Review of the medical literature and assessment of current utilization patterns regarding the use two common fluorescence in situ hybridization assays in the diagnosis of dermatofibrosarcoma protuberans and clear cell sarcoma

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wpYOgk

Immunohistochemical expression of melanocytic and myofibroblastic markers and their molecular correlation in atypical fibroxanthomas and pleomorphic dermal sarcomas MiTF and calponin expression in AFX and PDS

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2C4i8F4

Prenatal diagnosis and implications of microphthalmia and anophthalmia with a review of current ultrasound guidelines: two case reports

Microphthalmia and anophthalmia are rare congenital fetal abnormalities. The combined incidence is estimated at 1 in 10,000 births. These two conditions arise from complex and incompletely understood genetic a...

https://ift.tt/2oielKL

Ankylosing spondylitis, chronic fatigue and depression improved after stromal vascular fraction treatment for osteoarthritis: a case report

Osteoarthritis is a prevalent chronic disease that impacts quality of life and imposes a heavy economic burden. Despite this there is no confirmed treatment that could prevent progressive destruction of osteoa...

https://ift.tt/2ws7rGx

Isolated Fourth Nerve Palsy in Nontraumatic Tentorial Hemorrhage

Abstract: A 46-year-old woman being treated with warfarin for antiphospholipid antibody syndrome experienced a rise in international normalized ratio (INR) to 5.4 and developed sudden headache and diplopia. Neuro-ophthalmologic examination disclosed a right fourth nerve palsy. Noncontrast computed tomography revealed a subdural hematoma layered along the right tentorium cerebelli, directly in the path of the nerve. With normalization of the INR, the palsy markedly improved over subsequent weeks. This is a unique case of a nontraumatic subdural hematoma causing a fourth nerve palsy. Address correspondence to Jonathan D. Trobe, MD, University of Michigan, Ann Arbor, MI 48105; E-mail: jdtrobe@umich.edu The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

https://ift.tt/2NyP4H2

Visual Field Mean Deviation at Diagnosis of Idiopathic Intracranial Hypertension Predicts Visual Outcome

Background: A robust predictor of visual outcome in idiopathic intracranial hypertension (IIH) would be useful in management, but there is limited information on this point. The purpose of this study was to ascertain whether visual field mean deviation on standard static perimetry performed at diagnosis in a large patient cohort is a reliable predictor of visual outcome. Methods: We retrospectively reviewed the automated visual field mean deviations at diagnosis and at final encounter in 79 patients with IIH examined in the neuro-ophthalmology clinics at a single academic medical center from 1999 to 2015. Results: Of the 79 study patients, 66 (84%) entered with visual field mean deviations of −7 dB or better. Of those 66 patients, 59 (89%) had final mean deviations of −4 dB or better and 33 (56%) had final mean deviations of −2 dB or better. The single patient who had an initial mean deviation of −7 dB or better and a poor final mean deviation (−32 dB) was nonadherent to prescribed medication. Of the 13 (21%) patients who entered with mean deviations worse than −7 dB, 11 (85%) ended up with poor visual outcomes, their final mean deviations ranging from −5 dB to −32 dB. Over half of those 13 patients had required surgery for IIH, often within 3 weeks of diagnosis, owing to severe papilledema and visual dysfunction at the time of diagnosis. Conclusions: Based on this retrospective study, patients with IIH who have relatively mild visual dysfunction at diagnosis are likely to have a favorable visual outcome, provided they are adherent to recommended treatment. Many of those with poor visual function at diagnosis will have unfavorable visual outcomes despite aggressive treatment. Address correspondence to Jonathan D. Trobe, MD, 1000 Wall Street, Ann Arbor, MI 48105; E-mail: jdtrobe@umich.edu The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

https://ift.tt/2okfQIs

“We're Going to Leave You for Last, Because of How You Are”: Transgender Women's Experiences of Gender-Based Violence in Healthcare, Education, and Police Encounters in Latin America and the Caribbean

Violence and Gender, Ahead of Print.


https://ift.tt/2BVkw1a

Icariin inhibits inflammation via immunomodulation of the cutaneous hypothalamus–pituitary–adrenal axis in vitro

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2LC3yUO

Icariin inhibits inflammation via immunomodulation of the cutaneous hypothalamus–pituitary–adrenal axis in vitro

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2LC3yUO

Laser therapy for ocular lesions of naevus of Ota

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2MWaBws

Associated factors of widespread pattern of dermatitis among patch test population: 12‐Year retrospective study

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2NtbWrs

Severe cutaneous eruptions following the topical use of preparations containing bufexamac: Is it time to reconsider its registration in Australia?

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2ojeX2I

Laser therapy for ocular lesions of naevus of Ota

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2MWaBws

Associated factors of widespread pattern of dermatitis among patch test population: 12‐Year retrospective study

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2NtbWrs

Severe cutaneous eruptions following the topical use of preparations containing bufexamac: Is it time to reconsider its registration in Australia?

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2ojeX2I

Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study

British Journal of Dermatology, EarlyView.


https://ift.tt/2NqIvGF

A 10‐year longitudinal follow‐up study of a U.K. paediatric transplant population to assess for skin cancer

British Journal of Dermatology, EarlyView.


https://ift.tt/2MYha1G

Dermatology on the General Practice Bookshelf

British Journal of Dermatology, EarlyView.


https://ift.tt/2NtYCmQ

Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study

British Journal of Dermatology, EarlyView.


https://ift.tt/2NqIvGF

A 10‐year longitudinal follow‐up study of a U.K. paediatric transplant population to assess for skin cancer

British Journal of Dermatology, EarlyView.


https://ift.tt/2MYha1G

Dermatology on the General Practice Bookshelf

British Journal of Dermatology, EarlyView.


https://ift.tt/2NtYCmQ

Kidney Transplant Outcomes in Recipients with Cognitive Impairment: A National Registry and Prospective Cohort Study

Background Cognitive impairment is common in patients with end-stage renal disease and is associated with poor outcomes on dialysis. We hypothesized that cognitive impairment might be associated with an increased risk of all-cause graft loss (ACGL) in kidney transplant (KT) recipients. Methods Using the Modified Mini-Mental State (3MS) examination, we measured global cognitive function at KT hospital admission in a prospective, two-center cohort of 864 KT candidates (8/2009-7/2016). We estimated the association between pre-KT cognitive impairment and ACGL using Cox regression, adjusting for recipient, donor, and transplant factors. Results In living donor KT (LDKT) recipients, the prevalence was 3.3% for mild impairment (60≤3MS

https://ift.tt/2BWU2w5

International Liver Transplantation Consensus Statement on end-stage liver disease due to nonalcoholic steatohepatitis and liver transplantation

Nonalcoholic steatohepatitis (NASH)-related cirrhosis has become one of the most common indications for liver transplantation (LT), particularly in candidates over the age of 65 years. Typically, NASH candidates have concurrent obesity, metabolic and cardiovascular risks, which directly impact patient evaluation and selection, waitlist morbidity and mortality and eventually posttransplant outcomes. The purpose of these guidelines is to highlight specific features commonly observed in NASH candidates and strategies to optimize pretransplant evaluation and waitlist survival. More specifically, the working group addressed the following clinically-relevant questions providing recommendations based on the GRADE system supported by rigorous systematic reviews and consensus: (1) Is the outcome after LT similar to that of other etiologies of liver disease? (2) Is the natural history of NASH-related cirrhosis different from other etiologies of end-stage liver disease? (3) How should cardiovascular risk be assessed in the candidate for LT? Should the assessment differ from that done in other etiologies? (4) How should comorbidities (hypertension, diabetes, dyslipidemia, obesity, renal dysfunction, etc.) be treated in the candidate for LT? Should treatment and monitoring of these comorbidities differ from that applied in other etiologies? (5) What are the therapeutic strategies recommended to improve the cardiovascular and nutritional status of a NASH patient in the waiting list for LT? (6) Is there any circumstance where obesity should contraindicate LT? (7) What is the optimal time for bariatric surgery: before, during, or after LT? and (8) Donor steatosis: how much relevant is it for LT in NASH patients Contributions: All authors drafted sections of the manuscript and revised the final manuscript for important intellectual content. In addition, MB and ET also drafted some of the sections, combined all the sections in a single manuscript, and revised the final before submission. Conflict of interest: ET: none SN: none YT: none YL: Speaker for Gilead. Grants and Speaker for Novartis. MG: none JK: none MB: Speaker for Novartis, Astellas, Gilead. Grant from Gilead. Correspondence information: Marina Berenguer – MD, La Fe University Hospital, Avenida Fernando Abril Martorell, 106 (Torre F5) – 46026 Valencia (Spain), e-mail: marina.berenguer@uv.es Ciberehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas) is partially funded by the Instituto de Salud Carlos III. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2oiJGwR

Recipient age and mortality after liver transplantation: a population-based cohort tudy

Background The feasibility of liver transplantation (LT) in elderly recipients remains a topic of debate. Methods This cohort study evaluated the impact of recipient's age on LT outcome between January 2007 and May 2016 covered by the Korean National Health Insurance system (n = 9415). Multilevel regression models were used to determine the impact of recipient's age on in-hospital and long-term mortality after LT. Results All patients had a first LT, with 2,473 transplanted with liver from deceased donors (DD) and 6,942 from living donors (LD). The mean age was 52.2±9.0 years. The majority of LT was performed on patients in their 50s (n=4290, 45.6%) and 0.9% (n=84) of the LT was performed on patients aged over 70 years. The overall in-hospital mortality was 6.3%, and the 3-year mortality was 11.3%. The in-hospital mortality included, 13.5% associated with DDLT and 3.7% involved LDLT. When compared with that for patients aged 51 to 55 years, the risk of death among recipients aged over 70 years was about four-fold higher after adjusting for baseline liver disease (OR 4.1; 95% CI 2.21-7.58), and was nearly 3 fold higher after adjusting for baseline liver disease and perioperative complications (OR 2.92; 95% CI 1.37-6.24). And the cost of LT increased significantly with age. Conclusions The data shows that age remains an important risk factor for LT, suggesting that LT should be considered with caution in elderly recipients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address for Correspondence: Jinkyeong Park, M.D. Ph.D. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, E-mail: pjk3318@gmail.com Authorship E.Gil participated in its design and drafted the manuscript. JM. Kim, K.Jeon and GY. Seo participated in its design and coordination. H.Park and D.Kang performed the statistical analysis and helped to draft the manuscript. And J.Cho directed the statistical analysis form the HIRA database. J.Park participated in its design and coordination and contributed as a corresponding author. Disclosure: none Ethics approval and consent to participate The study was reviewed by the Institutional Review Board (IRB) of Samsung Medical Center (IRB SMC 2017-01-001) and was exempted because it involved only deidentified administrative data collected previously. Availability of data and materials We cannot share our data because of administrative data of Korean government Funding: This study was supported by Samsung Medical Center grant [#SMX1151381] Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2LzS0BK

Predictors of Hand Dexterity after Single-Digit Replantation

J reconstr Microsurg
DOI: 10.1055/s-0038-1669446

Background Microsurgical replantation of the thumb and digits has become an increasingly familiar technique in clinical practice worldwide. However, successful digit replantation does not always provide better hand function than revision amputation. Little information is available regarding predictors of motor skill activities of replanted hands. Therefore, we retrospectively evaluated hand dexterity after single-digit replantation at a minimum follow-up of 1 year and analyzed the factors influencing dexterity. Methods This retrospective cohort study included 23 patients treated for amputation injuries at our institution from 2014 to 2015. Patients with amputations from Tamai's zone 2 to 5 of the thumb (3 patients), index finger (11 patients), or middle finger (9 patients) who underwent digital replantation surgery and were followed up for more than 1 year were included. Follow-up evaluations were conducted at an average of 23 months postoperatively (range: 13–25 months). We hypothesized that possible factors influencing hand dexterity after single-digit replantation were patient age, injured finger, key pinch strength, Semmes–Weinstein test result, and percentage of total active motion. Relationships between the outcome variable, which was the result of the Purdue Pegboard Test of hand dexterity, and explanatory variables were analyzed using Spearman's correlation coefficient. A p-value of < 0.05 indicated statistical significance. Results No postoperative complications occurred. Univariate analysis indicated that decreased hand dexterity after single-digit replantation was significantly associated with older age (p = 0.001) and poor recovery of sensation, as shown by the Semmes–Weinstein test (p = 0.012). Conclusion Patient age was a risk factor for low hand dexterity after replantation surgery. Recovery of finger sensitivity enhanced dexterity of motor skill activities following finger replantation surgery.
[...]

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

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

https://ift.tt/2ogMniz

The Use of Pulse Oximetry to Diagnose Limb Ischaemia

The accurate diagnosis of limb ischaemia in the acute trauma setting is time critical. In cases of polytrauma and complex limb injuries this assessment can be difficult and is often first performed by a junior member of the team. The assessment of neurovascular status of these injuries is much the same as it was decades ago. Recently clinical methods thought to be of use are being proven otherwise. In our trauma centre we now routinely use pulse oximetry in the assessment of limb and digit ischaemia.

https://ift.tt/2wlraIM

Giants in Allergy-Immunology Dr. Henry N. Claman

Dr. Henry Claman recruited me to move to Denver and was my primary mentor during my early years at the University of Colorado School of Medicine. I knew Henry from 1988 until his death in 2017 first as a mentee and then as a colleague and friend. When I first met Henry, I was aware of his importance to the field of immunology as the first to demonstrate that small lymphocytes from the bone marrow (B cells) were responsible for antibody production and those from the thymus (T cells) provided necessary "help".

https://ift.tt/2wohDRj

Improving allergy office scheduling increases patient follow up and reduces asthma readmission after pediatric asthma hospitalization

Pediatric asthma is a major contributor to emergency room utilization and hospital readmission rates.

https://ift.tt/2wsLyH2

Disease in a Nutshell Sarcoidosis

Sarcoidosis is a granulomatous disease of unknown etiology which can affect any organ system. It may cause respiratory tract, cardiac, ocular, neurologic, and cutaneous manifestations in isolation or in combination. The etiology of sarcoidosis is poorly understood but since exposure to certain environmental antigens in genetically susceptible individuals can lead to granulomatous inflammation mediated by a predominant T helper-1 (Th1) mediated response, that mechanism is possible. Several disease clusters have been reported in response to environmental events such as exposures to industrial chemicals or dust such as observed in the World Trade Center (WTC) disaster.

https://ift.tt/2wlq5AI

Trends for facial injectable therapies in medical aesthetics

Shehnaz Z Arsiwala

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):45-46



https://ift.tt/2LBlMWz

Multiple miliary osteoma cutis of face

Anup K Lahiry

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):95-97

Multiple miliary osteoma cutis is an uncommon condition presenting as multiple skin-colored papules of variable sizes on the face. A 48-year-old woman presented with multiple skin-colored hard papules on both cheeks. Examination revealed firm-to-hard dome-shaped asymptomatic papules in cluster over both cheeks. A punch biopsy was performed, which showed evidence of focal bony trabeculae with associated normal appendages. Few larger papules were incised and followed up with curettage of bony material and closed. All lesions could not be incised and removed because of large number of lesions in cluster.

https://ift.tt/2wofk0B

Dynamic relaxers of the face

Rashmi Shetty

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):47-50

Dynamics of the facial aesthetics is changing rapidly as we treat more and more faces. Our understanding of the molecule at hand and its various applications only expands as our learnings progress. Perception and expectation of the end goal to beauty itself are evolving, and therefore newer ways of analyzing, understanding, and delivering of any aesthetic drug have to evolve continuously. Botulinum toxin is one of the wonders in the aesthetic world, which led the entire focus of the medical fraternity into nonsurgical facial aesthetics. Botulinum toxin was and is still the best tool for relaxing lateral canthal lines and glabellar frown lines. However, it has evolved further to now impart changes/enhancements in skin texture and luminosity, enhancement in facial shape, and reduction in glandular activity of sebaceous, sweat, and salivary glands, therefore leading to a lot more aesthetic application while it still remains as the line eraser.

https://ift.tt/2PaPbJt

Innovative use of abdominoplasty specimen

Saurabh Gupta, Devi P Mohapatra, Ravi K Chittoria, Elankumar Subbarayan, Sireesha K Reddy, Vinayak Chavan, Abhinav Aggarwal, Likhitha C Reddy

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):88-90

Simulator training is important for understanding nipple–areolar complex reconstruction. Human tissue is the best tissue simulator for surgical training. Abdominoplasty specimen is a useful tissue simulator, which is suitable for practicing nipple–areolar complex reconstruction. It is similar to the natural mound created in breast reconstruction. Authors have shared their experience of using abdominoplasty specimen for simulator training of nipple–areolar complex reconstruction for plastic surgery residents. Abdominoplasty specimen is cost-effective, readily available, and an efficient tool for plastic surgery training for the residents.

https://ift.tt/2MzhCUt

Simplifying injectables for volumetric rejuvenation of face

Shehnaz Zulfikar Arsiwala

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):51-59

Volumetric rejuvenation with fillers is a minimally invasive technique used for facial volume restoration. Volume restoration demands adequate knowledge of fat pads and vascularity of the face and the understanding of the depletion patterns. Volumetric restoration with injectable has witnessed a paradigm shift in the last decade with a global rejuvenation, acquiring a predominant emphasis over focal wrinkle filling to restore the depletion pattern of facial fat layers. The techniques used to achieve optimal restoration of facial volume revolve around zonal lifting and tenting, and the impact of treatment on one zone of the surrounding zones is crucial. A face mapping performed for filler technique has thus evolved, with many experts advocating varied techniques from global restoration to point lifts at key areas, to improve the outcome of filler injections, albeit safely, thus simplifying the process. A systematic approach to various techniques and the point lifts in various zones pertaining to the face structure in the Indian skin are highlighted in this article.

https://ift.tt/2LBlxuD

Dermatological surgery in patients with cardiac implantable electronic devices: A new paradigm

Andre B S Khoo, Vishal Madan

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):100-101



https://ift.tt/2wmJAJ7

Beware what you inject: Complications of injectables—dermal fillers

Maya Vedamurthy

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):60-66

Cosmetic filler injections are most popular among the antiaging procedures. As in any other cosmetic injectable procedures, complications are likely to occur even under experienced hands. However, it is the duty of the aesthetic physician to identify and manage these potential complications. The objective of this symposia is to help the aesthetic physician to identify these complications early and manage them appropriately to improve outcomes.

https://ift.tt/2PctM2I

An innovative training model for practicing hairline designing

Jyoti Gupta, Gillian Roga, Kavish Chouhan, Amrendra Kumar

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):83-87

Hair transplantation has undergone a massive transformation in todays world. Besides advancement in technique there has also been a great increase in the demand for hair transplant. This rise in demand for hair transplant has further led to an increase in the requirement of professionally trained hair transplant surgeons. In this article we have described a new, versatile and simple technique for hair transplant surgeons to effectively practice hair line designing. This innovative technique proves vital in perfecting the art of the recipient area designing for the hairline, eyebrow, beard etc. for a surgeon who is undergoing training as well as for previously trained surgeons to rehearse an old skill to gain further confidence. Besides helping us practice the art of hairline designing this technique also teaches us the correct angle, direction, depth and density of slits which are ideal and thus helps us to be better prepared for the real life scenario.

https://ift.tt/2MEpvbc

Fat busters: Lipolysis for face and neck

Abhay Talathi, Prajakta Talathi

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):67-72

Persistence and hypertrophy of fat pads particularly of the face and neck region disturb beauty proportions, thus demand treatments. Phosphatidylcholine and deoxycholic acid are the most commonly used solutions for injection lipolysis. As we stand today, sodium deoxycholate preparation is approved by the US Food and Drug Administration for the same. This article describes the correct use of solution to achieve fat reduction and ensure safety. Complete details of patient selection, assessment, dosing, and injection techniques are described in this article. A brief note on posttreatment care and complications is also provided.

https://ift.tt/2PfCsVN

Lipoid proteinosis: Skin resurfacing with combination of fractional CO2 and non-ablative radio frequency: A rare case report

Chandraiah Madura, Arti Priya, Byalekere Shivanna Chandrashekar

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):91-94

Lipoid proteinosis (LP) is a rare autosomal-recessive genodermatosis, characterized by the deposition of amorphous hyaline-like material in different parts of the body, especially the skin and mucous membranes. Disfiguring lesions predominantly affect the facial appearance. No curative therapy and treatment options limited to symptomatic approaches are available. Facial disfigurement in this disease may have a huge negative effect on the patients' psychology and quality of life. With this regard, the patients may benefit very much from the treatments that enhance their cosmetic outlook. We present a 19-year-old female patient with LP who came to us seeking treatment for her facial lesions. She was treated with a combination regimen of fractional carbon dioxide and non-ablative radio frequency with good clinical and aesthetic outcome.

https://ift.tt/2wprJkJ

Arm contouring after massive weight loss: Liposuction-assisted brachioplasty versus standard technique

Verdiana Di Pietro, Gianfranco M Colicchia, Valerio Cervelli, Pietro Gentile

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):73-78

Massive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience.

https://ift.tt/2LBl7Ez

A simple, efficient, and economical head drape technique for facial procedures: The nun’s veil drape

Guirgis A Awad

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):98-99



https://ift.tt/2MCKwDq

Anatomy and applications of the #15 scalpel blade and its variations

Somodyuti Chandra, Indrashis Podder, Manas Chatterjee, Lawrence Field

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):79-82

Scalpels have been used to make skin incisions since the advent of "modern" dermatosurgery. #15 Scalpel blade and #3 handle (Bard-Parker handle) are most frequently used by a dermatosurgeon. Besides the proper equipment, appropriate technique is mandatory to ensure a "precise" incision. In this article, we discuss about the anatomy, variations, and different uses of the #15 scalpel blade and the ideal method of making a "precise" skin incision.

https://ift.tt/2PfCmNV

29th National Dermatology Congress of the Algerian Society of Dermatology Algiers, October 18 and 19, 2017

Robert A Schwartz, Aicha Salhi

Journal of Cutaneous and Aesthetic Surgery 2018 11(2):102-103



https://ift.tt/2wknvuQ

Surgical Management of Postparalysis Facial Palsy and Synkinesis

Modified selective neurectomy of the distal branches of the buccal, zygomatic, and cervical branches of the facial nerve in addition to platysmal myotomy is an effective surgical procedure for the treatment of postfacial paralysis synkinesis. Success of this procedure depends on identification of the peripheral facial nerve branches, preservation of zygomatic and marginal mandibular branches that innervate key smile muscles, and ablation of buccal and cervical branches that cause lateral and/or inferior excursion of the oral commissure. Results are long-lasting; objective improvements in electronic clinician-graded facial function scale score, House-Brackmann score, and decreased botulinum toxin-A requirements have been observed.

https://ift.tt/2MVznwG

Management of Long-Standing Flaccid Facial Palsy

Ineffective eyelid closure can pose a serious risk of injury to the ocular surface and eye. In cases of eyelid paresis, systematic examination of the eye and ocular adnexa will direct appropriate interventions. Specifically, 4 distinct periorbital regions should be independently assessed: eyebrow, upper eyelid, ocular surface, and lower eyelid. Corneal exposure can lead to dehydration, thinning, scarring, infection, perforation, and blindness. Long-term sequelae following facial nerve palsy may also include epiphora, gustatory lacrimation, and synkinesis.

https://ift.tt/2NseuX0

Surgical Management of Acute Facial Palsy

Bell palsy and traumatic facial nerve injury are two common causes of acute facial palsy. Most patients with Bell palsy recover favorably with medical therapy alone. However, those with complete paralysis (House-Brackmann 6/6), greater than 90% degeneration on electroneurography, and absent electromyography activity may benefit from surgical decompression via a middle cranial fossa (MCF) approach. Patients with acute facial palsy from traumatic temporal bone fracture who meet these same criteria may be candidates for decompression via an MCF or translabyrinthine approach based on hearing status.

https://ift.tt/2MUrB6k

Optical coherence tomography for observation of the olfactory epithelium in mice

Optical coherence tomography (OCT) is an imaging tool that exploits the coherence of infrared light and is clinically utilized in the field of ophthalmology and dermatology. This study aimed to examine the feasibility of using OCT for diagnosing degeneration and regeneration of the olfactory epithelium in mice.

https://ift.tt/2Nt3GaY

Cancer of the mandibular gingiva metastasizing to the small intestine

Head and neck cancer metastasizing to the small intestine is very rare. Here we report a case of cancer of the mandibular gingiva metastasizing to the small intestine. The patient was an 82-year-old man who had squamous cell carcinoma of the mandibular gingiva staged as T2N2bM0. Two months after surgery, he presented with lower abdominal pain accompanied by signs of peritoneal irritation. Urgent abdominal surgery was performed, during which a crater-shaped perforation was noted on the wall of the ileum.

https://ift.tt/2MUmnHK

Advanced head and neck surgical techniques: A survey of US otolaryngology resident perspectives

To assess the perspectives of OHNS residents with regards to their training in the following advanced head and neck surgery techniques: transoral robotic surgery (TORS), transoral laser microsurgery (TLM), sialendoscopy, and surgeon-performed ultrasound (SP-US) for possible curricula development.

https://ift.tt/2NuLLkb

BrightOcular® Cosmetic Iris Implant: A Spectrum from Tolerability to Severe Morbidity

Purpose: The BrightOcular® implants are the newest model of cosmetic iris devices that are currently advertised as safe. The previous generation known as NewColorIris® have had severe ocular side effects and were subsequently withdrawn from the market. There is little literature on the safety profile of BrightOcular® implants. Case Report: Herein we describe two cases with varying degrees of ocular tolerability. The first case had a normal ocular exam 1 year after implantation, whereas the second case had unilateral severe corneal edema requiring explantation of the iris device and Descemet membrane endothelial keratoplasty 9 months after bilateral implantation. Conclusions: These two cases attest to the unpredictability of the results of these cosmetic surgeries. Patients should be counseled about the vision-threatening complications of iris implants.
Case Rep Ophthalmol 2018;9:395–400

https://ift.tt/2MZvIOy

A Case of Focal Choroidal Excavation Development Associated with Multiple Evanescent White Dot Syndrome

Focal choroidal excavation (FCE) is described as an excavated lesion of the choroid that can be detected by optical coherence tomography (OCT). While the exact pathogenesis of FCE remains unclear, it has been proposed in some cases that there is an association with the inflammation in the outer retina. We present a case of FCE development that was detected by spectral domain OCT (SD-OCT) and found to be associated with multiple evanescent white dot syndrome (MEWDS). A 40-year-old Japanese woman was diagnosed with MEWDS based on multiple white dots observed from the posterior pole to the midperiphery, along with yellow granularity in the fovea. SD-OCT revealed separation between the retinal pigment epithelium (RPE) and Bruch's membrane (BM) and discontinuations of the ellipsoid zone, RPE, and BM. At 4 weeks after onset, several of the white dots disappeared, the yellow granularity in the fovea became small, and we detected nonconforming choroidal excavation under the central fovea. The choroidal excavation gradually deepened and changed to a conforming pattern. These findings suggest that the degree of the impairment caused by inflammation and the plasticity of the BM and RPE complex may be associated with different types of acquired FCE.
Case Rep Ophthalmol 2018;9:388–394

https://ift.tt/2Lva67S

Radiologic/histologic discrepancies in tumor identification: The case of a “basketball‐sized” mandibular tumor in a woman from 17th century West Virginia

International Journal of Osteoarchaeology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2wjINbE

Europäische PanCare-Studien zu Spätfolgen nach Krebs im Kindes- und Jugendalter

https://ift.tt/2NsgY7C

Late adverse outcomes after treatment of testicular cancer

Abstract

Background

Modern oncological treatment has rendered testicular cancer (TC) a curative malignant disease but there is a risk of decreasing survival and reduced health-related quality of life (HR-QoL) related to long-term adverse health outcomes (AHOs).

Aim

To provide an overview on AHOs after oncological treatment of TC.

Material and methods

Summary of published studies and previous reviews.

Results

Relative survival rates decrease among TC survivors 25 years after diagnosis, mainly due to treatment-related second cancer and/or cardiovascular disease, the latter mediated by components of the metabolic syndrome. With increasing age cisplatin-induced ototoxicity becomes a clinical problem in patients, whereas reported peripheral neurotoxicity only exceptionally achieves major clinical relevance. Anxiety but not depression represents the dominating psychological problem. In most patients HR-QoL is good, but working ability may be reduced by very intensive treatment.

Conclusion

Awareness of long-term AHOs among TC survivors and health professionals can contribute to reduce long-term morbidity and mortality and to improve QoL by initiating early preventive and therapeutic measures. Radiotherapy should be avoided as much as possible during risk-adapted treatment of TC. Existing data indicate premature aging among strongly treated TC survivors but larger studies and longer follow-up in longitudinal studies are required to confirm these preliminary observations.

https://ift.tt/2MZwaw2

Besseres Gesamtüberleben durch Brachytherapie beim Endometriumkarzinom im Stadium III

https://ift.tt/2NvK2eM

Large-Scale Organization of the Hand Action Observation Network in Individuals Born Without Hands

Abstract

The human high-level visual cortex comprises regions specialized for the processing of distinct types of stimuli, such as objects, animals, and human actions. How does this specialization emerge? Here, we investigated the role of effector-specific visuomotor coupling experience in shaping the organization of the action observation network (AON) as a window on this question. Observed body movements are frequently coupled with corresponding motor codes, e.g., during monitoring one's own movements and imitation, resulting in bidirectionally connected circuits between areas involved in body movements observation (e.g., of the hand) and the motor codes involved in their execution. If the organization of the AON is shaped by this effector-specific visuomotor coupling, then, it should not form for body movements that do not belong to individuals' motor repertoire. To test this prediction, we used fMRI to investigate the spatial arrangement and functional properties of the hand and foot action observation circuits in individuals born without upper limbs. Multivoxel pattern decoding, pattern similarity, and univariate analyses revealed an intact hand AON in the individuals born without upper limbs. This suggests that the organization of the AON does not require effector-specific visuomotor coupling.

https://ift.tt/2NqENNh

Brain Activity Tracks Population Information Sharing by Capturing Consensus Judgments of Value

Abstract

Information that is shared widely can profoundly shape society. Evidence from neuroimaging suggests that activity in the ventromedial prefrontal cortex (vmPFC), a core region of the brain's valuation system tracks with this sharing. However, the mechanisms linking vmPFC responses in individuals to population behavior are still unclear. We used a multilevel brain-as-predictor approach to address this gap, finding that individual differences in how closely vmPFC activity corresponded with population news article sharing related to how closely its activity tracked with social consensus about article value. Moreover, how closely vmPFC activity corresponded with population behavior was linked to daily life news experience: frequent news readers tended to show high vmPFC across all articles, whereas infrequent readers showed high vmPFC only to articles that were more broadly valued and heavily shared. Using functional connectivity analyses, we found that superior tracking of consensus value was related to decreased connectivity of vmPFC with a dorsolateral PFC region associated with controlled processing. Taken together, our results demonstrate variability in the brain's capacity to track crowd wisdom about information value, and suggest (lower levels of) stimulus experience and vmPFC–dlPFC connectivity as psychological and neural sources of this variability.

https://ift.tt/2MSKGWB

Hippocampal Engagement During Recall Depends on Memory Content

https://ift.tt/2Ly5myp

Mechanisms of Spontaneous Electrical Activity in the Developing Cerebral Cortex—Mouse Subplate Zone

Abstract

Subplate (SP) neurons exhibit spontaneous plateau depolarizations mediated by connexin hemichannels. Postnatal (P1–P6) mice show identical voltage pattern and drug-sensitivity as observed in slices from human fetal cortex; indicating that the mouse is a useful model for studying the cellular physiology of the developing neocortex. In mouse SP neurons, spontaneous plateau depolarizations were insensitive to blockers of: synaptic transmission (glutamatergic, GABAergic, or glycinergic), pannexins (probenecid), or calcium channels (mibefradil, verapamil, diltiazem); while highly sensitive to blockers of gap junctions (octanol), hemichannels (La³⁺, lindane, Gd³⁺), or glial metabolism (DLFC). Application of La³⁺ (100 μM) does not exert its effect on electrical activity by blocking calcium channels. Intracellular application of Gd³⁺ determined that Gd³⁺-sensitive pores (putative connexin hemichannels) reside on the membrane of SP neurons. Immunostaining of cortical sections (P1–P6) detected connexins 26, and 45 in neurons, but not connexins 32 and 36. Vimentin-positive glial cells were detected in the SP zone suggesting a potential physiological interaction between SP neurons and radial glia. SP spontaneous activity was reduced by blocking glial metabolism with DFLC or by blocking purinergic receptors by PPADS. Connexin hemichannels and ATP release from vimentin-positive glial cells may underlie spontaneous plateau depolarizations in the developing mammalian cortex.

https://ift.tt/2MSKiY9

Domain-Specific Diaschisis: Lesions to Parietal Action Areas Modulate Neural Responses to Tools in the Ventral Stream

Abstract

Neural responses to small manipulable objects ("tools") in high-level visual areas in ventral temporal cortex (VTC) provide an opportunity to test how anatomically remote regions modulate ventral stream processing in a domain-specific manner. Prior patient studies indicate that grasp-relevant information can be computed about objects by dorsal stream structures independently of processing in VTC. Prior functional neuroimaging studies indicate privileged functional connectivity between regions of VTC exhibiting tool preferences and regions of parietal cortex supporting object-directed action. Here we test whether lesions to parietal cortex modulate tool preferences within ventral and lateral temporal cortex. We found that lesions to the left anterior intraparietal sulcus, a region that supports hand-shaping during object grasping and manipulation, modulate tool preferences in left VTC and in the left posterior middle temporal gyrus. Control analyses demonstrated that neural responses to "place" stimuli in left VTC were unaffected by lesions to parietal cortex, indicating domain-specific consequences for ventral stream neural responses in the setting of parietal lesions. These findings provide causal evidence that neural specificity for "tools" in ventral and lateral temporal lobe areas may arise, in part, from online inputs to VTC from parietal areas that receive inputs via the dorsal visual pathway.

https://ift.tt/2No927p

Sparse Labeling and Neural Tracing in Brain Circuits by STARS Strategy: Revealing Morphological Development of Type II Spiral Ganglion Neurons

https://ift.tt/2MEwql3

Learning to Read Increases the Informativeness of Distributed Ventral Temporal Responses

Abstract

Becoming a proficient reader requires substantial learning over many years. However, it is unknown how learning to read affects development of distributed visual representations across human ventral temporal cortex (VTC). Using fMRI and a data-driven, computational approach, we quantified the development of distributed VTC responses to characters (pseudowords and numbers) versus other domains in children, preteens, and adults. Results reveal anatomical- and hemisphere-specific development. With development, distributed responses to words and characters became more distinctive and informative in lateral but not medial VTC, and in the left but not right hemisphere. While the development of voxels with both positive and negative preference to words affected distributed information, only development of voxels with positive preference to words (i.e., word-selective) was correlated with reading ability. These data show that developmental increases in informativeness of distributed left lateral VTC responses are related to proficient reading and have important implications for both developmental theories and for elucidating neural mechanisms of reading disabilities.

https://ift.tt/2LxSMzd

Maturation of the Human Cerebral Cortex During Adolescence: Myelin or Dendritic Arbor?

Abstract

Previous in vivo studies revealed robust age-related variations in structural properties of the human cerebral cortex during adolescence. Neurobiology underlying these maturational phenomena is largely unknown. Here we employ a virtual-histology approach to gain insights into processes associated with inter-regional variations in cortical microstructure and its maturation, as indexed by magnetization transfer ratio (MTR). Inter-regional variations in MTR correlate with inter-regional variations in expression of genes specific to pyramidal cells (CA1) and ependymal cells; enrichment analyses indicate involvement of these genes in dendritic growth. On the other hand, inter-regional variations in the change of MTR during adolescence correlate with inter-regional profiles of oligodendrocyte-specific gene expression. Complemented by a quantitative hypothetical model of the contribution of surfaces associated with dendritic arbor (1631 m²) and myelin (48 m²), these findings suggest that MTR signals are driven mainly by macromolecules associated with dendritic arbor while maturational changes in the MTR signal are associated with myelination.

https://ift.tt/2MDqxEr

A Study of Guselkumab in Participants With Familial Adenomatous Polyposis

Condition:   Adenomatous Polyposis Coli
Interventions:   Drug: Guselkumab;   Drug: Placebo
Sponsor:   Janssen Research & Development, LLC
Not yet recruiting

https://ift.tt/2MDY9C8

Ketamine-ketorolac Versus Fentanyl- Ketorolac I.M in Children During Bone Marrow Biopsy

Condition:   Hematological Malignancy (Leukemia- Lymphoma)
Interventions:   Drug: ketamine-ketorolac;   Drug: fentanyl- ketorolac
Sponsor:   Mansoura University
Not yet recruiting

https://ift.tt/2LzxKjI

Low-Dose Weekly vs High-Dose Cisplatin

Condition:   Locally Advanced Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: High-Dose Cisplatin;   Drug: Low-Dose Cisplatin;   Radiation: Radiotherapy
Sponsor:   Lawson Health Research Institute
Not yet recruiting

https://ift.tt/2PL06e4

Endostatin Combined With Chemotherapy for Adjuvant Treatment of Esophageal Cancer

Condition:   Esophageal Cancer
Interventions:   Drug: Docetaxel;   Drug: Nedaplatin;   Drug: Endostar
Sponsor:   First Affiliated Hospital of Guangxi Medical University
Not yet recruiting

https://ift.tt/2Lzx7GS

Evaluation of early acute radiation-induced brain injury: Hybrid multifunctional MRI-based study

Publication date: Available online 27 August 2018

Source: Magnetic Resonance Imaging

Author(s): Jun Yang, Zeyan Xu, Jingyan Gao, Chengde Liao, Pengfei Wang, Yifan Liu, Tengfei Ke, Qinqing Li, Dan Han

Abstract

Purpose

Radiation injury is a serious threat to humans that requires prompt and accurate diagnosis and assessment. Currently, there is no effective imaging method to evaluate acute radiation injury in the early stage. We used hybrid multifunctional MRI to evaluate acute radiation-induced brain injury.

Materials and methods

Different extents of brain injury were created by exposing SD rats to different radiation doses, namely, 0, 10, 20, 30 and 40 Gy. DCE, IVIM-MRI and MRS were performed on the 5th day after irradiation. Immunohistochemistry, western blotting and electron microscopy were used to determine histopathological changes in neurons and glial cells.

Results

The Ktrans, Ve, and iAUC values in DCE and the S0, f and D* values in IVIM showed significant positive correlations with injury grade. In particular, Ktrans, iAUC and S0 showed very good correlations with injury grade (r > 0.5, P < 0.05), and the values in the 30 Gy group were significantly higher than those in the other groups (P < 0.05). The NAA/Cr ratio in the 30 Gy group was significantly lower than those in the other groups, whereas the NAA/Cho ratio increased from the 10 Gy to the 20 Gy group and decreased significantly in the 30 Gy group (P < 0.05). VEGF, Caspase-3 and GFAP increased with irradiation dose increasing from 10 Gy to 30 Gy (P < 0.05). ROC analysis demonstrated that multifunctional MRI was more effective for diagnosing the 30 Gy group than it was for the 10 Gy and 20 Gy groups.

Conclusion

Hybrid multifunctional MRI can noninvasively evaluate acute radiation-induced brain injury in the early stage, particularly high-dose radiation exposure.

https://ift.tt/2wjX8VO

Along-tract analysis of the arcuate fasciculus using the Laplacian operator to evaluate different tractography methods

Publication date: Available online 27 August 2018

Source: Magnetic Resonance Imaging

Author(s): Lia Talozzi, Claudia Testa, Stefania Evangelisti, Lorenzo Cirignotta, Claudio Bianchini, Stefano Ratti, Paola Fantazzini, Caterina Tonon, David Neil Manners, Raffaele Lodi

Abstract

Purpose

We propose a new along-tract algorithm to compare different tractography algorithms in tract curvature mapping and along-tract analysis of the arcuate fasciculus (AF). In particular, we quantified along-tract diffusion parameters and AF spatial distribution evaluating hemispheric asymmetries in a group of healthy subjects.

Methods

The AF was bilaterally reconstructed in a group of 29 healthy subjects using the probabilistic ball-and-sticks model, and both deterministic and probabilistic constrained spherical deconvolution. We chose cortical ROIs as tractography targets and the developed along-tract algorithm used the Laplacian operator to parameterize the volume of the tract, allowing along-tract analysis and tract curvature mapping independent of the tractography algorithm used.

Results

The Laplacian parameterization successfully described the tract geometry underlying hemispheric asymmetries in the AF curvature. Using the probabilistic tractography methods, we found more tracts branching towards cortical terminations in the left hemisphere. This influenced the left AF curvature and its diffusion parameters, which were significantly different with respect to the right. In particular, we detected projections towards the middle temporal and inferior frontal gyri bilaterally, and towards the superior temporal and precentral gyri in the left hemisphere, with a significantly increased volume and connectivity.

Conclusions

The approach we propose is useful to evaluate brain asymmetries, assessing the volume, the diffusion properties and the quantitative spatial localization of the AF.

https://ift.tt/2PflYNv

A Study of Guselkumab in Participants With Familial Adenomatous Polyposis

Condition:   Adenomatous Polyposis Coli
Interventions:   Drug: Guselkumab;   Drug: Placebo
Sponsor:   Janssen Research & Development, LLC
Not yet recruiting

https://ift.tt/2MDY9C8

Ketamine-ketorolac Versus Fentanyl- Ketorolac I.M in Children During Bone Marrow Biopsy

Condition:   Hematological Malignancy (Leukemia- Lymphoma)
Interventions:   Drug: ketamine-ketorolac;   Drug: fentanyl- ketorolac
Sponsor:   Mansoura University
Not yet recruiting

https://ift.tt/2LzxKjI

Low-Dose Weekly vs High-Dose Cisplatin

Condition:   Locally Advanced Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: High-Dose Cisplatin;   Drug: Low-Dose Cisplatin;   Radiation: Radiotherapy
Sponsor:   Lawson Health Research Institute
Not yet recruiting

https://ift.tt/2PL06e4

Endostatin Combined With Chemotherapy for Adjuvant Treatment of Esophageal Cancer

Condition:   Esophageal Cancer
Interventions:   Drug: Docetaxel;   Drug: Nedaplatin;   Drug: Endostar
Sponsor:   First Affiliated Hospital of Guangxi Medical University
Not yet recruiting

https://ift.tt/2Lzx7GS

TCR repertoire profiling of tumors, adjacent normal tissues, and peripheral blood predicts survival in nasopharyngeal carcinoma

Abstract

The T-cell immune responses in nasopharyngeal carcinoma patients have been extensively investigated recently for designing adoptive immunotherapy or immune checkpoint blockade therapy. However, the distribution characteristics of T cells associated with NPC pathogenesis are largely unknown. We performed deep sequencing for TCR repertoire profiling on matched tumor/adjacent normal tissue from 15 NPC patients and peripheral blood from 39 NPC patients, 39 patients with other nasopharyngeal diseases, and 33 healthy controls. We found that a lower diversity of TCR repertoire in tumors than paired tissues or a low similarity between the paired tissues was associated with a poor prognosis in NPC. A more diverse TCR repertoire was identified in the peripheral blood of NPC patients relative to the controls; this was related to a significant decrease in the proportion of high-frequency TCR clones in NPC. Higher diversity in peripheral blood of NPC patients was associated with a worse prognosis. Due to the peculiarity of the Vβ gene usage patterns in the peripheral blood of NPC patients, 15 Vβ genes were selected to distinguish NPC patients from controls by the least absolute shrinkage and selection operator analysis. We identified 11 clonotypes shared by tumors and peripheral blood samples from different NPC patients, defined as "NPC-associated" that might have value in adoptive immunotherapy. In conclusion, we here report the systematic and overall characteristics of the TCR repertoire in tumors, adjacent normal tissues, and peripheral blood of NPC patients. The data obtained may be relevant to future clinical studies in the setting of immunotherapy for NPC patients.

https://ift.tt/2NpVDMi

VV-ECMO during subsequent segmentectomy after right pneumonectomy

Abstract

Several reports have described subsequent pulmonary surgery after pneumonectomy. We herein report the case of an 82-year-old woman with metachronous multiple lung cancer who had undergone surgery for adenocarcinoma of the right upper lobe 17 years earlier. Completion pneumonectomy had been performed for residual lung adenocarcinoma 11 years before the presentation in question. The patient was elderly and had a poor pulmonary function, although her performance status and her cardiac function were good. Therefore, we decided to improve the safety of surgery with venovenous extracorporeal membrane oxygenation (VV-ECMO). Segmentectomy of S6 + S10a was performed under VV-ECMO support. The 30 months after surgery, the patient has had no complications but continues home oxygen therapy. Imaging has shown no evidence of recurrence.

https://ift.tt/2BPUsEx

NFkB mutations in humans: The devil is in the details

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Manfred Fliegauf, Bodo Grimbacher

https://ift.tt/2wnOqWt

A New Spin on Mast Cells and Cysteinyl Leukotrienes: Leukotriene E4 Activates Mast Cells in vivo

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Lora G. Bankova, Joshua A. Boyce

https://ift.tt/2Lzjx6m

The value of urgent care dermatology

International Journal of Dermatology, EarlyView.


https://ift.tt/2wo6YF6

Indoleamine-2,3-dioxygenase in murine and human systemic lupus erythematosus: Down-regulation by the tolerogeneic peptide hCDR1

Publication date: Available online 28 August 2018

Source: Clinical Immunology

Author(s): Zev Sthoeger, Amir Sharabi, Heidy Zinger, Ilan Asher, Edna Mozes

Abstract

וֹndoleamine-2,3-dioxygenase (IDO) plays a role in immune regulation. Increased IDO activity was reported in systemic lupus erythematosus (SLE). We investigated the effects of the tolerogenic peptide hCDR1, shown to ameliorate lupus manifestations, on IDO gene expression. mRNA was prepared from splenocytes of hCDR1- treated SLE-afflicted (NZBxNZW)F1 mice, from blood samples of lupus patients, collected before and after their in vivo treatment with hCDR1 and from peripheral blood mononuclear cells (PBMC) of patients incubated with hCDR1. IDO gene expression was determined by real-time RT-PCR. hCDR1 significantly down-regulated IDO expression in SLE-affected mice and in lupus patients (treated in vivo and in vitro). No effects were observed in healthy donors or following treatment with a control peptide. Diminished IDO gene expression was associated with hCDR1 beneficial effects. Our results suggest that the hCDR1-induced FOXP3 expressing regulatory T cells in lupus are not driven by IDO but rather by other hCDR1 regulated pathways.

https://ift.tt/2MyBxmy

Iatrogenic Neurological Injury in Children with Trisomy 21

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Renata E. Husnudinov, George M. Ibrahim, Evan J. Propst, Nikolaus E. Wolter

Abstract

Purpose

Children with trisomy 21 are at a greater risk for craniocervical junction instability than the general population. These children frequently require administration of anesthesia due to surgical (including otolaryngological) interventions and are at risk for neurological injury. We reviewed the current literature describing iatrogenic neurological injury in children with trisomy 21 undergoing anesthesia in order to facilitate the development of safety recommendations.

Methods

A systematic review of the literature was performed using Medline, Embase, Scopus, and Google Scholar, following the PRISMA statement. All cases of perioperative neurological injury in children with trisomy 21, aged 18 and under were identified. Clinical and radiographic data were extracted for each report. The data were synthesized to develop recommendations regarding perioperative management.

Results

Of 348 articles screened, 16 cases of iatrogenic neurological injury (in children ages 0.7 to 18 years) were identified. Three injuries occurred during otolaryngological surgeries, nine during sedation for intubation for non-otolaryngological surgery, one during sedation for neuroimaging, one while restraining a child, and two were due to intraoperative head and neck positioning while anesthetized. Preoperative screening was reported in four cases. A diagnosis of atlantoaxial instability (AAI) or atlantooccipital instability (AOI) was made immediately following symptom presentation in three cases but was often delayed by a median (IQR) of 30(11.5-912.5) days. No cases resolved spontaneously, with 2 patients progressing to brain death and 12 requiring surgical stabilization. Of the latter, seven showed improvement, whereas one died 5 months later. No intraoperative precautions during the index procedure were reported in any of the 16 cases.

Conclusion

Iatrogenic neurological injury in children with trisomy 21 are rare but severe and likely under reported. Although the role of preoperative screening remains controversial, all children with trisomy 21 undergoing surgery should be considered at risk for neurological injury due to confirmed or undiagnosed AAI or AOI and should be transferred and positioned with appropriate caution. Children with instability should be referred for neurosurgical attention for preoperative stabilization to mitigate perioperative risk. It is imperative to consider the possibility of neurological injury secondary to medical procedures, as it is clear that neck manipulation of any sort places these children at risk.

https://ift.tt/2og5Obl

Influence of infancy care strategy on hearing in children and adolescents: a longitudinal study of children with unilateral lip and /or cleft palate

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Maryna Kapitanova, Jean-François Knebel, Oumama El Ezzi, Melody Artaz, Anthony S. de Buys Roessingh, Céline Richard

Abstract

Objectives

To evaluate the relation between ventilation tube insertion, otitis media with effusion duration and otologic outcomes in unilateral cleft lip and/or cleft palate children from infancy to teenage age.

Design and Population

Retrospective longitudinal charts review of patients from the multidisciplinary cleft team of the University Hospital of Lausanne over a 30-year period. 146 charts from consecutive patients with non-syndromic unilateral cleft lip and/or cleft palate who were born between January 1986 and January 2003 were included.

Results

The earlier in life a cleft child experience his first otitis media with effusion (OME), the worse his long-term hearing will be. Along with the age of onset of OME, we disclosed an influence of the duration of OME without ventilation tube (VT) insertion on short and long-term hearing outcomes. Different patterns were observed between cleft palate (CP) and cleft lip palate children (CLP), with a higher incidence of otitis media with effusion for the CLP group than the CP group. Direct positive relationship between VT insertion and hearing were disclosed and evaluation of long-term complications did not reveal significant relation with VT insertion. Of note, OME in CLP children led to a higher rate (but not statistically significant) of chronic ear complications than in the CP group, that may indicate more persistent OME or different adverse effect on the middle ear mucosa between CP and CLP children.

Conclusions

Individualized counseling should take into account different factors such as the type of cleft, the age of onset of OME and duration of OME, keeping in mind the adverse effect of persistent middle ear fluid. In the present report, results prone an early ventilation tube insertion to prevent short and long-term injury to the middle ear homeostasis, hearing loss and related issues.

https://ift.tt/2NqW7BA

Transmastoid access in branchio-oto-renal syndrome: A reappraisal of computed tomography imaging

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): William J. Parkes, Sharon L. Cushing, Susan I. Blaser, Blake C. Papsin

Abstract

Objective

To evaluate for temporal bone abnormalities that might affect transmastoid surgery such as cochlear implantation in cases of branchio-oto-renal syndrome (BOR).

Study design

Retrospective review.

Methods

Qualitative assessment of temporal bone computed tomography imaging was performed by a neuroradiologist for 30 individuals with BOR (60 ears) and 20 controls with normal hearing (20 ears). Transmastoid access was assessed categorically across 4 features: tip development, cortex pneumatization, tegmen height, and facial recess pneumatization. The appearance of 4 standard landmarks (Koerner's septum, antrum, prominence of the horizontal semicircular canal, incudal short process) was also dichotomized as normal or abnormal. Data were compared using Fisher's exact testing.

Results

Mastoid height differed between the groups with tip underdevelopment noted in 72% of BOR ears vs. 40% of controls (p = 0.02), and a low tegmen was seen in 68% of BOR ears and 25% of controls (p < 0.01). Significant differences in pneumatization were also found for the mastoid cortex (28% non-pneumatized in BOR vs. 5% in controls; p = 0.03) and the facial recess (27% non-pneumatized in BOR vs. 0% in controls; p = 0.01). Standard landmarks were easily identified in all of the control mastoids. In the BOR group, Koerner's septum was abnormally located or absent in 45%, and the antrum was severely hypoplastic or absent in 50%. Similarly, the prominence of the horizontal semicircular canal and the short process of the incus were dysplastic in 73% (44/60) and 62% (37/60), respectively.

Conclusions

Mastoid abnormalities are common in BOR syndrome. Restricted transmastoid access and abnormal or absent mastoid landmarks should be anticipated in those patients with BOR who become cochlear implant candidates.

Level of evidence

4.

https://ift.tt/2MYbmVR

Safety of Radiofrequency Ablation for Adenotonsillectomy after Cochlear Implantation

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Matthew C. Gropler, Brittany A. Leader, David J. Brown, James R. Benke, Stephen P. Bowditch, Stacey L. Ishman

Abstract

Objective

While a cadaveric animal study has suggested that radiofrequency ablation can be safely used in patients with cochlear implants, no in vivo studies have been published to confirm that radiofrequency ablation does not alter the integrity of the cochlear implant device.

Methods

Cochlear implant impedance and functional performance were studied through a prospective case series in five children with seven functioning multichannel implants before and after radiofrequency ablation adenotonsillectomy.

Results

There were 4 females and 1 male patient, aged 6 to 10 years (mean 8.5 ± 1.95 years) with 7 functioning implants. Pre- and post-surgical impedance testing revealed all electrodes were within normal operating limits. There was no statistically significant difference between the mean pre and post-operative impedances in 5 of the 7 tested implants (P=0.2-0.8). The other two implants showed statistically significant improvement in impedance values which were not clinically significant (P=0.02 and P<0.001). Speech perception was unchanged as was functional performance for all 7 tested implants.

Conclusions

We found that radiofrequency ablation used in the oropharynx during adenotonsillectomy did not alter the integrity of the cochlear implant devices when assessed using electrode impedance testing, audiometry and speech perception evaluation. These results confirm those reported in previous in vitro studies and confirm the safety of radiofrequency ablation adenotonsillectomy for children who have undergone previous cochlear implant placement.

https://ift.tt/2NqVQyy

Outcomes of cochlear implantations for mumps deafness: A report of four pediatric cases

Publication date: Available online 27 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Masako Katsushika, Akinori Kashio, Erika Ogata, Yusuke Akamatsu, Yujirou Hoshi, Shinichi Iwasaki, Tatsuya Yamasoba

Abstract

Mumps virus occasionally causes bilateral hearing loss. We report 4 cases of bilateral mumps deafness in whom cochlear implantations (CI) were performed. The age at the onset of hearing loss was 1–9 years. CI surgery was performed within 6 months from the onset of hearing loss in 3 cases and after 9 years in the other case, showing good speech perception in the early intervention cases and a poor outcome after later implantation. Early CI surgery is highly recommended in sudden onset deafness by mumps in childhood.

https://ift.tt/2MPWsB5

How to get by with half a loop – An investigation of visual and auditory codes in a case of impaired phonological short-term memory (pSTM)

Publication date: Available online 27 August 2018

Source: Cortex

Author(s): Jeremy J. Tree, David Playfoot

Abstract

In the field of cognitive neuropsychology of phonological short-term memory (pSTM), a key debate surrounds the issue of how impairment on tasks deemed to tap this system imply a dissociable phonological input and output buffer system, with the implication that impairments can be fractionated across disruption to separate functional components (Nickels, Howard, & Best, 1997). This study presents CT, a conduction aphasic who showed no impairment on basic auditory discrimination tasks, but had very poor nonword repetition. Clear-cut examples of such cases are very rare (see Jacquemot, Dupoux & Bachoud-Levi, 2007), and we interpret the case with reference to a pSTM model that includes input and output buffers. The dissociation between performance on auditory phonological tasks and visual phonological tasks we interpret as consistent with disruption to the link from input buffer to output buffer without concurrent damage to connections from output to input. Previous research has also shown that patients with impairments of pSTM can make visual confusions with orthographically presented items in tasks seeking to tap this mechanism (Warrington & Shallice, 1972), which might stem from having an incomplete pSTM loop. In light of this we examined whether CT's ability on tests of ISR was affected by visual orthographic similarity among list items, and this is indeed what we observed. On balance then, CT's overall profile is considered best interpreted with respect to a dual buffer pSTM model (e.g., Vallar & Papagno, 2002).

https://ift.tt/2C3dJCG

Action-related dynamic changes in inferior frontal cortex effective connectivity: a TMS/EEG coregistration study

Publication date: Available online 27 August 2018

Source: Cortex

Author(s): Marco Zanon, Sara Borgomaneri, Alessio Avenanti

Abstract

Humans show exquisite abilities to perform versatile finger movements. The inferior frontal cortex (IFC) plays a pivotal role in the visual control of such movements through connections with other sensorimotor regions. Yet, the dynamics of IFC effective connectivity during action execution are still poorly understood. Using single-pulse TMS and simultaneous EEG recording (i.e., TMS-EEG coregistration), we stimulated the left posterior IFC at rest and during a visuomotor task. We recorded TMS-evoked potentials (TEPs) to assess action-related changes in IFC connectivity and localized their sources using sLORETA. We found two key time windows at ∼60 and ∼80 ms after IFC stimulation in which TEPs were modulated by task conditions in remote electrodes. In the first time window (∼60 ms), action-related changes in TEP amplitudes were observed over frontal and temporo-parietal electrodes, reflecting increased IFC connectivity with fronto-parietal motor areas and decreased IFC connectivity with visual occipito-temporal areas. In the second time window (∼80 ms), action-related TEP increases were observed in frontal, temporal and parietal regions partially overlapping with the default-mode network. No similar effects were observed when TMS was administered over a non-motor control area (the left posterior superior temporal sulcus, STS). These findings highlight dynamic changes in IFC connectivity with motor, sensory and default-mode networks. They suggest sequential stages of task-related changes in IFC connectivity possibly related to controlling and sensing actions and inhibiting default-mode brain activity during motor performance.

https://ift.tt/2ofZTTr

Distinct sensitivities of the lateral prefrontal cortex and extrastriate body area to contingency between executed and observed actions

Publication date: Available online 27 August 2018

Source: Cortex

Author(s): Akihiro T. Sasaki, Yuko Okamoto, Takanori Kochiyama, Ryo Kitada, Norihiro Sadato

Abstract

Detecting relationships between our own actions and the subsequent actions of others is critical for our social behavior. Self-actions differ from those of others in terms of action kinematics, body identity, and feedback timing. Thus, the detection of social contingency between self-actions and those of others requires comparison and integration of these three dimensions. Neuroimaging studies have highlighted the role of the frontotemporal network in action representation, but the role of each node and their relationships are still controversial. Here, we conducted a functional MRI experiment to test the hypothesis that the lateral prefrontal cortex and lateral occipito-temporal cortex are critical for the integration processes for social contingency. Twenty-four adults performed right finger gestures and then observed them as feedback. We manipulated three parameters of visual feedback: action kinematics (same or different gestures), body identity (self or other), and feedback timing (simultaneous or delayed). Three-way interactions of these factors were observed in the left inferior and middle frontal gyrus (IFG/MFG). These areas were active when self-actions were directly fed back in real-time (i.e., the condition causing a sense of agency), and when participants observed gestures performed by others after a short delay (i.e., the condition causing social contingency). In contrast, the left extrastriate body area (EBA) was sensitive to the concordance of action kinematics regardless of body identity or feedback timing. Body identity × feedback timing interactions were observed in regions including the superior parietal lobule (SPL). An effective connectivity analysis supported the model wherein experimental parameters modulated connections from the occipital cortex to the IFG/MFG via the EBA and SPL. These results suggest that both social contingency and the sense of agency are achieved by hierarchical processing that begins with simple concordance coding in the left EBA, leading to the complex coding of social relevance in the left IFG/MFG.

https://ift.tt/2C3e0FI

Refining understanding of working memory buffers through the construct of binding: evidence from a single case informs theory and clinical practice

Publication date: Available online 27 August 2018

Source: Cortex

Author(s): Pierre-Yves Jonin, Clara Calia, Sophie Muratot, Serge Belliard, Quentin Duche, Emmanuel J. Barbeau, Mario A. Parra

Abstract

Binding operations carried out in working memory enable the integration of information from different sources during online performance. While available evidence suggests that working memory may involve distinct binding functions, whether or not they all involve the episodic buffer as a cognitive substrate remains unclear. Similarly, knowledge about the neural underpinnings of working memory buffers is limited, more specifically regarding the involvement of medial temporal lobe structures. In the present study, we report on the case of patient KA, with developmental amnesia and selective damage to the whole hippocampal system. We found that KA was unable to hold shape-colours associations (relational binding) in working memory. In contrast, he could hold integrated coloured shapes (conjunctive binding) in two different tasks. Otherwise, and as expected, KA was impaired on three relational memory tasks thought to depend on the hippocampus that are widely used in the early detection of Alzheimer's disease. Our results emphasize a dissociation between two binding processes within working memory, suggesting that the visuo-spatial sketchpad could support conjunctive binding, and may rely upon a large cortical network including sub-hippocampal structures. By contrast, we found evidence for a selective impairment of relational binding in working memory when the hippocampal system is compromised, suggesting that the long-term memory deficit observed in amnesic patients may be related to impaired short-term relational binding at encoding. Finally, these findings may inform research on the early detection of Alzheimer's disease as the preservation of conjunctive binding in KA is in sharp contrast with the impaired performance demonstrated very early in this disease.

https://ift.tt/2of5k5d

Laryngopharyngeal reflux disease in singers: Pathophysiology, clinical findings and perspectives of a new patient-reported outcome instrument

Publication date: Available online 27 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): J.R. Lechien, A. Schindler, C. Robotti, L. Lejeune, C. Finck

Abstract

Purpose of review

Laryngopharyngeal reflux (LPR) is an inflammatory disease associated with the development of voice disorder and vocal fold lesions. The occurrence of LPR in professional voice users as singers can have a dramatic impact of daily life. The aims of this paper is to review the current literature about the pathophysiological mechanisms underlying the development of voice disorder, especially in singers, and to propose a new patient-reported outcome instrument to assess complaints of these patients.

Recent findings

Many clinical and experimental studies reported that LPR leads to the development of significant macroscopic and microscopic histological changes in the mucosa of the vibratory margin of the vocal folds. Epithelial cell dehiscence, microtraumas, Reinke's space modifications, inflammatory infiltrates, mucosal drying, and epithelial thickening are associated with LPR. These histological changes may modify the biomechanical properties of the vocal fold tissue leading to hoarseness. In practice, singers with LPR may have normal or discretely pathological speaking voice but impaired singing voice (vocal fatigue, hoarseness, and loss of range). To date, the literature about the specific LPR signs and symptoms in singers is almost non-existent. However, singers are at high risk to present LPR because of necessary air support involving higher intra-abdominal pressure, increased stress due to career management and uncomfortable schedules, late meals just before sleep, bad nutrition habits like increased intake of citrus products, fats foods and spicy foods.

Perspectives

The lack of clinical singer-reported outcome instrument may decrease the management of LPR in singers. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS) developed a new instrument to precisely assess symptoms related to LPR in singing voice. This instrument will be validated and could be used in clinical practice in voice centers.

https://ift.tt/2PHIXlg

Left frontotemporal effective connectivity during semantic feature judgments in patients with chronic aphasia and age-matched healthy controls

Publication date: Available online 27 August 2018

Source: Cortex

Author(s): Erin L. Meier, Jeffrey P. Johnson, Swathi Kiran

Abstract

Traditional models of neural reorganization of language skills in patients with chronic stroke-induced aphasia (PWA) propose activation of reperfused or spared left hemisphere tissue results in the most favorable language outcomes. However, these models do not fully explain variable behavioral recovery patterns observed in chronic patients. Instead, investigation of connectivity patterns of critical network nodes may elucidate better-informed recovery models. In the present study, we combined fMRI and dynamic causal modeling (DCM) to examine effective connectivity of a simple three-node left hemisphere network during a semantic feature decision task in 25 PWA and 18 age-matched neurologically intact healthy controls. The DCM model space utilized in Meier, Kapse, & Kiran (2016), which was organized according to exogenous input to one of three regions (i.e., left inferior frontal gyrus, pars triangularis [LIFGtri], left posterior middle temporal gyrus [LpMTG], or left middle frontal gyrus [LMFG]) implicated in various levels of lexical-semantic processing, was interrogated. This model space included all possible combinations of uni- and bidirectional task-modulated connections between LIFGtri, LMFG and LpMTG, resulting in 72 individual models that were partitioned into three separate families (i.e., Family #1: Input to LIFGtri, Family #2: Input to LMFG, Family #3: Input to LpMTG). Family-wise Bayesian model selection revealed Family #2: Input to LMFG best fit both patient and control data at a group level. Both groups relied heavily on LMFG's modulation of the other two model regions. By contrast, between-group differences in task-modulated coupling of LIFGtri and LpMTG were observed. Within the patient group, the strength of activity in LIFGtri and connectivity of LpMTG→LIFGtri were positively associated with lexical-semantic abilities inside and outside of the scanner, whereas greater recruitment of LpMTG was associated with poorer lexical-semantic skills.

https://ift.tt/2wnp3UF

Rhinological observations during a humanitarian mission in a rural sub-Saharan African setting

Publication date: Available online 27 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): R. Késmárszky, T. Hannington, A. Jakkel, G. Szabó

Abstract

Aims

Patients with rhinological symptoms and pathologies represent an important population. Their prevalence in developing areas without ENT care is not well documented. Due to various factors like migration, they may have an influence out of these territories. Our objective was to determine the prevalence and epidemiology of the main rhinological symptoms and pathologies during a humanitarian mission.

Material and methods

Six hundred and seventy nine patients presenting to our general medical consultations were examined. All of them had careful interrogation and a basic ENT check-up. Patient data and correlating photos were registered to be analyzed retrospectively.

Results

The ethnic origins of the patients were different. Most of them were younger than 50 years old. The rhinological problems were amongst the most frequent reasons to consult, the prevalence was higher when secondary findings and complaints were also considered, representing altogether 44 (6.48%) cases.

Conclusion

A high prevalence of rhinological pathologies showing the importance of public health issues, screening and an important need of adapted treatments was found. Due to migration, climatic changes and humanitarian missions, their presentation and incidence may vary. Health care providers and rhinologists need a thorough knowledge of community acquired and tropical pathologies.

https://ift.tt/2wsoF6t

Alpha oscillations reveal implicit visual processing of motion in hemianopia

Publication date: Available online 27 August 2018

Source: Cortex

Author(s): Paolo A. Grasso, Mattia Pietrelli, Marco Zanon, Elisabetta Làdavas, Caterina Bertini

Abstract

After lesion or deafferentation of the primary visual cortex, hemianopic patients experience loss of conscious vision in their blind field. However, due to the spared colliculo-extrastriate pathway, they might retain the ability to implicitly process motion stimuli through the activation of spared dorsal-extrastriate areas, despite the absence of awareness. To test this hypothesis, EEG was recorded from a group of hemianopic patients without blindsight (i.e., who performed at chance in different forced-choice tasks), while motion stimuli, static stimuli or no stimuli (i.e., blank condition) were presented either in their intact or in their blind visual field. EEG analyses were performed in the time-frequency domain. The presentation of both motion and static stimuli in the intact field induced synchronization in the theta band and desynchronization both in the alpha and the beta band. In contrast, for stimuli presented in the blind field, significantly greater desynchronization in the alpha range was observed only after the presentation of motion stimuli, compared to the blank condition, over posterior parietal-occipital electrodes in the lesioned hemisphere, at a late time window (500-800 ms). No alpha desynchronization was elicited by static stimuli. These results show that hemianopic patients can process only visual signals relying on the activation of the dorsal pathway (i.e., motion stimuli) in the absence of awareness and suggest different patterns of electrophysiological activity for conscious and unconscious visual processing. Specifically, visual processing in the absence of awareness elicits an activity limited to the alpha range, most likely reflecting a "local" process, occurring within the extrastriate areas and not participating in inter-areal communication. This also suggests a response specificity in this frequency band for implicit visual processing. In contrast, visual awareness evokes changes in different frequency bands, suggesting a "global" process, accomplished by activity in a wide range of frequencies, probably within and across cortical areas.

https://ift.tt/2NqVCYe

No evidence for enhanced distractor template representation in early visual cortex

Publication date: Available online 27 August 2018

Source: Cortex

Author(s): Reshanne R. Reeder, Christian N.L. Olivers, Michael Hanke, Stefan Pollmann

https://ift.tt/2wlc7P1

History of Eczema is Associated with More Severe Hospital Course in Children Hospitalized for Asthma

Publication date: Available online 27 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Mona Liu, Jay P. Patel, Evie Huang, Peck Y. Ong

https://ift.tt/2LzIwX0

Trichotillomania (hair pulling disorder): Clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations

Dermatologic Therapy, EarlyView.


https://ift.tt/2BUrd3v

Cyclosporine for corticosteroid‐refractory acute generalized exanthematous pustulosis due to hydroxychloroquine

Dermatologic Therapy, EarlyView.


https://ift.tt/2PP0AzU

Trichotillomania (hair pulling disorder): Clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations

Dermatologic Therapy, EarlyView.


https://ift.tt/2BUrd3v

Cyclosporine for corticosteroid‐refractory acute generalized exanthematous pustulosis due to hydroxychloroquine

Dermatologic Therapy, EarlyView.


https://ift.tt/2PP0AzU

Role of whole saliva in the efficacy of sublingual immunotherapy in seasonal allergic rhinitis

Publication date: Available online 27 August 2018

Source: Allergology International

Author(s): Takenori Haruna, Shin Kariya, Tazuko Fujiwara, Atsushi Yuta, Takaya Higaki, Pengfei Zhao, Yukiko Ogawa, Kengo Kanai, Yuji Hirata, Aiko Oka, Kazunori Nishizaki, Mitsuhiro Okano

Abstract

Background

The development of methods to predict the clinical effectiveness of sublingual immunotherapy (SLIT) for allergic diseases is a crucial matter. We sought to determine whether whole saliva, which is the first body component that contacts allergen extracts during SLIT, is associated with the clinical effectiveness of SLIT in Japanese cedar pollinosis.

Methods

Blood monocytes or monocytic THP-1 cells were cultured in the presence or absence of either whole saliva or pure saliva with or without treatments including filtration and blockade of TLR2 and/or TLR4 signaling. IL-10 levels in the supernatants were then measured. Whole saliva-induced IL-10 production by THP-1 cells was compared between asymptomatic and disease-onset patients during peak pollen dispersal after SLIT.

Results

Both monocytes and THP-1 cells produced substantial amounts of IL-10 in response to whole saliva. IL-10 production was significantly reduced in response to pure saliva and 0.2 μm-filtered saliva. Simultaneous treatment with polymyxin B and TL2.1, a neutralizing antibody against TLR2, also reduced IL-10 production. IL-10 levels produced by THP-1 cells in response to whole saliva collected prior to SLIT were significantly higher in asymptomatic patients determined by symptom-medication scores than disease-onset patients following SLIT. Such differences were not seen in saliva collected 3 months after the initiation of SLIT or saliva collected during peak pollen dispersal.

Conclusions

Our results provide a basis for why the sublingual route is effective and preferable in allergen immunotherapy. Saliva-induced IL-10 levels produced by THP-1 cells may be a predictive marker for clinical remission after SLIT.

https://ift.tt/2MYAQlV

Contact hypersensitivity in adolescents

Pediatric Dermatology, EarlyView.


https://ift.tt/2PLBp12

Globus Pallidus Internal Deep-Brain Stimulation in a Patient with Neuroacanthocytosis with Drug-Induced Parkinsonism

Stereotact Funct Neurosurg

https://ift.tt/2MV7LHZ

Safe Stereotactic Biopsy for Basal Ganglia Lesions: Avoiding Injury to the Basal Perforating Arteries

Background: One of the most serious complications of stereotactic biopsy is postoperative symptomatic hemorrhage due to injury to the basal perforating arteries such as the lenticulostriate arteries neighboring the basal ganglia lesions. Objectives: A new target-planning method was proposed to reduce hemorrhagic complications by avoiding injury to the perforating arteries. Methods: Three-dimensional 3-T time-of-flight (3D 3-T TOF) imaging was applied to delineate the basal perforating arteries such as the lenticulostriate arteries. The incidence of postoperative hemorrhage in basal ganglia cases was compared between a new method using 3D 3-T TOF and a conventional target-planning method based on contrast-enhanced T1-weighted magnetic resonance images obtained by 1.5-T scanning. Results: 3D 3-T TOF imaging could delineate the basal perforating arteries sufficiently in target planning. No postoperative hemorrhage occurred with the new method (n = 10), while 6 postoperative hemorrhages occurred with the conventional method (n = 14). The new method significantly reduced the occurrence of postoperative hemorrhages (p = 0.017). Conclusions: 3D 3-T TOF MR imaging with contrast medium administration provides useful information about the perforating arteries and allows safe stereotactic biopsy of basal ganglia lesions.
Stereotact Funct Neurosurg

https://ift.tt/2Ntj6MG

Primary Bone Marrow B-Cell Lymphoma Undetected by Multiple Imaging Modalities That Initially Presented with Hypercalcemia.

Primary Bone Marrow B-Cell Lymphoma Undetected by Multiple Imaging Modalities That Initially Presented with Hypercalcemia.

Case Rep Endocrinol. 2018;2018:7676580

Authors: Yoo JS, Kim J, Kwon HJ, Lim JS

Abstract
Purpose: We report a rare case of severe hypercalcemia that was ultimately diagnosed as primary bone marrow diffuse large B-cell lymphoma (BCL).
Case Report: A 74-year-old male patient visited our hospital complaining of tenderness and swelling of the left knee caused by supracondylar fracture of the left distal femur. His initial blood tests showed a serum calcium level of 13.9 mg/dL, inorganic phosphorus of 4.34 mg/dL, and a serum creatinine level of 1.54 mg/dL. A serum assay of intact parathyroid hormone showed 5.24 pg/mL, and the patient's serum 25(OH)D level was 22.33 ng/mL. To exclude malignancy, we performed imaging studies, including abdomen or chest computed tomography and positron emission tomography-computed tomography; however, no suspicious lesion was found, although the serum PTH-related peptide level was elevated at 4.0 pmol/L. A bone marrow biopsy was performed to identify any hidden hematologic malignancy. As a result, the pathology of bone marrow confirmed the presence of atypical lymphocytes that stained positive for the CD20 marker, which is consistent with BCL involving the bone marrow.
Conclusion: This case highlights the importance of pursuing a thorough workup for rare underlying causes of hypercalcemia when parathyroid-related etiologies can be excluded.

PMID: 30147967 [PubMed]

https://ift.tt/2PdwXXD

Catecholamine-Synthesizing Enzymes in Pheochromocytoma and Extraadrenal Paraganglioma

Abstract

In chromaffin cells, tyrosine hydroxylase (TH), aromatic l-amino acid decarboxylase (AADC), dopamine β-hydroxylase (DBH), and phenylethanolamine N-methyltransferase (PNMT) are mainly involved in catecholamine synthesis. In this study, we evaluated the association between the status of catecholamine-synthesizing enzymes and histopathological features of pheochromocytoma and extraadrenal paraganglioma with special emphasis upon their postoperative clinical behavior. Immunohistochemical evaluation of TH, DBH, AADC, PNMT, Ki 67, and S-100 was performed in 29 pheochromocytoma and 10 extraadrenal paraganglioma and one lymph node harboring metastatic pheochromocytoma. Among these cases, metastasis was subsequently developed in three cases. Urinary normetanephrine (U-NM) levels were significantly higher in clinical metastatic cases than non-metastatic ones. Ki 67 labeling index was significantly higher in both clinical metastatic cases and the Adrenal Gland Scaled Score (PASS) score of ≧ 4 cases than PASS < 4 cases, although this score was originally used in pheochromocytoma. H-score of AADC and DBH were significantly lower in PASS ≧ 4 cases than those with < 4 cases, and in the cases associated with intratumoral necrosis (n = 4), the presence of spindle shaped tumor cells (n = 4), and large nests of cells or diffuse growth (n = 5). Lower status of intratumoral AADC could be related to poor differentiation of tumor cells in both catecholamine production and morphology and could be related to aggressive biological behavior of both pheochromocytoma and extraadrenal paraganglioma.

https://ift.tt/2BQj8wy

Traumatic Epiglottitis following a Blind Insertion of the Hand during Convulsion

Traditionally, it has been recommended that first-responders should place chopsticks or their hand in a child's mouth to prevent the child from biting their tongue during convulsion. The practice persists locally in parts of Japan and can cause adverse events. We report a traumatic epiglottitis following the thrusting of a guardians' hand into a 13-month-old girl's mouth to prevent her from biting her tongue.

https://ift.tt/2BVza8A

Effect of some osmoregulators on photosynthesis, lipid peroxidation, antioxidative capacity, and productivity of barley ( Hordeum vulgare L.) under water deficit stress

Abstract

Water deficit stress is an abiotic stress that causes reductions in growth and yield of many field crops around the world. The present research was aimed to elucidate the mitigating efficiency of exogenous application of select osmoregulators and biostimulants, i.e., potassium dihydrogen phosphate, actosol® (humic acid), Amino more (amino acids), and Compound fertilizer, applied as a spray that reached both foliage and the soil, on growth characteristics, antioxidant capacity, and productivity of barley (Hordeum vulgare L. Giza123) under water deficit stress during two successive growing seasons of field experiments in Egypt. Water deficit resulted in stress as estimated by stress indicators and decreased growth and poor health and development as reflected in statistically significant decreases in chlorophyll a and b and major nutrient (NPK) levels in tissues, stem length, number of leaves, and fresh and dry mass as well as yield components such as spike length, grains per spike, biological yield, grain yield, and 1000-grain weight. As a response to water deficit stress, reactive oxygen species (ROS, i.e., superoxide and hydrogen peroxide) levels increased significantly resulting in lipid peroxidation and decreased membrane integrity and significant increases in antioxidant enzymes such as catalase (CAT), polyphenol oxidase (PPO), and peroxidase (POX). All four treatments alleviated the detrimental impacts of water deficit stress as evidenced by statistically significantly increased photosynthetic pigment concentration, tissue NPK levels, growth, and yield parameters compared to the water deficit-stressed control, while the stress responses were significantly reduced. The osmoregulators used either partially restored the growth and yield of osmotic-stressed barley plants or certain treatments enhanced them. All osmoregulators tested mitigated the adverse impacts of water deficit stress on barley plants, but the highest induction was found when plants were treated with actosol®. The beneficial effects of the osmoregulators tested were the strongest overall in the order actosol® ˃ potassium dihydrogen phosphate ˃ Amino more ˃ Compound fertilizer.

https://ift.tt/2MzarMi

Methylmercury exposure develops atherosclerotic risk factors in the aorta and programmed cell death in the cerebellum: ameliorative action of Celastrus paniculatus ethanolic extract in male Wistar rats

Abstract

Methylmercury (MeHg) is a bioaccumulative global environmental contaminant present in fishes and seafood. MeHg is the methylated form of mercury emitted from diverse anthropogenic and natural sources. MeHg is accumulated in the aquatic environment and eventually reaches human system via food chain by biomagnification. We have reported previously that the neurotoxic effect of MeHg in rat cerebellum is mitigated by the administration of an ayurvedic medicinal plant, Celastrus paniculatus ethanolic extract. The present study has focussed to further explore the mechanism of action of Celastrus paniculatus against MeHg-induced neurotoxicity in the cerebellum. We have also inspected the effect of Celastrus paniculatus (CP) against MeHg-induced atherosclerotic risk factors like alterations in antioxidant levels, aortic lipid profile, and aortic histology by MeHg in the largest vasculature, aorta, which are the initiating factors of cardiovascular diseases. Male Wistar rats were divided as (i) control, (ii) MeHg (5 mg/kg b.w.), (iii) MeHg + CP (200 mg/kg b.w.), and (iv) CP alone (200 mg/kg b.w.). All were given orally for 21 days. In cerebellum Celastrus paniculatus, there were increased mitochondrial electron transport chain (p < 0.05) activity, reduced cytochrome c release (p < 0.05), and caspase 3 mRNA expression (p < 0.05). In the aorta, MeHg-induced oxidative stress, lipid profile changes, and endothelial denudation were ameliorated by Celastrus paniculatus. Hence, we conclude that Celastrus paniculatus protects against MeHg toxicity by inhibiting mitochondrial cytochrome c/caspase 3 apoptotic pathway in the cerebellum and reducing the development of atherosclerotic risk factors in the aorta.

https://ift.tt/2BTAWa9

Toxic metals in Perna viridis mussel and surface seawater in Pasir Gudang coastal area, Malaysia, and its health implications

Abstract

Contamination of toxic metals in P. viridis mussels has been prevalently reported; hence, health risk assessment for consuming this aquaculture product as well as the surrounding surface seawater at its harvesting sites appears relevant. Since Kampung Pasir Puteh, Pasir Gudang is the major harvesting site in Malaysia, and because the last heavy metal assessment was done in 2009, its current status remains unclear. Herein, flame atomic absorption spectrometry and flow injection mercury/hydride system were used to determine the concentrations of Pb, Cd, Cu and total Hg in P. viridis mussels and surface seawater (January–March 2015), respectively. Significantly higher concentrations of these metals were found in P. viridis mussels (p < 0.05) than that of surface seawater samples. The concentrations for Pb (4.27–6.55 μg/g) and Cd (1.55–2.21 μg/g) in P. viridis mussels exceeded the maximum permitted proportion prescribed by the Malaysian law. The concentrations of all metals in surface seawater also violated the Malaysia Marine Water Quality Criteria and Standards. Significant (p < 0.05) and high strength of association (r = 0.787) observed between Pb concentration in P. viridis mussel with the surface seawater indicates its possible application for inferring Pb concentrations in the mussel. Since both the calculated target hazard quotient and hazard index for Pb and Cd exceeded 1, the possible detrimental health impacts on human for consuming P. viridis mussels from this rearing site cannot be ignored. Hence, promoting continuous monitoring programmes and developing efficient toxic metal removal techniques prior to entering the market are required.

https://ift.tt/2POdG0i

Dynamic transport of antibiotics and antibiotic resistance genes under different treatment processes in a typical pharmaceutical wastewater treatment plant

Abstract

The propagation of antibiotic resistance is a challenge for human health worldwide, which has drawn much attention on the reduction of the resistance genes. To understand their occurrence during different treatment processes, in this study, four classes of antibiotics (tetracyclines, sulfonamides, quinolones, and macrolides), eight antibiotic resistance genes (ARGs) (tetB, tetW, sul1, sul2, gyrA, qepA, ermB, and ermF), and two mobile elements (int1 and int2) were investigated in a typical pharmaceutical plant. The total concentrations of antibiotics were detected in the range of 2.6 × 10² to 2.5 × 10³ ng/L in the treatment processes, and the high abundance of ARGs was detected in the biological treatment unit. The dynamic trend analysis showed that antibiotics were partially removed in the anaerobic/aerobic processes, where ARGs were proliferated. The abundance of tetB and gyrA genes was positively correlated with pH and EC (p < 0.05), and the tetW, sul1 and sul2 genes were significantly correlated with TOC, TN, and DO (p < 0.05), indicating the influence of physicochemical properties of the solution on the levels of ARG subtypes. The phylogenetic analysis showed that the tetW clones had high homology with some pathogenic microorganisms, such as Klebsiella pneumonia and Neisseria meningitides, which would threaten human health. Results indicated that the horizontal transfer acted as a major driver in the ARGs evolution.

https://ift.tt/2BTAEjz