Head and Neck Diseases by Alexandros G.Sfakianakis: 09/20/18

Πέμπτη 20 Σεπτεμβρίου 2018

Genetics of perioperative pain management

Purpose of review The current review will discuss the current literature on genetics of pain and analgesia, with special emphasis on perioperative setting. We will also discuss pharmacogenetics-based management guidelines, current clinical status and future perspectives. Recent findings Recent literature suggests that the interindividual variability in pain and postoperative analgesic response is at least in part because of one's genetic make-up. Some of the well characterized polymorphisms that are associated with surgical pain and opioid-related postoperative adverse outcomes are described in catechol-O-methyl transferase, CYP2D6 and μ-opioid receptor (OPRM1), ATP-binding cassette subfamily B member 1, ABCC3, organic cation transporter 1 genes. Clinical Pharmacogenetics Implementation Consortium has put forth recommendations on CYP2D6 genotype-based opioid selection and dosing. The list of drug–gene pairs studied continue to expand. Summary Pharmacogenetic approach marks the dawn of personalized pain medicine both in perioperative and chronic pain settings. Correspondence to Senthilkumar Sadhasivam, MD, MPH, Gopal Krishna Professor and Chief of Anesthesia, Department of Anesthesia, Riley Hospital for Children at Indiana University Health, RH 2835, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA. Tel: +1 317 948 3845; fax: +1 317 944 0282; e-mail: ssadhasivam@iuhealth.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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False negative computed tomography scan due to pelvic binder in a patient with pelvic disruption: a case report and review of the literature

Pelvic binders are routinely used in the prehospital setting for stabilization of pelvic injuries in patients with trauma. Emergency department trauma management relies on primary and secondary survey assessme...

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Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Treatment-free survival, which is living without the need for treatment for recurrent cancer, is an important outcome for thyroid cancer patients. The goal of this study was to understand factors associated with treatment-free survival in the general population, because this will enable the care teams to tailor long term follow up to a particular situation, and, many times, help decrease patient worry. Read More…

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Clinical Thyroidology®for the Public – Highlighted Article

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

Feedback & Suggestions

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

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Is skip metastases associated with tumor thickness and tumor size in tongue carcinoma patients?

Abstract

Objective

To assess the correlation of skip metastases associated with increase in tumor thickness and size of the tumor.

Material and methods

A retrospective analysis was carried out from August 2009 to August 2015. In this study, a total number of 33 carcinoma tongue patients having T1, T2, and T3 sizes with N0 and N+ clinical necks who were treated by supraomohyoid neck dissection, extended supraomohyoid neck dissection, and modified radical neck dissection were analyzed. The data was assessed using Shapiro-Wilk W test, Nagelkerke R² regression model, mean, and standard deviation.

Results

Metastasis to lymph nodes was present in 75% of patients. Level I and level II were the commonest sites to be involved, i.e., 20 patients. Three patients had skip metastasis out of which two patients had metastasis at level III (6%), and one patient had skip metastasis at level IV (3%).

Conclusion

The incidence of skip metastasis increases with tumor thickness and tumor size in tongue carcinoma patients.

Clinical relevance

The article reveals the positive relationship between tumor thickness, tumor size, and skip metastasis. The analysis shows tumor thickness as a higher predictor for skip metastasis with odds ratio of 5.5 compared to the tumor size having odd ratio 2.

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Changes in Serum Immunoglobulin G4 Levels in Patients with Newly Diagnosed Graves’ Disease

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0669-9333

Objective Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated condition that can affect almost any organ. We investigated the association between IgG4-RD and the main characteristics of Graves' disease (GD) at the time of diagnosis. Additionally, we evaluated whether serum IgG4 levels change during treatment. Design and patients Twenty-eight patients with newly diagnosed GD were enrolled into this longitudinal follow-up study. Serum IgG4 levels and thyroid function were measured in all the participants at the time of diagnosis. Further, the serum IgG4 levels of nine of 28 patients with untreated GD were measured after the achievement of euthyroid state (through the use of methimazole). Results Two (7.1%) of 28 patients with untreated GD had elevated serum IgG4 levels of >135 mg/dL. There was no significant difference in the average IgG4 levels before and after the achievement of euthyroid state (66.2±74.0 mg/dL vs. 50.5±47.3 mg/dL). In two patients, the elevated serum IgG4 levels returned to normal after treatment. However, one patient had an elevated serum IgG4 level of 136.6 mg/dL after treatment. Conclusions This study showed that serum IgG4 levels varied with treatment in patients with GD, independent of thyroid function, suggesting that IgG4 might be indirectly related to GD.
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Altered TEG Parameters Identify Hypercoagulablilty and are of Diagnosis Value for Papillary Thyroid Carcinoma Patients

04-2018-0171-endo_10-1055-a-0723-3295-1.

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0723-3295

Objective The goal of this study was to clarify the changes and clinical significance of thromboelastography (TEG) parameters in papillary thyroid carcinomas and nodular goiters. Methods 62 nodular goiter (NG) patients and 53 papillary thyroid carcinoma (PTC) patients were included. Coagulation indicators, together with a series of TEG parameters were collected and analyzed, compared with results of 61 healthy controls (HC). Correlation analysis was conducted between routine coagulation indicators and TEG parameters. ROC curves were used to evaluate the potential diagnosis value of the TEG parameters that were altered in papillary thyroid carcinoma patients. Results APTT and PT in papillary thyroid carcinoma group were statistically significant higher than that in control group (p<0.05). MPV was found to be higher in PTC than NG and healthy controls.R, K and SP levels were significantly lower in PTC group than that in HC group; Angle, CI and TPI levels were significantly higher in PTC group than that in HC group. Areas under the ROC curve of CI, TPI, and angle were 0.725, 0.714, and 0.687 for distinguishing PTC from HC, 0.662, 0.668 and 0.591 for distinguishing PTC from NG. Conclusion TEG parameters are altered and indicate hypercoagulablilty status of papillary thyroid carcinoma patients; CI, TPI, and angle could be potential diagnosis indicators for detecting papillary thyroid carcinoma.
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Changes in Oxidized Low-Density Lipoprotein Rather Than in Paraoxonase1 are Associated with Changes in the Leptin/Leptin Receptor Ratio in Obese Children During Weight-Loss Therapy

08-2017-0337-endo_10-1055-a-0723-3951-1.

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0723-3951

Background Oxidative stress and impaired production of adipokines in childhood obesity contribute to the development of obesity-related disorders. We assessed whether weight loss after lifestyle intervention alters biomarkers of oxidant/antioxidant status, and whether these alterations are associated with changes in anthropometric parameters and adipokines in obese children. Materials and Methods We determined oxidized low-density lipoprotein (ox-LDL), anti ox-LDL, paraoxonase1 (PON1), leptin, soluble leptin receptor (sOB-R), total adiponectin, high molecular weight adiponectin concentrations and body composition (by dual-energy X-ray absorptiometry) in 60 prepubertal obese children (Body Mass Index, BMI Z-score>2) before and after a 3-month intervention. The control group consisted of 44 non-obese children (BMI Z-score<−1+1>). Results Ox-LDL, ox-LDL/LDL, and anti ox-LDL concentrations as well as leptin to sOb-R ratio were reduced (p<0.001; p=0.018; p<0.001; p<0.001, respectively) in obese children with weight loss (BMI Z-score change≤−0.5) after a 3-month therapy. These parameters were stable in the obese group without weight loss (BMI Z-score change>−0.5). Changes in ox-LDL and PON1 levels in all obese children correlated positively with changes in the leptin to sOB-R ratio (r=0.400, p=0.002; r=0.304, p=0.028, respectively). After adjustment for changes in BMI Z-score in the multivariate regression model, the association between the changes in ox-LDL levels and changes in the leptin/sOb-R ratio remained statistically significant (β=0.184, p=0.014). Conclusions We found out that a 3-month lifestyle intervention associated with weight loss improves the oxidant/antioxidant balance and promotes anti-atherogenic changes in prepubertal obese children in a way dependent on the alterations in the leptin to sOB-R ratio.
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Article in Thieme eJournals:
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Lipid Level Related with Osteoporosis in Type 2 Diabetes Patients

04-2018-0163-dia_10-1055-a-0735-9361-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0735-9361

Objective Osteoporosis is a systemic skeletal disorder characterizedby reduced bone mass, deteriorated bone structure. Various studies have tried to evaluate the association between lipid level and osteoporosis, but the results were proved to be controversial. The objectives of this study are to assess the correlation between BMD and serum lipid levels, to determine independent variables associated with osteoporosis and osteopenia in men and postmenopausal women with type 2 diabetes (T2D). Materials and methods All participants of the study were carried out biochemical analysis of blood and the analysis of the lipid profile that included total cholesterol (TC) and triglyceride (TG). Physical examination and dual-energy X-ray absorptiometry examination were performed. Multiple linear regression and multivariate logistic regression were used to evaluate associations between serum TC and TG levels and the osteoporosis or osteopenia. Results The level of serum TG was directly correlated with BMD at the lumbar spine in all patients in multiple linear regression models. After adjusting for potential confounding factors, decreased level of serum TG was independent risk factor for osteoporosis(p=0.022) in T2D patients. It also showed that a greater BMI was protective factor for osteoporosis (p=0.019) and lower level of β-CTX was an independent risk factor for osteopenia (p=0.008) and osteoporosis (p=0.001) in T2D patients. Conclusion Among Chinese patients with type 2 diabetes, the decreased level of serum TG might indicate a risk of osteoporosis. Further research is needed to confirm the finding and to clarify the contradictions identified.
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Metastatic Phaeochromocytoma: Spinning Towards More Promising Treatment Options

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0715-1888

Phaeochromocytomas (PCC) and paragangliomas (PGL) are rare tumours arising from the chromaffin cells of the adrenal medulla (PCC) or the paraganglia located outside the adrenal gland (PGL). However, their incidence is likely to be underestimated; around 10% of all PCC/PGL are metastatic, with higher metastatic potential of PGLs compared to PCCs. If benign, surgery is the treatment of choice, but if metastatic, therapy is challenging. Here we review the currently existing therapy options for metastatic PCCs/PGLs including conventional chemotherapy (the original Averbuch scheme, but updated), radiopharmaceutical treatments (131I-MIBG, 90Y- and 177Lu-DOTATATE) and novel targeted therapies (anti-angiogenic tyrosine kinase inhibitors and mTORC1 inhibitors), emphasising future therapeutic approaches (HIF-2α and PARP inhibitors, temozolomide alone, metronomic temozolomide, somatostatin analogues) based on the oncogenic signalling pathways related to three different clusters comprising more than 20 well-characterised PCC/PGL susceptibility genes. We suggest that targeted combination therapies including repurposed agents may offer more effective future options worthy of exploration.
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Induction of innate immune memory: the role of cellular metabolism

Jorge Domínguez-Andrés | Leo AB Joosten | Mihai G Netea

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Clinically Relevant Prognostic Parameters in Differentiated Thyroid Carcinoma

Abstract

Although differentiated thyroid carcinomas typically pursue an indolent clinical course, it is important to identify the subset of tumors that are most likely to behave aggressively so that patients with these tumors are counseled and treated appropriately. Extent of disease is fundamental to the prognostication for differentiated thyroid carcinoma; however, there are additional histologic features of the tumor separate from extent of disease that have been shown to affect clinical course. This review will start with a discussion of aggressive variants of papillary thyroid carcinoma, move to the prognostic significance of vascular invasion in follicular thyroid carcinoma, and finish with a discussion of Hürthle cell carcinoma, with an emphasis on why it is not considered a subtype of follicular thyroid carcinoma in the 2017 WHO Classification of Tumors of Endocrine Organs.

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Thyroid® High-Impact Articles

FREE ACCESS through October 2, 2018.

Read now:

Latest Impact Factor: 7.557
The Official Journal of: American Thyroid Association^®

Impact of Hypothyroidism and Heart Failure on Hospitalization Risk
Kevin Ro, Alexander D. Yuen, Lin Du, Clarissa C. Ro, Christian Seger, Michael W. Yeh, Angela M. Leung, and Connie M. Rhee

Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies
Shinje Moon, Min Joo Kim, Jae Myung Yu, Hyung Joon Yoo, and Young Joo Park

Cardiovascular Morbidity and Mortality After Treatment of Hyperthyroidism with Either Radioactive Iodine or Thyroidectomy
Ryödi Essi, Metso Saara, Huhtala Heini, Välimäki Matti, Auvinen Anssi, and Jaatinen Pia

Decreasing Disease-Specific Mortality of Differentiated Thyroid Cancer in Korea: A Multicenter Cohort Study
Min Ji Jeon, Hee Kyung Kim, Eun Heui Kim, Eun Sook Kim, Hyon-Seung Yi, Tae Yong Kim, Ho-Cheol Kang, Young Kee Shong, Won Bae Kim, Bo Hyun Kim, and Won Gu Kim

Incidence and Survival of Thyroid Cancer in Children, Adolescents, and Young Adults in Denmark: A Nationwide Study from 1980 to 2014
Jakob Schmidt Jensen, Christian Grønhøj, Christian Mirian, David Hebbelstrup Jensen, Jeppe Friborg, Christoffer Holst Hahn, Tina Klitmøller Agander, and Thomas Hjuler

Sonographically Estimated Risks of Malignancy for Thyroid Nodules Computed with Five Standard Classification Systems: Changes over Time and Their Relation to Malignancy
Giorgio Grani, Livia Lamartina, Marco Biffoni, Laura Giacomelli, Marianna Maranghi, Rosa Falcone, Valeria Ramundo, Vito Cantisani, Sebastiano Filetti, and Cosimo Durante

Sobetirome and its Amide Prodrug Sob-AM2 Exert Thyromimetic Actions in Mct8-Deficient Brain
Soledad Bárez-López, Meredith D. Hartley, Carmen Grijota-Martínez, Thomas S. Scanlan, and Ana Guadaño-Ferraz

The post Thyroid® High-Impact Articles appeared first on American Thyroid Association.

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Thyroid® High-Impact Articles

FREE ACCESS through October 2, 2018.

Read now:

Latest Impact Factor: 7.557
The Official Journal of: American Thyroid Association^®

Impact of Hypothyroidism and Heart Failure on Hospitalization Risk
Kevin Ro, Alexander D. Yuen, Lin Du, Clarissa C. Ro, Christian Seger, Michael W. Yeh, Angela M. Leung, and Connie M. Rhee

The post Thyroid® High-Impact Articles appeared first on American Thyroid Association.

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Reversible Auricular Necrosis Secondary to Systemic Thrombosis

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

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Nodular Mass in the Upper Lip

A man presents with a firm, painless, slow-growing mass in his upper lip. What is your diagnosis?

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September 2018 Issue Highlights

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Dornase Alfa Ototoxic Effects in Animals and Efficacy for Clogged Tympanostomy Tubes in Children

This pilot study investigates the ototoxic effects of dornase alfa in a chinchilla model and its efficacy vs ofloxacin in a randomized clinical trial of children with clogged tympanostomy tubes.

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Prevalence and Risk Factors for Olfactory Hallucinations in the United States

Olfactory dysfunction can result in substantial reductions in quality of life if left untreated. The presence of phantom smells, or phantosmia, is a clinically distinct olfactory dysfunction where patients sense odors when no odor source is present. The cause of phantosmia is not completely understood and has been most commonly associated with head trauma, psychiatric conditions, chronic rhinosinusitis, epilepsy, and a number of neurologic and neurodegenerative disorders.

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Physician Adherence to Guidelines for Benign Paroxysmal Positional Vertigo in Ambulatory Care Settings

This cohort study uses data from the National Ambulatory Medical Care Survey to evaluate the prevalence of patient visits to ambulatory care clinics for benign paroxysmal positional vertigo and whether physicians' diagnostic and treatment recommendations adhered to clinical practice guidelines over time.

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Association of Cytologically Indeterminate Thyroid Nodule Size With Histologic and Clinical Outcomes

This study assesses the association of indeterminate thyroid nodule size among adults with histologic and clinical outcomes such as cancer rates and response to therapy in considering a surgical approach.

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Errors in Figure 2 and Figure 3

In the Original Investigation titled "Effect of Nitrous Oxide as a Treatment for Subjective, Idiopathic, Nonpulsatile Bothersome Tinnitus: A Randomized Clinical Trial," published online August 2, 2018, there was an error the x-axis label and caption of Figure 2 and the key in Figure 3. In the x-axis, the labels read "Nitrous Oxide First" and "Placebo First." They should have been "Nitrous Oxide" and "Placebo." The caption included expansions of GBS and PI, which should not have been included. In Figure 3, the key indicates 'Nitrous oxide first" and "Placebo first." The key should have been "Nitrous oxide" and "Placebo." This article was corrected online.

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Safety of Drilling 3-Dimensional–Printed Temporal Bones

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

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Revisiting the 2015 American Thyroid Association Guidelines in the NIFTP Era

The incidence of thyroid cancer and subsequent thyroid surgery has increased significantly during the past decade in the United States. Mortality rates have remained unchanged, supporting the widely accepted hypothesis that this finding can, in part, be explained by increased detection of small, nonaggressive nodules, resulting in potential overdiagnosis and treatment.

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

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

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Factors Associated With Phantom Odor Perception Among US Adults

This cross-sectional study of data from the National Health and Nutrition Examination Survey examines the prevalence of phantom odor perception among US adults and evaluates differences by age, sex, socioeconomic position, health status, health behaviors, smell function, and oral and sinonasal symptoms.

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Management of Hoarseness

This guideline summary presents American Academy of Otolaryngology–Head and Neck Surgery recommendations for assessing and treating patients with hoarseness (dysphonia).

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Preoperative Tranexamic Acid for Rhinoplasty

This systematic review and meta-analysis of randomized clinical trials evaluates the preoperative use of tranexamic acid for reduction of bleeding, eyelid edema, and periorbital ecchymosis in patients undergoing rhinoplasty.

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Cocaine-Induced Midline Destructive Lesions and Erosion of the Eustachian Tube

This case report describes a 43-year-old woman with eustachian tube erosion associated with cocaine use.

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Artificial Saliva vs Saline Solution and Suture Degradation in Oropharyngeal Surgery

This in vitro study examines artificial saliva vs saline solution and their association with the strength of common types of absorbable sutures used in oral surgery.

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Pleomorphic Adenoma of the Nasolacrimal Duct

This study describes the case of a man in his 60s with a 2-year medical history of right epiphora with recent 6-week onset of hemolacrima who presented with an incidental soft tissue lesion along the left inferior turbinate with associated nasolacrimal duct dilatation above the mass.

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Device Safety

Medical devices are essential in the diagnosis and treatment of otolaryngologic disease. The US Food and Drug Administration (FDA) is tasked with assuring the safety and effectiveness of these devices. Otolaryngologists, in turn, are often responsible for helping patients understand risks, benefits, and alternatives when deciding whether to rely on devices in their care. To best counsel patients, otolaryngologists should be aware of the strengths and limitations of device regulation by the FDA. This article reviews the FDA regulatory framework for medical devices, premarket evidentiary standards for marketing devices, and postmarket methods of safety surveillance.

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Systems Science

In the 21st century, most medical care is not delivered by a single physician but rather, by a team. A team is a type of system, a set of people and things interacting together for a defined aim. The discipline of systems science concerns itself with how complex teams or organizations function. The application of systems science has had a major positive impact on safety and quality in such diverse disciplines as auto manufacturing, airline safety, and nuclear power generation. A modest understanding of how systems science applies to medical care can help improve safety and quality of care.

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The Impact of Cognitive and Implicit Bias on Patient Safety and Quality

Humans use cognitive shortcuts, or heuristics, to quickly assess and respond to situations and data. When applied inappropriately, heuristics have the potential to redirect analysis of available information in consistent ways, creating systematic biases resulting in decision errors. Heuristics have greater effect in high-pressure, high-stakes decisions, particularly when dealing with incomplete information, in other words, daily medical and surgical practice. This article discusses 2 major categories: cognitive biases, which affect how we perceive and interpret clinical data; and implicit biases, which affect how we perceive and respond to other individuals, and also discusses approaches to recognize and alleviate bias effects.

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The dynamic-lymphaticovenular anastomosis method for breast cancer treatment-related lymphedema: creation of functional lymphaticovenular anastomoses with use of preoperative dynamic ultrasonography

Lymphaticovenular anastomosis (LVA) is generally effective for breast cancer treatment-related upper extremity lymphedema (UEL). Clinical improvement is, however, limited by the degree of sclerosis of the lymphatic vessels. We have developed a method by which we use dynamic ultrasonography to depict vessels through which lymph can be propelled into the LVA under the power of the patient's natural hand movements.

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Adipose-derived regenerative cells and fat grafting for treating breast cancer-related lymphedema: Lymphoscintigraphic evaluation with one year follow-up

Background: Breast cancer-related lymphedema (BCRL) is a feared late complication. Present treatment options are lacking. Recent studies have suggested that mesenchymal stromal cells can alleviate lymphedema. Herein, we report the results from the first human pilot study with adipose-derived regenerative cells (ADRC) for treating BCRL with one year follow-up. Material and methods: We included ten BCRL patients. ADRCs were injected directly into the axillary region together with a scar releasing fat graft procedure.

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Outcomes of shoulder abduction after nerve surgery in patients over 50 following traumatic brachial plexus injury

There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients as it is felt that outcomes are poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 and factors related to success.

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Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects

Full thickness skin grafts (FTSGs) and flaps from the upper eyelid or cheek can be used for reconstruction of lower eyelid defects, including the anterior lamella. However, the upper eyelid has a limited and insufficient amount of skin, while cheek flaps have a restricted arch of rotation. Here we report the procedure and outcomes of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects including the anterior lamella.A retrospective study of 12 patients who underwent treatment for eyelid anterior lamella defects with perforator/subcutaneous pedicled propeller flaps was conducted between March 2015 and June 2017.

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Predictors of complications following breast reduction surgery: A national surgical quality improvement program study of 16812 cases.

Breast reduction is one of the most common procedures performed by plastic surgeons. Despite good outcomes and high patient satisfaction, there is little national data examining the predictors leading to complications in this patient population. We accessed a national outcomes database to examine these factors.

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A Critical Need: Increasing Interest in the Field of Allergy and Immunology in Medical Students and Residents

It is vital for any field in medicine to attract the best and brightest learners to ensure that the specialty continues to provide outstanding clinical care and cutting-edge research. This is especially true for the field of Allergy and Immunology (AI) as graduates of AI training programs have a very large depth and breadth of environments in which to practice, from private practice to faculty at a large tertiary care medical center to working in industry, integrated healthcare organizations, or for the government.

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Omalizumab as single-dose therapy for vernal keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a bilateral inflammatory ocular condition often brought on by an allergic response. Patients with VKC commonly exhibit ocular symptoms such as photophobia, redness of the eyes, itching, discharge, and lacrimation, which can have profound effects on quality of life. The pathogenesis of the disease is both immunoglobulin E (IgE) and non-IgE mediated, invoking several hypersensitivity mechanisms. The treatment for VKC is mainly centered on symptom control with the use of antihistamines, calcineurin inhibitors, and corticosteroids.

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Current State and Future of Biologic Therapies in the Treatment of Asthma in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 119-131, September 2018.

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Asthma Guidelines Priority Topic: Long-Acting Anti-Muscarinic Agents in Asthma Management as Add-On to Inhaled Corticosteroids

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 199-203, September 2018.

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Bethanechol in Tracheomalacia: Two Case Series and a Review of the Literature

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 180-183, September 2018.

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Allergic Diseases and Immune-Mediated Food Disorders in Pediatric Acute-Onset Neuropsychiatric Syndrome

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 158-165, September 2018.

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Minocycline-Induced Eosinophilic Pneumonia in a Pediatric Patient

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 194-198, September 2018.

https://ift.tt/2xtLfNo

Bethanechol in Tracheomalacia: Two Case Series and a Review of the Literature

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 180-183, September 2018.

https://ift.tt/2DeFMzi

Minocycline-Induced Eosinophilic Pneumonia in a Pediatric Patient

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 194-198, September 2018.

https://ift.tt/2DhdULa

Current State and Future of Biologic Therapies in the Treatment of Asthma in Children

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 119-131, September 2018.

https://ift.tt/2NoGIG2

Asthma Guidelines Priority Topic: Long-Acting Anti-Muscarinic Agents in Asthma Management as Add-On to Inhaled Corticosteroids

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 199-203, September 2018.

https://ift.tt/2NoGGxU

Allergic Diseases and Immune-Mediated Food Disorders in Pediatric Acute-Onset Neuropsychiatric Syndrome

Pediatric Allergy, Immunology, and Pulmonology, Volume 31, Issue 3, Page 158-165, September 2018.

https://ift.tt/2Nuq8Vc

Dickkopf-1 (Dkk1) protein expression in breast cancer with special reference to bone metastases

Abstract

Dysregulation of the Wnt inhibitor dickkopf-1 protein (Dkk1) has been reported in a variety of cancers. In addition, it has been linked to the progression of malignant bone disease by impairing osteoblast activity. This study investigated serum- and tissue levels of Dkk1 in breast cancer patients with- or without bone metastases. Serum Dkk1 levels were measured by ELISA in 89 breast cancer patients and 86 healthy women. Tissue levels of Dkk1 and β-catenin, a major downstream component of Wnt transduction pathway, were tested with immunohistochemical staining in 143 different tissues, including adjacent non-tumoral breast tissues, primary breast tumours, lymph nodes metastases, and bone metastases. Serum levels of Dkk1 were significantly increased in breast cancer patients without metastases compared with healthy controls and even more increased in patients with bone metastases. Tissue expression of Dkk1 was positive in 70% of tested primary breast cancer tissues and demonstrated significant correlation with histological type and PR status. Less frequent expression of Dkk1 was found in lymph nodes metastases and bone metastases compared with adjacent non-tumoral breast tissues and primary breast tumours. Tissue expression of β-catenin was positive in the vast majority of all tested tissue types indicating activated Wnt/β-catenin signalling. Our results suggested that Wnt/β-catenin signalling in breast tumours and their secondary lymph nodes- and bone metastases is dysregulated and this could be related to aberrant Dkk1 expression levels. Hence, Dkk1 protein might provide insights into the continued development of novel comprehensive and therapeutic strategies for breast cancer and its bone metastases.

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An Evolutionary Perspective on the Obesity Epidemic

Publication date: Available online 19 September 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Z. Hochberg

An evolutionary approach to obesity involves a genomic/anthropological dimension. For 1.8 Myr the lifestyle of hunter-gatherers (HGs) comprised intense physical activity and a high-protein/low-carbohydrate diet. Genomes of HGs were adapted to low insulin sensitivity. When the agrarian epoch began a new 'farmer diet' high in carbohydrates (CHO) emerged. Owing to periodic famines, the genome may not have adapted; they preserved a HG genome. Ever since the industrial revolution our genome is adapting rapidly to a CHO-rich diet. Individuals with preserved HG genome develop obesity at age 4–8 years and need a low-CHO diet. By contrast, those with a farmer genome become obese in infancy; they need a low-calorie diet. This knowledge prompts exploration of the two genomes and their clinical presentations.

https://ift.tt/2xr6z6b

On the influence of wetting behaviour on relaxation of adsorbed liquids – A combined NMR, EPR and DNP study of aged rocks

Publication date: Available online 20 September 2018

Source: Magnetic Resonance Imaging

Author(s): Bulat Gizatullin, Igor Shikhov, Christoph Arns, Carlos Mattea, Siegfried Stapf

Abstract

The influence of wettability modification in natural rocks has been studied by means of NMR relaxation dispersion of water and several organic liquids, employing ¹H, ¹⁹F and ²H relaxometry. Berea, Bentheimer and chalk were aged with a bitumen solution, altering the samples from water-wet to mixed-wet. Relaxation measurements were supported by EPR and DNP experiments which are sensitive to bulk radicals and interfacial radicals, respectively. The effect of ageing on relaxation was found to be twofold: first, the change from water-wet to oil-wet affects the dynamics of molecules differently, in particular their immediate interaction with the surface, which is reflected in their relaxation times; second, the bitumen cover includes paramagnetic impurities which act as additional relaxation sinks to all molecules. EPR was used to confirm the amount of deposited material and the total radical content of the rock samples, whereas DNP revealed a small but significant signal enhancement due to the surface-bound bitumen containing stable radicals. The DNP enhancement is dominated by the Solid Effect despite the low viscosity of the interacting fluids.

https://ift.tt/2pmcuVU

Non-destructive analysis of polymers and polymer-based materials by compact NMR

Publication date: Available online 20 September 2018

Source: Magnetic Resonance Imaging

Author(s): Alina Adams

Abstract

Low-field nuclear magnetic resonance (NMR) based on permanent magnet technologies is currently experiencing a considerable growth of popularity in studying polymer materials. Various bulk properties can be probed with compact NMR tabletop instruments by placing the sample of interest inside the magnet. Contrary to this, compact NMR sensors with open geometries give access to depth-dependent properties of polymer samples and objects of different sizes and shapes truly non-destructively by performing measurements in the inhomogeneous stray-field outside the magnet system. Some of the sensors are also portable being thus well suited for onsite measurements. The gain of both bulk and depth-dependent microscopic properties are important for establishing improved structure-property relationships needed for the rational design of new polymer formulations. Selected recent applications will be presented to illustrate this potential of compact NMR.

https://ift.tt/2MUKjqw

Diffusion of water in industrial cement and concrete

Publication date: Available online 19 September 2018

Source: Magnetic Resonance Imaging

Author(s): Marc Fleury, Guillaume Berthe, Thibaud Chevalier

Abstract

We propose a deuterium diffusion tracer approach to measure diffusion coefficient in the case of very short NMR relaxation times, too short for NMR pulsed field gradient sequences (T₁ or T₂ below 1 ms). We also treat the case of porous media containing metallic fibers (such as reinforced concrete) strongly disturbing the magnetic field, and the case of inhomogeneous porous media containing large non porous granulates. For the latter, we propose a hollow geometry maximizing the investigated volume and minimizing the experimental time. The method is a 3D diffusion technique in which samples are immersed in deuterium and the water content inside the sample is monitored as a function of time. Water diffusing outside the sample with very long relaxation times can be subtracted either from T₂ relaxation time distribution or not polarizing these components using a short repeat delay. Using analytical formulations describing the concentration of a tracer diffusing out of a cylinder or a hollow cylinder, we can calculate the corresponding pore diffusion coefficient.

https://ift.tt/2pnzfss

The comparison of the performance of 3 T and 7 T T2 mapping for untreated low-grade cartilage lesions

Publication date: Available online 19 September 2018

Source: Magnetic Resonance Imaging

Author(s): Vladimir Juras, Markus Schreiner, Didier Laurent, Štefan Zbýň, Vladimir Mlynarik, Pavol Szomolanyi, Benedikt Hager, Celeste Scotti, Jörg Goldhahn, Rahel Heule, Oliver Bieri, Siegfried Trattnig

Abstract

Objective

To investigate T₂ mapping as a possible marker for low-grade human articular cartilage lesions during a one-year follow-up, possible changes during the follow-up and compare the reliability and sensitivity of these measurements on high-field (3 T) and ultra-high-field (7 T) MRI scanners.

Design

Twenty-one patients with femoral, tibial and patellar cartilage defect in the knee joint participated in the study. The MRI protocol consisted of morphological, as well as three-dimensional triple-echo steady-state (3D-TESS) T₂ mapping sequences with similar parameters at 3T and 7T. Patients were scanned at five time-points up to 12 months. T₂ values were evaluated in the lesion and healthy-appearing regions for superficial and deep cartilage zone. The repeated ANOVA was used to determine differences in T₂ values at various time points.

Results

A significant decrease in T₂ values was observed between baseline and six months in the superficial layer of the lesion in patients at 3 T (decrease from 41.89 ± 9.3 ms to 31.21 ± 7.2 ms, which is a difference of −5.67 ± 2.2 ms (p = 0.031)), and at 12 months in the superficial layer of the lesion in patients at 3 T (decrease from 41.89 ± 9.3 ms to 35.28 ± 4.9 ms, which is a difference of −6.60 ± 4.4 ms (p = 0.044). No significant differences were recorded at 7 T.

Conclusion

The change in T₂ values acquired with 3 T 3D-TESS appears to be reflecting subtle changes of cartilage composition in the course of low-grade lesion development. 7 T T₂ mapping does not reflect these changes probably due to completely decayed short T₂ component.

https://ift.tt/2MSbstU

Compressive sensing image recovery using dictionary learning and shape-adaptive DCT thresholding

Publication date: Available online 19 September 2018

Source: Magnetic Resonance Imaging

Author(s): Dong Du, Zhibin Pan, Penghui Zhang, Yuxin Li, Weiping Ku

Abstract

Compressed sensing (CS) has shown to be a successful technique for image recovery. Designing an effective regularization term reflecting the image sparse prior information plays a critical role in this field. Dictionary learning (DL) strategy alleviates the drawback of fixed bases. But the structure information of the image is easy to be blurred in complex regions due to the absence of sparsity in dictionary learning. This paper proposes a novel joint dictionary learning and Shape-Adaptive DCT (SADCT) thresholding method. We first propose to exploit sparsity of image in shape-adaptive regions, which is beneficial to medical images of complex textures. In this framework, the local sparsity depicts the smoothness redundancies exploited by dictionary learning. Moreover, the sparsity is enhanced especially in detail areas by the newly introduced SADCT thresholding. The attenuated SADCT coefficients are used to reconstruct a local estimation of the signal within the adaptive-shape support. Image is represented sparser in SADCT transform domain and the details of the image information can be kept with a much larger probability. Based on split Bregman iterations, an efficient alternating minimization algorithm is developed to solve the proposed CS medical image recovery problem. The results of various experiments on MR images consistently demonstrate that the proposed algorithm efficiently recovers MR images and shows advantages over the current leading CS reconstruction approaches.

https://ift.tt/2prjuAW

JESREC score and mucosal eosinophilia can predict endotypes of chronic rhinosinusitis with nasal polyps

Publication date: Available online 19 September 2018

Source: Auris Nasus Larynx

Author(s): Tsuguhisa Nakayama, Naoki Sugimoto, Naoko Okada, Tadao Tsurumoto, Ryoto Mitsuyoshi, Shinya Takaishi, Daiya Asaka, Hiromi Kojima, Mamoru Yoshikawa, Yasuhiro Tanaka, Shin-ichi Haruna

Abstract

Objective

Recently, JESREC score and mucosal eosinophil count have been used to diagnose eosinophilic chronic rhinosinusitis (ECRS) in Japan. However, it remains unknown whether the subtypes of CRS diagnosed by these criteria have different endotypes. In the present study, we investigated whether JESREC score and mucosal eosinophil count were appropriate for classification of CRS subgroups into endotypes.

Methods

A cross-sectional study involving 71 consecutive patients with CRS with nasal polyps (CRSwNP) and 13 control patients was performed. Nasal polyp tissues from CRSwNP patients and uncinate process tissues from control patients were collected for analysis of inflammatory cells by immunohistochemistry and measurement of cytokines and chemokines by ELISA and quantitative real-time PCR. We compared the differences between subtypes according to JESREC score and mucosal eosinophil count and investigated the subgroups with different endotypes by cluster analysis and principal component analysis.

Results

In the 71 CRSwNP patients, 9 patients had JESREC score <11 and mucosal eosinophil count <70/HPF (Group A), 20 patients had JESREC score ≥11 and mucosal eosinophil count <70/HPF (Group C), and 42 patients had JESREC score ≥11 and mucosal eosinophil count ≥70/high-power field (HPF) (Group D). Semiquantitative analysis of inflammatory cells showed that eosinophils, neutrophils, macrophages, mast cells, and basophils differed significantly between the subgroups. At the mRNA level, CLC, IL5, IL13, CCL11, CCL24, CCL26, POSTN, CSF3, and IL8 showed significant differences. At the protein level, eotaxin-2/CCL24, eotaxin-3/CCL26, and G-CSF had significant differences. Cluster analysis using gene expression levels in 55 CRS patients and 11 control patients revealed that the patients could be classified into five clusters. Cluster 1 (n = 27) contained all patients with Group D. Cluster 2 (n = 11) comprised all control patients. Cluster 3 (n = 4) included mixed subtypes: one with Group A and three with Group D. Cluster 4 (n = 7) and Cluster 5 (n = 17) contained all patients with Groups A and C, respectively. Furthermore, the principal component analysis revealed that the subtypes had different characteristics.

Conclusion

CRS subtypes based on JESREC score and mucosal eosinophil count showed different inflammatory patterns, and unsupervised statistical analyses supported the classification that can predict endotypes. From these results, we concluded that the classification based on JESREC score and mucosal eosinophil count was useful for predicting CRS endotypes.

https://ift.tt/2Dja9F7

A Commentary on Parker Jones et al. on Gall's Cortical Faculties

Publication date: Available online 19 September 2018

Source: Cortex

Author(s): Paul Eling, Stanley Finger

https://ift.tt/2QMMsaQ

Golden oldies and silver brains: Deficits, preservation, learning, and rehabilitation effects of music in ageing-related neurological disorders

Publication date: Available online 19 September 2018

Source: Cortex

Author(s): Teppo Särkämö, Aleksi J. Sihvonen

Abstract

During the last decades, there has been major advances in mapping the brain regions that underlie our ability to perceive, experience, and produce music and how musical training can shape the structure and function of the brain. This progress has fueled and renewed clinical interest towards uncovering the neural basis for the impaired or preserved processing of music in different neurological disorders and how music-based interventions can be used in their rehabilitation and care. This article reviews our contribution to and the state-of-the-art of this field. We will provide a short overview outlining the key brain networks that participate in the processing of music and singing in the healthy brain and then present recent findings on the following key music-related research topics in neurological disorders: (i) the neural architecture underlying deficient processing of music (amusia), (ii) the preservation of singing in aphasia and music-evoked emotions and memories in Alzheimer's disease, (iii) the mnemonic impact of songs as a verbal learning tool, and (iv) the cognitive, emotional, and neural efficacy of music-based interventions and activities in the rehabilitation and care of major ageing-related neurological illnesses (stroke, Alzheimer's disease, and Parkinson's disease).

https://ift.tt/2xxLoPc

The Masked ABR (mABR): a New Measurement Method for the Auditory Brainstem Response

Abstract

The auditory brainstem response (ABR) is relatively non-invasive, and in many species, the only practical way to assess auditory sensitivity. The two main methods for measuring ABR are using either transients or tone bursts as a stimulus. The transient stimulus produces strong neural responses that contain no frequency information. In contrast, tone bursts stimulate only a small part of the auditory system, eliciting weaker neural responses but supplying frequency information. Furthermore, short tone bursts become less and less frequency specific with increasing stimulus wavelength, making them unsuitable for testing low-frequency hearing. Here, we develop a method that can measure sensitivity to both low and high-frequency stimuli. The method is based on masking of a transient response by long-duration sinusoids. The measurement system is developed as a highly portable system that runs on battery power. It has been used in a variety of animals in our lab and in the field, including squid (Mooney et al. in J Exp Biol 213: 3748–3759, 2010), lungfish (Christensen-Dalsgaard et al. in J Neurophys 105: 1992–2004, 2011b), alligators (Bierman et al. in J Exp Biol 217: 1094–1107, 2014), and mink (Brandt et al. in J Exp Biol 216: 3542–3550, 2013). Here, we present data recorded from Tokay geckos and compare the results with tone burst ABR measurements. This method produces results comparable to tone burst stimulations at higher frequencies (above 1 kHz) but has several advantages: it is relatively insensitive to fluctuations in neural signal level, it allows measurements at very low frequencies, it allows constant monitoring of the state of the animal, and can be used to measure directional hearing.

https://ift.tt/2NWjeaR

The Masked ABR (mABR): a New Measurement Method for the Auditory Brainstem Response

Abstract

https://ift.tt/2NWjeaR

Outcomes of Open vs Endoscopic Skull Base Surgery in Older Patients

This cohort study compares outcomes of endoscopic and open skull base surgery to investigate associations between surgical approaches, patient age, disease process, and intraoperative and postoperative complications among patients 70 years or older.

https://ift.tt/2QNgUlg

Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Oropharyngeal Squamous Cell Carcinoma

This cohort study examines the differences in overall survival and toxic effects in patients with oropharyngeal squamous cell carcinoma treated with radiotherapy vs primary surgery.

https://ift.tt/2xBDt3w

Three-Dimensional Printing Technology for Patients With Nasal Septal Deformities

This multicenter study examines the clinical application of a 3-D printed biomaterial implant in septoplasty for patients with caudal septal deviations.

https://ift.tt/2QNgHhY

An Unusual Entity Presenting as Bilateral Cervical Lymphadenopathy

A farmer in his 50s had bilateral periauricular swelling with no fever, weight loss, or loss of appetite. What is your diagnosis?

https://ift.tt/2xxoXti

Dialogue Systems and Conversational Agents for Patients with Dementia: The Human–Robot Interaction

Rejuvenation Research, Ahead of Print.

https://ift.tt/2pw6nhX

T follicular helper cells restricted by IRF8 contribute to T cell-mediated inflammation

Publication date: Available online 19 September 2018

Source: Journal of Autoimmunity

Author(s): Ruihua Zhang, Chen-feng Qi, Yuan Hu, Yanhong Shan, Yuan-Pang Hsieh, Feihong Xu, Geming Lu, Jun Dai, Monica Gupta, Miao Cui, Liang Peng, Jianjun Yang, Qingjie Xue, Ray Chen-Liang, Kang Chen, Yeyunfei Zhang, Wai-Ping Fung-Leung, J. Rodrigo Mora, Liwu Li, Herbert C. Morse

Abstract

The follicular helper T cell (T_FH) are established regulators of germinal center (GC) B cells, whether T_FH have pathogenic potential independent of B cells is unknown. Based on in vitro T_FH cell differentiation, in vivo T cell transfer animal colitis model, and intestinal tissues of inflammatory bowel disease (IBD) patients, T_FH and its functions in colitis development were analyzed by FACS, ChIP, ChIP-sequencing, WB, ELISA and PCR. Herein we demonstrate that intestinal tissues of patients and colon tissues obtained from Rag1^−/− recipients of naïve CD4⁺ T cells with colitis, each over-express T_FH-associated gene products. Adoptive transfer of naïve Bcl6^−/− CD4⁺ T cells into Rag1^−/− recipient mice abrogated development of colitis and limited T_FH differentiation in vivo, demonstrating a mechanistic link. In contrast, T cell deficiency of interferon regulatory factor 8 (IRF8) resulted in augmentation of T_FH induction in vitro and in vivo. Functional studies showed that adoptive transfer of IRF8 deficient CD4⁺ T cells into Rag1^−/− recipients exacerbated colitis development associated with increased gut T_FH-related gene expression, while Irf8^−/−/Bcl6^−/− CD4⁺ T cells abrogated colitis, together indicating that IRF8-regulated T_FH can directly cause colon inflammation. Molecular analyses revealed that IRF8 suppresses T_FH differentiation by inhibiting transcription and transactivation of the TF IRF4, which is also known to be essential for T_FH induction. Our documentation showed that IRF8-regulated T_FH can function as B-cell-independent, pathogenic, mediators of colitis suggests that targeting T_FH could be effective for treatment of IBD.

https://ift.tt/2pnaInk

Magnetic Resonance Imaging–Based Prediction of Prostate Cancer Risk—Reply

In Reply We thank Dr Bianchi and colleagues for reiterating the importance of external validation for any prediction tool. Decision support tools such as clinical nomograms are important components of individualized decision making and patient care. Currently, many nomograms are available for different clinical scenarios. Decision making in the prebiopsy setting is of utmost importance because suboptimal decisions can lead to unnecessary biopsies and ultimately overtreatment. Patients with clinically significant prostate cancer, however, need to undergo a biopsy procedure and receive treatment according to their risk profile.

https://ift.tt/2xB7rEx

Patient Navigator Intervention to Improve Palliative Care Outcomes for Latinos With Advanced Cancer

This randomized clinical trial investigates if a culturally tailored patient navigator intervention can improve palliative care outcomes for Latino patients with advanced cancer.

https://ift.tt/2QLzDNS

Magnetic Resonance Imaging–Based Prediction of Prostate Cancer Risk

To the Editor We read with great interest the article by Mehralivand et al. The prediction of prostate cancer aggressiveness represents a major concern; from the previous Partin nomograms, several predictive tools (PTs) have been developed to be applied in both the diagnostic and prognostic setting (ie, to distinguish clinically significant [CS] from indolent disease, to avoid unnecessary prostate biopsy or therapies), as well as in treatment planning, to tailor the procedure to the cancer's characteristics.

https://ift.tt/2xB7eRL

Hu3F8 Antibody Dosing With Granulocyte-Macrophage CSF in Patients With Resistant Neuroblastoma

This phase 1 clinical trial examines the escalation and safety of humanized anti-G_D2 antibody doses in combination with granulocyte-macrophage colony-stimulating factor for treating patients with high-risk neuroblastoma.

https://ift.tt/2QKqO6S

Targeted Alpha Therapy, an Emerging Class of Cancer Agents

This narrative review describes targeted alpha therapy and reviews the rationale and considerations for its development and implementation as a viable treatment strategy in oncology.

https://ift.tt/2xzeaPv

Association of Gleason Grade With Androgen Deprivation Therapy Duration and Survival Outcomes

This meta-analysis examines the association of Gleason grade with the effectiveness of androgen deprivation therapy with radiotherapy in treating patients with high-risk prostate cancer.

https://ift.tt/2QLyKow

Immune response mediated by Th1 / IL-17 / caspase-9 promotes evolution of periodontal disease

Publication date: Available online 19 September 2018

Source: Archives of Oral Biology

Author(s): M.E.L. Sommer, R.A. Dalia, A.V.B. Nogueira, J.A. Cirelli, M.A.R. Vinolo, J.L. Fachi, C.A. Oliveira, T.A.M. Andrade, F.A.S. Mendonça, M. Santamaria, M. Felonato

Abstract

Introduction

Periodontitis is characterized by inflammatory mediators beyond T lymphocyte function and phenotype (Th1/Th2/Th17). The clinical diversity in periodontitis makes it difficult to characterize the immune response in patients. This study evaluated the profile of the adaptive immune response in the periodontal disease model.

Methods

72 rats (Wistar) were divided into a control group (CTL/day 0) and periodontitis (PD15/15 days and PD60/60 days). In the PD15 and PD60 groups, periodontal disease was induced by ligature with a silk thread placed in the cervical region of the upper first molar. After euthanasia, the periodontal tissue was analyzed by flow cytometry (CD4, CD8, CD25, CD44), semi-quantitative RT-PCR (T-bet, GATA-3, RORγt), semi-quantitative RT-PCR and ELISA IFN-γ, TNF-α, IFN-γ, IL-4, IL-6, IL-10, IL-17) and by Western blotting (Caspase-9, PCNA).

Results

The number of CD4⁺CD25⁺, CD4⁺CD44⁺, CD8⁺CD25⁺ and CD8⁺CD44⁺ cells and expression levels of T-bet and GATA-3 are increased in the PD60 group compared to PD15 and CTL. The RORγ-t gene transcript increased in the PD15 group in relation to PD60 and CTL. The cytokines IFN-γ, TNF-α and IL-17 increased in the PD60 group in relation to PD15. The expression of Caspase-9 was higher in the PD60 group than in PD15.

Conclusions

The results suggest that the evolution of gingivitis to periodontitis is related to the accumulation of activated Th1 cells (IFN-γ and TNF-α) associated with the presence of increased IL-17. Studies with inhibitors of these cytokines in periodontal disease may lead to therapy directed at blocking the inflammatory process in this pathology, interrupting bone loss.

https://ift.tt/2MNPEzD

Seasonal aggravation of acne in summers and the effect of temperature and humidity in a study in a tropical setting

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2OMaYXW

Seasonal aggravation of acne in summers and the effect of temperature and humidity in a study in a tropical setting

Journal of Cosmetic Dermatology, EarlyView.

https://ift.tt/2OMaYXW

Gibt es einen Zusammenhang zwischen zirkulierenden Tumorzellen und dem Nutzen einer Strahlentherapie bei Brustkrebs im Frühstadium?

https://ift.tt/2PUvRAH

Effectiveness of preanesthetic administration of gabapentin on sedative action during intravenous sedation with propofol

Abstract

Purpose

There are no sufficient evidences for the sedative effect of gabapentin during anesthesia, especially intravenous sedation (IVS). The purpose of this study was to evaluate the sedative effect of gabapentin as preanesthetic medication during the IVS with propofol.

Methods

10 volunteer subjects joined this study. They underwent propofol IVS three times on separate days. On the first day, the IVS without gabapentin was performed as a control. On the second and the third day, gabapentin 200 mg and 400 mg were administered before the IVS, respectively. The target blood concentration (C_T) of propofol was gradually increased, and the bispectral index (BIS) value and Ramsay sedation score (RSS) were evaluated at each propofol C_T. Postanesthetic complications and influences on vital signs were also evaluated.

Results

Compared to the control group, the propofol C_Ts in the gabapentin 400 mg group significantly reduced at the BIS values of 60 and 70 (p = 0.031 and p = 0.043, respectively), and at RSS 3, 4, 5 and 6 (p = 0.040, p = 0.004, p = 0.001 and p = 0.004, respectively). There was no significant difference in propofol C_Ts between the control group and the gabapentin 200 mg group. There were no abnormality and no deterioration in circulation and respiration in all groups. There were no significant increases in complications with the administration of gabapentin.

Conclusion

The oral administration of 400 mg dose of gabapentin reduced the propofol C_Ts for achieving an adequate sedation level on IVS.

https://ift.tt/2OzSTfD

Micro-invasive interventions for managing non-cavitated proximal caries of different depths: a systematic review and meta-analysis

Abstract

Objectives

The aim of this study was to further evaluate the caries-arresting effectiveness of micro-invasive interventions for non-cavitated proximal caries and analyze their efficacy for caries lesions of different depths.

Materials and methods

Randomized clinical trials (RCTs) of micro-invasive interventions for non-cavitated proximal caries were included in this study. We searched the Cochrane Library, PubMed, Embase, and Web of Science on May 25, 2017, without restrictions. After duplicate study selection, data extraction, and risk of bias assessment, a meta-analysis of the odds ratios (OR) with 95% confidence intervals (95% CIs) and a publication bias analysis were conducted using Stata 12.0.

Results

After 2195 citations were screened, 8 citations of seven studies with follow-up periods from 12 to 36 months were included. The subgroup analysis showed that resin infiltration and resin sealant, but not glass ionomer cement (GIC), could reduce the caries progression rate (resin infiltration: OR = 0.15, 95% CI 0.09 to 0.24; resin sealant: OR = 0.33, 95% CI 0.19 to 0.58; GIC: OR = 0.13, 95% CI 0.01 to 2.65). Further analysis of their efficacies for caries lesions of different depths indicated that resin infiltration could arrest progression of enamel caries and caries around the enamel-dentin junction (EDJ) (enamel: OR = 0.05, 95% CI 0.01 to 0.35; EDJ: OR = 0.07, 95% CI 0.01 to 0.70). However, when the outer third of the dentin was involved, resin infiltration yielded significantly different results compared with the control group (OR = 0.42, 95% CI 0.16 to 1.10). Resin sealant seemed to be ineffective regardless of the caries depth (enamel: OR = 0.62, 95% CI 0.13 to 3.00; EDJ: OR = 0.44, 95% CI 0.09 to 2.15; dentin: OR = 0.43, 95% CI 0.07 to 2.63).

Conclusions

Resin infiltration is effective in arresting the progression of non-cavitated proximal caries involved in EDJ, while the therapeutic effects of resin sealant for different caries depths still needs to be further confirmed.

Clinical relevance

Based on existing evidence, dentists should carefully select appropriate micro-invasive interventions according to the different depths of non-cavitated proximal caries.

https://ift.tt/2DesL8V

Longevity, effectiveness, safety, and impact on quality of life of low-concentration hydrogen peroxides in-office bleaching: a randomized clinical trial

Abstract

Objective

The study evaluated the longevity, effectiveness, safety, and impact on the oral health-related quality of life of in-office dental bleaching using low-concentration hydrogen peroxides.

Materials and methods

Randomized, parallel, and double-blinded clinical trial was performed with 54 participants using 6% or 15% hydrogen peroxide (HP) in-office bleaching activated via hybrid LED/laser light. Tooth color was evaluated at baseline (T1), 1 week of bleaching (T2), 2 weeks of bleaching (T3) and 1 week (T4) and 6 months (T5) after finishing the bleaching using the Classical Vita™ scale and spectrophotometer. Tooth sensitivity and gingival irritation were measured with Visual Numeric Scale and Modified Gingival Index. The impact on quality of life was evaluated using the Oral Impact on Daily Performance. The data were analyzed using the Friedman, Mann-Whitney, and McNemar tests (p < 0.05).

Results

The group HP15% presented significant color change (ΔE) from T1 to T4 (p = 0.002) and T1 to T5 (p < 0.001). Parameters L, a*, and b* differed significantly at T3, T4, and T5 compared T1 for both groups. At 6-month follow-up, 57.1% of HP6 and 43.7% of HP15% participants migrated from B1 to a darker color. No significant differences were observed between the groups in tooth sensitivity, gingival irritation, or impact on quality of life.

Conclusions

Both agents showed bleaching effectiveness, but HP15% presented greater color stability than HP6%, at 6-month follow-up. The agents showed low levels of tooth sensitivity, gingival irritation, and did not affect the oral health-related quality of life of the participants.

Clinical relevance

Despite the greater presence of sensitivity during treatment compared with 6% hydrogen peroxide, 15% hydrogen peroxide demonstrated better bleaching effectiveness, and greater color stability at the end of bleaching and at 6-month follow-up. The use of 15% hydrogen peroxide presents more suitable results.

https://ift.tt/2NoCM8c

The impact of human papillomavirus (HPV) status on functional outcomes and quality of life (QOL) after surgical treatment of oropharyngeal carcinoma with free-flap reconstruction

To determine the impact of Human Papillomavirus (HPV) status on speech, swallowing, and quality of life (QOL) outcomes after surgical treatment of oropharyngeal cancer (OPSCC).

https://ift.tt/2O0UmyA

Angioedema is an unfavorable factor for the response to omalizumab in chronic spontaneous urticaria: a retrospective study

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2xrS1mX

Recurrent merkel cell carcinoma of the gluteal region: a case report

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PRpj5A

Atopic‐like dermatitis after Secukinumab injection: a case report

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2xpFJLM

A preliminary study of fractional CO2 laser added to topical tacrolimus combined with 308 nm excimer lamp for refractory vitiligo

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PPVKRQ

New therapeutic vision of Nutrition in dermatology: Integrative Nutrition

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2xpFFf0

ANGIOTENSIN‐CONVERTING‐ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS INDUCED PEMPHIGUS: A CASE SERIES AND LITERATURE REVIEW

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PMFZvc

Angioedema is an unfavorable factor for the response to omalizumab in chronic spontaneous urticaria: a retrospective study

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2xrS1mX

Recurrent merkel cell carcinoma of the gluteal region: a case report

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PRpj5A

Atopic‐like dermatitis after Secukinumab injection: a case report

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2xpFJLM

A preliminary study of fractional CO2 laser added to topical tacrolimus combined with 308 nm excimer lamp for refractory vitiligo

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PPVKRQ

New therapeutic vision of Nutrition in dermatology: Integrative Nutrition

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2xpFFf0

ANGIOTENSIN‐CONVERTING‐ENZYME INHIBITORS AND ANGIOTENSIN II RECEPTOR BLOCKERS INDUCED PEMPHIGUS: A CASE SERIES AND LITERATURE REVIEW

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.

https://ift.tt/2PMFZvc

Pomegranate chitinase III: Identification of a new allergen and analysis of sensitization patterns to chitinases

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Lisa Tuppo, Ivana Giangrieco, Claudia Alessandri, Teresa Ricciardi, Chiara Rafaiani, Michela Ciancamerla, Rosetta Ferrara, Danila Zennaro, Maria Livia Bernardi, Maurizio Tamburrini, Adriano Mari, Maria Antonietta Ciardiello

Abstract

Allergy to pomegranate is often associated with severe symptoms. Two allergens have previously been described: 9k-LTP Pun g 1 and pommaclein Pun g 7. This study describes the isolation of a chitinase III, identified by direct protein sequencing and mass spectrometry. It is a 29-kDa protein showing 69% sequence identity with the latex hevamine and IgE binding in dot blotting, immunoblotting and FABER^®test. Chitinase-specific IgE were detected in 69 of 357 patients sensitized to one or more pomegranate allergenic preparations present on the FABER^®test. Using this test, 19.2% of the patients sensitized to kiwifruit chitinase IV were also sensitized to pomegranate chitinase III, rather than to latex chitinase I (7.2%) with which it shares the N-terminal hevein-like domain. In conclusion, a new allergen has been identified, contributing to improving food allergy diagnosis. This study reveals the important role of chitinases III and IV as allergy sensitizers and prompts further investigations.

Graphical abstract

Graphical abstract for this article

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Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus

Publication date: Available online 19 September 2018

Source: American Journal of Otolaryngology

Author(s): Di Deng, Jintao Du, Feng Liu, Bing Zhong, Yixin Qiao, Yafeng Liu

Abstract

Background

Internal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis.

Objective

This study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus.

Methods

Various data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017.

Results

The patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients.

Conclusion

ICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.

https://ift.tt/2NSNyTR

Au-delà des kératoses actiniques, le champ de cancérisation cutané

Publication date: Available online 20 September 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): P. Reygagne, G. Rostain

Résumé

Les kératoses actiniques (KA) forment des papules érythémateuses, squameuses et kératosiques apparaissant sur la peau chroniquement exposée au soleil sous l'effet des rayons ultraviolets. Elles correspondent à une prolifération de kératinocytes atypiques limitée à l'épiderme et sont susceptibles de progression vers le carcinome épidermoïde in situ et le carcinome épidermoïde cutané (CEC). S'il est faible, le risque métastatique associé au CEC ne doit pas pour autant être négligé. Le concept de champ de cancérisation a été introduit en 1953 à la suite d'études de lésions néoplasiques de la muqueuse buccale. Il est défini comme une zone prétumorale d'aspect normal, comportant des anomalies infracliniques multifocales qui peuvent faire le lit de nouvelles lésions néoplasiques. De tels champs sont fréquents dans les zones cutanées photo-exposées et en périphérie des KA et des CEC. Dans cette situation, le traitement ne devrait pas se limiter aux lésions visibles ou palpables de KA et, en cas de suspicion de champ de cancérisation, un traitement visant à la destruction physique ou à l'élimination des kératinocytes atypiques de la totalité de la zone devrait être envisagé. Une telle approche pourrait en théorie améliorer le pronostic à long terme en diminuant l'émergence de nouvelles lésions, voire diminuer le coût économique global lié à la prise en charge des KA et optimiser l'aspect cosmétique du champ de cancérisation ; cela mérite, cependant, d'être confirmé.

Summary

Lesions occurring in actinic keratoses (AK) form erythematous, squamous, crusty and keratotic papules that appear on skin chronically exposed to the sun due to ultraviolet radiation. They are formed by the proliferation of atypical keratinocytes limited to the epidermis and may progress to squamous cell carcinoma in situ and to cutaneous squamous cell carcinoma (CEC). Although low, the metastatic risk associated with the CEC is not negligible. The concept of field cancerization was introduced in 1953 following studies of neoplastic lesions of the oral mucosa. A cancer field is a normal-looking pre-tumoral zone with subclinical, multifocal anomalies, which may constitute a base for new neoplastic lesions. Such fields are frequently seen in areas of photo-exposed skin and around the edges of AK and CEC. In this event, treatment should not be limited to visible or palpable AK lesions, and if a cancer field is suspected, treatment involving the physical destruction or elimination of atypical keratinocytes from the entire area should be considered. Such an approach may improve the long-term prognosis, reduce treatment costs and ensure optimal cosmetic outcome.

https://ift.tt/2DdKjlG

Antioxidant Properties of Ferulic Acid and Its Possible Application

Ferulic acid has low toxicity and possesses many physiological functions (anti-inflammatory, antioxidant, antimicrobial activity, anticancer, and antidiabetic effect). It has been widely used in the pharmaceutical, food, and cosmetics industry. Ferulic acid is a free radical scavenger, but also an inhibitor of enzymes that catalyze free radical generation and an enhancer of scavenger enzyme activity. Ferulic acid has a protective role for the main skin structures: keratinocytes, fibroblasts, collagen, elastin. It inhibits melanogenesis, enhances angiogenesis, and accelerates wound healing. It is widely applied in skin care formulations as a photoprotective agent, delayer of skin photoaging processes, and brightening component. Nonetheless, its use is limited by its tendency to be rapidly oxidized.
Skin Pharmacol Physiol 2018;31:332–336

https://ift.tt/2QJF3sC

Validated Patient-Reported Outcome Measurements for Psoriasis may not Reflect Patients’ Current Preferences

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Oluwatobi Ogbechie-Godec, Sarah Azarchi, Jasmine Lee, David E. Cohen, Andrea Neimann, Arielle R. Nagler

https://ift.tt/2xwD9Tw

Lack of an FDA indication should not limit access to appropriate treatment

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Joerg Albrecht, Adewole S. Adamson, John Barbieri, Daniel D. Bennett, Elizabeth A. Kiracofe, A. Shadi Kourosh, Kieron S. Leslie, Joseph F. Merola, Josephine Nguyen, Elaine Siegfried, Nicole Strickland, Suzanne Olbricht, Maryam M. Asgari, AADA Task Force on Drug Pricing and Transparency

https://ift.tt/2QLrzwz

A population-based registry study on relative survival from melanoma in Germany stratified by tumor thickness for each histological subtype

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Alicia Brunssen, Lina Jansen, Nora Eisemann, Annika Waldmann, Janick Weberpals, Klaus Kraywinkel, Andrea Eberle, Bernd Holleczek, Sylke Ruth Zeissig, Hermann Brenner, Alexander Katalinic, GEKID Cancer Survival Working Group

Abstract

Background

Differences in melanoma relative survival (RS) between histologies were discussed to be mainly caused by tumor thickness.

Objective

To investigate RS from melanoma, stratified by tumor thickness for each histological subtype, and identify survival trends.

Methods

Using cancer registry data on melanoma cases (ICD-10: C43.0-C43.9) diagnosed in Germany in 1997-2013, 5- and 10-year age-standardized RS stratified by histology and stratified or standardized by T-stage was estimated using standard and modelled period analyses. We restricted 10-year RS analyses to patients younger than 75 years.

Results

We analyzed 82,901 cases. Overall, 5- and 10-year RS was 91.7% and 90.8%, respectively. Prognosis worsened with increasing T-stage for all histologies but T-stage distribution varied substantially. Survival differences by histology were strongly alleviated after adjustment for T-stage, but remained significant. Overall, 5-year RS increased significantly by 3.8 percentage points between 2002-2005 and 2010-2013. This increase was no longer seen after adjustment for T-stage.

Limitations

Exclusion of cases due to missing information on T-stages, changes in the definition of T-stages, and lack of information on screening and treatment limit our analyses.

Conclusion

Differences in RS between histologies were strongly mediated by tumor thickness. Over time, melanoma RS increased due to changes in T-stage distribution.

https://ift.tt/2xB02Fz

Clinical and dermoscopic features of cutaneous BAP1 inactivated melanocytic tumors: results of a multicenter case-control study by the International Dermoscopy Society (IDS)

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Oriol Yélamos, Cristián Navarrete-Dechent, Michael A. Marchetti, Tova Rogers, Zoe Apalla, Philippe Bahadoran, Nuria Blázquez-Sánchez, Klaus Busam, Cristina Carrera, Stephen W. Dusza, Arnaud de la Fouchardière, Gerardo Ferrara, Pedram Gerami, Harald Kittler, Aimilios Lallas, Josep Malvehy, José F. Millán-Cayetano, Kelly C. Nelson, Victor Li Quan, Susana Puig

Abstract

Background

Multiple BAP-1 inactivated melanocytic tumors (BIMTs) have been associated with a familial cancer-syndrome involving germline mutations in BAP1.

Objectives

We sought to describe the clinical and dermoscopic features of BIMTs.

Methods

Retrospective, multicenter, case-control study. Participating centers clinical data, dermoscopic images, and histopathological data of biopsy-proven BIMTs. We compared the dermoscopic features between BIMTs and controls.

Results

The dataset consisted of 48 BIMTs from 31 patients (22 females, median age=37 years), and 80 controls. Eleven patients had a BAP1 germline mutation. Clinically, most BIMTs presented as pink, dome-shaped papules (n=24). Dermoscopically, we identified 5 patterns: structureless pink-to-tan with irregular eccentric dots/globules (n=14, 29.8%); structureless pink-to-tan with a peripheral vessels (n=10, 21.3%); structureless pink-to-tan (n=7, 14.9%); network with raised, structureless, pink-to-tan areas (n=7, 14.9%); and globular pattern (n=4, 8.5%). The structureless with eccentric dots/globules pattern and network with raised structureless areas pattern were only identified in BIMT and were more common in patients with BAP1 germline mutations (p<0.0001 and p=0.001, respectively)

Limitations

Small sample size, retrospective design, absence of germline genetic testing in all patients, inclusion bias towards more atypical-looking BIMTs.

Conclusion

Dome-shaped papules with pink-to-tan structureless areas and peripheral irregular dots/globules or network should raise suspicion for BIMT.

https://ift.tt/2QMczib

A Provider Global Assessment Quality Measure for Clinical Practice for Inflammatory Skin Disorders

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): International Dermatology Outcome Measures and the American Academy of Dermatology, Alice Gottlieb, Nicole Salame, April W. Armstrong, Joseph F. Merola, Sylvia Parra, Junko Takeshita, Suephy C. Chen, John Latella, Marta Van Beek

Abstract

In our evolving healthcare system, dermatologists are increasingly being asked to prove the value of care they provide to patients with severe skin diseases. Current quality measures for inflammatory dermatoses have limited validity and feasibility. Through collaboration and a modified Delphi process, the International Dermatology Outcome Measures (IDEOM) group and American Academy of Dermatology (AAD) sought to reach consensus on a valid and feasible provider-assessed global disease severity metric to be incorporated into a quality measure for inflammatory dermatoses. To inform the modified Delphi process, a review of the literature was performed, and data was collected on current provider-assessed global disease severity metrics. Following literature review, 36 members of IDEOM and the AAD participated in the modified Delphi process to reach consensus on features of the metric. Psoriasis, atopic dermatitis, and acne achieved overwhelming consensus for inflammatory dermatoses that could be measured in a global disease severity metric. Consensus was also reached on the utilization of a 5-point ordinal scale with descriptors provided through referenced electronic platforms. Expert development of quality measures incorporating this metric and its inclusion in data collection platforms are critical to enabling dermatologists to prove the value of care provided to patients with severe inflammatory dermatoses.

https://ift.tt/2xz7iSj

Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Gerardo Marrazzo, John A. Zitelli, David Brodland

Abstract

Background

There is little evidence to predict patient outcomes following the treatment of high risk cutaneous SCC (hrSCC) using Mohs micrographic surgery (MMS).

Objective

To report the rates of poor outcomes in patients with hrSCC treated by MMS alone, and determine if any specific clinical factors may be more predictive of these outcomes.

Methods

We conducted a retrospective chart review of all hrSCC patients treated in our clinic from October 2011 to December 2015.

Results

We identified 647 hrSCC tumors that met inclusion criteria. During the follow-up period, there were 19 local recurrences(LR) (2.9%), 31 nodal metastases(NM) (4.8%), 7 distant metastases(DM) (1.1%), and 7 disease-specific deaths(DSD) (1.1%). Two factors, poor differentiation and invasion beyond the subcutaneous fat, were positively associated with local recurrence, nodal metastasis, and disease-specific death through multivariate analysis.

Conclusions

Invasion beyond subcutaneous fat and poor histologic differentiation may carry a greater risk of poor outcomes than other factors in hrSCC. Mohs surgery alone provides excellent marginal control with low rates of local recurrence, nodal metastasis and disease-specific death.

https://ift.tt/2QLSaK4

Rethinking the classification of alopecia areata

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): C.G. Wambier, B.A. King

https://ift.tt/2xAzeoS

Comment on Okhovat et al “The first 30 years of the American Academy of Dermatology skin cancer screening program: 1985-2014”

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Dayoung Ko, Shari R. Lipner

https://ift.tt/2QM9zSY

Platelet rich plasma as an adjunctive treatment in Lichen Plano pilaris

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Abhijeet Kumar Jha

https://ift.tt/2xB000p

Reflectance confocal microscopy as novel tool for pre-surgical identification of basal cell carcinoma biopsy site

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Cristián Navarrete-Dechent, Shoko Mori, Miguel Cordova, Kishwer S. Nehal

https://ift.tt/2QMcATh

Dermoscopy of Pityrosporum Folliculitis

Publication date: Available online 20 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Deepak Jakhar, Ishmeet Kaur, Richa Chaudhary

https://ift.tt/2xCbhxq

Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience

Publication date: Available online 19 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Andrew F. Alexis, Valerie D. Callender, Hilary E. Baldwin, Seemal R. Desai, Marta I. Rendon, Susan C. Taylor

Abstract

Among individuals with skin of color, rosacea has been reported less frequently than in those with white skin, but it is not a rare disease. In fact, rosacea may be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin, as well as underestimation of the susceptibility of more highly pigmented skin to dermatologic conditions like rosacea whose triggers include sun exposure. Many people with skin of color who have rosacea may experience delayed diagnosis leading to inappropriate or inadequate treatment, greater morbidity, and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea. This paper reviews the epidemiology of rosacea in skin of color and highlights variations in the clinical presentation of rosacea across the diverse spectrum of patient populations affected. It presents strategies to aid in the timely diagnosis and effective treatment of rosacea in patients with skin of color, with an aim of promoting increased awareness of rosacea in these patients and reducing disparities in the management of their disease.

https://ift.tt/2QQUWOe

Non-smoking, non-drinking elderly females, a 5 year follow-up of a clinically distinct cohort of oral squamous cell carcinoma patients

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Adrian DeAngelis, Omar Breik, Kendrick Koo, Tim Iseli, Alf Nastri, Tsien Fua, Danny Rischin, Michael McCullough, David Wiesenfeld

Abstract

Objectives

To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma.

Materials & methods

Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non-smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded.

Results

Of the study population (N = 287), 24.4% were NSND and 9.75% were NSND elderly (older than 70 years) females. >50% of tumours arose from the oral tongue in NSND patients (p = 0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, p = 0.005). Disease specific survival at 5 years was significantly reduced when NSND elderly females were compared to all other patients (p < 0.001) as well as age matched controls (p = 0.006). This effect was verified independently in each cohort.

Conclusions

The results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes.

https://ift.tt/2pv1XI9

Aurora kinases are a novel therapeutic target for HPV-positive head and neck cancers

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Mushfiq H. Shaikh, Adi Idris, Newell W. Johnson, Sora Fallaha, Daniel T.W. Clarke, David Martin, Iain M. Morgan, Brian Gabrielli, Nigel A.J. McMillan

Abstract

Objectives

Human papilloma virus (HPV) is the main culprit in cancers of the cervix, penis, anus, skin, eye and head and neck. Current treatments for HPV cancers have not altered survival outcomes for 30 years and there is a significant lack of targeted therapeutic agents in the management of advanced HPV-related HNSCC. Here we show that survival and maintenance of HPV-positive HNC cells relies on the continuous expression of the major HPV oncogene, E7, and that Aurora kinases are critical for survival of high-risk HPV-positive HNC cells.

Materials and methods

To assess the role of HPV E7 on HNC cell survival, RNA interference (RNAi) of the E7 gene was initially performed. Using an Aurora kinase inhibitor, Alisertib, the role of Aurora kinases in the carcinogenesis of HPV E7 positive HNC tumour lines was then investigated. An in vivo HNC xenograft model was also utilised to assess loss of tumour volume in response to RNAi E7 gene silencing and Alisertib treatment.

Results

RNAi silencing of the HPV E7 gene inhibited the growth of HPV-positive HNC cells and in vivo tumour load. We show that HPV E7 oncogene expression confers sensitivity to Alisertib on HNC cells where Alisertib-mediated loss in in vitro cell viability and in vivo tumour load is dependent on E7 expression. Moreover, Aurora kinase inhibition induced degradation of MCL-1 in HPV E7-expressing HNC cells.

Conclusion

Overall, we show that Aurora kinases are a novel therapeutic target for HPV-positive HNCs. It might be feasible to combine Aurora kinase and MCL-1 inhibitors for future HNC therapies.

https://ift.tt/2MO6sXo

Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Parul Sinha, Omar A. Karadaghy, Michelle M. Doering, Methodius G. Tuuli, Ryan S. Jackson, Bruce H. Haughey

Abstract

The optimal management of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) with primary surgical versus non-surgical treatment is unclear. The objective of this systematic review was to evaluate the literature and compare survival for primary surgical versus non-surgical treatment of HPV-positive OPSCC. We performed a comprehensive literature search of multiple electronic databases for relevant articles up to February, 2017. Studies reporting mortality or hazard ratio (HR) for overall survival (OS) in primary HPV-positive OPSCC patients were eligible. Seventy-three articles were eligible, of which 66 included single-modality (19 surgical, 47 non-surgical), and 7 included both surgical and non-surgical modalities. There were no randomized studies comparing outcomes between both modalities. In a meta-analysis of both-modality studies, OS with surgical treatment was not significantly different from non-surgical treatment (pooled HR 1.12; 95% CI: 0.35, 3.57). There was significant heterogeneity between studies (I² = 82.4%). Among single-modality studies, the mortality rate was lower with surgical [pooled proportion 0.15 (95% CI: 0.09, 0.21)] versus non-surgical treatment [0.20 (95% CI:0.15, 0.24)]. In a subgroup analysis, OS was higher for HPV-positive versus HPV-negative OPSCC, irrespective of the treatment modality. We conclude that there is an absence of high-quality studies that compare survival for HPV-positive OPSCC treated with primary surgical versus non-surgical approach. The available data suggest no statistical or clinically meaningful difference in survival between the two approaches. HPV-positivity was a key prognostic factor irrespective of treatment modality. Further high-quality studies with consistent data reporting are needed to inform the choice for optimal treatment modality for HPV-positive OPSCC.

https://ift.tt/2pnsdnF

MTA and biodentine for primary teeth pulpotomy: a systematic review and meta-analysis of clinical trials

Abstract

Objective

This study aims to perform a systematic review and meta-analysis of clinical trials in order to evaluate the clinical and radiographic success rates of primary teeth pulpotomy performed with biodentine, when compared to MTA.

Methods

Search strategies were conducted in nine databases on August 5th, 2017, update on February 14th, 2018. Clinical articles were selected, which were in accordance with the inclusion and exclusion criteria and the research objective. They were analyzed by meta-analysis at three time points (6, 12, and 18 months).

Results

Out of the 233 publications initially identified, only 9 studies that fulfilled the inclusion criteria were included in the review. The 6-month overall clinical (RR = 0.99; 95% CI = 0.96–1.02, p = 0.92) and radiographic success rates (RR = 0.96; 95% CI = 0.92–1.00, p = 0.28) showed that biodentine vs. MTA did not differ statistically. The 12 and 18-month overall clinical success rates, respectively (RR = 1.01; 95% CI = 0.97–1.04, p = 0.77; RR = 0.98; 95% CI = 0.92–1.05, p = 0.74) and radiographic success rates, respectively (RR = 0.97; 95% CI = 0.92–1.02, p = 0.11; RR = 1.00; 95% CI = 0.91–1.10, p = 0.56) also showed that biodentine vs. MTA did not differ statistically.

Conclusion

There is no superiority of one material over the other, MTA versus biodentine.

Clinical relevance

This systematic review comparing the performance of biodentine in relation to the MTA when used in the pulpotomy technique in primary teeth. Although MTA is considered the gold standard material for pulpotomy procedures, it has some drawbacks (poor handling, staining potential, long setting time); thus, it is important to evaluate the clinical performance of other calcium silicate-based cements like biodentine that overcome this drawbacks.

https://ift.tt/2xoXjjd

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Πέμπτη 20 Σεπτεμβρίου 2018

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