Aluminum phosphide is a very common suicide agent in developing countries like Nepal. Due to the unavailability of a specific antidote, mortality is very high because the phosphine molecule that is formed lead...
https://ift.tt/2OW15uW
Σάββατο 27 Οκτωβρίου 2018
Extracorporeal membrane oxygenation in aluminum phosphide poisoning in Nepal: a case report
Transparent reporting of experimental parameters in assays measuring phenotypic steps in metastasis
Abstract
Metastasis is key to cancer mortality. Understanding its biology is vital for developing strategies to prevent and treat metastasis. Phenotypic assays to either study metastasis or evaluate anti-metastatic drugs are widely used in preclinical research. This technical note discusses the adherence of reporting essential experimental and methodological parameters in chemotactic invasion assays in vitro and spontaneous metastasis assays in vivo. Following the analysis of 130 recent (< 5 years) research papers, several shortcomings in reporting were identified. Therefore, we strongly argue to increase experimental rigor which should result in a significant improvement with respect to reproducibility of preclinical metastasis research.
https://ift.tt/2AuKeqv
Management of the Neck for Non-melanoma Skin Cancer
Abstract
Purpose of Review
To summarize the current management of the neck lymph node basin for head and neck non-melanoma skin cancers.
Recent Findings
Over the last 5 years, there have been updates to staging for cSCC and MCC. T classification of the AJCC staging system has been changed to match the UICC staging system. MCC staging has been updated based on data from the National Cancer Data Base. Sentinel lymph node biopsy, while established in MCC, is playing a growing role in the management of high-risk N0 cSCC.
Summary
The optimal management of N0 neck varies by metastatic potential. In low-risk malignancy, no workup is necessary. In cSCC, risk stratification is necessary. High-risk tumors with N0 necks should undergo preoperative imaging with CT and targeted FNA of suspicious lymph nodes. If radiologically negative, a SLNB should be considered. Selective neck dissection should be performed for N+ disease and positive SLNB. Elective neck dissection is not routinely recommended and should be reserved for positive parotid nodal disease. Merkel cell carcinoma has high rates of nodal metastases and requires preoperative imaging with targeted FNA of suspected metastases. SLNB should be performed for N0 disease to guide prognostication and further treatment. Management of negative SLN is controversial, and most can be observed while radiation may be considered for high-risk patients. Positive SLN requires completion neck dissection and radiation.
https://ift.tt/2PuEjd6
Can asthma be well controlled with NAEPP guideline care in morbidly obese children? The Breathmobile
Obesity is thought to be associated with poor asthma control, increased health resource utilization, and reduced responsiveness to inhaled corticosteroids.
https://ift.tt/2qaQ8XQ
Present and future perspective of photodynamic therapy for cutaneous squamous cell carcinoma
Photodynamic therapy may benefit patients with cutaneous squamous cell carcinoma who are not eligible for surgery. Photodynamic therapy can be modified to provide better effect by use of microneedles or laser, by use of intralesional injection of photosensitizers instead of topical application, by use of nanoparticles or by use of adjuncts.
https://ift.tt/2Rh30ac
Associations among regorafenib concentrations, severe adverse reactions, and ABCG2 and OATP1B1 polymorphisms
Abstract
Purpose
The ability of predicting severe adverse reactions caused by regorafenib is important. We evaluated regorafenib concentrations for adverse reaction risks and assessed the relevance of laboratory values and gene polymorphisms.
Methods
A total of 28 Japanese cancer patients who were treated with regorafenib were evaluated for the steady state of serum regorafenib concentrations and adverse reactions for 28 days. In addition, we determined the association of regorafenib concentrations with ABCG2 and OATP1B1 polymorphisms, which are regorafenib transporters.
Results
Regorafenib concentrations were significantly higher in the group with Grade 2 or higher total bilirubin elevation and thrombocytopenia compared with the group with grades 0 or 1 [3.45 (2.18–7.31) vs. 1.76 (0.26–2.77) µg/mL, P = 0.01 and 3.45 (2.12–7.31) vs. 1.76 (0.26–2.77) µg/mL, P = 0.02, respectively]. A strong association was noted between serum regorafenib concentrations and total bilirubin levels, but the physical and genetic factors predicting regorafenib pharmacokinetics could not be clarified.
Conclusions
Regorafenib concentrations were associated with total bilirubin elevation and thrombocytopenia. Total serum bilirubin could be a useful marker when estimating regorafenib pharmacokinetics.
https://ift.tt/2yAsl8o
An unexpected asymptomatic epiglottal site of Kimura disease
Publication date: Available online 26 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Dezoteux, R. Dubois, G. Lefèvre, J.P. Lecoutre, D. Staumont-Sallé, O. Carpentier
Abstract
Introduction
Kimura disease (KD) is a chronic lymphoproliferative disorder of unknown etiology that affects the skin and lymph nodes, mostly observed in males of Asian descent. The natural history of asymptomatic epiglottal KD remains unknown. This rare site of KD is often only diagnosed when tumor growth starts to obstruct the upper airways.
Observation
A 34-year-old North African male presented with fatigue and multiple, slowly progressive, fluctuating skin nodules in the right mandibular and retroauricular regions. Computed tomography of the head and neck revealed a large soft tissue tumor close to the right mandibular body and unexpected thickening of the epiglottis. Transnasal laryngoscopy confirmed the CT findings and showed thickening of the epiglottis. The diagnosis of KD was based on histological examination of biopsy specimens taken from the right mandibular tumor, a cervical lymph node, and the epiglottis.
Discussion
Most cases of KD with epiglottal involvement present with dysphonia and dysphagia. No consensus guidelines are available concerning the complementary investigations that should be performed. This case report raises the question of whether patients with suspected KD should be systematically screened for lesions in unusual and potentially dangerous anatomic sites.
https://ift.tt/2SozH7e
High expression of CCL2 in tumor cells and abundant infiltration with CD14 positive macrophages predict early relapse in breast cancer
Abstract
Macrophages are important for the function of the innate immune system, and in solid tumors, they represent a significant proportion of the tumor mass. Tumor-associated macrophages (TAM) have a M2 phenotype and show a multitude of pro-tumoral functions, promoting tumor cell survival, proliferation, and dissemination. CCL2, synthesized by tumor and stromal cells, initiates a chemokine cascade inducing these processes. We studied by immunohistochemistry (IHC) the frequency of TAMs and CCL2 expressing cells in three groups of primary tumor (PT)-recurrence (R) pairs, where relapse was recorded within 2 years (group 1), between 5 and 10 years (group 2), and after 10 years (group 3). In our study all established breast cancers were heavily infiltrated by CD68 positive cells. Both in PTs and in R lesions the infiltration was more abundant in the peritumoral than in the intratumoral stroma. The mean frequency of M2 marker and CD14 positive cells in the intratumoral stroma and CCL2 expressing tumor cells was higher in the Rs as compared to the corresponding PTs. In PTs, a high frequency of CD14 positive cells and a high expression of CCL2 by tumor cells was associated with an early recurrence. The findings support the current understanding of immune cell orchestrated development, progression and metastatic spread of breast cancer. Our study showed that a high frequency of CCL2 positive tumor cells and CD14 positive TAMs are significant risk factors for rapid tumor recurrence. Potential targets for intervention are discussed.
https://ift.tt/2Q086aO
Phase I study of BNC105P, carboplatin and gemcitabine in partially platinum-sensitive ovarian cancer patients in first or second relapse (ANZGOG-1103)
Abstract
Purpose
The primary objective of this study was to determine the recommended dose of the vascular disrupting agent, BNC105P, in combination with gemcitabine and carboplatin in patients with ovarian cancer in first or second relapse with a minimum 4 month progression-free interval after last platinum.
Methods
Patients received carboplatin AUC4 on day 1 in combination with escalating doses of 800 or 1000 mg/m2 gemcitabine on days 1 and 8 and escalating doses of 12 or 16 mg/m2 BNC105P on days 2 and 9 every 21 days for a maximum for six cycles. Maintenance treatment with 16 mg/m2 BNC105P treatment continued for a maximum of six additional cycles. Patients were followed for safety and anti-tumor activity.
Results
Fifteen patients were enrolled in the study. Adverse events were most commonly of hematological origin. Dose-limiting toxicities (thrombocytopenia and neutropenia) occurred in two patients at the dose level of 800 mg/m2 gemcitabine, carboplatin AUC4 and 16 mg/m2 BNC105P. No dose-limiting toxicities were observed at a dose level of gemcitabine 1000 mg/m2, carboplatin AUC4 and BNC105P 12 mg/m2. BNC105P as a single agent was well tolerated at a dose of 16 mg/m2 in maintenance treatment. Ten patients (67%) achieved a complete or partial response according to CA125 and/or RECIST response criteria, four of 13 (31%) responded by RECIST alone. The median progression-free survival was 5.9 months.
Conclusions
We have established that BNC105P 12 mg/m2 with gemcitabine 1000 mg/m2 and carboplatin AUC4 is the recommended dose level and has an acceptable toxicity profile. Further exploration of BNC105P in the ovarian cancer setting is planned.
https://ift.tt/2CIDGWF
Unilateral endoscopic resection with transnasal craniectomy for sinonasal intestinal-type adenocarcinoma: A bi-institutional case-control study on 54 patients
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Alberto Schreiber, Marco Ferrari, Davide Mattavelli, Vittorio Rampinelli, Stefano Taboni, Alperen Vural, Maurizio Bignami, Paolo Castelnuovo, Piero Nicolai
Abstract
Objectives
Intestinal-type adenocarcinoma (ITAC) of the ethmoid mostly affects patients exposed to wood dust and has been traditionally treated with bilateral resection. The aim of the present study was to validate unilateral endoscopic resection with transnasal craniectomy (uERTC) in selected ITACs.
Materials and methods
Patients affected by ITAC receiving uERTC from 2004 to 2017 at two tertiary referral centers were retrospectively analyzed. A control group of patients treated with bilateral endoscopic resection with transnasal craniectomy (bERTC) was selected. Olfaction, taste, and quality of life were evaluated. Survival and functional outcomes in the two groups were compared.
Results
Fifty-four patients who underwent uERTC (case group: 27/54) or bERTC (control group: 27/54) were enrolled. The two groups were statistically comparable. Five-year overall (OS), disease-specific (DSS), recurrence-free (RFS) survivals, and local recurrence rates were not significantly different between groups. Hospitalization time was significantly shorter in the uERTC group (p = 0.0004) and no significant difference in terms of complications was demonstrated. The rate of subjective olfaction preservation was significantly higher in the uERTC group (45.5%) than in the bERTC group (0.0%) (p = 0.0007). Median 22-Items Sinonasal Outcome Test (SNOT-22) values were not significantly different between groups. No significant association of olfaction and taste preservation/worsening with reconstructive technique, radiation therapy, and chemotherapy was observed.
Conclusions
uERTC is an adequate surgical procedure for selected unilateral ITAC with similar survival rates and lower morbidity compared to bERTC. A rigorous follow-up of patients with ITAC is crucial and strongly recommended independently of the extent of resection.
https://ift.tt/2OaVqMi
Eighth edition of tumor-node-metastasis staging system improve survival predictability for papillary, but not follicular thyroid carcinoma: A multicenter cohort study
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Mijin Kim, Hye In Kim, Min Ji Jeon, Hee Kyung Kim, Eun Heui Kim, Hyon-Seung Yi, Eun Sook Kim, Hosu Kim, Bo Hyun Kim, Tae Yong Kim, Sun Wook Kim, Ho-Cheol Kang, Won Bae Kim, Jae Hoon Chung, Young Kee Shong, Tae Hyuk Kim, Won Gu Kim
Abstract
Objectives
This study aimed to evaluate the proposed changes in the eighth edition of the tumor-node-metastasis staging system (TNM-8) compared with the seventh edition (TNM-7) in terms of pathologic subtypes, using a large multicenter thyroid cancer cohort.
Materials and methods
We retrospectively reviewed 7717 patients with papillary (PTC) and 273 with follicular thyroid carcinoma (FTC) who underwent thyroid surgery between 1996 and 2005. We assessed the proportion of variation explained (PVE) to compare the predictive accuracy of disease-specific survival (DSS).
Results
During a median 11.3 years of follow-up, 169 (2%) disease-specific deaths were recorded. In patients with PTC, the 10-year DSS rates of stages I, II, III, and IV disease in TNM-8 were 99.6%, 95.7%, 81.5%, and 54.8%, respectively; the corresponding rates in TNM-7 were 99.6%, 98.4%, 98.4%, and 90.1%, respectively. In patients with FTC, the 10-year DSS rates of stages I, II, III, and IV disease in TNM-8 were 97.2%, 69.8%, 50.0%, and 45.5%, respectively; the corresponding rates in TNM-7 were 98.3%, 90.0%, 92.3%, and 42.1%, respectively. Comparing TNM-7 and TNM-8, the PVE values increased from 3.4% to 4.7% in the PTC group, whereas they decreased from 17.5% to 14.5% in the FTC group.
Conclusion
Our study suggests that the changes in TNM-8 have improved the clinical usefulness of the TNM staging system in terms of predicting DSS in patients with PTC but not FTC. Further studies to establish a more predictable TNM staging system that focuses on patients with FTC are necessary.
https://ift.tt/2yChcUj
Co-existent TBX1 Mutation and Chromosomal 20q13.13-q13.2 Duplication in an Infant with Abnormal TREC Newborn Screening
Publication date: Available online 27 October 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Jason K. Lam, Stephen R. Braddock, Charles B. Huddleston, Alan P. Knutsen
https://ift.tt/2qfdnQg
Associations of unsafe, unsupportive and underdeveloped neighborhoods with atopic dermatitis in US children
Publication date: Available online 27 October 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Costner McKenzie, Jonathan I. Silverberg
https://ift.tt/2CKM4VN
Can asthma be well controlled with NAEPP guideline care in morbidly obese children? The Breathmobile
Publication date: Available online 27 October 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Tricia Morphew, Stanley P Galant
Abstract
Background
Obesity is thought to be associated with poor asthma control, increased health resource utilization, and reduced responsiveness to inhaled corticosteroids.
Objective
Based on previous experience our hypothesis was that by improved access to comprehensive guideline care that outcomes in normal weight would be comparable in obese asthmatic children.
Methods
This was a retrospective cohort study of predominately Hispanic children (3-18 years of age), in underserved areas of Orange County, CA, who enrolled in the Breathmobile Program from 2003 -2012. Outcomes were examined using Cox regression and generalized estimating equations analyses, adjusted for potential confounding factors.
Results
Clinical outcomes in over 1200 children followed for a mean of 6 visits (SD=2.2) across 403 days (SD=112) were improved, on average, regardless of BMI. MOB patients were able to achieve significant reductions of approximately 60% or more in report of ED visits, hospitalizations, school absenteeism, usual exercise limitations, and exacerbations to levels that were comparable to NW patients. The importance of close follow-up, particularly for the MOB patient, was evidenced by achieving 80% cumulative probability of well control asthma by visit 3, similar to patients in lower BMI risk groups with good adherence, when the visit interval did not exceed 90 days. These outcomes were achieved across all BMI groups with similar mean step of therapy, adjusted for severity (p<.001).
Conclusion
Access to effective community-based care where trust, education, and continuity of care consistent with NAEPP guidelines is possible, as demonstrated by the Breathmobile Program, can provide an opportunity for asthmatic children in all BMI categories to achieve well controlled disease.
https://ift.tt/2qcBbUX
Progestogen Hypersensitivity: presentation and natural history
Publication date: Available online 26 October 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): Dinah Foer, Kathleen M. Buchheit
Abstract
Objective
To review the published medical literature on the clinical presentation, risk factors, and natural history of hypersensitivity reactions to progestogens.
Data Sources
Through the use of PubMed, we conducted a review of allergy, dermatology, and obstetric literature for cases and case series of patients with hypersensitivity reactions to exogenous or endogenous progestogens. There are no longitudinal, prospective studies related to progestogen hypersensitivity.
Study Selections
Publications were selected that described cases that were clinically consistent with progesterone hypersensitivity with positive testing or clear symptoms with exposure to progestogens to confirm the diagnosis.
Results
Progestogen hypersensitivity symptoms can be triggered by endogenous progesterone or by exogenous progestins used for contraception or fertility treatments. Symptoms are varied and include dermatitis, urticaria, asthma, and anaphylaxis.
Conclusions
While the medical literature of progestogen hypersensitivity is limited to case reports and small case series, there exists significant heterogeneity in clinical presentation between patients.
https://ift.tt/2CIYFsg
A case of an infant with extremely low birth weight and hypothyroidism associated with massive cutaneous infantile hemangioma
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
https://ift.tt/2PXREaR
Cardiometabolic risk factors in preschool children with abdominal obesity from Medellín, Colombia
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
https://ift.tt/2Aw3oMy
The prevalence and volumetry of pituitary cysts in children with growth hormone deficiency and idiopathic short stature
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
https://ift.tt/2PXRzE5
Dear Dr. Dermatoethicist: Exam of the Future or Exam of Future Cheating? Ethical Issues Surrounding the American Board of Dermatology’s New Certification Examination
Publication date: Available online 27 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Reid A. Waldman, Jane M. Grant-Kels
https://ift.tt/2StEowy
Non-cultured epidermal suspension grafting using suction blisters as donor tissue for vitiligo
Publication date: Available online 27 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Andrea Tovar-Garza, Jorge A. Hinojosa, Linda S. Hynan, Amit G. Pandya
https://ift.tt/2z4Z70I
Benign subungual epidermoid inclusions
Publication date: Available online 27 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Josette André, Eckart Haneke
https://ift.tt/2SlU9Fz
Reply to "Benign subungual epidermoid inclusions"
Publication date: Available online 27 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Amélie Boespflug, Sébastien Debarbieux, Lauriane Depaepe, Brigitte Chouvet, Delphine Maucort-Boulch, Stéphane Dalle, Brigitte Balme, Luc Thomas
https://ift.tt/2zbWfz0
A Phase 2, Randomized Dose-Finding Study of Tapinarof (GSK2894512 Cream) for the Treatment of Plaque Psoriasis
Publication date: Available online 26 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Kevin Robbins, Robert Bissonnette, Tomoko Maeda-Chubachi, Li Ye, Johnny Peppers, Kelly Gallagher, John E. Kraus
Abstract
Background
There is a significant need for novel, safe and efficacious topical treatments for psoriasis.
Objective
We assessed the safety and efficacy of tapinarof in a new cream formulation in 2 concentrations and 2 application frequencies in adults with psoriasis.
Methods
Double-blind, vehicle-controlled, randomized, 6-arm trial (1:1:1:1:1:1) in adults, with psoriasis with body surface (BSA) involvement ≥1% and ≤15% and PGA ≥2 at Baseline. Primary endpoint included PGA = 0 or 1 at Week 12, and a 2-grade improvement from Baseline. Additional analyses included PASI75 and mean percent change in PASI and BSA.
Results
Treatment success defined by PGA 0 or 1 and a 2-Grade Improvement at Week 12 were statistically significantly higher (at a 0.05 significance level) in the tapinarof groups than the vehicle groups: (65% [1%BID]; 56% [1%QD]; 46% [0.5%BID]; 36% [0.5%QD]; 11% [vehicle BID], and 5% [vehicle QD]) and was maintained for 4 weeks post-treatment. Treatment-emergent adverse events (TEAEs) were higher with tapinarof (85/152 patients [56%] compared to vehicle 19/75 patients [25%]) and mild-to-moderate in intensity. Severe TEAEs were reported in all tapinarof groups except 0.5% QD.
Limitations
Large confirmation trials are needed.
Conclusions
Tapinarof cream is efficacious and well tolerated in adult patients with psoriasis.
https://ift.tt/2SoMC9d
Response to “A relapsing peeling of oral mucosa”
Publication date: Available online 26 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Andrea D. Maderal, Paul Lee Salisbury, Joseph L. Jorizzo
https://ift.tt/2z6Ng29
Histologic predictors of invasion in partially biopsied lentigo maligna melanoma
Publication date: Available online 26 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): I. Aouidad, C. Fargeas, P. Romero, J.F. Sei, V. Chaussade, A. Beauchet, T. Clerici, U. Zimmermann, P. Saiag, E. Funck-Brentano
https://ift.tt/2SlTVhH
Classic Dermatological Tools: Foreign Body Removal with Punch Biopsy
Publication date: Available online 26 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Jesus Alberto Cardenas-de la Garza, Adrian Cuellar-Barboza, Jesus Ancer-Arellano, Cesar Jair Ramos-Cavazos, Osvaldo Tomas Vazquez-Martinez, Jorge Ocampo-Candiani
https://ift.tt/2z9OPMC
Markers of systemic involvement and death in hospitalized cancer patients with severe cutaneous adverse reactions
Publication date: Available online 26 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Shoko Mori, Alanna Hickey, Stephen W. Dusza, Mario E. Lacouture, Alina Markova
Abstract
Background
Severe cutaneous adverse reactions (SCARs) are frequent in inpatient oncology. Early intervention may reduce morbidity, mortality, and hospitalization costs, however current clinical and histologic features are unreliable SCAR predictors. There is a need to identify rational markers of SCARs that could lead to effective therapeutic interventions.
Objective
To characterize the clinical and serologic features of hospitalized patients with cancer who developed SCARs.
Methods
Retrospective review of 49 hospitalized cancer patients with a morbilliform rash and recorded testing for serum cytokines (IL-6, IL-10, TNF-α) or elafin, and prior dermatology consultation. Patients were categorized as having a 'simple' morbilliform rash without systemic involvement or 'complex' morbilliform rash with systemic involvement.
Results
Fifteen out of 49 patients (30.6%) were deceased at 6 months from time of dermatologic consultation. Elafin, IL-6, and TNF-α were significantly higher in patients who died compared to patients who were still alive at 6 months. IL-6 and IL-10 were significantly higher in patients with a drug-related 'complex' rash.
Limitations
Retrospective design, limited sample size, high-risk patient population.
Conclusion
In cancer patients with SCARs, elafin, IL-6, and TNF- α may predict a poor outcome. Agents directed towards these targets may represent rational treatments for the prevention of fatal SCARs.
https://ift.tt/2So1vZa
A relapsing peeling of oral mucosa
Publication date: Available online 26 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): M.A. Chessa, E. Dika, G. Carlotta, B. Carlotta, A. Patrizi
https://ift.tt/2z3SX0O
The 2018 Nobel Prize in Physiology or Medicine: An exemplar of Bench to Bedside in Immunology
Publication date: Available online 26 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Zuhair K. Ballas
https://ift.tt/2JjBINL
Elevated regulatory T cells at diagnosis of Coccidioides infection associates with chronicity in pediatric patients
Publication date: Available online 26 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Dan Davini, Fouzia Naeem, Aron Phong, Mufadhal Al-Kuhlani, Kristen M. Valentine, James McCarty, David M. Ojcius, David M. Gravano, Katrina K. Hoyer
Summary
The inability to resolve Coccidioides infection correlates with elevated Treg frequency and functional marker expression at diagnosis. Treg frequency may be a diagnostic for calibrating treatment aggressiveness for patients likely to develop chronic cocciodiomycosis.
https://ift.tt/2Pq4sKh
Prognosticating autoimmune encephalitis: A systematic review
Publication date: Available online 26 October 2018
Source: Journal of Autoimmunity
Author(s): James Broadley, Udaya Seneviratne, Paul Beech, Katherine Buzzard, Helmut Butzkueven, Terence O'Brien, Mastura Monif
Abstract
Objective
To perform a systematic review of the current scientific literature in order to identify variables associated with patient prognosis in autoimmune encephalitis.
Methods
We performed a systematic literature search using MEDLINE, Embase, PubMed and PsychInfo databases. We selected studies that explored the correlation between early clinical and paraclinical findings, and patient outcomes. Data was extracted, analyzed and recorded in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
Results
Forty four publications detailing 2823 subjects matched our inclusion criteria. There was considerable heterogeneity in methodology, patient profile, investigation results and clinical outcome measures. Findings were often discrepant for cases of anti-NMDAR encephalitis when compared with other causes of autoimmune encephalitis. Delay in immunotherapy contributed to a variety of worse outcomes for patients with different subsets of autoimmune encephalitis. Altered consciousness, ICU admission and no use of immunotherapy were variables associated with poor prognosis in anti-NMDAR encephalitis. Older age, sex, the presence of status epilepticus, CSF abnormalities and MRI changes were unlikely to have significant prognostic value. The influence of antibody titers, autonomic dysfunction and underlying malignancy was unclear.
Conclusions
A number of variables were identified to have potential predictive value for outcomes in autoimmune encephalitis. Heterogeneous study design, size and quality were major limiting factors in this review.
https://ift.tt/2Awh6PB
Molecular mimicry and autoimmunity
Publication date: Available online 26 October 2018
Source: Journal of Autoimmunity
Author(s): Manuel Rojas, Paula Restrepo-Jiménez, Diana M. Monsalve, Yovana Pacheco, Yeny Acosta-Ampudia, Carolina Ramírez-Santana, Patrick S.C. Leung, Aftab A. Ansari, M. Eric Gershwin, Juan-Manuel Anaya
Abstract
Molecular mimicry is one of the leading mechanisms by which infectious or chemical agents may induce autoimmunity. It occurs when similarities between foreign and self-peptides favor an activation of autoreactive T or B cells by a foreign-derived antigen in a susceptible individual. However, molecular mimicry is unlikely to be the only underlying mechanism for autoimmune responses; other factors such as breach in central tolerance, non-specific bystander activation, or persistent antigenic stimuli (amongst others) may also contribute to the development of autoimmune diseases. Host genetics, exposure to microbiota and environmental chemicals are additional links to our understanding of molecular mimicry. Our current knowledge of the detailed mechanisms of molecular mimicry is limited by the issues of prolonged periods of latency before the appearance of disease, the lack of enough statistical power in epidemiological studies, the limitations of the potential role of genetics in human studies, the relevance of inbred murine models to the diverse human population and especially the limited technology to systematically dissect the human T-cell repertoire and B-cell responses. Nevertheless, studies on the role of autoreactive T-cells that are generated secondary to molecular mimicry, the diversity of the T-cell receptor repertoires of auto-reactive T-cells, the role of exposure to cryptic antigens, the generation of autoimmune B-cell responses, the interaction of microbiota and chemical adjuvants with the host immune systems all provide clues in advancing our understanding of the molecular mechanisms involved in the evolving concept of molecular mimicry and also may potentially aid in the prevention and treatment of autoimmune diseases.
https://ift.tt/2PXCFO9
Viral hepatitis, inflammation, and cancer: A lesson for autoimmunity
Publication date: Available online 26 October 2018
Source: Journal of Autoimmunity
Author(s): Silvia Piconese, Ilenia Cammarata, Vincenzo Barnaba
Abstract
In the present review, we analyzed the various overlapping and non-mutually exclusive mechanisms that intersect and form complex and highly flexible immunological networks allowing the defense against liver infections and tumors. Liver immunity results from the combination of the skills of systemic and local immune system(s) to sense and recognize pathogen or tumor antigens, to sensitize a wide range of innate and adaptive immune cells, and to clear the "invaders", through the establishment of a transient liver immunopathology state undergoing resolution/control of infections or tumors, and memory development. Then, a special emphasis is placed on discussing about the capacity of the immune system(s) to develop a state of chronic low-level immunopathology adapting through the intervention of simultaneous immunoregulatory mechanisms, when the liver is infected by highly mutable viruses (e.g., hepatitis B or C viruses [HBV or HCV]) capable to escape from the immune recognition. The establishment of chronic inflammation represents an advantage for the species survival, because it guarantees the long-term survival of human hosts despite the virus persistence. However, chronic inflammation, in the long run, can evolve towards severe consequences (decompensated cirrhosis and hepatocellular carcinoma) in some individuals, finding requiring the impelling need of discovering new therapeutic anti-viral and immunostimulatory agents addressed, in combination, to fight especially HBV that, in contrast to HCV, lacks antivirals capable to eradicate the virus. Finally, we discussed the concept proposing that the divergent immunoregulatory mechanisms that develop in persisting infections or tumors, on the one hand, and autoimmunity, on the other hand, are the mirror image of each other, whose understanding is also relevant for preparing novel immunotherapeutic approaches in autoimmune diseases.
https://ift.tt/2PZxKwa
The Use of Video Glasses Improved Learning of Tonsillectomy and Adenoidectomy Surgery: A Randomized Controlled Trial
Publication date: Available online 27 October 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Evie Landry, Michael Yong, Julie Pauwels, Neil K. Chadha
Abstract
Objective
One of the most common challenges in surgical education for trainees is gaining practical experience through observing procedures in the operating room. Due to the nature of some procedures, a narrow surgical view severely limits the learning experience. Video glasses are new devices that offer the potential to project the primary surgeon's exact view to learners in real-time, allowing for an enhanced operative learning experience.
Study Design
Single center randomized prospective trial.
Setting
Tertiary care pediatric hospital.
Participants
Using block randomization, medical students and surgical residents observed either a tonsillectomy or adenoidectomy, either directly at table-side or by real-time video feed from the surgeon's video glasses projected to a screen in the operating room, in random order. Participants then completed a survey comparing aspects of their learning experience viewing the procedure through the video feed in comparison to direct observation.
Main Outcome
Measures: Evaluating the hypothesis that video glasses provided an improved overall learning experience and a realistic simulation of the open surgical procedures tested.
Results
23 trainees participated in the study. Survey results demonstrated that the overall learning experience with the use of video glasses was significantly improved when compared to direct visualization (average Visual Analog scale (VAS) score 82/100 vs. 64/100, p=0.021).Video glasses were shown to be superior when comparing the view of the surgical field (83/100 vs. 54/100 on VAS, p<0.001) and the ability to identify anatomical structures (79/100 vs. 56/100 on VAS, p=0.001). The ease of following surgical steps with video glasses was also shown to be better than by direct visualization (81/100 vs. 69/100 on VAS, p=0.039). All participants stated that video glasses closely simulated the learning environment of the real-life open procedure.
Conclusion
This study showed that the use of video glasses was beneficial for surgical education and a realistic tool for learners at varying levels of training. Video glasses may significantly improve the learning experience for procedures with a narrow field of view.
https://ift.tt/2D7Drpg
Prediction of uptake and retention of conventional hearing aids in Korean pediatric patients with unilateral hearing loss
Publication date: Available online 26 October 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Hyesook Lee, Hyunyong Lee, Heil Noh
Abstract
Objective
The purpose of this study was to describe and predict hearing aid uptake and retention in Korean pediatric patients with unilateral hearing loss (UHL) in a secondary referral hospital.
Methods
This was a retrospective study using clinical data collected at the time of UHL diagnosis. The study included data collected from 2009 to 2016. Serial audiograms were extracted from clinical charts, and follow-up status and rehabilitation decisions were analyzed.
Results
Of 102 children and adolescents (9.5±5.1 years, 64 male), 52.9% followed a check-up schedule, and 31 (30.4%) obtained a hearing aid. Hearing threshold and speech discrimination scores were predictive parameters of hearing aid uptake. Among those who used a hearing aid, 17 (56.7%) subjects used it successfully based on significant predictive parameters of channel number.
Conclusion
Hearing aid retention in pediatric patients seems less predictable than in adults with UHL. No good predictable parameter for hearing aid retention was identified except channel number for pediatric UHL cases. Regular monitoring of hearing and selection of a multi-channel hearing aid are crucial to minimize the potential negative effects of UHL.
https://ift.tt/2ENzBmQ
Pigmentation du palais dur sous imatinib
Publication date: Available online 27 October 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): N. Kluger, P. Cassier, N. Ruffion
https://ift.tt/2Pu4dh6
Uncommon presentation of desmoplastic fibroblastoma on the tongue of a female patient
Desmoplastic fibroblastoma (DF) is a rare benign soft tissue with spindle-to-stellate-shaped fibroblasts and myofibroblasts embedded in a prominent collagenous background. DF, mainly affecting subcutaneous and muscle tissue, very rarely occurs in the oral cavity. Hitherto, only one case of DF on the tongue has been reported. Here, we report another case. A 66-year-old woman was referred to our hospital with a mass formation in the tongue. On examination, a well-circumscribed, elastic, soft tumour with normal surface mucosa, measuring 13x12 mm, was observed on the left dorsal surface of her tongue. MRI and ultrasonography confirmed the mass, and a benign tongue tumour was suspected. The tumour was surgically resected under general anaesthesia 1 month later, leading to the histopathological diagnosis of DF. She experienced an uneventful clinical recovery after surgery, with no recurrence noted for more than 1 year postoperatively.
https://ift.tt/2Pt1XXu
Aggressive treatment in paediatric or young patients with drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with future development of type III polyglandular autoimmune syndrome
We experienced a 6-year-old case of drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) with subsequent development autoimmune thyroiditis (Hashimoto's thyroiditis), type 1 diabetes with antithyroglobulin, thyroid peroxidase, insulinoma-associated antigen and anti-insulin antibodies at 4 months, alopecia at 7 months, vitiligo, uveitis due to Vogt-Koyanagi-Harada disease at 8 months after clinical resolution of the DiHS/DRESS. He was diagnosed as type III polyglandular autoimmune syndrome (PASIII) after DiHS/DRESS. Prompted by this case, we sought to determine which triggering factors were responsible for later development of PASIII in previously published cases with autoimmune sequelae. In the literature review, five patients with DIHS/DRESS were found to develop autoimmune sequelae consistent with PASIII. All cases with PASIII were much younger than those without them. Four out of the five patients were treated with intravenous immunoglobulin or pulsed prednisolone in the acute stage, although effective in short-term outcomes.
https://ift.tt/2JjGz1m
Lemierres syndrome: a life-threatening sore throat
Description
A 25-year-old previously healthy Japanese man presented to our emergency department with a 1-day history of dyspnoea, following a sore throat in the previous week. Physical examination revealed acute exudative tonsillitis and right-sided diminished breath sounds. The laboratory analysis revealed a significantly elevated C reactive protein level of 30.67 mg/dL. A CT scan with contrast revealed a thrombophlebitis of the left internal jugular vein, a right-sided empyema and bilateral septic pulmonary emboli (figure 1).
Figure 1
Axial CT scan with contrast of the neck (left) and the chest (right). A thrombus in the left internal jugular vein (arrow, left), empyema (asterisks) and septic pulmonary emboli (arrow, right) are depicted.
In addition to thoracocentesis, curettage and irrigation of the right-sided thoracic cavity were performed with video-assisted thoracoscopic surgery. Gram staining of the purulent pleural fluid showed Gram-negative rods with abundant polymorphonuclear leukocytes....
https://ift.tt/2PskdQW
When things are not quite what they seem!
Description
A 61-year-old man presented with recurrent presyncope, 12-lead ECG and echocardiographic features of a right ventricular (RV) cardiomyopathy, and non-sustained ventricular tachycardia on Holter monitoring. During defibrillator implant for presumed arrhythmogenic RV cardiomyopathy, ventricular pacing parameters were satisfactory and the following images were obtained (figure 1). The implantable cardioverter defibrillator lead appeared well sited in the RV apex on posterior-anterior fluoroscopy (figure 1A). However, screening in the left anterior oblique (LAO) projection raised doubts about the true lead position (figure 1B). On-table echocardiography and 12-lead ECG confirmed lead placement within the left ventricle (LV). Pullback of the lead, while screening, suggested passage to the systemic circulation via an atrial septal defect (ASD; figure 2A–D and video 1). Attempts to reposition the lead by advancing it from the superior vena cava (SVC) revealed an anomalous connection to a right pulmonary...
https://ift.tt/2JjGxXi
Concurrent testicular torsion and acute incarcerated inguinal hernia in an adolescent boy
Testicular torsion and acute incarcerated inguinal hernia are both common surgical emergencies in the paediatric population. We present the unusual case of a 16-year-old adolescent boy who presented with both of these conditions concurrently. He had a history of a right inguinal hernia, but ultrasound confirmed a testicular torsion and we employed manual detorsion in the emergency department prior to taking him to the operating room. We successfully salvaged the testicle in addition to performing inguinal hernia reduction and repair. The goal of this report is to emphasise the importance of maintaining a broad differential and early utilisation of ultrasound in the patient with acute groin pain.
https://ift.tt/2Pl20Vt
Pleural tuberculosis: a key differential diagnosis for pleural thickening, even without obvious risk factors for tuberculosis in a low incidence setting
We report the case of a 64-year-old woman, presenting with pleuritic chest pain and weight loss. She had a previous history of breast malignancy and no clear risk factors for tuberculosis (TB). Initial investigations showed a right-sided pleural effusion and pleural thickening suggestive of malignancy, which would have been in keeping with the clinical presentation. Initial pleural biopsy showed features suggestive of possible TB infection, though no growth on cultures. A repeat biopsy was negative on initial microscopy, but was culture positive for Mycobacterium tuberculosis, also identifying isoniazid resistance. This case highlights that TB remains an important differential even in the absence of classical risk factors, and illustrates the diagnostic challenges it poses. It also highlights the value of culture positivity in identification of drug resistance and facilitation of appropriate treatment.
https://ift.tt/2JjH5wk
Interaction between angiotensin II and glucose sensing at the subfornical organ
Journal of Neuroendocrinology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OSuXIM
Two cases of primary cutaneous nocardiosis caused by intralesional injection
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2CIAeeE
GEOGRAPHIC TONGUE THAT RESPONDS TO THE TREATMENT OF PREGABALIN: CAN IT BE A NEW TREATMENT CHOICE?
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2qbwUkN
Two cases of primary cutaneous nocardiosis caused by intralesional injection
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2CIAeeE
GEOGRAPHIC TONGUE THAT RESPONDS TO THE TREATMENT OF PREGABALIN: CAN IT BE A NEW TREATMENT CHOICE?
Dermatologic Therapy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2qbwUkN
Fixed airflow obstruction relates to eosinophil activation in asthmatics
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2ORkIUZ
Photodynamic therapy for actinic keratosis of the forehead and scalp: a randomized, controlled, phase II clinical study evaluating the non‐inferiority of a new protocol involving irradiation with a light‐emitting, fabric‐based device (the Flexitheralight protocol) compared with the conventional protocol involving irradiation with the Aktilite CL 128 lamp
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2So3ooX
Differential expression of secreted factors SOSTDC1 and ADAMTS8 cause pro‐fibrotic changes in linear morphoea fibroblasts
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2zawaAG
Diverse assays from a single skin punch biopsy to assess topical drug intervention
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2So3lth
Effect of secukinumab on clinical activity and disease burden of nail psoriasis: 32‐week results from the randomized placebo‐controlled TRANSFIGURE trial
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2z6TZsR
Pyoderma gangrenosum and its impact on quality of life: a multicentre, prospective study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2SiCEGa
Patient reported outcome measures for facial skin cancer: A systematic review and evaluation of the quality of their measurement properties
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2z5OCdE
Photodynamic therapy for actinic keratosis of the forehead and scalp: a randomized, controlled, phase II clinical study evaluating the non‐inferiority of a new protocol involving irradiation with a light‐emitting, fabric‐based device (the Flexitheralight protocol) compared with the conventional protocol involving irradiation with the Aktilite CL 128 lamp
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2So3ooX
Differential expression of secreted factors SOSTDC1 and ADAMTS8 cause pro‐fibrotic changes in linear morphoea fibroblasts
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2zawaAG
Diverse assays from a single skin punch biopsy to assess topical drug intervention
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2So3lth
Effect of secukinumab on clinical activity and disease burden of nail psoriasis: 32‐week results from the randomized placebo‐controlled TRANSFIGURE trial
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2z6TZsR
Pyoderma gangrenosum and its impact on quality of life: a multicentre, prospective study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2SiCEGa
Patient reported outcome measures for facial skin cancer: A systematic review and evaluation of the quality of their measurement properties
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2z5OCdE
Letter to the Editor in reference to: Expression of 15‐lipoxygenase‐1 in Merkel cell carcinoma is linked to advanced disease
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2RipS9h
Reducing observation time in children post‐adenoidectomy
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2OSmYLO
Osteopontin protects against pneumococcal infection in a murine model of allergic airway inflammation
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PU1Dhj
The hippo pathway effector YAP promotes epithelial proliferation and remodeling in chronic rhinosinusitis with nasal polyps
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2AuHhGk
Clustering analysis in outpatients with allergic rhinitis in clinical practice
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PVuAcV
Recurrent biliary dissemination of colon cancer liver metastasis: a case report
Most colorectal cancer liver metastases form nodules within the hepatic parenchyma, and hepatectomy is the only radical treatment for synchronous metastases. There is concern about intrabiliary tumor growth wh...
https://ift.tt/2CM3l0u
Εγγραφή σε:
Αναρτήσεις (Atom)