Head and Neck Diseases by Alexandros G.Sfakianakis: 08/23/18

Πέμπτη 23 Αυγούστου 2018

e-learning: the anesthesiology media lab of Yale University School of Medicine. A review

No abstract available

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Evaluation of Mucociliary Activity in Maxillary Antra in Patients with Squamous Cell Carcinoma of Buccal Mucosa Undergoing Post Operative Radiotherapy

Abstract

A prospective longitudinal observational study was conducted on 24 patients of histopathologically confirmed squamous cell carcinoma of buccal mucosa upon whom bilateral 'middle meatal antrostomy was performed during the same sitting as the tumour resection with the main aim to assess the maxillary mucociliary clearance, pre-, during and post-irradiation; and compare the findings with the non-irradiated side in the same patient to avoid any confounding factors. All patients underwent methylene blue dye clearance and saccharine clearance tests before the commencement of radiation therapy, weekly during irradiation and again at first and sixth month of completion of irradiation. Pre-radiation there was statistically no difference (P > 0.05) in clearance times between both sides. But, there was a significant (P < 0.001) increase in saccharin and methylene blue clearance times on the irradiated side in comparison to contralateral non-irradiated side, during and post-radiation. It is concluded that external beam radiotherapy for oral cancers significantly affect ciliary activity in the adjacent maxillary antrum and has no effect on the opposite side. Recovery in mucociliary activity was not seen even after 6 months after radiation therapy.

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Sinonasal Metastatic Renal Cell Carcinoma: A Report of Two Cases with Varied Presentation and a Review of Literature

Abstract

Renal cell carcinoma is usually slow growing with delayed vague symptoms and may not be detected until an advanced stage. In only 9% of the cases the classical triad of "haematuria, costovertebral pain and abdominal mass" is seen. Less commonly, sinonasal metastasis may also be the presenting feature of RCC. So, in any case of sinonasal mass, possibility of metastasis from renal malignancy should be considered. Sinonasal metastasis from renal malignancy can occur even several years after the primary is treated with nephrectomy. In sinonasal region maxillary sinus is the most commonly affected. Isolated metastasis to the nose is extremely rare. Malignancies from various other sites of the body can also metastasize to sinonasal region. Epistaxis is the most common symptom. This is because of vascular stroma of the metastatic deposit. A 45 year old male with history of right nephrectomy 1 year back presented with intractable epistaxis. A 66 year old male presented with profuse epistaxis without any history of previous malignancies. Both the cases were evaluated resulting to the diagnosis of sinonasal metastasis from Renal Cell carcinoma. In the first case, metastasis occurred 1 year post surgery whereas in second case sinonasal metastasis was the presenting feature of Renal Cell carcinoma. Epistaxis is the most common symptom. This is because of vascular stroma of this metastatic deposit. In renal cancer, symptoms of metastasis often precede the symptoms of primary tumor.

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Facial nerve decompression

Purpose of review Facial nerve paralysis is a debilitating condition. Bell's palsy and temporal bone trauma are common causes of acute facial palsy, with recurrent idiopathic paralysis and Melkersson–Rosenthal syndrome accounting for a smaller subset of cases. Properly selected patients may benefit from facial nerve decompression. This article will review the relevant literature on facial nerve decompression. Recent findings The middle cranial fossa approach provides access to the primary site of lesion in Bell's palsy while preserving hearing. Patients with complete facial paralysis secondary to Bell's palsy or temporal bone trauma, more than 90% degeneration on electroneurography testing, and absent voluntary electromyography within 14 days of onset may benefit from facial nerve decompression. Facial nerve decompression may prevent future occurrences of recurrent forms of facial nerve paralysis. The return of facial nerve function following decompression will occur over weeks to months. Summary Appropriately selected patients with facial paralysis secondary to Bell's palsy or temporal bone trauma may benefit from facial nerve decompression. Patients should be counseled regarding the risks of decompression and that the return of maximal facial nerve function may be delayed up to 12 months. Correspondence to Marlan R. Hansen, MD, Departments of Otolaryngology – Head and Neck Surgery and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Tel: +1 319 353 7151; fax: +1 319 356 3967; e-mail: marlan-hansen@uiowa.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Aktuelle Therapie der systemischen Sklerodermie

Zusammenfassung

Die systemische Sklerose (SSc, Sklerodermie) ist eine schwere chronisch entzündliche Bindegewebserkrankung der Haut, des muskuloskeletalen Systems und vieler innerer Organe. Der heterogene, langjährige Verlauf dieser Erkrankung mit dem Befall multipler Organe stellt eine besondere Herausforderung an den betreuenden Arzt dar. Die therapeutischen Möglichkeiten haben sich in den vergangenen Jahren in verschiedenen Bereichen entscheidend verbessert. Diese positiven Entwicklungen haben dazu geführt, dass in verschiedenen Arbeitsgruppen abgestimmte Empfehlungen zur Behandlung der SSc veröffentlicht wurden. Ziel dieser Übersicht ist es, die wesentlichen Empfehlungen vorzustellen und in ein Konzept einer modernen interdisziplinären Betreuung einzubetten.

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Evaluation of Mucociliary Activity in Maxillary Antra in Patients with Squamous Cell Carcinoma of Buccal Mucosa Undergoing Post Operative Radiotherapy

Abstract

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Sinonasal Metastatic Renal Cell Carcinoma: A Report of Two Cases with Varied Presentation and a Review of Literature

Abstract

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Targeted Therapies in the Treatment of Sarcomas

Abstract

About 50% of sarcomas have specific pathology-defining molecular alterations including mutations, fusion genes, and gene amplifications. Some of these alterations appear to be oncogenic drivers, and a subset can be utilized as targets for standard or experimental molecularly targeted agents in the clinic. In addition, immunotherapies may have a growing role in the treatment of sarcomas in the future.

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Chlordecone consumption estimated by sewage epidemiology approach for health policy assessment

Abstract

Chlordecone is an organochlorine insecticide that was intensively used in the French West Indies to control the black weevil Cosmopolites sordidus in bananas. Its usage, however, resulted in the widespread pollution of the environment with heavy sanitary and social consequences, leading to population exposure mainly through food. Time-consuming and costly programs have been used to tackle this problem, and this study proposes to use the emerging sewage epidemiology approach to evaluate the current situation and the effect of such programs. The results determine the maximal value of chlordecone consumption, and considering the detection limit of the analytical protocol, the wastewater was found to have undetectable amounts of chlordecone. This value confirms the efficiency of the population protection strategy provided by French sanitary and environmental authorities. It also bolsters the usage of sewage epidemiology in pesticide assessment and relativizes the chlordecone risk compared to other chemicals of lesser concern.

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Dianchi Lake watershed impervious surface area dynamics and their impact on lake water quality from 1988 to 2017

Abstract

The relationships between impervious surface area (ISA) patterns and characteristics have long been studied to examine the impacts of hydrological cycles, water management, surface energy balances, and biodiversity. This study assessed the Dianchi Lake watershed as a case study area to illustrate ISA change characteristics and their impacts on Dianchi Lake water quality. More than 200 Landsat images (from 1988 to 2017) were first downloaded through the US Geological Survey (USGS) online portal. Then, a series of ISA maps of the Dianchi Lake watershed at an annual resolution were built using a robust method we proposed. Then, the change characteristics of main water quality parameters were analyzed from spatial-temporal viewpoints. Finally, correlations between ISA and Lake water quality were made. The research results indicated that the ISA proportion of the Dianchi Lake watershed rapidly increased (from 1.84% in 1988 to 34.32% in 2017), the annual ISA total growth rate exceeded 21 km²/year, and the urban area encircled Dianchi Lake. The Dianchi Lake watershed has begun to adopt the "Rashly Advancing" and "Great Leap Forward" strategies of urbanization. Chlorophyll a (Chla), dissolved oxygen (DO), and transparency (Trans) showed significantly changing tendencies, whereas the values of pH, total nitrogen, and total phosphorus stayed relatively constant. The polynomial regression models and corresponding R² values indicated strong correlations between ISA and three water quality parameters (Chla, DO, and Trans). The development of better strategies for the control and reduction of water pollution without optimizing ISA spatial distribution is essential for Kunming's continued urbanization.

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Probiotic supplementation with Lactobacillus plantarum and Pediococcus acidilactici for Helicobacter pylori therapy: A randomized, double‐blind, placebo‐controlled trial

Helicobacter, EarlyView.

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Probiotic supplementation with Lactobacillus plantarum and Pediococcus acidilactici for Helicobacter pylori therapy: A randomized, double‐blind, placebo‐controlled trial

Helicobacter, EarlyView.

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Stem Cell-Induced Pulp Regeneration Can Be Enhanced by Administration of CCL11-Neutralizing Antibody in the Ectopic Tooth Transplantation Model in the Aged Mice

Rejuvenation Research, Ahead of Print.

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The Effects of Light and Moderate Intensity Exercise on the Femoral Bone and Cerebellum of d-Galactose-Exposed Rats

Rejuvenation Research, Ahead of Print.

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Rapamycin Confers Neuroprotection Against Aging-Induced Oxidative Stress, Mitochondrial Dysfunction, and Neurodegeneration in Old Rats Through Activation of Autophagy

Rejuvenation Research, Ahead of Print.

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Multicomponent Training Program with High-Speed Movement Execution of Ankle Muscles Reduces Risk of Falls in Older Adults

Rejuvenation Research, Ahead of Print.

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Systemic Treatment of Metastatic/Recurrent Uterine Leiomyosarcoma: A Changing Paradigm

AbstractThe treatment of metastatic and recurrent uterine leoimyosarcoma (uLMS) has evolved rapidly in the past several years. Leoimyosarcoma is extremely aggressive and responds poorly to traditional chemotherapeutics. Recent regulatory approval of novel treatment options has significantly expanded the therapeutic armamentarium, and the addition of these therapies has challenged clinicians to select and optimally sequence these new compounds. Additionally, the potential role of immunotherapy is being assessed in current uLMS clinical trials. Given the increasing number of agents available both in the U.S. and globally, a treatment template that addresses optimal sequencing based upon expert consensus would be useful. Current guidelines, although listing various options, lack granularity by line of therapy. Most patients with leiomyosarcoma, even in early stage, are treated with surgery followed by adjuvant chemotherapy despite uLMS being relatively chemoresistant. Adjuvant chemotherapy often includes the combination of gemcitabine and docetaxel with or without doxorubicin in first‐line systemic therapy, but these cytotoxic agents only provide patients with advanced disease a 5‐year survival <30%. This review will focus on examination of current guidelines and consensus building for optimal sequencing of systemic therapies for advanced or recurrent uLMS. Critical ongoing studies investigating novel approaches including immunotherapeutics and genetic alterations also will be discussed.Implications for Practice.Recent regulatory approval of novel treatment options has significantly expanded the therapeutic armamentarium, and the addition of these therapies has challenged clinicians to select and optimally sequence these compounds. This review will focus on examination of current guidelines and consensus building for optimal sequencing of systemic therapies for advanced or recurrent uterine leoimyosarcoma.

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Patient‐Clinician Discordance in Perceptions of Treatment Risks and Benefits in Older Patients with Acute Myeloid Leukemia

AbstractBackground.Older patients (≥60 years) with acute myeloid leukemia (AML) face difficult decisions regarding treatment with "intensive" chemotherapy that carries significant toxicity for a small chance of a cure versus "nonintensive" chemotherapy to control the disease, but with fewer side effects. However, studies of how these patients understand the risks and benefits of such treatments are lacking.Methods.We conducted a longitudinal study of older patients newly diagnosed with AML assessing patients' (n = 100) and oncologists' (n = 11) perceptions of treatment‐related mortality at enrollment and prognosis at 1 month. We examined concordance between patients' and oncologists' perceptions using Cohen's kappa (κ < 0.10 indicates little/no concordance).Results.We enrolled patients within 72 hours of initiating intensive (n = 50) or nonintensive (n = 50) chemotherapy. Whereas 91% of patients reported that they were "somewhat" to "extremely likely" to die from treatment, oncologists estimated that only 12% were at high risk of dying because of treatment (κ = −0.09). Ninety percent of patients reported that they were "somewhat" or "very likely" to be cured of their AML, whereas oncologists estimated this chance of cure for only 31% of patients (κ = 0.05). Among patients receiving intensive chemotherapy, 98% reported that they were "somewhat" or "very likely" to be cured, whereas their oncologists estimated this likelihood of cure for only 49% (κ = 0.04); among those receiving nonintensive chemotherapy and their clinicians, these proportions were 82% and 13%, respectively (κ = 0.03). Patients who indicated a lower likelihood of cure reported significantly higher depression symptoms (p = .03).Conclusion.Older patients with AML overestimate the risks and benefits of treatment. Interventions to facilitate communication and enhance patients' understanding of the goals of therapy and treatment risk are needed.Implications for Practice.Older patients with acute myeloid leukemia (AML) are confronted with challenging decisions regarding treatment with "intensive" chemotherapy that carries significant toxicity for a small chance of a cure versus "nonintensive" chemotherapy to control the disease, but with fewer side effects. A clear understanding of the likely outcome and risks of the various treatment strategies is essential for these patients to make informed decisions about their care. This article reports that older patients with AML overestimate both the risks and benefits of treatment and have substantial misperceptions about their prognosis. Interventions to enhance patients' understanding of their prognosis and treatment risk are needed.

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Comparative Effectiveness of an mTOR‐Based Systemic Therapy Regimen in Advanced, Metaplastic and Nonmetaplastic Triple‐Negative Breast Cancer

AbstractBackground.Triple‐negative breast cancer (TNBC) is a heterogeneous disease with subtypes having different "targetable" molecular aberrations. Metaplastic breast cancers (MpBCs) are typically TNBCs and commonly have alterations in the PI3K/Akt/mTOR pathway. We previously reported efficacy for an mTOR‐based chemotherapy regimen in MpBC. To determine if tumor subtype influences prognosis, we compared treatment outcomes of patients with MpBC with those of patients with nonmetaplastic TNBC receiving an mTOR‐based systemic therapy regimen.Patients and Methods.Patients with advanced MpBC and nonmetaplastic TNBC were treated at our institution from April 16, 2009, through November 4, 2014, using mTOR inhibition (temsirolimus or everolimus) with liposomal doxorubicin and bevacizumab (DAT/DAE). Median progression‐free survival (PFS) and overall survival (OS) were estimated by the Kaplan‐Meier method. Cox regression analyses were used to evaluate associations between tumor histology and outcomes. Multivariable models were adjusted for all covariates.Results.Fourteen patients with nonmetaplastic TNBC and 59 patients with advanced MpBC were treated with DAT/DAE. MpBC patients were older (p = .002) and less likely to have a history of bevacizumab use (p = .023). Median PFS for the nonmetaplastic TNBC and MpBC patients was 2.5 months and 4.8 months, respectively. This difference in PFS was statistically significant on univariable (p = .006) but not multivariable analysis (p = .087). Median OS for the nonmetaplastic TNBC and MpBC patients was 3.7 months and 10.0 months, respectively (p = .0003). MpBC remained significantly associated with improved OS on multivariable analysis (p < .0001).Conclusion.In our study, DAT/DAE appeared to be more effective in MpBC compared with nonmetaplastic TNBC. These data support patient selection for targeted therapy in TNBC.Implications for Practice.Metaplastic breast cancers (MpBCs) represent <1% of all breast cancers, demonstrate mesenchymal differentiation, and are typically resistant to chemotherapy. Patients with advanced MpBC treated with an mTOR‐based systemic therapy regimen had better long‐term outcomes compared with patients with nonmetaplastic triple‐negative breast cancer treated with the same regimen, suggesting that metaplastic histology may predict benefit from agents targeting the PI3K/Akt/mTOR pathway.

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A Phase I Dose‐Escalation Study of Linsitinib (OSI‐906), a Small‐Molecule Dual Insulin‐Like Growth Factor‐1 Receptor/Insulin Receptor Kinase Inhibitor, in Combination with Irinotecan in Patients with Advanced Cancer

AbstractLessons Learned. The maximum tolerated dose of the combination of linsitinib and irinotecan is linsitinib 450 mg daily on days 1–3 every 7 days and irinotecan 125 mg/m2 days 1 and 8 of a 21‐day cycle.The adverse effects associated with the combination are not significantly increased beyond what is expected of each drug as a single agent.Multiple negative trials of insulin‐like growth factor‐1 receptor inhibitors performed in unselected patient populations led to the early discontinuation of linistinib development and this trial.Earlier integration of assessment of potential predictive biomarkers into clinical trials, as was planned in this study, is vital to the development of targeted therapies in oncology.Background.This phase I dose‐escalation study was designed to evaluate the safety and tolerability of the combination of irinotecan and insulin‐like growth factor‐1 receptor (IGF‐1R) inhibitor linsitinib in patients with advanced cancer refractory to standard therapy.Methods.Dose escalation in three specified dose levels was performed according to a standard 3 + 3 design. Dose levels were as follows: (a) linsitinib 400 mg and irinotecan 100 mg/m2, (b) linsitinib 450 mg and irinotecan 100 mg/m2, and (c) linsitinib 450 mg and irinotecan 125 mg/m2. Linisitinib was administered once daily on days 1–3, 8–10, and 15–17, and irinotecan on days 1 and 8. Assessment of a candidate predictive biomarker was planned in all patients, with further evaluation in an expansion cohort of advanced colorectal cancer.Results.A total of 17 patients were treated, with 1 patient in both cohort 2 and 3 experiencing dose‐limiting toxicity. Linsitinib 450 mg and irinotecan 125 mg/m2 was the maximum tolerated dose. Sixteen (94%) patients experienced at least one treatment‐related adverse event. Neutropenia was the only grade >3 toxicity (4%). No significant hyperglycemia or QT interval prolongation was noted. No objective responses were observed; 47% (n = 8) had stable disease with median duration of 5.25 months.Conclusion.Although the combination was determined safe, the study was halted due to termination of linsitinib development, and biomarker testing was not performed.

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Definitive Radiotherapy in Invasive Vaginal Carcinoma: A Systematic Review

AbstractAim.This study systematically reviews the recent literature on the role of definitive radiotherapy (RT) in the management of vaginal cancer (VC) and presents comprehensive data on clinical outcomes and toxicity.Methods.The authors performed a literature search using PubMed (2007–2016) to identify all prospective and retrospective studies that have been published on RT in invasive VC.Results.Of the 199 identified studies, 13 met the inclusion criteria. All studies had a retrospective design. Overall, 793 patients (median, 45; range, 26–138) were included. A high heterogeneity was found across studies in terms of RT techniques, assessment criteria, and reported outcomes. The majority of the patients were treated with a combination of external beam RT and brachytherapy (74.2%). Acute and late grade ≥3 toxicity rates ranged from 0.0% to 24.4% (median, 8.7%) and from 0.0% to 22.5% (median, 12.8%), respectively. The 5‐year local control rates ranged between 39% and 79%. The 5‐year overall survival ranged between 34% and 71.0% (median, 63.5%). Early stage of the disease (International Federation of Gynecology and Obstetrics stages I–II vs. III–IV), small tumor size (<4 cm), previous hysterectomy, high pretreatment/treatment hemoglobin levels (≥12/12.5 mg/dL), and patients' age <70 or <64 years were correlated with better clinical outcomes.Conclusion.Only retrospective studies, in a limited number, have been published on RT in VC in the past decade, with significant heterogeneity in terms of treatment characteristic and evaluation criteria. Clinical results were strongly influenced by tumor stage. Prospective randomized studies are needed to improve patients' outcomes, especially in advanced‐stage disease.;23:1–10Implications for Practice.This study systematically reviews the recent literature on the role of definitive radiotherapy in the management of vaginal cancer and presents comprehensive data on clinical outcome and toxicity. The prognosis of patients is dismal, with a 5‐year overall survival of approximately 50%. Early stage of the disease, small tumor size, previous hysterectomy, high pretreatment/treatment hemoglobin levels, and patients' age were correlated with a better clinical outcome. A brachytherapy boost should be delivered, especially in patients with higher‐stage disease. The addition of concurrent weekly cisplatin should be considered in most patients, and transfusion should be used to maintain high hemoglobin levels.

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Long‐Term Survival of De Novo Stage IV Human Epidermal Growth Receptor 2 (HER2) Positive Breast Cancers Treated with HER2‐Targeted Therapy

AbstractBackground.An increasing proportion of human epidermal growth receptor 2 (HER2) positive (HER2+) metastatic breast cancer (MBC) is diagnosed as de novo stage IV disease. We hypothesize that a subset of these patients who achieve no evidence of disease (NED) status after multimodality HER2‐targeted treatments may have prolonged progression‐free survival (PFS) and overall survival (OS).Materials and Methods.Patients with de novo stage IV, HER2+ MBC (n = 483) diagnosed between 1998 and 2015 were identified at two institutions (Yale and MD Anderson Cancer Centers). Clinical variables, treatment details, and survival outcomes were compared between those who achieved NED and those who did not.Results.All patients received trastuzumab, and 20% also received pertuzumab as first‐line therapy. The median OS was 5.5 years (95% confidence interval [Cl]: 4.8–6.2). Sixty‐three patients (13.0%) achieved NED; their PFS and OS rates were 100% and 98% (95% CI: 94.6%–100%), respectively, at 5 years and remained the same at 10 years. For patients with no NED (n = 420), the PFS and OS rates were 12% (95% CI: 4.5%–30.4%) and 45% (95% CI: 38.4%–52.0%) at 5 years and 0% and 4% (95% CI, 1.3%–13.2%) at 10 years, respectively. NED patients more frequently had solitary metastasis (79% vs. 51%, p = .005) and surgery to resect cancer (59% vs. 22%, p ≤ .001). In multivariate analysis, NED status (hazard ratio [HR]: 0.014, p = .0002) and estrogen receptor positive status (HR: 0.72; p = .04) were associated with prolonged OS.Conclusion.Among patients with de novo stage IV, HER2+ MBC, those who achieve NED status have a very high PFS and OS. Further randomized studies are required to fully understand the impact of systemic or locoregional therapy on achieving these excellent long‐term outcomes.Implications for Practice.In this retrospective review at two institutions, it was demonstrated that 13% of patients with de novo stage IV, human epidermal growth receptor 2 positive metastatic breast cancer achieved no evidence of disease (NED) status with trastuzumab‐based therapy plus/minus local therapies, and these patients had a very high progression‐free survival (100%) and overall survival (98%) at both the 5‐ and 10‐year time points. Achieving NED status may be an important therapeutic goal. However, further randomized studies are required to fully understand the impact of systemic or locoregional therapy on achieving these excellent long‐term outcomes.

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Retrospective Assessment of a Serum Proteomic Test in a Phase III Study Comparing Erlotinib plus Placebo with Erlotinib plus Tivantinib (MARQUEE) in Previously Treated Patients with Advanced Non‐Small Cell Lung Cancer

AbstractBackground.The VeriStrat test provides accurate predictions of outcomes in all lines of therapy for patients with non‐small cell lung cancer (NSCLC). We investigated the predictive and prognostic role of VeriStrat in patients enrolled on the MARQUEE phase III trial of tivantinib plus erlotinib (T+E) versus placebo plus erlotinib (P+E) in previously treated patients with advanced NSCLC.Methods.Pretreatment plasma samples were available for 996 patients and were analyzed by matrix‐assisted laser desorption/ionization‐time of flight mass spectrometry to generate VeriStrat labels (good, VS‐G, or poor, VS‐P).Results.Overall, no significant benefit in overall survival (OS) and progression‐free survival (PFS) were observed for the addition of tivantinib to erlotinib. Regardless of treatment arm, patients who were classified as VS‐G had significantly longer PFS (3.8 mo for T+E arm, 2.0 mo for P+E arm) and OS (11.6 mo for T+E, 10.2 mo for P+E arm) than patients classified as VS‐P (PFS: 1.9 mo for both arms, hazard ratio [HR], 0.584; 95% confidence interval [CI], 0.468–0.733; p < .0001 for T+E, HR, 0.686; 95% CI, 0.546–0.870; p = .0015 for P+E; OS: 4.0 mo for both arms, HR, 0.333; 95% CI, 0.264–0.422; p < .0001 for T+E; HR, 0.449; 95% CI, 0.353–0.576; p < .0001 for P+E). The VS‐G population had higher OS than the VS‐P population within Eastern Cooperative Oncology Group (ECOG) performance score (PS) categories. VS‐G patients on the T+E arm had longer PFS, but not OS, than VS‐G patients on the P+E arm (p = .0108). Among EGFR mutation‐positive patients, those with VS‐G status had a median OS more than twice that of any other group (OS: 31.6 mo for T+E and 22.8 mo for P+E), whereas VS‐P patients had similar survival rates as VS‐G, EGFR‐wild type patients (OS: 13.7 mo for T+E and 6.5 mo for P+E).Conclusion.In these analyses, VeriStrat showed a prognostic role within EGOC PS categories and regardless of treatment arm and EGFR status, suggesting that VeriStrat could be used to identify EGFR mutation‐positive patients who will have a poor response to EGFR tyrosine kinase inhibitors.Implications for Practice.This study suggests that VeriStrat testing could enhance the prognostic role of performance status and smoking status and replicates findings from other trials that showed that the VeriStrat test identifies EGFR mutation‐positive patients likely to have a poor response to EGFR tyrosine kinase inhibitors (TKIs). Although these findings should be confirmed in other populations, VeriStrat use could be considered in EGFR mutation‐positive patients as an additional prognostic tool, and these results suggest that EGFR mutation‐positive patients with VeriStrat "poor" classification could benefit from other therapeutic agents given in conjunction with TKI monotherapy.

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Targeting Endoglin to Treat Metastatic Renal Cell Carcinoma: Lessons from Osler‐Weber‐Rendu Syndrome

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A verrucous plaque on the intergluteal cleft

MD Fernández Ballesteros, E Gómez Moyano, M Ayala Blanca, S Simonsen

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):641-642

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Polymorphic presentation of disseminated cutaneous rhinosporidiosis in an immunocompetent individual

Swetalina Pradhan, Chandra Sekhar Sirka, Manas Ranjan Baisakh

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):614-617

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Hair manifestations of endocrine diseases: A brief review

Keshavamurthy Vinay, Gitesh U Sawatkar, Sunil Dogra

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):528-538

Hair disorders are common in clinical practice and depending upon social and ethnic norms, it can cause significant psychosocial distress. Hair growth, cycling and density are regulated by many endogenous factors, mainly circulating hormones. Thus, diseases affecting the endocrine system can cause varied changes in physiological hair growth and cycling. Diagnosis and treatment of these disorders require a multidisciplinary approach involving a dermatologist, gynecologist and an endocrinologist. In this review, we briefly discuss the influence of hormones on the hair cycle and hair changes in various endocrine disorders.

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Verruciform xanthoma of the penis: A rare case with an unusual clinical morphology

Goncagul Babuna Kobaner, Ozgur Demir, Sule Ozturk Sari, Can Baykal, Nesimi Buyukbabani

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):600-602

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Safety of important dermatological drugs (retinoids, immune suppressants, anti androgens and thalidomide) in reproductively active males with respect to pregnancy outcome: A brief review of literature

Piyush Kumar, Anupam Das, Niharika Ranjan Lal, Sourabh Jain, Anupama Ghosh

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):539-546

Paternally transmitted damage to offspring is recognized as a complex issue. Each parent contributes 23 chromosomes to a child; hence, it is necessary to know the effects of both maternal and paternal pre-and peri-conceptional exposure to drugs on pregnancy outcome. While there are many studies on the effects of maternal drug exposure on pregnancy outcome, literature on paternal exposure is scarce. Of late however, paternal exposure has been receiving increasing attention. We present a brief review on the safety of commonly used drugs in dermatology, focused on retinoids, immune suppressants, anti androgens and thalidomide.

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Distal infection of the middle finger caused by Mycobacterium abscessus

Daniel Morgado-Carrasco, Constanza Riquelme-Mc Loughlin, Xavier Fusta-Novell, Adriana Garcia, Pilar Iranzo-Fernandez

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):626-628

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The effectiveness of adding low-level light therapy to minoxidil 5% solution in the treatment of patients with androgenetic alopecia

Gita Faghihi, Samaneh Mozafarpoor, Ali Asilian, Fatemeh Mokhtari, Alireza Asemi Esfahani, Behzad Bafandeh, Saeid Nouraei, Mohammad Ali Nilforoushzadeh, Seyed Mohsen Hosseini

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):547-553

Background: Androgenetic alopecia is the commonest type of alopecia affecting over half of men and women. Low-level light therapy is a new technique for stimulating hair growth in both genders. Aims: To overcome the shortcomings of previous epidemiological studies and a lack of controlled clinical trials on the subject, this study compared the effectiveness of adding low-level light therapy to minoxidil topical solution in the treatment of androgenetic alopecia in patients presenting to two skin clinics in Isfahan, Iran during 2014–2015. Materials and Methods: This clinical trial included 50 patients aged 17–45 presenting to Khorshid and Alzahra educational centers and skin diseases research center for androgenetic alopecia during 2014–2015. The patients were randomly divided into a control and a case group. The case group received topical minoxidil 5% solution plus low-level light therapy twice per day. The control group was given the same topical solution and a laser comb system that was turned off to act as a placebo. Changes in patients' hair density and diameter and its overall regrowth as well as their satisfaction with the treatment were assessed at months 0 (baseline), 3, 6, 9 and 12. Results: The percentage of recovery from androgenetic alopecia and the patients' satisfaction with their treatment were significantly higher in the case group compared to the control group. The patients' mean hair density and diameter were found to be higher in the case group after the intervention compared to the control group. Limitations: The study limitations included patient compliance, small sample size, patient insight due to novelty of the method and clinical judgement. Conclusion: As a new method of treatment, low-level light therapy can help improve the percentage of recovery from androgenetic alopecia and increase patients' satisfaction with their treatment.

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Angiospastic macules of Bier: A cause of mottled skin

Cesar Daniel Villarreal-Villarreal, Juan Carlos Robles-Mendez, Angel Eduardo Guerra-Vazquez, Jorge Ocampo-Candiani

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):645-645

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Anti-RO 52-positive systemic sclerosis sine scleroderma with multisystem involvement and recurrent vasculitis

Angoori Gnaneshwar Rao, Syeda Saba Farheen, Uday Deshmukh Reddy, Amit Kolli, K Aparna, J Kranthi, Ruhi Haqqani, T Sandhya Rani

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):607-610

https://ift.tt/2o2mOlg

Reduced immunohistochemical expression of CCN3 in vitiligo

Adriane Reichert Faria, Juliana Elizabeth Jung, Caio Cesar Silva de Catro, Lucia de Noronha

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):558-562

Background: Defective adhesion seems to be involved in the chronic loss of melanocytes observed in vitiligo. Recent findings showed an association of genetic variants of an adhesion gene with vitiligo and reduced immunohistochemical expression of some adhesion molecules in vitiligo skin. Aims: To compare CCN3 immunohistochemical expression in lesional and non-lesional epidermis of individuals with vitiligo. Methods: A total of 66 skin specimens from 33 volunteers with vitiligo were analyzed by immunohistochemistry using anti-CCN3 antibodies. Absence of topical or systemic treatment for vitiligo over the previous 30 days and availability of an area of non-lesional skin for biopsy at least 15 cm away from any vitiliginous macules were the main inclusion criteria. Results: A significant reduction of CCN3 expression was observed in lesional skin as compared to non-lesional skin (P = 0.001). Limitations: Paraffin embedded skin samples do not allow investigation by molecular biology methods. Not all samples allowed analysis due to the lamina preparation technique. Complete clinical data was not available for all patients. Conclusion: Our results support the hypothesis of impaired cell adhesion in vitiligo suggested by genetic studies. The pattern of immunohistochemical expression suggests that vitiligo might be an epithelial disease and not just a melanocyte disorder.

https://ift.tt/2BEmQth

Pleomorphic hyalinizing angiectatic tumor of soft parts with unusual lipoma-like clinical morphology

Zoltan Szep, Alexandra Majernikova, Boris Rychly, Juraj Majtan

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):619-621

https://ift.tt/2o4aMYD

Oral sex related knowledge and oral sex behavior among homosexual and heterosexual men in Belgrade: A cross-sectional study

Milan D Bjekic, Sandra B Sipetic-Grujicic, Hristina D Vlajinac, Aleksandra M Nikolic

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):563-568

Background: Although the risk of sexually transmitted infections is far greater during vaginal and anal sex than during oral sex, increasing practice of oral sex and low rates of barrier method use will probably increase the relative importance of oral sex as a route of transmission for genital pathogens. Aims: The aim of this study was to evaluate knowledge and attitudes about oral sex and sexually transmitted infections, as well as oral sex practices, both among heterosexuals and homosexual men and to compare those two groups. Materials and Methods: In this cross-sectional study, data were collected from consecutive sexually active male patients who ever had oral sex and who attended counselling for sexually transmitted infections at the City Institute for Skin and Venereal Diseases in Belgrade from March to June 2016. One dermatologist interviewed all participants. Results: The study included 359 men who ever had oral sex, 95 (26.5%) homosexual and 264 (73.5%) heterosexual men. In comparison with heterosexual men, homosexual men had considerably more lifetime sexual partners and oral sex partners during the past 3 months, and significantly more frequently practiced oral-anal sex. Oral-sex related knowledge of all participants was unsatisfactory [correct answers were given by 95 (26.5%) to 277 (77.2%) participants], but it was significantly better in homosexual men than in heterosexual. Frequency of condom use and human immunodeficiency virus testing was also significantly higher in the case of homosexual than heterosexual men. Limitations: The study was not performed in representative sample of population. It was restricted to the patients. Consequently it is questionable whether the results obtained could be generalized. Conclusion: Oral sex related knowledge deficits and risky oral sex practice exist in both homosexual and heterosexual men. These findings indicate a need for effective public health campaign and patient education about the risks of unprotected oral sex.

https://ift.tt/2BGUKgQ

Massive cutaneous nodules in a 92-year-old man

Ferran Ballescá, Aram Boada, Carlos Ferrándiz

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):632-633

https://ift.tt/2o4hxtm

Primary cutaneous cribriform apocrine carcinoma: Case report and literature review

Jiann-Der Wu, Chih-Hsuan Changchien, Kai-Sheng Liao

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):569-572

Primary cutaneous cribriform apocrine carcinoma is a rare but distinct variant of primary cutaneous apocrine carcinoma and it is considered a low grade malignancy. We herein present a case of primary cutaneous cribriform apocrine carcinoma at the neck of a 26-year-old female. The tumor features a relatively well-circumscribed border and multiple aggregations of mildly pleomorphic epithelial cells with large ovoid nuclei, small nucleoli and abundant eosinophilic cytoplasms. Cribriform and tubular structures are the major architectural patterns. The primary differential diagnosis is cutaneous metastasis from a cribriform visceral carcinoma; others include primary secretory carcinoma of the skin, adenoid cystic basal cell carcinoma and primary cutaneous adenoid cystic carcinoma.

https://ift.tt/2BCWTKk

Identification of a novel missense mutation in the NOD2 gene in a Chinese child with early-onset sarcoidosis

Xiaopo Wang, Xiaofeng Zhang, Wei Zhang, Jianfang Sun

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):645-645

https://ift.tt/2o4gWrC

Serum macrophage migration inhibitory factor levels in leprosy patients with erythema nodosum leprosum

Frainey Bansal, Tarun Narang, Sunil Dogra, Keshavamurthy Vinay, Seema Chhabra

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):573-577

Background: Erythema nodosum leprosum is an immune-mediated complication of leprosy which causes significant morbidity. Biomarkers in the pathogenesis of erythema nodosum leprosum are not yet fully determined. Aim: To determine macrophage migration inhibitory factor levels in the sera of leprosy patients with erythema nodosum leprosum and to correlate the same with clinical parameters. Methods: This cross-sectional study included 37 consecutive leprosy patients with active erythema nodosum leprosum and 31 age- and sex-matched controls. Detailed clinical history and examination findings were recorded including the severity and frequency of erythema nodosum leprosum. Slit skin smears and histopathologic examination were done in all patients at baseline. Serum macrophage migration inhibitory factor levels were determined using an enzyme-linked immunosorbent assay. Results: Most of our patients were males (78.4%) and suffering from lepromatous leprosy (27, 73%) with a mean initial bacillary index of 3.38 ± 1.36. Recurrent and chronic patterns of erythema nodosum leprosum were seen in 15 (40.5%) and 6 (16.3%) patients, respectively. Most (86.5%) of our patients presented with moderate to severe erythema nodosum leprosum. The mean serum macrophage migration inhibitory factor level was 21.86 ± 18.7 ng/ml among patients while it was 11.78 ± 8.4 ng/ml in the control group (P < 0.01). There were no statistically significant correlations of macrophage migration inhibitory factor levels with erythema nodosum leprosum frequency or severity. Limitation: Serum macrophage migration inhibitory factor levels in leprosy patients with no erythema nodosum leprosum and in patients with other inflammatory and autoimmune conditions were not assessed. Hence, this study falls short of providing the predictive value and specificity of higher macrophage migration inhibitory factor concentrations in serum as a biomarker of erythema nodosum leprosum. Conclusion: Macrophage migration inhibitory factor levels are elevated in erythema nodosum leprosum patients as compared to controls. A larger sample size and macrophage migration inhibitory factor gene polymorphism analysis will be needed to elucidate the role of this pro-inflammatory cytokine in erythema nodosum leprosum.

https://ift.tt/2BHtxuy

IJDVL and impact factor

Saumya Panda

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):525-527

https://ift.tt/2o4gLMY

Congenital asymptomatic papule on the lower eyelid

Keshavmurthy A Adya, Aparna Palit, Arun C Inamadar

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):578-580

https://ift.tt/2BHt4bM

Excision of basal cell carcinomas smaller than 1 cm with 2 mm safety margins: Lateral margin adequacy evaluated by double-bladed scalpel method

Gabriela R Haddad, Hélio Amante Miot, Mariangela Esther Alencar Marques, Juliano Vilaverde Schmitt

Indian Journal of Dermatology, Venereology, and Leprology 2018 84(5):603-606

https://ift.tt/2o2UTBD

Composite neuroendocrine carcinoma and squamous cell carcinoma with regional lymph node metastasis: a case report

Neuroendocrine cell carcinoma is a rare variant of esophageal carcinoma. The characteristic clinical features and diagnosis of superficial neuroendocrine cell carcinoma remain to be established. We report a ra...

https://ift.tt/2MvVw5d

Biomass pellets for power generation in India: a techno-economic evaluation

Abstract

Modern bioenergy is being recognized as an increasingly important low-carbon resource by policy-makers around the world to meet climate policy targets. In India also, there is a clear recognition of the significant role of bioenergy in electricity generation as well as in other applications. In this study, a preliminary attempt has been made to assess the techno-economic feasibility of biomass pellets-based power (BPBP) generation in India. Surplus availability of biomass feedstock from agriculture and forestry/wasteland sector is estimated at 242 million tonnes (Mt) for 2010–11 and is expected to rise to 281 Mt in 2030–31 due to increased crop production and associated waste/residue availability. In terms of related capacity, the potential of BPBP projects is estimated at 35 GW for 2030–31. The associated carbon dioxide mitigation potential resulting from the substitution of coal is estimated at 205 Mt in 2030–31 if the entire biomass surplus is to be diverted for power generation. The levelized cost of electricity is estimated at €0.12 per kWh for BPBP projects as compared to €0.10 per kWh for imported coal based power plants. For states with the lower tariff for biomass power, the break-even price of carbon for BPBP projects is estimated at €18 per tonne. Additionally, BPBP projects will generate employment of more than 5 million person-months in the construction of biomass power plants and over 200,000 full-time employments in the operation of BPBP plants and in the production of biomass pellets.

https://ift.tt/2Nd0yA3

Acute and chronic phagocyte determinants of cardiac allograft vasculopathy

Abstract

Post-transplant immunosuppression has reduced the incidence of T cell-mediated acute rejection, yet long-term cardiac graft survival rates remain a challenge. An important determinant of chronic solid organ allograft complication is accelerated vascular disease of the transplanted graft. In the case of cardiac allograft vasculopathy (CAV), the precise cellular etiology remains inadequately understood; however, histologic evidence hints at the accumulation and activation of innate phagocytes as a causal contributing factor. This includes monocytes, macrophages, and immature dendritic cell subsets. In addition to crosstalk with adaptive T and B immune cells, myeloid phagocytes secrete paracrine signals that directly activate fibroblasts and vascular smooth muscle cells, both of which contribute to fibrous intimal thickening. Though maladaptive phagocyte functions may promote CAV, directed modulation of myeloid cell function, at the molecular level, holds promise for tolerance and prolonged cardiac graft function.

https://ift.tt/2N9LByz

Analysis of metal content and vertical stratification of epiphytic mosses along a Karst Mountain highway

Abstract

Road-based transport emissions are a major source of atmospheric metal pollution. However, there have been few studies on emissions from road traffic in mountainous areas. In this study, epiphytic mosses from trees at different elevations of a highway, a typical road with extraordinary elevation change in a mountainous area of karst in Guizhou, China, were analyzed for metal content as well as the spatial distribution pattern of metals. Mosses were sampled from three sections of highway at different elevations, from 1292–1357, 1394–1441, to 1481–1548 m. Principal component analysis and heat-map clustering were used to identify the principal factors affecting metal deposition. The results show that the metals of mosses from different elevations were divided into four factors. Group 1 which included Ni, Fe, Mg, Ba, and Al was attributed to a dominantly geogenic source. Group 2 included Zn, Cu, Mn, and Cr, from vehicle-related materials including tires and brakes. Group 3, Cd, can be attributed to high Cd background levels from local origins and traffic emissions, particularly tire wear. Group 4, Pb, is associated with brake wear and historical deposition. The epiphytic moss widely distributed in the study area, Ectropothecium aneitense Broth. & Watts, was used to analyze the spatial distribution pattern of the metals. Metal content gradually decreased with increase in elevation. Levels of Ni, Fe, Mn, Ba, and Cd were all significantly correlated with elevation (p < 0.05), simultaneously affected by terrain and vertically stratified. We highlighted the vertical distribution characteristics of metal in epiphytic mosses in this study, which could improve moss application for ecological monitoring due to road-based transport emissions with elevation changes.

https://ift.tt/2PzXqji

What new technology means for the energy demand in China? A sustainable development perspective

Abstract

This paper explores the direct impact of new technology on the energy intensity in China. The autoregressive distributed lag (ARDL) bounds test approach to cointegration is utilised over the extended period of 1985–2013. The variables found cointegrated and confirm the long-run association among all the underlying vectors. Furthermore, the results of long- and short-run analysis reveal that new technology spurs energy intensity in China. A 1% increase in technological innovation boosts energy intensity by 0.4% and 0.03% in the long and short run, respectively. The findings suggest that the establishment of smart grids and solar energy parks followed by the reforms in energy sector is yet to achieve plausible efficiency in China. The existing investment and innovation policy reforms are insufficient to assist the energy sector to cope up with the country's exceptional economic growth trend. Unlike other studies, this paper accommodates structural break in the series. During sensitivity analysis, the model is found stable. Hence, the findings possess important policy implications for China and open up new discussion in the field.

https://ift.tt/2wiy8NO

Secukinumab treatment of moderate to severe plaque psoriasis in routine clinical care: Baseline characteristics, previous therapies, and transition periods of the first 2,000 subjects in the PROSPECT study

Introduction: Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has demonstrated substantial efficacy in the treatment of moderate to severe psoriasis. The PROSPECT study was designed to assess previous and concomitant use of Pso treatments in 2,504 subjects receiving secukinumab and the duration of transition periods from previous treatments to secukinumab in real-life settings. Here we report the baseline characteristics and previous therapies in an interim analysis of the first 1,988 subjects.

https://ift.tt/2OVm7Fy

The prevalence of inflammatory bowel disease in patients with hidradenitis suppurativa

Background: Hidradenitis suppurativa is a chronic inflammatory skin disease associated with many other systemic manifestations including metabolic syndrome. Multiple other inflammatory disorders have been associated with inflammatory bowel disease including psoriasis and rosacea. IBD has been reported with HS however analysis have often utilized large data pulls which rely on International Classification of Diseases (ICD) coding. This leads to the possibility of overestimating prevalence.

https://ift.tt/2MsjHlc

Sun behaviors and quality of life after first cutaneous melanoma diagnosis

Background: There is a growing population of patients living with a history of cutaneous malignant melanomas (CMM) and recent studies indicate that sun-protective behaviors may not be maintained long term. These patients are at increased risk of developing a second primary melanoma and little is known regarding barriers to successful patient education and behavioral change.

https://ift.tt/2OVm7p2

The bacteria stroke: Leclercia adecarboxylata folliculitis in a healthy swimmer—an emerging aquatic pathogen?

A 12-year-old healthy boy presented with a 2-month painful acneiform eruption. On exam erythematous follicular papules and pustules were scattered over bilateral shoulders and back. These surfaces were moderately tender to light palpation; the patient even complained that clothing in contact with his skin elicited pain. Doxycycline 75 mg po qd × 10 days was prescribed to cover common Staphylococcus aureus folliculitis. Due to the atypical presentation of significant pain, a bacterial culture was collected.

https://ift.tt/2Mrhdn7

Solid persistent facial edema (Morbihan syndrome) in a young Mexican-Mestizo woman

Introduction: Morbihan syndrome (MS) is a rare entity characterized by chronic erythematous edema of the upper portion of the face, believed to be a clinical complication of acne vulgaris and/or rosacea, that mostly affects Caucasian adults. There are no laboratory abnormalities or specific histopathologic findings described and thus, MS is mainly a diagnosis of exclusion.

https://ift.tt/2P2lwlE

Role of industry funding in academic dermatology

Since 2003, the NIH Budget for research grants has diminished. As a result more academic physicians are turning to pharmaceutical and medical device companies for funding. The aim of this project was to examine the relationship between private industry funding in dermatology and the relative scholarly impact created by investigators who received this funding. The objective of this study was to compare the impact of the h-index, a weighted index of academic productivity, to the amount of industry research funding received by colleagues.

https://ift.tt/2MrAPHE

The evolution of confocal microscopy in dermatology

Reflectance confocal microscopy (RCM) is a diagnostic imaging tool used to visualize the skin in vivo at the bedside with accuracy that parallels histology. For tissue examination, RCM uses lasers to produce optical sections by illuminating the specimen and by scanning focused beams of light across the tissue. The principle of point illumination in confocal microscopy was first proposed by Marvin Minsky in 1955, and serves as the basis for all subsequent developments for this technology. In the 1970s, lasers were introduced, and shortly after that photomicrographs of histologically recognizable cells were published.

https://ift.tt/2P2rWBf

Systemic lupus erythematosus with toxic epidermal necrolysis–like lesions: An infrequent variant of acute cutaneous erythematous lupus

Introduction: Skin manifestations in systemic lupus erythematosus (SLE) are very heterogeneous. Toxic epidermal necrolysis (TEN)–like lesions are an infrequent clinical presentation of SLE that are included as diagnostic criteria and a variant of acute cutaneous lupus. It presents with photodistributed exanthema and minimal mucositis and the onset of the rash is insidious. Differential diagnosis between "TEN-like" LE and classic TEN, could be difficult especially when LE has not been previously diagnosed.

https://ift.tt/2MvCPii

Steroid-assisted drug delivery with chemical peels for lichen amyloidosis: A case series

Cutaneous amyloidosis is a chronic dermatologic problem that can be extremely frustrating to patients and for which there are limited therapeutic options, often of inadequate efficacy. Patient quality of life is affected by the severe pruritus and cosmetic disfigurement of their lesions. First-line therapy for this condition is potent topical corticosteroids, but therapeutic efficacy is often limited by ineffective drug delivery to the target site. Intralesional kenalog can be a useful alternative for those with small, localized areas of disease involvement.

https://ift.tt/2OZOwKC

Simultaneous treatment of moderate-to-severe horizontal frontalis lines, glabellar lines, and lateral canthal lines with onabotulinumtoxinA, from the subject’s perspective: Patient-reported satisfaction and impact outcomes from a phase 3 double-blind study

Purpose: Safety and efficacy of onabotulinumtoxinA (onabotA) for simultaneous treatment of horizontal forehead lines (FHL) and glabellar complex and simultaneous treatment of upper facial lines (UFL) were assessed in a 12-month, placebo-controlled study. The primary end point was met. Secondary efficacy results (patient-reported satisfaction and treatment impacts) are presented here.

https://ift.tt/2MwsKRW

Scalp photodamage in balding men: An observational study combining a novel clinical scoring method with estimation of individual sun exposure history and risk factors

Background: Despite the fact that actinic damage is well documented, particularly in men due to balding, to our knowledge, the intensity of the relationship between scalp actinic damage and sun exposure remains to be fully elucidated.

https://ift.tt/2OZOvq2

Removal of skin tags with Erbium:YAG Laser: A simple, safe, quick, and effective technique requiring no local anesthesia

Background: Acrochordons are a one of the commonest type of benign cutaneous tumors. These are soft skin fibromas, and have been thought to represent as a cutaneous marker of metabolic syndrome. Treatments like snipping, cryotherapy, electrocautery, and radiofrequency ablation though effective, have there own limitations.

https://ift.tt/2Mw1x1Z

Pythriasis versicolor atypica: A difficult diagnosis

Introduction: Pityriasis versicolor is a superficial mycosis of the skin caused by Malassezia spp., a dimorphic, lipophilic yeast, which is part of the cutaneous microbiota. The most frequent topography is the trunk and is distinguished by showing plaques with fine scales on the surface, of varying shape and size that may be hypochromic, hyperchromic or erythematous, with a chronic and recurrent evolution, usually asymptomatic. The genus Malassezia, from its description, causes confusion and controversy.

https://ift.tt/2P2lv14

The thousand faces of the Sweet syndrome

Introduction: Sweet syndrome is an acute febrile neutrophilic dermatosis described in 1964 by Robert Douglas Sweet, that primarily affects individuals in their fifth to seventh decades. It can be classified into classic or idiopathic, parainflammatory, paraneoplastic, and pregnancy associated. Etiology is unknown, but many authors proposes an unusual hypersensitivity that may be mediated by cytokines, such as interleukin-1, followed by infiltration of neutrophils. Clinically, it is characterized by the abrupt onset of multiple tender, erythematous plaques or nodules.

https://ift.tt/2MujQoc

The importance of eyebrows in the treatment of alopecia areata: An online questionnaire

Background: Alopecia areata (AA) affects not only scalp hair, but often also involves the eyebrows. Most clinical studies focus on scalp hair regrowth as the primary outcome. Our study aims to assess the importance of eyebrows to AA patients.

https://ift.tt/2P0DCV0

The effectiveness of using 1% diclofenac gel and 20% azelaic acid cream for melasma: A single-blind, placebo-controlled, split-face study

Background: Nonsteroidal antiinflammatory drugs that inhibit the mediator of UV-induced melanogenesis (1-6) may be another alternate option for melasma as were azelaic acid.

https://ift.tt/2MxJEQr

Teledermatology: An updated overview of clinical applications and reimbursement policies

Telemedicine is an emerging field in health care that provides services from different medical specialties to patients all around the world. One of the specialties in telemedicine, teledermatology, has grown exponentially as a cost-effective way to implement dermatologic health care to underserved areas and populations. This article reviews the literature that pertains to the cost-effectiveness, reliability, public access, patient satisfaction, and reimbursement policies of teledermatology. Teledermatology has two established modalities: store-and-forward (asynchronous) and live interaction (synchronous).

https://ift.tt/2P0Gnpu

Sweet syndrome induced by influenza vaccination

History: A 41-year-old Caucasian man with no significant medical history presented with a painful rash on his left neck and arm. His symptoms began one day after receiving an influenza vaccination and persisted for several months. Review of systems was positive for occasional fevers and arthralgias.

https://ift.tt/2MuCvAf

Subjective facial dynamics with the use of hyaluronic acid dermal fillers formulated for facial movement and expression

Background: Not only do patients want to look younger and more attractive, patients also want to maintain a natural look following rejuvenation treatments that don't alter their facial expressions. Hence, it becomes increasingly important to assess facial dynamics as results that appear natural at rest may appear unnatural with expression. An open-label clinical study was conducted to evaluate the perception of the naturalness of facial expressions in motion following correction of wrinkles and folds in the lower face.

https://ift.tt/2OZNY7w

Sporotrichoid chromoblastomycosis on right lower leg

Introduction: Chromoblastomycosis is a worldwide chronic fungal infection caused mainly by Fonsecaea pedrosoi or Cladophialophora carrionii affecting predominantly men in tropical and subtropical countries. Patients acquire the infection through a traumatic implantation of fungi from soil. Most common clinical manifestation is a verrucous plaque. Very few cases of sporotrichoid chromoblastomycosis have been described. We report a rare lymphangitic chromoblastomycosis on right lower leg in a young male patient.

https://ift.tt/2MxtdUc

Re: Wound outcomes in negative pressure dressings (WOUND) study - A randomised trial in lower limb skin cancer grafts

Dear Sir,

https://ift.tt/2MufWf2

Radiological features of synovial chondromatosis affecting the temporomandibular joint: report of three cases

Abstract

Synovial chondromatosis is a benign nodular cartilaginous proliferation that mainly occurs in large joints. The temporomandibular joint is considered to be rarely affected. Several cases of synovial chondromatosis of the temporomandibular joint have been reported with clinical and histological features. People with this disease may present with swelling, pain, intracapsular sounds, and limitation of mandibular movement. Radiographs are an important component in the diagnostic process for synovial chondromatosis. In this article, we report three cases of synovial chondromatosis occurring in the temporomandibular joint with a focus on the radiological features, including those on plain films, cone-beam computed tomography (CT) images, and conventional CT images. The three cases had totally different radiological features. The imaging differences were analyzed and compared to create combined diagnostic methods based on clinical features and examination techniques. The role of cone-beam CT examination in the diagnosis of the disease is discussed.

https://ift.tt/2PtHpLE

Age-related changes affecting the cricoarytenoid joint seen on computed tomography

Georges Ziade, MD; Sahar Semaan, MD; Sarah Assaad, MPH; Abdul Latif Hamdan, MD, EMBA, MPH

Abstract

We conducted a retrospective chart review to compare four characteristics-cricoarytenoid joint ankylosis, narrowing, erosion, and density increases-in patients younger and older than 65 years. Our study population was made up of 100 patients, who were divided into two groups on the basis of age. The younger group (<65 yr) comprised 49 patients (27 men and 22 women), and the older group (≥65 yr) was made up of 51 patients (25 men and 26 women). Findings on computed tomography (CT) of the neck were used to determine whether each of the four characteristics was present or absent. Overall, we found only one statistically significant difference between the two groups: ankylosis was significantly more common in the older group (p = 0.036). When we looked further at the side of these anatomic changes, we found that the older group had significantly more right-sided and left-sided ankylosis than did the younger group (p = 0.026 for both), as well as significantly more left-sided narrowing (p = 0.028) (some patients had bilateral involvement). When we analyzed age as a continuous variable, older age was again associated with significantly more ankylosis (p = 0.047) and narrowing (p = 0.011). We conclude that CT can be useful for assessing radiologic changes in the cricoarytenoid joint in elderly patients during the workup of dysphonia and abnormal movement of the vocal folds.

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https://ift.tt/2BFwUSx

Hepatozelluläres Karzinom

https://ift.tt/2o25VqN

Psychisches Wohlbefinden bei Patienten mit Leberzellkarzinom

Zusammenfassung

Hintergrund

Krebserkrankungen sowie die daraus resultierenden Folgen und Behandlungen stellen für Betroffene meist eine starke Belastung dar. Bei einem hepatozellulären Karzinom (HCC) handelt es sich um eine Krebserkrankung mit sehr schlechter Prognose. Mögliche Risikofaktoren, ein HCC zu entwickeln, nehmen in der Bevölkerung seit Jahren zu. Dennoch ist nur wenig über die psychische Belastung der Betroffenen bekannt.

Ziel der Arbeit

Ziel dieser Untersuchung war es, die psychische Belastung und Unterstützungswünsche von HCC-Patienten darzustellen.

Patienten und Methoden

In einer prospektiven Studie wurden Leberzellkarzinompatienten untersucht. Sie wurden zu Beginn und während eines Krankenhausaufenthalts, kurz vor der Entlassung aus demselben sowie 1/2 und 1 Jahr später befragt. Die psychische Belastung wurde mittels „hospital anxiety and depression scale" (HADS) erhoben. Zusätzlich wurden die Patienten gefragt, durch wen sie sich zusätzliche Betreuung wünschen. Bei der Auswertung wurde Häufigkeitsvergleiche mittels χ²-Test und Korrelationen mittels Pearson-Korrelationskoeffizient berechnet.

Ergebnisse

Insgesamt nahmen 97 Patienten an der Studie teil. Bei mehr als der Hälfte (56 %) lag der HADS-Gesamtwert zu Beginn der stationären Aufnahmen über 13, was einer überdurchschnittlichen psychischen Belastung entspricht. Über 90 % der befragten Patienten wünschten sich zu diesem Zeitpunkt psychosoziale Betreuung, zumeist durch Ärzte, Pflegekräfte und/oder Psychologen. Vor der Entlassung erhofften sich alle befragten Personen Unterstützung von Ärzten sowie Pflegekräften. Nach 1/2 Jahr wünschten sich die Betroffenen v. a. Unterstützung von Ärzten und Selbsthilfegruppen.

Diskussion

HCC-Patienten sind psychisch erheblich belastet, mit erhöhtem Betreuungsbedarf.

https://ift.tt/2BDmiDZ

Schlafendoskopie und komplett konzentrischer Weichgaumenkollaps bei CPAP-Nutzungsproblemen

Zusammenfassung

Hintergrund

Mittel der ersten Wahl bei obstruktiver Schlafapnoe (OSA) ist die Überdrucktherapie (CPAP). Allerdings kann sie von vielen Patienten nicht ausreichend genutzt werden. Mit einer medikamenteninduzierten Schlafendoskopie (DISE) lässt sich das Kollapsmuster im oberen Atemweg gut beurteilen. Ziel der Arbeit war es, ein Patientenkollektiv mit CPAP-Nutzungsproblemen mittels DISE hinsichtlich von Nutzungsproblemen und Therapieempfehlungen auszuwerten.

Methode

Über einen Zeitraum von 5 Jahren wurden alle Patienten mit einem Apnoe-Hypopnoe-Index (AHI) ≥15/h mittels DISE retrospektiv ausgewertet und die empfohlenen Therapieoptionen erfasst.

Ergebnisse

Die Datenanalyse von 210 Patienten ergab, dass etwa zwei Drittel Maskenprobleme als ursächlich für die CPAP-Ablehnung angaben. Bei 75 % konnte ein komplett konzentrischer Kollaps (CCC) ausgeschlossen werden, diese Patienten wiesen niedrigere AHI-Werte auf und hatten häufiger eine Tonsillektomie (TE) als Patienten mit CCC. Patienten mit einem Body-Mass-Index (BMI) > 35 kg/m² hatten doppelt so oft einen CCC wie die mit einem BMI < 35 kg/m². Bei fast gleichem BMI und AHI war bei Patienten ohne vorangegangene TE knapp doppelt so oft ein CCC zu erkennen wie mit TE.

Schlussfolgerung

Die Reihung der Therapieempfehlungen verändert sich häufig bei der Berücksichtigung von CCC, BMI > 35 kg/m² und vorheriger TE.

https://ift.tt/2LmquaC

Safety of Drilling 3-Dimensional–Printed Temporal Bones

This occupational safety assessment evaluates a surgeon's exposure to volatile organic compounds when drilling 3 commonly used materials in 3-dimensional–printed temporal bone implants using a standard Office of Safety and Health Administration protocol.

https://ift.tt/2o23Eff

Evolving Nomenclature of Thyroid Cancer

"Cancer is a word, not a sentence," acknowledged John Diamond as he embarked on an ultimately losing fight with oral carcinoma. It reflects the fear that the word cancer has instilled in the public for millennia. To many, a cancer diagnosis was, and remains, akin to a death sentence or, at the very least, a jarring call to battle. This connotation is rooted in the long-established theory of linguistic relativism, which stipulates that thought and action are determined a priori by language itself. Even today, our nuanced understanding of cancer biology and the inherent diversity of malignant processes has not erased the stigma and terror that the word evokes in our patients.

https://ift.tt/2BHpUF3

Medical Practice Entrepreneurship

To the Editor Faucett et al, in their review of Accreditation Council for Graduate Medical Education (ACGME) core competencies, concluded that there should be an increased emphasis on nonclinical core competencies, such as professionalism and systems-based practice.

https://ift.tt/2o6j6XM

Medical Practice Entrepreneurship—Reply

In Reply We appreciate the comments made by Dr Meyers regarding the integration of business education into residency program curricula. As we all know, rising health care costs, decreasing reimbursement rates, and changes in American health care reform are forcing physicians to become more business-minded. However, a significant percentage of physicians indicate that their training did a fair or poor job of preparing them to manage the business aspects of medicine, which suggests that it would be useful for educators to reexamine residency training education to ensure that physicians are prepared for the practice environment.

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Reversible Auricular Necrosis Secondary to Systemic Thrombosis

This report describes a woman diagnosed with a rare case of concomitant heparin-induced thrombocytopenia and antiphospholipid antibody syndrome that presented with auricular necrosis.

https://ift.tt/2o4vTtG

Evaluation of Social Media Presence of Otolaryngology Residency Programs in the United States

This cross-sectional study examines the presence and activity of otolaryngology residency programs on social media sites.

https://ift.tt/2BDQDlS

Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences

This randomized cross-over trial analyzes how use of the word cancer may affect adults' level of anxiety and choice to undergo surgery for small, low-risk papillary thyroid cancer.

https://ift.tt/2o52UpL

Towards a universal MRI atlas of the prostate and prostate zones

Abstract

Background and purpose

The aim of this study was to evaluate an automatic multi-atlas-based segmentation method for generating prostate, peripheral (PZ), and transition zone (TZ) contours on MRIs with and without fat saturation (±FS), and compare MRIs from different vendor MRI systems.

Methods

T2-weighted (T2) and fat-saturated (T2FS) MRIs were acquired on 3T GE (GE, Waukesha, WI, USA) and Siemens (Erlangen, Germany) systems. Manual prostate and PZ contours were used to create atlas libraries. As a test MRI is entered, the procedure for atlas segmentation automatically identifies the atlas subjects that best match the test subject, followed by a normalized intensity-based free-form deformable registration. The contours are transformed to the test subject, and Dice similarity coefficients (DSC) and Hausdorff distances between atlas-generated and manual contours were used to assess performance.

Results

Three atlases were generated based on GE_T2 (n = 30), GE_T2FS (n = 30), and Siem_T2FS (n = 31). When test images matched the contrast and vendor of the atlas, DSCs of 0.81 and 0.83 for T2 ± FS were obtained (baseline performance). Atlases performed with higher accuracy when segmenting (i) T2FS vs. T2 images, likely due to a superior contrast between prostate vs. surrounding tissue; (ii) prostate vs. zonal anatomy; (iii) in the mid-gland vs. base and apex. Atlases performance declined when tested with images with differing contrast and MRI vendor. Conversely, combined atlases showed similar performance to baseline.

Conclusion

The MRI atlas-based segmentation method achieved good results for prostate, PZ, and TZ compared to expert contoured volumes. Combined atlases performed similarly to matching atlas and scan type. The technique is fast, fully automatic, and implemented on commercially available clinical platform.

https://ift.tt/2NeyIn8

Castleman disease

Jason E. Cohn, DO; Jing Zhou, MD, PhD; Amanda Hu, MD

HIV-negative Castleman disease has been associated with autoimmune disease, collagen vascular disorders, pulmonary arterial hypertension, and glomerulopathy.

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Insurance and Diagnosis Stage Among Patients With Cancer Before vs After ACA Implementation

This population-based registry study of nonelderly patients with newly diagnosed cancer examines changes in the percentage of uninsured patients and stage at diagnosis before and after implementation of the Patient Protection and Affordable Care Act (ACA).

https://ift.tt/2P1iA8H

Comparing Adjuvant vs Early-Salvage Radiotherapy After Radical Prostatectomy—Reply

In Reply We thank Abdollah et al, Berg et al, and Chandrasekar et al for their feedback regarding our article.

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Comparing Adjuvant vs Early-Salvage Radiotherapy After Radical Prostatectomy

To the Editor Hwang et al must be congratulated for their great effort in putting together the data of 10 big institutions. However, given the limitations that we discuss herein, their conclusions that adjuvant radiotherapy (ART) reduces biochemical failure, distant metastases, and overall mortality may be optimistic.

https://ift.tt/2P1TnLH

Comparing Adjuvant vs Early-Salvage Radiotherapy After Radical Prostatectomy

To the Editor Hwang et al compared outcomes for men with prostate cancer treated with prostatectomy for those who underwent immediate adjuvant radiotherapy (ART) vs delayed radiotherapy (early-salvage radiotherapy [ESRT]). Using pooled data from 1566 patients with early-stage prostate cancer who were treated with prostatectomy, those who received ART had better outcomes than those who received ESRT. First, we need to highlight an error in the abstract Results incorrectly assigning prostate-specific antigen level descriptions of the ESRT and ART groups.

https://ift.tt/2Mv6pUT

Comparing Adjuvant vs Early-Salvage Radiotherapy After Radical Prostatectomy

To the Editor Optimum management for men with adverse pathologic features (ie, pT3 and/or positive margins) at radical prostatectomy remains a topic of ongoing research. Specifically, should these patients receive immediate adjuvant radiotherapy (ART), or is it better to observe until a change in prostate-specific antigen (PSA) level suggests disease progression? The work by Hwang et al adds a valuable perspective to this debate. The authors compared men who received immediate ART with an undetectable PSA vs early-salvage radiotherapy (ESRT), once the PSA reaches 0.1 to 0.5 ng/mL (to convert to micrograms per liter, multiply by 1.0). They found that ART was associated with lower risks of biochemical recurrence, distant metastases, and death for these high-risk patients.

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Esophageal Adenocarcinoma Risk After Antireflux Surgery in Patients With GERD

This cohort study of patients from the 5 Nordic countries examines whether gastroesophageal antireflux surgery is associated with decreased risk of esophageal adenocarcinoma and whether surgically and medically treated patients experience different outcomes.

https://ift.tt/2Ncpx6F

Orphan Cancer Drugs in the Era of Precision Medicine

This Viewpoint discusses whether the changes in the health care marketplace, the evolution of precision medicine, and the uniqueness of drug development and labeling for cancer diagnoses make the Orphan Drug Act less necessary and less relevant today than at its inception.

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Challenges Encountered by Oncologists When Patients Ask for Second Opinions

This analysis of interviews with Dutch oncologists investigates the outcomes of second-opinion requests for physician-patient and physician-colleague relationships.

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Evidence for a potential role of miR-1908-5p and miR-3614-5p in autoimmune disease risk using integrative bioinformatics

Publication date: Available online 22 August 2018

Source: Journal of Autoimmunity

Author(s): Inken Wohlers, Lars Bertram, Christina M. Lill

Abstract

Genome-wide association studies (GWAS) have identified a large number of genetic risk loci for autoimmune diseases. However, the functional variants underlying these disease associations remain largely unknown. There is evidence that microRNA-mediated regulation may play an important role in this context. Therefore, we assessed whether autoimmune disease loci unfold their effects via altering microRNA expression in relevant immune cells.

To this end, we performed comprehensive data integration of many large and publicly available datasets to combine information on autoimmune disease risk loci with RNA-Seq-based microRNA expression data. Specifically, we carried out microRNA expression quantitative trait loci (eQTL) analyses across 115 GWAS regions associated with 12 autoimmune diseases using next-generation sequencing data of 345 lymphoblastoid cell lines. Statistical analyses included the application and extension of a recently proposed framework (joint likelihood mapping) to microRNA expression data and microRNA target gene enrichment analyses of relevant GWAS data.

Overall, only a minority of autoimmune disease risk loci may exert their pathophysiologic effects by altering microRNA expression based on JLIM. However, detailed functional fine-mapping revealed two independent GWAS regions harboring autoimmune disease risk SNPs with significant effects on microRNA expression. These relate to SNPs associated with Crohn's disease (CD; rs102275) and rheumatoid arthritis (RA; rs968567), which affect the expression of miR-1908-5p (p_rs102275 = 1.44e-20, p_rs968567 = 2.54e-14). In addition, an independent CD risk SNP, rs3853824, was found to alter the expression of miR-3614-5p (p = 5.70e-7). To support these findings, we demonstrate that GWAS signals for RA and CD were enriched in genes predicted to be targeted by both microRNAs (all with p < 0.05).

In summary, our study points towards a potential pathophysiological role of miR-1908-5p and miR-3614-5p in autoimmunity.

Graphical abstract

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Physical exercise contributes to cisplatin-induced nephrotoxicity protection with decreased CD4+ T cells activation

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Mariana Yasue Saito Miyagi, Marcela Teatin Latancia, Leonardo Abreu Testagrossa, Vinicius de Andrade-Oliveira, Welbert Oliveira Pereira, Meire Ioshie Hiyane, Lucas Maceratesi Enjiu, Marcus Pisciottano, Marilia Cerqueira Leite Seelaender, Niels Olsen Saraiva Camara, Mariane Tami Amano

Abstract

Cisplatin is a chemotherapy used to treat different types of cancer, such as testicular, bladder and head and neck. Physical exercise has been shown to improve cancer therapy and recently, it was demonstrated to be able to diminish side effects such as acute kidney injury (AKI), a common side effect in cisplatin treatment. In both cases, the modulation of inflammatory cytokines seems to be one of the mechanisms, but little is known about the immune cells in this process. Here, we investigated the role of CD4 + T cells in the AKI protection by physical exercise. We subjected C57Bl6 mice to long-term physical exercise (EX) before cisplatin treatment. Sedentary groups were used as control (CT). We confirmed that physical exercise decreased AKI by evaluating creatinine and Kim-1 levels, in the serum and kidney respectively. Analyzing the organs weight, we noticed a decrease in sedentary (CIS) and exercised (CIS-EX) cisplatin treated groups. Epididymal and brown adipose tissue weight were decreased in cisplatin treated subjects in comparison to untreated groups, as well as liver and spleen. We then investigated the profile of CD4 + T cells in the spleen and we observed increased levels of Tregs and CD4+CD25+ cells in CIS group, while CIS-EX presented similar amounts as control groups. Analyzing the kidney lymph nodes, we noticed a decrease of CD4+ cells in both CIS and CIS-EX group. However, a more activated phenotype (CD69+ and CD25+) was observed in CIS groups in comparison to CIS-EX group, as well as the presence of Tregs. We then investigated the production of cytokines by these cells and no difference among the groups was observed in cytokines production in splenic CD4 + T cells. However, a clear increase in TNF and IL-10 production was observed in CD4 + T cells from lymph nodes, while CIS-EX group presented similar levels as the control groups. We confirmed that physical exercise was able to diminish cisplatin-induced AKI with concomitant decrease in CD4 + T cell activation.

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Generation of novel Id2 and E2-2, E2A and HEB antibodies reveals novel Id2 binding partners and species-specific expression of E-proteins in NK cells

Publication date: Available online 23 August 2018

Source: Molecular Immunology

Author(s): Jai Rautela, Laura F. Dagley, Tobias Kratina, Angaleena Anthony, Wilford Goh, Elliot Surgenor, Rebecca B. Delconte, Andrew I. Webb, Ngaire Elwood, Joanna R. Groom, Fernando Souza-Fonseca-Guimaraes, Lynn Corcoran, Nicholas D. Huntington

Abstract

NK cells are cytotoxic lymphocytes with a key role in limiting tumour metastases. In mice, the NK cell lineage continually expresses high levels of the Inhibitor of DNA-binding 2 (Id2) protein and loss of Id2 is incongruous with their survival due to aberrant E-protein target gene activity. Using novel Id2 and E-protein antibodies that detect both mouse and human proteins, we have extensively characterised Id2 and E-protein expression in murine and human NK cells. We detected clear expression of E2 A and HEB, and to a lesser extent E2-2 in murine NK cells. In contrast HEB appears to be the major E-protein expressed in human NK cells, with minor E2-2 expression and surprisingly, no E2 A detected in primary NK cells nor human NK cell lines. These novel antibodies are also functional in immunofluorescence and immunoprecipitation. Mass spectrometry analysis of Id2 immuno-precipitated from murine NK cells revealed a number of novel associated proteins including several members of the SWI/SNF-related matrix-associated actin-dependent regulator chromatin (SMARC) and Mediator complex (MED) families. Taken together, these data highlight the utility of novel Id2 and E-protein antibodies and caution against mouse models for understanding Id2/E-protein biology in NK cells given their clearly disparate expression patternbetween species.

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Ancillary medications and outcomes in post-tonsillectomy patients

Ashley P. O'Connell Ferster, MD; Eric Schaefer, MS; Jane R. Schubart, MBA, PhD; Michele M. Carr, DDS, MD, PhD

Abstract

To investigate the impact of medications on outcomes after tonsillectomy, a retrospective review using the MarketScan database was performed. A total of 306,536 privately insured children and adolescents (1 to 17 years old) who underwent tonsillectomy/adenoidectomy were identified from 2008 to 2012. Pharmaceutical claims identified patients who received outpatient prescriptions for ibuprofen, steroids, or topical anesthetics until discharge and for medications for the treatment of attention deficit hyperactivity disorder (ADHD) or montelukast up to 14 days postoperatively. Logistic regression compared prescription claims to outcomes, including postoperative bleeding, dehydration, emergency department visits, and readmissions. Ibuprofen was the only medication associated with increased odds of postoperative bleeding (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.07 to 1.95). Patients receiving steroids had lower odds of dehydration (OR: 0.74, 95% CI: 0.65 to 0.84) and emergency department visits (OR: 0.82, 95% CI: 0.76 to 0.88). Odds of dehydration were highest in patients taking ADHD medications (OR: 1.38, 95% CI: 1.15 to 1.66) and topical anesthetics (OR: 1.32, 95% CI: 1.10 to 1.59). Although causality cannot be assumed in observational studies, steroids and ibuprofen should be used judiciously.

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Treatment outcomes in HPV-negative oropharyngeal cancer: Surgery plus radiotherapy vs. definitive chemoradiotherapy

Dominique Rash, MD; Megan E. Daly, MD; Blythe Durbin-Johnson, PhD; Andrew T. Vaughan, PhD; Allen M. Chen, MD

Abstract

We performed a retrospective study to compare clinical outcomes among 51 consecutively presenting patients-38 men and 13 women, aged 46 to 74 years (median: 57)-with locally advanced human papillomavirus (HPV)-negative oropharyngeal cancer who were treated with either primary surgery followed by postoperative radiotherapy (S/RT group; n = 22) or definitive chemoradiotherapy alone (CRT group; n = 29). Within the cohort, 45 patients reported a history of tobacco use, with a median intensity of 40 pack-years. In addition, 39 patients (76%) reported moderate to heavy alcohol use. At baseline, there were no statistically significant differences between the two cohorts in sex, median age, cancer stage, intensity of smoking history, and alcohol use (p > 0.05 for all). Radiation doses ranged from 40 to 70 Gy (median: 70). Follow-up ranged from 2 to 93 months (median: 29). After treatment, we found no difference between the S/RT group and the CRT group in the incidence of locoregional recurrence (36 vs. 24%; p = 0.43) or distant metastases (14 vs. 21%; p = 0.56). Likewise, the difference in 2-year estimates of progression-free survival in the two groups was not significant (66 vs. 62%; p = 0.64), nor was the difference in 2-year overall survival (75 vs. 76%; p = 0.83). We conclude that treatment with either (1) primary surgery followed by postoperative radiotherapy or (2) CRT for locally advanced HPV-negative oropharyngeal cancer results in similar outcomes. In view of the relatively poor prognosis for patients with HPV-negative disease compared with their HPV-positive counterparts, clinical trials to investigate intensifying treatment may be warranted.

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A rare case of odontoameloblastoma in a geriatric patient

Pratyusha Yalamanchi, MD, MBA; Orly Coblens, MD; Meejin Ahn, DO; Steven B. Cannady, MD; Jason G. Newman, MD

Abstract

Odontoameloblastoma is an extremely rare tumor derived from odontogenic epithelium and mesenchyme. In the fewer than 20 reported cases, odontoameloblastoma is described as occurring in the maxilla or mandible of young men with a history of unerupted teeth. Here we report a case of a 73-year-old woman who presented to the dentist for routine cleaning and x-rays, which displayed a mandibular lesion. After referral to multiple providers, a biopsy of two involved teeth was obtained and computed tomography of the neck was performed, revealing a large, destructive lesion of the mandible. Histology was consistent with odontoameloblastoma. The patient underwent wide segmental mandibular resection and scapula tip free flap reconstruction. She recovered uneventfully and continues to have close follow-up, given the risk of recurrence. To the best of our knowledge, this is the first reported case of odontoameloblastoma in a patient over age 50. The goal of the authors is to raise awareness of this rare pathology and its diagnostic and management modalities.

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Dacryocystorhinostomy with a thulium:YAG laser-a case series

Christopher Tang, MD; Scott Rickert, MD; Niv Mor, MD; Andrew Blitzer, MD, DDS; Martin Leib, MD

Abstract

We conducted a retrospective chart review of 27 patients-7 men and 20 women, aged 47 to 94 years (mean: 71.3)-with symptomatic epiphora secondary to dacryostenosis who had undergone thulium: YAG (Tm:YAG) laser dacryocystorhinostomy (DCR). Among them, dacryostenosis had been documented in 35 eyes by dacryocystography. The Tm:YAG procedure involved the administration of local anesthesia, after which a 600-μm laser fiber was inserted into the lacrimal canaliculi and then into the nasolacrimal duct. Under endoscopic visualization, the DCR was performed anterior and inferior to the middle turbinate, which created an opening. Silicone stents were then inserted and tied intranasally. In the immediate postoperative period, all 27 patients noted initial improvement. During a follow-up of 22 days to 25 months (mean: 11.3 mo), 24 of the 27 patients (89%) remained symptom-free, while the remaining 3 patients (11%) experienced a treatment failure and required revision surgery. To the best of our knowledge, only two articles on thulium laser therapy for DCR have been previously published, both approximately 25 years ago; both involved the use of a thulium along with holmium and chromium in cadavers. As far as we know, our case series is the largest in the English-language literature that has documented the use of the thulium in laser therapy for DCR, and it is the only in vivo study. We found that DCR with the Tm:YAG laser was an effective and affordable option for patients with symptomatic epiphora secondary to lacrimal obstruction.

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A polyp originating in the middle turbinate and extending to the maxillary sinus ostium

Jae Hoon Lee, MD

The clinical presentations of nasal polyps include nasal obstruction, rhinorrhea, postnasal drip, anosmia, hyposmia, and facial pain.

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Endoscopic view of postoperative maxillary sinus mucoceles separated by bony septum

Jae Hoon Lee, MD

Postoperative maxillary sinus mucocele usually presents 20 to 30 years after Caldwell-Luc surgery involving the maxillary sinus.

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Bilateral massive pharyngoceles

Norair Adjamian, DO; Lyndsay L. Madden, DO; Libby J. Smith, DO

The differential diagnosis of pharyngoceles can be vast, and misdiagnosis often can occur without proper imaging studies.

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Inflammatory myofibroblastic tumor of the epiglottis excised with a carbon dioxide laser: Case report and literature review

Blake Raggio, MD; Neil Chheda, MD

Abstract

Inflammatory myofibroblastic tumor (IMT) is a benign neoplasm of intermediate biologic potential. It rarely occurs in the larynx, and it has not been previously reported in the epiglottis. We treated a 66-year-old woman who presented with progressive dysphonia and a mass on her suprahyoid epiglottis. The tumor was completely excised with a CO2 laser; no adjuvant therapy was administered. Histopathology revealed that the mass was an IMT. No evidence of recurrence was noted after 6 months of follow-up. We present what we believe is the first case of an epiglottic IMT to be reported in the literature, and we propose CO2 laser excision without adjuvant therapy as an acceptable treatment.

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Persistent stapedial artery with ankylosis of the stapes footplate

Fiona C. Hill, MBBS; Bing Teh, MBBS; Michael Tykocinski, FRACS

Persistent stapedial artery may present as a pulsatile middle ear mass or may appear as an incidental finding during middle ear surgery.

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Applicability of the real ear measurement for audiological intervention of tinnitus

Publication date: Available online 23 August 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Andressa Vital Rocha, Maria Fernanda Capoani Garcia Mondelli

Abstract

Introduction

Tinnitus is present in a large part of chronic health complaints, and it is considered a public health problem injurious to the individual's quality of life. Considering the increase of the world population associated with an increase of life expectancy, tinnitus remains a cause for medical concern, since during aging the occurrence of auditory impairments due to the deterioration of the peripheral auditory structures and central impairs the quality of life.

Objective

The aim of the present study was to analyze the applicability of real ear measurements for audiological intervention of tinnitus through specific evaluation, selection, verification and validation of the hearing aids combined with the sound generator.

Methods

Forty individuals of both genders with hearing loss and tinnitus complaints were deemed eligible to compose the sample. They were enrolled according to clinical symptoms and submitted to the following procedures: anamnesis and previous complaint history, high frequency audiometry, immittanciometry and acuphenometry with the research of psychoacoustic thresholds of pitch, loudness and minimum masking threshold, sound generator, in addition to the application of the Tinnitus Handicap Inventory and Visual Analog Scale tools. The entire sample was adapted with Siemens hearing aids and a sound generator, participated in a counseling session with support of digital material and evaluated in two situations: Initial Assessment (before the hearing aids and sound generator adaptation) and Final Assessment (6 months, after adaptation). The statistical analyzes were descriptive and inferential, adopted a significance level of 5% and the T-Paired Test and the Spearman Correlation test were performed.

Results

The results showed that there was a benefit with the use of hearing aids combined with a sound generator from the statistically significant values and strong correlations between the sound generator verification data regarding acuphenometry and the nuisance/severity questionnaires. Regarding the verification of the sound generator, it is important to highlight that the entire sample selected the effective acoustic stimulation based on the comfort levels, which was proved in the present study to be a sufficient intensity for positive prognosis, whereas the users' noises were found below the psychoacoustic thresholds of acuphenometry.

Conclusion

The present study concluded that the audiological intervention with any level of sound stimulus is enough to obtain a positive prognosis in the medium term. Data that specifies that the verification of sound generator was effective at the real ear measurements are important in the evaluation and intervention of the complaint. In addition, it points out that the greater the tinnitus perception, the greater its severity, and the greater the nuisance, the higher the psychoacoustics thresholds of frequency and the minimum threshold of masking.

Resumo

Introdução

O zumbido está presente em grande parte das queixas crônicas de saúde, sendo considerado um problema de saúde pública, prejudicial à qualidade de vida do indivíduo. Considerando o aumento da população mundial associado ao aumento da expectativa de vida, a tendência é que o zumbido permaneça como um motivo de preocupação, uma vez que com a idade a ocorrência de prejuízos auditivos decorrentes da deterioração das estruturas auditivas periféricas e centrais, ocasionam grande impacto negativo na qualidade de vida.

Objetivo

O objetivo do presente estudo foi analisar a aplicabilidade das medidas da orelha real para a intervenção audiológica do zumbido através de avaliação específica, seleção, verificação e validação do aparelho de amplificação sonora individual combinado ao gerador de som.

Método

Quarenta indivíduos de ambos os sexos com perda auditiva e queixa de zumbido foram considerados elegíveis para compor a amostra. Eles foram atendidos conforme a demanda clínica e submetidos aos seguintes procedimentos: anamnese e histórico prévio de queixa, audiometria de alta frequência, imitanciometria e acufenometria com pesquisa dos limiares psicoacústicos de pitch, loudness e limiar mínimo de mascaramento, gerador de som, além da aplicação das ferramentas tinnitus handicap inventory e escala visual analógica. Toda a amostra recebeu aparelho de amplificação sonora individual e gerador de som, ambos da marca Siemens, participaram de uma sessão de aconselhamento com apoio de material digital e foram avaliados em duas situações: Avaliação inicial (antes da adaptação dos aparelhos de amplificação sonora individual e gerador de som) e Avaliação final (6 meses após a adaptação). As análises estatísticas foram descritivas e inferenciais, adotando um nível de significância de 5% com a realização do teste t-pareado e o teste de correlação de Spearman.

Resultados

Os resultados mostraram que houve benefício com o uso de aparelho de amplificação sonora individual combinado ao gerador de som com base nos valores estatisticamente significantes e fortes correlações entre os dados da verificação do gerador de som em relação à acufenometria e os questionários de incômodo/gravidade. Em relação à verificação do gerador de sons, é importante destacar que toda a amostra selecionou a estimulação acústica efetiva baseada nos níveis de conforto, e no presente estudo demonstraram ser de intensidade suficiente para o prognóstico positivo, enquanto que os ruídos dos usuários estavam abaixo dos limiares psicoacústicos da acufenometria.

Conclusão

O presente estudo concluiu que a intervenção audiológica com qualquer nível de estímulo sonoro é suficiente para obter um prognóstico positivo em médio prazo. Os dados que demonstram que a verificação do gerador de som foi efetiva nas medidas da orelha real são importantes na avaliação e intervenção da queixa. Além disso, mostram que quanto maior a percepção do zumbido, maior a sua gravidade; e quanto maior o incômodo, maiores os limiares de frequência psicoacústica e o limiar mínimo de mascaramento.

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Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 23 Αυγούστου 2018

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