Thyroid, Ahead of Print.
https://ift.tt/2MuGhJY
Παρασκευή 24 Αυγούστου 2018
Transcutaneous Recording During Intraoperative Neuromonitoring in Thyroid Surgery
Immune tumor board: integral part in the multidisciplinary management of cancer patients treated with cancer immunotherapy
Abstract
Recent progress in the understanding of immune responses to cancer and how tumor cells evade immune control have led to the successful introduction of cancer immunotherapy, in particular immune checkpoint inhibitors (ICI). Treatment of cancer patients with immunotherapy such as ICIs has led to new challenges, including starting and stopping rules for immunotherapy, the management of immune-related adverse events, and logistic issues for the production of cellular therapies and viral delivery vectors. These challenges are not disease- or organ-specific and several potential biomarkers to predict response to ICI are under investigation. We installed an interdisciplinary discussion platform for managing patient-specific challenges associated with cancer immunotherapy in our institution. Here, we describe an immune tumor board for the management of cancer patients treated with immunotherapy and provide an outlook on how such a platform could be potentially used in the future to discuss rational and personalized combination therapies, and how to improve the management of side effects occurring under immunotherapy.
https://ift.tt/2PzHXzH
Traumatic tibia shaft fractures caused by the impact of a golf ball: two case reports
As golf becomes increasingly popular, the number of injuries while playing golf also increases. We experienced two cases of traumatic tibia shaft fractures caused by the impact of a golf ball.
https://ift.tt/2P1CVuU
FDA OKs New Prophylactic Drug for Rare Hereditary Angioedema
Lanadelumab (Takhzyro) is the first monoclonal antibody to help prevent attacks of hereditary angioedema in patients age 12 years and older.
FDA Approvals
https://ift.tt/2LpEP61
5 tips to provide safe and effective ventilation
Assign someone to monitor the patient's airway visually and with capnography using these five tips
https://ift.tt/2LodaT7
Metabolic Determinants of Impaired Pulmonary Function in Patients with Newly Diagnosed Type 2 Diabetes Mellitus
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0653-7135
Aims Impaired lung function associates with deterioration of glycemic control and diabetes-related oxidative stress in long-standing type 2 diabetes. We hypothesized that recent-onset type 2 diabetes patients exhibit abnormal pulmonary function when compared to glucose-tolerant controls and that the frequencies of single-nucleotide polymorphisms (SNPs), known to associate with lung dysfunction, are different between both groups. Methods Type 2 diabetes patients with a known disease duration<1 year (n=34) had similar age, sex distribution and BMI as overweight controls (n=26). Lung function was assessed by spirometry comprising predicted forced vital capacity (FVC%), predicted forced expiratory volume in one second (FEV1%) and the FEV1/FVC ratio. Multivariable linear regressions were performed to investigate group differences, which were adjusted for potential confounders such as age, sex, BMI, height and smoking status. SNP genotyping was conducted using real-time polymerase chain reaction-based allelic discrimination. Results Patients with type 2 diabetes had lower FEV1%, FEV1/FVC and VO2max (all p<0.05). Among patients with type 2 diabetes, FEV1% correlated positively with VO2max (r=0.40, p<0.05) and FEV1/FVC correlated negatively with HbA1c (r=−0.49, p<0.01). Regression analyses across the whole cohort indicated that the group differences in FEV1/FVC can be explained by the confounding effect of HbA1c. The frequencies of the SNPs rs1042713, rs1079572, rs11172113, rs12504628, rs1422795, rs1481345, rs2235910, rs2277027, rs2284746, rs4341, rs7068966, rs925284, rs993925 and rs3824658 did not differ between both groups. Conclusions Recent-onset type 2 diabetes patients exhibit reductions in features of pulmonary function, which might be at least in part resulting from glucotoxicity.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Ornamental hyperaccumulator Mirabilis jalapa L. phytoremediating combine contaminated soil enhanced by some chelators and surfactants
Abstract
Mirabilis jalapa L. is an ornamental plant of the composite family, which was found hyperaccumulating Cd. Due to its larger biomass, developed root system, root exudation, and microbial interactions, certain organic pollutants in its rhizosphere can be effectively degraded. Thus, M. jalapacan be used to co-remediate heavy metal and organic pollutant co-contaminated soil. The aim of this paper is to explore the remediation capacity of M. jalapa for Cd-PAHs co-contaminated soil in the presence of five chelators or surfactants. The concentrations of Cd and PAHs in collected soil samples were 0.85 mg kg−1 Cd and 1.138 mg kg−1 PAHs (16 kinds of priority control polycyclic aromatic hydrocarbons by USEPA). The chelators or surfactants of EDTA, EGTA, CA, TW80, and SA were respectively spiked to the pots according to the experiment design at 1 month before the plant harvested. The results showed that the capacity of Cd in shoot of M. jalapa was 7.99 μg pot−1 without any addition (CK4, M. jalapa in original soil without amendment). However, Cd capacity in shoot of M. jalapa was increased (p < 0.05) by 31.7%, 181.7%, and 107.4% in treatment of REGTA, RCA and REGTA + SA, respectively. As for the degradation of PAHs in soil, there was no significant decrease (p < 0.05) in the treatment of CK2 (original soil spiked with 0.9 SA without M. jalapa), CK3 (original soil spiked with 0.3 TW80 without M. jalapa), and CK4 compared to the control CK1 (original soil without M. jalapa and amendment). When amendments were added to soils with M. jalapa,the PAHs concentrations in soils significantly decreased (p < 0.05) by 21.7%, 23.8%, 27.0%, 19.8%, 21.8%, 31.2%, and 25.5% for the treatment of REDTA + SA, REDTA + T80, REGTA + SA, REGTA + T80, RCA + T80, RSA + T80 + EDTA, and RSA + T80 + CA, respectively. Basically, Cd capacity in shoot of M. jalapa was improved by chelators. PAHs degradation was caused by the existence of surfactants in rhizosphere of M. jalapa. But the roles of different chelators or surfactants were quite distinct. In short, the Cd capacity in the shoot and PAHs degradation in the rhizosphere of M. jalapa in the treatment of REGTA + SA were all significantly increased (p < 0.05), which was more practical for M. jalapa phytoremediating Cd-PAHs co-contaminated soil.
https://ift.tt/2oacQhI
Preoperative percutaneous arthrography provides detailed information for treatment of Wassel type IV thumb duplication
: We aimed to detect whether percutaneous arthrography can provide detailed information for surgery for Wassel type IV thumb duplication prior to skin incision.
https://ift.tt/2BK27nR
Upper blepharoplasty revision technique: Correction of the high fold using the pretarsal orbicularis oculi flap
With the growing popularity of upper lid blepharoplasty, there have been increasing reports of unsatisfactory outcomes that have necessitated a revision surgery. This study aimed to evaluate aesthetic outcomes of surgical correction of the high fold using a pretarsal orbicularis oculi flap, and to highlight the key practice points of this surgical procedure in secondary blepharoplasty.
https://ift.tt/2o7lbCT
Endoscopic assisted retrograde release of posterior interosseous nerve: Preliminary results of a new technique
Open surgical release of posterior interosseous nerve(PIN) has been well defined in literature with different surgical approaches. In this retrospective study, we aimed to present outcomes of endoscopic assisted retrograde release of posterior interosseous nerve.
https://ift.tt/2P1fguA
Autologous Fat Grafting after Breast Conserving Surgery – Breast-Imaging Changes and Patient-Reported Outcome
Autologous fat grafting (AFG) to the breast is known to cause radiologic breast-imaging changes. However, these changes have primarily been investigated in breast augmentation settings, whereas the radiologic breast-imaging changes after AFG in breast conserving surgery (BCS) patients have only been sparsely studied.
https://ift.tt/2PBzBYb
The Surgical Anatomy of the Superficial and Deep Palmar Arches: a Meta-Analysis
The following study aimed to find the pooled prevalence estimate of anatomical variations in the palmar vasculature, namely the superficial palmar arch (SPA) and the deep palmar arch (DPA). The importance of understanding the vasculature of the hand is critical with the increasing use of hand microsurgery.
https://ift.tt/2wnSyFg
Clinical results and quality of life after reconstruction following sacrectomy for primary bone malignancy
Sacrectomy is a rare and demanding surgical procedure resulting in major soft tissue defects and spinopelvic discontinuity. No consensus is available on the optimal reconstruction algorithm. Therefore, the present study evaluated the results of sacrectomy reconstruction and its impact on patients' quality of life.
https://ift.tt/2PzvGeF
Technical refinements to a validated autologous fat harvesting technique
Dear Sir,
https://ift.tt/2P52ona
Absorbable Sutures for Carpal Tunnel Decompression: A Cochrane Review Summary
Carpal tunnel decompression (CTD) is the most common elective hand operation, with approximately 73,000 procedures performed annually in England1. After CTD, skin closure may be achieved with absorbable or non-absorbable sutures. Our Cochrane review2 collates the evidence comparing absorbable versus non-absorbable sutures for skin closure after CTD and we have summarised our findings below.
https://ift.tt/2PBzuMf
The amounts of melanin pigment causing color differences between the vermilion and lip mucosa
Text
https://ift.tt/2P4kxl4
Techniques to enable identification and safe elevation of the Posterior interosseous artery flap.
The distally-based, pedicled posterior interosseous artery (PIA) flap can be a useful option for reconstruction of dorsal hand defects, particularly following trauma.1,2 The flap is generally thin and pliable and avoids sacrificing a major vessel supplying the hand. It can be raised as a skin flap, adipofascial variant, or the super-thin fascia-only type.
https://ift.tt/2PwvvRc
Delayed-Onset Nodules After Polymethyl Methacrylate Injections
No abstract availablehttps://ift.tt/2Lorzij
How We Do It: Utility of Conservative Thickness Layers in Mohs Micrographic Surgery in Selected Patients
No abstract availablehttps://ift.tt/2wct2U6
Measuring the Depth of Perineural Invasion in Cutaneous Squamous Cell Carcinoma: Implications on Biopsy Technique
BACKGROUND Perineural invasion (PNI) is a high-risk feature of cutaneous squamous cell carcinoma (CSCC). Depths at which PNI occurs are unknown. OBJECTIVE To determine the most superficial depth at which PNI occurs in CSCC and stratify by tumor clinical diameter and body location. METHODS AND MATERIALS Single-institution retrospective review of CSCC specimens reporting PNI on pathology reports between January 2004 and August 2014. Depth was defined as distance from top of granular layer to middle of nerve invaded by CSCC or distance from erosion to middle of nerve affected by CSCC. RESULTS Of 66 specimens identified with PNI, 45 specimens were included. Mean histopathologic depth to PNI was 2.7 mm (SD = 1.8 mm, median depth = 2.2 mm, range 0.5–12 mm). Perineural invasion depth varied by anatomic location, with the head associated with most superficial average PNI depth (2.2 mm) and trunk with greatest average PNI depth (4.3 mm). Perineural invasion depth correlated with clinical tumor diameter. The largest percentage of specimens with PNI were of clinical diameter of at least 2 cm (20/45 = 44%). CONCLUSION Clinicians encountering lesions suspicious for CSCC have the greatest chance of detecting PNI using biopsy techniques that reach at least 3 to 4 mm deep.https://ift.tt/2LqDKej
Systematic Review of Surgical Treatment and Outcomes After Local Surgery of Primary Cutaneous Melanomas of the Penis and Scrotum
BACKGROUND Few data exist to guide surgical management and counseling about local recurrence after surgery of primary male genital melanoma. OBJECTIVE To compile all available data on local recurrence rates after surgery of primary cutaneous melanoma of the penis and scrotum. MATERIALS AND METHODS A systematic review of PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Excerpta Medica database (EMBASE), and Web of Science identified all surgically treated penile and scrotal melanomas that reported local recurrence status and follow-up time. RESULTS One hundred twenty-seven melanomas from 74 manuscripts were included. Eighty-six percent of melanomas were located on the penis, and 14% were located on the scrotum. Average follow-up time was 35.7 months. Scrotal melanomas were predominantly treated with organ-sparing surgeries (16/18, 88.9%), whereas penile melanomas were treated more often with amputation (61/109, 56.0%). Overall, local recurrence rate was 15.7% (20/127). Local recurrence rates for penile cases were 18.8% (9/48) after organ-sparing surgery versus 13.1% (8/61) for amputative surgery. Local recurrence rates were 66.7% (4/6) after positive surgical margins versus 10.2% (5/49) after negative surgical margins. CONCLUSION Local recurrence rates are high after both organ-sparing and amputative surgery of primary cutaneous melanoma of the penis and scrotum. There is a need to standardize reporting for this rare tumor, as more complete data are necessary to develop consensus guidelines for surgical management of male genital melanoma.https://ift.tt/2o8sJoZ
Classification of Foreign Body Reactions due to Industrial Silicone Injection
BACKGROUND A foreign body reaction (FBR) is a typical tissue response to a biomaterial that has been injected or implanted in human body tissue. There has been a lack of data on the classification of foreign body reaction to silicone injection, which can describe the pattern of body tissue responses to silicone. OBJECTIVE Determine the foreign body reaction to silicone injection. METHOD We modified the classification proposed by Duranti and colleagues, which has categorized a FBR to hyaluronic acid injection into a new classification of an FBR to silicone injection. A cohort study of 31 women suffering from silicone-induced granulomas on their chin was conducted. Granulomatous tissue and submental skin were stained with hematoxylin–eosin and evaluated. RESULTS Our data revealed that there were at least 7 categories of FBRs to silicone injection that could be developed. Categories 1 to 4 showed inflammatory activity, and categories 5 to 8 showed tissue repair by fibrosis. CONCLUSION Using histopathological staining, we are able to sequence the steps of body reactions to silicone injection. Initial inflammatory reaction is then replaced by fibrosis process repairing the damaged tissues. The process depends on the host immune tolerance.https://ift.tt/2LojOcf
Inside “Outside” Job: Unexpected Geometric Skin Ulcerations Overlying Orthopedic Hardware After Multimodal Laser Scar Revision
No abstract availablehttps://ift.tt/2wdvrxL
Injectable Platelet-, Leukocyte-, and Fibrin-Rich Plasma (iL-PRF) in the Management of Androgenetic Alopecia
BACKGROUND The role of enriched autologous plasmas in androgenetic alopecia (AGA) management is emerging in recent literature. OBJECTIVE In this prospective study, the authors aimed to confirm that the induction of a minor local trauma immediately followed by injections of an enriched plasma made of a strongly concentrated platelet fraction, a robust white cell presence, concentrated fibrinogen, and other plasma proteins (injectable leukocyte platelet-rich fibrin [iL-PRF]) could be able to produce positive clinical results in patients with AGA. MATERIALS AND METHODS A 2-injection regimen was instituted, with a 3-month interval between the 2 interventions. A treatment group (TG) and a control group (CG) were instituted. Macrophotographs were taken at baseline and after 6 months, and rated by 5-people expert panel (blinded to this assignment) using the 15-point scale proposed by Jaeschke to evaluate the clinical change. RESULTS Overall, TG showed better scores compared with the CG in all 5 classes of global physician assessment at baseline, all age groups, and in both sexes, and such differences always reached statistical significance. A greater severity at baseline showed a larger improvement after treatment in the TG. CONCLUSION This study provides preliminary evidence that the biological composition of the iL-PRF is of crucial importance in ensuring a good degree of clinical efficacy in patients with AGA.https://ift.tt/2LnYF1O
Evaluating the Efficacy of Different Platelet-Rich Plasma Regimens for Management of Androgenetic Alopecia: A Single-Center, Blinded, Randomized Clinical Trial
BACKGROUND Studies suggest platelet-rich plasma (PRP) may mitigate androgenetic alopecia (AGA), but each varies in the frequency of and interval between treatments. OBJECTIVE To compare the efficacy, satisfaction, tolerability, and safety of 2 initial PRP injection protocols over 6 months. METHODS Prospective, randomized, single-blinded trial among 40 patients with moderate AGA. Participants received subdermal PRP injections according to 1 of 2 treatment protocols: 3 monthly sessions with booster 3 months later (Group 1) or 2 sessions every 3 months (Group 2). Folliscope hair count and shaft caliber, global photography, and patient satisfaction questionnaires were obtained at baseline, 3 months, and 6 months. RESULTS At 6 months, both groups demonstrated statistically significant increases in hair count (phttps://ift.tt/2LnYALy
A Tender Subcutaneous Fluctuant Forehead Nodule: An Unexpected Foray Into the Cranium
No abstract availablehttps://ift.tt/2w9Z9Uo
Concomitant Use of 1,550-nm Nonablative Fractional Laser With Low-Dose Isotretinoin for the Treatment of Acne Vulgaris in Asian Patients: A Randomized Split-Face Controlled Study
BACKGROUND Nonablative fractional laser (NAFL) has been shown to improve the appearance of inflammatory acne and acne scars. Isotretinoin is effective for the treatment of moderate-to-severe cases of recalcitrant acne. However, the recommended dose of isotretinoin can have profound effects. OBJECTIVE To investigate the clinical efficacy and safety of performing NAFL treatment in patients with moderate-to-severe acne vulgaris under treatment with low-dose oral isotretinoin. METHODS AND MATERIALS Eighteen patients who received 10-mg oral isotretinoin per day completed 3 sessions of NAFL treatment on one half of the face and presented for each scheduled follow-up appointment. RESULTS Low-dose isotretinoin was effective in managing papules and nodule lesions (phttps://ift.tt/2LnYsM4
Atypical Fibroxanthoma Arising in a Burn Scar Treated With Mohs Micrographic Surgery
No abstract availablehttps://ift.tt/2waz6fC
Dual-Frequency Ultrasound as a New Treatment Modality for Refractory Rosacea: A Retrospective Study
BACKGROUND Dual-frequency ultrasound (DFU) has emerged as a new treatment modality for improving inflammatory skin disorders. Although there have been few pilot studies, there are a limited number of studies that investigated efficacy of DFU on refractory rosacea. OBJECTIVE This study investigated the effect of DFU on patients with refractory rosacea. MATERIALS AND METHODS The authors retrospectively analyzed medical records of 42 patients with refractory rosacea (erythematotelangiectatic rosacea [ETR], n = 26; papulopustular rosacea [PPR], n = 14, mixed, n = 2). The patients were treated with DFU twice per week for the 1st week, and then once per week thereafter. Efficacy was assessed using erythema index (EI), transepithelial water loss (TEWL), and patient self-assessment (PSA). RESULTS Treatment with DFU resulted in significant decrease in EI, TEWL, and PSA. No significant difference was noted between ETR and PPR. CONCLUSION Application of DFU in patients with refractory rosacea resulted in improvement in persistent erythema, barrier dysfunction, and patient-reported symptoms. Dual-frequency ultrasound may be an additional treatment option for rosacea that is resistant to other treatments.https://ift.tt/2LpLEob
Prolonged Inflammatory Reaction After Fractional Radiofrequency Microneedle Treatment
No abstract availablehttps://ift.tt/2wiVAeP
Cosmetic Dermatology Training During Residency: Outcomes of a Resident-Reported Survey
BACKGROUND As the demand for cosmetic treatments increases, it is important for dermatology residents to be educated about and achieve proficiency in dermatologic cosmetic procedures. OBJECTIVE To assess dermatology residents' educational exposure to cosmetic dermatology. MATERIALS AND METHODS An anonymous 18-question survey was sent electronically to 1,266 dermatology residents requesting information about cosmetic dermatology training during residency. RESULTS Two hundred sixty-eight residents responded to the survey (21% response rate). Most residents receive didactic instruction (94%) and hands-on training (91%) on cosmetic dermatology topics during residency. Survey participants in residency programs perceived as supportive of cosmetic dermatology training are more frequently provided lectures (70% vs 31%, phttps://ift.tt/2LpIMrq
The Use of Silicone Microdroplet Injections for Correction of Depressed Scars
No abstract availablehttps://ift.tt/2w9Z6YI
Medial Canthal Reconstruction With Malar Advancement Flap Combined With Cutaneous Island Flap Created Using “Conventionally Discarded” Tissue
No abstract availablehttps://ift.tt/2LnYfIM
AMPH-1 is a tumor suppressor of lung cancer by inhibiting Ras-Raf-MEK-ERK signal pathway
Abstract
Amphiphysin 1 (AMPH-1) is a nerve terminal-enriched protein and it is a 128-kD protein with three identified functional domains. Some studies found that AMPH-1 was a dominant autoantigen associated with breast cancer and melanoma. However, its function in lung cancer is unknown. Here, we showed that AMPH-1 knockdown dramatically increased cell proliferation, attenuated cell apoptosis, and promoted cell cycle progression in human lung cancer cells. In vivo xenograft studies confirmed that the AMPH-1-knockdown cells were more tumorigenic than the controls. Moreover, we demonstrated that silencing AMPH-1 markedly activated Ras-Raf-MEK-ERK signal pathway. In summary, our results identified the anti-oncogenic function of AMPH-1 in lung cancer in vitro and in vivo. It is proposed that AMPH-1 may have potential as a new therapeutic target in human lung cancer treatment.
https://ift.tt/2BKdjAM
Management of Long-Standing Flaccid Facial Palsy: Midface/Smile
Masseter and temporalis muscle transfer is an effective technique for restoring facial symmetry and commissure excursion in flaccid facial paralysis. Adherence to the principles and biomechanics of muscle transfer is essential for achieving optimal results. Muscle transfer has the advantage of being single staged with fast recovery of function. It is particularly useful in patients with low life expectancy or multiple comorbidities where a more complex, multiple stage procedure may be detrimental.
https://ift.tt/2wcDCdz
γ-H2AX foci as indication for the DNA damage in erythrocytes of medaka ( Oryzias latipes ) intoxicated with 4-nonylphenol
Abstract
The present study aimed to investigate the genotoxicity in erythrocytes induced after exposure of medaka (Oryzias latipes) to 4-nonylphenol (4-NP). Adult female medaka fish were exposed to 4-NP at three sublethal concentrations for 15 days to compare their sensitivity with that of catfish as an aquatic model. Comet assay and γ-H2AX were used as biomarkers to detect DNA damage in erythrocytes. Exposure to 4-NP resulted in an increase in the tail moment in a dose-dependent manner. The highest level of DNA damage was recorded after exposure to 100 μg/l 4-NP. The number of foci was increased after exposure to 4-NP, indicating damage to DNA. The present results confirmed the high level of morphological alterations and apoptosis of erythrocytes detected in the first part of this study. 4-NP induced genotoxic effects in medaka, which were found to be more sensitive than catfish after exposure to 4-nonylphenol.
Graphical abstract
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https://ift.tt/2wpMnQL
Photo-modulation of zinc phthalocyanine-treated breast cancer cell line ZR-75-1 inhibited the normal tumor activity in vitro
Abstract
Regarding post-complication of convenient therapies against breast cancer, the emergence of effective approaches is essential. Photodynamic therapy is touted as a novel invasive therapeutic approach by the application of a photosensitizer promoted by laser irradiation. This study aimed to investigate the combined regime of low-level laser irradiation with zinc phthalocyanine in human breast cancer ZR-75-1 cell line. Cells were treated with 0.01 and 5 μg/ml of ZnPc for 24 h and exposed to radiation (70 mW) for 60 s. Cell viability was evaluated by MTT and flow cytometry. Cell migration capacity was monitored by scratch test, Transwell migration insert, and gelatin zymography. The function of MDR in treated cells was examined by Rhodamine 123 exclusion test. The level of GALNT11 was measured by ELISA. The expression of Bax and Bcl-2 genes was evaluated by real-time PCR. Laser irradiation and zinc phthalocyanine induced cell cytotoxicity in a dose-dependent manner. Flow cytometry analysis showed the induction of apoptotic and necrotic changes in treated cells. We found a reduction in migration rate and MMP-9 activity in cells undergoing the experimental procedure (p < 0.05). Immunofluorescence imaging revealed the intracellular accumulation of Rhodamine 123 coincided with a reduction in the level of GALNT11 in treated cells, showing the reduction of MDR activity and tumor cell resistance. Similar to flow cytometry assay, the reduction of Bcl-2 (approximately twofold) and upregulation of Bax genes were found in treated cells. Photodynamic therapy could be as an effective and alternative method for the treatment of breast cancer in a human.
https://ift.tt/2BLPI2M
A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns
Abstract
Introduction
Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns.
Methods
Searches of Embase (2005–2016) and abstracts from selected meetings (2014–2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity.
Results
Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids.
Conclusion
This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease.
Funding
Regeneron Pharmaceuticals Inc.
https://ift.tt/2MvXVwJ
Treatment of Grade II and III Actinic Keratosis Lesions with a Film-Forming Medical Device Containing Sunscreen/Piroxicam 0.8% and a Retinoic Acid/Glycolic Gel: A Pilot Trial
Abstract
Introduction
Lesion and field-targeted treatments of actinic keratosis (AK) are commonly indicated for grade I and II type lesions. Grade III lesions are in general more difficult to treat. A film-forming medical device containing piroxicam 0.8% and sunscreen (SPF 50+) (PS) has been shown to be effective in the treatment of grade I and II AK lesions. Topical and oral retinoids have been utilized in AK and non-melanoma skin cancers. Topical glycolic acid promotes keratolysis and stimulates collagen synthesis for repair and skin rejuvenation and could be useful in AK treatment strategies. A gel containing retinoid acid (0.02%) and glycolic acid (4%) (RC) is commercially available. The objective of the study was to evaluate the efficacy and local tolerability of a combined treatment approach with PS and RC in subjects with multiple grade II and III AK lesions.
Methods
Twenty-two subjects (16 males and 6 females; mean age 68 years) with more than five AK lesions were enrolled after obtaining their informed consent in a 3-month trial. PS cream was applied twice daily every day and RC gel was applied twice daily for 2 consecutive days every week. The primary endpoint was the evolution of the AK mean number from baseline to the end of the trial. Secondary endpoints were the thickness of the target lesion (expressed in mm3) and the erythema score (hemoglobin content), evaluated using a standardized computer-based image acquisition analysis system (Anthera 3D).
Results
At baseline, the mean (SD) lesion number was 7.7 (3) for grade II and 1.4 (1) for grade III AK. At the end of the study, a significant (P = 0.001) reduction was observed for both grade II (− 81%; from 7.7 to 1.5) and grade III (− 22%) lesions. Six grade III lesions out of 31 (20%), presented at baseline, completely disappeared at month 3. For grade III lesions, a significant mean thickness reduction of 51% was observed at month 3. The erythema score (all lesions) was reduced by 70%. Four patients out of 22 (18%) were completely free of AK lesions at month 3. No severe side effects were reported.
Conclusion
In this exploratory trial, a combined treatment with a cream containing piroxicam and sunscreen and a retinoic/glycolic gel was associated with a substantial reduction of both grade II and III AK lesions with good local tolerability.
Funding
Cantabria Labs Difa Cooper.
https://ift.tt/2P2RhLg
Basal Cell Carcinoma: A Patient and Physician’s Experience
Abstract
In this article, the first coauthor, a patient with a basal cell carcinoma on her upper lip, discusses her experience with Mohs micrographic surgery for the treatment of the skin cancer. The second coauthor, who is the patient's physician (a dermatologist who shares her last name but is not a relative), diagnosed her skin cancer and referred her for Mohs surgery. The third coauthor, who is the patient's son and not only a dermatologist, but also a dermatopathologist and a Mohs surgeon (and also shares her last name), summarizes the presentation and treatment of the basal cell carcinoma.
https://ift.tt/2MxBNlU
Squamous Cell Carcinomas in Two Cases of Nail Lichen Planus: Is There a Real Association?
Abstract
Lichen planus (LP) is a chronic inflammatory disease that affects the skin and oral mucosa. Although its etiology is unknown, its potential for cancerization has been confirmed. We herein report the cases of a brother and sister, both with a 15-year history of nail lichen planus of the fingers and toes, who developed squamous cell carcinomas of the nail bed and matrix. This article shows the potential for malignant transformation in lichen planus disease and highlights the importance of periodic clinical follow-up.
https://ift.tt/2LnwcJi
Building a Citizen Pscientist: Advancing Patient-Centered Psoriasis Research by Empowering Patients as Contributors and Analysts
Abstract
Introduction
To design and implement a novel cloud-based digital platform that allows psoriatic patients and researchers to engage in the research process.
Methods
Citizen Pscientist (CP) was created by the National Psoriasis Foundation (NPF) to support and educate the global psoriatic disease community, where patients and researchers have the ability to analyze data. Psoriatic patients were invited to enroll in CP and contribute health data to a cloud database by responding to a 59-question online survey. They were then invited to perform their own analyses of the data using built-in visualization tools allowing for the creation of "discovery charts." These charts were posted on the CP website allowing for further discussion.
Results
As of May 2017, 3534 patients have enrolled in CP and have collectively contributed over 200,000 data points on their health status. Patients posted 70 discovery charts, generating 209 discussion comments.
Conclusion
With the growing influence of the internet and technology in society, medical research can be enhanced by crowdsourcing and online patient portals. Patient discovery charts focused on the topics of psoriatic disease demographics, clinical features, environmental triggers, and quality of life. Patients noted that the CP platform adds to their well-being and allows them to express what research questions matter most to them in a direct and quantifiable way. The implementation of CP is a successful and novel method of allowing patients to engage in research. Thus, CP is an important tool to promote patient-centered psoriatic disease research.
https://ift.tt/2PCgugS
Assessment of the cellular localisation of the annexin A2/S100A10 complex in human placenta
Abstract
The AnxA2/S100A10 complex has been implicated in various placental functions but although the localisation of these proteins individually has been studied, there is no information about the localisation of their complex in situ at the cellular level. Using the proximity ligation technique, we have investigated the in situ localisation of AnxA2/S100A10 complex in the placenta and have compared this with the location patterns of the individual proteins. High levels of expression of AnxA2/S100A10 complexes were observed in the amniotic membrane and in blood vessel endothelial cells. Lower levels were detected in the brush border area of the syncytium and in the trophoblasts. Immunohistochemical analysis of AnxA2 and S100A10 individually revealed broadly similar patterns of localisation. The brush border staining pattern suggests that in this location at least some of the AnxA2 is not in complex with S100A10. The formal location of the AnxA2/S100A10 complex is compatible with a role in cell–cell interaction, intracellular transport and secretory processes and regulation of cell surface proteases, implying contributions to membrane integrity, nutrient exchange, placentation and vascular remodelling in different parts of the placenta. Future applications will allow specific assessment of the association of the complex with pathophysiological disorders.
https://ift.tt/2BIAKud
Historical trends and assessment of radionuclides and heavy metals in sediments near an abandoned mine, Lavrio, Greece
Abstract
Two sediment cores (coastal and offshore) and surface sediments were collected near an abandoned mine area in the marine environment of Oxygono Bay at Lavreotiki peninsula to investigate temporal and spatial variations among radionuclides and trace metals/major elements. Lavreotiki was and still is well known for the mining and metallurgical activities, which lasted from ancient times to nowadays (early 1980s). Gamma-ray and X-ray fluorescence measurements were held to determine the radionuclide and trace metal/major element concentrations, respectively. The sedimentation rate at Oxygono Bay coastal core was determined using the 210Pb and 137Cs tracers, while the enrichment factors were estimated to assess the anthropogenic influence due to metals in a spatial (surface sediments) and a temporal (coastal core sediments) basis. The mass flux at the coastal core was utilized to provide a baseline information at Lavreotiki peninsula. The trace metal/major element profiles were indeed associated with the mining activity in the area, revealing the mining history. The ERICA Tool was incorporated to estimate the dose rates due to natural and 137Cs radioactivity in the marine organisms and the values were found below the screening levels.
https://ift.tt/2Pyuc4i
The effect of innovation on CO 2 emissions of OCED countries from 1990 to 2014
Abstract
Human activities are accelerating CO2 emissions all over the world most especially in high-income nations, spurring the rise in greenhouse gas emissions. For decades, technologies have been developed and patented in response to the environmental problems. There is an outcry for innovative ways to combat the environmental menace. This attests to the enormity of research being done, in recent years, to investigate how innovation can help mitigate CO2 emissions. This research aims at investigating into the effect of innovation on CO2 emissions in 28 OCED countries at an individual level for the recent period 1990 to 2014. The source of data for our utilized variables is the World Bank Indicators. Our study employed three key models based on the STIRPAT model, the economic-EKC growth model, and the innovation-EKC model. The findings of our study revealed that innovation plays a key role towards mitigation of CO2 emissions in most OECD countries. Its impact, however, varies across the countries, depending on some key factors and channels elucidated in this paper. Additionally, our study asserts that improvement in GDP per capita leads to the rise in CO2 in most OECD economies, although mitigate emissions in few OECDs; hence, the economic-EKC model is not valid for most economies. Non-renewable energy accelerates emissions whiles renewable energy sources mitigate emissions. Research and development (R&D) improves environmental quality and the EKC for both economic growth and innovation, valid for a few economies of the OECDs. We conclude that innovation is necessary in mitigating CO2 emissions; hence, governments and policy makers should invest and promote innovative renewable energy sources.
https://ift.tt/2wonFR0
Dose variability in different lymph node levels during locoregional breast cancer irradiation: the impact of deep-inspiration breath hold
Abstract
Purpose
Aim of the present analysis was to evaluate the movement and dose variability of the different lymph node levels of node-positive breast cancer patients during adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) in deep-inspiration breath hold (DIBH).
Methods
Thirty-five consecutive node-positive breast cancer patients treated from October 2016 to February 2018 receiving postoperative RT of the breast or chest wall including RNI of the supra-/infraclavicular lymph node levels (corresponding to levels IV, III, Rotter LN (interpectoral), and some parts of level II) were analyzed. To evaluate the lymph node level movement, a center of volume (COV) was obtained for each lymph node level for free-breathing (FB) and DIBH plans. Geometric shifts and dose differences between FB and DIBH were analyzed.
Results
A significant movement of the COV in anterior (y) and cranial (z) dimensions was observed for lymph node levels I–II and Rotter lymph nodes (p < 0.001) due to DIBH. Only minor changes in the lateral dimension (x axis) were observed, without reaching significance for levels III, IV, and internal mammary. There was a significant difference in the mean dose of level I (DIBH vs. FB: 38.2 Gy/41.3 Gy, p < 0.001) and level II (DIBH vs. FB: 45.9 Gy/47.2 Gy, p < 0.001), while there was no significant difference in level III (p = 0.298), level IV (p = 0.476), or internal mammary nodes (p = 0.471).
Conclusion
A significant movement of the axillary lymph node levels was observed during DIBH in anterior and cranial directions for node-positive breast cancer patients in comparison to FB. The movement leads to a significant dose reduction in level I and level II.
https://ift.tt/2PAV2Jd
Untersuchung zur Inanspruchnahme einer HNO-Klinik im ländlichen Bereich: Elektive Patienten
Zusammenfassung
Hintergrund
Die ambulante medizinische Versorgung wird in Deutschland überwiegend von niedergelassenen Fachärzten für Allgemeinmedizin und anderer Fachrichtungen gewährleistet. Nur unter speziellen Auflagen stehen die Krankenhausambulanzen für Fälle auf Facharztüberweisung zur spezielleren Abklärung bzw. zur Behandlung und in definierten Ausnahmefällen wie nach § 116b zur Verfügung. Ziel der Untersuchung war die Evaluation der ambulanten elektiven Patienten.
Material und Methoden
Es handelt sich um eine prospektive Untersuchung über den Zeitraum eines Jahres. Es wurden bei allen elektiven, ambulanten Patienten neben den persönlichen bzw. medizinischen Daten Vorstellungszeitpunkt, -grund und Sinnhaftigkeit der Inanspruchnahme erfasst.
Ergebnisse
Insgesamt konnten 6463 Fälle in die Untersuchung einbezogen werden. Die junge und betagtere Patientengruppe war quantitativ stärker repräsentiert im Vergleich zu den Notfallpatienten. Unter Berücksichtigung des definierten Scores war die überwiegende Mehrheit der Vorstellungen (87 %) medizinisch sinnvoll, was positiv mit der Distanz des Anfahrtswegs der Patienten korrelierte.
Diskussion
Die Analyse unterstreicht, dass das duale fachärztliche Versorgungsprinzip in Deutschland zu einer medizinisch vernünftigen Inanspruchnahme der vorhandenen Ressourcen beiträgt, was für die Notfallpatienten mit freier Wahl der Anlaufstelle nicht zutrifft.
https://ift.tt/2wqGa7r
Three distinct genomic subtypes of head and neck squamous cell carcinoma associated with clinical outcomes
Publication date: October 2018
Source: Oral Oncology, Volume 85
Author(s): Dong Jin Lee, Young-Gyu Eun, Young Soo Rho, Eui Hyun Kim, Sun Young Yim, Sang Hee Kang, Bo Hwa Sohn, Gee Hwan Kwon, Ju-Seog Lee
Abstract
Objectives
Heterogeneity of head and neck squamous cell carcinomas (HNSCCs) results in unpredictable outcomes for patients with similar stages of cancer. Beyond the role of human papilloma virus (HPV), no validated molecular marker of HNSCCs has been established. Thus, clinically relevant molecular subtypes are needed to optimize HNSCC therapy. The purpose of this study was to identify subtypes of HNSCC that have distinct biological characteristics associated with clinical outcomes and to characterize genomic alterations that best reflect the biological and clinical characteristics of each subtype.
Materials and methods
We analyzed gene expression profiling data from pan-SCC tissues including cervical SCC, esophageal SCC, lung SCC, and HNSCC (n = 1346) to assess the similarities and differences among SCCs and to identify molecular subtypes of HNSCC associated with prognosis. Subtype-specific gene expression signatures were identified and used to construct predictive models. The association of the subtypes with prognosis was validated in two independent cohorts of patients.
Results
Pan-SCC analysis identified three novel subtypes of HNSCC. Subtype 1 had the best prognosis and was similar to cervical SCC, whereas subtype 3 had the worst prognosis and was similar to lung SCC. Subtype 2 had a moderate prognosis. The 600-gene signature associated with the three subtypes significantly predicted prognosis in two independent validation cohorts. These three subtypes also were associated with potential benefit of immunotherapy.
Conclusion
We identified three clinically relevant HNSCC molecular subtypes. Independent prospective studies to assess the clinical utility of the subtypes and associated gene signature are warranted.
https://ift.tt/2w9XP3M
Trial of Ibrutinib Combined With Nivolumab or Cetuximab to Treat Recurrent/Metastatic HNSCC
Conditions: Head and Neck Cancer; Squamous Cell Carcinoma of the Head and Neck
Interventions: Drug: Ibrutinib 560mg PO daily; Drug: Ibrutinib 560mg PO daily (Imbruvica); Drug: Cetuximab; Drug: Nivolumab
Sponsors: University of California, San Diego; Pharmacyclics LLC.
Not yet recruiting
https://ift.tt/2P3Ac3N
Interventions: Drug: Ibrutinib 560mg PO daily; Drug: Ibrutinib 560mg PO daily (Imbruvica); Drug: Cetuximab; Drug: Nivolumab
Sponsors: University of California, San Diego; Pharmacyclics LLC.
Not yet recruiting
https://ift.tt/2P3Ac3N
Study of the Feasibility of Radiofrequency Ablation of Benign Thyroid Nodules
Condition: Benign Thyroid Nodules
Intervention: Procedure: Radiofrequency ablation
Sponsor: University Hospital, Toulouse
Not yet recruiting
https://ift.tt/2MsTWB8
Intervention: Procedure: Radiofrequency ablation
Sponsor: University Hospital, Toulouse
Not yet recruiting
https://ift.tt/2MsTWB8
Oxygen Enhanced MRI Measurement in Head and Neck Cancer: Validation and Efficacy of Response.
Condition: Head and Neck Cancer
Intervention: Diagnostic Test: MRI scan
Sponsors: Sally Falk; University of Manchester
Not yet recruiting
https://ift.tt/2P5sqqr
Intervention: Diagnostic Test: MRI scan
Sponsors: Sally Falk; University of Manchester
Not yet recruiting
https://ift.tt/2P5sqqr
The Comparison of Single and Multi-incision MIE for Esophageal Cancer
Condition: Esophageal Cancer
Intervention: Procedure: Minimally invasive esophagectomy
Sponsor: National Taiwan University Hospital
Recruiting
https://ift.tt/2MsztMV
Intervention: Procedure: Minimally invasive esophagectomy
Sponsor: National Taiwan University Hospital
Recruiting
https://ift.tt/2MsztMV
Venous Thromboembolism and Bleeding Risk in Patients With Esophageal Cancer: a Retrospective Study
Conditions: Venous Thromboembolism; Esophagus Cancer; Bleeding; Chemotherapy Effect
Intervention: Other: Venous thromboembolic event, arterial thromboembolic event, bleeding events
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Recruiting
https://ift.tt/2OY8HbY
Intervention: Other: Venous thromboembolic event, arterial thromboembolic event, bleeding events
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Recruiting
https://ift.tt/2OY8HbY
Prospective Pilot Study of Multi-actor Tolerance Evaluation Using the VIRARE Device (VIrtual Reality Assisted Rehabilitation) in Visually Impaired Patients
Condition: Visual Impairment
Intervention: Device: Virtual reality tests
Sponsor: Centre Hospitalier Universitaire de Nīmes
Not yet recruiting
https://ift.tt/2MtRpXm
Intervention: Device: Virtual reality tests
Sponsor: Centre Hospitalier Universitaire de Nīmes
Not yet recruiting
https://ift.tt/2MtRpXm
Study of Autologous Tumor Infiltrating Lymphocytes in Patients With Solid Tumors
Conditions: Metastatic Melanoma; Squamous Cell Carcinoma of the Head and Neck; Non-small Cell Lung Cancer
Interventions: Biological: Lifileucel; Biological: LN-145; Drug: Pembrolizumab
Sponsor: Iovance Biotherapeutics, Inc.
Not yet recruiting
https://ift.tt/2P06pco
Interventions: Biological: Lifileucel; Biological: LN-145; Drug: Pembrolizumab
Sponsor: Iovance Biotherapeutics, Inc.
Not yet recruiting
https://ift.tt/2P06pco
Trial of Ibrutinib Combined With Nivolumab or Cetuximab to Treat Recurrent/Metastatic HNSCC
Conditions: Head and Neck Cancer; Squamous Cell Carcinoma of the Head and Neck
Interventions: Drug: Ibrutinib 560mg PO daily; Drug: Ibrutinib 560mg PO daily (Imbruvica); Drug: Cetuximab; Drug: Nivolumab
Sponsors: University of California, San Diego; Pharmacyclics LLC.
Not yet recruiting
https://ift.tt/2P3Ac3N
Interventions: Drug: Ibrutinib 560mg PO daily; Drug: Ibrutinib 560mg PO daily (Imbruvica); Drug: Cetuximab; Drug: Nivolumab
Sponsors: University of California, San Diego; Pharmacyclics LLC.
Not yet recruiting
https://ift.tt/2P3Ac3N
Study of the Feasibility of Radiofrequency Ablation of Benign Thyroid Nodules
Condition: Benign Thyroid Nodules
Intervention: Procedure: Radiofrequency ablation
Sponsor: University Hospital, Toulouse
Not yet recruiting
https://ift.tt/2MsTWB8
Intervention: Procedure: Radiofrequency ablation
Sponsor: University Hospital, Toulouse
Not yet recruiting
https://ift.tt/2MsTWB8
Oxygen Enhanced MRI Measurement in Head and Neck Cancer: Validation and Efficacy of Response.
Condition: Head and Neck Cancer
Intervention: Diagnostic Test: MRI scan
Sponsors: Sally Falk; University of Manchester
Not yet recruiting
https://ift.tt/2P5sqqr
Intervention: Diagnostic Test: MRI scan
Sponsors: Sally Falk; University of Manchester
Not yet recruiting
https://ift.tt/2P5sqqr
The Comparison of Single and Multi-incision MIE for Esophageal Cancer
Condition: Esophageal Cancer
Intervention: Procedure: Minimally invasive esophagectomy
Sponsor: National Taiwan University Hospital
Recruiting
https://ift.tt/2MsztMV
Intervention: Procedure: Minimally invasive esophagectomy
Sponsor: National Taiwan University Hospital
Recruiting
https://ift.tt/2MsztMV
Venous Thromboembolism and Bleeding Risk in Patients With Esophageal Cancer: a Retrospective Study
Conditions: Venous Thromboembolism; Esophagus Cancer; Bleeding; Chemotherapy Effect
Intervention: Other: Venous thromboembolic event, arterial thromboembolic event, bleeding events
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Recruiting
https://ift.tt/2OY8HbY
Intervention: Other: Venous thromboembolic event, arterial thromboembolic event, bleeding events
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Recruiting
https://ift.tt/2OY8HbY
Prospective Pilot Study of Multi-actor Tolerance Evaluation Using the VIRARE Device (VIrtual Reality Assisted Rehabilitation) in Visually Impaired Patients
Condition: Visual Impairment
Intervention: Device: Virtual reality tests
Sponsor: Centre Hospitalier Universitaire de Nīmes
Not yet recruiting
https://ift.tt/2MtRpXm
Intervention: Device: Virtual reality tests
Sponsor: Centre Hospitalier Universitaire de Nīmes
Not yet recruiting
https://ift.tt/2MtRpXm
Study of Autologous Tumor Infiltrating Lymphocytes in Patients With Solid Tumors
Conditions: Metastatic Melanoma; Squamous Cell Carcinoma of the Head and Neck; Non-small Cell Lung Cancer
Interventions: Biological: Lifileucel; Biological: LN-145; Drug: Pembrolizumab
Sponsor: Iovance Biotherapeutics, Inc.
Not yet recruiting
https://ift.tt/2P06pco
Interventions: Biological: Lifileucel; Biological: LN-145; Drug: Pembrolizumab
Sponsor: Iovance Biotherapeutics, Inc.
Not yet recruiting
https://ift.tt/2P06pco
Comprehensive modeling reveals proximity, seasonality, and hygiene practices as key determinants of MRSA colonization in exposed households.
| Related Articles |
Comprehensive modeling reveals proximity, seasonality, and hygiene practices as key determinants of MRSA colonization in exposed households.
Pediatr Res. 2018 Jul 19;:
Authors: Mork RL, Hogan PG, Muenks CE, Boyle MG, Thompson RM, Morelli JJ, Sullivan ML, Gehlert SJ, Ross DG, Yn A, Bubeck Wardenburg J, Rzhetsky A, Burnham CD, Fritz SA
Abstract
BACKGROUND: Staphylococcus aureus is the leading cause of skin and soft tissue infections (SSTIs). To develop interventions to prevent recurrent infections, household attributes and individual practices influencing S. aureus colonization must be discerned.
METHODS: Households of healthy children with methicillin-resistant S. aureus (MRSA) SSTI (n = 150; 671 participants) were interviewed regarding health history, activities, and hygiene practices. S. aureus colonization was assessed in household members, and recovered isolates were typed by repetitive sequence-based PCR.
RESULTS: The number of unique strain types in a household (median 1, range 0-7) correlated with the number of colonized individuals (p < 0.001). The MRSA infecting strain type colonized a household member in 57% of 91 households with an available infecting strain, and was the most common strain type recovered in 45% of these households. In multivariable models, household MRSA colonization burden (p < 0.001), sharing a bedroom with MRSA-colonized individuals (p = 0.03), renting dwelling (p = 0.048), and warmer seasons (p = 0.02) were associated with increased MRSA colonization. Increasing age (p = 0.02), bathing at least daily (p = 0.01), and antibacterial soap use (p = 0.03) correlated with reduced MRSA colonization.
CONCLUSIONS: This study identified practices that correlate with MRSA colonization, which will inform physician counseling and multifaceted interventions among MRSA-affected households to mitigate MRSA in the community.
PMID: 30135590 [PubMed - as supplied by publisher]
https://ift.tt/2NevtvL
Dental fluorosis and a polymorphism in the COL1A2 gene in Mexican children
Publication date: Available online 23 August 2018
Source: Archives of Oral Biology
Author(s): Lizet Jarquín-Yañez, Jorge Alejandro Alegría-Torres, Claudia G. Castillo, José de Jesús Mejía-Saavedra
Abstract
Objective
To determine the allelic and genotypic frequencies of rs 412777 polymorphism in the Collagen type I alpha 2 chain (COL1A2) gene and the association with the severity of dental fluorosis in children between 6 and 12 years old in the State of San Luis Potosi, Mexico.
Design
A cross-sectional study was designed; participants were 230 children from two rural communities of San Luis Potosí. Fluoride in drinking water and urine samples was quantified using a potentiometric method with a selective ion electrode. Dental fluorosis was diagnosed using the Thylstrup-Fejerskov index while the identification of the polymorphism was made by allelic discrimination, using allele-specific probes by real-time Polymerase chain reaction (PCR). Statistical analysis was carried out with Student's t-test and Chi-square and Odds Ratio (OR). A confidence interval of 95% and a value of p < 0.05 were considered.
Results
The concentration of fluoride in drinking water was 2.36 ± 0.02 mg/L in Ojo Caliente and 4.56 ± 0.07 mg/L in La Reforma, the concentration of fluoride in urine was 2.05 ± 0.62 mg/L and 2.99 ± 0.99 mg/L respectively. The prevalence of dental fluorosis was 100% and the frequency of alleles was 67% wild-type and 33% mutant allelic, alleles were found in Hardy-Weinberg equilibrium (X2 = 0.33, p = 0.89). The association between the degree of dental fluorosis and the evaluated polymorphism was statistically significant (OR = 7.10, 95% CI = 3.96-12.70, p < 0.05).
Conclusions
An association of rs 412777 polymorphism in the COL1A2 gene with dental fluorosis was found. Therefore, genetic variants represent a relevant risk factor to develop dental fluorosis, as it was proven in this study conducted in Mexican children.
https://ift.tt/2o8r02U
Immediate anaphylaxis due to beef intestine following tick bites
Publication date: Available online 23 August 2018
Source: Allergology International
Author(s): Michimasa Fujiwara, Tooru Araki
https://ift.tt/2MyEG5W
Central suppressant therapies in unexplained chronic cough patients whose sputum cultures yielded Bjerkandera adusta
Publication date: Available online 23 August 2018
Source: Allergology International
Author(s): Haruhiko Ogawa, Kazuya Tone, Masaki Fujimura, Koichi Makimura
https://ift.tt/2P5im0D
Defective TLR9-driven STAT3 activation in B cells of patients with CVID
Publication date: Available online 23 August 2018
Source: Clinical Immunology
Author(s): Arturo Borzutzky, Ingrid Rauter, Ari Fried, Rima Rachid, Douglas R. McDonald, Lennart Hammarstrom, Bodo Grimbacher, Roshini S. Abraham, Raif S. Geha
Abstract
B cell activation by Toll-like receptor 9 (TLR9) ligands is dependent on STAT3 and is important for optimal antibody responses to microbial antigens. B cells from patients with common variable immune deficiency (CVID) have impaired proliferation and differentiation in response to the TLR9 ligand CpG, despite normal levels of TLR9 expression. We demonstrate that CpG-driven STAT3 phosphorylation, but not activation of NFκB and p38, is selectively impaired in B cells from CVID patients. These results suggest that defective STAT3 activation contributes to the defective TLR9 and antibody response of B cells in CVID.
https://ift.tt/2BIdDjn
Recombinant chemotaxis inhibitory protein of Staphylococcus aureus (CHIPS) protects against LPS-induced lung injury in mice
Publication date: Available online 23 August 2018
Source: Clinical Immunology
Author(s): Youssif M. Ali, Abeer M. Abd El-Aziz, Maha Mabrook, Ahmed A. Shabaan, Robert B. Sim, Ramadan Hassan
Abstract
Acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS) are clinical conditions caused by trauma, lung infection or sepsis. ALI/ARDS is associated with massive recruitment of neutrophils into the lung with release of reactive oxygen species and excessive inflammatory response that damage alveolar tissue. Here we report the successful use of a potent chemotaxis inhibitory protein (rCHIPS) derived from Staphylococcus aureus in reducing the severity of ALI/ARDS. Treatment with rCHIPS reduces pulmonary inflammation and permeability in mice after intranasal administration of lipopolysaccharide (LPS). rCHIPS treatment significantly reduces lung myeloperoxidase (MPO) activity, pro-inflammatory cytokines, broncho-alveolar lavage fluid (BALF) protein content as well as histopathological changes. In addition, treatment with rCHIPS significantly diminishes neutrophils and leukocytes recruitment into lung tissue after LPS administration and hence protects mice from reactive oxygen species mediated lung injury. Our finding reveals potential therapeutic benefits of using rCHIPS for the treatment of ALI/ARDS.
https://ift.tt/2o6SAxm
Simple and fast adaptive nonlocal multispectral filtering algorithm for efficient noise reduction in magnetic resonance imaging
Publication date: Available online 24 August 2018
Source: Magnetic Resonance Imaging
Author(s): Mustapha Bouhrara, Michael C. Maring, Richard G. Spencer
Abstract
Purpose
We recently introduced a multispectral (MS) nonlocal (NL) filter based on maximum likelihood estimation (MLE) of voxel intensities, termed MS-NLML. While MS-NLML provides excellent noise reduction and improved image feature preservation as compared to other NL or MS filters, it requires considerable processing time, limiting its application in routine analyses. In this work, we introduced a fast, simple, and robust filter, termed nonlocal estimation of multispectral magnitudes (NESMA), for noise reduction in multispectral (MS) magnetic resonance imaging (MRI).
Methods
Through extensive simulation and in-vivo analyses, we compared the performance of NESMA and MS-NLML in terms of noise reduction and processing efficiency. Further, we introduce two simple adaptive methods that permit spatial variation of similar voxel, R, used in the filtering. The first method is semi-adaptive and permits variation of R across the image by using a relative Euclidean distance (RED) similarity threshold. The second method is fully adaptive and filters the raw data with several RED similarity thresholds to spatially determine the optimal threshold value using an unbiased criterion.
Results
NESMA shows very similar filtering performance as compared to MS-NLML, however, with much simple implementation and very fast processing time. Further, for both filters, the adaptive methods were shown to further reduce noise in comparison with the conventional non-adaptive method in which R is set to a constant value throughout the image.
Conclusions
NESMA is fast, robust, and straightforward to implement filter. These features render it suitable for routine clinical use and analysis of large MRI datasets.
https://ift.tt/2PzUovi
Human cystatin SN is an endogenous protease inhibitor that prevents allergic rhinitis
Publication date: Available online 23 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Ayumi Fukuoka, Kazufumi Matsushita, Taiyo Morikawa, Takumi Adachi, Koubun Yasuda, Hiroshi Kiyonari, Shigeharu Fujieda, Tomohiro Yoshimoto
Background
Protease allergens disrupt epithelial barriers to exert their allergenicity. Cystatin SN (encoded by CST1) is an endogenous cysteine protease inhibitor upregulated in nasal epithelia in patients with allergic rhinitis (AR).
Objective
We sought to investigate the protective effect of human cystatin SN on AR symptoms using pollen-induced AR mouse models.
Methods
We performed an in vitro protease activity assay to evaluate the effect of recombinant human cystatin SN (rhCystatin SN) on Japanese cedar (JC) or ragweed proteases. A human nasal epithelial cell line, RPMI 2650, was used to examine tight junction (TJ) disruption in vitro. Mice were sensitized and nasally challenged with JC or ragweed pollens with or without rhCystatin SN to examine the effect of rhCystatin SN on AR symptoms and the epithelial barrier in vivo. Because mice lack CST1, we generated transgenic (Tg) mice expressing human CST1 under control of its genomic control region (hCST1-Tg mice) to examine the role of cystatin SN in physiologically expressed conditions.
Results
rhCystatin SN inhibited JC but not ragweed protease activities and prevented JC-induced but not ragweed-induced TJ disruption in vitro. Exogenous administration of rhCystatin SN ameliorated JC-induced but not ragweed-induced sneezing and nasal TJ disruption in vivo. Furthermore, hCST1-Tg mice showed decreased JC-induced but not ragweed-induced sneezing symptoms and nasal TJ disruption compared with wild-type mice.
Conclusion
Human cystatin SN suppresses AR symptoms through inhibiting allergen protease activities and protecting the nasal TJ barrier in an allergen-specific manner. We propose that upregulation of nasal endogenous protease inhibitors, including cystatin SN, is a novel therapeutic strategy for protease allergen–induced AR.
https://ift.tt/2BHgUzs
Impaired cytolytic activity of asthma-associated natural killer cells is linked to dysregulated transcriptional program in energy metabolism
Publication date: September 2018
Source: Molecular Immunology, Volume 101
Author(s): Haisi Wu, Jiacheng Bi, Gaohui Wu, Chaoyue Zheng, Zhen Lu, Lulu Cui, Xiaochun Wan
Abstract
Natural killer (NK) cells are a cytotoxic subset of the innate lymphoid cells, playing essential roles in host defense against tumors and infections, which, however, are usually functionally compromised in chronic diseases. Atopic diseases, such as allergic asthma, characterized by type 2 immune responses, are usually associated with chronic inflammations. Whether asthma -associated immune environment affects the cytolytic function of NK cells has not been elucidated. Here, YTS, a human NK cell line, was exposed to serum from healthy donors or asthma patients for analysis of its cytolytic function. We found that, serum from asthma patients reduced the cytolytic activity of YTS cells against Raji human B lymphoblasts, in comparison with normal serum. The impairment of cytolytic activity of these YTS cells was accompanied with decreased degranulation potentials, weakened conjugation formation with Raji cells, and premature termination of ERK phosphorylation upon stimulation. Meanwhile, apoptosis or cell death of YTS cells was not increased after exposure to serum from asthma patients. Importantly, such impairment of cytolytic activity of asthma -associated YTS NK cells was accompanied with aberrantly enriched genes involved in oxidative phosphorylation. Taken together, these results demonstrate that the serum of asthma patients directly suppresses the cytolytic function of NK cells, possibly through dysregulation of energy metabolism in NK cells.
https://ift.tt/2BKvvdG
Selection of immunodominant epitopes during antigen processing is hierarchical
Publication date: Available online 24 August 2018
Source: Molecular Immunology
Author(s): Scheherazade Sadegh-Nasseri, AeRyon Kim
Abstract
MHC II proteins present processed antigens to CD4 + T cells through a complex set of events and players that include chaperons and accessory molecules. Antigen processing machinery is optimized for the selection of the best fitting peptides, called 'immunodominant epitopes', in the MHC II groove to which, specific CD4 + T cells respond and differentiate into memory T cells. However, due to the complexity of antigen processing, understanding the parameters that lead to immunodominance has proved difficult. Moreover, immunodominance of epitopes vary, depending on multiple factors that include; simultaneous processing of multiple proteins, involvement of multiple alleles of MHC II that can bind to the same antigen, or competition among several suitable epitopes on a single protein antigen. The current dogma assumes that once an antigenic determinant is selected under a specific condition, it would emerge immunodominant wherever it is placed. Here we will discuss some established parameters that contribute to immunodominance as well as some new findings, which demonstrate that slight changes to antigen structure can cause a complete shift in epitope selection during antigen processing and distort the natural immunodominant epitope.
Graphical abstract
https://ift.tt/2o5P1Yr
Initial findings of Shortwave Infrared Otoscopy in a Pediatric Population
Publication date: Available online 23 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Tulio A. Valdez, Jessica A. Carr, Katherine R. Kavanagh, Marissa Schwartz, Danielle Blake, Oliver Bruns, Moungi Bawendi
Abstract
Objective
To evaluate the feasibility of Shortwave infrared (SWIR) otoscopy in a pediatric population and establish differences with visible otoscopy
Methods
Pediatric patients 3 years of age and older seen in the otolaryngology clinic with an audiogram and tympanogram obtained within a week of the visit were recruited for video otoscopy using visible light otoscopy and SWIR otoscopy. Videos were rated by two otolaryngologists based on ability to identify the promontory, ability to identify the ossicular chain and presence or absence of middle ear fluid.
Results
A total of 74 video recordings of ears were obtained in 20 patients. We obtained interpretable images in 63/74 (85.1%) ears. There was no statistical significance between ability to perform SWIR otoscopy versus white light video otoscopy as indicated by a p-value of 0.376.
There was high inter-rater agreement for identification of both the promontory and the ossicular chain with Kappa values of 0.81 and 0.92 respectively. There was statistical significance between SWIR otoscopy and visible otoscopy in the ability to image the promontory (p =0.012) and the ossicular chain (p=0.010). Increased contrast of middle ear fluid was seen in SWIR otoscopy when compared to visible otoscopy.
Conclusion
SWIR otoscopy is feasible in a pediatric population and could offer some advantages over visible light otoscopy such as better visualization of the middle ear structures through the tympanic membrane and increased contrast for middle ear effusions.
https://ift.tt/2w9lK3o
Epistaxis health disparities in the United States pediatric population
Publication date: Available online 23 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Lindsay Yang, Kevin Hur, Jeffrey Koempel, Elisabeth H. Ference
Abstract
Objective
Despite epistaxis occurring in up to 60% of the population, few studies have investigated health status disparities in the pediatric epistaxis population. The aim of this study was to evaluate sociodemographic risk factors associated with epistaxis visits for pediatric patients.
Methods
Data were extracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey Outpatient Department from 2001-2010. Outpatient visits of children less than 18 years who received a primary, secondary, or tertiary diagnosis of epistaxis (ICD-9CM code 784.7X) were included. Bivariate and stepwise multivariate regressions were conducted to develop a final model for epistaxis visits described by sociodemographics.
Results
Epistaxis visits accounted for 5 ± 0.6 million visits in children less than 18 years. 51% and 33% of children presenting with epistaxis had private insurance and Medicaid, respectively (p=0.001). 69% of epistaxis visits were evaluated at a pediatric clinic, 18% at an ENT/surgery clinic, and 13% at a general/family medicine clinic (p<0.0001). After multivariate adjustment, epistaxis visits were associated with older age (p=0.006). Black children were more likely to present with epistaxis (95% CI 1.3-4.1, p=0.005) compared to white children. Allergic rhinitis, present in 11% of epistaxis visits, was a significant comorbidity associated with visits (95%CI 1.3-4.6, p=0.008). Patients were also more likely to present to an ENT/surgery clinic (95% CI 4.5-16.5, p<0.0001) compared to a general/family medicine clinic.
Conclusions
Epistaxis visits by children are associated with age, race, and specialty. Targeted interventions to help reduce this common presentation should be developed.
https://ift.tt/2LoW3jY
The effects of nasal decongestion on obstructive sleep apnoea
Publication date: Available online 23 August 2018
Source: American Journal of Otolaryngology
Author(s): Yunsong An, Yanru Li, Dan Kang, S.K. Sharama-adhikari, Wen Xu, Yunchuan Li, Demin Han
Abstract
Background
Many studies have indicated associations between impaired nasal breathing and sleep disorders. However, the precise nature of the relationship between nasal patency and sleep remains unclear.
Purpose
We analysed the effects of nasal patency on sleep architecture and breath in nasal obstruction-predominant obstructive sleep apnoea (NO-OSA) patients by applying nasal decongestant.
Material and methods
A randomized, placebo-controlled double-blind crossover study was performed in OSA patients with chronic nasal obstruction and without obvious pharyngeal narrowing. All OSA patients (confirmed by polysomnography) were recruited and completed 2 overnight studies (randomly applying oxymetazoline or placebo). Data collected after oxymetazoline or placebo treatments were compared. The ClinicalTrials.gov identifier is NCT03506178.
Results
Compared with placebo, oxymetazoline resulted in significant increase in rapid eye movement sleep (p = 0.027) and reduction of stage 1 sleep (p = 0.004), as well as arousal index (p = 0.002). Moreover, great improvements in apnoea/hypopnea index (AHI) were observed (p < 0.001); AHI in the supine position was significantly reduced (p = 0.001). Oxygen saturation during sleep was increased significantly [mean oxygen saturation (p = 0.005) and lowest oxygen saturation (p = 0.024)]. Oxygen desaturation index was significantly reduced (p < 0.001).
Conclusions
Improving nasal patency by decongestant could improve sleep quality, AHI, and oxygen saturation level during sleep.
https://ift.tt/2Ln44pR
Microglia polarization by methylprednizolone acetate accelerates cuprizone induced demyelination
Abstract
Glucocorticoids (GC) are known as inflammatory drugs, which are used in neuroinflammatory diseases. Unlike the classic picture, recent studies have revealed that some GC drugs exacerbate inflammatory responses in their acute and prolonged administration. Multiple sclerosis (MS) is a demyelinating inflammatory disorder, in which reactive M1 microglia phenotype play a central role. Since methylprednisolone (MP), as a synthetic GC, are commonly used by MS patients, in this study, we evaluated the effect of long-term administration of MP on microglia polarization in cuprizone (CPZ)-induced MS model. The immunostaining results showed that chronic exposure to MP in the CPZ treated mice increased the number of Iba-1 positive microglia, which significantly expressed IP10 as M1 marker than arginase as M2 marker. MP treatment induced significant amplification in the transcript levels of iNOS and TNF-α (M1-related markers) in the corpus callosum of the MS mice, whereas no change detected in the expression of IL-10 (M2-related marker) between the groups. In addition, evaluation of myelin by luxol fast blue staining and transmission electron microscopy revealed that prolonged MP administration increased demyelination in comparison to the CPZ group. In conclusion, our results show that chronic MP therapy in the CPZ-induced demyelination model of MS polarized microglia to M1 pro-inflammatory phenotype.
https://ift.tt/2NetB6j
Accuracy of Microelectrode Trajectory Adjustments during DBS Assessed by Intraoperative CT
Background/Aims: Microelectrode recording (MER)-guided deep brain stimulation (DBS) aims to place the DBS lead in the optimal electrophysiological target. When single-track MER or test stimulation yields suboptimal results, trajectory adjustments are made. The accuracy of these trajectory adjustments is unknown. Intraoperative computed tomography can visualize the microelectrode (ME) and verify ME adjustments. We aimed to determine the accuracy of ME movements in patients undergoing MER-guided DBS. Methods: Coordinates following three methods of adjustment were compared: (1) those within the default "+" configuration of the ME holder; (2) those involving rotation of the default "+" to the "x" configuration; and (3) those involving head stage adjustments. Radial error and absolute differences between coordinates were determined. Results: 87 ME movements in 59 patients were analyzed. Median (IQR) radial error was 0.59 (0.64) mm. Median (IQR) absolute x and y coordinate errors were 0.29 (0.52) and 0.38 (0.44) mm, respectively. Errors were largest after rotating the multielectrode holder to its "x"-shaped setup. Conclusion: ME trajectory adjustments can be made accurately. In a considerable number of cases, errors exceeding 1 mm were found. Adjustments from the "+" setup to the "x" setup are most prone to inaccuracies.
Stereotact Funct Neurosurg
https://ift.tt/2w7KE3u
Stereotact Funct Neurosurg
https://ift.tt/2w7KE3u
Influence of rainfall intensity and slope on suspended solids and phosphorus losses in runoff
Abstract
Suspended solids (SS) and phosphorus (P) losses in rainfall generated runoff can lead to the deterioration of surface water quality. Simulated rainfall experiments were conducted to investigate the effects of rainfall intensity (30, 50, 65, and 100 mm h−1) and land slope (0°, 5°, and 10°) on SS and P losses in runoff from experimental rigs containing bare land soil and soil planted with grass (tall fescue). In addition, total phosphorus (TP), particulate phosphorus (PP), and dissolved phosphorus (DP) losses in runoff were also measured. Results showed that tall fescue could reduce loads of SS by 86–99.5%, PP by 92–98.5%, and TP by 55–89.8% in runoff compared with losses from bare soil; this is due to a combination reduced raindrop kinetic energy at the soil surface, reduced soil erodibility in the presence of plant roots and shoots, and an increase in roughness and consequently reduced overland flow velocity resulting in the trapping of particles. Linear relationships between losses of SS and TP and between TP and PP in runoff were significant (R2 > 0.93) in both bare soil and grass. In addition, SS and TP losses increased greatly significantly with rainfall intensity and slope. The influence of rainfall intensity on SS and P losses was greater than the influence of slope. Simple linear regressions were constructed between losses of SS and P, the rainfall intensity (30 to 100 mm h−1), and land slope (0° to 10°). The multiple regression equations of SS and P losses in runoff established in this study can provide a simple predicting approach for estimating the non-point source pollution load of SS and P arising from rainfall.
https://ift.tt/2o7Q5uA
Groundwater–surface water exchange associated metals at two intertidal transects, Dan’ao Estuary, Daya Bay, China
Abstract
In the evaluation of aquatic environments in estuarine waters, the groundwater–surface water exchanges and associated metal fluxes are difficult to quantify and often ignored. This study made such an attempt based on field data at two intertidal transects in the estuarine wetland of Dan'ao River, the largest river flowing into Daya Bay, China. The results of groundwater–surface water exchange associated six common metals (Cu, Zn, As, Cd, Pb, and Cr) indicate the following: the cumulative concentrations of the six metals are ranked as seawater > groundwater > river water. Among all estuarine groundwaters, the sum of metal concentrations in rhizospheric groundwater at the upstream transect is the highest, owing to the enriching effects of mangrove rhizospheres on metals. The net fluxes of Cu, Zn, As, Cd, and Cr at the upstream transect are 4.8–13.8, 11.9–16.7, 147.8–190.2, 4.1–4.9, and 10.0–12.6 times higher than those at the downstream one. The much higher groundwater discharge rates at the upstream mangrove transect plays a vital role in increasing metal fluxes from groundwater to surface water in this estuary.
https://ift.tt/2BItheI
Effectiveness of photopneumatic technology: a descriptive review of the literature
Abstract
Usage of photopneumatic technology has recently increased for treatment of different skin conditions such as acne, keratosis pilaris (KP), and rosacea. Photopneumatic devices combine gentle negative pressure with broad band pulsed light simultaneously to attack multiple targets in the skin for better treatment outcomes. In this literature review, we evaluate the efficacy of photopneumatic therapy on treatment of acne, keratosis pilaris (KP), and rosacea.
https://ift.tt/2wmuEKi
Changes in airway inflammation and remodeling in swimmers after quitting sport competition
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2MtbDAG
Tetrahydrocurcumin, a major metabolite of curcumin, ameliorates allergic airway inflammation by attenuating Th2 responses and suppressing the IL4Ra‐Jak1‐STAT6 and Jagged1/Jagged2 ‐Notch1/Notch2 pathways in asthmatic mice
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2o3McHc
Large Divergence in Testosterone Concentrations between Men and Women: Frame of Reference for Elite Athletes in Sex‐Specific Competition in Sports, a Narrative Review
Clinical Endocrinology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PBfWYK
Comprehensive screening shows that mutations in the known syndromic genes are rare in infants presenting with hyperinsulinaemic hypoglycaemia
Clinical Endocrinology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2whLbPm
Cost-effectiveness of Linac-based single-isocenter non-coplanar technique (HyperArcTM) for brain metastases radiosurgery
Abstract
In the last few years, the major change has occurred in the expansion of indications for radiosurgery (SRS) to include patients with more than four brain metastases (BM). To address the expanding indications for SRS in the treatment of multiple BMs, HyperArcTM (Varian Medical System, Palo Alto, CA, U.S.) was recently introduced in order to automate and simplify sophisticated treatments such as SRS/FSRT for multiple lesions (up to 20 BM). In this editorial some consideration about HyperArc cost-effectiveness were discussed in terms of reduction of treatment delivery time (multiple intracranial targets can be treated in a few minutes), the reduction of overall treatment time (treatment course of SRS of multiple BMs in a single session, rather than having to irradiate lesion per lesion during separate sessions on different days); reduction of costs for health systems. In summary HyperArc™ system is a promising, safe and accurate solution for SRS/SFRT to treat multiple BMs in a single or few sessions. This has the potential to impact direct and indirect costs of SRS/SFRT delivery.
https://ift.tt/2PxuDfb
Transcutaneous Baha Attract system: long‐term outcomes of the French multicenter study
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2LnurMj
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.
https://ift.tt/2MKPmh2
https://ift.tt/2MKPmh2
Use of high-strength electromagnetic radiation to remove phototrophic biofilms from terracotta artifacts
Abstract
A novel technique, effective in eliminating biodeteriogens from biofilms encrusting terracotta artifacts, is presented here. This method is based on the use of high-strength electromagnetic radiation (EMR) in the radiofrequency band. Shards of terracotta from historical pots at the Botanical Garden of Naples, Italy, were used. The shards, after sterilization, were inoculated with several phototrophic microorganisms previously isolated from whole terracotta pots. The newly formed biofilms were exposed to EMR amplitude modulated by a train of rectangular pulses with Tr = 200 ns repetition time and 10% duty cycle. The exposure protocol consisted of three applications of 2 h each, every other day. Denaturing gradient gel electrophoresis analyses conducted on the newly formed biofilms showed that, after the first exposure to EMR, all species in the biofilms but one were still alive. The second exposure resulted in the disappearance of 9 out of 13 species that were initially present on the samples. After the third exposure, all species disappeared. Superficial layers of terracotta from the exposed samples, transferred to a culture medium at 24 °C for 72 h, did not show any re-growing of organisms. Petrographic analyses of the sampleswere carried out before and after the treatments; they showed that exposure to EMR did not cause structural alterations in the treated substrates. Moreover, the amplitude of the EMR that samples were exposed to was not high enough to cause any significant increase in the temperature of the substrates; that is, no thermal effect, which is the most relevant effect when matter or organisms containing water are exposed to EMR, was observed. Finally, the field strength of the EMR showed to be non-invasive for the artifacts and non-dangerous for operators and the environment as compared to other techniques adopted in the field of conservation of cultural heritage.
https://ift.tt/2OYnN1h
The Spectrum of Histopathologic Findings in Pemphigoid: Avoiding Diagnostic Pitfalls
Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Nc1bK1
Issue Information
Journal of Neuroendocrinology, Volume 30, Issue 9, September 2018.
https://ift.tt/2LlTyiw
Treatments of uremic pruritus: A systematic review
Dermatologic Therapy, EarlyView.
https://ift.tt/2LqXQFg
Treatments of uremic pruritus: A systematic review
Dermatologic Therapy, EarlyView.
https://ift.tt/2LqXQFg
Dermatological manifestations in cardiofaciocutaneous syndrome: A prospective multicentric study of 45 mutation‐positive patients
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2BIaUXh
Sleep disturbance in psoriasis: a case‐controlled study
British Journal of Dermatology, EarlyView.
https://ift.tt/2o4umE3
Dermatological manifestations in cardiofaciocutaneous syndrome: A prospective multicentric study of 45 mutation‐positive patients
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2BIaUXh
Sleep disturbance in psoriasis: a case‐controlled study
British Journal of Dermatology, EarlyView.
https://ift.tt/2o4umE3
Association between bullous pemphigoid and psoriasis: Systematic review and meta‐analysis of case‐control studies
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2wksXwR
Association between bullous pemphigoid and psoriasis: Systematic review and meta‐analysis of case‐control studies
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2wksXwR
Oxygen Reserve Index: Validation of a New Variable
BACKGROUND: Pulse oximetry–derived oxygen saturation is typically >97% in normoxia and hyperoxia, limiting its clinical use. The new Oxygen Reserve Index (ORi), a relative indicator of the partial pressure of oxygen dissolved in arterial blood (PaO2) in the range of 100–200 mm Hg, may allow additional monitoring of oxygen status. METHODS: In this prospective validation intervention study, 20 healthy volunteers were breathing standardized oxygen concentrations ranging from mild hypoxia (fraction of inspired oxygen = 0.14) to hyperoxia (fraction of inspired oxygen = 1.0) via a tight-fitting face mask. ORi was measured noninvasively by multiwavelength pulse co-oximetry using 2 finger sensors. These ORi values (unitless scale, 0.00–1.00) were compared with measured PaO2 values. Repeated-measurements correlation analysis was performed to assess the ORi/PaO2 relationship. ORi trending ability was assessed using a 4-quadrant plot. The area under the receiver operating characteristics curve was calculated to assess the prediction of hypoxia (low-ranged PaO2,
https://ift.tt/2PDH0qe
https://ift.tt/2PDH0qe
Dexmedetomidine Pharmacokinetics and a New Dosing Paradigm in Infants Supported With Cardiopulmonary Bypass
BACKGROUND: Dexmedetomidine is increasingly used off-label in infants and children with cardiac disease during cardiopulmonary bypass (CPB) and in the postoperative period. Despite its frequent use, optimal dosing of dexmedetomidine in the setting of CPB has not been identified but is expected to differ from dosing in those not supported with CPB. This study had the following aims: (1) characterize the effect of CPB on dexmedetomidine clearance (CL) and volume of distribution (V) in infants and young children; (2) characterize tolerance and sedation in patients receiving dexmedetomidine; and (3) identify preliminary dosing recommendations for infants and children undergoing CPB. We hypothesized that CL would decrease, and V would increase during CPB compared to pre- or post-CPB states. METHODS: Open-label, single-center, opportunistic pharmacokinetics (PK) and safety study of dexmedetomidine in patients ≤36 months of age administered dexmedetomidine per standard of care via continuous infusion. We analyzed dexmedetomidine PK data using standard nonlinear mixed effects modeling with NONMEM software. We compared model-estimated PK parameters to those from historical patients receiving dexmedetomidine before anesthesia for urologic, lower abdominal, or plastic surgery; after low-risk cardiac or craniofacial surgery; or during bronchoscopy or nuclear magnetic resonance imaging. We investigated the influence of CPB-related factors on PK estimates and used the final model to simulate dosing recommendations, targeting a plasma concentration previously associated with safety and efficacy (0.6 ng/mL). We used the Wilcoxon rank sum test to evaluate differences in dexmedetomidine exposure between infants with hypotension or bradycardia and those who did not develop these adverse events. RESULTS: We collected 213 dexmedetomidine plasma samples from 18 patients. Patients had a median (range) age of 3.3 months (0.1–34.0 months) and underwent CPB for 161 minutes (63–394 minutes). We estimated a CL of 13.4 L/h/70 kg (95% confidence interval, 2.6–24.2 L/h/70 kg) during CPB, compared to 42.1 L/h/70 kg (95% confidence interval, 38.7–45.8 L/h/70 kg) in the historical patients. No specific CPB-related factor had a statistically significant effect on PK. A loading dose of 0.7 µg/kg over 10 minutes before CPB, followed by maintenance infusions through CPB of 0.2 or 0.25 µg/kg/h in infants with postmenstrual ages of 42 or 92 weeks, respectively, maintained targeted concentrations. We identified no association between dexmedetomidine exposure and selected adverse events (P = .13). CONCLUSIONS: CPB is associated with lower CL during CPB in infants and young children compared to those not undergoing CPB. Further study should more closely investigate CPB-related factors that may influence CL. Accepted for publication June 27, 2018. Funding: K.O.Z. is funded by grant KL2TR001115-03 from the Duke Clinical and Translational Science Awards and K23 grant HD091398 from the National Institutes of Health (NIH). H.W. received salary support from grant K23HD0785891 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) for completion of this project. M.L. receives support from the US government for work in neonatal clinical pharmacology, clinical trials, and cohort studies including Food and Drug Administration (FDA) R01 FD005101, Prinicipal Investigator (PI) M.L.; National Heart, Lung and Blood Institute (NHLBI) R34 HL124038, PI M.L.; the NIH Office of the Director, Environmental Influences on Child Health Outcomes (ECHO) Coordinating Center U2C OD023375, PI P.B.S., Duke University School of Medicine; the NICHD Pediatric Trials Network Government Contract HHSN267200700051C, PI Daniel Benjamin Jr, Duke University School of Medicine; and as the satellite site PI for the NICHD Neonatal Research Network NICHD U10 HD040492, PI C. Michael Cotten, Duke University School of Medicine. R.G.G. receives salary support for research from the NIH training grants (5T32HD043029-13), NIH awards (HHSN 275201000003I, HHSN 272201300017I), and from the FDA (HHSF223201610082C). P.B.S. receives salary support for research from the NIH (NIH-1R21HD080606-01ª1) and the National Center for Advancing Translational Sciences of the NIH (UL1TR001117), the NICHD (HHSN275201000003I), and the FDA (1R18-FD005292-01). C.P.H. receives salary support for research from the National Center for Advancing Translational Sciences of the NIH (UL1TR001117) and the US government for his work in pediatric and neonatal clinical pharmacology (Government Contract HHSN267200700051C, PI: Daniel Benjamin Jr under the Best Pharmaceuticals for Children Act). M.C.-W. receives support for research from the NIH (1R01-HD076676-01A1), the National Institute of Allergy and Infectious Disease (HHSN272201500006I and HHSN272201300017I), the NICHD (HHSN275201000003I), the Biomedical Advanced Research and Development Authority (HHSO100201300009C), and industry for drug development in adults and children (https://ift.tt/2PAHZY8). K.M.W. receives support from the Pediatric Critical Care and Trauma Scientist Development Program (5K12HD047349) and the NICHD (1K23HD075891) for his work in pediatric clinical pharmacology. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Kanecia O. Zimmerman, MD, MPH, Department of Pediatrics, Duke University School of Medicine, Box 3850, Durham, NC 27710. Address e-mail to Kanecia.obie@dm.duke.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2wo5w5B
https://ift.tt/2wo5w5B
Process Optimization and Digital Quality Improvement to Enhance Timely Initiation of Epidural Infusions and Postoperative Pain Control
BACKGROUND: Although intraoperative epidural analgesia improves postoperative pain control, a recent quality improvement project demonstrated that only 59% of epidural infusions are started in the operating room before patient arrival in the postanesthesia care unit. We evaluated the combined effect of process and digital quality improvement efforts on provider compliance with starting continuous epidural infusions during surgery. METHODS: In October 2014, we instituted 2 process improvement initiatives: (1) an electronic order queue to assist the operating room pharmacy with infusate preparation; and (2) a designated workspace for the storage of equipment related to epidural catheter placement and drug infusion delivery. In addition, we implemented a digital quality improvement initiative, an Anesthesia Information Management System–mediated clinical decision support, to prompt anesthesia providers to start and document epidural infusions in pertinent patients. We assessed anesthesia provider compliance with epidural infusion initiation in the operating room and postoperative pain-related outcomes before (PRE: October 1, 2012 to September 31, 2014) and after (POST: January 1, 2015 to December 31, 2016) implementation of the quality improvement initiatives. RESULTS: Compliance with starting intraoperative epidural infusions was 59% in the PRE group and 85% in the POST group. After adjustment for confounders and preintervention time trends, segmented regression analysis demonstrated a statistically significant increase in compliance with the intervention in the POST phase (odds ratio, 2.78; 95% confidence interval, 1.73–4.49; P
https://ift.tt/2PxLPBj
https://ift.tt/2PxLPBj
Update on Perioperative Acute Kidney Injury
Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of AKI. Several specific considerations for AKI risk are important in surgical patients. The surgery, especially major and emergency procedures in critically ill patients, may cause AKI. In addition, certain comorbidities, such as chronic kidney disease and chronic heart failure, are important risk factors for AKI. Diuretics, contrast agents, and nephrotoxic drugs are commonly used in the perioperative period and may result in a significant amount of in-hospital AKI. Before and during surgery, anesthetists are supposed to optimize the patient, including preventing and treating a hypovolemia and correcting an anemia. Intraoperative episodes of hypotension have to be avoided because even short periods of hypotension are associated with an increased risk of AKI. During the intraoperative period, urine output might be reduced in the absence of kidney injury or the presence of kidney injury with or without fluid responsiveness. Therefore, fluids should be used carefully to avoid hypovolemia and hypervolemia. The Kidney Disease: Improving Global Outcomes guidelines suggest implementing preventive strategies in high-risk patients, which include optimization of hemodynamics, restoration of the circulating volume, institution of functional hemodynamic monitoring, and avoidance of nephrotoxic agents and hyperglycemia. Two recently published studies found that implementing this bundle in high-risk patients reduced the occurrence of AKI in the perioperative period. In addition, the application of remote ischemic preconditioning has been studied to potentially reduce the incidence of perioperative AKI. This review discusses the epidemiology and pathophysiology of surgery-associated AKI, highlights the importance of intraoperative oliguria, and emphasizes potential preventive strategies. Accepted for publication July 17, 2018. Funding: A.Z. received lecture fees from Baxter, Astute Medical, Fresenius, Braun, and Ratiopharm and unrestricted research grants from Fresenius, German Research Foundation, Astellas, and Astute Medical. J.L.K. reports receiving consulting fees from Astute Medical, Sphingotec, and Pfizer and research funds from Astute Medical, Bioporto, Nxstage, Satellite Healthcare, and the National Institutes of Health. J.A.K. reports consulting fees and grant support from Astute Medical. E.A.J.H. received a travel grant from AM Pharma, a speaker's fee from Astute Medical, and a research grant from Bellco. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Alexander Zarbock, MD, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1, 48149 Münster, Germany. Address email to zarbock@uni-muenster.de. © 2018 International Anesthesia Research Society
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https://ift.tt/2wnRnpd
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