Head and Neck Diseases by Alexandros G.Sfakianakis: 07/10/18

Τρίτη 10 Ιουλίου 2018

Education in neuroanesthesia and neurocritical care: trends, challenges and advancements

Purpose of review We summarize the latest evidence in neuroanesthesia and neurocritical care (NCC) training. In addition, we describe the newer advancements that clinical educators face in these subspecialties. Lastly, we highlight educational approaches that may lead to an enhanced learning experience and development of necessary skills for neurosciences trainees. Recent findings Current neuroanesthesia and NCC training requires acquisition of specific skills for increasing complex surgical cases, specialized neurosurgical practice and new perioperative technologies. Furthermore, there is increasing international interest for standardization and accreditation of neuroanesthesia fellowship programs. Recent evidence has demonstrated that well structured training using high-fidelity simulation improves cognitive and technical skills in acute neurological crises. Summary High-fidelity simulation in perioperative care of neurosurgical patients can be part of formal neuroanesthesia and NCC curricula, and potentially impact trainees' proficiency. A research agenda is needed to validate the assessment of most effective educational interventions in neurosciences trainees with diverse medical backgrounds. Creative combinations of cost-effective interventions including traditional teaching, specific technical skills workshops, low and high-fidelity simulation deserve to be assessed in future studies. Correspondence to Angela Builes-Aguilar, MD, MSc, MsEpi, Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, Western University, 275 Regent Street, London, ON, Canada N6A2H3. Tel: +1 519 671 0313; e-mail: Angelitabuiles@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anesthesia for awake craniotomy

Purpose of review The current review reports on current trends in the anesthetic management of awake craniotomy, including preoperative preparation, sedation schemes, pain management, and prevention of intraoperative complications. Recent findings Both approaches for anesthesia for awake craniotomy, asleep–awake–asleep and monitored anesthesia care (MAC), have shown equal efficacy for performing intraoperative brain mapping. Choice of the appropriate scheme is currently based mainly on the preferences of the particular anesthesiologist. Dexmedetomidine has demonstrated high efficacy and safety in MAC for awake craniotomy and has become a rational alternative to propofol. Despite the high efficacy of scalp block and opioids, pain remains a common compliant in awake craniotomy. Appropriate surgical tactics can reduce pain and even prevent postoperative neurological complications. Although the efficacy of prophylaxis of intraoperative seizures with anticonvulsants remains doubtful, levetiracetam can be superior to other drugs for this purpose. Summary Following a great deal of progress in anesthetic management, awake craniotomy, which had been a relatively rare approach, is now a commonly performed procedure for neurosurgical intervention. Modern anesthesia techniques can provide for successful brain mapping in almost any patient. Management of awake craniotomy in high-risk patients is a central task for future research. Correspondence to Alexander Kulikov, MD, PhD, Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia. Tel: +7 903 963 73 64; e-mail: akulikov@nsi.ru Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Opioid-free anesthesia: a different regard to anesthesia practice

Purpose of review In the past two decades, opioids have been prescribed increasingly for the treatment of various chronic pain conditions and during the perioperative period. Perioperative opioid administration is associated with well known adverse effects and recently to long-term use and poor surgical outcomes. In this context, the anesthesiologists have to face their responsibilities. The review discusses the neurophysiological basis of opioid-free anesthesia (OFA), the rational supporting its use in perioperative medicine as well as barriers and future challenges in the field. Recent findings OFA has gained in popularity as a way to enhance early recovery and to spare opioids for the postoperative period. Whether it is possible to deliver safe and stable anesthesia without intraoperative opioids to many patients undergoing various surgical procedures, OFA still raises questions. Accurate monitoring to measure intraoperative nociception and guide the use of adjuvants are not available. There is a need for the development of procedure-specific strategies as well as indications and contraindications to the technique. Finally, objective assessment of OFA use on patient outcomes should be recorded in large multicenter studies. Summary OFA stands as a new paradigm, which questions anesthesiology practice and might help to rationalize perioperative opioids use. Correspondence to Patricia Lavand'homme, MD, PhD, Department of Anesthesiology, Cliniques Universitaires St Luc - University Catholic of Louvain, Av Hippocrate 10, B-1200 Brussels, Belgium. Tel: +32 2 764 18 21; fax: +32 2 764 36 99; e-mail: patricia.lavandhomme@uclouvain.be Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Genetics and genomics in postoperative pain and analgesia

Purpose of review The review describes recent advances in genetics and genomics of postoperative pain, the association between genetic variants and the efficacy of analgesics, and the role of pharmacogenomics in the selection of appropriate analgesic treatments for postoperative pain. Recent findings Recent genetic studies have reported associations of genetic variants in catechol-O-methyltransferase (COMT), brain-derived neurotrophic factor (BDNF), voltage-gated channel alpha subunit 11 (SCN11A) and μ-opioid receptor (OPRM1) genes with postoperative pain. The recent pharmacogenetics studies revealed an association of the organic cation transporter 1 (OCT1) and ATP-binding cassette C3 (ABCC3) polymorphisms with morphine-related adverse effects, an effect of polymorphisms in cytochrome P450 gene CYP2D6 on the analgesic efficacy of tramadol and no effect of CYP2C8 and CYP2C9 variants on efficacy of piroxicam. Summary Genetic variants associate with inter-individual variability in drug responses and they can affect pain sensitivity and intensity of postoperative pain. Despite the recent progress in genetics and genomics of postoperative pain, it is still not possible to precisely predict the patients who are genetically predisposed to have severe postoperative pain or who develop chronic postoperative pain. Correspondence to Eija Kalso, MD, PhD, Pain Clinic, PB 140, 00029 HUS, Finland. Tel: +358 9 47175885; e-mail: eija.kalso@helsinki.fi Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Is epidural analgesia still a viable option for enhanced recovery after abdominal surgery

Purpose of review Although thoracic epidural analgesia (TEA) is considered often as gold standard in multimodal analgesia with regard to major abdominal surgery, there is an ongoing debate if it is still a viable option for enhanced recovery because of its potential severe complications. Recent findings In addition to the unsurpassed analgesic quality, a TEA offers several advantages. Studies have shown that a TEA does have a positive effect on perioperative morbidity and mortality, bowel function, the occurrence of ileus and patient mobility. Furthermore, TEA can reduce opioid-induced side effects, cardiac arrhythmias and pneumonia. When it is embedded into a multimodal fast-track program, it also shortens intensive care and hospital stay. Summary TEA provides superior pain control with a handful of important advantages if used sensibly and with caution. Because of associated risks for severe neurological complications, clear contraindications should be ruled out. Special attention needs be paid to potential hypotension in the setting of epidural analgesia. If these key points are considered, a TEA still represents a viable option for enhanced recovery after major abdominal surgery. Correspondence to Raphael Weiss, MD, University Hospital Münster, Departement of Anesthesiology and Intensive Care Medicine, Albert-Schweitzer-Campus 1, 48149 Münster, NRW, Germany. Tel: +49 251 83 47266; fax: +49 251 83 47257; e-mail: r_weiss@anit.uni-muenster.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The road to accreditation for fellowship training in regional anesthesiology and acute pain medicine

Purpose of review The purpose of this review is to provide the background and rationale for pursuing accreditation of regional anesthesiology and acute pain medicine (RAAPM) fellowships, explain specific steps and challenges in the process, and forecast the future of fellowship training. Recent findings In 2016, the first fellowship program in RAAPM was able to apply for accreditation from the Accreditation Council for Graduate Medical Education (ACGME). The establishment of this newly accredited subspecialty fellowship and the announcement of the first accredited programs represented a tremendous achievement in anesthesiology training and medical education in general and was the culmination of nearly 4 years of dedicated effort. Summary Programs with initial ACGME accreditation are on a 2-year term and will be reviewed to evaluate adherence to the program requirements and the quality of fellowship training. Deficiencies identified will need to be resolved or face loss of accreditation. However, a program's maintenance of accreditation represents a commitment to its fellows to provide a training experience that can be held as a benchmark for all programs. Correspondence to Edward R. Mariano, MD, MAS, Anesthesiology and Perioperative Care Service; VA Palo Alto Health care System; 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA. Tel: +650 849 0254; fax: +650 852 3423; e-mail: emariano@stanford.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Anesthesia for electroconvulsive therapy

Purpose of review Electroconvulsive therapy (ECT) is a well established and effective therapy in treatment-resistant depression. It is performed under general anesthesia, but no consensus exists regarding the optimal anesthetic drugs. A growing interest in optimizing adjunctive medication regimes in ECT anesthesia has emerged in recent years. Moreover different methods of seizure induction have been evaluated. Recent findings Pretreatment with dexmedetomidine eased the propofol injection pain and reduced the hyperdynamic response to ECT, but prolonged recovery. Remifentanil exhibited no proconvulsive effect and had no effect on seizure quality. Ketamine showed an antidepressive effect but was associated with cardiovascular side effects and an increased recovery time. A bispectral index-guided anesthesia or a time delay between anesthesia and seizure induction resulted in a better seizure quality presumably by avoiding high concentrations of (anticonvulsive) hypnotics. Seizure induction by magnetism seems to be an alternative to ECT, as the former is associated with less cognitive side effects but comparable antidepressive efficacy. Summary The current practice of anesthesia for ECT should not be modified, as the evidence of studies is either too low or the results are inconsistent. Some approaches are promising but require validation in further studies with a higher number of participants. Correspondence to Prof Dr Martin Soehle, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany. Tel: +49 228 28714127; e-mail: martin.soehle@ukbonn.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Recent developments in ultrasound imaging for neuraxial blockade

Purpose of review Recent research has shed further light on the place of ultrasound imaging in neuraxial blockade in routine clinical practice, its use in thoracic epidurals, and real-time ultrasound-guided techniques. Recent findings Compared with the conventional technique of surface landmark palpation, preprocedural ultrasound imaging minimizes technical difficulty associated with lumbar neuraxial blockade in patients with poor-quality surface landmarks. Novice practitioners are able to learn to employ the technique effectively. Safety benefits include a reduction in postprocedural back pain associated with fewer needle passes and a lower risk of procedure-associated bleeding. The advantage of ultrasound is minimal however in patients with easily discernible surface landmarks, especially if the practitioner is highly experienced. Recent trials show that preprocedural ultrasound scanning for thoracic epidural insertion reduces needle punctures and increases early analgesic efficacy compared with the palpation technique. Real-time ultrasound-guided techniques, while feasible, remain challenging and may not offer significant benefit over preprocedural imaging in lumbar neuraxial blockade. Their role in thoracic epidural insertion requires further investigation. Summary Ultrasound imaging of the spine is a valuable technique that, while not indicated for routine use, should be part of the skillset of any practitioner that regularly performs lumbar and thoracic neuraxial blockade. Correspondence to Ki Jinn Chin, MBBS, MMed, FRCPC, Department of Anesthesia, Toronto Western Hospital, 399 Bathurst St, McL 2–405, Toronto, Ontario M5T 2S8, Canada. Tel: +1 416 603 5118; fax: +1 416 603 6494; e-mail: gasgenie@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Increasing grassland degradation stimulates the non-growing season CO 2 emissions from an alpine meadow on the Qinghai–Tibetan Plateau

Abstract

The alpine meadow ecosystem is one of the major vegetation biomes on the Qinghai–Tibetan Plateau, which hold substantial quantities of soil organic carbon. Pronounced grassland degradations (induced by overgrazing/climate change and further exacerbated by the subterranean rodent activities) that have widely occurred in this ecosystem may significantly alter the non-growing season carbon turnover processes such as carbon dioxide (CO₂) efflux, but little is known about how the non-growing season CO₂ emissions respond to the degradation (particularly the exacerbated degradations by plateau zokor), as most previous studies have focused primarily on the growing season. In this study, the effects of four degradation levels (i.e., the healthy meadow (HM), degraded patches (DP), 2-year-old zokor mounds (ZM2), and current-year zokor mounds (ZM1)) on CO₂ emissions and corresponding environmental and agronomic variables were investigated over the two non-growing seasons under contrasting climatic conditions (a normal season in 2013–2014 and a "warm and humid" season in 2014–2015). The temporal variation in the non-growing season CO₂ emissions was mainly regulated by soil temperature, while increasing degradation levels reduced the temperature sensitivity of CO₂ emissions due to a reduction in soil water content. The cumulative CO₂ emissions across the non-growing season were 587–1283 kg C ha⁻¹ for all degradation levels, which varied significantly (p < 0.05) interannually. The degradation of alpine meadows significantly (p < 0.05) reduced the vegetation cover and aboveground net primary productivity as well as the belowground biomass, which are typically thought to decrease soil CO₂ emissions. However, the non-growing season CO₂ emissions for the degraded meadow, weighted by the areal extent of the DP, ZM2, and ZM1, were estimated to be 641–1280 kg C ha⁻¹, which was significantly higher (p < 0.05) as compared with the HM in the warm and humid season of 2014–2015 but not in the normal season of 2013–2014. Additionally, grassland degradation substantially increased the productivity-scaled non-growing season CO₂ emissions, which showed an exponential trend with increasing degradation levels. These results suggest that there is a strong connection between grassland degradation and soil carbon loss, e.g., in the form of CO₂ release, pointing to the urgent need to manage degraded grassland restoration that contributes to climate change mitigation.

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Influence of chronic alcoholism and estrogen deficiency on the immunohistochemical expression of regulatory proteins of the bone resorption process in the periodontium of Wistar rats

Publication date: Available online 10 July 2018

Source: Archives of Oral Biology

Author(s): Adriana Mathias Pereira da Silva Marchini, Gabriela de Fátima Santana-Melo, Miriane Carneiro Machado Salgado, Elis Andrade de Lima Zutin, Leonardo Marchini, Rosilene Fernandes da Rocha, Luana Marotta Reis de Vasconcellos

Abstract

OBJECTIVE

The aim of this study was to investigate possible changes in immunohistochemical expression of proteins regulating the bone resorption process in the periodontium of rats subjected to alcoholism and/or estrogen deficiency. The investigated proteins were receptor activator of nuclear factor-kappa β ligand (RANKL), a protein that stimulates bone resorption, and osteoprotegerin (OPG), a protein that inhibits bone resorption. At the molecular level, decreased OPG expression and/or increased RANKL expression are consistent with a greater predisposition to bone resorption.

DESIGN

Wistar female rats were divided into ovariectomized (ovx) and non-ovariectomized (sham) groups, and subdivided into ad libitum diet (free diet), alcoholic diet (20% solution), and isocaloric diet (diet with a similar amount of calories as compared with groups ingesting an alcoholic diet). The alveolar bone crest and adjacent tissues were evaluated by immunohistochemical analyses for detection of OPG and RANKL.

RESULTS

A significant decrease in OPG expression and a significant increase in RANKL expression were observed in ovariectomized animals which received alcohol as compared with non-ovariectomized animals which received isocaloric diet (experimental control). When estrogen deficiency was evaluated independently of the diet type, a significant decrease in OPG expression and a significant increase in RANKL expression were observed in ovariectomized animals as compared with non-ovariectomized animals.

CONCLUSIONS

Estrogen deficiency associated with alcoholic diet, as well as estrogen deficiency (analyzed independently of diet type), decreased the immunostaining for OPG and increased the immunostaining for RANKL in the periodontium of rats.

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Letter to the Editor: Autoimmune pathogenic mechanisms in Huntington's disease

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Antonio Greco, Massimo Ralli, Armando De Virgilio, Maurizio Inghilleri, Massimo Fusconi, Marco de Vincentiis

https://ift.tt/2zzlwqe

Nature versus nurture in the spectrum of rheumatic diseases: Classification of spondyloarthritis as autoimmune or autoinflammatory

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): Elena Generali, Tanima Bose, Carlo Selmi, J. Willem Voncken, Jan G.M.C. Damoiseaux

Abstract

Spondyloarthritides (SpA) include inflammatory joint diseases with various clinical phenotypes that may also include the axial skeleton and/or entheses. SpA include psoriatic arthritis, reactive arthritis, enteropathic arthritis and ankylosing spondylitis; the latter is frequently associated with extra-articular manifestations, such as uveitis, psoriasis, and inflammatory bowel disease. SpA are associated with the HLA-B27 allele and recognize T cells as key pathogenetic players. In contrast to other rheumatic diseases, SpA affect women and men equally and are not associated with detectable serum autoantibodies. In addition, but opposite to rheumatoid arthritis, SpA are responsive to treatment regimens including IL-23 or IL-17-targeting biologics, yet are virtually unresponsive to steroid treatment. Based on these differences with prototypical autoimmune diseases, such as rheumatoid arthritis or connective tissue diseases, SpA may be better classified among autoinflammatory diseases, with a predominant innate immunity involvement. This would rank SpA closer to gouty arthritis and periodic fevers in the spectrum of rheumatic diseases, as opposed to autoimmune-predominant diseases. We herein provide available literature on risk factors associated with SpA in support of this hypothesis with a specific focus on genetic and environmental factors.

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Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): I. Sanz Pérez, F. Martínez Valle, A. Guillén del Castillo, A. Roque Pérez, H. Cuéllar Calàbria, M.N. Pizzi, A. Fernández Codina, E. Callejas Moragas, O. Orozco Gálvez, V. Fonollosa Pla, C.P. Simeón Aznar

Abstract

Background and objectives

Recently published population-based cohort studies have shown a high prevalence of cardiovascular disease in Systemic Sclerosis (SSc) patients. The aim of this study is to compare three different methods to measure cardiovascular risk in patients with scleroderma.

Methods

Forty-three SSc patients were included. A prospective study was performed for evaluation of cardiovascular risk and subclinical atheromatosis using 3 non-invasive methods: cardiovascular risk tables, carotid Doppler ultrasonography and quantification of coronary calcium by computerized tomography (CT).

Results

The cardiovascular risk charts for the Spanish population did not identify patients at high cardiovascular risk. Framingham-REGICOR identified 13 intermediate-risk patients. Twenty-two patients (51.2%) had plaques on carotid ultrasonography. We performed a ROC curve to identify the best cutoff point for the quantification of coronary artery calcium (CACscore), the value of CACscore > 28 AU (Agatston Units) had the highest sensitivity (73%) and specificity (81%) for the diagnosis of subclinical atheromatosis. In the multiple regression study, age and decreased HDL cholesterol levels were identified as independent factors for subclinical atherosclerotic disease. No disease-related factors were associated with increased subclinical arteriosclerosis.

Conclusion

Carotid ultrasound and CACscore are useful for identifying subclinical atheromatosis in patients with SSc and are superior compared to risk charts used for general population. HDL cholesterol and age were independent factors for the presence of subclinical atherosclerotic disease. A carotid ultrasound or CT should be performed for early detection of subclinical atheromatosis if these factors are present.

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Inflammation and dementia: Using rheumatoid arthritis as a model to develop treatments?

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Alice Mason, Clive Holmes, Christopher J. Edwards

Abstract

Dementia is a major international public health problem which looks set to grow as the ageing population increases. Despite large amounts of investment there has been relatively little progress in developing new therapies to combat this. There is a growing body of evidence that both local and systemic inflammation are important in dementia; with cerebral inflammation occurring secondarily to beta-amyloid plaques, raised levels of serum inflammatory molecules and cytokines being present in Alzheimer's disease patients and systemic inflammation being associated with cerebral microvasculature disease in vascular dementia. Observational studies had suggested that non-steroidal anti-inflammatory drugs may reduce the risk of dementia, but subsequent interventional studies have been disappointing. More recently some observational studies have suggested a protective effect from conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS) and tumour necrosis factor inhibiting (TNFi) biological therapies. Treatments for inflammatory rheumatic diseases have previously been repurposed and used successfully in other diseases, such as TNFi for inflammatory bowel disease. There are also studies looking at the use of csDMARDs such as methotrexate to improve outcomes after cardiovascular events. Ongoing interventional trials are currently looking at whether therapies designed to treat inflammatory and autoimmune diseases have the potential to be used to treat dementia.

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Efficacy and patient satisfaction in the use of subcutaneous immunoglobulin immunotherapy for the treatment of auto-immune neuromuscular diseases

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Taylor Pindi Sala, Jean-Charles Crave, Martin Duracinsky, Lepira Bompeka, Abir Tadmouri, Olivier Chassany, Patrick Cherin

Abstract

We reviewed the efficacy of SCIg administration in terms of muscle strength maintenance and patient satisfaction comparing with IVIg in the treatment of auto-immune neuromuscular diseases. A systematic review was conducted, and identified studies from databases (PUBMED, EMBASE, EBSCO, Web of Science and Google Scholar) which were analyzed. The methodological quality of the selected publications was evaluated using the Newcastle-Ottawa Scale. Data were extracted from a total of 11 studies Fixed and random-effect model meta-analyses were performed. For the maintenance of muscle strength, Overall Neuropathy Limitations Scale (ONLS) data from 100 patients diagnosed with multifocal mononeuropathy (MMN) or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) were pooled together. Switching to subcutaneous immunoglobulin administration led to a significant improvement (fixed effects model, p = 0.002). In data collected using the Medical Research Council Scale for Muscle Strength data from 140 patients with a wider range of disorders, a small but significant improvement in overall strength was observed in the SCIg group (p < 0.0001). In addition, the results of two studies measuring health-related quality of life and patient satisfaction were pooled. Data from 49 patients suffering from MMN, CIDP, and a variety of different myopathies demonstrated a small but significant increase in the mean 36-Item Short Form Survey (SF-36) scores (p < 0.0001). A highly significant difference was revealed when comparing data from 119 patients' responses to the Life Quality Index questionnaire (LQI) assessing patient satisfaction (p < 0.0001). This is the first analysis showing that SCIg is more effective than IVIg in improving Patient Reported Outcomes in auto-immune neuromuscular disease. These results should permit a broad range of patients to self-administer immunoglobulin treatments at home, potentially improving patient acceptability while reducing hospital visits and healthcare costs for the treatment of chronic auto-immune neuropathies.

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Therapy of scleroderma renal crisis: State of the art

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Elisabetta Zanatta, Pamela Polito, Mariangela Favaro, Maddalena Larosa, Piero Marson, Franco Cozzi, Andrea Doria

Abstract

Scleroderma renal crisis (SRC) is an uncommon but still life-threatening manifestation of systemic sclerosis (SSc). The incidence of SRC has decreased in the last few decades, probably due to a widespread use of vasodilators in SSc patients. It is well-recognized that exposure to different drugs can trigger SRC (corticosteroids, cyclosporine) or prevent its occurrence (iloprost, calcium channel blockers). The prognosis of this life-threatening manifestation has not substantially improved since 1980s, when ACE-inhibitors were introduced in its treatment. ACE-inhibitors remain the mainstay in the therapy of SRC due to their efficacy in controlling malignant hypertension; indeed, the prognosis largely depends on the rapid improvement of the ongoing renal ischemia. Calcium-channel blockers and in third line diuretics and alpha-blockers should be used as additional therapy if blood pressure control remains suboptimal despite maximum tolerated doses of ACE-inhibitors. Given the growing evidence on the role of complement activation and endothelin-1 in the pathogenesis of SRC, recent case-series and case reports have suggested the use of C5-inhibitors and endothelin receptor antagonists in the therapy of SRC, mainly in the refractory cases. Plasma-exchange seems to give some benefits in patients with SRC and microangiopathy or intolerant to ACE-inhibitors. Renal transplantation is the last treatment option and its outcome is similar to that reported in other connective tissue disorders, with a 5-year patient survival rate of about 82%. In this review we summarize the current knowledge in the treatment of SRC.

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Classification of primary antiphospholipid syndrome as systemic lupus erythematosus: Analysis of a cohort of 214 patients

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Romain Paule, Nathalie Morel, Véronique Le Guern, Micaela Fredi, Laetitia Coutte, Meriem Belhocine, Luc Mouthon, Claire le Jeunne, Anthony Chauvin, Jean-Charles Piette, Nathalie Costedoat-Chalumeau

Abstract

Objectives

To assess the limitations of the SLICC (Systemic Lupus International Collaborating Clinics) classification criteria for systemic lupus erythematosus (SLE), in patients with primary antiphospholipid syndrome (PAPS).

Methods

Retrospective study of a cohort of APS patients (Sydney criteria). We successively excluded patients with (1) at least one "SLE-specific" manifestation (biopsy-proven SLE nephropathy, arthritis, cutaneous, or neurologic SLE manifestations, pericarditis, autoimmune haemolytic anaemia, oral and nasal ulcers, non-scarring alopecia, anti-dsDNA, and anti-Sm antibodies), (2) any other autoimmune connective tissue disease, and/or (3) antinuclear antibodies >1/320. Careful file review confirmed PAPS among the remaining patients. We then assessed the number of SLICC criteria each patient met.

Results

Among these 214 APS patients, we excluded 85 with at least one SLE-specific manifestation, 8 with another connective tissue disease, and 21 with antinuclear antibodies >1/320, leaving 100 patients with primary APS. Among them, 28% met at least 4 SLICC classification criteria including one clinical and one immunological criterion (antiphospholipid antibodies, aPL, by definition) and could thus theoretically be classified with SLE. Fourteen had an arterial phenotype (50%), 9 a history of catastrophic APS (32%), and 18 a triple-positive profile for aPL (64%). None had developed SLE during a median follow-up of 12 [6.5–17] years.

Conclusion

Because 28% of our patients with longstanding and strictly defined PAPS could be mistakenly classified as SLE, they were at risk of deleterious therapeutic management. We therefore suggest that any future classification for SLE should specifically require at least one SLE-specific criterion for patients with aPL.

https://ift.tt/2mavbdC

Nature versus nurture in the spectrum of rheumatic diseases: Classification of spondyloarthritis as autoimmune or autoinflammatory

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Author(s): Elena Generali, Tanima Bose, Carlo Selmi, J. Willem Voncken, Jan G.M.C. Damoiseaux

Abstract

https://ift.tt/2unqSPE

Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography

Publication date: Available online 11 July 2018

Source: Autoimmunity Reviews

Abstract

Background and objectives

Methods

Results

Conclusion

https://ift.tt/2m845np

Inflammation and dementia: Using rheumatoid arthritis as a model to develop treatments?

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Alice Mason, Clive Holmes, Christopher J. Edwards

Abstract

https://ift.tt/2zuCm9O

Efficacy and patient satisfaction in the use of subcutaneous immunoglobulin immunotherapy for the treatment of auto-immune neuromuscular diseases

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Taylor Pindi Sala, Jean-Charles Crave, Martin Duracinsky, Lepira Bompeka, Abir Tadmouri, Olivier Chassany, Patrick Cherin

Abstract

https://ift.tt/2m7xZYQ

Letter to the Editor: Autoimmune pathogenic mechanisms in Huntington's disease

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Antonio Greco, Massimo Ralli, Armando De Virgilio, Maurizio Inghilleri, Massimo Fusconi, Marco de Vincentiis

https://ift.tt/2zzlwqe

Therapy of scleroderma renal crisis: State of the art

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Elisabetta Zanatta, Pamela Polito, Mariangela Favaro, Maddalena Larosa, Piero Marson, Franco Cozzi, Andrea Doria

Abstract

https://ift.tt/2m77HWz

Drug-induced lupus: Traditional and new concepts

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Author(s): Augusto Vaglio, Peter C. Grayson, Paride Fenaroli, Davide Gianfreda, Valeria Boccaletti, Gian Marco Ghiggeri, Gabriella Moroni

Abstract

Drug-induced lupus (DIL) includes a spectrum of drug-induced reactions often characterised by a clinical phenotype similar to that of idiopathic systemic lupus eruthematosus (SLE) but usually lacking major SLE complications. Different drugs may be associated with distinct clinical and serological profiles, and early recognition is crucial. Drugs traditionally associated with DIL include procainamide, hydralazine, quinidine and others, but strong associations with newer agents, such as TNF α (TNFα) inhibitors, are increasingly recognised. The pathogenic mechanisms explaining how drugs that have heterogeneous chemical structure and function lead to autoimmunity are only partially understood. However, it is likely that traditional DIL-associated agents can boost innate immune responses, particularly neutrophil responses, with neutrophil extracellular trap (NET) formation and exposure of autoantigens. Research in the field of DIL is evolving and may provide interesting models for the study of autoimmunity.

https://ift.tt/2zuuepU

Classification of primary antiphospholipid syndrome as systemic lupus erythematosus: Analysis of a cohort of 214 patients

Publication date: Available online 10 July 2018

Source: Autoimmunity Reviews

Abstract

Objectives

Methods

Results

Conclusion

https://ift.tt/2mavbdC

Phenotypic and lipidomic characterization of primary human epidermal keratinocytes exposed to simulated solar UV radiation

Publication date: Available online 10 July 2018

Source: Journal of Dermatological Science

Author(s): Núria Dalmau, Nathalie Andrieu-Abadie, Romà Tauler, Carmen Bedia

Abstract

Background

Ultraviolet (UV) radiation is known to be one of the most important environmental hazards acting on the skin. The most part of UV radiation is absorbed in the epidermis, where keratinocytes are the most abundant and exposed cell type. Lipids have an important role in skin biology, not only for their important contribution to the maintenance of the permeability barrier but also for the production and storage of energy, membrane organization and cell signalling functions. However, the effects on the lipid composition of keratinocytes under UV radiation are little explored.

Objective

The present work aims to explore the effects on the phenotype and lipid content of primary human keratinocytes exposed to simulated solar UV radiation.

Methods

Keratinocytes were exposed to a single (acute exposure) and repeated simulated solar UV irradiations for 4 weeks (chronic exposure). Cell viability and morphology were explored, as well as the production of reactive oxygen species. Then, lipid extracts were analysed through liquid chromatography coupled to mass spectrometry (LC-MS) and the data generated was processed using the ROIMCR chemometric methodology together with partial least squares discriminant analysis (PLS-DA), to finally reveal the most relevant lipid changes that occurred in keratinocytes upon UV irradiation. Also, the potential induction of keratinocyte differentiation was explored by measuring the increase of involucrin.

Results

Under acute irradiation, cell viability and morphology were not altered. However, a general increase of phosphatidylcholines (PC) phosphatidylethanolamines (PE) and phosphatidylglycerol (PG) together with a slight sphingomyelin (SM) decrease were found in UV irradiated cells, among other changes. In addition, keratinocyte cultures did not present any differentiation hallmark. Contrary to acute-irradiated cells, in chronic exposures, cell viability was reduced and keratinocytes presented an altered morphology. Also, hallmarks of differentiation, such as the increase of involucrin protein and the autophagy induction were detected. Among the main lipid changes that accompanied this phenotype, the increase of long-chain ceramides, lysoPC and glycerolipid species were found.

Conclusion

Important lipid changes were detected under acute and chronic UV irradiation. The lipid profile under chronic exposure may represent a lipid fingerprint of the keratinocyte differentiation phenotype.

https://ift.tt/2L6gFlj

Universal varicella vaccination increased the incidence of herpes zoster in the child-rearing generation as its short-term effect

Publication date: Available online 10 July 2018

Source: Journal of Dermatological Science

Author(s): Nozomu Toyama, Kimiyasu Shiraki, for the Miyazaki Dermatologist Society

Abstract

Background

Effects of universal varicella vaccination on the herpes zoster (HZ) incidence have not been elucidated. Universal varicella vaccination was introduced in Japan in October 2014.

Objective

We investigated the effects of universal varicella vaccination on HZ epidemiology.

Methods

Patients with HZ have been monitored by the Miyazaki Dermatologist Society since 1997, and the effects of universal vaccination on the HZ incidences have been analyzed to determine which generation is most affected.

Results

The number of HZ patients increased 1.54 times, and the gradual increase in the HZ incidence was observed in not only patients >60 years, but also other generations during the period from 1997 to 2017. The number of varicella patients was gradually reduced from 2010 to 2017 before introduction of universal varicella vaccination, and the HZ incidence in yearly change significantly increased from 2014 to 2016 in the total population associated with the significant decrease in varicella incidence. The HZ incidence significantly increased for individuals aged 20 to 49 years from 2014 to 2015 and most for individuals age 20–29 years (odds ratio [OR], 1.270; 95% confidence interval [CI], 1.071–1.505, P < 0.001). We identified the child-rearing generation of age 20 to 49 years (OR, 1.270; 95% CI, 1.071–1.505, P < 0.001) as the generation most influenced by universal varicella vaccination, when the HZ incidence increased gradually by approximately 2% per year.

Conclusions

Universal vaccination increased the HZ incidence in the child-rearing generation among the generations, possibly by reduced chance of boosting their immunity by exposure to varicella.

https://ift.tt/2JcKgUN

HLA-G protein expression in colorectal cancer evaluated by immunohistochemistry and western blot analysis: Its expression characteristics remain enigmatic

Publication date: Available online 10 July 2018

Source: Clinical Immunology

Author(s): Marloes Swets, Anne Wouters, Daniëlle Krijgsman, Ronald L.P. van Vlierberghe, Arnoud Boot, Jaap D. van Eendenburg, Tom van Wezel, Hans Gelderblom, Cornelis J.H. van de Velde, Peter J. van den Elsen, Peter J.K. Kuppen

Abstract

HLA-G protein expression could play a role in evasion of tumor immune surveillance. Accumulating evidence demonstrates that HLA-G is expressed in different types of malignancies, including colorectal cancer (CRC). The purpose of the current study was to further unravel whether HLA-G protein expression could play a role in immune evasion of CRC. Therefore, to firmly establish HLA-G protein expression, eight early passage human CRC cell lines and five human rectal cancer tissues were analyzed by western blot analysis. The results obtained by western blot analysis were compared with immunohistochemistry on tumor tissue sections of the same patient. Furthermore, multiple monoclonal antibodies (mAbs), 4H84, MEM-G/1 and 5A6G7, targeting HLA-G were used to unravel staining patterns. We showed that results obtained with immunohistochemistry did not correlate with protein expression detected by western blot analysis, using three different HLA-G targeting mAbs. Furthermore, with respect to the specificity of the mAbs employed, additional immune reactivity was detected using the mAbs MEM-G/1 and 5A6G7 in western blot analysis with K562 control cell lines overexpressing HLA-A2 or HLA-G, all tumor tissues and in two out of eight CRC cell lines. Based on the current study and our previously reported results, we conclude that claiming HLA-G plays a role in immune modulation of CRC seems premature, as results from anti-body based detection of HLA-G protein remain inconclusive. Until the time that detection of HLA-G is sensitive enough to detect all aspects of HLA-G expression in biological samples, rather than transfected cells or long time cultured cell lines, conclusions should be drawn with great care.

https://ift.tt/2NEkFaR

Changing Trend of Thyroglobulin Antibodies in Patients With Differentiated Thyroid Cancer Treated With Total Thyroidectomy Without 131I Ablation

Thyroid, Volume 28, Issue 7, Page 871-879, July 2018.

https://ift.tt/2zuvDN6

Future Meetings

Thyroid, Volume 28, Issue 7, Page 955-956, July 2018.

https://ift.tt/2zuvmd2

An InDel in Phospholipase-C-B-1 Is Linked with Euthyroid Multinodular Goiter

Thyroid, Volume 28, Issue 7, Page 891-901, July 2018.

https://ift.tt/2u9dGOX

Oral Health Status of Children with Mouth Breathing Due to Adenotonsillar Hypertrophy

Publication date: Available online 11 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Elif Ballikaya, Bahar Guciz Dogan, Ovsen Onay, Meryem Tekcicek

Abstract

Objectives

Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3-15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January-July 2015.

Methods

The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05.

Results

Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9±2.6. Mean dmft was 3.8±3.6, dmfs 9.7±1.1, DMFT 0.4±1.0 and DMFS 0.6±1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p<0,001).

Conclusions

The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.

https://ift.tt/2NFOM1H

A novel rat model for assessment of laryngotracheal injury following transoral intubation

Publication date: Available online 10 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jahshan F, Ertracht O, A. Abu-Amar, Ronen O, Srouji S, L. Apel-Sarid, Eisenbach N, Atar S, Sela E, Gruber M

Abstract

Objective

Laryngotracheal damage is a well-described complication of endotracheal intubation and animal models are essential for studying the underlying cellular injury cascade. This novel rat model is based on transoral intubation and aims to simulate the common clinical scenario of tube-related airway damage.

Methods

Prospective randomized control pilot study. 28 male Sprague-Dawley were randomly assigned into three groups: control, 3-h' intubation and 6-h' intubation. The animals were then euthanized and their laryngotracheal complexes sent for histological analysis. Epithelial damage, mucosal thickness and mucosal gland hypertrophy were reviewed.

Results

Total of 13 control animals and 15 intubated animals. 10 intubated animals survived the study protocol. Loss of epithelial surface architecture including damage to the microscopic ciliary mechanism was a common feature amongst all intubated animals. Average mucosal thickness of the larynx (including vocal cords and subglottic area) was 143±88 μm for control rats, 315±101 μm for rats intubated 3 h and 574±174 μm for rats intubated 6 h .This was a statistically significant difference. Average mucosal gland hypertrophy in the laryngeal subsite was 0.41±0.5 in control rats, 1.4±0.5 in rats intubated 3 h and 2.0±0.0 for rats intubated 6 h (statistically significant difference). There was a clear difference between three and 6 h of intubation with poorer mucosal injury parameters for longer intubation.

Conclusions

We describe a novel rat-based animal model for simulating airway mucosal damage following transoral intubation. This animal model is easy to carry out, reproducible and involves containable animal mortality rates.

https://ift.tt/2JgTqQe

Accuracy of Chest X-Ray Measurements of Pediatric Esophageal Coins

Publication date: Available online 10 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Phillip Huyett, Amber Shaffer, Linda Flom, Jeffrey P. Simons, Noel Jabbour

Abstract

Objective

To determine the accuracy of chest x-ray measurements in children using ingested radiopaque foreign bodies of known size.

Methods

A database of foreign body ingestions at a tertiary care children's hospital was queried from 2013-2016 for children who had ingested a US coin, had a pre-operative chest x-ray and documentation of coin type at the time of endoscopic removal. Four blinded research subjects measured the coin diameter on chest x-ray using iSite PACS software and based on the measurement, predicted the coin type. Measurements were compared to the known coin diameters published by the US Mint.

Results

A total of 51 patients with sixteen esophageal quarters (diameter 24.26 mm), fourteen nickels (21.21 mm), fourteen pennies (19.05 mm) and seven dimes (17.91 mm) were included in the study. The four subjects had a mean accuracy of 60.3% (range 49.0%-72.5%) in predicting the correct coin type. Across all raters, there was poor agreement for pennies (kappa=0.161) and dimes (kappa=0.131), fair agreement for nickels (kappa=0.259), good agreement for quarters (kappa=0.687), and fair agreement overall (kappa=0.371). The study measurements overestimated the coin size in 203 of the 204 measurements by a mean of 1.84 mm (range -0.31 to 3.85 mm). The mean size discrepancy was larger (2.40 vs. 1.30 mm, p<0.001) and accuracy of coin type identification was worse (44.6% vs. 74.1%, p=0.001) in children <4 years old.

Conclusions

Measurement of esophageal coins on chest x-ray is relatively inaccurate and overestimates the size in the majority of cases. Clinicians should use caution when performing fine measurements on chest x-rays, especially in children younger than 4 years old.

https://ift.tt/2NFJCmk

Urinary Iodine Concentration and Mortality Among U.S. Adults

Thyroid, Volume 28, Issue 7, Page 913-920, July 2018.

https://ift.tt/2uuB895

Correction to: Hypofractionated Radiotherapy Is Superior to Conventional Fractionation in an Orthotopic Model of Anaplastic Thyroid Cancer, by Oweida A, Phan A, Vancourt B, Robin T, Hararah MK, Bhatia S, Milner D, Lennon S, Pike L, Raben D, Haugen B, Pozdeyev N, Schweppe R, and Karam SD. Thyroid 2018;28:739–747. DOI: 10.1089/thy.2017.0706

Thyroid, Volume 28, Issue 7, Page 957-957, July 2018.

https://ift.tt/2uav0TK

Thyroid Hypoplasia in Congenital Hypothyroidism Associated with Thyroid Peroxidase Mutations

Thyroid, Volume 28, Issue 7, Page 941-944, July 2018.

https://ift.tt/2ubHF8Z

Low-Activity Radioactive Iodine Therapy for Thyroid Carcinomas Exhibiting Nodal Metastases and Extrathyroidal Extension May Lead to Early Disease Recurrence

Thyroid, Volume 28, Issue 7, Page 902-912, July 2018.

https://ift.tt/2ugPI4L

Gly m 5/Gly m 8 fusion component as a potential novel candidate molecule for diagnosing soybean allergy in Japanese children

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2uoZnFm

Cancer initiation and progression within the cancer microenvironment

Abstract

Within the cancer microenvironment, the growth and proliferation of cancer cells in the primary site as well as in the metastatic site represent a global biological phenomenon. To understand the growth, proliferation and progression of cancer either by local expansion and/or metastasis, it is important to understand the cancer microenvironment and host response to cancer growth. Melanoma is an excellent model to study the interaction of cancer initiation and growth in relationship to its microenvironment. Social evolution with cooperative cellular groups within an organism is what gives rise to multicellularity in the first place. Cancer cells evolve to exploit their cellular environment. The foundations of multicellular cooperation break down in cancer because those cells that misbehave have an evolutionary advantage over their normally behaving neighbors. It is important to classify evolutionary and ecological aspects of cancer growth, thus, data for cancer growth and outcomes need to be collected to define these parameters so that accurate predictions of how cancer cells may proliferate and metastasize can be developed.

https://ift.tt/2up26i2

Association Between Serum CK-18 Levels and the Degree of Liver Damage in Fructose-Induced Metabolic Syndrome

Metabolic Syndrome and Related Disorders, Ahead of Print.

https://ift.tt/2N3Swcc

Yong Ju Jang

https://ift.tt/2umycLD

Contributors

J. REGAN THOMAS, MD

https://ift.tt/2m9QOL9

Injection Rhinoplasty Using Filler

Rhinoplasty is a commonly performed cosmetic surgery in Asia. Rhinoplasty using filler is preferred because has fewer side effects and shorter down time. The part of external nose between the skin and bone or cartilages consists of 4 layers. To prevent vascular compromise, the injection should be into deep fatty layer, preventing embolization. Filler is usually injected in the order of radix, rhinion, tip, and the supratip area. To minimize asymmetry, the surgeon should always mark the midline on the nasal bridge and perform the procedure without deviating from it.

https://ift.tt/2m58Gqi

Alar Base Reduction and Alar-Columellar Relationship

Nasal base modification can improve nostril shape and orientation, reduce alar flaring, improve nasal base width, correct nasal hooding, improve symmetry, and create overall facial harmony. For the correction of alar rim deformities, careful examination, consultation, and analysis and consideration of the condition of the skin are essential. Understanding the ala and surrounding tissue, supporting the lower lateral cartilage, and selecting the proper technique produce functionally and aesthetically good results.

https://ift.tt/2umBrTg

Septal Extension Graft in Asian Rhinoplasty

A septal extension graft (SEG) can control nasal tip projection, shape, and rotation. SEG and dorsal alloplastic implants have predominated in Asian rhinoplasty, leading to iatrogenic complications such as a foreshortened nose and destruction of remaining septum. The lower nasal two-thirds can be enhanced anteriorly and caudally using the septal L-strut extension graft in Asians with relatively small noses. The septal L-strut extension graft is indicated in primary cases in which the bony dorsum is acceptable but the cartilaginous dorsum is relatively hypoplastic, and in secondary cases with an iatrogenic short-nose deformity due to alloplastic implants.

https://ift.tt/2m58CXA

Rhinoplasty for the Asian Nose

FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA

https://ift.tt/2undPh8

Tip Grafting for the Asian Nose

Tip surgery during rhinoplasty is particularly difficult in Asians. Tip grafting is the best approach. Conchal cartilage with perichondrium and costal cartilage are powerful grafting materials. The most important grafting techniques are tip-onlay grafting, shield grafting, and multilayer tip grafting. Tip-onlay grafts are useful for dorsal convexity. Shield grafts require sufficient support to prevent bending. Multilayer tip grafts (usually 2 layers) are versatile. Asians vary in cartilage configuration, skin thickness, and aesthetic desires: tip-grafting strategies must be tailored to meet the aesthetic goals of individuals. Tip-grafting complications (eg, visible graft contour and infection) are not uncommon and should be considered.

https://ift.tt/2m58yXQ

Hump Nose Correction in Asians

Nasal hump surgery is frequently regarded as a reduction surgery in most Western rhinoplasty textbooks and referred to as reduction rhinoplasty. Most Asian hump noses have a small hump frequently associated with a low nasal dorsum and underprojection of the nasal tip. Correcting a hump nose in Asians has distinct differences in concept and technique. A small hump and additional need for augmentation of the dorsum and the tip often minimizes the amount of hump removal or obviates resection itself. Characteristics of the Asian hump nose with emphasis on surgical techniques commonly used to obtain reliable results are presented.

https://ift.tt/2m9PBmO

Hybrid Approach for Asian Rhinoplasty

The hybrid approach delivers unlimited exposure and technical access, enabling all the procedures of the open approach. In addition, the hybrid approach is flexible in its extent of "dissection/ exposure" It can be more of a classic endonasal or limited access approach in some cases or open structural rhinoplasty and reconstruction in others. The benefits of the nonopen approach deserve equal attention among Asian rhinoplasty surgeons and residents-in-training courses. The difference is not merely that it spares an incision, it is an opportunity to fine-tune minor millimeters of changes in every step of rhinoplasty, a real and significant benefit.

https://ift.tt/2zup6C4

Forthcoming Issues

Current Utilization of Biologicals

https://ift.tt/2m58qrk

Truly Asian Rhinoplasty

It is a well-recognized fact that there is a distinctive quality to Asian Rhinoplasty when compared with rhinoplasty for patients from other regions. For Asian patients, especially from East and Southeast Asia, the relatively smaller sized noses have made simple augmentation of the nose using alloplastic implant stand in for the term "Rhinoplasty." However, with growing understanding of the diverse anatomical features of Asian noses and an increased sophistication in patients' aesthetic demands, Asian surgeons came to realize that "Asian Rhinoplasty" can be far more complex.

https://ift.tt/2zziCCe

Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: The aim of this study was to determine whether selenium supplementation given to patients with Graves' disease who were starting treatment with methimazole resulted in improved response or remission rates Read More…

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

Feedback & Suggestions

The post Clinical Thyroidology<sup>®</sup>for the Public – Highlighted Article appeared first on American Thyroid Association.

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Clinical Thyroidology®for the Public – Highlighted Article

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

Feedback & Suggestions

The post Clinical Thyroidology<sup>®</sup>for the Public – Highlighted Article appeared first on American Thyroid Association.

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The ubiquitous hospital polyethylene pinny: an ideal temporary wound cover

Abstract

Background

Daily plastic surgery ward rounds involve regular complex wound monitoring to direct management. As a tertiary service, our patients are often located on different wards that lack a full gamut of dressings. We propose the use of a novel, expedient, temporary dressing for wound coverage and review the literature on the subject matter.

Methods

Our trauma team trialled the use of standard polyethylene aprons' inner surface as temporary cover for open wounds. Microbiology wound swabs were taken from the unfolded apron prior to use, and sent for routine culture. Twenty-one consecutive patients were recruited to the trial. All patients were asked to rate the dressing on pain and comfort.

Results

No bacterial growth was reported. The average price of each apron is 3 pence and patients reported that their use was comfortable, painless and quick. The plastic apron was popular with our outreach nursing team (responsible for applying full dressings post ward round) who reported always finding one with ease.

Conclusions

Polyethylene aprons are widely available in all clinical areas. We found no evidence that they are colonised with or harbour bacteria at the point when taken from the roll. They are inexpensive, easy to handle, waterproof and in our experience, do not adhere to wounds. In addition, no specialty specific knowledge or training is required for their use. We believe these qualities make the polyethylene apron an ideal temporary dressing.

Level of Evidence: Level IV, therapeutic study

https://ift.tt/2JgHQEK

A Lack of consistent brain alterations in insomnia disorder: an activation likelihood estimation meta-analysis

Insomnia disorder is a prevalent sleep disorder, which affects about 10% of general population. However, its neural mechanisms are poorly understood. Recently, several structural and functional neuroimaging studies have been conducted in patients with insomnia disorder, but these studies have yielded diverse findings. Here, we aimed to identify consistent patterns of abnormal brain alterations in insomnia disorder by performing a quantitative coordinate-based meta-analysis. Following the preferred reporting for systematic reviews and meta-analyses statement, we searched PubMed database and used reference tracking and finally retrieved 19 eligible studies (6 task-based functional magnetic resonance imaging, 8 resting-state functional magnetic resonance imaging, 3 voxel-based morphometry, and 2 positron emission tomography).

https://ift.tt/2JbI53Y

Associations Between Sleep Duration and Suicidality in Adolescents: A Systematic Review and Dose–Response Meta-Analysis

Sleep duration has received considerable attention as a potential risk factor of suicidality in youths; however, evidence on the dose–response association between sleep duration and suicidality has not been synthesized. This meta-analysis examined linear and nonlinear dose–response relationships between sleep duration and the risk of suicidality in adolescents and explored potential moderators of the associations. Electronic databases, namely EMBASE, PubMed, PsycINFO, Wanfang Data (Chinese database), and the China Knowledge Resource Integrated Database, were searched from their inception to April 18, 2017.

https://ift.tt/2NI1GMK

Einfluss einer strukturierten Nachsorge auf die Therapietreue bei OSAS-Patienten unter CPAP-Therapie

Laryngo-Rhino-Otol
DOI: 10.1055/a-0640-9198

Hintergrund Die Therapie mit CPAP (continuous positive airway pressure therapy) ist die Referenztherapie beim mittel- und hochgradigen obstruktiven Schlafapnoesyndrom (OSAS). Die Therapietreue bei diesem Verfahren ist jedoch nicht zufriedenstellend. Ziel der Untersuchung war die Analyse der Einflussfaktoren auf die Therapietreue sowie die Evaluation, ob eine strukturierte Nachsorge die Therapietreue verbessert. Material und Methoden In dieser Studie wurden alle Patienten (n = 237) mit der Diagnose eines milden bis schweren OSAS und einer neu angepassten CPAP-Therapie im Zeitraum zwischen 2011 und 2013 untersucht. Die Nachsorgetermine fanden alle 1593,7 ± 77,4 CPAP-Betriebsstunden statt. Ergebnisse Unter Therapie nahm der AHI-Wert (Apnoe-Hypopnoe-Index) signifikant ab (5,6 ± 8,5/h; p < 0,001). 79 % erfüllten die Kriterien einer CPAP-Therapietreue (mindestens 4 Betriebsstunden an 7 Tagen pro Woche). Es gab keine signifikanten Einflüsse von demografischen, klinischen oder pharmakologischen Charakteristika der Patienten auf die Therapietreue. Die häufigsten Probleme unter CPAP-Therapie waren Trockenheit der Nasen- und Rachenschleimhäute (43,7 %) und Druckstellen (22,4 %). Die CPAP-Therapietreue korrelierte nicht mit den Werten der Epworth Sleepiness Scale. Die Zufriedenheit mit der Nachsorge korrelierte signifikant mit der Therapietreue (r = 0,185; p = 0,032), während der Therapiedruck keinen signifikanten Einfluss hierauf zeigte (r = −0,072; p = 0,383). Schlussfolgerungen Eine strukturierte, individuell angepasste Nachsorge ist wichtig für die Therapietreue. In Zukunft sollte im Rahmen der Nachsorge neben der Kontrolle des Therapieerfolges mehr Aufmerksamkeit auf Aspekte der Problemlösung, Rückkopplung, Schulung und Motivation gerichtet werden.
[...]

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

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Erratum: Economic Analysis of Using Free Fat Graft or Acellular Dermis to Prevent Post-parotidectomy Frey Syndrome

Facial plast Surg
DOI: 10.1055/s-0038-1667294

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents | Full text

https://ift.tt/2mdt60B

Regular follow-up visits reduce the risk for asthma exacerbation requiring admission in Korean adults with asthma

Asthma requires regular follow-up visits and sustained medication use. Although several studies have reported the importance of adherence to medication and compliance with the treatment, none to date have repo...

https://ift.tt/2N1tYkb

Does long-term success from endoscopic DCR correlate with early post-operative reduction in tearing?

The purpose of the study was to determine the association between early post-operative improvement in tearing and the long-term success rate of endoscopic dacryocystorhinostomy (eDCR).

https://ift.tt/2NGse0P

Bio-cord plays a similar role as submerged macrophytes in harboring bacterial assemblages in an eco-ditch

Abstract

Artificial carriers are widely used to enhance the formation of biofilm and improve pollutants' removal efficiency in agricultural wastewater treatment ditches (eco-ditches), yet comprehensive insight into their bacterial community is scarce. In this study, bacterial diversities in four different habitats—the water column, surface sediments, submerged macrophytes (Myriophyllum verticillatum L.), and the artificial carriers (bio-cord)—were compared in a Chinese eco-ditch. Comparable richness and evenness of bacterial communities were observed on M. verticillatum and bio-cord, both being higher than for free-living bacteria in the water column but lower than for bacteria in the surface sediment. The highest similarity of bacterial community composition and structure also occurred between M. verticillatum and the bio-cord, dominated by α- and γ-proteobacteria, Verrucomicrobia, and Bacteroidetes. Firmicutes and Planctomycetes, respectively, were the exclusive abundant phyla in M. verticillatum and the bio-cord, probably indicating the unique interaction between M. verticillatum and their epiphytic bacteria. Some abundant genera, such as Roseomonas, Pseudomonas, and Rhodopirellula, which were exclusively observed in M. verticillatum or the bio-cord, have been reported to have the same capacity to remove nitrogen and organic matter in wastewater treatment systems. In conclusion, in the studied eco-ditch, the bio-cord was found to play a similar role as submerged macrophytes in harboring bacterial assemblages, and we therefore propose that bio-cord may be a good alternative or supplement to enhance wastewater treatment in agricultural ditches.

https://ift.tt/2L3bpyD

Production, characterization, and potential of activated biochar as adsorbent for phenolic compounds from leachates in a lumber industry site

Abstract

There is growing interest in low-cost, efficient materials for the removal of organic contaminants in municipal and industrial effluents. In this study, the efficiency of biochar and activated biochar, as promising adsorbents for phenol removal, was investigated at high (up to 1500 mg L⁻¹) and low concentrations (0.54 mg L⁻¹) in synthetic and real effluents (from wood-residue deposits in Québec), respectively. The performance of both materials was then evaluated in batch adsorption experiments, which were conducted using a low solid/liquid ratio (0.1 g:100 mL) at different phenol concentrations (C₀ = 5–1500 mg L⁻¹), and at 20 °C. Activated biochars presented higher phenol adsorption capacity compared to biochars due to their improved textural properties, higher micropore volume, and proportion of oxygenated carbonyl groups connected to their surface. The sorption equilibrium was reached within less than 4 h for all of materials, while the Langmuir model best described their sorption process. The maximum sorption capacity of activated biochars for phenol was found to be twofold relative to biochars (303 vs. 159 mg g⁻¹). Results also showed that activated biochars were more effective than biochars in removing low phenol concentrations in real effluents. In addition, 95% of phenol removal was attained within 96 h (although 85% was removed after 4 h), thus reaching below the maximum authorized concentration allowed by Québec's discharge criteria (0.05 mg L⁻¹). These results show that activated biochars made from wood residues are promising potential adsorbent materials for the efficient treatment of phenol in synthetic and real effluents.

https://ift.tt/2Jd4Ep0

Responses of magnetic properties to heavy metal pollution recorded by lacustrine sediments from the Lugu Lake, Southwest China

Abstract

Environmental magnetism, which is rapid, sensitive, economical, and non-destructive, has been used to assess heavy metal pollution in lake sediments based on the relationships between magnetic properties and heavy metal concentrations. We conducted a systematic environmental magnetic and heavy metal study of the sediments of the core LGS from Lugu Lake in Southwest China. The results show that the concentration-related magnetic parameters (χ, χ_ARM, and SIRM) in the core LGS showed an increasing trend from bottom to top. The results of rock magnetism indicated that the dominant magnetic particles were magnetite. Two sources of magnetic minerals can be distinguished by the correlations of χ vs. χ_fd% and χ vs. χ_ARM/χ: the surrounding catchment and anthropogenic activities. In addition, Pearson correlation analysis and principal component analysis showed that the concentration-dependent magnetic parameters have significant correlations with heavy metal (Al, Ti, Fe, Cr, Ni, Cu, Zn, and Cd) concentrations as well as the Tomlinson pollution load index (PLI), indicating that there are essential linkages of sources, deposition, and migration between magnetic particles and heavy metals. Based on previously reported ¹³⁷Cs and ²¹⁰Pb data, the historical trends of heavy metal pollution in Lugu Lake were successfully reconstructed, and the causes of heavy metal pollution were mainly agricultural practices and atmospheric metal depositions from anthropogenic sources. The significant correlations between magnetic parameters, heavy metals, and the PLI indicate that magnetic parameters can potentially be used as an index of heavy metal pollution in lacustrine deposits.

https://ift.tt/2L6TaoS

Enhancing bacterial transport with saponins in saturated porous media for the bioaugmentation of groundwater: visual investigation and surface interactions

Abstract

The success of bioaugmentation processes for the remediation of groundwater contamination relies on effective transport of the injected microorganisms in a subsurface environment. Biosurfactants potentially affect bacterial attachment and transport behavior in porous media. Although saponins as biosurfactants are abundant in nature, their influence on bacterial transport in groundwater systems remains unknown. In this research, tank visual-transport experiments, breakthrough curve monitoring, and surface property measurement were performed to evaluate the effects of saponins on the transport of Pseudomonas migulae AN-1 cells, which were used as a model bacterium in saturated sand. Results show that the 0.1% saponins could effectively facilitated the AN-1 secondary transport and the addition of saponins decreased the hydrophobicity of AN-1 and sand. The role of the promotion of saponins was more dominant than that of the inhibition of ions on AN-1 transport in a saturated porous medium when ions and saponins coexisted. The interactions between AN-1 and sand grains with saponins and ions were explained in accordance with the Derjaguin–Landau–Verwey–Overbeek theory.

https://ift.tt/2NE7Sp7

Interleukin-18 as a diagnostic marker of adult-onset Still’s disease in older patients: a case report and review of the literature

Adult onset Still's disease is a systemic auto-inflammatory condition of unknown etiology characterized by intermittent spiking high fever, an evanescent salmon-pink or erythematous maculopapular skin rash, ar...

https://ift.tt/2KP8WZi

Remote partner assisted skin self‐examination skills training of melanoma survivors and their partners

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2L7dMNy

Remote partner assisted skin self‐examination skills training of melanoma survivors and their partners

Australasian Journal of Dermatology, EarlyView.

https://ift.tt/2L7dMNy

Aggregate and disaggregate analysis on energy consumption and economic growth nexus in China

Abstract

This study examines the relationship between energy consumption and economic growth based on three models in China covering the period of 1982–2015. From the Ng-Perron (NP) and Zivot-Andrews (ZA) unit root test, each variable has no unit root in the first difference. Based on Johansen multivariable co-integration test and autoregressive distributed lag (ARDL) bounds test, the co-integrating relationship existed between selected variables. Moreover, dynamic ordinary least squares (DOLS), fully modified ordinary least squares (FMOLS), and ARDL estimates are used to estimate the coefficients of each variable, which presents that any increasing of each kinds of energy sources can increase China's economic growth in the long term. Additionally, the vector error correction model (VECM) Granger causality test based on three models is investigated. Some implications based on the empirical results are given.

https://ift.tt/2u9Udho

Alcohol‐induced respiratory symptoms improve after aspirin desensitization in patients with aspirin‐exacerbated respiratory disease

International Forum of Allergy &Rhinology, EarlyView.

https://ift.tt/2L7aXMs

PBMT and topical diclofenac as single and combined treatment on skeletal muscle injury in diabetic rats: effects on biochemical and functional aspects

Abstract

Physical exercise generates several benefits in a short time in patients with diabetes mellitus. However, it can increase the chances of muscle damage, a serious problem for diabetic patients. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat these injuries, despite the serious adverse effects. In this way, photobiomodulation therapy (PBMT) with low-level laser therapy (LLLT) and/or light emitting diode therapy (LEDT) can be used as an alternative in this case. However, its efficacy in tissue repair of trauma injuries in diabetes mellitus until now is unknown, as well as the combination between PBMT and NSAIDs. The objective of the present study was to evaluate the effects of NSAIDs and PBMT applied alone or combined on functional and biochemical aspects, in an experimental model of muscle injury through controlled trauma in diabetic rats. Muscle injury was induced by means of a single trauma to the animals' anterior tibialis muscle. After 1 h, the rats were treated with PBMT (830 nm; continuous mode, with a power output of 100 mW; 3.57 W/cm²; 3 J; 107.1 J/cm², 30 s), diclofenac sodium for topical use (1 g), or combination of them. Our results demonstrated that PBMT + diclofenac, and PBMT alone reduced the gene expression of cyclooxygenase-2 (COX-2) at all assessed times as compared to the injury and diclofenac groups (p < 0.05 and p < 0.01 respectively). The diclofenac alone showed reduced levels of COX-2 only in relation to the injury group (p < 0.05). Prostaglandin E₂ levels in blood plasma demonstrated similar results to COX2. In addition, we observed that PBMT + diclofenac and PBMT alone showed significant improvement compared with injury and diclofenac groups in functional analysis at all time points. The results indicate that PBMT alone or in combination with diclofenac reduces levels of inflammatory markers and improves gait of diabetic rats in the acute phase of muscle injury.

https://ift.tt/2m94NAN

Infratemporal fossa tumors: When to suspect a malignant tumor? A retrospective cohort study of 62 cases

Publication date: Available online 10 July 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): Q. Lisan, N. Leclerc, R. Kania, J.-P. Guichard, P. Herman, B. Verillaud

Abstract

Objectives

Infratemporal fossa (ITF) tumors are rare and little is known about their general epidemiology, making it sometimes difficult for clinicians, who seldom encounter them, to distinguish between benign and malignant forms on the basis of the initial clinical and radiological work-up alone. The objectives of this retrospective study were: (i) to determine the respective prevalences of the various histologic types of ITF tumor, and (ii) to assess associations between certain clinical and radiological features and malignancy.

Methods

A single-center observational study in a university hospital included all new consecutive cases of ITF tumor treated from January 2000 to December 2016. Histologic type, demographics, clinical presentation and imaging findings were analyzed.

Results

In total, 62 patients were included. 74% of tumors were benign (n = 46) and 26% malignant. Juvenile nasopharyngeal angiofibroma, adenoid cystic carcinoma and schwannoma were the most frequent histologic types, accounting for 47%, 16% and 10% of cases, respectively. The only clinical or imaging signs significantly associated with malignancy were trismus, facial pain, facial hypoesthesia and neural invasion on magnetic resonance imaging (all P-values < 0.05).

Conclusion

This study provides general epidemiological data on ITF tumors, and identified several clinical and radiologic signs to help clinicians suspect malignancy.

https://ift.tt/2uhXqdW

Expression of tumor suppressors miR-195 and let-7a as potential biomarkers of invasive breast cancer

OBJECTIVE: MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression at the posttranscriptional level. Some miRNAs, including let-7a and miR-195, have been described as tumor suppressors. However, the roles of these microRNAs in breast cancer progression remain controversial. The aim of this study is to evaluate miR-195 and let-7a expression as potential biomarkers of invasive breast cancer. METHODS: In the present study, 200 individuals were separated into three groups: (i) 72 women constituting the control group who were selected according to rigorous and well-established criteria; (ii) 56 patients with benign breast tumors; and (iii) 72 patients with malignant breast cancers of different clinical stages. The miR-195 and let-7a expression levels in serum were evaluated by real-time PCR. The results were assessed alone and in combination, and the analysis included an estimation of sensitivity and specificity in ROC curves. RESULTS: Compared with the benign and control groups, both microRNAs were downregulated in the malignant breast cancer patient group. Compared with the malignant group, the combination of both biomarkers in the control and benign groups showed good sensitivity and specificity in the serum with AUCs of 0.75 and 0.72, respectively. The biomarker combination for the control group versus the malignant group exhibited a better sensitivity and specificity than for the benign group versus the malignant group. CONCLUSION: These findings support the evidence that the analysis of miR-195 and let-7a can be used as a non-invasive biomarker for breast cancer detection.

https://ift.tt/2KXEGe9

Novel approaches for the management of primary hyperparathyroidism during pregnancy

Clinical Endocrinology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2L0Glzm

Dysregulated Growth Hormone‐Insulin‐Like Growth Factor‐1 Axis in Adult Type 1 Diabetes with Long Duration

Clinical Endocrinology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2L62Dgf

Serum Paraoxonase, Arylesterase, and Glutathione-S-Transferase Activities and Oxidative Stress Levels in Patients with Mushroom Poisoning

OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (p<0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (p<0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, p<0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.

https://ift.tt/2J8IZhK

Current management of biliary atresia based on 35 years of experience at a single center

OBJECTIVE: The prognosis of patients with biliary atresia undergoing Kasai portoenterostomy is related to the timing of the diagnosis and the indication for the procedure. The purpose of the present study is to present a practical flowchart based on 257 children who underwent Kasai portoenterostomy. METHODS: We conducted a retrospective cohort study of patients who underwent Kasai portoenterostomy between 1981 and 2016. RESULTS: During the first period (1981 to 2009), 230 infants were treated, and the median age at the time of surgery was 84 days; jaundice was resolved in 77 patients (33.5%). During the second period, from 2010 to 2016, a new diagnostic approach was adopted to shorten the wait time for portoenterostomy; an ultrasonography examination suggestive of the disease was followed by primary surgical exploration of the biliary tract without complementary examination or liver biopsy. Once the diagnosis of biliary atresia was confirmed, a portoenterostomy was performed during the same surgery. During this period, 27 infants underwent operations; the median age at the time of surgery was 66 days (p<0.001), and jaundice was resolved in 15 patients (55.6% - p=0.021), with a survival rate of the native liver of 66.7%. CONCLUSION: Primary surgical exploration of the biliary tract without previous biopsy was effective at improving the prognostic indicators of patients with biliary atresia undergoing Kasai portoenterostomy.

https://ift.tt/2Jbu6uS

Simple but not simpler: a systematic review of Markov models for economic evaluation of cervical cancer screening

The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).

https://ift.tt/2KUW9E3

NCI and VA collaborate to boost veterans’ access to cancer clinical trials

NCI and the Department of Veterans Affairs (VA) are launching the NAVIGATE program at 12 VA facilities across the country to make it easier for veterans to participate in NCI-sponsored clinical trials.

https://ift.tt/2zpGO9M

Head‐to‐head trials of systemic psoriasis therapies: A systematic review of study design and maximum acceptable treatment differences

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2JcGSJF

Multisystem amyloidosis as the unifying diagnosis for constipation, collapse and cardiomyopathy

Amyloidosis a rare disorder characterised by the deposition of amyloid protein aggregates in different organ systems throughout the body with resulting functional impairment of affected organs. It can present with localised or multisystemic deposits. Diagnosis is often delayed due to the non-specific nature of the symptoms. We present the case of a 59-year-old man with a 12-month history of non-specific symptoms. Investigations revealed Helicobacter pylori positive gastritis. Blood tests showed only a normocytic anaemia and thrombocytopaenia. CT scan showed proximal sigmoid thickening. Biopsies were unremarkable. Echocardiogram and cardiac MRI scan showed restrictive cardiomyopathy. Congo red staining of gastric biopsies showed amyloid deposition. The patient had elevated serum kappa light chains and a bone marrow biopsy confirmed multiple myeloma and he was subsequently diagnosed with systemic light chain (AL) amyloidosis secondary to this. He was started on chemotherapy and parenteral nutrition; however, he deteriorated rapidly and so was started on palliative treatment and discharged home.

https://ift.tt/2ufg4Dc

Bilateral serpentine radio-opaque shadows near the urinary bladder: nothing but calcified vas deferens!

Description

A 77-year-old man presented with voiding lower urinary tract symptoms with history of terminal haematuria. His ultrasonography (USG) was suggestive of a 58 g prostate with thickened urinary bladder walls along with two vesical calculi. A plain X-ray was taken that showed two radio-opaque shadows in the urinary bladder corresponding to vesical calculi reported on the USG. Along with that there were two serpentine radio-opaque shadows on each side of the urinary bladder (figure 1). The primary care physician thought these shadows to be ureteric calculi/calcification and referred the patient to our centre for further workup and management. On carefully reviewing the X-ray we immediately recognised that the serpentine radio-opaque shadows were nothing but bilaterally calcified vas deferens. The shadow on the left also had a characteristic pattern of loop that the vas makes during its course towards the inguinal canal. The patient was non-diabetic and...

https://ift.tt/2ualRup

Gluten-free diet: a possible treatment for chronic diarrhoea in common variable immunodeficiency

Gastrointestinal disorders are frequent in common variable immunodeficiency (CVID). Clinical symptoms and histological alterations in CIVD can resemble celiac disease. Usually, patients with chronic diarrhoea associated with CVID do not improve with a gluten-free diet. The authors present a case of a male patient who was diagnosed with CVID at age 33 and had chronic diarrhoea which resolved after initiating a gluten-free diet. Clinical relapse occurred after gluten reintroduction. The main objective of this case report is to alert clinicians to implement a gluten-free diet in patients with CVID with chronic diarrhoea.

https://ift.tt/2u7o3TC

A novel cause of postmenopausal bleeding in an immunosuppressed patient

Malakoplakia is a rare histiocytic disease first described in 1902 by Michaelis and Gutmann. It is associated with host immunocompromise including chronic inflammatory conditions, infectious conditions or malnutrition. Here, we report the case of uterine malakoplakia as a rare cause of postmenopausal bleeding in an immunocompromised patient.

https://ift.tt/2u7LlZl

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 10 Ιουλίου 2018

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