Portable Infrared Pupillometer in Patients With Subarachnoid Hemorrhage: Prognostic Value and Circadian Rhythm of the Neurological Pupil Index (NPi)

Background: Portable automated infrared pupillometry is becoming increasingly popular. To generate an objective reference base, the Neurological Pupil index (NPi) which combines different values of the pupillary light reflex is being introduced into clinical practice. In this explorative study, we examined different aspects of the NPi in relation to clinical severity and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Materials and Methods: Patients with serial assessment of the NPi (NeurOptics pupillometer NPi-200, Irvine, CA) starting no later than day 2 after aSAH onset were included in the study. Relative numbers of pathologic NPi's, absolute NPi values, and their variances were compared according to aSAH clinical severity grade, functional outcome, and case fatality. The correlation between NPi and intracranial pressure, and NPi periodicity, were also examined. Results: In total, 18 patients with 4456 NPi values were eligible for inclusion in the analysis. The general trend of the NPi over time reflected the course of the neurological illness. Mean NPi tended to be lower in patients with clinically severe compared with nonsevere aSAH (3.75±0.40 vs. 4.56±0.06; P=0.171), and in patients with unfavorable compared with favorable outcomes (3.64±0.48 vs. 4.50±0.08; P=0.198). The mean variance of the NPi was higher in patients with severe compared with nonsevere aSAH (0.49±0.17 vs. 0.06±0.02; P=0.025). Pathologic NPi values were recorded more frequently in patients with severe compared with nonsevere aSAH (16.3%±8.8% vs. 0.0%±0.0%; P=0.002), and in those with unfavorable compared with favorable outcomes (19.2%±10.6% vs. 0.7%±0.6%; P=0.017). NPi was inversely correlated with intracranial pressure (Spearman r=−0.551, P

https://ift.tt/2A3bT1w

Dexamethasone Is Superior to Dexmedetomidine as a Perineural Adjunct for Supraclavicular Brachial Plexus Block: Systematic Review and Indirect Meta-analysis

BACKGROUND: Both dexamethasone and dexmedetomidine are effective peripheral nerve block (PNB) perineural adjuncts that prolong block duration. However, each is associated with side effects. With paucity of head-to-head comparisons of these adjuncts, the question of the best adjunct to mix with local anesthetics (LA) for PNB is unanswered. This meta-analysis aims to inform current practice and future research by identifying the superior adjunct by comparing dexamethasone and dexmedetomidine. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, trials comparing the combination of perineural dexamethasone or dexmedetomidine with LA to LA alone for PNB were sought. The Cochrane Risk of Bias Tool was used to assess the methodological quality of trials, and indirect or network meta-analyses using random-effects modeling were planned. We designated duration of analgesia as a primary outcome. Secondary outcomes included sensory and motor block durations, sensory and motor block onset times, and the risks of hypotension, sedation, and neurological symptoms. RESULTS: Fifty trials were identified, including only 1 direct comparison, precluding a network meta-analysis. Indirect meta-analysis of 49 trials (3019 patients) was performed. Compared to dexmedetomidine, dexamethasone prolonged the duration of analgesia by a mean difference (95% confidence interval [CI]) of 148 minutes (37–259 minutes) (P = .003), without prolonging sensory/motor blockade. Dexmedetomidine increased rates of hypotension (risk ratio [95% CI], 6.3 [1.5–27.5]; P = .01) and sedation (risk ratio [95% CI], 15.8 [3.9–64.6]; P = .0001). Overall risk of bias was moderate, and publication bias was noted, resulting in downgrading evidence strength. CONCLUSIONS: There is low-quality evidence that both adjuncts similarly prolong sensory/motor blockade. However, dexamethasone may be a superior adjunct; it improves the duration of analgesia by a statistically significant increase, albeit clinically modest, equivalent to 2.5 hours more than dexmedetomidine, without the risks of hypotension or sedation. Future direct comparisons are encouraged. Accepted for publication September 10, 2018. Funding: This work was supported by departmental funding from the Department of Anesthesia, Lausanne University Hospital, Lausanne, Switzerland (E.A.), and also from the Department of Anaesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (F.W.A.). Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Faraj W. Abdallah, MD, Department of Anesthesiology and Pain Medicine, and Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Address e-mail to FAbdallah@toh.ca. © 2018 International Anesthesia Research Society

https://ift.tt/2A415jz

Airway Management and Clinical Outcomes in External Laryngeal Trauma: A Case Series

External laryngeal trauma is a rare but potentially fatal event that presents several management challenges. This retrospective observational case series conducted at a level-1 trauma center over a 12-year period consists of 62 cases of acute external laryngeal trauma. Patient demographics, mode and mechanisms of injury, presenting signs and symptoms, initial imaging results, airway management, time to surgical management, and 6-month outcomes including airway status, deglutition status, and voice quality were investigated. No difference was found in mortality or 6-month outcomes between patients requiring surgical repair and/or tracheostomy versus patients with less severe injuries managed conservatively. Accepted for publication August 30, 2018. Funding: None. The authors declare no conflicts of interest. Institutional review board Number and Contact Information: HUM00125057. 2800 Plymouth Rd, Bldg 520, Room 3214, Ann Arbor, MI 48109. E-mail: irbmed@umich.edu. Reprints will not be available from the authors. Address correspondence to Alexandra R. DePorre, MD, Department of Anesthesiology, Michigan Medicine, University of Michigan, 1H247 UH, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Address e-mail to adeporre@med.umich.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2QGXCgw

Labor Pain's Relationship With Depression: From Whence, and What Shall be Done?

No abstract available

https://ift.tt/2A4vLRK

Propofol Regulates Neural Stem Cell Proliferation and Differentiation via Calmodulin-Dependent Protein Kinase II/AMPK/ATF5 Signaling Axis

BACKGROUND: Propofol can cause degeneration of developing brain cells and subsequent long-term learning or memory impairment. However, at the early stage of embryonic development, the molecular mechanism of propofol-induced inhibition in neural stem cells (NSCs) neurogenesis is still unclear. The aim of this study was to determine the role of propofol in NSCs neurogenesis and, more importantly, to explore the underlying mechanism. METHODS: First, a single intraperitoneal injection of propofol was performed in pregnant mice, and 6 hours after administration of propofol, the hippocampus RNA and the protein of the embryos' brains was extracted to analyze the expression of neuron-specific markers. Second, the primary NSCs were isolated from the hippocampus of mouse embryonic brain and then treated with propofol for cell viability, immunostaining, and transwell assays; more importantly, we performed RNA sequencing (RNA-seq) and q-reverse transcription polymerase chain reaction assays to identify genes regulated by propofol; the Western blot, small interfering RNA (SiRNA), and luciferase reporter assays were used to study the effects of propofol on calmodulin-dependent protein kinase (CaMk) II/5' adenosine monophosphate-activated protein kinase (AMPK)/activating transcription factor 5 (ATF5) signaling pathway. RESULTS: Our results indicated that propofol treatment could inhibit the proliferation, migration, and differentiation of NSCs. The results of RNA-seq assays showed that propofol treatment resulted in downregulation of a group of Ca2+-dependent genes. The following mechanism studies showed that propofol regulates the proliferation, differentiation, and migration of NSCs through the CaMkII/phosphorylation of serine at amino acid position 485 (pS485)/AMPK/ATF5 signaling pathway. CONCLUSIONS: The results from study demonstrated that propofol inhibits the proliferation, differentiation, and migration of NSCs, and these effects are partially mediated by CaMkII/pS485/AMPK/ATF5 signaling pathway. Accepted for publication August 30, 2018. Funding: This research was supported by National Natural Science Foundation of China (Grant No. 81400930). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Jing Cang, MD, Department of Anesthesiology, Zhongshan Hospital, Fudan University, Xuhui Qu, Shanghai Shi 200032, China. Address e-mail to cangjing1998@126.com. © 2018 International Anesthesia Research Society

https://ift.tt/2QNA9dF

Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group

As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks. Thus, the workshop was provider and patient oriented as well as solution focused rather than etiology focused. For those areas in which we determined that there were limited evidence-based recommendations, we identified knowledge gaps and the types of scientific knowledge and investigations needed to direct future best practice. Because concerns about perioperative neurocognitive injury in pediatric patients are already being addressed by the SmartTots initiative, our workshop discussion (and thus this article) focuses specifically on perioperative cognition in older adults. The 2 main perioperative cognitive disorders that have been studied to date are postoperative delirium and cognitive dysfunction. Postoperative delirium is a syndrome of fluctuating changes in attention and level of consciousness that occurs in 20%–40% of patients >60 years of age after major surgery and inpatient hospitalization. Many older surgical patients also develop postoperative cognitive deficits that typically last for weeks to months, thus referred to as postoperative cognitive dysfunction. Because of the heterogeneity of different tools and thresholds used to assess and define these disorders at varying points in time after anesthesia and surgery, a recent article has proposed a new recommended nomenclature for these perioperative neurocognitive disorders. Our discussion about this topic was organized around 4 key issues: preprocedure consent, preoperative cognitive assessment, intraoperative management, and postoperative follow-up. These 4 issues also form the structure of this document. Multiple viewpoints were presented by participants and discussed at this in-person meeting, and the overall group consensus from these discussions was then drafted by a smaller writing group (the 6 primary authors of this article) into this manuscript. Of course, further studies have appeared since the workshop, which the writing group has incorporated where appropriate. All participants from this in-person meeting then had the opportunity to review, edit, and approve this final manuscript; 1 participant did not approve the final manuscript and asked for his/her name to be removed. Accepted for publication August 27, 2018. Funding: This workshop was sponsored by the American Society of Anesthesiology Brain Health Initiative, the Society for Neuroscience in Anesthesiology and Critical Care, Baxter, and Pfizer. M.B. acknowledges receiving private consulting income from a legal case regarding postoperative cognitive function in an older adult and material support (ie, monitors) from Masimo for a research study. C.H.B. has consulted for and has a data share agreement with Medtronic. M.B. acknowledges support from National Institute on Aging (NIA) K76 AG057020 (and additional support from R03-AG050918 and P30AG028716), K.J.S. from National Institutes of Health (NIH) K12 HD043488 and an Alzheimer's Association Clinician Scientist Fellowship, C.H.B. from NIA K76 AG057020, S.G.D. from NIA K23 AG048332 and the American Foundation for Aging Research, R.A.W. from NIH 2R01GM101698, and R.G.E. from National Institute of General Medical Sciences P01 55876. All collaborators participated in the Best Practices Discussion at the 2016 International Perioperative Neurotoxicity Working Group meeting and helped edit the manuscript. The 2016 Perioperative Neurotoxicity Working group are also listed in Appendix. The authors declare no conflicts of interest. Address correspondence to Miles Berger, MD, PhD, Anesthesiology Department, Duke University Medical Center, 4317 Duke S Orange Zone, Durham, NC 27710. Address e-mail to Miles.berger@duke.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2QNA0a7

Effect of Apneic Oxygenation on Tracheal Oxygen Levels, Tracheal Pressure, and Carbon Dioxide Accumulation: A Randomized, Controlled Trial of Buccal Oxygen Administration

BACKGROUND: Apneic oxygenation via the oral route using a buccal device extends the safe apnea time in most but not all obese patients. Apneic oxygenation techniques are most effective when tracheal oxygen concentrations are maintained >90%. It remains unclear whether buccal oxygen administration consistently achieves this goal and whether significant risks of hypercarbia or barotrauma exist. METHODS: We conducted a randomized trial of buccal or sham oxygenation in healthy, nonobese patients (n = 20), using prolonged laryngoscopy to maintain apnea with a patent airway until arterial oxygen saturation (SpO2) dropped 90% during apnea. RESULTS: Buccal patients were more likely to achieve the primary outcome (P 94%; 750 seconds (750–750 seconds) vs 447 seconds (405–525 seconds); P

https://ift.tt/2A3CVpk

Preclinical Evaluation of Ropivacaine in 2 Liposomal Modified Systems

BACKGROUND: Our research group has recently developed liposomes with ionic gradient and in a combined manner as donor and acceptor vesicles containing ropivacaine (RVC; at 2% or 0.75%). Looking for applications of such novel formulations for postoperative pain control, we evaluated the duration of anesthesia, pharmacokinetics, and tissue reaction evoked by these new RVC formulations. METHODS: The formulations used in this study were large multivesicular vesicle (LMVV) containing sodium acetate buffer at pH 5.5 or in a combined manner with LMVV as donor and large unilamellar vesicles (LUVs) as acceptor vesicles with an external pH of 7.4. Wistar rats were divided into 6 groups (n = 6) and received sciatic nerve block (0.4 mL) with 6 formulations of RVC (LMVVRVC0.75%, LMVV/LUVRVC0.75%, LMVVRVC2%, LMVV/LUVRVC2%, RVC 0.75%, and RVC 2%). To verify the anesthetic effect, the animals were submitted to the pain pressure test and the motor block was also monitored. Histopathology of the tissues surrounding the sciatic nerve region was also assessed 2 and 7 days after treatment. Rats (n = 6) were submitted to a hind paw incision, and mechanical hypersensitivity was measured via the withdrawal response using von Frey filaments after injection of the 6 formulations. Finally, New Zealand white rabbits (n = 6) received sciatic nerve block (3 mL) with 1 of the 6 formulations of RVC. Blood samples were collected predose (0 minutes) and at 15, 30, 45, 60, 90, 120, 180, 240, 300, 360, 420, 480, and 540 minutes after injection. RVC plasma levels were determined using a triple-stage quadrupole mass spectrometer. RESULTS: Duration and intensity of the sensory block were longer with all liposomal formulations, when compared to the plain RVC solution (P

https://ift.tt/2QGK3gR

The Masseter Muscle and Its Role in Facial Contouring, Aging, and Quality of Life: A Literature Review

BACKGROUND: Masseter muscle hypertrophy manifests itself as enlargement of masseter muscle. It can be associated with square shaped lower face, pain, dental attrition, maxillary and mandibular bone resorption, and accelerated aging process of the lower face. OBJECTIVE: Is to assess efficacy and safety of botulinum toxin type A in contouring the masseter and its impact on quality of life, the aging process of the lower face, and it's role in full face rejuvenation. METHODS: A PubMed search was conducted for articles on masseter treatment with botulinum toxin type A, masseter muscle hypertrophy, and aging process of the lower face. Key studies are reviewed and findings are summarized. RESULTS: Botulinum toxin type A can be injected in the lower posterior aspect of the masseter muscle. Treatment decreases muscle bulk and reshapes the lower face. Furthermore, patient quality of life measures, including pain and symptoms of grinding and clenching are improved. Treatment can decrease shear stress on maxillary and mandibular bones and can possibly prevent tooth loss and progressive bone resorption of the lower face. Adverse effects are minimal and short lasting. CONCLUSION: Botulinum toxin type A is a safe and effective treatment of masseter hypertrophy. The treatment results in improvement of functionality, cosmesis and restoring facial harmony. Financial Disclosure: This manuscript received no financial support. Sabrina G. Fabi is an investigator and consultant for Allergan, Merz, Galderma, and Revance. Corresponding author: Rawaa M. Almukhtar, MD, MPH, Louisiana State University, Department of Dermatology, 1542 Tulane Ave., Ste. 639 , New Orleans, LA 70112, Email: ralmuk@lsuhsc.edu ©2018American Society of Plastic Surgeons

https://ift.tt/2Ee721D

Tissue Expander Complications Do Not Preclude A Second Successful Implant Based Breast Reconstruction

Background: Implant based breast reconstruction is the most common method of breast reconstruction in the United States but the outcomes of subsequent implant based reconstruction after a tissue expander (TE) complication are rarely studied. The purpose of this study is to determine the long term incidence of implant loss in patents with a previous TE complication. Methods: This is a retrospective review of the long term outcomes of all patients with TE complications at a large academic medical center from 2003-2013. Patients with subsequent TE or implant complications were compared to those with no further complications to assess risk factors for additional complications, or reconstructive failure. Results: One hundred sixty-two women were included in this study. The mean follow up was 8.3 ± 3.1 years. Forty-eight women (30%) went on to have a second TE or implant placed. They did not differ from women who went on to autologous reconstruction or no further reconstruction. Of these, 34 women (71%) had no further complications, and 38 women (79%) had a successful implant based reconstruction at final follow-up. There were no patient or surgical factors significantly associated with a second complication or implant loss. Conclusions: Following TE complications, it is reasonable to offer women a second attempt at tissue expansion and implant placement. This study demonstrates that long term success rates are high and there are no definitive patient or surgical factors that preclude a second attempt at implant based breast reconstruction. Financial Disclosure Statement: Dr. Myckatyn receives grant funding, consultant, and advisory board fees from Allergan, investigator-initiated grant funding and consultant fees from LifeCell, investigator-initiated grant funding and consultant fees from RTI, and advisory board fees from Viveve. No other authors report any disclosures. No funds were received to conduct this study. Presented at: Not Applicable Corresponding Author: Terence M. Myckatyn, MD, 1020 North Mason Road, Suite #110, Creve Coeur, MO 63141 ©2018American Society of Plastic Surgeons

https://ift.tt/2RE5vVj

Effect of the endogenous vascular endothelial growth factor on flap surgical delay in a rat flap model

Background: Experimental evidence suggests that endogenous vascular endothelial growth factor (VEGF) may play a major role in the surgical delay phenomenon. The purpose of this study was to investigate the effect of the endogenous vascular endothelial growth factor on flap surgical delay. Methods: A total of 82 adult male Sprague-Dawley rats with an average weight of 330g were used for these experiments. These experiments were then conducted in two parts. In part 1, thirty-two rats were used to assess the effectiveness of VEGF inhibitor through western blot assay and ELISA. In part 2, fifty rats were used to investigate the effect of VEGF on flap surgical delay via arteriography, histology analysis, and flap viability. Results: The VEGF protein inhibition ratio reached the maximum (approximately 91.6%) on the 5 to 7 days. The number of transverse arteries and the number of vessels > 0.1mm in diameter on the 3-day delay duration and the 6-day delay duration were significantly greater than those of the normal group. The number of transverse arteries and the number of vessels > 0.1mm in diameter on the 6-day inhibition duration were not significantly changed compared with the normal group. Microvascular density on the 6-day delay duration obviously increased whereas the 6-day inhibition duration was not significantly changed in comparison to the normal group. Conclusions: Endogenous VEGF is an initiating factor of the surgical delay effect by controlling choke vessel dilation and neovascularization within the choke zones. Conflict of interest: None Source of fund: This work is supported by the National Natural Science Foundation of China (NO.81472062). Corresponding Authors:* Xu Gong, E-mail: 13944099151@163.com, Tel.: +86 13944099151, Address: Department of Hand Surgery, The First Hospital of Jilin University, No.71, Xinmin Street, Changchun, Jilin Province, 130021, China. ©2018American Society of Plastic Surgeons

https://ift.tt/2EaV60x

Evaluation of prepectoral implant placement and complete coverage with TiLoop® Bra mesh for breast reconstruction: a prospective study on long-term and patient reported BREAST-Q outcomes.

Background: Breast reconstruction is rapidly evolving, owing to the changing face of cancer surgery and the growing acceptance of acellular dermal matrices (ADM) and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long term outcomes. Methods: Between January 2012 and March 2015, 179 patients undergoing mastectomy were enrolled at our institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop®). BREAST-Q questionnaire was administered prior to surgery and after 2 years. Capsular contracture was evaluated by Baker scale. Oncological, surgical and aesthetic outcomes along with the changes in BREAST-Q score were analyzed over time. Results: Patients were followed up for an average of 38.5 months. A total of 250 mastectomies were performed. Locoregional recurrence rate was 2.1 %. Complications requiring a reoperation were recorded in 6 patients (2.4%) and implant removal was necessary in 3 cases (1.2%), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in 5 breasts (2%), while 212 breasts were evaluated as grade I (84.8%), 28 breasts as grade II (11.2%) and 5 breast as grade III (2%). Patients reported significant high rates in the BREAST-Q overall satisfaction with outcome (73.8), overall satisfaction with breasts (72.5), psychosocial well-being (77.7) and sexual well-being (57.9), scoring a significant increase in these domains from the preoperative to the postoperative period (p

https://ift.tt/2RERjv7

“Three-Dimensional Topography of the Emerging Point of the Ophthalmic Artery.”

Background: During periorbital noninvasive and surgical procedures there is the risk of iatrogenic injury to the emerging point of the ophthalmic artery. This study aimed to determine the three-dimensional location of the emerging point of the ophthalmic artery and to provide clinicians with anatomic information that would help them to avoid associated complications. Methods: Seventeen hemifaces of the emerging point of the ophthalmic artery from 10 Korean and 7 Thai cadavers were dissected and scanned by a three-dimensional scanner. The emerging points of the ophthalmic artery of 30 healthy Korean volunteers were also detected using an ultrasound imaging system. Results: The transverse distance from the medial canthus to the emerging of the ophthalmic artery was 3.8±1.0 mm medially, while the vertical distance was 14.0±2.9 mm superiorly. The transverse distance from the midline was 16.5±1.7 mm to the emerging point of the ophthalmic artery and 20.0±2.0 mm to the medial canthus. The measured depth from the skin surface to the emerging point of the ophthalmic artery was 4.8±1.7 mm in three-dimensional scanning and 4.5±1.1 mm in ultrasound detection. The vertical distance from the inferior margin of the superior orbital rim to the emerging point of the ophthalmic artery was 5.3±1.4 mm. Conclusions: These data inform clinicians about the anatomic three-dimensional location of the emerging point of the ophthalmic artery, which will help them to avoid iatrogenic injury when they are performing periorbital clinical procedures. Lists of Authors and their participation: * None of the authors have financial or private relationships with commercial, academic, or political organizations or people that could have improperly influenced this research. All cadaveric objects in this study were legally donated to Yonsei Medical Center and Chulalongkorn University. Financial Disclosure Statement: None of the authors has received any financial support for this study. The institutional ethics committee approved the study, and the volunteers provided written informed consents after the study had been fully explained to them (IRB No. 2-2017-0023). Correspondence to: Name: Hee-Jin Kim, Address: Room 601, Division in Anatomy & Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Telephone: +82-2-2228-3067; Fax: +82-2-393-8076 E-mail: hjk776@yuhs.ac ©2018American Society of Plastic Surgeons

https://ift.tt/2EdruzJ

The First AAPS Cannon Student Scholarship Experience

No abstract available

https://ift.tt/2RFR5DS

Preparing for the Plastic Surgery In-Service Examination: Evidence-Based Essentials for the Plastic Surgery Resident

No abstract available

https://ift.tt/2EfBokm

The natural history of cutaneous sarcoidosis. Clinical spectrum and histological analysis of 40 cases

International Journal of Dermatology, EarlyView.


https://ift.tt/2IO7wKp

Overaugmentation to compensate for postextraction ridge atrophy using a putty-type porcine bone substitute material with recombinant bone morphogenetic protein-2: 4 weeks of healing in a canine model

Abstract

Objectives

The aims of the present study were (i) to determine the short-term effects of putty-type porcine bone substitute material (PB) with recombinant bone morphogenetic protein-2 (rhBMP-2) for alveolar ridge preservation (ARP) and (ii) evaluate the early healing of labial overaugmentation.

Materials and methods

Two groups were randomly assigned to the extraction sockets in mandibular incisors of eight dogs: labial overaugmentation with (i) PB (control) or (ii) rhBMP-2-loaded PB (BMP). Microcomputed tomography (micro-CT), and histologic and histomorphometric analyses were performed after 4 weeks.

Results

Micro-CT revealed that some of the overaugmented PB was dispersed in both groups. The new bone volume was significantly larger in the BMP group than in the control group (18.4 ± 3.3 vs. 15.5 ± 3.0 mm³, mean ± SD, P < 0.05). Labial bone resorption was generally found histologically. No signs of mineralization were observed in the overaugmented area despite significantly increased ridge width, as compared to the adjacent tooth area. The area of new bone formation was larger in the BMP group than in the control group overall (23.7 ± 18.8 vs. 18.3 ± 21.2 mm²) and in three parts (apical, middle, and coronal), although the difference was statistically significant only in the coronal part (7.7 ± 7.9 vs. 4.6 ± 6.4 mm², P < 0.05).

Conclusions

The addition of rhBMP-2 enhanced ossification in the coronal part of the extraction socket relative to using PB alone. Overaugmentation increased the ridge dimension with no evidence of ossification in situ at 4 weeks.

Clinical relevance

In early healing following ARP, rhBMP-2 enhances bone formation within the socket, but ossification in the overaugmented area needs to be studied further.

https://ift.tt/2PtcTB8

Increasing trends of anaphylaxis-related events: an analysis of anaphylaxis using nationwide data in Taiwan, 2001–2013

Anaphylaxis is a severe, potentially fatal, and systemic allergic reaction. Previous studies document increasing trends in incidence rates of anaphylaxis-related events in Western countries, yet little is know...

https://ift.tt/2Ec7EET

From zero to sixty and back to zero again: the metabolic life of B cells

Munir Akkaya | Susan K Pierce

https://ift.tt/2NxwIpn

Outcomes for patients with second primary malignancy after primary surgical treatment for early‐stage squamous cell carcinoma of the oral cavity

Head &Neck, EarlyView.


https://ift.tt/2QFIvDO

Prognostic role of epiregulin/amphiregulin expression in recurrent/metastatic head and neck cancer treated with cetuximab

Head &Neck, EarlyView.


https://ift.tt/2A3YTbO

Transoral surgery using the Flex Robotic System: Initial experience in the United States

Head &Neck, EarlyView.


https://ift.tt/2QKSbx5

Overexpression of cysteine‐glutamate transporter and CD44 for prediction of recurrence and survival in patients with oral cavity squamous cell carcinoma

Head &Neck, EarlyView.


https://ift.tt/2A39vYp

Deficiency of sun protection advertising exists in consumer magazines across demographic groups and varies by target demographic

https://ift.tt/2A3qHNy

Galeatomy: A Useful Technique Aiding High-Tension Scalp Closures

https://ift.tt/2QHcYkS

Re-evaluating the Need for Routine Laboratory Monitoring in Isotretinoin Patients: A Retrospective Analysis

https://ift.tt/2A32sPC

Eczema Drug Dupilumab Spurs Hair Regrowth in Alopecia Totalis

Shared immune characteristics of alopecia totalis and atopic dermatitis might explain the hair regrowth in a patient with alopecia totalis being treated with dupilumab for persistent eczema.
Medscape Medical News

https://ift.tt/2IOY4Gu

Bone-anchored maxillary protraction in patients with unilateral complete cleft lip and palate and Class III malocclusion

Abstract

Objective

This prospective controlled study evaluated the effect of bone-anchored maxillary protraction therapy in cleft children with Class III malocclusion using CBCT-derived 3D surface models.

Materials and subjects

Eighteen cleft patients between 10 and 12 years old were included. Intermaxillary elastics were worn after the placement of four zygoma bone plates for 18 months. Uniquely, three age-matched untreated groups including both cleft subjects and non-cleft subjects with Class III malocclusion served as controls. Profile photos and CBCT scans for each patient were taken before (T0) and 18 months after the protraction (T1). 3D measurements were made on CBCT surface models from the treatment group using tomographic color mapping method. Cephalometric measurements were made on lateral cephalogram reconstructed from the CBCT scans and were compared with those obtained from the control groups.

Results

Two thirds of the treatment subjects showed improved lip projection towards more convex facial profile. The most significant skeletal changes on 3D surface models were observed at the zygomatic regions (mean 1.5-mm forward, downward, and outward displacement) and at the maxillary complex (mean 1.5-mm forward displacement). Compared with the control groups, the treatment subjects showed significant increase in the SNA and ANB angles, increased Wits appraisal, a more forward movement of point A and overjet improvement (p < 0.05).

Conclusions

BAMP in cleft patients gives a significant forward displacement of the zygomaxillairy complex in favor of the Class III treatment.

Clinical relevance

This treatment method shows clearly favorable outcome in cleft patients after 1.5 years of BAMP.

https://ift.tt/2QFWVDQ

Successful treatment of a traumatic tattoo in a pediatric patient using a 755‐nm picosecond laser

Pediatric Dermatology, EarlyView.


https://ift.tt/2CzaS3y

A comparison of international management guidelines for atopic dermatitis

Pediatric Dermatology, EarlyView.


https://ift.tt/2C843VE

Can subunit specific phenotypes guide surveillance imaging decisions in asymptomatic SDH mutation carriers?

Clinical Endocrinology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2OiwlUL

Influence of the emollient on emulsions containing lamellar liquid crystals: from molecular organization towards applicative properties

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


https://ift.tt/2CC9ai8

Changes in neurosteroidogenesis during demyelination and remyelination in cuprizone treated mice

Journal of Neuroendocrinology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2RzWIUh

Onychomycosis caused by Scopulariopsis brevicaulis: The third documented case in Japan

The Journal of Dermatology, EarlyView.


https://ift.tt/2QGhTmo

Comprehensive mapping of human body skin hydration: A pilot study

Skin Research and Technology, EarlyView.


https://ift.tt/2yxLxTa

Announcement

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1828-1828, October 2018.


https://ift.tt/2CCnc36

Pioneers in dermatology and venereology: an interview with Prof. Helmut Kerl

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1629-1630, October 2018.


https://ift.tt/2C5OJc2

Issue Information

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1617-1622, October 2018.


https://ift.tt/2CC3d4M

Commentary to “Mogamulizumab‐induced photosensitivity in patients with mycosis fungoides and other T‐cell neoplasms” by Y. Masuda et al.

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1626-1626, October 2018.


https://ift.tt/2C5OFsO

Hidradenitis suppurativa in Korea

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1625-1625, October 2018.


https://ift.tt/2CBbaH5

Forthcoming Events

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1827-1827, October 2018.


https://ift.tt/2C5OCNE

Psoriasis: identifying trends through search engines

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1628-1628, October 2018.


https://ift.tt/2CAa7ar

Assessment of serious infections in pemphigus and pemphigoid by a national registry

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1623-1624, October 2018.


https://ift.tt/2C5Owpg

New attempts to improve in vitro diagnosis of contact allergy are still far from regular clinical practice

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1627-1627, October 2018.


https://ift.tt/2CBbaqz

Risk Factors for Dupilumab-Associated Conjunctivitis in Patients With Atopic Dermatitis

This case series evaluates 12 patients with atopic dermatitis who experienced conjunctivitis secondary to injectable dupilumab treatment to investigate severity and common risk factors for secondary conjunctivitis.

https://ift.tt/2MYcybL

Laser Treatment Performed Decades After Napalm Burns

This case report describes the use of laser treatment beginning in 2015 to treat napalm burns sustained by the famous Vietnamese "Napalm Girl" in 1972.

https://ift.tt/2MSEkHx

Myths, Truths, and Clinical Relevance of Comedogenicity Product Labeling

This Viewpoint evaluates the meaning of the noncomedogenic label and the need for an objective assay for assessment of facial products.

https://ift.tt/2KNqRj4

Aprepitant for the Treatment of Pruritus in Sézary Syndrome

This randomized clinical trial assesses whether treatment with the neurokinin 1 receptor antagonist aprepitant decreases pruritus vs placebo in patients with Sézary syndrome.

https://ift.tt/2nEDleN

Increasing Minority Representation in the Dermatology Department

This Viewpoint reviews Johns Hopkins' successful experience in increasing the number of faculty physicians in dermatology from groups underrepresented in medicine and suggests steps that other institutions can take to replicate this success.

https://ift.tt/2OcMYxo

October 2018 Issue Highlights

https://ift.tt/2Pr0spH

Core Outcome Sets for Psoriasis Clinical Trials

Standardized and relevant psoriasis-specific outcome measures would contribute to a better understanding of the benefits of a growing list of highly effective therapies. To this end, in this issue of JAMA Dermatology, Callis Duffin et al present the results of an effort to define core outcome sets (COSs) for clinical trials of psoriasis. Under the auspices of the International Dermatology Outcome Measures group, the authors conducted a Delphi survey and determined that the following 6 domains should be addressed in all psoriasis trials: (1) psoriatic skin manifestations (including location), (2) an investigator global assessment, (3) an evaluation of signs and symptoms of both psoriasis and psoriatic arthritis, (4) a patient global assessment of his or her condition, (5) an assessment of treatment satisfaction, and (6) a measure of health-related quality of life.

https://ift.tt/2HpmFzr

Persistent Malar Erythema With Atrophy in a Young Woman

A young woman had asymptomatic, facial redness that flared in sunlight, previously treated with doxycycline and topical sulfacetamide with no effect; on her cheeks and nasal bridge there were multiple erythematous, annular plaques with focal areas of atrophy. What is your diagnosis?

https://ift.tt/2tpzq86

Identifying a Core Domain Set to Assess Psoriasis in Clinical Trials

This Delphi survey of patients, health care professionals, and other stakeholders identifies a core set of 6 domains that should be measured in all clinical trials for psoriasis therapies.

https://ift.tt/2sCuRrq

Dupilumab for the Treatment of Recalcitrant Bullous Pemphigoid

This case report describes the use of dupilumab to treat recalcitrant bullous pemphigoid.

https://ift.tt/2Ljzf5a

Hair Regrowth Outcomes of Contact Immunotherapy for Patients With Alopecia Areata

This systematic review and meta-analysis uses standardized criteria and prognostic factors to examine the clinical hair regrowth outcomes of contact immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester for patients with alopecia areata.

https://ift.tt/2vlWQwe

Performance of Dermatology Physician Assistants—Reply

In Reply We thank Marghoob et al for the opportunity to address their concerns regarding our study. Number needed to biopsy (NNB) (or excise) is a well-established measure consistent with prior publications, including studies by Marghoob and colleagues. While NNB can vary with disease prevalence, patients in both cohorts in our study had similar rates of keratinocyte carcinomas and invasive melanomas. Patients were also similarly distributed by age and sex, and our NNB findings remained consistent when patients with a melanoma history were excluded.

https://ift.tt/2mJAyQY

Association of Bullous Pemphigoid With Dipeptidyl-Peptidase 4 Inhibitors in Patients With Diabetes

This case-control study evaluates the association between use of dipeptidyl-peptidase 4 (DPP-4) inhibitors and development of bullous pemphigoid (BP) in patients with diabetes and characterizes those patients who develop DPP-4 inhibitor–associated BP.

https://ift.tt/2OUniGb

Safety Risk of Dermatoscope Magnets in Patients With Cardiovascular Implanted Electronic Devices

This observational cross-sectional study assesses the magnets in 3 different dermatoscopes to determine their ability to disrupt the functionality of pacemakers, defibrillators, and other implanted devices in patients.

https://ift.tt/2MR39iO

Interpretation of Melanocytic Lesions in the Digital Era vs Traditional Microscopy

This study of 87 pathologists compares the use of digital whole-slide imaging vs traditional microscopy in pathologists' ability to accurately interpret melanocytic lesions and reproduce correct diagnoses.

https://ift.tt/2PbZVIg

An Annular Eruption in a Young Child

A young child had a 6-month history of an asymptomatic expanding erythematous eruption on the lower legs, abdomen, and buttocks; clinical examination was significant for faint, nonscaling annular serpiginous, erythematous plaques. What is your diagnosis?

https://ift.tt/2NpjuMn

Self-reported Patient Motivations for Seeking Cosmetic Procedures

This multicenter observational study assesses the importance of self-reported factors that motivate patients to undergo minimally invasive cosmetic surgical procedures.

https://ift.tt/2MORUYf

An Elderly Woman With Painful Buttock and Vulvar Ulcers

A woman in her 80s presented with somnolence, fatigue, lower urinary tract symptoms, and progressively worsening vulvar and buttock pain. What is your diagnosis?

https://ift.tt/2y50QWB

Combined Reflectance Confocal Microscopy–Optical Coherence Tomography for Basal Cell Carcinoma

This pilot study of 85 lesions from 55 patients assesses the accuracy of a handheld imaging device that combines reflective confocal microscopy (RCM) and optical coherence tomography (OCT) to detect, diagnose, and estimate the depth of basal cell carcinoma in adults.

https://ift.tt/2MvL1PG

Program Director and Resident Perspectives on New Parent Leave in Dermatology Residency

This study investigates how new parent leave policies are perceived by dermatology program directors and residents.

https://ift.tt/2BXRQVd

Risk of Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Margins

This multicenter cohort study examines the outcomes and risk for the development of subsequent cutaneous melanoma in moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins, observed for 3 years or more.

https://ift.tt/2ydrk61

Association Between Psoriasis and Sexual and Erectile Dysfunction in Epidemiologic Studies

This systematic review evaluates the main characteristics of the studies of psoriasis and sexual dysfunction (SD) or erectile dysfunction (ED), including level of evidence, tools used to assess SD or ED, and prevalence and incidence of SD or ED.

https://ift.tt/2Pmqx9c

Hair Regrowth After Long-standing Alopecia Totalis and Atopic Dermatitis Treated With Dupilumab

This case report describes hair regrowth in a patient with long-standing alopecia totalis and atopic dermatitis treated with dupilumab.

https://ift.tt/2yejM2O

Observation of Moderately Dysplastic Nevi With Positive Margins

The management of dysplastic nevi is a quotidian part of the clinical practice of dermatology, yet even directors of pigmented lesion clinics in the United States demonstrate significant practice variation with observation or therapeutic excision of dysplastic nevi. This scenario is particularly true for biopsies of dysplastic nevi that have histologically positive margins. A 2015 consensus statement summarizing this practice gap included a call for further study of this common clinical question. There are several important challenges in establishing evidence-based guidelines for the management of dysplastic nevi, and thus establishing practice consensus for the management of dysplastic nevi, including the lack of definitive evidence that dysplastic nevi are precursor lesions to melanoma, interobserver histopathologic variation in gradation of dysplasia, longitudinal risk of monitoring for clinical recurrence, and variation in diagnostic biopsy procedures (ie, risk of incisional or partial biopsies).

https://ift.tt/2Po52oE

Treatment of Severe Hailey-Hailey Disease With Apremilast

This case series describes 4 adult patients who received apremilast (a phosphodiesterase-4 inhibitor) for treatment-resistant Hailey-Hailey disease.

https://ift.tt/2ybBFzi

Blistering Distal Dactylitis

This case report describes a case of blistering distal dactylitis.

https://ift.tt/2Po4xuF

Twenty classic signs in oral and maxillofacial radiology

Abstract

Teachers of radiology often employ the use of classic signs to help learners identify the typical appearance of various pathologies. This article is a compendium of simply-described classic signs in oral and maxillofacial radiology, including their use in differential diagnoses.

https://ift.tt/2ytXEAS

Effect of arch wire size on orthodontic reverse closing loop and retraction force in canine tooth distalization

Abstract

Aim

The purpose of this study is to compare the effects of different wire size reverse closing loop and retraction forces in canine tooth distalization using the finite element analysis method.

Materials and methods

Maxillary alveolar bone, maxillary first molar, second premolar and canine teeth were constructed in three dimensions along with their periodontal ligaments and standard edgewise brackets of 0.022 inch and stainless-steel reverse closing loop of 0.016 × 0.022 inch and 0.019 × 0.025 inch were designed. Force of 0.98 N and 1.96 N were applied to the arch wire from the posterior region of the molar tooth in the distal direction for activating the reverse closing loop. The stress distribution and displacement of the maxillary canine tooth were performed using the three-dimensional finite element analysis method.

Results

The maximum deformation on the canine tooth was higher in the x‑, y‑, and z‑axes in both arch wires with 1.96 N force activation. Moreover, 1.96 N caused more stress on the canine tooth in both arch wires compared to the application of 0.98 N. In terms of von Mises stress distribution on alveolar bones, the amount of stress was higher during the application of 1.96 N than the application of 0.98 N.

Conclusion

The finite element method is a reliable instrument which allows the effects of biomechanics applied in orthodontics to be evaluated. The finite element analysis method precisely predicted the mechanical effects of reverse closing loop of different wire sizes and different retraction forces.

https://ift.tt/2IMQi01

Clinical manifestations of hydropic ear disease (Menière’s)

Abstract

Introduction

Hydropic ear disease, initially described by and named after Prosper Menière, is one of the most frequent vertigo disorders and one of the most frequent inner ear disorders. It is the syndrome of endolymphatic hydrops which until 2007 could be diagnostically confirmed only by post-mortem histology. In the past, various attempts to formulate clinical diagnostic criteria have been undertaken but were hampered by the inability to ascertain the diagnosis in living patients. With the milestone achievement of endolymphatic hydrops imaging, today the pathology can be ascertained. In this study, we have performed a detailed analysis of the clinical features of hydropic ear disease for the first time by examining a large cohort of patients with morphologically confirmed endolymphatic hydrops using a detailed physician-administered neurotologic face-to-face interview.

Results

During a hydropic vertigo attack, the patients report nausea, vomiting, sweating, urge to defecate, urge to urinate, phosphenes, headache, photophobia, phonophobia and even transient loss of consciousness. A third of the patients does not experience auditory symptoms during the vertigo attacks. Vertigo attacks last less than 20 min in more than one-fourth of the patients. Audiometric hearing loss has its greatest diagnostic value at the frequencies of 1 kHz and below. Cochleovestibular symptom onset simultaneity is associated with a high frequency of drop-attacks. Migraine and autoimmune disorders are not associated with hydropic ear disease.

Conclusion

This study marks the beginning of the clinical characterization of hydropic ear disease. The findings have important implications for the future formulation of clinical diagnostic criteria.

https://ift.tt/2Prmxo0

Effect of arch wire size on orthodontic reverse closing loop and retraction force in canine tooth distalization

Abstract

Aim

The purpose of this study is to compare the effects of different wire size reverse closing loop and retraction forces in canine tooth distalization using the finite element analysis method.

Materials and methods

Maxillary alveolar bone, maxillary first molar, second premolar and canine teeth were constructed in three dimensions along with their periodontal ligaments and standard edgewise brackets of 0.022 inch and stainless-steel reverse closing loop of 0.016 × 0.022 inch and 0.019 × 0.025 inch were designed. Force of 0.98 N and 1.96 N were applied to the arch wire from the posterior region of the molar tooth in the distal direction for activating the reverse closing loop. The stress distribution and displacement of the maxillary canine tooth were performed using the three-dimensional finite element analysis method.

Results

The maximum deformation on the canine tooth was higher in the x‑, y‑, and z‑axes in both arch wires with 1.96 N force activation. Moreover, 1.96 N caused more stress on the canine tooth in both arch wires compared to the application of 0.98 N. In terms of von Mises stress distribution on alveolar bones, the amount of stress was higher during the application of 1.96 N than the application of 0.98 N.

Conclusion

The finite element method is a reliable instrument which allows the effects of biomechanics applied in orthodontics to be evaluated. The finite element analysis method precisely predicted the mechanical effects of reverse closing loop of different wire sizes and different retraction forces.

https://ift.tt/2IMQi01

A ‘Nobel’ Look at Metabolism

Publication date: Available online 9 October 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Jianhua Xiong

Metabolism has recently been in the spotlight because of technical advances in metabolite measurement; however, it is not a new topic in the Nobel Prize's history. Emerging evidence suggests that metabolism is more complex than was previously believed. Retrospective analysis of the Nobel Prize-winning metabolic discoveries may inspire future studies.

https://ift.tt/2RG7Y1m

Quantitative analysis of the coupling coefficients between energy flow, value flow, and material flow in a Chinese lead-acid battery system

Abstract

To reveal the historic characteristics of the material flow, energy flow and value flow in a lead-acid battery (LAB) system, a framework for the coupling relationship among the three flows was established based on material flow analysis and the characteristics of the energy and value flows. The coupling coefficients between energy and material (CCEM) and value and material (CCVM) were also defined. The investigation used by China as a case to study changes in stages and the historic evolution. The results show that the CCEM for lead in LABs was highest in the usage stage, approximately 5–16 times greater than in the other stages. The CCEM for production was almost twice as high for primary lead as for secondary lead, and the CCEM was lowest for the fabrication and product manufacture stage. The CCVM for lead in LABs was 2.5–6 times higher than for other types of lead. The CCVM was lower for scrap lead than for lead ore, and the CCVM was approximately 1.7 times higher for refined lead than for scrap and refined lead. For lead trade, CCVM was correlated with domestic and overseas markets. From 1990 to 2014, the CCEM for each stage was in decline, whereas the opposite was the case for CCVM. The influencing factors were analyzed in terms of resources, the environment, and markets. Increasing the circulation rate of scrap lead is an effective way to rapidly save resources, reduce lead pollution, and promote a circular economy. The limitations and potential value of the study are also highlighted, and future research is outlined.

https://ift.tt/2CCeJNu

In Reply

https://ift.tt/2pLnJaD

A Prospective Trial Evaluating the Safety of a Shortened Infusion of Ramucirumab in Patients with Gastrointestinal Cancer

AbstractLessons Learned. A shortened infusion of ramucirumab (from 60 to 20 minutes) was safe and feasible without infusion‐related reactions.Twenty‐minute infusions of ramucirumab can be an option for patients with no infusion‐related reactions during the first 60‐minute treatment.Background.Ramucirumab is usually administered over 60 minutes, during which it is unlikely to cause infusion‐related reactions (IRRs). This prospective study evaluated the safety of a shortened infusion of ramucirumab.Methods.Patients who received their first dose of ramucirumab in a 60‐minute infusion without developing IRRs were eligible and received their second ramucirumab dose for 20 minutes. The primary study endpoint was incidence of IRR during the first short‐term infusion, and the secondary endpoints were incidence of IRR at any time and adverse events other than IRR.Results.Of the 40 patients enrolled (median age, 68.5 years), 20 (55%) were male, 27 (67.5%) had stage IV gastric cancer, 25 (62.5%) received ramucirumab in combination with taxane‐based chemotherapy, and 24 (60%) received only a single administration of ramucirumab prior to their enrollment. Notably, no IRR was observed during the first short‐term infusion (IRR rate, 0%; 95% confidence interval [CI], 0%–0.72%). Among the 149 short‐term infusions performed, there were no instances of IRRs or unexpected adverse events related to the treatment (Table 1).Conclusion.For patients without development of IRRs upon the first ramucirumab administration, shortening infusion time (from 60 to 20 minutes) is safe and feasible.

https://ift.tt/2IOHPcI

Magnetic Resonance Imaging‐Based Screening for Asymptomatic Brain Tumors: A Review

AbstractBrain tumors comprise 2% of all cancers but are disproportionately responsible for cancer‐related deaths. The 5‐year survival rate of glioblastoma, the most common form of malignant brain tumor, is only 4.7%, and the overall 5‐year survival rate for any brain tumor is 34.4%. In light of the generally poor clinical outcomes associated with these malignancies, there has been interest in the concept of brain tumor screening through magnetic resonance imaging. Here, we will provide a general overview of the screening principles and brain tumor epidemiology, then highlight the major studies examining brain tumor prevalence in asymptomatic populations in order to assess the potential benefits and drawbacks of screening for brain tumors.Implications for Practice.Magnetic resonance imaging (MRI) screening in healthy asymptomatic adults can detect both early gliomas and other benign central nervous system abnormalities. Further research is needed to determine whether MRI will improve overall morbidity and mortality for the screened populations and make screening a worthwhile endeavor.

https://ift.tt/2pLnIDB

Möglichkeiten des chirurgischen Zugangs zur Orbita

Zusammenfassung

Zur Entfernung von Tumoren und Fremdkörpern aus der Orbita, zur Behandlung von schweren entzündlichen Erkrankungen und zur Reposition von Knochenfragmenten nach Frakturen bzw. zur Rekonstruktion der knöchernen Strukturen der Orbita stehen unterschiedliche chirurgische Zugangswege zur Verfügung. Die zunehmende Kenntnis über die Pathologie und Pathophysiologie einzelner Erkrankungen, die Weiterentwicklung der Mikroskop- und Endoskoptechnik, die besseren Möglichkeiten der präoperativen bildgebenden Darstellung von pathologischen Prozessen, die modernen Möglichkeiten der Rekonstruktion der Orbita sowie die Weiterentwicklung der adjuvanten Therapie hat zu einer verminderten Invasivität und zur Entwicklung der heute i. d. R. angewandten minimalinvasiven chirurgischen Zugangswege zur Orbita geführt. Hierbei ist die operative Therapie häufig eine interdisziplinäre Aufgabe. Zielsetzung der vorliegenden Übersichtsarbeit ist die Beschreibung von heute gängigen chirurgischen Zugangswegen zur Orbita, ihrer Indikation und den potenziellen Komplikationen. Hierbei wird ein besonderes Augenmerk auf die minimalinvasiven Zugangswege gelegt. Die verschiedenen Zugangswege ermöglichen eine 360°-Exposition der Orbitabinnenstrukturen mit dem N. opticus als Zentrum („round the clock access to the orbit"). Die Beschreibung von Tipps und Tricks sowie eine Übersicht der aktuellen Literatur runden die Darstellungen der einzelnen Zugangswege ab.

https://ift.tt/2yt6bE1

Morphometric properties of the facial nerve in fetal temporal bones

Publication date: Available online 10 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Derya Ümit Talas, Orhan Beger, Turan Koç, Vural Hamzaoğlu, Hakan Özalp, Melike Mavruk, Cemre Yıldırım, İrem Güzelyüz, Yusuf Vayisoğlu, Deniz Uzmansel, Mehmet Farsak, Ahmet Dağtekin

Abstract

Objectives

The main aim of the study was to examine the development and course of the facial nerve within fetal temporal bones from an anatomical and neuro-otological perspective.

Methods

The study was conducted on 32 temporal bones from obtained fetuses (7 females, 9 male), on a mean gestational age of 26.75±4.36 (range, 20-34) weeks from the collection of the Anatomy Department of Medicine Faculty. All the measurements were collected with a digital image analysis software.

Results

Neither male/female nor right/left significant differences were observed in relation with the algebraic data of the segment lengths and angles of the facial nerve (p > 0.05). Linear functions for meatal, labyrinthine, tympanic, and mastoid segment lengths of the facial nerve were calculated as: y = -1.206 + 0.200 x Age (weeks), y = -1.868 + 0.153 x Age (weeks), y = -2.327+ 0.325 x Age (weeks), and y = -1.507+ 0.246 x Age (weeks), respectively. In addition, linear functions for first and second genu angles were calculated as: y = 105.475 - 0.117 x Age (weeks) and y = 140.446 - 0.042 x Age (weeks), respectively.

Conclusion

The regression equations and the scatter plot with increment curve, representing the growth dynamics of the facial nerve can be used for estimating its lengths and for understanding its development. The data suggest that there is a dramatic change transition from fetal life to the gathered data of adulthood in the length of meatal and mastoid segments as well as in the second genu angle; in addition, there is a partial change in the length of labyrinthine and tympanic segments as well as in the first genu angle.

https://ift.tt/2C7cSPr

TERT Immunohistochemistry Is a Poor Predictor of TERT Promoter Mutations and Gene Expression in Follicular Thyroid Carcinoma

https://ift.tt/2EdoBip

Effect of Collagenase ointment versus Mebo ointment on healing of full‐thickness burns in mice by removing of necrotic tissue

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


https://ift.tt/2RFz0pt

Effect of Collagenase ointment versus Mebo ointment on healing of full‐thickness burns in mice by removing of necrotic tissue

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


https://ift.tt/2RFz0pt

Transcriptome analysis of differentially expressed genes involved in innate immunity following Bacillus thuringiensis challenge in Bombyx mori larvae

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Gongqing Wu, Yunhong Yi

Abstract

In this study, we describe RNA-seq expression profiling of larval Bombyx mori response to hemocoel injection of Bacillus thuringiensis (Bt). Two transcriptomes were generated from the hemocytes of the PBS- and Bt-injected B. mori larvae. More than 49 million 100-bp paired-end reads, encompassing over 7.3 Gb of sequence data, were generated for each library. After filtering the raw reads and removing the rRNA mapped reads, more than 89% of the reads in each library could be mapped to the silkworm genome reference sequence. Comparison of gene expression levels revealed that a total of 133 unigenes were upregulated while 84 unigenes were downregulated in PBS vs Bt. To further investigate the biological functions of different expression genes (DEGs), gene ontology (GO) and functional enrichment analysis were performed to map all the DEGs to terms in the GO, euKaryotic Ortholog Groups of proteins (KOG) and Kyoto Encyclopedia of Genes and Genomes Pathway (KEGG) database. Among these DEGs, many genes involved in immunity against Bt challenge were identified. These included genes participated in pattern recognition, antimicrobial peptides, insecticide resistance or detoxification, immune melanization, cytoskeleton reorganization and many other immune effectors. To confirm the gene expression patterns identified by the RNA-seq data, the transcript levels of 10 immune related DEGs were examined by quantitative real-time PCR (qRT-PCR). The results showed that the DEGs obtained from the deep sequencing data were accurate and gene expression profiles from RNA-Seq data were reliable. Our studies provide insights into the to immune response of B. mori underling the stress of Bt, which is valuable to understand how Bt affects the innate immune system of silkworm and provide new approaches to control insect pests by using Bt as a biological insecticide.

https://ift.tt/2NuhYrf

Usefulness of OLGA and OLGIM system not only for intestinal type but also for diffuse type of gastric cancer, and no interaction among the gastric cancer risk factors

Helicobacter, EarlyView.


https://ift.tt/2A34C1B

Usefulness of OLGA and OLGIM system not only for intestinal type but also for diffuse type of gastric cancer, and no interaction among the gastric cancer risk factors

Helicobacter, EarlyView.


https://ift.tt/2A34C1B

Comparison of bleach, acetic acid, and other topical anti‐infective treatments in pediatric atopic dermatitis: A retrospective cohort study on antibiotic exposure

Pediatric Dermatology, EarlyView.


https://ift.tt/2yrEgV9

Upregulated P-Rex1 exacerbates human airway smooth muscle hyperplasia in asthma

Publication date: Available online 10 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Yapei Huang, Yan Xie, Haihong Jiang, Peter W. Abel, Reynold A. Panettieri, Thomas B. Casale, Yaping Tu

https://ift.tt/2E7zZvY

Intestinal dysbiosis in Inflammatory Bowel Disease associated with primary immunodeficiency.

Publication date: Available online 10 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Harry Sokol, Nizar Mahlaoui, Claire Aguilar, Perrine Bach, Olivier Join-Lambert, Aurélie Garraffo, Philippe Seksik, François Danion, Sarah Jegou, Marjolene Straube, Christelle Lenoir, Bénédicte Neven, Despina Moshous, Stéphane Blanche, Bénédicte Pigneur, Olivier Goulet, Frank Ruemmele, Felipe Suarez, Laurent Beaugerie, Stéphanie Pannier

https://ift.tt/2RFFftm

Hsa-mir-144-3p is increased in umbilical cord serum of infants developing atopic dermatitis

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Eishika Dissanayake, Yuzaburo Inoue, Shingo Ochiai, Akifumi Eguchi, Taiji Nakano, Fumiya Yamaide, Satomi Hasegawa, Hiroyuki Kojima, Hiroko Suzuki, Chisato Mori, Yoichi Kohno, Masaru Taniguchi, Naoki Shimojo

https://ift.tt/2E9dOWg

EROS mutations: decreased NADPH oxidase function and chronic granulomatous disease

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): David C. Thomas, Louis-Marie Charbonnier, Andrea Schejtman, Hasan Aldhekri, Eve L. Coomber, Elizabeth R. Dufficy, Anne E. Beenken, James C. Lee, Simon Clare, Anneliese O. Speak, Adrian J. Thrasher, Giorgia Santilli, Hamoud Al-Mousa, Fowzan S. Alkuraya, Talal A. Chatila, Kenneth G.C. Smith

Short Summary

The phagocyte respiratory burst is mediated by the phagocyte NADPH oxidase, a multi-protein subunit complex that facilitates production of reactive oxygen species and which is essential for host defence. Monogenic deficiency of individual subunits leads to chronic granulomatous disease (CGD), which is characterized by an inability to make reactive oxygen species, leading to severe opportunistic infections and auto-inflammation. However, not all cases of CGD are due to mutations in previously identified subunits. We recently showed that Eros, a novel and highly conserved ER-resident transmembrane protein, is essential for the phagocyte respiratory burst in mice because it is required for expression of gp91phox-p22phox heterodimer, which are the membrane bound components of the phagocyte NADPH oxidase. Eros has a human orthologue, CYBC1/EROS. We now show that the function of CYBC1/EROS is conserved in human cells and describe a case of CGD secondary to a homozygous CYBC1/EROS mutation that abolishes EROS protein expression. This work demonstrates the fundamental importance of CYBC1/EROS in human immunity and describes a novel cause of CGD.

https://ift.tt/2RDhYIF

Real life treatment of Cholinergic Urticaria with Omalizumab

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): S. Altrichter, M. Chuamanochan, H. Knoth, A. Asady, T. Ohanyan, M. Metz, M. Maurer

Abstract

Background

Cholinergic urticaria (CholU), a frequent type of chronic inducible urticaria, presents with small itchy wheals upon physical exercise or passive warming. Omalizumab has been shown to be very effective in patients with chronic spontaneous urticaria. Whether or not omalizumab is also effective in CholU is largely unknown.

Aim

To assess the effectiveness of omalizumab treatment in CholU

Method

We assessed the effects of real life omalizumab treatment at standard and higher than standard doses in CholU patients including their time to response, the effects on concomitant urticaria forms and links to clinical features.

Results

Of 16 CholU patients treated with omalizumab, 11 (68%) reported a major or complete response, 2 patients reported a minor effect (13 %) and 3 patients (19%) showed no benefit. Omalizumab updosing led to complete response in 4 of 6 patients, who did not achieve controlled disease on standard dosed omalizumab therapy, i.e. 300 mg/4wks. Time to onset of benefit was fast, and concomitant urticaria forms showed similar response patterns. Treatment effects were linked to patient gender, with better responses in female patients (p < 0.05), but not patient age, age at onset of disease, duration of disease, or total IgE serum levels.

Conclusion

Omalizumab treatment is effective in the majority of CholU patients, especially in female patients. Most non-responders to standard-dosed omalizumab benefit from updosing. Our findings call for controlled clinical trials of omalizumab and other IgE-targeted treatments in CholU.

https://ift.tt/2E9dI0Q

CSF3R/CD114 mediates infection-dependent transition to severe asthma

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Hao Wang, Meaghan FitzPatrick, Nicholas J. Wilson, Desiree Anthony, Patrick C. Reading, Catherine Satzke, Eileen M. Dunne, Paul V. Licciardi, Huei Jiunn Seow, Kristy Nichol, Ian M. Adcock, Kian Fan Chung, Gary P. Anderson, Ross Vlahos, Peter Wark, Steven Bozinovski

https://ift.tt/2RDh9zz

Maintained thymic output of conventional and regulatory T cells during human pregnancy

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Sandra Hellberg, Ratnesh B. Mehta, Anna Forsberg, Göran Berg, Jan Brynhildsen, Ola Winqvist, Maria C. Jenmalm, Jan Ernerudh

https://ift.tt/2E9dzdO

Neutropenia as a sign of immunodeficiency

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Kathleen E. Sullivan

https://ift.tt/2RDgYnT

A Personal Perspective on Mentoring

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Dean D. Metcalfe

https://ift.tt/2E9hM1i

Métastases cutanées des extrémités

Publication date: Available online 10 October 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): H. Martin, M. Mariano-Bourin, L. Antunes, A. Bonhomme, J.-F. Cuny, L. Dubouis, F. Truchetet, A. Schoeffler

Résumé

Introduction

Les métastases cutanées (MC) localisées aux extrémités sont des complications exceptionnelles des cancers solides, au pronostic sévère. Dans la majorité des cas, elles simulent une infection. Nous en rapportons deux nouvelles observations de présentation originale.

Observations

Cas n^o 1 : un homme de 71 ans consultait pour suspicion de botryomycomes de la main gauche évoluant depuis 3 mois. Il avait pour antécédent deux carcinomes épidermoïdes (lingual et pulmonaire) en rémission. L'examen clinique objectivait trois lésions bourgeonnantes de la main gauche. La biopsie d'une des lésions concluait à une métastase de carcinome épidermoïde. Au bilan d'extension, on notait l'apparition de micronodules pulmonaires disséminés suspects de localisations secondaires. Cas n^o 2 : un homme de 68 ans consultait pour un œdème du membre inférieur droit infiltré, dur, mal limité, qui évoluait depuis plusieurs mois. Six mois auparavant, il avait eu un adénocarcinome bronchique traité par lobectomie supérieure gauche et dont le bilan d'extension ne révélait pas de lésion secondaire. Cliniquement, on notait un œdème induré prédominant au pied. La biopsie cutanée objectivait une métastase d'adénocarcinome. Le bilan d'extension montrait des lésions ostéolytiques du tarse droit ainsi que des adénomégalies.

Discussion

Nous rapportons deux cas originaux de MC des extrémités ayant permis de diagnostiquer une évolution tumorale. Il s'agit d'une complication rare, de présentation clinique variable, ayant un impact sur la prise en charge du cancer et sur le pronostic vital du patient. Ces observations illustrent l'importance d'évoquer le diagnostic en cas de lésions cutanées distales persistantes, a fortiori en cas d'antécédents néoplasiques.

Summary

Background

Cutaneous metastases (CM) on the extremities are rare complication of cancer with poor prognosis. In general, lesions simulate an infection. Herein, we report two new cases with atypical presentation.

Patients and methods

Case no 1: a 71-year-old man consulted for suspicion of left hand pyogenic granuloma present for 3 months. His history revealed two treated squamous-cell carcinomas (tongue and lung). On physical examination, he presented three budding and foul-smelling lesions on his left hand. Histopathology showed metastasis of squamous-cell carcinoma. Radiographic examination revealed spread of pulmonary nodules with suspicion of metastasis. Case no 2: a 68-year-old man was hospitalized for indurated edema of the right leg present for several months. Six months earlier, he had undergone surgery for left pulmonary adenocarcinoma without metastasis. Physical examination revealed an indurated edema on the right foot. Histopathology showed metastasis from adenocarcinoma. A scan revealed several osteolytic lesions in the right foot as well as lymphadenopathy.

Discussion

Herein, we report two original cases of CM of the extremities diagnosed as tumor progression. This is a rare complication of variable clinical presentation and impacts both cancer management and prognosis. It is important to consider the diagnosis when distal cutaneous lesions persist, particularly where there is a history of cancer.

https://ift.tt/2Pqt1Dv

The effect of human serum and dentin powder alone or in combination on the antibacterial activity of sodium hypochlorite against Enterococcus faecalis

Publication date: Available online 9 October 2018

Source: Archives of Oral Biology

Author(s): Zhongchun Tong, Yanqing Zhang, Xi Wei

Abstract

Objective

Dentin debris and organic components may affect the properties of intracanal irrigants. This study aimed to evaluate the effect of dentin powder (DP) and human serum (HS) on the antibacterial and antibiofilm activity of sodium hypochlorite (NaOCl) against Enterococcus faecalis.

Design

DP from 100 to 6.25 mg/mL and HS from 10% to 0.3125% were interactively mixed and added into E. faecalis and 1% NaOCl solution. The live E. faecalis were counted after 1 min of contact. For biofilm testing, 7 days of E. faecalis biofilms were treated by 100 mg/mL DP and 10% HS alone or combination with 1% NaOCl solution for 1 min. Furthermore, after challenges, E. faecalis biofilms were stained with SYTO 9 and propidium iodide, and confocal laser scanning microscopy (CLSM) was used to determine the proportion of dead and live cells in the biofilm.

Results

One hundred mg/mL DP or 10% HS alone showed the excellent inhibition of 1% NaOCl against planktonic E. faecalis, and the low concentration of DP and HS presented an additive inhibitory effect. The number of live bacteria in biofilms were significantly higher in the 1% NaOCl-treated group with DP or HS than without DP and HS (p <  0.05), and a higher percentage of dead bacteria was found in the challenge of NaOCl in the absence of DP and HS than in the presence of DP and HS.

Conclusion

DP and HS generated the inhibition of antibacterial and antibiofilm activities of NaOCl, whereas the effect of HS was greater than DP.

https://ift.tt/2RCtIeu

Demethylated Drug in the Treatment of Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Intervention:   Drug: Demethylated drug decitabine
Sponsors:   Wei Jiang;   Guilin Hospital of Traditional Chinese Medicine
Recruiting

https://ift.tt/2yxK7bg

Demethylated Drug in the Treatment of Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Intervention:   Drug: Demethylated drug decitabine
Sponsors:   Wei Jiang;   Guilin Hospital of Traditional Chinese Medicine
Recruiting

https://ift.tt/2yxK7bg

The protective effect of metformin against the noise-induced hearing loss

Abstract

Objective

To test the protective effect of metformin against noise-induced hearing loss.

Methods

24 rats were included in the study. The first group was exposed to noise only, the second group took metformin, the third group was exposed to noise and took metformin, and the fourth group was neither exposed to noise nor took metformin as control group. After measurement of baseline DPOAE and ABR of rats, the metformin group and the metformin + noise group received 300 mg/kg/day metformin via gavage for 10 days. On the 11th day, group 1 and group 3 were exposured to white noise at 105 dB SPL for 15 h. After noise exposure, DPOAE and ABR measurements of all rats were repeated on days 1st, 7th, and 21st. At the end of the study, all animals were sacrificed and cochlear tissues were separated for immunohistochemical assessments.

Results

ABR threshold values and DPAOE measurements of groups 1 and 3 were deteriorated on the 1st day after noise, while deterioration in group 1 continued on 7th and 21st days, but normalized on 7th day in group 3. After immune staining, a significant immunoreaction was observed in the noise group, while the reaction in the noise + metformin group was close to the control group.

Conclusion

Metformin has a protective effect on noise-induced hearing loss in rats. As a conclusion, it is determined that metformin protects from permanent threshold shift in rats. It can be considered a good alternative for protecting noise-induced hearing loss.

https://ift.tt/2pNmFTC

Androgens in Women: Hormone modulating therapies for skin disease (Part II)

Publication date: Available online 10 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Sarah Azarchi, Amanda Bienenfeld, Kristen Lo Sicco, Shari Marchbein, Jerry Shapiro, Arielle R. Nagler

Abstract

Androgen-mediated cutaneous disorders (AMCDs) in women including acne, hirsutism, and female pattern hair loss (FPHL) can be treated with hormone-modulating therapies. In the second part of this Continuing Medical Education series, we discuss the hormone-modulating therapies available to dermatologists for the treatment of AMCDs including combined oral contraceptives, spironolactone, finasteride, dutasteride, and flutamide. Available hormone-modulating treatments utilized for each AMCDs are reviewed, along with mechanisms of androgen modulation, safety profile, contraindications, monitoring parameters, and evidence of efficacy. Medications discussed include ones that are FDA-approved for certain AMCDs as well as some that are used off-label. Despite the ubiquity of hormone-modulating therapies used for AMCDs, this review highlights the need for more rigorous studies to evaluate these therapies for acne, hirsutism, and FPHL.

https://ift.tt/2PsaqqI

Androgens in Women: Androgen mediated skin disease and patient evaluation (Part I)

Publication date: Available online 10 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Amanda Bienenfeld, Sarah Azarchi, Kristen Lo Sicco, Shari Marchbein, Jerry Shapiro, Arielle R. Nagler

Abstract

Androgens are produced throughout the body in steroid-producing organs, such as the adrenal glands and ovaries, as well as in other tissues, like the skin. Several androgens are found normally in women, including dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEA-S), testosterone, dihydrotestosterone (DHT), and androstenedione. These androgens are essential in the development of several common cutaneous conditions in women, including acne, hirsutism, and female pattern hair loss (FPHL) – androgen mediated cutaneous disorders (AMCDs). However, the role of androgens in the pathophysiology of these diseases is complicated and incompletely understood. In the first article in this Continuing Medical Education series, we discuss the role of the skin in androgen production as well as the impact of androgens on the skin in women. Specifically, we review the necessary, but insufficient role that androgens play in the development of acne, hirsutism, and FPHL in women. Dermatologists face the challenge of differentiating physiologic from pathologic presentations of AMCDs in women. There are currently no dermatology guidelines outlining the indications for endocrinologic evaluation in women presenting with acne, hirsutism, and/or FPHL. We review available evidence regarding when to consider an endocrinologic work-up in women presenting with AMCDs, including the appropriate type and timing of testing.

https://ift.tt/2ychtgx

Nachruf auf Herrn Prof. Dr. med. Joachim Heermann

https://ift.tt/2C79NyW

Tinnitus is multicausal and may not only be related to DNA variants

https://ift.tt/2OfSYJE

Macrophage-microbe interaction: lessons learned from the pathogen Mycobacterium tuberculosis

Abstract

Macrophages, being the cornerstone of the immune system, have adapted the ancient nutrient acquisition mechanism of phagocytosis to engulf various infectious organisms thereby helping to orchestrate an appropriate host response. Phagocytosis refers to the process of internalization and degradation of particulate material, damaged and senescent cells and microorganisms by specialized cells, after which the vesicle containing the ingested particle, the phagosome, matures into acidic phagolysosomes upon fusion with hydrolytic enzyme-containing lysosomes. The destructive power of the macrophage is further exacerbated through the induction of macrophage activation upon a variety of inflammatory stimuli. Despite being the end-point for many phagocytosed microbes, the macrophage can also serve as an intracellular survival niche for a number of intracellular microorganisms. One microbe that is particularly successful at surviving within macrophages is the pathogen Mycobacterium tuberculosis, which can efficiently manipulate the macrophage at several levels, including modulation of the phagocytic pathway as well as interfering with a number of immune activation pathways that normally would lead to eradication of the internalized bacilli. M. tuberculosis excels at circumventing destruction within macrophages, thus establishing itself successfully for prolonged times within the macrophage. In this contribution, we describe a number of general features of macrophages in the context of their function to clear an infection, and highlight the strategies employed by M. tuberculosis to counter macrophage attack. Interestingly, research on the evasion tactics employed by M. tuberculosis within macrophages not only helps to design strategies to curb tuberculosis, but also allows a better understanding of host cell biology.

https://ift.tt/2Cy2nWJ

Localisation of DBS Electrodes Post-Implantation, to CT or MRI? Which Is the Best Option?

Stereotact Funct Neurosurg

https://ift.tt/2ysrTbf

Extension of the Clinical Significance of the “Cog”

Objective: To study the clinical anatomy of the epitympanum, the attic, and its medial wall, to try to discover a new clinical operation-related anatomical landmark, and to investigate the adjacent anatomical relationship with this landmark. Materials and Methods: Eight donor temporal bone specimens were dissected endoscopically. For 29 healthy persons (17 males and 12 females), CT images of the temporal bone (57 ears) were taken, 3-dimensional (3-D) reconstruction and multidimensional plane reconstruction were performed, and identification and assessment of 3-D spatial relationships between any 2 of these complex structures were done. Results: 3-D images of the temporal bone structures including the facial nerve, the cochlea, the semicircular canal, and the brain plate were reconstructed and shown in detail. We discovered a new clinical surgery-related anatomical landmark (the "cog" tangent and the trailing edge of the cog). Based on the tangent and the trailing edge of the cog, we quantified the anatomical relationship between it and its neighboring important structures. Conclusion: Based on endoscopic anatomy and the temporal bone spiral CT 3-D structure reconstruction of the epitympanum, the attic, and the adjacent structures, we found an extension of the clinical significance the cog. Quantification of the adjacent anatomical relationship of this landmark is very important for otology microsurgical operation.
ORL

https://ift.tt/2A2KtZu

Is calcitonin gene-related peptide a modulator of menopausal vasomotor symptoms?

Abstract

Purpose

Calcitonin gene-related peptide (CGRP) is a neuropeptide widely distributed in the central and peripheral nervous systems, which is known as a potent vasodilator. Postmenopausal women who experience hot flushes have high levels of plasma CGRP, suggesting its involvement in menopausal vasomotor symptoms.

Methods

In this review, we describe the biochemical aspects of CGRP and its effects associated with deficiencies of sexual hormones on skin temperature, vasodilatation, and sweating as well as the possible peripheral and central mechanisms involved in these events.

Results

Several studies have shown that the effects of CGRP on increasing skin temperature and inducing vasodilatation are potentiated by a deficiency of sex hormones, a common condition of postmenopausal women. Additionally, the medial preoptic area of the hypothalamus, involved in thermoregulation, contains over 25-fold more CGRP-immunoreactive cells in female rodents compared with male rodents, reinforcing the role of female sex hormones on the action of CGRP. Some studies suggest that ovarian hormone deficiency decreases circulating endogenous CGRP, inducing an upregulation of CGRP receptors. Consequently, the high CGRP receptor density, especially in blood vessels, amplifies the stimulatory effects of this neuropeptide to raise skin temperature in postmenopausal women during hot flushes.

Conclusions

The duration of the perception of each hot flush in a woman is brief, while local reddening after intradermal administration of α-CGRP persists for 1 to 6 h. This contrast remains unclear.

https://ift.tt/2NxFO5p

Actions Speak Louder than Words: Examining the Relationship Between Violent Behaviors and Bullying Victimization Among Adolescents

Violence and Gender, Ahead of Print.


https://ift.tt/2yqiPni

Sequential bilateral cochlear implants in children and adolescents: Outcomes and prognostic factors

Publication date: Available online 9 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): S. Baron, M. Blanchard, M. Parodi, I. Rouillon, N. Loundon

Abstract

Objectives

Cochlear implants (CI) have enabled an increasing proportion of deaf children to develop oral communication. Despite the well-known benefits of bilateral implantation, many of these children and teenagers have only a unilateral implant. The aim of this study was to evaluate the benefits of sequential bilateral CI and the influence of relevant factors on outcome.

Material and methods

A single-center retrospective study included 109 children and adolescents who received a second sequential CI between 2008 and 2016. Subjects were evaluated before sequential implantation and subsequently at 3, 12 and 24 months, on Speech Intelligibility Rating and speech perception tests: Categories of Auditory Performance, word and sentence recognition in silence and in noise. The influence of inter-implant interval and performance with the first CI were analyzed.

Results

In the majority of patients, sequential CI provided significant improvement in speech and intelligibility perception. These benefits were seen not only for short but also for long inter-implant intervals. Some subjects with poor performance with their first implant showed significant progression after sequential bilateral implantation.

Conclusion

In view of the benefits of sequential bilateral CI, we suggest that a second CI should be proposed to all unilaterally implanted children and adolescents, regardless of inter-implant interval and initial performance with the first CI. Further studies need to be conducted to identify prognostic factors for success in sequential contralateral implantation.

https://ift.tt/2C44BMp

Comparison of outcomes between hemithyroidectomy alone and hemithyroidectomy with elective unilateral central neck dissection in patients with papillary thyroid microcarcinoma

Head &Neck, EarlyView.


https://ift.tt/2C6IyV6

Is calcitonin gene-related peptide a modulator of menopausal vasomotor symptoms?

Abstract

Purpose

Calcitonin gene-related peptide (CGRP) is a neuropeptide widely distributed in the central and peripheral nervous systems, which is known as a potent vasodilator. Postmenopausal women who experience hot flushes have high levels of plasma CGRP, suggesting its involvement in menopausal vasomotor symptoms.

Methods

In this review, we describe the biochemical aspects of CGRP and its effects associated with deficiencies of sexual hormones on skin temperature, vasodilatation, and sweating as well as the possible peripheral and central mechanisms involved in these events.

Results

Several studies have shown that the effects of CGRP on increasing skin temperature and inducing vasodilatation are potentiated by a deficiency of sex hormones, a common condition of postmenopausal women. Additionally, the medial preoptic area of the hypothalamus, involved in thermoregulation, contains over 25-fold more CGRP-immunoreactive cells in female rodents compared with male rodents, reinforcing the role of female sex hormones on the action of CGRP. Some studies suggest that ovarian hormone deficiency decreases circulating endogenous CGRP, inducing an upregulation of CGRP receptors. Consequently, the high CGRP receptor density, especially in blood vessels, amplifies the stimulatory effects of this neuropeptide to raise skin temperature in postmenopausal women during hot flushes.

Conclusions

The duration of the perception of each hot flush in a woman is brief, while local reddening after intradermal administration of α-CGRP persists for 1 to 6 h. This contrast remains unclear.

https://ift.tt/2NxFO5p

90 Y-radioembolization of hepatocellular carcinoma from a theranostic perspective: towards a personalized approach

https://ift.tt/2OJaCoz

Sodium-fluoride PET-CT for the non-invasive evaluation of coronary plaques in symptomatic patients with coronary artery disease: a cross-correlation study with intravascular ultrasound

Abstract

Objectives

The aim of this study was to evaluate the ¹⁸F-sodium fluoride (¹⁸F-NaF) coronary uptake compared to coronary intravascular ultrasound (IVUS) in patients with symptomatic coronary artery disease.

Background

¹⁸F-NaF PET enables the assessment of vascular osteogenesis by interaction with surface hydroxyapatite, while IVUS enables both identification and quantification of intra-plaque components.

Methods

Forty-four patients with symptomatic coronary artery disease were included in this prospective controlled trial, 32 of them (30 patients with unstable angina and 2 patients with stable angina), representing the final study cohort, got additional IVUS. All patients underwent cardiac ¹⁸F-NaF PET/CT and IVUS within 2 days. ¹⁸F-NaF maximum tissue-to-blood ratios (TBR_max) were calculated for 69 coronary plaques and correlated with IVUS plaque classification.

Results

Significantly increased ¹⁸F-NaF uptake ratios were observed in fibrocalcific lesions (meanTBR_max = 1.42 ± 0.28), thin-cap atheroma with spotty calcifications (meanTBR_max = 1.32 ± 0.23), and thick-cap mixed atheroma (meanTBR_max = 1.28 ± 0.38), while fibrotic plaques showed no increased uptake (meanTBR_max = 0.96 ± 0.18). The ¹⁸F-NaF uptake ratio was consistently higher in atherosclerotic lesions with severe calcification (meanTBR_max = 1.34 ± 0.22). The regional ¹⁸F-NaF uptake was most likely localized in the border region of intensive calcification. Coronary lesions with positive ¹⁸F-NaF uptake showed some increased high-risk anatomical features on IVUS in comparison to ¹⁸F-NaF negative plaques. It included a significant severe plaque burden (70.1 ± 13.8 vs. 61.0 ± 13.8, p = 0.01) and positive remodeling index (1.03 ± 0.08 vs. 0.99 ± 0.07, p = 0.05), as well as a higher percentage of necrotic tissue (37.6 ± 13.3 vs. 29.3 ± 15.7, p = 0.02) in positive ¹⁸F-NaF lesions.

Conclusions

¹⁸F-NaF coronary uptake may provide a molecular insight for the characterization of coronary atherosclerotic lesions. Specific regional uptake is needed to be determined by histology.

https://ift.tt/2NyDnzF

Wael E. A. Saad: Portal hypertension. Imaging, diagnosis, and endovascular management. Third edition

https://ift.tt/2OO06w8

Radiochemotherapy-induced reactivation of scar tissue on 18 F-FDG PET/CT

https://ift.tt/2Nxh5y1

68 Ga-PSMA PET/CT in patients with recurrent prostate cancer after radical treatment: prospective results in 314 patients

Abstract

Purpose

We studied the usefulness of ⁶⁸Ga-prostate-specific membrane antigen (PSMA) PET/CT for detecting relapse in a prospective series of patients with biochemical recurrence (BCR) of prostate cancer (PCa) after radical treatment.

Methods

Patients with BCR of PCa after radical surgery and/or radiotherapy with or without androgen-deprivation therapy were included in the study. ⁶⁸Ga-PSMA PET/CT scans performed from the top of the head to the mid-thigh 60 min after intravenous injection of 150 ± 50 MBq of ⁶⁸Ga-PSMA were interpreted by two nuclear medicine physicians. The results were correlated with prostate-specific antigen (PSA) levels at the time of the scan (PSApet), PSA doubling time, Gleason score, tumour stage, postsurgery tumour residue, time from primary therapy to BCR, and patient age. When available, ⁶⁸Ga-PSMA PET/CT scans were compared with negative ¹⁸F-choline PET/CT scans routinely performed up to 1 month previously.

Results

From November 2015 to October 2017, 314 PCa patients with BCR were evaluated. Their median age was 70 years (range 44–92 years) and their median PSApet was 0.83 ng/ml (range 0.003–80.0 ng/ml). ⁶⁸Ga-PSMA PET/CT was positive (one or more suspected PCa lesions detected) in 197 patients (62.7%). Lesions limited to the pelvis, i.e. the prostate/prostate bed and/or pelvic lymph nodes (LNs), were detected in 117 patients (59.4%). At least one distant lesion (LNs, bone, other organs, separately or combined with local lesions) was detected in 80 patients (40.6%). PSApet was higher in PET-positive than in PET-negative patients (P < 0.0001). Of 88 patients negative on choline PET/CT scans, 59 (67%) were positive on ⁶⁸Ga-PSMA PET/CT.

Conclusion

We confirmed the value of ⁶⁸Ga-PSMA PET/CT in restaging PCa patients with BCR, highlighting its superior performance and safety compared with choline PET/CT. Higher PSApet was associated with a higher relapse detection rate.

https://ift.tt/2ONS5r3

Correction to: PET imaging of EGFR expression using an 18 F-labeled RNA aptamer

The original version of this article contained a mistake in the first paragraph of "Cell uptake and internalization of ¹⁸F-FB-ME07" section. The text "The specific activity was 7.4–14.8 kBq/nmol" should have been "The specific activity was 7.4–14.8 Mbq/nmol".

https://ift.tt/2NAYb9A

Martin Vahlensieck and Maximilian Reiser (Eds). MRI of the Musculoskeletal System, Second Edition

https://ift.tt/2OORIwf

Correction to: Regulation of human brown adipose tissue by adenosine and A 2A receptors – studies with [ 15 O]H 2 O and [ 11 C]TMSX PET/CT

The original version of this article contained a mistake in the first sentence of the Results section of the Abstract.

https://ift.tt/2NAY5Pg

Can integrated 18F-FDG PET/MR replace sentinel lymph node resection in malignant melanoma?

Abstract

Purpose

To compare the sensitivity and specificity of 18F-fluordesoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), 18F-FDG PET/magnetic resonance (18F-FDG PET/MR) and 18F-FDG PET/MR including diffusion weighted imaging (DWI) in the detection of sentinel lymph node metastases in patients suffering from malignant melanoma.

Material & Methods

Fifty-two patients with malignant melanoma (female: n = 30, male: n = 22, mean age 50.5 ± 16.0 years, mean tumor thickness 2.28 ± 1.97 mm) who underwent 18F-FDG PET/CT and subsequent PET/MR & DWI for distant metastasis staging were included in this retrospective study. After hybrid imaging, lymphoscintigraphy including single photon emission computed tomography/CT (SPECT/CT) was performed to identify the sentinel lymph node prior to sentinel lymph node biopsy (SLNB). In a total of 87 sentinel lymph nodes in 64 lymph node basins visible on SPECT/CT, 17 lymph node metastases were detected by histopathology. In separate sessions PET/CT, PET/MR, and PET/MR & DWI were assessed for sentinel lymph node metastases by two independent readers. Discrepant results were resolved in a consensus reading. Sensitivities, specificities, positive predictive values and negative predictive values were calculated with histopathology following SPECT/CT guided SLNB as a reference standard.

Results

Compared with histopathology, lymph nodes were true positive in three cases, true negative in 65 cases, false positive in three cases and false negative in 14 cases in PET/CT. PET/MR was true positive in four cases, true negative in 63 cases, false positive in two cases and false negative in 13 cases. Hence, we observed a sensitivity, specificity, positive predictive value and negative predictive value of 17.7, 95.6, 50.0 and 82.3% for PET/CT and 23.5, 96.9, 66.7 and 82.3% for PET/MR. In DWI, 56 sentinel lymph node basins could be analyzed. Here, the additional analysis of DWI led to two additional false positive findings, while the number of true positive findings could not be increased.

Conclusion

In conclusion, integrated 18F-FDG PET/MR does not reliably differentiate N-positive from N-negative melanoma patients. Additional DWI does not increase the sensitivity of 18F-FDG PET/MR. Hence, sentinel lymph node biopsy cannot be replaced by 18F-FDG-PE/MR or 18F-FDG-PET/CT.

https://ift.tt/2ONr9aP

Feasibility of dynamic stress 201 Tl/rest 99m Tc-tetrofosmin single photon emission computed tomography for quantification of myocardial perfusion reserve in patients with stable coronary artery disease

Abstract

Purpose

We evaluated the feasibility of dynamic stress ²⁰¹Tl/rest ^99mTc-tetrofosmin SPECT imaging using a cardiac camera equipped with cadmium-zinc-telluride detectors for the quantification of myocardial perfusion reserve (MPR).

Methods

Subjects with stable known or suspected coronary artery disease (CAD) who had undergone or were scheduled to undergo fractional flow reserve (FFR) measurement were prospectively enrolled. Dynamic stress ²⁰¹Tl/rest ^99mTc-tetrofosmin SPECT imaging was performed using a dedicated multiple pinhole SPECT camera with cadmium-zinc-telluride detectors. MPR was derived using Corridor4DM software.

Results

A total of 34 subjects were enrolled (25 men and 9 women; mean age 60.4 years). FFR was measured in 65 coronary arteries with intermediate lesions. The average global MPR was 2.58 ± 1.03. Global MPR was associated with the extent of CAD (P = 0.028) and global summed stress score (r = −0.60, P < 0.001). Regional MPR showed a significant correlation with diameter stenosis (r = −0.57, P < 0.001), minimum lumen diameter (r = 0.50, P < 0.001), summed stress score (r = −0.52, P < 0.001) and FFR (r = 0.52, P < 0.001). The area under the receiver operating characteristic curve of MPR for the diagnosis of functionally significant stenosis (FFR ≤0.8) was 0.79 (P < 0.001). The sensitivity and specificity of regional MPR were 67% and 83%, respectively, using a cut-off value of 2.0.

Conclusion

Dynamic stress ²⁰¹Tl/rest ^99mTc-tetrofosmin SPECT imaging and quantification of MPR is feasible in patients with stable CAD. The preliminary results of this study in a small number of patients require confirmation in a larger cohort to determine their implications for bolstering the role of SPECT imaging in the diagnosis and risk prediction of CAD.

https://ift.tt/2NAXsoS

Prognostic value of posttreatment 18 F-FDG PET/CT and predictors of metabolic response to therapy in patients with locally advanced cervical cancer treated with concomitant chemoradiation therapy: an analysis of intensity- and volume-based PET parameters

Abstract

Purpose

To investigate the prognostic value of posttreatment ¹⁸F-FDG PET/CT in patients with locally advanced cervical cancer (LACC) treated with concomitant chemoradiation therapy (CCRT). The secondary aim was to assess the possible role of intensity-based and volume-based PET parameters including SUVmax, SUVmean, MTV and TLG, and clinical parameters including age, pathology, FIGO stage and nodal involvement as factors predicting response to treatment.

Methods

This retrospective study included 82 patients affected by LACC treated with CCRT. All patients underwent ¹⁸F-FDG PET/CT both before and after treatment. The posttreatment PET/CT scans were used to classify patients as complete metabolic responders (CMR) or non-complete metabolic responders (N-CMR) according to the EORTC criteria. Kaplan-Meier analysis was used to evaluate differences in overall survival (OS) between the CMR and N-CMR groups. Student's t test, Pearson's chi-squared test and logistic regression were used to investigate the possible value of PET and clinical parameters as predictors of metabolic response to therapy.

Results

Kaplan­Meier analysis showed a highly significant difference in OS between the CMR and N-CMR groups (log-rank test p < 0.0001). Significant independent predictors of response to therapy were MTV (p = 0.019, odds ratio = 1.015, 95% CI = 1.002–1.028, Nagelkerke R² = 0.110), TLG (p = 0.045, odds ratio = 1.001, 95% CI = 1.000–1.002, Nagelkerke R² = 0.081) and nodal involvement (p = 0.088, odds ratio = 2.361, 95% CI = 0.879–6.343, Nagelkerke R² = 0.051).

Conclusion

¹⁸F-FDG PET/CT-based response assessment using the EORTC criteria reliably predicts OS in LACC patients treated with CCRT. In our cohort of patients, pretreatment MTV and TLG and nodal involvement were predictors of response to therapy. MTV was the best predictor of response. However, its additional risk value seems to be low (MTV odds ratio = 1.015).

https://ift.tt/2OQhOiD