biopolymer composite: adsorption isotherm, kinetic, thermodynamic, and regeneration studies

Abstract

In this study, an insoluble nanosponge biopolymer composite was synthesized, using a combined process of amidation reaction, cross-linking polymerization, and sol-gel method to obtain a phosphorylated multiwalled carbon nanotube-cyclodextrin/silver-doped titania (pMWCNT-βCD/TiO₂-Ag). This work mainly emphasized on the removal of lead (Pb²⁺) and cobalt (Co²⁺) metal ions from synthetic and real wastewater samples using the synthesized pMWCNT-βCD/TiO₂-Ag as a biosorbent. The new material was characterized by Fourier transform infrared (FTIR) spectroscopy, zeta potential, Brunauer-Emmett-Teller (BET) method, and scanning electron microscopy (SEM). Adsorption studies for the model pollutants were performed in batch mode. The effect of the solution pH, adsorbent dosage and the presence of competiting ions were investigated. The isotherm, kinetic, thermodynamic, and regeneration studies were also undertaken. The ability of the new material to effectively remove Pb²⁺ and Co²⁺ from synthetic wastewater and mine effluent samples was tested. The maximum removal capacities achieved for the removal of Pb²⁺ and Co²⁺ from mine effluent sample were 35.86 and 7.812 mg/g, respectively.

https://ift.tt/2kfoFkJ

Retropharyngeal SOL: An unusual presentation of a multifaceted entity

Poojan Agarwal, Manju Kaushal, Shruti Dogra, Ankur Gupta, Nishi Sharma

CytoJournal 2018 15(1):12-12



https://ift.tt/2kezuDA

Cytologic features, immunocytochemical findings, and DNA ploidy in four rare cases of epithelioid hemangioendothelioma involving effusions

Ying Chen, Abha Khanna, Jie Qing Chen, Hua Zhong Zhang, Nancy P Caraway, Ruth L Katz

CytoJournal 2018 15(1):13-13

Background: Epithelioid hemangioendothelioma (EHE) involving serous effusion is extremely rare, and the diagnosis can be challenging. DNA ploidy quantitation of EHE in effusion fluids has not been previously described in the English-language literature. Methods: Specimens of cytological diagnosed with EHE in effusion fluids between 2002 and 2009 were retrieved from the pathology files at MD Anderson Cancer Center. A total of four cases of EHE involving or arising from effusion fluids were found, and we reviewed cytospin, smears, cell block sections, and immunostained slides. DNA image analysis for ploidy and proliferation evaluation was performed on a destained, papanicolaou-stained slide from each case. Results: The tumor cells were epithelioid with prominent cytoplasmic vacuolization and intracytoplasmic inclusions, which could resemble reactive mesothelial cells, mesothelioma, or adenocarcinoma. The tumor cells were positive for endothelial markers. DNA image analysis in three of the four cases revealed predominantly diploid and tetraploid subpopulations, with few aneuploid cells and fairly low proliferation indices, and these patients had fairly prolonged survival. Conclusions: DNA image analysis is useful for differentiating EHE from reactive mesothelial cells and high-grade carcinoma. For accurate diagnosis of EHE in effusion fluids, cytologic features should be considered together with clinical history and ancillary studies.

https://ift.tt/2GIXQy3

Defining and Understanding Adaptive Resistance in Cancer Immunotherapy

Publication date: Available online 22 May 2018
Source:Trends in Immunology
Author(s): Tae Kon Kim, Roy S. Herbst, Lieping Chen
Despite the unprecedented tumor regression and long-term survival benefit observed with anti-programmed death (PD) [anti-PD-1 or anti-B7-homolog 1 (B7-H1)] therapy in patients with advanced cancers, a large portion of patients do not benefit from such treatment and a fraction of responders relapse. Current efforts to overcome resistance and improve efficacy of anti-PD therapy require a clear understanding of resistance and should precede current avenues using random combinations with available treatment regimens. Here, we categorized three types of resistance, namely target-missing, primary, and acquired resistance. This categorization requires reliable, accurate tissue sampling and appropriate interpretation of results based on the four classifications of tumor immunity in the microenvironment (TIME). We believe that fundamental understanding of these complex tumor-immune interactions and of the cellular and molecular mechanisms underlying these types of true resistance is the key for targeting the right targets in combination with or beyond anti-PD therapy in the future.



https://ift.tt/2IDvvep

Effect of photobiomodulation (670 nm) associated with vitamin A on the inflammatory phase of wound healing

Abstract

Wound healing is a complex biological process with specific phases. Photobiomodulation (PBM) decreases the inflammatory infiltrate, stimulating fibroblast proliferation and angiogenesis, and therefore, is indicated for wound healing. Vitamin A is used to reverse the inhibitory effects on wound healing and accelerate the healthy granulation tissue. The study aimed to evaluate the effect of topical vitamin A and PBM (GaAlAs) in inflammatory phase of cutaneous wounds. Forty Wistar male rats were separated into four groups: (1) control (CG); (2) laser group (LG) GaAlAs, 670 nm, 30 mW, energy per point of 0.9 J, radiating by 1 point in 30 s; (3) vitamin A group (VitAG); and (4) laser group plus vitamin A (LG + VitAG). Wounds were surgically made by a punch biopsy with 10 mm of diameter on the back of the animals and all treatments were started according to the experiment. The treatments were administered for four consecutive days and biopsy was performed on day 4. We performed both H&E and immunohistochemistry analysis. The results were compared between groups by one-way analysis of variance ANOVA test with post hoc Tukey (p < 0.05). Inflammatory infiltrate increased significantly in LG compared to CG and VitAG (p < 0.05). Regarding angiogenesis, VEGF expression was increased significantly in LG and LG + VitAG groups, p < 0.01. The results indicate that proposed treatments were effective on the healing process improved by LG and LG + VitAG. We show that laser plus vitamin A enhances healing by reducing the wound area and may have potential application for clinical management of cutaneous wounds.

https://ift.tt/2J3oDKY

Adequacy of Fixed-Dose Heparin Infusions for Venous Thromboembolism Prevention after Microsurgical Procedures

J reconstr Microsurg
DOI: 10.1055/s-0038-1655735

Background In microvascular surgery, patients often receive unfractionated heparin infusions to minimize risk for microvascular thrombosis. Patients who receive intravenous (IV) heparin are believed to have adequate prophylaxis against venous thromboembolism (VTE). Whether a fixed dose of IV heparin provides detectable levels of anticoagulation, or whether the "one size fits all" approach provides adequate prophylaxis against VTE remains unknown. This study examined the pharmacodynamics of fixed-dose heparin infusions and the effects of real-time, anti-factor Xa (aFXa) level driven heparin dose adjustments. Methods This prospective clinical trial recruited adult microvascular surgery patients placed on a fixed-dose (500 units/h) unfractionated heparin infusion during their initial microsurgical procedure. Steady-state aFXa levels, a marker of unfractionated heparin efficacy and safety, were monitored. Patients with out-of-range aFXa levels received protocol-driven real-time dose adjustments. Outcomes of interest included aFXa levels in response to heparin 500 units/h, number of dose adjustments required to achieve goal aFXa levels, time to reach goal aFXa level, and 90-day clinically relevant bleeding and VTE. Results Twenty patients were recruited prospectively. None of 20 patients had any detectable level of anticoagulation in response to heparin infusions at 500 units/h. The median number of dose adjustments required to reach goal level was five, and median weight-based dose to reach goal level was 11.8 units/kg/h. Real-time dose adjustments significantly increased the proportion of patients with in-range levels (60 vs. 0%, p = 0.0001). The 90-day VTE rate was 5% and 90-day clinically relevant bleeding rate was 5%. Conclusions Fixed-dose heparin infusions at a rate of 500 units/h do not provide a detectable level of anticoagulation after microsurgical procedures and are insufficient for the majority of patients who require VTE prophylaxis. Weight-based heparin infusions at 10 to 12 units/kg/h deserve future study in patients undergoing microsurgical procedures to increase the proportion of patients receiving adequate VTE prophylaxis.
[...]

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

https://ift.tt/2s7BFgP

Outcomes of Adoptive Cell Transfer With Tumor-infiltrating Lymphocytes for Metastatic Melanoma Patients With and Without Brain Metastases

Brain metastases cause significant morbidity and mortality in patients with metastatic melanoma. Although adoptive cell therapy (ACT) with tumor-infiltrating lymphocytes (TIL) can achieve complete and durable remission of advanced cutaneous melanoma, the efficacy of this therapy for brain metastases is unclear. Records of patients with M1c melanoma treated with ACT using TIL, including patients with treated and untreated brain metastases, were analyzed. Treatment consisted of preparative chemotherapy, autologous TIL infusion, and high-dose interleukin-2. Treatment outcomes, sites of initial tumor progression, and overall survival were analyzed. Among 144 total patients, 15 patients with treated and 18 patients with untreated brain metastases were identified. Intracranial objective responses (OR) occurred in 28% patients with untreated brain metastases. The systemic OR rates for patients with M1c disease without identified brain disease, treated brain disease, and untreated brain disease, and were 49%, 33% and 33%, respectively, of which 59%, 20% and 16% were durable at last follow-up. The site of untreated brain disease was the most likely site of initial tumor progression (61%) in patients with untreated brain metastases. Overall, we found that ACT with TIL can eliminate small melanoma brain metastases. However, following TIL therapy these patients frequently progress in the brain at a site of untreated brain disease. Patients with treated or untreated brain disease are less likely to achieve durable systemic ORs following TIL therapy compared with M1c disease and no history of brain disease. Melanoma brain metastases likely require local therapy despite the systemic effect of ACT.

https://ift.tt/2IFvczA

IL-21 Increases the Reactivity of Allogeneic Human Vγ9Vδ2 T Cells Against Primary Glioblastoma Tumors

Glioblastoma multiforme (GBM) remains the most frequent and deadliest primary brain tumor in adults despite aggressive treatments, because of the persistence of infiltrative and resistant tumor cells. Nonalloreactive human Vγ9Vδ2 T lymphocytes, the major peripheral γδ T-cell subset in adults, represent attractive effectors for designing immunotherapeutic strategies to track and eliminate brain tumor cells, with limited side effects. We analyzed the effects of ex vivo sensitizations of Vγ9Vδ2 T cells by IL-21, a modulating cytokine, on their cytolytic reactivity. We first showed that primary human GBM-1 cells were naturally eliminated by allogeneic Vγ9Vδ2 T lymphocytes, through a perforin/granzyme-mediated cytotoxicity. IL-21 increased both intracellular granzyme B levels and cytotoxicity of allogeneic human Vγ9Vδ2 T lymphocytes in vitro. Importantly, IL-21-enhanced cytotoxicity was rapid, which supports the development of sensitization(s) of γδ T lymphocytes before adoptive transfer, a process that avoids any deleterious effect associated with direct administrations of IL-21. Finally, we showed, for the first time, that IL-21-sensitized allogeneic Vγ9Vδ2 T cells significantly eliminated GBM tumor cells that developed in the brain after orthotopic administrations in vivo. Altogether our observations pave the way for novel efficient stereotaxic immunotherapies in GBM patients by using IL-21-sensitized allogeneic human Vγ9Vδ2 T cells.

https://ift.tt/2II6naE

Blockade of BAFF Receptor BR3 on T Cells Enhances Their Activation and Cytotoxicity

The BAFF receptor BR3 plays key roles in B-cell activation, maturation, and survival whereas the function of BR3 on T lymphocytes is less well characterized. Previous reports have demonstrated that BR3 costimulates human T-cell activation in vitro in the presence of high nonphysiological levels of plate-bound BAFF. Here, relying on the soluble and membrane-bound BAFF expressed by T cells themselves, we investigated the function of BR3 on activated primary CD4+ and CD8+ T lymphocytes using a BR3-specific neutralization antibody and shRNA gene down-modulation. Interestingly, the anti-BR3 blocking antibody resulted in significant augmentation of CD25 and IFN-γ expression by both subsets, as did shRNA-mediated down-modulation of BR3. In addition, granzyme B expression was substantially elevated in anti-BR3–treated and BR3-silenced T cells. Anti-BR3 blockade increased the expression of CD25 on cytolytic CRTAM+ T cells. Importantly, anti-BR3 significantly enhanced redirected killing of P-815 cells by both CD4+ and CD8+ cytotoxic T cells [cytotoxic T lymphocytes (CTLs)]. Furthermore, anti-BR3–augmented CD4+ T-cell–mediated killing of class II+ melanoma cell line A375 and cervical cancer cell line HeLa in vitro, increasing the level of granzyme B activity as measured by PARP-1 cleavage and active caspase 3. Together, our data indicate that BR3 neutralization increases the activation and cytolytic function of CD4+ and CD8+ cytotoxic T lymphocytes. Our findings provide a novel strategy for ex vivo T-cell activation applicable to T-cell immunotherapy platforms such as TIL or CAR-T cell therapeutics.

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Diabetes and Blood Glucose Disorders Under Anti-PD1

Acute type 1 diabetes (AD1) is a rare but definitive immune-related adverse event associated with anti-PD1. Most of the reported cases are close to what has been described as "fulminant type 1 diabetes." We sought to determine whether anti-PD1 could impair glycoregulation and whether occurrence of AD1 could be anticipated by prior glycemic changes. Fasting glycemia collected before, under, and after treatment in melanoma patients treated with anti-PD1 over a period of 36 months were retrospectively analyzed. Glycemic trend analyses were performed using linear regression analysis. In total, 1470 glucose values were monitored in 163 patients treated for a mean duration of 5.96 months. Three patients developed an AD1 (1, 84%). Two other cases were observed in the same period in a still-blinded trial of anti-PD1 versus ipilimumab. All cases of AD1 occurred in patients with a normal pretreatment glycemia, and there was no detectable drift of glycemia before ketoacidosis onset. In 4 of 5 cases of AD1, the HLA subgroups were DRB01* 03 or 04, known to increase type 1 diabetes risk in the general population. In the 28 patients with preexisting type 2 diabetes, there was a slight trend for glycemia increase with anti-PD1 infusions (0.05 mmol/L/infusion P=0.004). In the 132 patients with normal pretreatment glycemia, there was a slight trend for a decrease of glycemia with anti-PD1 infusions (−0.012/mmol/L/infusion P=0.026). These data suggest that the monitoring of glycemia under anti-PD1 cannot help to anticipate AD1, and there is no general tendency to glycemic disorder. HLA genotyping before treatment may help to focus surveillance in patients with the HLA DRB1*03/04 group.

https://ift.tt/2LllpAB

Characterization of Postinfusion Phenotypic Differences in Fresh Versus Cryopreserved TCR Engineered Adoptive Cell Therapy Products

Adoptive cell therapy (ACT) consisting of genetically engineered T cells expressing tumor antigen-specific T-cell receptors displays robust initial antitumor activity, followed by loss of T-cell activity/persistence and frequent disease relapse. We characterized baseline and longitudinal T-cell phenotype variations resulting from different manufacturing and administration protocols in patients who received ACT. Patients with melanoma who enrolled in the F5-MART-1 clinical trial (NCT00910650) received infusions of MART-1 T-cell receptors transgenic T cells with MART-1 peptide-pulsed dendritic cell vaccination. Patients were divided into cohorts based on several manufacturing changes in the generation and administration of the transgenic T cells: decreasing ex vivo stimulation/expansion time, increased cell dose, and receiving fresh instead of cryopreserved cells. T-cell phenotypes were analyzed by flow cytometry at baseline and longitudinally in peripheral blood. Transgenic T cells with shorter ex vivo culture/expansion periods displayed significantly increased expression of markers associated with less differentiated naive/memory populations, as well as significantly decreased expression of the inhibitory receptor programmed death 1 (PD1). Patients receiving fresh infusions of transgenic cells demonstrated expansion of central memory T cells and delayed acquisition of PD1 expression compared with patients who received cryopreserved products. Freshly infused transgenic T cells showed persistence and expansion of naive and memory T-cell populations and delayed acquisition of PD1 expression, which correlated with this cohort's superior persistence of transgenic cells and response to dendritic cell vaccines. These results may be useful in designing future ACT protocols.

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Tonsillar cytokine expression between patients with tonsillar hypertrophy and recurrent tonsillitis

Tonsils provide an innovative in vivo model for investigating immune response to infections and allergens. However, data are scarce on the differences in tonsillar virus infections and immune responses between...

https://ift.tt/2IH4niD

Joint attention in Down syndrome: A meta-analysis

Publication date: July 2018
Source:Research in Developmental Disabilities, Volume 78
Author(s): Laura J. Hahn, Susan J. Loveall, Madison T. Savoy, Allie M. Neumann, Toshikazu Ikuta
BackgroundSome studies have indicated that joint attention may be a relative strength in Down syndrome (DS), but other studies have not.AimTo conduct a meta-analysis of joint attention in DS to more conclusively determine if this is a relative strength or weakness when compared to children with typical development (TD), developmental disabilities (DD), and autism spectrum disorder (ASD).Methods and proceduresJournal articles published before September 13, 2016, were identified by using the search terms "Down syndrome" and "joint attention" or "coordinating attention". Identified studies were reviewed and coded for inclusion criteria, descriptive information, and outcome variables.Outcomes and resultsEleven studies (553 participants) met inclusion criteria. Children with DS showed similar joint attention as TD children and higher joint attention than children with DD and ASD. Meta-regression revealed a significant association between age and joint attention effect sizes in the DS vs. TD contrast.Conclusions and implicationsJoint attention appears to not be a weakness for children with DS, but may be commensurate with developmental level. Joint attention may be a relative strength in comparison to other skills associated with the DS behavioral phenotype. Early interventions for children with DS may benefit from leveraging joint attention skills.



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Plastic surgeons’ opinions and practices regarding compatibility of MRI and breast tissue expanders

As more women undergo breast reconstruction with tissue expanders, the situation where a patient with ferromagnetic port-containing breast tissue expanders (FPCBTE) develops a need for magnetic resonance imaging (MRI) has also become more frequent. Such indications include the new symptoms suggestive of neurologic or osseous metastases, trauma, and perforator mapping if the patient transitions to autologous reconstruction.

https://ift.tt/2GFbdiJ

Deep inferior epigastric perforator (DIEP) flap: Impact of drain free donor abdominal site on long term patient outcomes and duration of inpatient stay

The deep inferior epigastric perforator (DIEP) flap is widely regarded as the Gold Standard in autologous breast reconstruction. Although drain-free abdominoplasty is performed in many centres, there is a paucity of evidence comparing outcomes when applied to DIEP breast reconstruction.

https://ift.tt/2keDtAa

Managing aesthetic referrals in NHS Scotland: Outcomes from 1,122 patients in the East of Scotland

The Adult Exceptional Aesthetic Referral Protocol (AEARP) encompasses a series of aesthetic procedures which, as they do not treat an underlying disease process, are not routinely available within the National Health Service. Provision of these services can only be provided on an exceptional basis.In this prospective study, we evaluated the referral process and outcomes of 1,122 patients referred under the AEARP over a 3.5-year period. Referrals were screened by a vetting panel comprising of a plastic surgeon, clinical nurse specialist, and clinical psychologist.

https://ift.tt/2s01TAO

Long-term Results of Bacterial Septic Arthritis of the Wrist

Septic arthritis of the wrist is a serious condition, yet little is known about its long-term outcome. A retrospective analysis of 22 patients treated for bacterial septic arthritis of the wrist was conducted with subsequent follow-up of 18 patients with a median period of 44 months to assess functional results via DASH-Score and clinical examination.Arthrotomy was used to treat all patients; in 19 patients, multiple operations were needed to cure the infection. Follow-up revealed a mean DASH-score of 34 (SD 22) and a significant correlation with needed surgical radicality and number of needed operations.

https://ift.tt/2khKfVy

Response to letter commenting on Upgrading the BREAST-Q questionnaire

We read with interest the reply from Klassen and colleagues1 to our publication2 and we fully agree about the lack of methodological validity related to our suggestion of a BREAST-Q expansion. In fact, our aim was meant to focus the attention on the need for an update of the already existing autologous BREAST-Q, according to the evolution in breast reconstruction and flap choice. This was the reason why we wanted to highlight and in parallel put the accent on this topic.

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Adding Scales to BREAST-Q Must Follow the Same Rigor as Original Scales

Dear Editor,

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Sentinel lymph node biopsy in melanoma: which hot nodes should be harvested and is blue dye really necessary?,,✯✯✯

The '10% rule' has become widely accepted by surgeons performing sentinel lymph node biopsy (SLNB) for melanoma. The purpose of this study was to compare the '10% rule' with alternative node harvesting criteria. In particular, we were interested to see whether the use of blue dye had any impact on the sensitivity of the test and whether it is necessary to remove all hot nodes.

https://ift.tt/2s4CVjI

Age affects reinforcement learning through dopamine-based learning imbalance and high decision noise—not through Parkinsonian mechanisms

Publication date: August 2018
Source:Neurobiology of Aging, Volume 68
Author(s): Ravi B. Sojitra, Itamar Lerner, Jessica R. Petok, Mark A. Gluck
Probabilistic reinforcement learning declines in healthy cognitive aging. While some findings suggest impairments are especially conspicuous in learning from rewards, resembling deficits in Parkinson's disease, others also show impairments in learning from punishments. To reconcile these findings, we tested 252 adults from 3 age groups on a probabilistic reinforcement learning task, analyzed trial-by-trial performance with a Q-reinforcement learning model, and correlated both fitted model parameters and behavior to polymorphisms in dopamine-related genes. Analyses revealed that learning from both positive and negative feedback declines with age but through different mechanisms: when learning from negative feedback, older adults were slower due to noisy decision-making; when learning from positive feedback, they tended to settle for a nonoptimal solution due to an imbalance in learning from positive and negative prediction errors. The imbalance was associated with polymorphisms in the DARPP-32 gene and appeared to arise from mechanisms different from those previously attributed to Parkinson's disease. Moreover, this imbalance predicted previous findings on aging using the Probabilistic Selection Task, which were misattributed to Parkinsonian mechanisms.



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A Survey Analysis on the Management of Moderately Dysplastic Nevi Among Academic Dermatologists Across the United States

https://ift.tt/2x1vRKk

The Potential of Narrow Band UVB to Induce Sustained Durable Complete Remission off-Therapy in Stage I Mycosis Fungoides

Narrow Band UVB (NB UVB) produces high rates of complete response (CR) for patients with stage I mycosis fungoides (MF). Data on long-term remission off therapy are lacking. NB UVB induced >5 years disease and therapy free survival in ∼ 60% of CR patients. NB UVB can be considered a disease modifying and potentially curative therapy for patients with stage I MF..

https://ift.tt/2ID2sf2

Financial burden of emergency department visits for atopic dermatitis in the United States

Patients with atopic dermatitis have multiple risk factors for utilizing the emergency department.; The prevalence and cost of emergency department visits for atopic dermatitis was high and increased between 2006 and 2012.; Interventions are needed to decrease ED visits for AD.

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Atopic dermatitis is associated with osteoporosis and osteopenia in older adults

https://ift.tt/2Lk1wtI

Head and Neck Cancer and the Elderly Patient

Management of head and neck cancer in the elderly patient is particularly challenging given the high morbidity associated with treatment. Surgery, radiotherapy, and chemotherapy have all been demonstrated as effective in older patients; however, older patients are more susceptible to treatment-induced toxicity, which can limit the survival benefits of certain interventions. This susceptibility is better associated with the presence of multiple comorbidities and decreasing functional status than with age alone. Screening tools allow for risk stratification, treatment deintensification, and even treatment avoidance in patients who are deemed at high-risk of being harmed by standard therapy.

https://ift.tt/2IDeYXT

Acid and alkaline solubilization (pH shift) process: a better approach for the utilization of fish processing waste and by-products

Abstract

Several technologies and methods have been developed over the years to address the environmental pollution and nutritional losses associated with the dumping of fish processing waste and low-cost fish and by-products. Despite the continuous efforts put in this field, none of the developed technologies was successful in addressing the issues due to various technical problems. To solve the problems associated with the fish processing waste and low-value fish and by-products, a process called pH shift/acid and alkaline solubilization process was developed. In this process, proteins are first solubilized using acid and alkali followed by precipitating them at their isoelectric pH to recover functional and stable protein isolates from underutilized fish species and by-products. Many studies were conducted using pH shift process to recover proteins from fish and fish by-products and found to be most successful in recovering proteins with increased yields than conventional surimi (three cycle washing) process and with good functional properties. In this paper, problems associated with conventional processing, advantages and principle of pH shift processing, effect of pH shift process on the quality and storage stability of recovered isolates, applications protein isolates, etc. are discussed in detail for better understanding.

https://ift.tt/2IZiAHe

Intramedullary nail fixation versus locking plate fixation for adults with a fracture of the distal tibia: the UK FixDT RCT.

Both nail fixation and locking plate fixation had similar disability ratings at 6 months, but nail fixation cost about £970 less in the first year after the fracture.

https://ift.tt/2LpiUgu

Extreme Diets: Fads and Facts

Radical diets have exploded in popularity since the 19th century. We dig into notable examples -- from Fletcherism to liquid diets to Beverly Hills -- reviewing their history, claims, and impact.
Medscape Internal Medicine

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Consumer Reports Ranks Top Sunscreens for 2018

Despite concerns about chemical sunscreens, they protect you better from the sun than "natural" sunscreens, Consumer Reports' latest sunscreen report finds.
WebMD Health News

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A Pilot Study of a Novel Automated Somatosensory Evoked Potential (SSEP) Monitoring Device for Detection and Prevention of Intraoperative Peripheral Nerve Injury in Total Shoulder Arthroplasty Surgery

Introduction: Peripheral nerve injury is a potentially devastating complication after total shoulder arthroplasty (TSA) surgery. This pilot study aimed to assess the feasibility of using an automated somatosensory evoked potential (SSEP) device to provide a timely alert/intervention to minimize intraoperative nerve insults during TSA surgery. Methods: A prospective, single-arm, observational study was conducted in a single university hospital. The attending anesthesiologist monitored the study participants using the EPAD automated SSEP device and an intervention was made if there was an alert during TSA surgery. The median, radial, and ulnar nerve SSEP on the operative arm, as well as the median nerve SSEP of the nonoperative arm were monitored for each patient. All patients were evaluated for postoperative neurological deficits 6 weeks postoperatively. Results: In total, 21 patients were consented and were successfully monitored. In total, 4 (19%) patients developed intraoperative abnormal SSEP signal changes in the operative arm, in which 3 were reversible and 1 was irreversible till the end of surgery. Median and radial nerves were mostly involved (3/4 patients). The mean cumulative duration of nerve insult (abnormal SSEP) was 21.7±26.2 minutes. Univariate analysis did not identify predictor of intraoperative nerve insults. No patients demonstrated postoperative peripheral neuropathy at 6 weeks. Conclusions: A high incidence (19%) of intraoperative nerve insult was observed in this study demonstrating the feasibility of using an automated SSEP device to provide a timely alert and enable an intervention in order to minimize peripheral nerve injury during TSA. Further randomized studies are warranted. The study (IRB #107438) was approved by Lawson Health Research Institute, Western University. Clinical trial registration #: NCT02237599 (www.clinicaltrials.gov). J.C. is the archival author. J.M.M. is member of Scientific Advisory Board of SafeOp Surgical, Hunt Valley, MD. J.C. and D.D. has no conflicts of interest to disclose. Address correspondence to: Jason Chui, MBChB, FANZCA, C3-106, University Hospital, 339 Windermere Road, London, ON, Canada N6A 5A5 (e-mail: Jason.chui@lhsc.on.ca). Received January 31, 2018 Accepted March 29, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Application of Standardised Yoga Protocols as the Basis of Physiotherapy Recommendation in Treatment of Sleep Apneas: Moving Beyond Pranayamas

Abstract

Yoga is an ancient Indian practice of mental and physical exercises (syn: asanas), postures (syn: mudras), movements and breathing techniques which sustain healthy living of the body and the mind. It incorporates various exercises of breathing, oropharyngeal structures and facial expressions, the physiology and effect of which are comparable to international physiotherapy recommendations in treatment of obstructive sleep apnea (OSA) i.e. to preserve upper airway patency by maintaining airway dilator muscle tone. Preliminary results show that yoga can be an effective and constructive alternative to physiotherapy for sleep apnea and snoring patients. To compare the physiotherapy recommendations in snoring patients with various yoga exercises postures. To determine the efficacy of yoga in treatment of sleep apnea. To formulate a standardized yoga protocol for universal usage in sleep apnea. We studied the available literature on physiotherapy recommendations for OSA and yoga asanas involving the nasal, oropharynx and facial structures and perceived a noteworthy similarity in physiological basis of both. A set of these yogasanas were put together and patients presenting with snoring and diagnosed with mild to moderate sleep apnea were presented and encouraged to perform the standardized set of yoga exercises for a period of 3 months. A total of 23 patients were recommended yoga protocols as initial form of treatment in snoring and mild to moderate sleep apnea. Clinical and statistically significant improvement gauzed by recommended score chart was discerned in majority of subjects. The results were comparable to the efficacy of existing physiotherapy regimen published in international literature. The benefits of yoga in sleep disorders go beyond the scope of measured outcomes. Standardizing the protocols for yoga in treatment for snoring and sleep apnea is the need of the hour. Further studies on efficacy of yoga need to be performed to understand its full realm of potential.

https://ift.tt/2x1Uerr

Under the Knife: The History of Surgery in 28 Remarkable Operations

No abstract available

https://ift.tt/2KNX0mh

Identifying Barriers to Implementation of the National Partnership for Maternal Safety Obstetric Hemorrhage Bundle at a Tertiary Center: Utilization of the Delphi Method

BACKGROUND: In 2015, the National Partnership for Maternal Safety (NPMS) developed an obstetric hemorrhage consensus bundle to provide birthing facilities in the United States with consistent, validated practice guidelines for postpartum hemorrhage management. The process of implementing each bundle element at a large tertiary labor and delivery unit has not been described; we sought to identify practice deficiencies and perceived barriers to bundle implementation among multidisciplinary providers. METHODS: We conducted a prospective, cross-sectional, consensus-building study based on the Delphi method. A multidisciplinary expert panel comprised of anesthesiologists, obstetricians, nurses, and surgical technicians was assembled and participated in 4 sequential questionnaires. The first round identified bundle elements that experts determined as not currently adequate and perceived barriers to implementation. The second round established prioritization of elements within each professional group; and the third round ranked the elements with at least 60% agreement on feasibility of implementation and positive impact on patient care. The last round revealed responses across all 4 professional groups to derive a final consensus. Descriptive statistics were performed. RESULTS: A total of 38 experts completed the study (11 anesthesiologists, 11 obstetricians, 10 nurses, and 6 surgical technicians). While all 13 (100%) NPMS obstetric bundle elements were described as deficient in our labor and delivery unit by a provider in at least 1 discipline, consensus among at least 3 of the 4 disciplines was achieved for 6 element deficiencies. Barriers to implementation were determined. The initiatives that achieved consensus as possessing high patient impact and implementation feasibility were protocol-driven management, unit-based simulation drills, blood loss quantification, and team huddles and debriefings. CONCLUSIONS: The NPMS obstetric hemorrhage bundle was created to help guide practice and systems improvement for US birthing facilities. The Delphi method enabled identification of deficient elements and perceived barriers to element implementation, as well as group consensus on elements with highest patient impact and feasibility. Multidisciplinary group consensus can identify deficiencies and promote tangible, quality improvements in a large, tertiary-care labor and delivery unit. Institutions may utilize our described technique to guide implementation of future care bundles. Accepted for publication April 12, 2018. Funding: Departmental. The authors declare 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 HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Institutional Research Ethics Board: Partners HealthCare Institutional Review Board, Partners Human Research Committee, 116 Huntington Ave, Suite 1002, Boston, MA 02116. Clinical trial number and registry URL: NCT03018119 https://ift.tt/2IIP98H. Reprints will not be available from the authors. Address correspondence to Annemaria De Tina, MD, FRCPC, Department of Anesthesiology, McMaster University, Third Floor, 237 Barton St E, Hamilton, ON L8L 2X2, Canada. Address e-mail to detinaa@mcmaster.ca. © 2018 International Anesthesia Research Society

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Organ Donation After Circulatory Death: Ethical Issues and International Practices

Donation after circulatory death (DCD) is an increasingly utilized practice that can contribute to reducing the difference between the supply of organs and the demand for organs for transplantation. As the number of transplanted organs from DCD donors continues to increase, there is an essential need to address the ethical aspects of DCD in institutional DCD protocols and clinical practice. Ethical issues of respecting the end-of-life wishes of a potential donor, respecting a recipient's wishes, and addressing potential conflicts of interest are important considerations in developing policies and procedures for DCD programs. Although there may be diversity among DCD programs in Europe, Australia, Israel, China, the United States, and Canada, addressing ethical considerations in these DCD programs is essential to respect donors and recipients during the altruistic and generous act of organ donation. Accepted for publication April 12, 2018. Funding: None. The author declares no conflicts of interest. Reprints will not be available from the author. Address correspondence to Barbara G. Jericho, MD, FASA, Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, 1740 W Taylor St, Suite 3200, M\C 515, Chicago, IL 60612. Address e-mail to jericho@uic.edu. © 2018 International Anesthesia Research Society

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“Modified Dynamic Needle Tip Positioning” Short-Axis, Out-of-Plane, Ultrasound-Guided Radial Artery Cannulation in Neonates: A Randomized Controlled Trial

BACKGROUND: Radial artery cannulation is extremely challenging in neonatal patients. Herein, we compared the success rate of the modified dynamic needle tip positioning short-axis, out-of-plane, ultrasound-guided technique with that of the traditional palpation technique in neonatal radial artery cannulation. METHODS: Sixty term neonates undergoing major abdominal surgery were randomized into the ultrasound or palpation group via the sealed-envelope method. The ultrasound group underwent radial artery cannulation using an ultrasonic apparatus, while traditional palpation of arterial pulsation was used in the palpation group. The arterial diameter and depth were measured on ultrasound before the puncture. We recorded age, weight, sex, and other background characteristics. The primary outcomes included the first-attempt, total success rates, and the total puncture procedure duration. Secondary outcomes included the incidence of complications (hematoma and thrombosis). Data were compared between the 2 groups. RESULTS: Sixty term neonates were enrolled in the study. The success rates of the first attempt in the ultrasound and palpation groups were 40% (n = 30) and 10% (n = 30), respectively (P = .007; relative risk, 4.0; 95% confidence interval, 1.3–12.8). The total success rate was 96.7% in the ultrasound group and 60.0% in the palpation group (P = .001; relative risk, 1.61; 95% confidence interval, 1.19–2.17). The average time to accomplish radial artery cannulation in the ultrasound and palpation groups was 91.4 ± 55.4 and 284.7 ± 153.6 seconds, respectively (P

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The Effect of Dexmedetomidine on Propofol Requirements During Anesthesia Administered by Bispectral Index-Guided Closed-Loop Anesthesia Delivery System: A Randomized Controlled Study

BACKGROUND: Dexmedetomidine, a selective α2-adrenergic agonist currently approved for continuous intensive care unit sedation, is being widely evaluated for its role as a potential anesthetic. The closed-loop anesthesia delivery system (CLADS) is a method to automatically administer propofol total intravenous anesthesia using bi-spectral index (BIS) feedback and attain general anesthesia (GA) steady state with greater consistency. This study assessed whether dexmedetomidine is effective in further lowering the propofol requirements for total intravenous anesthesia facilitated by CLADS. METHODS: After ethics committee approval and written informed consent, 80 patients undergoing elective major laparoscopic/robotic surgery were randomly allocated to receive GA with propofol CLADS with or without the addition of dexmedetomidine. Quantitative reduction of propofol and quality of depth-of-anesthesia (primary objectives), intraoperative hemodynamics, incidence of postoperative adverse events (sedation, analgesia, nausea, and vomiting), and intraoperative awareness recall (secondary objectives) were analyzed. RESULTS: There was a statistically significant lowering of propofol requirement (by 15%) in the dexmedetomidine group for induction of anesthesia (dexmedetomidine group: mean ± standard deviation 0.91 ± 0.26 mg/kg; nondexmedetomidine group: 1.07 ± 0.23 mg/kg, mean difference: 0.163, 95% CI, 0.04–0.28; P = .01) and maintenance of GA (dexmedetomidine group: 3.25 ± 0.97 mg/kg/h; nondexmedetomidine group: 4.57 ± 1.21 mg/kg/h, mean difference: 1.32, 95% CI, 0.78–1.85; P

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Interviewing in Social Science Research: A Relational Approach

No abstract available

https://ift.tt/2KO2GwG

Perianesthetic and Anesthesia-Related Mortality in a Southeastern United States Population: A Longitudinal Review of a Prospectively Collected Quality Assurance Data Base

BACKGROUND: Perianesthetic mortality (death occurring within 48 hours of an anesthetic) continues to vary widely depending on the study population examined. The authors study in a private practice physician group that covers multiple anesthetizing locations in the Southeastern United States. This group has in place a robust quality assurance (QA) database to follow all patients undergoing anesthesia. With this study, we estimate the incidence of anesthesia-related and perianesthetic mortality in this QA database. METHODS: Following institutional review board approval, data from 2011 to 2016 were obtained from the QA database of a large, community-based anesthesiology group practice. The physician practice covers 233 anesthetizing locations across 20 facilities in 2 US states. All detected cases of perianesthetic death were extracted from the database and compared to the patients' electronic medical record. These cases were further examined by a committee of 3 anesthesiologists to determine whether the death was anesthesia related (a perioperative death solely attributable to either the anesthesia provider or anesthetic technique), anesthetic contributory (a perioperative death in which anesthesia role could not be entirely excluded), or not due to anesthesia. RESULTS: A total of 785,467 anesthesia procedures were examined from the study period. A total of 592 cases of perianesthetic deaths were detected, giving an overall death rate of 75.37 in 100,000 cases (95% CI, 69.5–81.7). Mortality judged to be anesthesia related was found in 4 cases, giving a mortality rate of 0.509 in 100,000 (95% CI, 0.198–1.31). Mortality judged to be anesthesia contributory were found in 18 cases, giving a mortality of 2.29 in 100,000 patients (95% CI, 1.45–3.7). A total of 570 cases were judged to be nonanesthesia related, giving an incidence of 72.6 per 100,000 anesthetics (95% CI, 69.3–75.7). CONCLUSIONS: In a large, comprehensive database representing the full range of anesthesia practices and locations in the Southeastern United States, the rate of perianesthestic death was 0.509 in 100,000 (95% CI, 0.198–1.31). Future in-depth analysis of the epidemiology of perianesthetic deaths will be reported in later studies. Accepted for publication April 20, 2018. Funding: Departmental. The authors declare no conflicts of interest. This study was presented in part at the International Anesthesia Research Society Annual Meeting, Washington, DC, May 6, 2017. Reprints will not be available from the authors. Address correspondence to Richard Pollard, MD, FASA, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. Address e-mail to rpollard@bidmc.harvard.edu. © 2018 International Anesthesia Research Society

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Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients? A Systematic Review and Meta-analysis

BACKGROUND: We performed a systematic review and meta-analysis of studies investigating the diagnostic accuracy of respiratory variation in inferior vena cava diameter (ΔIVC) for predicting fluid responsiveness in patients receiving mechanical ventilation. METHODS: MEDLINE, EMBASE, the Cochrane Library, and Web of Science were screened from inception to February 2017. The meta-analysis assessed the pooled sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve. In addition, heterogeneity and subgroup analyses were performed. RESULTS: A total of 12 studies involving 753 patients were included. Significant heterogeneity existed among the studies, and meta-regression indicated that ventilator settings were the main sources of heterogeneity. Subgroup analysis indicated that ΔIVC exhibited better diagnostic performance in the group of patients ventilated with tidal volume (TV) ≥8 mL/kg and positive end-expiratory pressure (PEEP) ≤5 cm H2O than in the group ventilated with TV 5 cm H2O, as demonstrated by higher sensitivity (0.80 vs 0.66; P = .02), specificity (0.94 vs 0.68; P 5 cm H2O, this threshold was 14% ± 5%. CONCLUSIONS: ΔIVC shows limited ability for predicting fluid responsiveness in distinct ventilator settings. In patients with TV ≥8 mL/kg and PEEP ≤5 cm H2O, ΔIVC was an accurate predictor of fluid responsiveness, while in patients with TV 5 cm H2O, ΔIVC was a poor predictor. Thus, intensivists must be cautious when using ΔIVC. Accepted for publication April 16, 2018. Funding: This study was supported by the grants from Sun Yat-Sen University Clinical Research 5010 Program (2007015). The authors declare 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 HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). X. Si and H. Xu contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Xiangdong Guan, PhD, MD, Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan No. 2 Rd, Guangzhou, People's Republic of China. Address e-mail to guanxiangdong1962@163.com. © 2018 International Anesthesia Research Society

https://ift.tt/2ICOpC6

Halving the Volume of AnaConDa: Evaluation of a New Small-Volume Anesthetic Reflector in a Test Lung Model

BACKGROUND: Volatile anesthetics are increasingly used for sedation in intensive care units. The most common administration system is AnaConDa-100 mL (ACD-100; Sedana Medical, Uppsala, Sweden), which reflects volatile anesthetics in open ventilation circuits. AnaConDa-50 mL (ACD-50) is a new device with half the volumetric dead space. Carbon dioxide (CO2) can be retained with both devices. We therefore compared the CO2 elimination and isoflurane reflection efficiency of both devices. METHODS: A test lung constantly insufflated with CO2 was ventilated with a tidal volume of 500 mL at 10 breaths/min. End-tidal CO2 (EtCO2) partial pressure was measured using 3 different devices: a heat-and-moisture exchanger (HME, 35 mL), ACD-100, and ACD-50 under 4 different experimental conditions: ambient temperature pressure (ATP), body temperature pressure saturated (BTPS) conditions, BTPS with 0.4 Vol% isoflurane (ISO-0.4), and BTPS with 1.2 Vol% isoflurane. Fifty breaths were recorded at 3 time points (n = 150) for each device and each condition. To determine device dead space, we adjusted the tidal volume to maintain normocapnia (n = 3), for each device. Thereafter, we determined reflection efficiency by measuring isoflurane concentrations at infusion rates varying from 0.5 to 20 mL/h (n = 3), for each device. RESULTS: EtCO2 was consistently greater with ACD-100 than with ACD-50 and HME (ISO-0.4, mean ± standard deviations: ACD-100, 52.4 ± 0.8; ACD-50, 44.4 ± 0.8; HME, 40.1 ± 0.4 mm Hg; differences of means of EtCO2 [respective 95% confidence intervals]: ACD-100 − ACD-50, 8.0 [7.9–8.1] mm Hg, P

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Perioperative Peripheral Nerve Injury After General Anesthesia: A Qualitative Systematic Review

Perioperative peripheral nerve injury (PNI) is a well-recognized complication of general anesthesia that continues to result in patient disability and malpractice claims. However, the multifactorial etiology of PNI is often not appreciated in malpractice claims given that most PNI is alleged to be due to errors in patient positioning. New advances in monitoring may aid anesthesiologists in the early detection of PNI. This article reviews recent studies of perioperative PNI after general anesthesia and discusses the epidemiology and potential mechanisms of injury and preventive measures. We performed a systematic literature search, reviewed the available evidence, and identified areas for further investigation. We also reviewed perioperative PNI in the Anesthesia Closed Claims Project database for adverse events from 1990 to 2013. The incidence of perioperative PNI after general anesthesia varies considerably depending on the type of surgical procedure, the age and risk factors of the patient population, and whether the detection was made retrospectively or prospectively. Taken together, studies suggest that the incidence in a general population of surgical patients undergoing all types of procedures is

https://ift.tt/2rZci0s

Anesthesia and Neurotoxicity

No abstract available

https://ift.tt/2KI4SFN

Real Time Ultrasound Assisted Gluteal Fat Grafting

Background: Outcomes in primary breast augmentation depend on careful preoperative planning and clear communication between patient and surgeon. Three-dimensional imaging with computer simulation is an evolving technology with the potential to enhance the preoperative consultation for patients considering primary breast augmentation. The purpose of this study was to prospectively evaluate the impact of three-dimensional imaging with computer simulation on patient-reported and objective, mammometric outcomes in women undergoing primary breast augmentation. Methods: One hundred patients were enrolled in a prospective trial with randomized and non-randomized arms. The randomized arm was comprised of a control group who underwent tissue-based planning without simulation (n=13) and an intervention group who were simulated (n=10). The remainder comprised the non-randomized group who specifically sought preoperative simulation. Patient-reported outcomes (BREAST-Q) and mammometric data were recorded and compared preoperatively and six months postoperatively. Results: Over time significantly more patients refused randomization and chose simulation (p=0.03). Breast augmentation led to substantial improvements in satisfaction with breasts, sexual well-being, and outcome. Simulation, however, did not significantly impact patient-reported outcomes or mammometric parameters. No strong correlations were identified between patient reported outcomes and mammometrics. Conclusions: Patients are likely to use novel technology like three-dimensional photography with computer simulation if they perceive it to enhance their understanding of their final outcome. These patients may seek out practices specifically offering such technology. Incorporation of simulation into the preoperative consultation, however, did not lead to clinically meaningful changes in patient-reported outcomes. This study was presented at the panel "Buttock augmentation: Optimization of Long term results and mortality risks" at Plastic Surgery The meeting 2017, in Orlando, Florida on October 9, 2017. Disclosure: The authors declare no conflicts of interests with respect to the authorship and/or publication of this manuscript. Funding: The authors received no financial support for the research and/or authorship of this manuscript. Corresponding author: Alvaro Luiz Cansancao , Avenida das Americas 3200, sala 212, Rio de Janeiro, RJ, Brazil, Zip 22640-102, email: dr.alvaroluiz@hotmail.com, Tel: 55(21)993339392 ©2018American Society of Plastic Surgeons

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Therapeutic effects of human adipose-derived products on impaired wound healing in irradiated tissue

Background: Clinical sequelae of irradiation (ischemia, fibrosis, and atrophy) result in tissue devitalization, where wound healing capacity is impaired. Fat or fat-derived products may work to treat such pathology. Methods: Non-lethal irradiation at various doses (5 Gy, 10 Gy, 15 Gy) and frequencies (1-3 times on sequential days) was delivered to dorsal skin of 7-week-old nude mice, evaluating subsequent gross and microscopic changes for up to 4 weeks. Cutaneous punch wounds were then created, to compare wound healing in irradiated and non-irradiated states. Wounds were also locally injected with vehicle, cultured adipose-derived stem cells (ASCs), centrifuged fat tissue, or micronized cellular adipose matrix, monitoring therapeutic impact for up to 15 days. Results: Nude mice given total doses >15 Gy spontaneously developed skin ulcers ~2 weeks after exposure and radiation damage was dose-dependent, but a fractionated irradiation protocol could reduce the damage. Histologic assessment revealed dose-dependent dermal fibrosis/thickening and subcutaneous atrophy. Dose-dependent (5-15 Gy) impairment of wound healing was also evident. At highest dosage (15 Gy × 3), open wounds persisted on Day 15. However, wounds injected with cultured ASCs were nearly healed on Day 12, and those treated with injection of centrifuged fat or micronized connective tissue healed faster than untreated controls (p

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The Evolving Role of Blending of The Lid-Cheek Junction in Lower Blepharoplasty

No abstract available

https://ift.tt/2s1J5BX

"Microanatomy of sensory nerves in the upper eyelid: A cadaveric anatomical study”

Background: Plastic surgery requires detailed knowledge of upper eyelid anatomy, but few authors have sufficiently described the specifics of upper eyelid nerve anatomy. This study aimed to provide a thorough description of sensory nerve anatomy in the upper eyelid and to propose considerations for upper eyelid surgery. Methods: Sixteen orbits were dissected from sixteen fixed, adult human cadavers. Microscopically, we identified the main trunks of the infratrochlear, supratrochlear, and supraorbital nerves and all branches that projected toward the upper eyelid. The number, size, and distribution of nerve branches were recorded. Results: The branches of the infratrochlear, supratrochlear, and supraorbital nerves covered a wide range in the upper eyelid. The mean numbers of branches/nerve were 1.6 ± 1.2, 3.2 ± 1.5, and 2.6 ± 1.4, respectively. The branches of the infratrochlear nerve were distributed throughout the medial area of the upper eyelid. Those of the supratrochlear nerve were distributed throughout the medial and central areas, and the palpebral branches of the supraorbital nerve were distributed throughout the central and lateral areas of the upper eyelid. The lateral branches of the supraorbital nerve and the cutaneous branches of the lacrimal nerve were distributed in the lateral region of the orbit. Conclusions: We show that upper eyelid sensation is transmitted mainly by the supratrochlear and supraorbital nerves, and we provide a map of the distribution of upper eyelid sensory nerves. This precise anatomical knowledge about upper eyelid sensory nerves will facilitate pain control and help minimize nerve injuries during surgery. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Presented at: the 25th Research Council Meeting of Japan Society of Plastic and Reconstructive Surgery, in Osaka, Japan, September 15 through 16, 2016. ACKNOWLEDGMENTS: The authors would like to thank Masako Akiyama in the URA office of Tokyo Medical and Dental University for her advice regarding statistical analyses. Corresponding author: Takuya Higashino, MD, Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan., higashino-pla@umin.ac.jp ©2018American Society of Plastic Surgeons

https://ift.tt/2ICVQt3

Browning of human subcutaneous adipose tissue after its transplantation in nude mice

Background: The clinical unpredictability of autologous fat grafting originates partially from the unique characteristics of adipose tissue. Evidences of adipose remodeling toward browning (developing of brown-like adipocytes in white adipose tissue) in response to trauma are emerging. With regard to fat grafting surgery procedure by which adipose tissue depots are directly and ubiquitously traumatized, whether it affect adipose phenotype change toward browning has not been previously reported. Methods: Human subcutaneous adipose tissues were harvested from the abdominal region of female patients via liposuction and were then injected into the dorsal flank of athymic nude mice. After 12 weeks, fat grafts were harvested and subjected to histological analysis. Results: Hematoxylin and eosin staining showed appearance of small multilocular adipocytes in the peripheral region of the grafts. These adipocytes exhibited higher staining for uncoupling protein 1 (fat-browning-specific marker), mitochondrial protein and CD31 compared with the central ones, indicating the presence of brown-like adipocytes, namely beige adipocytes, in this area. Furthermore, immunofluorescence staining demonstrated that these beige adipocytes might be derived from de novo adipogenesis from progenitors of graft origin. Conclusions: Results of this study suggest that browning of subcutaneous white adipose tissue participates in adaptive tissue remodeling following grafting and contributes to adipose tissue repair. # Lihong Qiu, and Zhaoxiang Zhang contributed equally to this research and should be viewed as co-first authors. Financial Disclosure Statement: None of the authors has a financial interest in any of the products or devices mentioned in this article. Acknowledgments: This study was supported by the National Natural Science Foundation of China (81671932, 81701919 and 81401598). The authors thank all of their colleagues at the Institute of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, for their full cooperation and support. *Corresponding author: Chenggang Yi, M.D., Ph.D., Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi'an, Shaanxi 710032, China. Tel: +86-029-775306; Fax: +86-029-84775301; Email: yichg@163.com ©2018American Society of Plastic Surgeons

https://ift.tt/2IDCnIM

Beneficial Effects of Antioxidant Furfuryl Palmitate in Non-pharmacologic Treatments (Prescription Emollient Devices, PEDs) for Atopic Dermatitis and Related Skin Disorders

Abstract

Introduction

Atopic dermatitis (AD) is a common chronic inflammatory skin disease; it requires long-term treatments focused on symptomatic relief. Current first-line treatments include moisturizers and topical corticosteroids. Recently, topical antioxidants have been added to moisturizer formulations to alleviate mild-to-moderate AD. The aim of this review was to evaluate the efficacy and tolerability of furfuryl palmitate, a new antioxidant molecule, and furfuryl derivatives.

Methods

A PubMed/Google Scholar search was conducted using the term "furfuryl palmitate" (and its derivatives, including AR-GG27^®) combined with "skin," "atopic dermatitis," and "atopic eczema." Existing trials including adult and pediatric patients with AD and related skin disorders were evaluated. The treatment indication(s), number of subjects, treatment protocols, results, and side effects were recorded.

Results

Effective treatments with furfuryl palmitate and furfuryl derivatives have been reported for the following conditions: atopic, seborrheic, irritative, and allergic contact dermatitis, eczema, xerosis, and cutaneous inflammatory pathologies. All the products tested showed a good tolerability profile.

Conclusion

Studies performed up to now showed that furfuryl derivatives can efficaciously contrast signs and symptoms of mild-to-moderate AD, erythema, and widespread diffuse cutaneous pathologies in both adult and pediatric patients, representing a real alternative to steroids and a valid aid in the treatment of skin disorders, with no side effects and without requiring precautions in use.

Funding

Relife-Menarini Industrie Farmaceutiche.

Plain Language Summary

Plain language summary available for this article.

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Biomarkers for early identification of recurrences in HPV-driven oropharyngeal cancer

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Haitham Mirghani, Krystle A. Lang Kuhs, Tim Waterboer
One of the major concerns in oncology lies in the ability to detect recurrences at their earliest stage to increase the likelihood of cure following second line, or salvage, therapy. Although human papillomavirus (HPV)-driven oropharyngeal cancers have a good prognosis, 20–25% of patients will recur within 5 years of treatment and a significant portion will die from their disease. In recent years, great effort has been put toward evaluating the potential clinical utility of HPV-related biomarkers for early diagnosis of recurrent disease. Indeed, following completion of treatment, detection of HPV-DNA in oral rinses or blood and serologic assays against HPV oncoproteins could be helpful to track residual disease or recurrence. Several recent studies have reported promising findings, thus potentially paving the way for the use of biomarkers in the management of HPV-OPC.In this review, we evaluate and discuss the current knowledge on this topic and provide some directions for future research.



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An assessment of patient burdens from head and neck cancer survivorship care

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Sean T. Massa, Rebecca L. Rohde, Carole Mckinstry, Malia Gresham, Nosayaba Osazuwa-Peters, Gregory M. Ward, Ronald J Walker
ObjectivesTo assess head and neck cancer (HNC) patients' perspectives on the value and burdens of routine cancer follow-up care.Materials and methodsData was obtained from HNC patients (n = 100) at an urban, tertiary head and neck cancer clinic. A novel 15-question survey tool evaluated the logistic, financial, and psychosocial burdens associated with clinic visits. The clinical characteristics and survey responses of demographic groups were analyzed with comparative statistics. Linear regression modeling was utilized to identify predictors of overall stress.ResultsA majority of study participants were male (74%), white (83%), and had histories of tobacco (77%) and alcohol (77%) use. Most participants were satisfied with the frequency of their office visits (75%). Patients with laryngeal cancer, advanced stage disease, or who underwent multimodality therapy more often desired increased appointment frequency. These patients also rated the burdens of travel cost and overall stress higher, compared to patients desiring visits less often (41.5% vs 28.4%, p = 0.047 and 46.6% vs 38.3%, p = 0.003, respectively). Travel stress was associated with highest overall stress (beta 0.6, CI: 0.4, 0.7).ConclusionThe HNC survivor population is uniquely disenfranchised in several social and economic ways. While most patients are satisfied with their follow-up care, a significant subset of patients – those with limited social support, high financial stress, functional deficits, and those with transportation burdens – desire more frequent care. Survivorship care plans should incorporate the perspectives of current survivors.



https://ift.tt/2GHi77c

The unique and valuable soft tissue free flap in head and neck reconstruction: Lateral arm

Publication date: July 2018
Source:Oral Oncology, Volume 82
Author(s): Stephen Y. Kang, Antoine Eskander, Krupal Patel, Theodoros N. Teknos, Matthew O. Old
While the lateral arm free flap has been well described, there is a relative paucity in its use compared to other free flaps and regional flaps. The lateral arm free flap is a unique soft tissue free flap that provides several reconstructive advantages in head and neck reconstruction: excellent contour and color match to facial skin, well compartmentalized fat, donor nerves for nerve grafting, and the ability to two-team harvest and close the donor site without a skin graft. A detailed anatomic and harvest technique is described, along with indications and advantages of using lateral free flap for head and neck reconstruction. A scoping literature review was also conducted to tabulate indications, overall success and complications of the flap. The lateral arm flap is a primary option for defects requiring soft tissue reconstruction in the head and neck.



https://ift.tt/2khrzFO

Early TLR4 blockade attenuates sterile inflammation-mediated stress in islets during isolation and promotes successful transplant outcomes

Background During the isolation process, pancreatic islets are exposed to an environment of sterile inflammation resulting in an upregulated inflammatory state prior to transplantation. Toll-like receptor 4 (TLR4) has been identified as a major mediator of sterile inflammation. Therefore, we sought to determine whether early TLR4 blockade would be effective in reducing the inflammatory burden in islets pretransplant. Methods Islets from C57BL/6 mice were treated with a TLR4 antagonist during the pancreatic ductal perfusion and digestion steps of the isolation process. Islets were then analyzed for inflammation by RT-PCR and western blot, and for viability and function in vitro. A syngeneic transplant model using a marginal mass of islets transplanted intraportally into mice with streptozotocin-induced diabetes was used to study transplant outcomes after early TLR4 blockade. Results Diabetic mice receiving 150 islets treated with early TLR4 blockade achieved euglycemia at a higher rate than mice receiving untreated islets (75% vs 29%; p

https://ift.tt/2kjfO1s

Survival and Metabolic Function of Syngeneic Mouse Islet Grafts Transplanted into the Hepatic Sinus-tract

Background Islet grafts are transplanted into the liver via a portal vein in 90% of the clinical islet transplantations. However, the portal vein is far from being the ideal infusion site due to its unique drawbacks. These issues necessitated the exploration of an alternatively optimized site for clinical islet transplantation. With the widespread clinical application of percutaneous transhepatic puncture technique, we envisioned the possibility of islet transplantation into the hepatic sinus-tract (HST). Methods The HST was created by temporarily placing a medically approved material into the hepatic parenchyma of C57BL/6 mice. The syngeneic islets were transplanted into the HST, following which, the nonfasting blood glucose, intraperitoneal glucose tolerance, and morphology were evaluated. Results A collagen-lined HST was formed by the 28-day implantation of a cylindrical nylon rod. Transplantation of ~300 syngeneic islets into the HST routinely reversed the hyperglycemia of the recipient mice and maintained normoglycemia for >100 days until the graft was removed. The islet grafts within the HST stained positively for insulin, glucagon, and abundant microvessels and achieved comparable results to the islet grafts under the kidney capsule (KC) with respect to glycemic control and glucose tolerance. Conclusions These results suggested that an HST can be constructed for islet transplantation by temporarily placing a nylon material in the liver parenchyma. The HST is a promising site for clinical islet transplantation, thereby providing a satisfactory environment for the survival and metabolic function of islet grafts. Corresponding author Jialin Zhang, MD, PhD, Hepatobiliary Surgery Department and Unit of Organ Transplantation, the First Hospital of China Medical University, Shenyang 110001, China. Tel: 86-24-83283310. Fax: 86-24-83282997. Email: jlz2000@yeah.net Contribution: F.L participated in the research design, performance of the research, data analysis and writing of the manuscript. A.J, X.L, C.Z and N.S participated in the performance of the research and writing of the manuscript. J.Z participated in research design and writing of the manuscript. Disclosure Statement The authors report no conflicts of interest and are solely responsible for the content and writing of this manuscript. Financial Support: This work was supported by the National Natural Science Foundation of China (NSFC) (no. 31370989). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2x6JBDS

Belatacept in Solid Organ Transplant: Review of Current Literature Across Transplant Types

Calcineurin inhibitors (CNIs) have been the backbone immunosuppressant for solid organ transplant recipients for decades. Long-term use of CNIs unfortunately is associated with multiple toxicities, with the biggest concern being CNI-induced nephrotoxicity. Belatacept is a novel agent approved for maintenance immunosuppression in renal transplant recipients. In the kidney transplant literature, it has shown promise as being an alternative agent by preserving renal function and having a minimal adverse effect profile. There are emerging studies of its use in other organ groups, particularly liver transplantation, as well as using with other alternative immunosuppressive strategies. The purpose of this review is to analyze the current literature of belatacept use in solid organ transplantation and discuss its use in current practice. Corresponding author: Caroline P. Perez, PharmD, BCPS, Clinical Pharmacy Specialist, Solid Organ Transplant, Medical University of South Carolina, 150 Ashley Avenue, MSC 584, Charleston, SC 29425. perezca@musc.edu Authorship contribution: All authors were involved with analyzing the literature, interpreting the data, and writing the manuscript. CP, NP, and NAP were involved with revising the manuscript. CP was involved with coordination and final editing of the manuscript. All authors agreed upon final approval of the version submitted. Disclosure: The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Secondhand hypertrophy: a rare case of genetically-based pathology developing within a transplanted heart

No abstract available

https://ift.tt/2x56U0D

Critical Appraisal of International Clinical Practice Guidelines in Kidney Transplantation Using the Appraisal of Guidelines for Research and Education (AGREE) II Tool: A Systematic Review

Background Whilst Clinical Practice Guidelines (CPGs) are used for the development of local protocols in kidney transplantation (Ktx), the quality of their methodology is variable. This systematic review aimed to critically appraise international CPGs in all aspects of Ktx using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Methods CPGs in Ktx and donation published between 2010 and 2017 were identified from MEDLINE, Embase, National Guideline Clearinghouse, NHS and NICE Evidence Searches, and the websites of transplant societies. Using AGREE II, 3 appraisers assessed the quality of CPGs. Interrater reliability was measured using the intraclass correlation coefficient (ICC). Results Searches identified 3,168 records and 115 CPGs were included. The highest scoring AGREE II domain was 'Scope and Purpose' (80%; Range 30-100%), followed by 'Clarity of Presentation' (77%; Range 43-98%), 'Editorial independence' (52%; Range 0-94%), 'Rigour of Development' (47%; Range 6-97%) and 'Stakeholder Involvement' (41%; Range 11-85%). The poorest scoring domain was 'Applicability' (31%; Range 3-74%). Most CPGs were recommended for future use either with (63%) or without modifications (18%). A small number were not recommended for future use (14%) or reviewers did not agree on recommending the CPG (5%). The overall mean CPG quality score was 4 out of 7 (Range 2-7). The mean ICC of 0.74 indicated substantial agreement between reviewers. Conclusions The quality of international CPGs in Ktx was variable, and most CPGs lacked key aspects of methodological robustness and transparency. Improvements in methodology, patient involvement and strategies for implementation are required. Correspondence information: Corresponding Author: Katriona JM O'Donoghue, E-mail: kodonoghue@rcseng.ac.uk, Mailing address: Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons, 35-43 Lincoln's Inn Fields, London WC2A 3PE. Systematic review registration PROSPERO ID: CRD42015027356 AUTHORSHIP PAGE Authorship KO, RR, SK, JO, PM and LP were involved in the concept and design of the systematic review. KO and LP designed the search strategy. KO and RR screened search results for relevant full-texts and these were checked by LP. KO and RR performed the data extraction. All authors were involved in the critical appraisal of guidelines with AGREE II. KO wrote the initial drafts of the manuscript and these were revised by LP. All authors critically revised the final draft of the manuscript. KO had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. KO is guarantor. Disclosure All authors have completed the ICMJE uniform disclosure form at https://ift.tt/PN8RmS and the authors declare no conflicts of interest. Funding No funding received Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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