No abstract available
https://ift.tt/2Dm0KMK
Παρασκευή 21 Σεπτεμβρίου 2018
Identifying Incidence of and Risk Factors for Fluoroscopy-Guided Lumbar Puncture and Subsequent Persistent Low-Pressure Syndrome in Patients With Idiopathic Intracranial Hypertension
Background: To explore the incidence of and potential risk factors for developing persistent low-pressure syndrome after lumbar puncture (LP) in patients with idiopathic intracranial hypertension (IIH), as measured by use of blood patches. Methods: A retrospective chart review was conducted of patients with definitively diagnosed IIH by clinical examination and LP, comparing them to patients with multiple sclerosis (MS) as controls who also received diagnostic LPs. Demographic, clinical, and radiological data were collected for each patient. The main outcome measure was the rate of post-LP blood patches in IIH patients compared with MS patients. Secondary outcome measures were the likelihood of undergoing an epidural blood patch related to age, body mass index, volume removed, opening pressure, the difference between opening and closing pressure, and the level of puncture within the IIH cohort. Results: One hundred four IIH patients and 149 MS patients were included in the study. Among IIH patients, 12/104 (11.5%) underwent an epidural blood patch after LP as compared to 8/149 (5.4%) of the MS control patients (P = 0.086). Within the IIH population, none of the clinical or LP parameters were significantly correlated with increased risk of needing a blood patch. Conclusions: The incidence of low-pressure syndrome, as measured by blood patches, is similar in IIH patients and MS controls. This suggests that having elevated intracranial pressure before an LP is not protective against developing postpuncture low-pressure syndrome, contrary to common assumptions. Address correspondence to Gregory P. Van Stavern, MD, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8096, St. Louis, MO 63110-1010; E-mail: vanstaverng@vision.wustl.edu Supported by DOVS Core Grant 5 P30 EY02687, Institute for Clinical and Translational Sciences grant RR023496, Biostat Core Grant U54 RR023496, an unrestricted grant from Research to Prevent Blindness, NIH Core Vision Grant P30 EY02687, and Dean's Fellowship (Washington University School of Medicine, Washington University in St. Louis, Missouri). The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society
https://ift.tt/2I47hKI
https://ift.tt/2I47hKI
Cosmetics, Vol. 5, Pages 55: Anti-Aging Properties of Plant Stem Cell Extracts
Cosmetics, Vol. 5, Pages 55: Anti-Aging Properties of Plant Stem Cell Extracts
Cosmetics doi: 10.3390/cosmetics5040055
Authors: Małgorzata Miastkowska Elżbieta Sikora
Skin aging is a complex process which involves all the layers of the epidermis and dermis. In order to slow skin aging, methods are researched which would strengthen and protect skin stem cells. Science is in search of the right method to stimulate the proliferation of epidermal stem cells. Plant stem cells show outstanding anti-aging properties, as they can, among other activities, stimulate fibroblasts to synthesise collagen, which, in turn, stimulates skin regeneration. One of the most important agents which give anti-aging properties to plant stem cell extracts is kinetin (6-furfuryladenine). This compound belongs to a cytokine group and is considered to be a strong antioxidant which protects protein and nucleic acids from oxidation and glycoxidation processes. It enables cells to remove the excess of free radicals to protect them from oxidative stress.
https://ift.tt/2xuWrtn
Dermoscopy of skin metastases from breast cancer: two case reports
Cutaneous metastatic breast cancer is the most common cutaneous metastatic malignancy in women. The assessment of cutaneous metastatic disease can be perplexing because the clinical presentation appears simila...
https://ift.tt/2Dnb5bi
Rare case of Propionibacterium acnes-related splenic abscess
A 64-year-old woman with a medical history of morbid obesity, chronic hepatitis C, essential hypertension, multiple episodes of abdominal cellulitis, diabetes mellitus type 2 on insulin, intravenous and subcutaneous drug abuse presented to the emergency department complaining of left lower chest pain for 6 weeks along with multiple episodes of vomiting. Initial laboratory data revealed leucocytosis of 17 200x103/μL with left shift. She reported multiple episodes of fever spikes. Abdominal and pelvic CT showed a splenic hypodense lesion. Specimens from interventional radiology aspiration and splenectomy grew Propionibacterium acnes. Following splenectomy, patient's symptoms resolved. To the best of our knowledge, this would represent the fifth reported case of P. acnes splenic abscess.
https://ift.tt/2Q1311F
Alpha-2 antiplasmin-associated aortic valve thrombus presenting as a STEMI in a patient with Graves disease
Description
A 36-year-old Caucasian woman with a medical history of Graves disease presented to the emergency department with typical chest pain, and she was found to have a ST-elevation myocardial infarction (STEMI) via ECG and elevated troponins. Emergent cardiac catheterisation revealed distal blockages in the left anterior descending artery and second obtuse marginal artery (figure 1A,B). After distal balloon angioplasty, the decision was made to further treat the patient medically and discharge home after clinical stability was achieved. She was readmitted 2 days later for new onset of palpitations with up-trending troponins. Laboratory tests were significant for a low thyroid-stimulating hormone of <0.01 µLU/mL (reference range: 0.27–4.2 µLU/mL), and elevated free T4 of 4.02 µLU/mL (reference range: 0.9–1.7 ng/dL), free T3 of 4.8 pg/mL (reference range: 2.5–4.3 pg/mL) and a thyroid stimulating immunoglobulin of 386 (reference range: <140% baseline). She was immediately started on both methimazole 20 mg and potassium iodine oral solution (SSKI). Further workup...
https://ift.tt/2O1edhj
Haemorrhagic cholecystitis: a rare entity not to be forgotten
Haemorrhagic cholecystitis is a rare entity of acute cholecystitis that carries a high morbidity and mortality rate if management is delayed. Its clinical course can mirror that of acute cholecystitis. Characteristic findings on ultrasound or CT scan are useful clues to early diagnosis. Urgent cholecystectomy is required prior to progressing to perforation of gallbladder. Most of the literature are case reports with causes associated with anticoagulation. Herein, we described a morbidly obese patient with poorly controlled diabetes presenting with non-specific right upper quadrant pain and was subsequently diagnosed with haemorrhagic cholecystitis. A review of the literature was also performed to summarise the potential clinical presentations, distinctive imaging findings and management options available for this rare condition.
https://ift.tt/2PWjVy7
Pneumomediastinum: a complication of reinserting a dislodged tracheostomy
Description
A 54-year-old woman with a background of obesity and hypertension presented following a pulseless electrical activity (PEA) cardiac arrest. Cardiopulmonary resuscitation (CPR) was commenced on arrival of the paramedics and she was intubated and ventilated (figure 1). Return of spontaneous circulation was achieved in the emergency department following a total of 45 min of CPR. No clear cause of her arrest was identified. She was transferred to the intensive care unit (ICU) for post-arrest management.
Figure 1
Initial chest radiograph following return of spontaneous circulation, with endotracheal tube present (included as a baseline for comparison).
Seizure activity off of sedation necessitated further investigation. Her CT head was unremarkable, but her lumbar puncture showed features in keeping with meningitis. She was therefore treated with antibiotics and antiepileptics. Her cerebrospinal fluid viral PCR and blood HIV tests were negative.
Although appropriate seizure control was achieved,...
https://ift.tt/2NWZUub
Naclerios V sign and continuous diaphragm sign after endoscopy
Description
An otherwise healthy 72-year-old woman presented with dyspnoea and systemic subcutaneous emphysema. She had undergone upper endoscopy, in which duodenal ulcer was found. The community hospital where the endoscopy was conducted transferred her to our tertiary hospital for further diagnosis and management. On arrival, she complained of severe difficulty in breathing; massive subcutaneous emphysema on her chest to the feet was observed on palpation. Chest X-ray image showed Naclerio's V sign (figure 1A, black arrow) and continuous diaphragm sign (figure 1A, white arrows). CT scan confirmed massive subcutaneous and mediastinal emphysema with pneumothorax, pneumopericardium and free air in retroperitoneal space (figure 1B,C). Emergent laparotomy revealed duodenal perforation, 9 mm in diameter at the descending part of duodenum (figure 1D, white arrow), and was surgically repaired. After the surgery, the emphysema gradually disappeared in weeks and had not recurred at 6-month follow-up.
...https://ift.tt/2PWjUKz
Hypertrophic pyloric stenosis following repair of oesophageal atresia and tracheo-oesophageal fistula in a neonate
Development of hypertrophic pyloric stenosis (HPS) after a few weeks of repair of an oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF) is a rare condition in early infancy. Although vomiting or feeding intolerance in operated cases of OA+TOF are attributed to oesophageal stricture, gastro-oesophageal reflux and oesophageal dysmotility, it may also be caused by HPS. Herein, we report a newborn infant who had OA and TOF operation on day 2 of life and diagnosed to have HPS at 15th day of age. Even though it is a rare anomaly, HPS should be kept on mind in the presence of persistent vomiting following repair of OA.
https://ift.tt/2O7mBfm
Primary renal angiosarcoma: a diagnostic and therapeutic challenge
Primary renal angiosarcoma is an exceedingly rare and aggressive neoplasm. Although it may occur in youth, this tumour is frequently reported in the sixth and seventh decades of life. The clinical presentation is frequently varied. Pathogenesis remains largely unknown and it has overlapping features with other tumours of the kidney. Current treatment options include variable combinations of surgery, chemotherapy and radiotherapy. Reports regarding the disease prognosis and natural history are limited. In this article, we chronicle the case of a patient with primary renal angiosarcoma presenting at an advanced stage as a widely metastasised tumour. Additionally, we undertake here a brief literature review highlighting the rarity and aggressiveness of this condition, its poor prognosis, and the lack of specific management guidelines.
https://ift.tt/2PWjTGv
Intestinal obstruction with a twist: a rare case of congenital portal vein aneurysm causing intestinal obstruction
Bilious vomiting is often a presenting feature of upper intestinal obstruction in newborn. We present a case of intestinal obstruction in a newborn baby caused by abnormal vascular band arising from portal vein aneurysm in association with a midgut volvulus. Congenital anomalies of portovenous system are very rare, and it usually presents with portal hypertension in late infancy or childhood. In this particular child, the portal vein aneurysm contributed to intestinal obstruction due to both a failure of intestinal rotation and a mechanical band over the transverse colon.
https://ift.tt/2NWZOmj
Significant cephalad lead migration with use of externally powered spinal cord stimulator
Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention. The epidural stimulator leads in the patient migrated cranially to the T2 level that required extensive neurosurgical exploration. We believe this is the first reported case of such significant cranial epidural lead migration with the use of neurostimulation devices and demands more research into the safety of externally powered neurostimulation devices.
https://ift.tt/2PWjQKP
Intrahepatic sarcomatoid cholangiocarcinoma
Sarcomatoid carcinoma is a rare tumour composed of intermingled malignant epithelial and mesenchymal cells, and it has been reported in various organs including the liver. Sarcomatoid cholangiocarcinoma (CCC) is an extremely rare liver primary tumour. Here, we report a case of an elderly man who was admitted to our hospital after head trauma. He performed a head CT that diagnosed cerebral metastasis. On abdominal CT, he presented a 10x8x9 cm-sized hypodense liver mass in the VII and VIII segments, with peripheral enhancement. Histological and immunohistochemical examination of the tumour showed a malignant neoplasm with both carcinomatous and sarcomatous components and positive expression of cytokeratin and vimentin antibodies. The patient was diagnosed with intrahepatic sarcomatoid CCC at an advanced stage and died 45 days after the diagnosis. We emphasise the importance of immunohistochemistry which may provide a clue to proper diagnosis.
https://ift.tt/2O7mCzW
Case of colonic mucosal Schwann cell hamartoma and review of literature on unusual colonic polyps
Mucosal Schwann cell hamartomas (MSCH) are benign mesenchymal tumours rarely seen in the gastrointestinal tract. They occasionally present as incidental sessile polyps during colonoscopy. A 55-year-old asymptomatic female patient with a medical history of multiple sclerosis presented for a screening colonoscopy. A 5 mm low-risk tubular adenoma was noted in the caecum, and a second 5 mm polyp was found in the ascending colon. Histopathology of the ascending colon polyp showed proliferation of spindle cells without ganglion cells in the lamina propria. Immunohistochemical findings are compatible with an MSCH. Surveillance colonoscopy was scheduled in 5 years based on the presence of a single low-risk tubular adenoma.
https://ift.tt/2PXrxAn
Long-Term Effects on Volume Change in Musculocutaneous Flaps after Head and Neck Reconstruction
J reconstr Microsurg
DOI: 10.1055/s-0038-1672134
Objective Musculocutaneous flap reconstruction surgery is one of the standard procedures following head and neck cancer resection. However, no previous studies have classified flaps in terms of muscle and fat or examined them after long-term follow-up. The purpose of this study was to estimate the fat and muscle volume changes in musculocutaneous flaps during long-term follow-up. Methods We conducted a retrospective analysis of 35 patients after musculocutaneous flap reconstruction. The total, fat, and muscle volumes of the musculocutaneous flaps were measured using 3-dimensional images. Changes in flap volumes over time (1 month, 1 year [POY1], and 5 years [POY5] postoperatively) were assessed. Flap persistence was calculated using flap volumes at 1 month after reconstruction for reference. Results Flap persistence at POY5 was 42.0% in total, 64.1% in fat, and 25.4% in muscle. Muscle persistence was significantly decreased (p < 0.0001). In a multiple regression analysis, decreased body mass index (BMI) of ≥ 5% influenced fat persistence less than muscle persistence at POY1; however, there was no significant difference at POY5. Postoperative radiation therapy was associated with a significant decrease in total flap persistence at POY1 (p = 0.046) and POY5 (p = 0.0097). Muscle persistence significantly decreased at POY5 (p = 0.0108). Age significantly influenced muscle volume at POY1 (p = 0.0072). Conclusion Reconstruction flaps are well-preserved with high fat-to-muscle ratios. Recommendations for weight maintenance are necessary for patients less than 2 years after surgery due to the influence of BMI on fat persistence. Radiation therapy is necessary for some patients based on their disease state. Intensity-modulated radiation therapy can be offered to reduce scattering irradiation to normal tissues.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2OIm94a
Ahead of the Curve: Tracking Progress in Novice Microsurgeons
J reconstr Microsurg
DOI: 10.1055/s-0038-1670652
Background The purpose of this study was to evaluate learning curves for an existing microsurgical training model. We compared efficiency and amount of training needed to achieve proficiency between novice microsurgeons without operative experience versus those who had completed a surgical internship. Methods Ten novice microsurgeons anastomosed a silastic tube model. Time to perform each anastomosis, luminal diameter, and number of errors were recorded. Results First year residents improved up to a brief plateau at 10 repetitions, followed by continued improvement. Second year residents improved up to a plateau at 10 repetitions with no further improvement thereafter. There was no significant difference in luminal area or errors between groups. Conclusion Residents with no operative experience can benefit from early exposure to microsurgical training. These interns continue to improve with additional repetitions while second year residents achieve proficiency with fewer repetitions.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2zm4Hgo
Risk factors for cervical lymph node metastasis in endoscopically resected superficial hypopharyngeal cancers
Hypopharyngeal cancer is a head and neck cancer with a poor prognosis, and most cases show metastases on diagnosis. Cervical lymph node (LN) metastasis is a poor prognostic factor in hypopharyngeal cancer patients. The identification of risk factors for LN metastasis can help guide surgical treatment strategies for these patients.
https://ift.tt/2QPRiUD
Penicillin minor determinants: History and relevance for current diagnosis
To review the history of the penicillin minor determinants and evaluate their relevance for current diagnosis.
https://ift.tt/2DmGMS4
Recycling Full Thickness Skin Graft from Failing Free Flaps in Salvage Procedures
Free flap loss is a dreaded complication in microsurgery. When a second free flap is harvested, the enlarged donor site may not be amenable to primary closure, and a split thickness skin graft (STSG) is necessary. If we salvage the skin portion of the failing flap for subsequent wound closure, we not only minimize additional donor sites, we also reap the many functional and cosmetic advantages of full thickness skin grafts (FTSG) over STSG. The recyclability of salvaged skin is mainly dependent on the warm ischemia time.
https://ift.tt/2Dna17v
Cytokine levels in persistent skin lesions of adult-onset Still disease
To the Editor: Adult-onset Still disease (AOSD) is an inflammatory disease characterized by fever, polyarthritis, and skin inflammation, with increased serum levels of interferon-γ (IFN-γ), interleukin 1β (IL-1β), IL-18, IL-6, tumor necrosis factor-α, IL-8, IL-2 receptor, C-X-C motif chemokine 10, and C-X-C motif chemokine 13 (CXCL13).1 The cutaneous manifestations of AOSD include the classic evanescent skin eruption (ESE) and atypical persistent skin eruptions (APSEs), the latter possibly being related to more severe AOSD forms.
https://ift.tt/2I4pzf5
Anesthesia Safety in Otolaryngology
This article highlights the important relationship between the otolaryngologist and anesthesiologist, focusing on intraoperative patient safety for otolaryngologic surgery. In addition, consideration of preoperative history, physical examination, and potential postoperative complications helps guide the otolaryngologist and anesthesiologist in formulating an appropriate and collaborative management strategy.
https://ift.tt/2xEM4SV
Simulation Saves the Day (and Patient)
Surgeons can use simulation to improve the safety of the systems they work within, around, because of, and despite. Health care is a complex adaptive system that can never be completely knowable; simulation can expose aspects of patient care delivery that are not necessarily evident prospectively, during planning, or retrospectively, during investigations or audits. The constraints of patient care processes and adaptive capacity of health care providers may become most evident during simulations conducted "in situ" using real teams and real equipment, in actual patient care locations.
https://ift.tt/2QN8LNr
Patient Safety and Quality for Office-Based Procedures in Otolaryngology
Office-based procedures have increased in frequency with the recent changes in the current health care climate prioritizing improved efficiency and greater value in the care that is delivered. This article focuses on patient safety and quality issues that are specific to procedures in the office setting of an Otolaryngologist. Specific topics are categorized into preprocedure planning, procedural execution, and postprocedure follow-up. Several best practice recommendations are included to promote and simplify the integration of these quality and safety measures into every office setting.
https://ift.tt/2xF8KlT
The molecular mechanisms of increased radiosensitivity of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC): an extensive review
Abstract
Head and neck carcinomas (HNCs) collectively are the sixth most common cancer with an annual incidence of about 400,000 cases in the US. The most well-established risk factors for HNCs are tobacco and alcohol abuse. With the increasing public awareness, the incidence of HNCs is decreasing. But there is an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been observed during the last decade. This phenomena is associated with persistent infection with high-risk HPV. HPV associated OPSCC patients tend to be younger males of high socioeconomic status. The increasing incidence causes a significant loss to social resources, given that it's reported that HPV associated OPSCC represents about 60% of OPSCC cases. There is a growing amount of data supporting the hypothesis that HPV-associated OPSCC has a better survival rate due to a higher sensitivity to chemotherapy and radiotherapy as compared to HPV-unrelated OPSCC. Although the HPV positivity is associated with increased radio-sensitivity, the underlying mechanisms are not yet fully understood. This review summarizes the current knowledge on the effects of HPV infection and its carcinogenesis on the radiosensitivity of OPSCC, from the molecular to histologic level, providing a comprehensive insight of this special tumor entity.
https://ift.tt/2MXNi1q
A new rocuronium formulation not causing vascular pain in a flexor reflex model of anesthetized rats
Abstract
Purpose
Intravenous administration of the brand formulation of rocuronium bromide, currently used as a muscle relaxant, has been associated with vascular pain accompanied by withdrawal movements of the arm and wrist. The purpose of this study was to identify the cause of vascular pain induced by the brand formulation and to develop a new rocuronium formulation, not causing vascular pain, using a vascular pain-evoked flexor reflex response model of anesthetized rats.
Methods
A rat flexor reflex model, monitored by electromyography, was used to evaluate a flexor reflex response as the index of vascular pain. A catheter for drug administration was inserted into the superficial caudal epigastric artery. A needle electrode was inserted into a muscle in the femoral area to obtain an electromyogram (EMG) value. The integrated EMG values obtained after the administration of each test drug were compared to the baseline value and quantified.
Results
The acetate buffer contained in the solvent could cause flexor reflex response. Furthermore, the flexor reflex response increased in an acid concentration-dependent manner. Based on these results, we prepared a new rocuronium formulation using a low-acid-concentration buffer solution and found that it decreased the integrated EMG value in the rat model. The integrated EMG value acquired using the brand formulation was reduced by pretreatment with the TRPA1 channel inhibitor.
Conclusion
Our findings suggest that the high acid concentration in the brand formulation buffer solution is the cause of vascular pain. The rocuronium formulation developed using a low-acid-concentration buffer solution might help eliminate vascular pain in the clinic.
https://ift.tt/2DiGmfq
Introduction of robotic surgery for endometrial cancer into a Brazilian cancer service: a randomized trial evaluating perioperative clinical outcomes and costs
OBJECTIVE: The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to the traditional laparoscopic approach. METHODS: In this prospective randomized study from 2015 to 2017, eighty-nine patients with endometrial carcinoma that was clinically restricted to the uterus were randomized in robotic surgery (44 cases) and traditional laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs. RESULTS: The ages of the patients ranged from 47 to 69 years. The median body mass index was 31.1 (21.4-54.2) in the robotic surgery arm and 31.6 (22.9-58.6) in the traditional laparoscopic arm. The median tumor sizes were 4.0 (1.5-10.0) cm and 4.0 (0.0-9.0) cm in the robotic and traditional laparoscopic surgery groups, respectively. The median total numbers of lymph nodes retrieved were 19 (3-61) and 20 (4-34) in the robotic and traditional laparoscopic surgery arms, respectively. The median total duration of the whole procedure was 319.5 (170-520) minutes in the robotic surgery arm and 248 (85-465) minutes in the traditional laparoscopic arm. Eight major complications were registered in each group. The total cost was 41% higher for robotic surgery than for traditional laparoscopic surgery. CONCLUSIONS: Robotic surgery for endometrial cancer presented equivalent perioperative morbidity to that of traditional laparoscopic surgery. The duration and total cost of robotic surgery were higher than those of traditional laparoscopic surgery.
https://ift.tt/2xFXiXo
Survival and prognosis of young adults with gastric cancer
OBJECTIVES: Survival data for young adults (YA) with gastric cancer is conflicting and scarce in Brazil. The aim of this study was to compare the clinicopathological factors and survival rates of younger and older patients with gastric cancer. METHODS: Hospital registries for 294 gastric cancer patients from a reference cancer hospital in São Paulo, Brazil, were consulted for the retrieval of clinicopathological information and follow-up time. Patients were placed into the following groups: YA (≤40 years; N=71), older adult (OA: 41 to 65 years; N=129) and elderly (E: ≥66 years; N=94). Differences were assessed through Pearson's χ2 test, Kaplan-Meier analysis, Log rank test and Cox regression. RESULTS: More YA were diagnosed with advanced disease (clinical stage III/IV: 86.7% YA, 69.9% OA, and 67% E); however, fewer E patients underwent surgery (64.3% YA, 72.7% OA, and 52.4% E). The median overall survival among all patients was 16 months, and the overall survival rate was not significantly different among the age groups (p=0.129). There were no significant differences in the disease-free survival rate. Metastatic disease at diagnosis (HR=4.84; p<0.01) was associated with an increased hazard of death for YA. CONCLUSION: Overall survival was similar among age groups. Metastatic disease at diagnosis was the only factor associated with a poorer prognosis in YA. These results suggest that younger patients deserve special attention regarding the detection of early stage disease.
https://ift.tt/2NZEbBS
Clinical stage and histological type of the most common carcinomas diagnosed in young adults in a reference cancer hospital
OBJECTIVES: Cancer in young adults represents a great challenge, both biologically and socially, and understanding the unique characteristics of neoplasms in this age group is important to improving care. We aimed to evaluate the most common carcinomas and their characteristics, such as histological type and clinical stage, in young adults in the largest cancer hospital in Latin America. METHODS: The hospital registry was consulted for the period between 2008 and 2014. Young adults were defined as individuals aged 18 to 39 years, and older adults were defined as individuals aged 40 years and older. Differences between age groups were assessed through chi-square tests. RESULTS: Of the 39,389 patients included, 3,821 (9.7%) were young adults. Among the young adults, the most frequent cancer types were the following: breast, lymph node, colorectal, thyroid, testicle, hematopoietic and reticuloendothelial, uterine cervix, brain, soft tissue and stomach; these sites accounted for 74.5% of the observed tumors. Breast, colorectal and stomach cancers were more frequently diagnosed at advanced stages in young adults than in older adults (p<0.001). The most common histological types were infiltrating ductal carcinoma (86.12%) for breast cancer, adenocarcinomas not otherwise specified (45.35%) for colorectal cancer, squamous cell carcinoma not otherwise specified (65.26%) for uterine cervix cancer, signet ring cell adenocarcinomas (49.32%) for stomach cancer and adenocarcinomas not otherwise specified (50.79%) for lung cancer. CONCLUSION: Young adults are diagnosed with cancer at more advanced stages, indicating that health professionals should be aware of cancer incidence in this age group. It is necessary to develop a better understanding of cancer in young adults and to implement dedicated health care strategies for these patients.
https://ift.tt/2xE3ten
Lessons and perspectives for applications of stochastic models in biological and cancer research
The effects of randomness, an unavoidable feature of intracellular environments, are observed at higher hierarchical levels of living matter organization, such as cells, tissues, and organisms. Additionally, the many compounds interacting as a well-orchestrated network of reactions increase the difficulties of assessing these systems using only experiments. This limitation indicates that elucidation of the dynamics of biological systems is a complex task that will benefit from the establishment of principles to help describe, categorize, and predict the behavior of these systems. The theoretical machinery already available, or ones to be discovered to help solve biological problems, might play an important role in these processes. Here, we demonstrate the application of theoretical tools by discussing some biological problems that we have approached mathematically: fluctuations in gene expression and cell proliferation in the context of loss of contact inhibition. We discuss the methods that have been employed to provide the reader with a biologically motivated phenomenological perspective of the use of theoretical methods. Finally, we end this review with a discussion of new research perspectives motivated by our results.
https://ift.tt/2NZxz6m
Organization of the cancer network in SUS: evolution of the care model
In the current context of epidemiological transition, demographic changes, changes in consumption and lifestyle habits, and pressure on care costs and organized health systems for acute conditions, the Integrated Care Model by Shortell has become a conceptual reference in the search for new methods to manage chronic conditions by focusing on the health conditions of a given population that must be addressed by a set of institutions organized into networks. Within the last 15 years, cancer has gone from the third- to the second-leading cause of death in the State of São Paulo and has shown a gradual increase in the number of new cases; it has thus become a relevant issue for public health and health management. The model adopted by the State for the organization of the cancer care network was the motivation for this study, which aimed to evaluate the evolution of the model of care for cancer patients within the Unified Health System (Sistema Único de Saúde) based on the integrated care model. Since 1993, the year that cancer was first considered highly complex in the Sistema Único de Saúde by the Ministry of Health, it has been possible to observe a progressive orientation towards the integral and integrated care of patients with cancer. In the State of São Paulo, the active participation of qualified service providers through a Technical Reference Committee showed that experts could contribute to the definition of public policies, thereby providing a technical base for decision making and contributing to the development of clinical management.
https://ift.tt/2xANPR4
Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges
Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status ≥2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations.
https://ift.tt/2NTQQGv
Clinical perspectives of PSMA PET/MRI for prostate cancer
Prostate cancer imaging has become an important diagnostic modality for tumor evaluation. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) has been extensively studied, and the results are robust and promising. The advent of the PET/magnetic resonance imaging (MRI) has added morphofunctional information from the standard of reference MRI to highly accurate molecular information from PET. Different PSMA ligands have been used for this purpose including 68gallium and 18fluorine-labeled PET probes, which have particular features including spatial resolution, imaging quality and tracer biodistribution. The use of PSMA PET imaging is well established for evaluating biochemical recurrence, even at low prostate-specific antigen (PSA) levels, but has also shown interesting applications for tumor detection, primary staging, assessment of therapeutic responses and treatment planning. This review will outline the potential role of PSMA PET/MRI for the clinical assessment of PCa.
https://ift.tt/2xFXiqm
Epidemiological science and cancer control
Epidemiological methods are essential for the discovery of cancer risks and prognostic factors as well as for the evaluation of cancer prevention measures. In this review, we discuss epidemiological surveillance procedures for data collection and processing to guide and evaluate the consequences of anticancer efforts for populations, assess the identification of cancer risk factors, examine barriers to cancer screening and recommended rules for early diagnosis programs. Epidemiological studies have shown that hindrances to cancer information assessment are currently encountered in developing countries. Known cancer risk factors include social determinants, lifestyle factors, occupational exposures, infectious agents, and genetic and epigenetic alterations. Challenges remain in studying the effectiveness of cancer screening; screening can have detrimental effects, and few cancers clearly benefit from screening. Currently, epidemiology faces the challenge of dealing with distinct levels of data, including factors related to social status, lifestyle and genetics, to reconstruct the causal traits of cancer. Additionally, translating epidemiological knowledge into cancer control demands more implementation studies in the population.
https://ift.tt/2NZDWqs
Academic health centers: integration of clinical research with healthcare and education. Comments on a workshop
Epidemiological methods are essential for the discovery of cancer risks and prognostic factors as well as for the evaluation of cancer prevention measures. In this review, we discuss epidemiological surveillance procedures for data collection and processing to guide and evaluate the consequences of anticancer efforts for populations, assess the identification of cancer risk factors, examine barriers to cancer screening and recommended rules for early diagnosis programs. Epidemiological studies have shown that hindrances to cancer information assessment are currently encountered in developing countries. Known cancer risk factors include social determinants, lifestyle factors, occupational exposures, infectious agents, and genetic and epigenetic alterations. Challenges remain in studying the effectiveness of cancer screening; screening can have detrimental effects, and few cancers clearly benefit from screening. Currently, epidemiology faces the challenge of dealing with distinct levels of data, including factors related to social status, lifestyle and genetics, to reconstruct the causal traits of cancer. Additionally, translating epidemiological knowledge into cancer control demands more implementation studies in the population.
https://ift.tt/2xDjyRN
Normocomplementaemic urticarial vasculitis: effective treatment with omalizumab
We report two patients with normocomplementaemic urticarial vasculitis with impressive response to omalizumab. This contrasts recent reports on hypocomplementaemic urticarial vasculitis syndrome, highlighting ...
https://ift.tt/2MSxTiw
Co-occurrence of mycotoxins in maize food and maize-based feed from small-scale farms in Brazil: a pilot study
Abstract
A limited survey was conducted to assess the co-occurrence of aflatoxins (AF) B1, B2, G1, and G2; fumonisins (FB) B1 and B2; ochratoxin A (OTA); zearalenone (ZEN); and deoxynivalenol (DON) in maize food (N = 26) and animal feed (N = 45) collected from 21 small-scale farms from the states of São Paulo (SP) and Santa Catarina (SC), Brazil. Samples evaluated were maize meal and maize flour for human consumption available in the farm households, and maize-based feed intended for broiler chicks, laying hens, and dairy cows. Analyses of mycotoxins were performed by ultra-performance liquid chromatography coupled with tandem mass spectrometry. The median levels of mycotoxins found in maize food were 2.5 μg/kg (total AF), 120 μg/kg (total FB), 13 μg/kg (ZEN), and 57 μg/kg (DON). All values were below the Brazilian tolerance limits, except for total FB in one sample of maize flour. In feed samples, median levels of total AF, total FB, ZEN, and DON were 100 μg/kg, 680 μg/kg, 160 μg/kg, and 200 μg/kg, respectively. The co-occurrence of two or more mycotoxins was confirmed in 35% and 51% of maize food and feed, respectively. Results indicate a low human exposure to mycotoxins in the small-scale farms evaluated and a higher exposure of farm animals to mycotoxins in the feed.
https://ift.tt/2MQJpuV
Traumatic arteriovenous fistula formation secondary to crush injury
Abstract
We describe a patient who suffered a crush injury after a motor vehicle accident leading to complex pelvic injuries complicated by an AV fistula. Traumatic arteriovenous (AV) fistulas from blunt, non-penetrating injuries are uncommon and rarely described in medical literature. A CT followed by pelvic angiogram performed by interventional radiology revealed a traumatic fistula which was then treated by embolization. Patient underwent exploratory laparotomy, craniotomy and open reduction internal fixation of pelvis and was stabilized prior to discharge to rehabilitation.https://ift.tt/2xEMXuS
Acute anterograde intussusception as a late complication of distal gastric bypass
Abstract
Small bowel intussusception is an uncommon cause of adult intestinal obstruction after gastric bypass for morbid obesity. It usually affects the Roux or the common limb at the jejunojejunostomy site and is mainly retrograde. An altered motility of the Roux limb seems to be the main explanation for its developement. We report the case of a patient with a late acute anterograde intussusception after a previous distal Roux-en-Y gastric bypass. Clinical, radiological and operative findings are presented and surgical solutions described in the literature are reviewed.https://ift.tt/2QPfI0r
Large rib osteochondroma in a child in Aleppo, Syria
Abstract
Background
Osteochondromas are the most common tumors of the long bones in children. Osteochondromas can rarely be seen in the chest wall and they are usually diagnosed at a young age. They can be sporadic or part of the hereditary multiple exostoses. Case presentation
We report a 12-year-old boy, who presented with a hard and large mass in the chest wall. The mass grew slowly after the original resection. Diagnosis and treatment were delayed because of the war. Radiological examination showed a large calcified tumor pushing the upper lung lobe. He was treated surgically. Pathology confirmed the diagnosis of an osteochondroma with no evidence of malignancy. Conclusion
Osteochondroma occur most frequently in long bones next to the metaphysic. These tumors can also develop in unusual sites. Wide total excision with negative margins is important to prevent recurrence.https://ift.tt/2xHTSmK
Wilkie’s syndrome, a missed opportunity
Abstract
Wilkie's syndrome is a rare cause of duodenal obstruction that can easily be missed at clinical practice. It is characterized by nausea, abdominal pain and vomit. It usually affects young adults, and it's caused by a low aortomesenteric angle resulting in vascular compression of the duodenum. Symptoms could resemble many of the symptoms presented in a patient with a suspected eating disorder. The non-specificity of the clinical signs and symptoms can confuse, delay the diagnosis and expose the patient to potentially hazardous therapies. We report a case of a 20-year-old patient who presented to the emergency room with a history of intermittent vomiting and abdominal pain. He had been previously misdiagnosed with an eating disorder and received physiological therapy. Nonetheless, his pain persisted. After further evaluation with the use of imaging techniques, a low aortomesenteric angle was discovered. He underwent surgery and completely recovered. On follow up controls patient is well and he no longer had episodes of vomiting.https://ift.tt/2QPg8nt
The Burden of Sinusitis in Hematologic Transplant Patients: A National Perspective
The Laryngoscope, EarlyView.
https://ift.tt/2PTJqAg
Prevalence of gingival recession after orthodontic treatment of infraversion and open bite
Abstract
Purpose
Aim of the present study was to investigate the prevalence of gingival recession and related factors in teeth with low occlusal function (open bite and infraversion) after orthodontic treatment.
Methods
From January 2014 to December 2017, 403 patients received orthodontic treatment. Their gingival recession and related factors before and after treatment were retrospectively analyzed.
Results
The prevalence of gingival recession in patients with infraversion and open bite after orthodontic treatment were 80.6 and 75.0%, respectively; these values were 43.4 and 47.5% before treatment, respectively. Notably, the Miller index of gingival recession increased after orthodontic treatment (P < 0.05). The risk of gingival recession in patients with infraversion or open bite after orthodontic treatment was remarkably higher than the risk in other patients (odds ratio [OR] = 16.712 and 5.073, respectively); the gingival recession rate was related to treatment with tooth extraction (OR = 2.043), as well as gingival biotype (OR = 0.341) and gingival index (GI) before orthodontic treatment (OR = 97.404; P < 0.05).
Conclusions
Patients with these two types of low occlusal function are more likely to exhibit gingival recession after orthodontic treatment. Moreover, the prevalence of gingival recession after orthodontic treatment is higher among patients who have undergone tooth extraction during orthodontic treatment, and among those who exhibit thin gingival biotype and high gingival index before orthodontic treatment.
https://ift.tt/2QMakLH
Effect of Reversed Tracking Method for Identification of EBSLN in Thyroid Surgery
Conditions: Thyroid Cancer; Recurrent Laryngeal Nerve Injuries
Intervention: Procedure: Reversed Tracking Method
Sponsor: Fujian Medical University
Not yet recruiting
https://ift.tt/2xGNn3B
Intervention: Procedure: Reversed Tracking Method
Sponsor: Fujian Medical University
Not yet recruiting
https://ift.tt/2xGNn3B
Resting parasympathetic dysfunction predicts prosocial helping deficits in behavioral variant frontotemporal dementia
Publication date: Available online 20 September 2018
Source: Cortex
Author(s): Virginia E. Sturm, Isabel J. Sible, Samir Datta, Alice Y. Hua, David C. Perry, Joel H. Kramer, Bruce L. Miller, William W. Seeley, Howard J. Rosen
Abstract
In the behavioral variant of frontotemporal dementia (bvFTD), left-lateralized salience network dysfunction reduces basal activity in the parasympathetic nervous system, a branch of the autonomic nervous system that reduces arousal and fosters empathy and prosociality. Here we examined whether resting parasympathetic deficits in bvFTD related to diminished prosocial behavior. Eighty participants (30 with bvFTD, 25 with Alzheimer's disease [AD], and 25 healthy controls) completed a "helping task" in which we quantified participants' spontaneous reactions to an experimenter who struggled to find a lost key. Participants also underwent an assessment of baseline autonomic nervous system activity and structural magnetic resonance imaging. An exploratory factor analysis of participants' behaviors during the helping task revealed four factors: empathic concern, consolation, disengagement, and impatience. Patients with bvFTD had lower empathic concern and greater disengagement and impatience than the AD and healthy control groups. Patients with bvFTD had lower resting respiratory sinus arrhythmia and faster respiration and heart rates than patients with AD and healthy controls, a pattern consistent with parasympathetic dysfunction. Skin conductance level was also lower in bvFTD than in the other groups. Lower baseline respiratory sinus arrhythmia and faster baseline respiration rates, but not skin conductance level, predicted lower prosocial helping behaviors. Voxel-based morphometry analyses revealed that atrophy in the bilateral medial pulvinar nucleus of the thalamus, midcingulate cortex, and caudate was associated with lower empathic concern and consolation, and atrophy in the bilateral medial pulvinar nucleus of the thalamus, left frontoinsula, and left ventral striatum was associated with greater disengagement and impatience. Left-lateralized frontoinsula atrophy was associated with not only lower respiratory sinus arrhythmia but also with lower consolation and greater disengagement. This study offers evidence for prosocial behavior deficits in bvFTD and suggests that left-lateralized salience network atrophy reduces patients' resting parasympathetic activity and motivation to help others in need.
https://ift.tt/2MSORgK
Effect of Reversed Tracking Method for Identification of EBSLN in Thyroid Surgery
Conditions: Thyroid Cancer; Recurrent Laryngeal Nerve Injuries
Intervention: Procedure: Reversed Tracking Method
Sponsor: Fujian Medical University
Not yet recruiting
https://ift.tt/2xGNn3B
Intervention: Procedure: Reversed Tracking Method
Sponsor: Fujian Medical University
Not yet recruiting
https://ift.tt/2xGNn3B
Correction to: Complement in the pathogenesis of Alzheimer’s disease
The presentation of Fig. 2 was incorrect.
https://ift.tt/2ptz2nE
Prevalence of potential contact allergens in baby cosmetic products
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2OIjZBF
Prevalence of gingival recession after orthodontic treatment of infraversion and open bite
Abstract
Purpose
Aim of the present study was to investigate the prevalence of gingival recession and related factors in teeth with low occlusal function (open bite and infraversion) after orthodontic treatment.
Methods
From January 2014 to December 2017, 403 patients received orthodontic treatment. Their gingival recession and related factors before and after treatment were retrospectively analyzed.
Results
The prevalence of gingival recession in patients with infraversion and open bite after orthodontic treatment were 80.6 and 75.0%, respectively; these values were 43.4 and 47.5% before treatment, respectively. Notably, the Miller index of gingival recession increased after orthodontic treatment (P < 0.05). The risk of gingival recession in patients with infraversion or open bite after orthodontic treatment was remarkably higher than the risk in other patients (odds ratio [OR] = 16.712 and 5.073, respectively); the gingival recession rate was related to treatment with tooth extraction (OR = 2.043), as well as gingival biotype (OR = 0.341) and gingival index (GI) before orthodontic treatment (OR = 97.404; P < 0.05).
Conclusions
Patients with these two types of low occlusal function are more likely to exhibit gingival recession after orthodontic treatment. Moreover, the prevalence of gingival recession after orthodontic treatment is higher among patients who have undergone tooth extraction during orthodontic treatment, and among those who exhibit thin gingival biotype and high gingival index before orthodontic treatment.
https://ift.tt/2QMakLH
Prevalence of potential contact allergens in baby cosmetic products
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2OIjZBF
Real-world-Datenquellen für die Versorgungsforschung zum Hautkrebs
Zusammenfassung
Dermatologische Versorgungsforschung mit dem Ziel der Verbesserung von Prävention, effizienter Diagnostik und Therapie des Hautkrebses braucht Real-world-Daten aus allen Sektoren der Versorgung. Der Beitrag liefert eine Übersicht aktuell verfügbarer, relevanter Real-world-Datenquellen und ihres Nutzungspotenzials und führt beispielhaft Ergebnisse vorliegender Studien auf: Sekundärdatenanalysen mit Abrechnungsdaten der gesetzlichen Krankenkassen wurden genutzt, um u. a. die Teilnahmerate am gesetzlichen Hautkrebsscreening abzuschätzen. Diese betrug im Zweijahreszeitraum ca. 31 %, war in den westlichen Bundesländern höher als in den östlichen und bei Frauen höher als bei Männern. Für die dermatologische Versorgungsplanung stehen regionale Daten in Kombination mit sozialstrukturellen und soziodemografischen Indikatoren zur Verfügung, und die Analyse verweist auf einen Zusammenhang mit der Hautkrebsprävalenz. Primäre Daten sind verfügbar und notwendig zur Erfassung patientenberichteter Endpunkte sowie der arztseitigen Bewertung der Versorgung von Hautkrebspatienten. Umfangreiche histopathologische Datenbanken erfassen neben klinischen auch soziodemografische Parameter und deuten auf einen Zusammenhang von Diagnose- bzw. Therapiezeitpunkt mit dem Versicherungsstatus und Wohnortmerkmalen hin. Neben dem Nutzungspotenzial werden spezifische Limitationen der Datenquellen aufgeführt.
https://ift.tt/2PUgc46
A Critical Need: Increasing Interest in the Field of Allergy and Immunology in Medical Students and Residents
Publication date: Available online 20 September 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Rebecca Scherzer
https://ift.tt/2MS0NQb
Omalizumab as single-dose therapy for vernal keratoconjunctivitis
Publication date: Available online 20 September 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Rachel Simpson, Jason K. Lee
https://ift.tt/2ptr7a2
HASAN: Highly Accurate Sensitivity for Auto-contrast-corrected pMRI Reconstruction
Publication date: Available online 21 September 2018
Source: Magnetic Resonance Imaging
Author(s): Md. Sakibur Rahman Sajal, Md. Kamrul Hasan
Abstract
A novel method for highly accurate coil sensitivity-map estimation, based on a constrained image-domain multi-channel LMS (c-iMCLMS) algorithm, is proposed for image reconstruction using self-calibrating SENSE. The sensitivity information is extracted by developing an image-domain cross-relation equation using the low-resolution images constructed from the fully sampled central region of the variable density MR data. Then this formulation is solved in an iterative way using a novel sum-of-squares (SOS) constraint. The improvement of the convergence speed of the c-iMCLMS algorithm is accomplished by SOS normalization of the low resolution image data and using a variable step-size in the update equation. The salient feature of the proposed technique is that it does not require any prior selection of the basis function and/or simultaneous estimation of the object image and the coil sensitivity-map. Only the low resolution images are re-filtered for the compensation of the data truncation effect to improve the consistency of the estimated coil maps. Besides, the application of the novel SOS-constraint, estimated using the pixel position-wise variance of the coil maps, gives closest to the true sensitivity-map. As a result, true object image with auto-corrected contrast is reconstructed without adopting any traditional post-contrast correction techniques. For minimization of the process noise, regularized conjugate gradient (CG) based SENSE reconstruction algorithm is used for image reconstruction using the estimated coil sensitivity-map. The proposed technique is tested on various simulation, synthetic and in-vivo datasets and significant signal-to-artifact-noise-ration (SANR) improvement closest to the theoretical limit set by coil geometric factor is obtained as compared to some noted techniques in the literature both visually and numerically.
https://ift.tt/2pr9c3z
Prevalence of self-reported drug hypersensitivity reactions among Lithuanian children and adults
Publication date: Available online 20 September 2018
Source: Allergologia et Immunopathologia
Author(s): V. Kvedariene, B. Sitkauskiene, L. Tamasauskiene, O. Rudzeviciene, V. Kasiulevicius, G. Nekrosyte, E.R. Gomes, P. Demoly
Abstract
Introduction and objectives
Drug hypersensitivity reactions (DHRs) are the adverse effects of drugs that, when taken at doses generally tolerated by normal subjects, clinically resemble allergy. We aimed to assess the prevalence of self-reported DHRs among Lithuanian children and adults and to identify possible risk factors.
Materials and methods
A cross-sectional survey of a population visiting their general practitioners in Vilnius and Kaunas regions of Lithuania was performed. Thirty-five questions on drug allergy symptoms, in addition, food, pollen allergy and family history were included.
Results
3222 (60.0%) children and 2148 (40.0%) adults were included in the study. 7.9% of children and 13.8% of adults reported a DHR for at least one drug (p < 0.001). 69.8% of children and 47.3% of adults, who indicated DHRs, had skin symptoms. Rate of anaphylaxis was similar in both groups (about 10%). 4.5% of children and 7.3% of adults had DHRs induced by antibiotics and this was the most implicated group of drugs. Significant self-reported risk factors for DHRs were family history of DHRs (OR = 6.007, 95%CI 4.756–7.587), pollen allergy (OR = 2.0, 95%CI 1.573–2.544), food allergy (OR = 1.92, 95%CI 1.505–2.448), female gender (OR = 1.439, 95%CI 1.187–1.744) and age (OR = 1.017 in favour of adults, 95%CI 1.013–1.021).
Conclusions
The prevalence of self-reported DHRs in Lithuania is higher among adults than children. Drug-induced skin reactions were the predominant symptom in both groups. Besides female gender and age, a positive family history of DHR and presence of pollen or food allergy may be associated with DHR.
https://ift.tt/2pr7fnK
Molecular diagnostics improves diagnosis and treatment of respiratory allergy and food allergy with economic optimization and cost saving
Publication date: Available online 20 September 2018
Source: Allergologia et Immunopathologia
Author(s): S. Peveri, S. Pattini, M.T. Costantino, C. Incorvaia, M. Montagni, C. Roncallo, D. Villalta, E. Savi
Abstract
Background
Component resolved diagnosis (CRD) allows to precisely identify the sensitization to specific molecules of a given allergenic source, resulting in an important improvement in clinical management, particularly of polysensitized subjects. This will end in the correct prescription of allergen immunotherapy (AIT) for respiratory allergy and in adequate avoidance diets or prescription of self-injectable adrenaline in food allergy.
Objective
The aim of this multicenter, real life study is to evaluate the percentage change of the diagnostic-therapeutic choice in polysensitized patients with respiratory allergy and in patients with food allergy, after using CRD compared to a first level diagnosis, along with an economic analysis of the patient's overall management according to the two different approaches.
Methods
An overall number of 462 polysensitized patients, as suggested by skin prick tests (SPT), and with clinical symptoms related to a respiratory (275 pts) or food (187 pts) allergy, were recruited. All patients underwent CRD for specific IgE against food or inhalant recombinant molecules, which were chosen according to medical history and positivity to SPT. The first diagnostic-therapeutic hypothesis, based only on medical history and SPT, was recorded for each patient while the final diagnostic-therapeutic choice was based on the results from CRD. The rate of change of the diagnostic-therapeutic choice from the first hypothesis to the final choice was statistically evaluated. The economic impact of CRD on the overall management of the allergic patients was analyzed to evaluate whether the increase in the diagnostic costs would be compensated and eventually exceeded by savings coming from the improved diagnostic-therapeutic appropriateness.
Results
An approximate 50% change (k index 0.54) in the prescription of AIT for respiratory allergy as well as a change in the prescription of self-injectable adrenaline (k index 0.56) was measured; an overall saving of financial resources along with a higher diagnostic-therapeutic appropriateness was also detected.
Conclusion
There is moderate agreement concerning prescription of AIT and self-injectable adrenaline before and after performing CRD: this highlights the usefulness of CRD, at least in polysensitized patients, in indicating the risk assessment and therefore the correct therapy of respiratory and food allergy, which results in a cost-saving approach.
https://ift.tt/2MTTN5c
Omentin-1 protects against bleomycin-induced acute lung injury
Publication date: November 2018
Source: Molecular Immunology, Volume 103
Author(s): Yan Zhou, CaiXia Hao, Chen Li, XiaoTing Huang, XiaoHong Li, YiTing Tang, YanHong Huang, SiYuan Tang, Wei Liu, DanDan Feng, JianPing Xu, ShaoJie Yue, Hui Xie, ZiQiang Luo
Abstract
Acute lung injury (ALI) is characterized by inflammatory cell infiltration, macrophage activation, and excessive pro-inflammatory cytokine production. Bleomycin (BLM) is widely used to induce acute lung injury (ALI) and fibrosis in murine models. Intratracheally administration of BLM leads to the early stage of inflammatory response and the late stage of collagen deposition. Omentin-1 exerts an anti-inflammatory role in reducing tumor necrosis factor α (TNF-α)-induced cyclooxygenase-2 expression in endothelial cells and attenuating lipopolysaccharide (LPS)-induced ALI. However, the role of omentin-1 in BLM-induced ALI remains unclear. The aim of this study is to examine the effects of omentin-1 on BLM-induced ALI. We found that omentin-1 was decreased in lungs of BLM-induced ALI mice. Omentin-1 overexpression mediated by adenovirus alleviated lung injury and maintained the integrity of the alveolar septa. Omentin-1 overexpression also remarkably decreased the aggregation of neutrophil and macrophages activation, the expression of monocyte chemotactic protein 1 (MCP-1), and down-regulated expression of interleukin 1β (IL-1β) in lungs of BLM-induced ALI mice. Furthermore, we observed that omentin-1 reduced oxidative stress and suppressed the activation of NF-κB pathway in BLM-induced ALI and LPS-induced macrophages activation. Together, our findings indicated that omentin-1 protected mice from BLM-induced ALI may through reducing inflammatory cells recruitment and macrophages activation via alleviation of oxidative stress and NF-κB pathway. Thus, therapeutic strategies aiming to restore omentin-1 levels may be valuable for the prevention of BLM-induced ALI.
https://ift.tt/2O56grc
GM-CSF intrinsically controls eosinophil accumulation in allergic airway inflammation
Publication date: Available online 20 September 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Samuel Philip Nobs, Merve Kayhan, Manfred Kopf
Abstract
Background
Eosinophils are a therapeutic target in asthma and GM-CSF has been suggested to control various aspects of eosinophil biology including development, function and survival. However, to date the role of GM-CSF signaling in eosinophils in vivo is largely unclear.
Objective
We sought to elucidate the role of GM-CSF signaling in asthmatic inflammation.
Methods
Wild-type and wild-type alveolar macrophage-reconstituted GM-CSF receptor α (Csf2ra)-deficient mice were subjected to different models of airway inflammation to evaluate the impact of GM-CSF signaling deficiency on asthmatic inflammation in general and on eosinophils in particular
Results
We demonstrate that GM-CSF signaling, while being largely dispensable for eosinophil development in steady-state, intrinsically promotes the accumulation of eosinophils in the lung during allergic airway inflammation. In contrast, chitin-induced eosinophil accumulation in the peritoneal cavity occurs independent of GM-CSF indicating organ specificity. We show that GM-CSF induces chemokinesis and promotes eosinophil survival in vitro, which likely contribute to eosinophil accumulation in the airways in vivo.
Conclusion
GM-CSF is a lung-specific regulator of eosinophil biology in pulmonary allergic inflammation.
Graphical abstract
https://ift.tt/2pqJXhZ
Characterizing drug-induced capillary leak syndromes using the Wold Health Organization VigiBase
Publication date: Available online 20 September 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Philippe Mertz, Bénédicte Lebrun-Vignes, Joe-Elie Salem, Laurent Arnaud
https://ift.tt/2MQ261P
FPIES: increased prevalence of this great unknown. Results of PREVALE study
Publication date: Available online 20 September 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): S. Bellón, J. García, P. Torija, S. Díaz, M. Muñoz, P. Alonso, T. Bracamonte, S. Quevedo, L.Á. Echeverría
https://ift.tt/2pqJP1Z
Oral vitamin D3 5000 IU/day as an adjuvant in the treatment of atopic dermatitis: a randomized control trial
International Journal of Dermatology, EarlyView.
https://ift.tt/2xEIgBc
Gardner‐Diamond syndrome: a systematic review of treatment options for a rare psychodermatological disorder
International Journal of Dermatology, EarlyView.
https://ift.tt/2QNZeFV
Serum irisin: A prognostic marker for severe acne vulgaris
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2xrikK8
SWEET SYNDROME FOLLOWING A POSITIVE MANTOUX TEST DUE TO PULMONARY TUBERCULOSIS
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xBh0n7
Topical diltiazem for ulceration of striae distensae associated with bevacizumab therapy
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2QOVljX
“Chemical” surgery in treating basal cell carcinoma in elderly
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xGEEOS
Serum irisin: A prognostic marker for severe acne vulgaris
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2xrikK8
SWEET SYNDROME FOLLOWING A POSITIVE MANTOUX TEST DUE TO PULMONARY TUBERCULOSIS
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xBh0n7
Topical diltiazem for ulceration of striae distensae associated with bevacizumab therapy
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2QOVljX
“Chemical” surgery in treating basal cell carcinoma in elderly
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2xGEEOS
A Randomized Trial of Early Endovenous Ablation in Venous Ulceration: a critical appraisal
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2psSG3g
A Randomized Trial of Early Endovenous Ablation in Venous Ulceration: a critical appraisal
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2psSG3g
Identifying Predictors of Time to Soft Tissue Reconstruction Following Open Tibia Fractures
INTRODUCTION: Controversy remains regarding the optimal timing of soft tissue coverage following severe lower extremity trauma. This study identifies nationwide practice patterns and factors associated with discrepancies in time to first flap surgery following open tibia fractures. METHODS: A retrospective analysis was performed on the National Trauma Databank from 2008-2015 to identify patients who presented with an open tibia fracture and underwent subsequent flap reconstruction. A lasso algorithm was performed, revealing those factors most significantly associated with differences in time to flap surgery from hospitalization. RESULTS: A total of 3,297 patients were included in the analysis. Mean and median times to first flap surgery were 230.1 hours (SD; 246.7 hours), and 169.1 hours, respectively. Older age, a non-white race, treatment in the South, and a non-private insurance status were all independently associated with an increased time to flap surgery. In addition, more surgical debridements, a higher injury severity and/or abbreviated injury score, and a nerve, vascular, and/or crush injury were independent predictors of an increased time to flap surgery. CONCLUSION: Most patients who present with open tibia fractures requiring soft tissue coverage undergo flap reconstruction after the historical 72-hour window. Specific sociodemographic and clinical factors were independently predictive of an increased time to flap surgery. These findings suggest that not all patients in the United States are receiving the same level of care in lower extremity trauma reconstruction, emphasizing the need to develop more explicit national standards. * These authors contributed equally to this work Financial Disclosure Statement: None of the authors have a financial disclosure Corresponding Author Contact Information: Scott T. Hollenbeck, MD, Associate Professor, Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Box 3945, Durham, NC 27710, USA. Phone: (919) 681-5079 | Fax: (919) 681-2670, Email: scott.hollenbeck@duke.edu ©2018American Society of Plastic Surgeons
https://ift.tt/2ppVMVx
https://ift.tt/2ppVMVx
Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of Lymphatic Vessel Detection Rates on 840 Surgical Fields in Lower Extremity Lymphedema Patients
Background: Supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming a useful treatment option for progressive lower extremity lymphedema (LEL) with its minimal invasiveness. Finding lymphatic vessel is a minimum requirement for LVA surgery, but no study has reported comprehensive analysis on factors associated with lymphatic vessel detection (LVD). Methods: One hundred thirty-four female secondary LEL patients who underwent indocyanine green (ICG) lymphography and LVA without past history of lymphedema surgery were included. Medical charts were reviewed to obtain clinical, ICG lymphographic, and intraoperative findings. LVD was defined as positive when one or more lymphatic vessels were found in a surgical field of LVA. Logistic regression analysis was used to identify independent factors associated with LVD. Results: Patients' age ranged from 36 to 81 years, duration of edema from 3 to 324 months, and BMI from 16.2 to 33.3 kg/m2. Forty-eight patients (35.8%) had past history of radiation, and 76 patients (56.7%) had past history of cellulitis. LVAs were performed in 840 surgical fields, among which LVD was positive in 807 fields; overall LVD rate was 96.1%. Multivariate analysis revealed inverse associations in higher body mass index (odds ratio [OR] 0.323; P = 0.008) and S-region/D-region on ICG lymphography compared with L-region (OR 1.049 x 10-8/1.724 x 10-9; P
https://ift.tt/2MQWnsO
https://ift.tt/2MQWnsO
“Towards the Assessment of Core Procedural Competencies amongst Canadian Plastic Surgery Residents.”
Background: Plastic surgery residency training programs are working towards integrating competency-based education into program curriculum and training, a key component of which involves establishing Core Procedural Competencies. This study aims to determine the exposure of graduating Canadian plastic surgery residents to established Core Procedural Competencies. Methods: A retrospective review of case log procedure data using three databases (T-Res, POWER, New Innovations) from graduating residents at all 10 Canadian English-speaking plastic surgery training programs between 2004-2014 was completed. Case logs were coded according to 177 Core Procedural Competencies identified as 'Core' by the Delphi Method amongst an expert panel of Canadian plastic surgeons. Results: A total of 59,405 procedures were logged by 55 graduating residents across Canada between 2004-2014 (average 1,080 ± 352 procedures per resident). Of thirteen plastic surgery domains, 44% of all procedures were within either Hand, Upper Extremity & Peripheral Nerve (28.3%) or Non-Aesthetic Breast (16.1%). The most frequently performed Core Procedural Competencies (average case logs per resident) included: breast reduction (65.3 ± 33.9), open carpal tunnel release (46.7 ± 34.2), breast reconstruction – implant-based (39.6 ± 20.5), and wound management (35.7 ± 28.6). Sixty-two of 177 procedures were logged on average less than once in 5 years of residency, including: escharotomy, temporal parietal fascia flap, Guyon's canal release and soft tissue fillers. Conclusions: This study identifies areas of exposure and underexposure to plastic surgery Core Procedural Competencies, and can help focus surgical education on areas of greater need for surgical skills training and acquisition. Financial Disclosure Statement:D Courtemanche is a shareholder and board member of Resilience Software. Resilience Software makes and supports T-Res. Presented at: 70th Annual Meeting of the Canadian Society of Plastic Surgeons 2016 in Ottawa, Ontario. Acknowledgements: We would like to thank the Postgraduate Medical Education Office, program directors and database vendors at University of Toronto and Western University for their assistance and support in extracting data from the POWER (©Knowledge4YouCorporation) and New Innovations (©New Innovations, Inc.) databases, respectively. In addition to participating in the research involved in this study, Dr. Courtemanche also generated the anonymous data set for the other 9 Canadian plastic surgery training programs that use T-Res. Corresponding Author: Jessica G. Shih, MD, The Division of Plastic & Reconstructive Surgery, 149 College Street, 5th Floor, Suite 508, Toronto, Ontario M5T 1P5, e-mail address: jessica.shih@utoronto.ca ©2018American Society of Plastic Surgeons
https://ift.tt/2psQGIi
https://ift.tt/2psQGIi
The Osteoseptocutaneous Fibula Flap: Concise Review, Goal-Oriented Surgical Technique, and Tips and Tricks
The fibula osteoseptocutaneous flap is a workhorse flap for bone reconstruction. Mastery of the flap is essential for a rewarding reconstruction. Yet, there's no complete work on this versatile flap. The authors provide concise review of the literature, address the myths and challenges associated with the flap, and describe their refined techniques for different reconstruction scenarios and possible anatomic variations. Conflict of interest: The authors have no conflict of interest to declare. Correspondence Author and Requests for Reprints: Fu-Chan Wei. MD, FACS, Distinguished Chair Professor, Chang Gung University Medical College, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei 10591, Taiwan, E-mail: ,Tel: +886- 3-328-1200 ext 3535 or 2007 ©2018American Society of Plastic Surgeons
https://ift.tt/2MTIQ3L
https://ift.tt/2MTIQ3L
Microvascular Hepatic Artery Anastomosis in Pediatric Living Donor Liver Transplantation: 73 Consecutive Cases by a Single Surgeon
Background: Living donor liver transplantation (LDLT) is an important strategy of procuring segmental liver allografts for pediatric patients with liver failure, as suitably sized whole donor organs are scarce. Early pediatric LDLT experience was associated with high rates of hepatic artery thrombosis, graft loss, and mortality. Collaboration with microsurgeons for hepatic artery anastomosis in pediatric LDLT has decreased rates of arterial complications; however, reported outcomes are limited. Methods: A 14-year retrospective review was undertaken of children at our institution who underwent LDLT with hepatic artery anastomosis performed by a single microsurgeon using an operating microscope. Data were collected on demographics, etiology of liver failure, graft donor, vessel calibre, vessel anastomosis, arterial complications, and long-term follow up. Results: Seventy-three children with end stage liver failure underwent LDLT with microvascular hepatic artery anastomosis. The commonest etiology for liver failure was biliary atresia (63%). A total of 83 end to end hepatic artery anastomoses were completed using an operating microscope. Hepatic artery complications occurred in 5 patients, consisting of 3 cases of kinked anastomoses that were revised without complications and 2 cases of hepatic artery thrombosis (3%), of which one resulted in graft loss and patient death. Patient survival was 94% at 1 year and 90% at 5 years. Conclusions: Microvascular hepatic artery anastomosis in pediatric patients undergoing LDLT is associated with a low hepatic artery complication rate and excellent long-term liver graft function. Collaboration between microsurgeons and transplant surgeons can significantly reduce technical complications and improve patient outcomes. Financial Disclosure Statement: none Presented at the 2017 Annual Meeting of the American Society of Reconstructive Microsurgery in Waikoloa, HI, USA, January 14-17, 2017 and the 71st Annual Meeting of the Canadian Society of Plastic Surgeons in Winnipeg, MB, Canada, June 20-24, 2017. Corresponding Author: Dr. Ronald M. Zuker MD, FRCS(C), FACS, FAAP, Professor, Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children , 555 University Avenue, Toronto, ON M5G 1X8, Phone: 416-813-6447, Fax: 416-813-6147, E-mail: ronald.zuker@sickkids.ca ©2018American Society of Plastic Surgeons
https://ift.tt/2MTIjyN
https://ift.tt/2MTIjyN
Εγγραφή σε:
Αναρτήσεις (Atom)