Background Ex situ normothermic machine perfusion (NMP) can be used to assess viability of suboptimal donor livers prior to implantation. Our aim was to assess the diagnostic accuracy of bile biochemistry for the assessment of bile duct injury (BDI). Methods In a preclinical study, 23 human donor livers underwent 6 hours of end-ischemic NMP to determine biomarkers of BDI. Livers were divided into groups with low or high BDI, based on a clinically relevant histological grading system. During NMP, bile was analyzed biochemically and potential biomarkers were correlated with the degree of BDI. Receiver operating characteristics curves were generated to determine optimal cut-off values. For clinical validation, identified biomarkers were subsequently included as viability criteria in a clinical trial (n=6) to identify transplantable liver grafts with low BDI. Results Biliary bicarbonate and pH were significantly higher and biliary glucose was significantly lower in livers with low BDI, compared to high BDI. The following cut-off values were associated with low BDI: biliary bicarbonate >18 mmol/L (P=0.002), biliary pH >7.48 (P=0.019), biliary glucose
https://ift.tt/2Pa4BCp
Παρασκευή 2 Νοεμβρίου 2018
Proliferating Trichilemmal Tumor of the Auricula: A Very Rare Locus
Abstract
Proliferating trichilemmal tumor (PTT) is a rare but morphologically characteristic tumor, derived from the external root sheath. They are commonly localized as a solitary lesion on the scalp. They rarely occur in other regions. PTTs generally behave in a benign fashion, up to 20% of the lesions may undergo malignant transformation into squamous carcinoma. We present an elderly woman with a cystic swelling on the crus of auricular helix diagnosed as PTT. To our knowledge, this is the first case in the English literature, of PTT of the auricula.
https://ift.tt/2JzjF6p
Proliferating Trichilemmal Tumor of the Auricula: A Very Rare Locus
Abstract
Proliferating trichilemmal tumor (PTT) is a rare but morphologically characteristic tumor, derived from the external root sheath. They are commonly localized as a solitary lesion on the scalp. They rarely occur in other regions. PTTs generally behave in a benign fashion, up to 20% of the lesions may undergo malignant transformation into squamous carcinoma. We present an elderly woman with a cystic swelling on the crus of auricular helix diagnosed as PTT. To our knowledge, this is the first case in the English literature, of PTT of the auricula.
https://ift.tt/2JzjF6p
Takotsubo Cardiomyopathy During Anti‐HER2 Therapy for Metastatic Breast Cancer
AbstractHuman epidermal growth factor receptor 2 (HER2)‐targeted antibodies, including pertuzumab and trastuzumab, improve overall survival and progression‐free survival among women with HER2‐positive metastatic breast cancer, but grade ≥3 cardiotoxicity occurs in approximately 8% of cases. Here we report a case of Takotsubo cardiomyopathy associated with the use of dual anti‐HER2 therapy in a 63‐year‐old woman who presented to the emergency department with an 8‐ to 10‐hour history of progressive dyspnea after completing her third cycle of pertuzumab plus trastuzumab in addition to nab‐paclitaxel chemotherapy. To our knowledge, this patient represents the first reported case of Takotsubo cardiomyopathy associated with pertuzumab plus trastuzumab combination therapy in the literature.
https://ift.tt/2JEaEsU
Donor limb assessment after vascularized groin lymph node transfer for the treatment of breast cancer-related lymphedema: Clinical and lymphoscintigraphy findings
Vascularized lymph node transfer is an established treatment for secondary lymphedema. Different donor sites of lymph node flap have been described. In our institute, vascularized groin lymph node (VGLN) flap is the workhorse flap for treating breast cancer-related lymphedema (BCRL). Potential complications of VGLN flap harvesting include seroma formation, thigh dysaesthesia and iatrogenic lymphedema.
https://ift.tt/2Dkg4sE
Lower eyelid excursion: A functional and cosmetically relevant parameter in the treatment of lower eyelid retraction
The purpose of this study was to assess and quantify lower lid excursion following repair of lower lid retraction.In this retrospective cohort study, a case review of patients who had undergone ear-cartilage grafting for lower lid retraction was undertaken. Surgical correction involved the placement of autologous cartilage between the tarsal plate and lower lid retractors. Measurements taken pre- and post-operatively were the marginal reflex 2 (MRD2) and the lower scleral show (LSS). The lower lid excursion on downgaze (LLE) was measured only post-operatively with a comparison made between operated eyes and control eyes.
https://ift.tt/2JE6SzG
The long and the short of it: insights into the cellular source of autoantibodies as revealed by B cell depletion therapy
Malika Hale | David J Rawlings | Shaun W Jackson
https://ift.tt/2FcMfft
Familial congenital choanal atresia with GATA3 associated hypoparathyroidism-deafness-renal dysplasia syndrome unidentified on auditory brainstem response
Hypoparathyroidism-deafness-renal dysplasia (HDR) syndrome is a rare autosomal dominant disorder primarily caused by GATA3 haploinsufficiency and is challenging to diagnose in early childhood. We report a Japanese family with HDR syndrome and congenital choanal atresia. The 6-year-old female proband was diagnosed with epilepsy at the age of three. Under carbamazepine monotherapy, the patient presented hypoparathyroidism accompanied by severe hypocalcemia. Subsequently, renal ultrasound analysis revealed bilateral multicystic dysplastic kidneys.
https://ift.tt/2F9WD7k
A nomogram to identify high-risk melanoma patients with a negative sentinel node biopsy
Melanoma may recur even after a negative sentinel node biopsy, A nomogram identifies patients without nodal disease who are at a higher risk of recurrent melanoma, who deserve more strict surveillance and adjuvant treatments.
https://ift.tt/2zt46s6
Insect Repellents: An Updated Review for the Clinician
Malaria, Zika virus, West Nile virus, Dengue fever, and Lyme disease are common causes of morbidity and mortality around the world. While arthropod bites may cause local inflammation and discomfort, a greater concern is the potential to develop deadly systemic infection. The use of insect repellents (IR) to prevent systemic infections constitutes a fundamental public health effort. Cost-effectiveness, availability, and high-efficacy against arthropod vectors are key characteristics of an ideal IR.
https://ift.tt/2zpZwuL
Rhytidectomy in Patients with Cochlear Implants
Facial plast Surg
DOI: 10.1055/s-0038-1666872
As the incidence of rhytidectomy and cochlear implantation increases, so does the likelihood that an individual patient will undergo both procedures over their lifetime. This is particularly relevant as the US population not only ages but ages well. The purpose of this paper is to describe cochlear implants and to characterize pre-, intra-, and postoperative considerations of rhytidectomy in patients with cochlear implants. A thorough understanding of the relevant anatomy and physiology is crucial to the avoidance of potentially serious complications in patients with cochlear implants.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2RxPTBQ
A New Technique for Augmentation Rhinoplasty Using Hybrid Autologous Grafts with Septal Extension Grafts in Asian Patients
Facial plast Surg
DOI: 10.1055/s-0038-1666992
Augmentation rhinoplasty is commonly performed to raise the nasal dorsum in Asian individuals. However, materials used for dorsal augmentation are associated with various surgical challenges and complications. In this article, the authors present a novel dorsal augmentation technique combining hybrid autologous costal grafts with septal extension grafts. The records of 28 patients (19 women and 9 men; mean age: 27 years; range: 18–43 years) who underwent augmentation rhinoplasty (primary or revision) with our novel technique from December 2007 to December 2016 were retrospectively reviewed. Our technique included septal extension grafts for nasal tip projection and hybrid costal cartilage grafts, with a solid boat-shaped portion for bony dorsum augmentation and a fascia-wrapped diced cartilage graft for cartilaginous dorsum augmentation. Objective and subjective outcomes and complications were evaluated. Anthropometric parameters were measured on facial photographs to evaluate surgical outcomes in the 15 primary cases. Objective anthropometric measurements revealed successful augmentation of all nasal parameters. The nasal tip was mobile and comfortable in all patients. Among the 28 patients, 12 (42.9%) were very satisfied, 10 (35.7%) were satisfied, and 6 (21.4%) were unsatisfied with surgical results and required revision surgery. No immediate postoperative complications occurred. Ten (35.7%) patients experienced graft-related complications, including visibility or warping of the solid graft, supratip depression, and caudal deviation of the septal extension graft. None of these complications was serious. Augmentation rhinoplasty using hybrid autologous costal grafts with septal extension grafts allows dorsal augmentation with suitable graft material for each recipient site and can achieve successful outcomes in Asian patients.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2PB0qP3
Bioelectrical Impedance Analysis of Water Reduction in Lower-Limb Lymphedema by Lymphaticovenular Anastomosis
J reconstr Microsurg
DOI: 10.1055/s-0038-1675368
Background Although lymphedema is fundamentally abnormal accumulation of excess water in the extracellular space, previous studies have evaluated the efficacy of physiological bypass surgery (lymphaticovenular anastomosis [LVA]) for lymphedema without measuring water volume. This study clarified the water reductive effect of LVA using bioelectrical impedance analysis (BIA). Methods The efficacy of LVA for unilateral lower-limb lymphedema was evaluated using BIA in a retrospective cohort. The water volume of affected and unaffected legs was measured using multifrequency BIA before and after LVA. Preoperative measurements were undertaken after compression therapy for at least 3 months. The follow-up period after LVA was a minimum of 6 months. Results Thirty consecutive patients with unilateral lower-limb lymphedema were enrolled. The mean water volume reduction of the affected leg by LVA (ΔLBW) was 0.86 L (standard deviation [SD]: 0.86, median: 0.65) with a mean number of 3.3 anastomoses (SD: 1.7). The mean reduction rate of edema was 45.1% (SD: 36.3). Multiple linear regression analysis revealed water volume difference between the affected and unaffected legs before LVA (excess LBW) as the strongest predictor of ΔLBW (R 2 = 0.759, p < 0.01; β = 0.500, p < 0.01). Conclusion The LVA reduces the volume of accumulated body water in lower-limb lymphedema. As excess LBW most strongly predicted the amount of water volume reduction by LVA, body water volume measurement by BIA before LVA might identify patients with low excess LBW not expected to benefit from LVA, regardless of apparent differences in limb circumference.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2AJGZvl
Nasal challenges in allergen immunotherapy trials
Purpose of review The nasal allergen challenge (NAC) model can be a valuable diagnostic tool for allergic rhinitis. Alongside its clinical use, NACs can be used as primary and secondary endpoints in studies evaluating allergen immunotherapy (AIT) products for allergic rhinitis treatment. This review will discuss the technical aspects of the NAC model and provide a summary of recent studies using NACs to assess existing and new AIT treatments. Recent findings Over the last 2 years, both titrated and single-dose nasal challenge protocols have been used to evaluate immunotherapies targeting grass, birch, house dust mite, and cat allergens. Early efficacy and dose-finding trials showed improvements in allergic symptoms and nasal tolerance to allergens after AIT treatment with standardized extracts or modified forms of whole allergen. NACs were also used in two proof-of-concept studies to illustrate the efficacy of intralymphatic immunotherapy with two concomitant allergens and subcutaneous immunotherapy with Fel d 1-specific IgG-blocking antibodies. Summary Along with existing therapies, nasal challenges are useful in evaluating AIT treatments in the very early stages of clinical development. However, because of the variety in challenge techniques and symptom assessments available, special attention must be placed in the protocol design in order to compare the study results with existing NAC publications.https://ift.tt/2qroBBi
What is new in HIES? Recent insights from the interface of primary immune deficiency and atopy
Purpose of review Understanding the pathophysiology of monogenic primary immunodeficiency (PID) with atopic presentation has pivotal implications for intervention strategies and potentially wider polygenic atopic-related traits. This review will discuss advances in gene discovery arising from monogenic defects at the interface between PID and atopy, notably the hyper-IgE syndromes. Recent findings Key molecular pathways underlying development of primary atopic diseases have recently been proposed. We test this classification through reviewing novel genes reported in the last 2 years and compare insights from pathway-analysis of genome-wide association studies (GWAS) of atopic-related traits. Growing access to next-generation sequencing (NGS) has resulted in a surge in gene discovery, highlighting the utility and some pitfalls of this approach in clinical practice. The variability of presenting phenotypes reveals important gene-dosage effects. This has important implications for therapeutic strategies such as protein stabilization and modulators of JAK-STAT or TH2-cytokine signalling. We also consider the therapeutic implications raised by CARD11 deficiency, and wider applications of NGS including polygenic risk score in atopy. Summary Disorders presenting at the interface between PID and allergy are often difficult to diagnose, with serious consequences if missed. Application of NGS has already provided critical insights to pathways enabling targeted therapeutic interventions, and potential wider translation to polygenic disorders.https://ift.tt/2qoaa0S
Allergen immunotherapy as add-on to biologic agents
Purpose of review In this review, we sought to outline many of the recent evidences about the available clinical trials in which biologic agents [i.e. omalizumab (OMA)] were associated as add-on to allergen-specific immunotherapy (AIT). Recent findings The available literature shows that OMA may be a valuable option as add-on to AIT for respiratory allergy, or food desensitization, especially in the escalation or build-up phases, in which adverse events are more commonly expected. The encouraging data for hymenoptera venom allergy remain limited to case reports, and no structured clinical trial is available. Summary Over the past decade, studies of OMA used with AIT have shown promising results. Today, big randomized, double-blind, placebo-controlled trials are needed to better select those patients who would benefit from the addition of OMA (or other biologic agents) to AIT, as well as optimal dosing schedules, optimal duration of treatments and, finally, adequate evaluation about pharmacoeconomic aspects.https://ift.tt/2QfY0CN
Advances in site-specific gene editing for primary immune deficiencies
Purpose of review Conventional gene therapy has been a successful, curative treatment modality for many primary immune deficiencies with significant improvements in the last decade. However, the risk of leukemic transformation with viral-mediated gene addition still remains, and unregulated gene addition is not an option for certain diseases in which the target gene is closely controlled. The recent bloom in genome modification platforms has created the opportunity to site-specifically correct mutated DNA base pairs or insert a corrective cDNA minigene while maintaining gene expression under control of endogenous regulatory elements. Recent findings There is an abundance of ongoing research utilizing programmable nucleases to facilitate site-specific gene correction of many primary immune deficiencies including X-linked severe combined immune deficiency, X-linked chronic granulomatous disease, Wiskott–Aldrich syndrome, X-linked hyper-IgM syndrome, X-linked agammaglobulinemia, and immune dysregulation, polyendocrinopathy, enteropathy, X-linked. In all, these studies have demonstrated the ability to integrate corrective DNA sequences at a precise location in the genome at rates likely to either cure or ameliorate disease. Summary Gene editing for primary immune deficiency (PID) has advanced to the point to that translation to clinical trials is likely to occur in the next several years. At the current pace of research in DNA repair mechanisms, stem cell biology, and genome-editing technology, targeted genome modification represents the next chapter of gene therapy for PID.https://ift.tt/2qoa75c
Secondary antibody deficiency in neurology
Purpose of review Induction of lymphocyte depletion is increasingly used as a therapeutic strategy for central and peripheral neuroinflammatory disease. However, there is also a growing recognition of the treatment-related complication of secondary antibody deficiency (SAD). Although the occurrence of hypogammaglobulinaemia is a recognized phenomenon during immunomodulation, robust data on the coexistence of impaired responses to immunization, and significant and/or atypical infections is scarce. Here we review the literature on SAD in anti-CD20 therapy. Recent findings Several factors that may increase the incidence of SAD have now been identified, including low levels of immunoglobulins prior to the commencement of B-cell ablation therapy, duration of maintenance therapy, and concurrent or prior use of other immunosuppressing agents such as cyclophosphamide and steroids. Measurement of disease-specific antibodies and vaccine response are likely to be helpful adjuncts to measurement of serum immunoglobulin levels during B-cell depleting therapy. Supportive treatment may include amending the treatment schedule to limit cumulative dose. Summary B-cell depleting agents offer considerable therapeutic benefit in neurology. We propose modifications in current practice that include risk stratification and early identification of SAD, with the aim of minimising morbidity and mortality related to this underappreciated condition.https://ift.tt/2QgmtIb
Very early-onset inflammatory bowel disease: an integrated approach
Purpose of review Immune dysregulation disorders are among the most rapidly growing set of inborn errors of immunity. One particular subset is the category where early-onset inflammatory bowel disease (IBD) is the most common manifestation. These disorders are being increasingly appreciated although there has been minimal effort to articulate a unified approach to their diagnosis and management. This review will cover current thinking and strategies related to diagnosis and management of very early-onset IBD. Recent findings There is an expanding set of monogenic causes of early-onset IBD. In many cases, the precise genetic cause dictates management. Lessons learned from the management of these monogenic conditions can sometimes be extrapolated to other refractory cases of IBD. Summary An integrated approach to diagnosis, risk analysis, and management can include diagnostic approaches not often utilized for traditional IBD such as whole exome sequencing. Management can also include nontraditional approaches such as targeted biologics or hematopoietic cell transplantation.https://ift.tt/2qroIgc
Role of allergen-specific T-follicular helper cells in immunotherapy
Purpose of review The discovery of novel T-cell subsets including follicular helper T (Tfh) cells has broadened our knowledge on the complex immune networks in allergic diseases. This review summarizes the evidence for Tfh cells in controlling immune responses to allergens with a particular focus on immunoglobulin E (IgE) production and discusses the implication of such regulation in allergen-specific immunotherapy. Recent findings Tfh cells support the production of IgE in animal models for allergic diseases. Among Tfh cells, the type 2 subset (Tfh2) is considered as the major player that secretes IL-4 and promotes the isotype switching to IgE. In human inflammatory airway diseases, including allergic rhinitis, asthma, and nasal polyps, the increased frequencies of circulating or tissue Tfh2 cells have been reported. Notably, the frequencies of Dermatophagoides pteronyssinus group 1 (Der p 1)-specific IL-4+ Tfh cells in blood positively correlated with serum Der p-specific IgE levels in allergic rhinitis patients. After allergen immunotherapy (AIT), Der p 1-specific IL-4+ Tfh cells declined in allergic rhinitis patients, which associated with the remission of clinical symptoms. Summary Allergen-specific IL-4+ Tfh cells contribute to the production of allergen-specific IgE and correlate with clinical efficacy of AIT in allergic rhinitis patients, which suggest allergen-specific Tfh cells as a promising therapeutic target and biomarker for AIT in allergic rhinitis.https://ift.tt/2Qebj6x
Very early onset IBD: novel genetic aetiologies
Purpose of review To summarize the current understanding and recent advances on the genetic aetiology in the pathogenesis of very early onset inflammatory bowel disease (VEO-IBD). Recent findings IBD is a chronic disorder of the gastrointestinal tract whose manifestation is a result of complex interactions between genetics, environment, immune system and microbial flora. Over 230 IBD risk loci have been reported in genome wide association studies but the genetic contribution of the majority of these loci in the manifestation of IBD is very low. Patients with VEO-IBD present with a more severe disease than older patients, characterized by poor prognosis and failure of conventional therapy. Recent studies have reported several monogenic diseases with high penetrance that present with IBD and IBD-like intestinal manifestations and overlap with primary immunodeficiencies. Increasing body of evidence supports a prominent role of genetics in the onset of VEO-IBD. New genetic variants and diagnoses in VEO-IBD are reviewed and current challenges in therapy with potential strategy to manage the disease are discussed. Summary Functional analysis of the genes implicated in monogenic IBD has increased the understanding of the underlying pathobiological mechanism of the disease. This knowledge can be used to personalize medicine for specific patients, improving the standard of care and quality of life.https://ift.tt/2qro0zy
Biological treatments for severe asthma: where do we stand?
Purpose of review For patients with severe asthma, disease control is not achieved resulting in persistent morbidity and risks for exacerbations. The advent of biologics is providing a new form of treatment for many with severe asthma. Recent findings Four mAb biologics are approved for clinical use: omalizumab (anti-IgE) and three antieosinophilic interventions (mepolizumab, reslizumab, and benralizumab). These four biologics target components of the type 2-inflammatory pathway which is reflected by biomarkers: peripheral blood eosinophils and exhaled nitric oxide. In severe asthma, biologics have reduced asthma exacerbations. The antieosinophilic biologics have also improved lung function. The safety profile of these biologics has been good. Summary For patients with severe asthma and biomarkers indicating a type 2 inflammatory pathway, the addition of biologics has proven to be an effective approach to achieve disease control and is an appropriate next step treatment.https://ift.tt/2QhmETl
Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin
Suleiman Furmli<br />Oct 9, 2018; 2018:bcr-2017-221854-bcr-2017-221854<br />Myth exploded
https://ift.tt/2yNLDXJ
Alpha 1 antitrypsin distribution in an allergic asthmatic population sensitized to house dust mites
Severe alpha1 antitrypsin deficiency has been clearly associated with pulmonary emphysema, but its relationship with bronchial asthma remains controversial. Some deficient alpha 1 antitrypsin (AAT) genotypes s...
https://ift.tt/2QeJ7Ax
Chemoradiotherapy with and without deep regional hyperthermia for squamous cell carcinoma of the anus
Abstract
Purpose
To compare results after chemoradiotherapy with and without deep regional hyperthermia in patients with anal cancer.
Methods
Between 2000 and 2015, a total of 112 consecutive patients with UICC stage I–IV anal cancer received chemoradiotherapy with 5‑fluororuracil and mitomycin C (CRT). In case of insufficient tumor response 4–6 weeks after chemoradiotherapy, patients received an interstitial pulsed-dose-rate brachytherapy boost. Additionally, 50/112 patients received hyperthermia treatments (HCRT).
Results
Median follow-up was 41 (2–165) months. After 5 years follow-up, overall (95.8 vs. 74.5%, P = 0.045), disease-free (89.1 vs. 70.4%, P = 0.027), local recurrence-free (97.7 vs. 78.7%, P = 0.006), and colostomy-free survival rates (87.7 vs. 69.0%, P = 0.016) were better for the HCRT group. Disease-specific, regional failure-free, and distant metastasis-free survival rates showed no significant differences. The adjusted hazard ratios for death were 0.25 (95% CI, 0.07 to 0.92; P = 0.036) and for local recurrence 0.14 (95% CI, 0.02 to 1.09; P = 0.06), respectively. Grades 3–4 early toxicities were comparable with the exception of hematotoxicity, which was higher in the HCRT group (66 vs. 43%, P = 0.032). Incidences of late side effects were similar with the exception of a higher telangiectasia rate in the HCRT group (38.0 vs. 16.1%, P = 0.009).
Conclusion
Additional regional hyperthermia improved overall survival, local control, and colostomy rates. Its potential beneficial role has to be confirmed in a prospective randomized setting. Therefore, the HyCAN trial has already been established by our group and is currently recruiting patients (Clinicaltrials.gov identifier: NCT02369939).
https://ift.tt/2qr8Cn0
Toxicity and risk factors after combined high-dose-rate brachytherapy and external beam radiation therapy in men ≥75 years with localized prostate cancer
Abstract
Purpose
Combined high-dose-rate brachytherapy (HDR-BT) and external beam radiation therapy (EBRT) is a favorable treatment option in non-metastatic prostate cancer. However, reports on toxicity and outcome have mainly focused on younger patients. We aimed to determine toxicity and biochemical control rates after combined HDR-BT and EBRT in men ≥75 years.
Methods
From 1999 to 2015, 134 patients aged ≥75 years (median 76 years; 75–82 years) were identified. Patients received 18 Gy of HDR-BT (9 Gy/fraction on days 1 and 8) with an iridium-192 source. After 1 week, supplemental EBRT with a target dose of 50.4 Gy was started (delivered in 1.8 Gy fractions).
Results
Median follow-up time was 25 months (0–127 months). No severe (grade 4) gastrointestinal (GIT) or genitourinary (GUT) toxicities were observed. In 76 patients (56.7%), 3D conformal radiation therapy (CRT) and in 34.3% intensity-modulated radiotherapy (IMRT) was applied. CRT-treated patients were at a 2.17-times higher risk (hazard ratio [HR]: 2.17, 95% confidence interval [CI]: 1.31–3.57, p = 0.002) of experiencing GUT. GIT risks could be reduced by 78% using IMRT (HR: 0.22, 95% CI: 0.07–0.75, p = 0.015). Patients with a higher T stage (T2c–3a/b) were less likely to experience GIT or GUT (HR: 0.49, 95% CI: 0.29–0.85, p = 0.011 and HR: 0.5, 95% CI: 0.3–0.81, p = 0.005, respectively).
Conclusion
HDR-BT/EBRT is a well-tolerated treatment option for elderly men ≥75 years with a limited number of comorbidities and localized intermediate- or high-risk prostate cancer. IMRT should be favored since side effects were significantly reduced in IMRT-treated patients.
https://ift.tt/2QeuMnO
The Medical and Psychosocial Associations of Alopecia: Recognizing Hair Loss as More Than a Cosmetic Concern
Abstract
Alopecia encompasses a broad range of hair loss disorders, generally categorized into scarring and non-scarring forms. Depending on the specific pathogenesis of hair loss and geographic location, a number of psychiatric and medical comorbidities, including but not limited to thyroid disease, lupus erythematosus, diabetes mellitus, atopic dermatitis, sinusitis, coronary artery disease, anxiety, depression, and suicidality, have been identified in association with alopecia. In addition to the numerous associated comorbid conditions, patients with alopecia report decreased quality-of-life measures across symptomatic, functional, and global domains. While alopecia can affect patients of all ages, genders, and ethnicities, hair loss may more significantly impact women as hair represents an essential element of femininity, fertility, and female attractiveness in society. Individuals of lower socioeconomic status may also face health disparities in the context of alopecia as a majority of hair loss treatments are considered cosmetic in nature and accordingly are not covered by third-party insurance providers. Although traditionally thought of as a merely aesthetic concern, alopecia encompasses a significant burden of disease with well-defined comorbid associations and genuine psychosocial implications, and thus should be assessed and managed within a proper medical paradigm.
https://ift.tt/2QfcRgH
Expression of PTEN, Androgen Receptor, HER2/ neu , Cytokeratin 5/6, Estrogen Receptor-Beta, HMGA2, and PLAG1 in Salivary Duct Carcinoma
Abstract
Salivary duct carcinoma (SDC) is an aggressive neoplasm that resembles high-grade invasive ductal carcinoma of the breast. It can develop de novo or from the malignant transformation of pleomorphic adenoma (PA). We performed immunohistochemical stains for phosphatase and tensin homologue [PTEN androgen receptor (AR)], HER2/neu, cytokeratin 5/6, estrogen receptor-beta, high-mobility group AT-hook 2 (HMGA2), and pleomorphic adenoma gene 1 (PLAG1) on tissue microarray samples of 75 SDCs and 31 adenocarcinomas, not otherwise specified (NOS). Our data showed the following in SDC samples: loss of PTEN was found in 17 of 60 (28.3%); AR was expressed in 43 of 62 (69.4%); HER2/neu was overexpressed in 25 of 58 (43.1%); cytokeratin 5/6 was expressed in 14 of 54 (25.9%); estrogen receptor-beta was expressed in 37 of 56 (66.1%); HMGA2 was expressed in 29 of 63 (46.0%); and PLAG1 was expressed in 0 of 62 (0%). In addition, there was no statistically significant difference in the age at onset between patients with HMGA2-positive SDCs (range 32–85 years; mean: 64.3 years; median: 64.5 years) and those with HMGA2-negative SDCs (range 41–79 years; mean: 62.5 years; median: 64.5 years). There was also no statistically significant difference in overall survival between patients with HMGA2-positive and HMGA2-negative SDCs (follow-up period range 3–201 months; mean: 49.8 months; median: 30 months). Among 10 patients with a definite PA component (SDC ex-PA), 6 were positive and 4 were negative for HMGA2. Our data were consistent with previous findings that AR and estrogen receptor-beta are expressed in most SDCs, whereas HER2/neu overexpression and loss of PTEN are expressed in a subset of SDCs. In our cohort of patients, HMGA2 was expressed in approximately half of SDCs. HMGA2 and PTEN are promising therapeutic targets for salivary gland tumors.
https://ift.tt/2zqTU3h
Reticular Oral Lichen Planus
Abstract
Reticular oral lichen planus is a common clinical finding, often found incidentally on routine oral examination. Patients rarely complain of symptoms and the condition does not require treatment, as a result, biopsies and ancillary laboratory evaluation are seldom performed. We present a case of reticular oral lichen planus with a classic clinical presentation and characteristic histologic findings.
https://ift.tt/2SDK9I1
Expression of PTEN, Androgen Receptor, HER2/ neu , Cytokeratin 5/6, Estrogen Receptor-Beta, HMGA2, and PLAG1 in Salivary Duct Carcinoma
Abstract
Salivary duct carcinoma (SDC) is an aggressive neoplasm that resembles high-grade invasive ductal carcinoma of the breast. It can develop de novo or from the malignant transformation of pleomorphic adenoma (PA). We performed immunohistochemical stains for phosphatase and tensin homologue [PTEN androgen receptor (AR)], HER2/neu, cytokeratin 5/6, estrogen receptor-beta, high-mobility group AT-hook 2 (HMGA2), and pleomorphic adenoma gene 1 (PLAG1) on tissue microarray samples of 75 SDCs and 31 adenocarcinomas, not otherwise specified (NOS). Our data showed the following in SDC samples: loss of PTEN was found in 17 of 60 (28.3%); AR was expressed in 43 of 62 (69.4%); HER2/neu was overexpressed in 25 of 58 (43.1%); cytokeratin 5/6 was expressed in 14 of 54 (25.9%); estrogen receptor-beta was expressed in 37 of 56 (66.1%); HMGA2 was expressed in 29 of 63 (46.0%); and PLAG1 was expressed in 0 of 62 (0%). In addition, there was no statistically significant difference in the age at onset between patients with HMGA2-positive SDCs (range 32–85 years; mean: 64.3 years; median: 64.5 years) and those with HMGA2-negative SDCs (range 41–79 years; mean: 62.5 years; median: 64.5 years). There was also no statistically significant difference in overall survival between patients with HMGA2-positive and HMGA2-negative SDCs (follow-up period range 3–201 months; mean: 49.8 months; median: 30 months). Among 10 patients with a definite PA component (SDC ex-PA), 6 were positive and 4 were negative for HMGA2. Our data were consistent with previous findings that AR and estrogen receptor-beta are expressed in most SDCs, whereas HER2/neu overexpression and loss of PTEN are expressed in a subset of SDCs. In our cohort of patients, HMGA2 was expressed in approximately half of SDCs. HMGA2 and PTEN are promising therapeutic targets for salivary gland tumors.
https://ift.tt/2zqTU3h
Reticular Oral Lichen Planus
Abstract
Reticular oral lichen planus is a common clinical finding, often found incidentally on routine oral examination. Patients rarely complain of symptoms and the condition does not require treatment, as a result, biopsies and ancillary laboratory evaluation are seldom performed. We present a case of reticular oral lichen planus with a classic clinical presentation and characteristic histologic findings.
https://ift.tt/2SDK9I1
Expression of PTEN, Androgen Receptor, HER2/ neu , Cytokeratin 5/6, Estrogen Receptor-Beta, HMGA2, and PLAG1 in Salivary Duct Carcinoma
Abstract
Salivary duct carcinoma (SDC) is an aggressive neoplasm that resembles high-grade invasive ductal carcinoma of the breast. It can develop de novo or from the malignant transformation of pleomorphic adenoma (PA). We performed immunohistochemical stains for phosphatase and tensin homologue [PTEN androgen receptor (AR)], HER2/neu, cytokeratin 5/6, estrogen receptor-beta, high-mobility group AT-hook 2 (HMGA2), and pleomorphic adenoma gene 1 (PLAG1) on tissue microarray samples of 75 SDCs and 31 adenocarcinomas, not otherwise specified (NOS). Our data showed the following in SDC samples: loss of PTEN was found in 17 of 60 (28.3%); AR was expressed in 43 of 62 (69.4%); HER2/neu was overexpressed in 25 of 58 (43.1%); cytokeratin 5/6 was expressed in 14 of 54 (25.9%); estrogen receptor-beta was expressed in 37 of 56 (66.1%); HMGA2 was expressed in 29 of 63 (46.0%); and PLAG1 was expressed in 0 of 62 (0%). In addition, there was no statistically significant difference in the age at onset between patients with HMGA2-positive SDCs (range 32–85 years; mean: 64.3 years; median: 64.5 years) and those with HMGA2-negative SDCs (range 41–79 years; mean: 62.5 years; median: 64.5 years). There was also no statistically significant difference in overall survival between patients with HMGA2-positive and HMGA2-negative SDCs (follow-up period range 3–201 months; mean: 49.8 months; median: 30 months). Among 10 patients with a definite PA component (SDC ex-PA), 6 were positive and 4 were negative for HMGA2. Our data were consistent with previous findings that AR and estrogen receptor-beta are expressed in most SDCs, whereas HER2/neu overexpression and loss of PTEN are expressed in a subset of SDCs. In our cohort of patients, HMGA2 was expressed in approximately half of SDCs. HMGA2 and PTEN are promising therapeutic targets for salivary gland tumors.
https://ift.tt/2zqTU3h
Reticular Oral Lichen Planus
Abstract
Reticular oral lichen planus is a common clinical finding, often found incidentally on routine oral examination. Patients rarely complain of symptoms and the condition does not require treatment, as a result, biopsies and ancillary laboratory evaluation are seldom performed. We present a case of reticular oral lichen planus with a classic clinical presentation and characteristic histologic findings.
https://ift.tt/2SDK9I1
Cabozantinib in Advanced Salivary Gland Cancer Patients
Condition: Salivary Gland Cancer
Intervention: Drug: Cabozantinib
Sponsors: Radboud University; Ipsen
Recruiting
https://ift.tt/2JAhTC7
Intervention: Drug: Cabozantinib
Sponsors: Radboud University; Ipsen
Recruiting
https://ift.tt/2JAhTC7
TORS De-Intensification Protocol Version 2.0: Dose and Volume Reduction in the Neck
Conditions: Oropharyngeal Cancer; Squamous Cell Carcinoma; Human Papilloma Virus
Intervention: Radiation: Radiation Therapy (IMRT or IMPT)
Sponsor: Abramson Cancer Center of the University of Pennsylvania
Recruiting
https://ift.tt/2Dj45vu
Intervention: Radiation: Radiation Therapy (IMRT or IMPT)
Sponsor: Abramson Cancer Center of the University of Pennsylvania
Recruiting
https://ift.tt/2Dj45vu
Add-on Low Dose Dextromethorphan and Memantine in Patients With Amphetamine-type Stimulants Use Disorder
Condition: Stimulants Use Disorder
Interventions: Drug: dextromethorphan and memantine (DM+MM); Drug: Placebos
Sponsors: Tzu-Yun Wang; Ministry of Science and Technology, Taiwan
Recruiting
https://ift.tt/2JxdtM5
Interventions: Drug: dextromethorphan and memantine (DM+MM); Drug: Placebos
Sponsors: Tzu-Yun Wang; Ministry of Science and Technology, Taiwan
Recruiting
https://ift.tt/2JxdtM5
Cabozantinib in Advanced Salivary Gland Cancer Patients
Condition: Salivary Gland Cancer
Intervention: Drug: Cabozantinib
Sponsors: Radboud University; Ipsen
Recruiting
https://ift.tt/2JAhTC7
Intervention: Drug: Cabozantinib
Sponsors: Radboud University; Ipsen
Recruiting
https://ift.tt/2JAhTC7
TORS De-Intensification Protocol Version 2.0: Dose and Volume Reduction in the Neck
Conditions: Oropharyngeal Cancer; Squamous Cell Carcinoma; Human Papilloma Virus
Intervention: Radiation: Radiation Therapy (IMRT or IMPT)
Sponsor: Abramson Cancer Center of the University of Pennsylvania
Recruiting
https://ift.tt/2Dj45vu
Intervention: Radiation: Radiation Therapy (IMRT or IMPT)
Sponsor: Abramson Cancer Center of the University of Pennsylvania
Recruiting
https://ift.tt/2Dj45vu
Add-on Low Dose Dextromethorphan and Memantine in Patients With Amphetamine-type Stimulants Use Disorder
Condition: Stimulants Use Disorder
Interventions: Drug: dextromethorphan and memantine (DM+MM); Drug: Placebos
Sponsors: Tzu-Yun Wang; Ministry of Science and Technology, Taiwan
Recruiting
https://ift.tt/2JxdtM5
Interventions: Drug: dextromethorphan and memantine (DM+MM); Drug: Placebos
Sponsors: Tzu-Yun Wang; Ministry of Science and Technology, Taiwan
Recruiting
https://ift.tt/2JxdtM5
Limited short-term effects on human prostate cancer xenograft growth and epidermal growth factor receptor gene expression by the ghrelin receptor antagonist [D-Lys 3 ]-GHRP-6
Abstract
Purpose
The ghrelin axis regulates many physiological functions (including appetite, metabolism, and energy balance) and plays a role in disease processes. As ghrelin stimulates prostate cancer proliferation, the ghrelin receptor antagonist [D-Lys3]-GHRP-6 is a potential treatment for castrate-resistant prostate cancer and for preventing the metabolic consequences of androgen-targeted therapies. We therefore explored the effect of [D-Lys3]-GHRP-6 on PC3 prostate cancer xenograft growth.
Methods
NOD/SCID mice with PC3 prostate cancer xenografts were administered 20 nmoles/mouse [D-Lys3]-GHRP-6 daily by intraperitoneal injection for 14 days and tumour volume and weight were measured. RNA sequencing of tumours was conducted to investigate expression changes following [D-Lys3]-GHRP-6 treatment. A second experiment, extending treatment time to 18 days and including a higher dose of [D-Lys3]-GHRP-6 (200 nmoles/mouse/day), was undertaken to ensure repeatability.
Results
We demonstrate here that daily intraperitoneal injection of 20 nmoles/mouse [D-Lys3]-GHRP-6 reduces PC3 prostate cancer xenograft tumour volume and weight in NOD/SCID mice at two weeks post treatment initiation. RNA-sequencing revealed reduced expression of epidermal growth factor receptor (EGFR) in these tumours. Further experiments demonstrated that the effects of [D-Lys3]-GHRP-6 are transitory and lost after 18 days of treatment.
Conclusions
We show that [D-Lys3]-GHRP-6 has transitory effects on prostate xenograft tumours in mice, which rapidly develop an apparent resistance to the antagonist. Although further studies on [D-Lys3]-GHRP-6 are warranted, we suggest that daily treatment with the antagonist is not a suitable treatment for advanced prostate cancer.
https://ift.tt/2SKlZM6
Lymphomes cutanés : avancées et perspectives en 2018
Publication date: Available online 1 November 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): M. Beylot-Barry
https://ift.tt/2QeuHAx
Distortions of perceived volume and length of body parts
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Renata Sadibolova, Elisa R. Ferrè, Sally A. Linkenauger, Matthew R. Longo
Abstract
We experience our body as a 3D, volumetric object in the world. Measures of our conscious body image, in contrast, have investigated the perception of body size along one or two dimensions at a time. There is, thus, a discrepancy between existing methods for measuring body image and our subjective experience of having 3D body. Here we assessed in a sample of healthy adults the perception of body size in terms of its 1D length and 3D volume. Participants were randomly assigned to two groups using different measuring units (other body part and non-body object). They estimated how many units would fit in a perceived size of body segments and the whole body. The patterns of length and volume misperception across judged segments were determined as their perceived size proportional to their actual size. The pattern of volume misperception paints the representation of 3D body proportions resembling those of a somatosensory homunculus. The body parts with a smaller actual surface area relative to their volume were underestimated more. There was a tendency for body parts underestimated in volume to be overestimated in length. Perceived body proportions thus changed as a function of judgement type while showing a similarity in magnitude of the absolute estimation error, be it an underestimation of volume or overestimation of length. The main contribution of this study is assessing the body image as a 3D body representation, and thus extending beyond the conventional 'allocentric' focus to include the body on the inside. Our findings highlight the value of studying the perceptual distortions "at the baseline", i.e. in healthy population, so as to advance the understanding of the nature of perceptual distortions in clinical conditions.
Graphical abstract
https://ift.tt/2QjXe7W
Exploring prism exposure after hemispheric damage: reduced aftereffects following left-sided lesions
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Roberta Ronchi, Irene Rossi, Elena Calzolari, Nadia Bolognini, Giuseppe Vallar
Abstract
Prism adaptation is a well-known method used to investigate brain plasticity, and a promising technique for the rehabilitation of unilateral spatial neglect (USN). Only little evidence about the mechanisms of prism adaptation (PA) in patients with left-brain damage is on record, and about putative differences of PA, and the aftereffects (AEs), between patients with left and right brain damage. In the present study, PA and the AEs were assessed in 30 brain-damaged patients, 20 with right-sided lesions (10 with and 10 without USN), and 10 with left-sided lesions without USN, as well as in a control group of 24 age-matched participants. All patients underwent adaptation to lenses shifting the field of vision towards the side of the lesion, followed by two measures for detecting AEs: the proprioceptive (P) and the visuo-proprioceptive (VP) straight-ahead tasks. To investigate the temporal course of AEs in the different groups, the two measures were recorded immediately and 10 minutes after PA. Before PA, and at the end of the 10-minute delayed evaluation, two tasks to assess USN (target cancellation and drawing) were also administered. All patients adapted to prisms. However, left-brain-damaged (LBD) patients presented with reduced AEs, as compared with right-brain-damaged (RBD) patients with USN. Moreover, while both controls and LBD patients adapting to left-shifting prisms had reduced VP AEs in the delayed condition, AEs were not different from zero (i.e., no AEs) in LBD patients. Finally, in the delayed condition USN patients showed an improvement in the drawing, but not in the cancellation, tasks. These results suggest that adaptation to leftward shifting lenses is associated with larger decay of VP AEs, and a role of the left hemisphere in maintaining these AEs after PA. These findings can be of relevance for the clinical application of this technique in neurological populations.
https://ift.tt/2qlps6O
The time course of encoding and maintenance of task-relevant versus irrelevant object features in working memory
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Andrea Bocincova, Jeffrey S. Johnson
Abstract
Access to WM can be restricted on the basis of goal-relevant properties such as spatial location. However, the extent of voluntary control over which features of an attended multi-feature object are encoded and maintained in WM is debated. Some evidence suggests that attending to an object leads to obligatory storage of all of its features, whereas other evidence suggests that access to WM can be restricted to only goal-relevant features. Another possibility is that all features are initially encoded, but irrelevant features are removed from WM over time. To address these various possibilities, we used pattern classification of EEG signals to track the temporal evolution of representations reflecting the encoding and storage of task-relevant and irrelevant features in WM. In different blocks, participants remembered the orientation, color or both orientation and color of a colored, oriented grating. The color and orientation of the grating was randomly drawn from two distinct feature bins on each trial. To examine trial-specific activity reflecting storage of the object's features, a support vector machine (SVM) classifier was trained to classify what bin the stimulus features came from. Importantly, for orientation, the classifier produced reliably above-chance classification across the delay when orientation was task-relevant but not when it was task-irrelevant. Interestingly, orientation could be accurately classified on trials for which both orientation and color were remembered. Moreover, a separate measure corresponding to the probability of a feature belonging to the correct bin was significantly higher when orientation was task-relevant compared to task-irrelevant during encoding. Above-chance classification for color was only present during the initial 500 ms across all conditions. Our results suggest that although information about all of an object's features is present in the initial stimulus-evoked neural response, information about the task-irrelevant features is attenuated during stimulus encoding and is largely absent throughout the delay.
https://ift.tt/2QfbQ8z
The frontal aslant tract (FAT) and its role in speech, language and executive function
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Anthony Steven Dick, Dea Garic, Paulo Graziano, Pascale Tremblay
Abstract
In this review, we examine the structural connectivity of a recently-identified fiber pathway, the frontal aslant tract (FAT), and explore its function. We first review structural connectivity studies using tract-tracing methods in non-human primates, and diffusion-weighted imaging and electrostimulation in humans. These studies suggest a monosynaptic connection exists between the lateral inferior frontal gyrus and the pre-supplementary and supplementary motor areas of the medial superior frontal gyrus. This connection is termed the FAT. We then review research on the left FAT's putative role in supporting speech and language function, with particular focus on speech initiation, stuttering and verbal fluency. Next, we review research on the right FAT's putative role supporting executive function, namely inhibitory control and conflict monitoring for action. We summarize the extant body of empirical work by suggesting that the FAT plays a domain general role in the planning, timing, and coordination of sequential motor movements through the resolution of competition among potential motor plans. However, we also propose some domain specialization across the hemispheres. On the left hemisphere, the circuit is proposed to be specialized for speech actions. On the right hemisphere, the circuit is proposed to be specialized for general action control of the organism, especially in the visuo-spatial domain. We close the review with a discussion of the clinical significance of the FAT, and suggestions for further research on the pathway.
https://ift.tt/2qpTTsn
Robust neurocognitive individual differences in grammatical agreement processing: A latent variable approach
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Darren Tanner
Abstract
Many neurocognitive accounts of language processing presume that neural responses detected in grand mean analyses of cortical electrophysiological activity reflect the normative brain response in the population under investigation. However, emerging work now shows that individuals' brain responses can vary systematically in both the size and type of effect elicited. The present research therefore examined individual differences in neural activity elicited by grammatical agreement anomalies during language comprehension in a large cohort of highly literate, monolingual English speakers (N = 114), a population generally assumed to be relatively homogenous in terms of linguistic knowledge and processing. Results showed systematic variability in event-related brain potentials (ERPs) elicited by subject-verb agreement anomalies, with brain responses varying on a continuum between N400 and P600 dominant responses. Similar variation was found both when agreement was realized via inflectional morphology or via lexical alternations. Individuals' brain response type correlated strongly across these two conditions. Similar variation was also found for ERPs elicited during rapid serial visual presentation and when self-paced ERPs were recorded. Multilevel latent variable regression showed that variation in brain response amplitude and type was not related to individual differences in language experience or verbal working memory capacity, despite high statistical power. These findings indicate that descriptions of processing dynamics predicated solely on grand mean analyses of central tendency can fail to provide an accurate, generalizable account of how processing unfolds in many or most individual members of the population studied. Furthermore, these findings show that systematic individual variation in engagement of neural system supporting grammatical processing is found even in language users at the highest end of the proficiency spectrum and in grammatically simple sentences. This study therefore has implications for studies of language processing in atypical populations.
https://ift.tt/2QiL2UZ
Prisms for timing better: A review on application of prism adaptation on temporal domain
Publication date: Available online 1 November 2018
Source: Cortex
Author(s): Filomena Anelli, Francesca Frassinetti
Abstract
The possibility to induce a transient modulation of visuo-spatial attention boosted so far the implementation of the prism adaptation in a variety of domains. This sensorimotor technique has been adopted to investigate the neural plasticity in neurologically healthy individuals, as well as to ameliorate deficit of visuo-spatial attention (which characterizes neglect patients' performance). We review here evidence about a new promising application of prisms in exploring how the human brain represents the subjective time flow on a spatially oriented "mental time line". Converging observations in healthy individuals suggest that altering spatial attention processing via prism adaptation can influence the spatial representation of time. These modulatory effects are generalizable to different aspects of time, such as the abilities to estimate time duration and to mentally travel in time. Furthermore, data from brain damaged patients, with a special focus on right brain-damaged patients with neglect, indicate that prismatic procedure ameliorates temporal deficits, hence paving the way to novel clinical applications. We conclude by discussing the possible cognitive mechanisms and neural circuits of the prism adaptation effects on time.
https://ift.tt/2qlp7RA
Short-Term Swallowing Outcomes Following Type 1 Laryngeal Cleft Injection
Publication date: Available online 1 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Ashley. L. Miller, Cheryl. J. Hersh, Kaalan. E. Johnson, Christopher. J. Hartnick
Abstract
Introduction
Interarytenoid injection augmentation at the time of initial diagnostic endoscopy for aspiration and dysphagia may result in near-immediate improvement in swallowing function, potentially obviating the need for future formal endoscopic repair of type 1 laryngeal cleft. Interarytenoid injection augmentation may also address physiologic aspiration. Early treatment of type 1 laryngeal cleft may allow for expedited liberalization of feedings. The objective of this study was to evaluate the effect of interarytenoid injection augmentation (IIA) for type 1 laryngeal clefts (LC-1) on short-term swallowing function assessed by videofluoroscopic swallowing study (VFSS).
Methods
This was a retrospective cohort study of patients age ≤24 months with dysphagia on preoperative VFSS who underwent IIA with calcium hydroxyapatite for LC-1 during direct laryngoscopy and bronchoscopy from June to October 2017 at a tertiary care academic subspecialty hospital. Exclusion criteria included prior endoscopic or open LC repair (n=1), gastrostomy tube dependence (n=1), additional procedures at the time of IIA (supraglottoplasty, frenulectomy, n=1). Children without postoperative VFSS within 30 days of injection were excluded (n=2). Fifteen children met inclusion criteria for analysis. The primary endpoint was improvement in safely swallowed consistency as defined by recommendation to liberalize diet by at least a half-consistency (e.g. half-honey to nectar thick liquid). Secondary endpoints included clinical assessment of dysphagia and postoperative respiratory events.
Results
Median [range] age at injection was 15.2 [7.7-24.3] months and 67% of patients were female (n=10). The majority (13/15) of patients were full-term and 80% of patients (n=12) had documented gastroesophageal reflux disease (GERD). Median time from injection to VFSS was 16 [9-29] days. Improvement in safely swallowed consistency was noted in 60% (n=9) of patients. Aspiration completely resolved in two patients. Swallow function was unchanged in 40% of patients (n=6); no patients experienced worsening dysphagia. No respiratory complications were documented during inpatient observation.
Conclusion
IIA is a safe procedure that may result in immediate improvement in dysphagia in select patients with LC-1. IIA does not address neurologic, developmental, or other anatomic etiologies of dysphagia. Additional studies are required to determine long-term efficacy of IIA on dysphagia and pulmonary complications, as well as the patient- and caregiver-related outcome measures.
https://ift.tt/2CSXMh7
Genotyping and audiological characteristics of infants with a single-allele SLC26A4 mutation
Publication date: Available online 1 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Xuelei Zhao, Lihui Huang, Xueyao Wang, Xianlei Wang, Liping Zhao, Xiaohua Cheng, Yu Ruan
Abstract
Objectives
To identify second-allele variant in infants with a known single-allele mutation of the SLC26A4 gene and to determine the frequency of their occurrence; and to investigate the clinical audiological characteristics of infants with bi-allelic mutations in SLC26A4.
Methods
The study subjects were 371 patients with a single-allele SLC26A4 mutation detected by neonatal deafness gene screening (4 genes and 9 pathogenic variants) who were treated at the otology outpatient department of Beijing Tongren Hospital. The exonic and flanking splice site regions of the SLC26A4 gene were sequenced for all patients. All patients with bi-allelic SLC26A4 mutations underwent audiological evaluation, and some also underwent temporal bone computed tomography and/or inner ear magnetic resonance imaging.
Results
Of the 371 patients, 314 (84.64%) had an c.919-2A>G heterozygous mutation and 57 (15.36%) had a c.2168A>G (p.H723R) heterozygous mutation. 13 patients (3.50%) had a second-allele variant, including 11 (2.96%) with pathogenic mutations and 1 (0.27%) with a likely benign variant. Of the 13 patients with bi-allelic mutations, 11 had hearing loss and 2 had normal hearing, the latter of whom had c.919-2A>G/c.1766A>G and c.919-2A>G/c.757A>G compound heterozygous mutations, respectively. Four of the 13 patients with bi-allelic mutations had passed the universal newborn hearing screening, including 2 cases (15.38%) with hearing loss. The most prevalent degree of hearing loss was profound (40.91%), followed by severe (36.36%). The most prevalent audiometric configuration was sloping hearing loss (50.00%), followed by flat-type hearing loss (40.91%).
Conclusions
This is the first report in China of the frequency of occurrence of second-allele variant in infants with a known single-allele mutation of the SLC26A4 gene; the frequency was 3.50% for any type of variant and 2.96% for pathogenic mutations. A novel variant, c.1766A>G (p.Q589R), which is likely benign, was identified. The pathogenicity of c.757A>G (p.I253V) mutation deserves more in-depth research. For infants with bi-allelic SLC26A4 mutations, the degree of hearing loss was mainly severe-to-profound and the audiometric configuration was mainly sloping.
https://ift.tt/2P3CrbX
Limited short-term effects on human prostate cancer xenograft growth and epidermal growth factor receptor gene expression by the ghrelin receptor antagonist [D-Lys 3 ]-GHRP-6
Abstract
Purpose
The ghrelin axis regulates many physiological functions (including appetite, metabolism, and energy balance) and plays a role in disease processes. As ghrelin stimulates prostate cancer proliferation, the ghrelin receptor antagonist [D-Lys3]-GHRP-6 is a potential treatment for castrate-resistant prostate cancer and for preventing the metabolic consequences of androgen-targeted therapies. We therefore explored the effect of [D-Lys3]-GHRP-6 on PC3 prostate cancer xenograft growth.
Methods
NOD/SCID mice with PC3 prostate cancer xenografts were administered 20 nmoles/mouse [D-Lys3]-GHRP-6 daily by intraperitoneal injection for 14 days and tumour volume and weight were measured. RNA sequencing of tumours was conducted to investigate expression changes following [D-Lys3]-GHRP-6 treatment. A second experiment, extending treatment time to 18 days and including a higher dose of [D-Lys3]-GHRP-6 (200 nmoles/mouse/day), was undertaken to ensure repeatability.
Results
We demonstrate here that daily intraperitoneal injection of 20 nmoles/mouse [D-Lys3]-GHRP-6 reduces PC3 prostate cancer xenograft tumour volume and weight in NOD/SCID mice at two weeks post treatment initiation. RNA-sequencing revealed reduced expression of epidermal growth factor receptor (EGFR) in these tumours. Further experiments demonstrated that the effects of [D-Lys3]-GHRP-6 are transitory and lost after 18 days of treatment.
Conclusions
We show that [D-Lys3]-GHRP-6 has transitory effects on prostate xenograft tumours in mice, which rapidly develop an apparent resistance to the antagonist. Although further studies on [D-Lys3]-GHRP-6 are warranted, we suggest that daily treatment with the antagonist is not a suitable treatment for advanced prostate cancer.
https://ift.tt/2SKlZM6
Optimal extent of lateral neck dissection for well-differentiated thyroid carcinoma with metastatic lateral neck lymph nodes: A systematic review and meta-analysis
Publication date: December 2018
Source: Oral Oncology, Volume 87
Author(s): Ho-Ryun Won, Jae Won Chang, Yea Eun Kang, Jae Yoon Kang, Bon Seok Koo
Abstract
The purpose of this systematic review and meta-analysis was to determine the optimal extent of lateral neck dissection in patients with well-differentiated thyroid carcinoma with clinically confirmed lateral neck lymph node metastases. All studies reporting the distribution of metastatic lymph nodes in level IIb or level V, complication rate, recurrence rate, or clinical outcomes according to the extent of lateral neck dissection were collected from MEDLINE and Embase databases. Two reviewers independently retrieved articles, extracted data, and assessed the quality of the studies. A total of 40 criteria-meeting studies were included in the systematic review and meta-analysis, representing a total of 6 027 patients. The distribution of metastatic lymph nodes was 13.7% (95% confidence interval [CI]: 8.2–21.9%) in level IIb and 22.1% (95% CI: 18.6–26.1%) in level V. Shoulder syndrome complication showed a tendency to increase when comprehensive neck dissection was performed. The recurrence rate was 11.2% (95% CI: 8.4–14.9%) in the comprehensive neck dissection group and 11.0% (95% CI: 4.2–26.1%) in the selective neck dissection group. Clinical outcomes showed no difference between groups. In conclusion, selective neck dissection may be considered in patients with well-differentiated thyroid carcinoma with lateral neck lymph node metastases without any other risk factors.
https://ift.tt/2SCXctb
High Molecular Weight Hyaluronic Acid Regulates P. gingivalis–induced Inflammation and Migration in Human Gingival Fibroblasts via MAPK and NF-κB Signaling Pathway
Publication date: Available online 1 November 2018
Source: Archives of Oral Biology
Author(s): Minshan Chen, Lin Li, Zhenshi Wang, Ping Li, Feng Feng, Xi Zheng
Abstract
Chronic periodontitis is associated with Porphyromonas gingivalis (P. gingivalis) infection. Hyaluronic Acid (HA), a critical component of the extracellular matrix, exhibits anti-inflammatory and wound-healing properties. This study aimed to investigate the effect of various molecular weights of HA (30, 300 and 1300 kDa) on P. gingivalis-induced inflammatory and wound-healing responses in human gingival fibroblasts (HGFs). Cell cytotoxicity and proliferation were assessed by Lactate dehydrogenase and MTT assays, respectively. An enzyme linked immunosorbent assay was used to detect the levels of interleukin (IL) -1β, IL-6, IL-8, IL-4 and IL-10. Cell migration was evaluated with a scratch wound healing assay. The expression of nuclear factor kappa B (NF-кB), IкBα, p38 and extracellular signal-regulated kinase (ERK) were analyzed with Western blotting. The results showed that P. gingivalis (1.6 × 106 CFU/mL) and HA (1, 2, 5 and 10 mg/mL) exhibited no toxicity to the HGFs. The 1300 kDa HA inhibited P. gingivalis-induced IL-1β, IL-6, IL-8, IL-4 and IL-10 production in a dose-dependent manner, while the 30 and 300 kDa HA did not have an effect. Meanwhile, cell migration was significantly promoted by the 30 and 1300 kDa HA. Furthermore, the 1300 kDa HA inhibited NF-κB expression, IκBα degradation and P. gingivalis-induced ERK and P38 activation. Therefore, our study suggests that high molecular weight HA may have beneficial effects on periodontal inflammation and oral wounds.
https://ift.tt/2P2bJ3s
MMP-3 and MMP-8 in Rat Mandibular Condylar Cartilage Associated with Dietary Loading, Estrogen Level, and Aging
Publication date: Available online 1 November 2018
Source: Archives of Oral Biology
Author(s): Jia Yu, Eerika Mursu, Matleena Typpo, Sakari Laaksonen, Hanna-Marja Voipio, Paula Pesonen, Aune Raustia, Pertti Pirttiniemi
Abstract
Objectives
The structure of the mandibular condylar cartilage (MCC) is regulated by dynamic and multifactorial processes. The aim of this study was to examine the effects of altered dietary loading, estrogen level, and aging on the structure of the condylar cartilage and the expressions of matrix metalloproteinase (MMP) -3 and MMP-8 of rat MCC.
Methods
In this study, Crl:CD (SD) female rats were randomly divided into 3 groups according to dietary hardness: hard diet (diet board), normal diet (pellet), and soft diet (powder). In each group, the rats were further divided into 2 subgroups by ovariectomy at the age of 7 weeks. The rats were sacrificed at 5- and 14-month-old. Histomorphometric analysis of the MCC thickness was performed after toluidine blue staining. Immunochemical staining was done for MMP-3 and MMP-8. A linear mixed model was used to assess the effects of dietary loading, estrogen level, and aging. Results: Increased dietary loading was the main factor to increase the MMP-3 expression and the anterior and central thickness of the MCC. Lack of estrogen was the main factor associated with decreased MMP-8. Aging was associated with the thickness changes of the whole condylar cartilage and the reduced expression of MMP-8.
Conclusion
The condylar cartilage structure and metabolism of the female rats are sensitive to dietary loading changes, estrogen level as well as aging. The proper balance of these factors seems to be essential for the maintenance of the condylar cartilage.
https://ift.tt/2CXyxu3
Preoperative Evaluation of the Pediatric Patient
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Allison Basel, Dusica Bajic
https://ift.tt/2PvZxrl
Preoperative Management of Medications
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Zdravka Zafirova, Karina G. Vázquez-Narváez, Delia Borunda
https://ift.tt/2RuuNEf
Creating a Pathway for Multidisciplinary Shared Decision-Making to Improve Communication During Preoperative Assessment
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Timothy D. Quinn, Piotr Wolczynski, Raymond Sroka, Richard D. Urman
https://ift.tt/2PGhtj6
Diabetes Mellitus: Preoperative Concerns and Evaluation
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Roshni Sreedharan, Basem Abdelmalak
https://ift.tt/2RxVMyZ
Surgical Prehabilitation: Nutrition and Exercise
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): John Whittle, Paul E. Wischmeyer, Michael P.W. Grocott, Timothy E. Miller
https://ift.tt/2PEaqHq
Preoperative Cardiac Evaluation for Noncardiac Surgery
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Vahé S. Tateosian, Deborah C. Richman
https://ift.tt/2Rx5wJQ
Designing and Running a Preoperative Clinic
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Jeanna D. Blitz, Christian Mabry
https://ift.tt/2Pwq6N1
Forthcoming Issues
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s):
https://ift.tt/2Rvxqpf
Contents
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s):
https://ift.tt/2PCdPXl
Contributors
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s):
https://ift.tt/2RvUZhF
Copyright
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s):
https://ift.tt/2PyHEYO
Preoperative Patient Evaluation
Publication date: December 2018
Source: Anesthesiology Clinics, Volume 36, Issue 4
Author(s): Zdravka Zafirova, Richard D. Urman
https://ift.tt/2RuQfZJ
Determination of IgE and IgG reactivity to more than 170 allergen molecules in paper-dried blood spots
Publication date: Available online 1 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Victoria Garib, Eva Rigler, Felix Gastager, Raffaela Campana, Yulia Dorofeeva, Pia Gattinger, Yury Zhernov, Musa Khaitov, Rudolf Valenta
https://ift.tt/2RBishR
Reply
Publication date: Available online 1 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Ana Olivera, Dean D. Metcalfe
https://ift.tt/2PxmxpT
Effect of IL-33 on de novo synthesized mediators from human mast cells
Publication date: Available online 1 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Theoharis C. Theoharides, Susan E. Leeman
https://ift.tt/2RvVwAm
Guidelines of care for the management of primary cutaneous melanoma
Publication date: Available online 1 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Work Group, Susan M. Swetter, Hensin Tsao, Christopher K. Bichakjian, Clara Curiel-Lewandrowski, David E. Elder, Jeffrey E. Gershenwald, Valerie Guild, Jane M. Grant-Kels, Allan C. Halpern, Timothy M. Johnson, Arthur J. Sober, John A. Thompson, Oliver J. Wisco, Samantha Wyatt, Shasa Hu, Toyin Lamina
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer–related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
https://ift.tt/2znU6R6
Histochemical study of the distribution of epidermal melanoblasts and melanocytes in Asian human skin
Skin Research and Technology, EarlyView.
https://ift.tt/2RuOXOn
Identification of novel susceptibility genes associated with seven autoimmune disorders using whole genome molecular interaction networks
Publication date: Available online 1 November 2018
Source: Journal of Autoimmunity
Author(s): Sam Kara, Gerardo A. Pirela-Morillo, Conrad T. Gilliam, George D. Wilson
Abstract
Convergent evidence from multiple and independent genetics studies implicate a small number of genes that predispose individuals to multiple autoimmune disorders (AuD). These intersecting loci reinforced the hypothesis that disorders with overlapping etiology group into a cluster of closely related genes within a whole genome molecular interaction network. We tested the hypothesis that "biological network proximity" within a whole genome molecular interaction network can be used to inform the search for multigene inheritance. Using a set of nine previously published genome wide association studies (GWAS) of AuD genes, we generated AuD-specific molecular interaction networks to identify networks of associated genes. We show that all nine "seed genes" can be connected within a 35-member network via interactions with 26 connecting genes. We show that this network is more connected than expected by chance, and 13 of the connecting genes showed association with multiple AuD upon GWAS reanalysis. Furthermore, we report association of SNPs in five new genes (IL10RA, DGKA, GRB2, STAT5A, and NFATC2) which were not previously considered as AuD candidates, and show significant association in novel disease samples of Crohn's disease and systemic lupus erythematosus. Furthermore, we show that the connecting genes show no association in four non-AuD GWAS. Finally, we test the connecting genes in psoriasis GWAS, and show association to previously identified loci and report new loci. These findings support the hypothesis that molecular interaction networks can be used to inform the search for multigene disease etiology, especially for disorders with overlapping etiology.
https://ift.tt/2CUrXnU
Targeting CTCFL/BORIS for the immunotherapy of cancer
Abstract
Cancer vaccines have great potential in the fight against metastatic malignancies. Current anti-tumor immunotherapy is hindered by existing tolerance to tumor-associated antigens (TAA) and tumor escape using various mechanisms, highlighting the need for improved targets for immunotherapy. The cancer–testis antigen CTCFL/BORIS was discovered 16 years ago and possesses all features necessary for an ideal TAA. Recently CTCFL/BORIS has received additional attention as a target expressed in cancer stem cells (CSC). These cells drive tumor growth recurrence, metastasis, and treatment resistance. CTCFL/BORIS silencing leads to senescence and death of CSC. Therefore, an immunotherapeutic strategy that targets CTCFL/BORIS may lead to the selective destruction of CSC and potential eradication of metastatic disease. The high immunotherapeutic potential of CTCFL/BORIS antigen was shown in a stringent 4T1 mouse model of breast cancer. Using these highly metastatic, poorly immunogenic carcinoma cells inoculated into T-helper2 prone mice, we showed that DC fed with recombinant CTCFL/BORIS as an immunogen inhibited tumor growth and reduced the number of metastases in distant organs. About 20% of CTCFL/BORIS immunized animals were tumor free. 50% of animals remained metastasis free. Those having metastasis showed at least tenfold fewer metastases compared to controls. In a rat model of breast cancer, we showed that alphavirus-based CTCFL/BORIS immunotherapy was capable of cancer elimination as we were able to cure 50% of animals. Based on the above data, we believe that translation of CTCFL/BORIS-targeting immunotherapeutic strategies to the clinic will provide new avenues for improving survival of breast cancer patients with advanced metastatic disease.
https://ift.tt/2Qf8OkC
Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis.
Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Carpenter DJ, Ferrante S, Bakos SR, Clary MS, Gelbard AH, Daniero JJ
Abstract
Importance: Because of the recurrent nature of idiopathic subglottic stenosis, routine follow-up is necessary for monitoring progression of stenosis. However, no easily accessible, standardized objective measure exists to monitor disease progression.
Objective: To determine whether peak expiratory flow (PEF) can be used as a reliable and easily accessible biometric indicator of disease progression relative to other validated spirometry measures in patients with idiopathic subglottic stenosis.
Design, Setting, and Participants: Prospectively collected data on PEF, expiratory disproportion index (EDI), and total peak flow (TPF) from 42 women with idiopathic subglottic stenosis without comorbid lower airway or parenchymal lung disease who were treated at a single tertiary referral center between 2014 and 2018 were analyzed. The mean follow-up period was 18.2 months (range, 2-40 months). Ten patients initially screened were not included in the analysis owing to comorbid glottic or supraglottic stenosis or nonidiopathic etiology.
Main Outcomes and Measures: Measurements of PEF, EDI, and TPF were taken at preoperative visits and at all other visits.
Results: Forty-two women (mean age, 51.5 years; 98% white [n = 41]) met the inclusion criteria. The area under the curve for PEF was 0.855 (95% CI, 0.784-0.926). The optimal cutoff value was 4.4 liters per second (264 L/min), with a sensitivity and specificity of 84.4% and 82.0%, respectively. The area under the curve for EDI was 0.853 (95% CI, 0.782-0.925). For TPF, this was 0.836 (95% CI, 0.757-0.916).
Conclusions and Relevance: This study provides evidence supporting the use of PEF as a simple, efficient, and accessible way of monitoring progression of idiopathic subglottic stenosis and predicting receipt of surgical intervention. Sensitivity and specificity of PEF were comparable to those of the more complex measures of TPF and EDI.
PMID: 30383170 [PubMed - as supplied by publisher]
https://ift.tt/2On7URg
A Destructive Sinonasal Process Leading to Sudden Blindness.
A Destructive Sinonasal Process Leading to Sudden Blindness.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Weber MH, Stein AP, D'Anza BD
PMID: 30383156 [PubMed - as supplied by publisher]
https://ift.tt/2SCKISl
Iodine Deficiency and Hearing Impairment-Reply.
Iodine Deficiency and Hearing Impairment-Reply.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Scinicariello F, Buser MC
PMID: 30383151 [PubMed - as supplied by publisher]
https://ift.tt/2zmRi6N
Iodine Deficiency and Hearing Impairment.
Iodine Deficiency and Hearing Impairment.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Millon-Ramirez C, García-Fuentes E, Soriguer F
PMID: 30383149 [PubMed - as supplied by publisher]
https://ift.tt/2CX6vPa
Defining Optimal Treatment Times in Head and Neck Cancer Care: What Are We Waiting For?
Defining Optimal Treatment Times in Head and Neck Cancer Care: What Are We Waiting For?
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Houlton JJ
PMID: 30383147 [PubMed - as supplied by publisher]
https://ift.tt/2P21AE1
Association of Treatment Delays With Survival for Patients With Head and Neck Cancer: A Systematic Review.
Association of Treatment Delays With Survival for Patients With Head and Neck Cancer: A Systematic Review.
JAMA Otolaryngol Head Neck Surg. 2018 Nov 01;:
Authors: Graboyes EM, Kompelli AR, Neskey DM, Brennan E, Nguyen S, Sterba KR, Warren GW, Hughes-Halbert C, Nussenbaum B, Day TA
Abstract
Importance: Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target.
Objective: To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes.
Evidence Review: A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies.
Findings: A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days.
Conclusions and Relevance: Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.
PMID: 30383146 [PubMed - as supplied by publisher]
https://ift.tt/2CXnIYT
Editorial: The Fourteenth International Bologna Conference on Magnetic Resonance in Porous Media (MRPM14)
Publication date: Available online 1 November 2018
Source: Magnetic Resonance Imaging
Author(s): Clifford R. Bowers, Sergey Vasenkov
https://ift.tt/2znKyFK
Maternal Perception of Self-Efficacy and Involvement in Young Children with Prelingual Hearing Loss
Abstract
Appropriate intervention needs to support families and consider them as a part of rehabilitation program. Parents who have high self-efficacy are more likely to put their knowledge and skills into action and have positive interactions with their children. In addition, there has been a positive relation between parental involvement and child educational success. The aim of present study was evaluating maternal perception of both self-efficacy and involvement between mothers of children with hearing aid and cochlear implant via Scale of Parental Involvement and Self Efficacy (SPISE) and exploring relationship between maternal self-efficacy and parental involvement and child factors. 100 mothers of children with hearing loss were available. 49 mothers participated in study, filled SPISE, and return it on time. SPISE consisted of three sections (1) demographic information, (2) maternal self-efficacy, (3) parental involvement. All cases had received at least 6 months auditory training and speech therapy. Participants included 30 (61.2%) mothers of children with hearing aid, 19 (38.8%) mothers of children with cochlear implant. ANOVA analysis showed that there is no significant difference between hearing aid (HA) and cochlear implant (CI) groups in term of self-efficacy and parent-involvement except for question 21 (comfortable in participating in individualized program) that score in HA group was significantly higher than CI group. Results of present study has practical implications for early interventionists working with families. Every early intervention program should consider families to reach maximum outcome. Early interventionists can use SPISE to evaluate parental selfefficacy and involvement and work on parents with low score to achieve the best results.
https://ift.tt/2qqnwtI
Correlation of Eustachian Tube Dysfunction with Results of Tympanoplasty in Mucosal Type of Chronic Suppurative Otitis Media
Abstract
To Assess the relation between eustachian tube function and outcome of tympanoplasty in mucosal type of chronic suppurative otitis media, a prospective study was carried out over a period of one and half years (January 2016–July 2017) at a tertiary referral centre (Gujarat Cancer Society Medical College and Research Institute, Ahmedabad). Total 90 Patients of any age and sex and with Mucosal type of chronic suppurative otitis media and Patients with follow up of 12 months were selected. The Eustachian Tube function was assessed preoperatively by pressure swallow equalization test and impedance audiometry. All patients were categorized based on function of eustachian tube. All patients were operated by type 1 tympanoplasty with or without mastoidectomy. We measure the Graft uptake rate after type 1 tympanoplasty (with or without mastoidectomy) in patients with or without eustachian tube dysfunction. Graft uptake rate is higher in patients with normal or mild eustachian dysfunction compared to severe eustachian tube dysfunction. In our study we found 87% success rate in patients with normal Eustachian tube function, 80% in partially impaired Eustachian tube function, and 70% in totally impaired Eustachian tube. So, pre-operative planning in tympanoplasty surgery eustachian tube function assessment is must to increase graft uptake rate by preoperative utilization of decongestant. It is also important to comment outcome of surgery.
https://ift.tt/2Qe0kKB
Adenoid Cystic Carcinoma of the Nasopharynx: A Case Series
Abstract
Adenoid cystic carcinomas are tumors that are more commonly seen in the salivary glands than in the nasopharynx. Nasopharyngeal adenoid cystic carcinomas are rare and cases that are reported in the literatures are few. Treatment is mainly by surgical resection. Here, we report 2 cases of nasopharyngeal adenoid cystic carcinoma.
https://ift.tt/2CV2ESW
Maternal Perception of Self-Efficacy and Involvement in Young Children with Prelingual Hearing Loss
Abstract
Appropriate intervention needs to support families and consider them as a part of rehabilitation program. Parents who have high self-efficacy are more likely to put their knowledge and skills into action and have positive interactions with their children. In addition, there has been a positive relation between parental involvement and child educational success. The aim of present study was evaluating maternal perception of both self-efficacy and involvement between mothers of children with hearing aid and cochlear implant via Scale of Parental Involvement and Self Efficacy (SPISE) and exploring relationship between maternal self-efficacy and parental involvement and child factors. 100 mothers of children with hearing loss were available. 49 mothers participated in study, filled SPISE, and return it on time. SPISE consisted of three sections (1) demographic information, (2) maternal self-efficacy, (3) parental involvement. All cases had received at least 6 months auditory training and speech therapy. Participants included 30 (61.2%) mothers of children with hearing aid, 19 (38.8%) mothers of children with cochlear implant. ANOVA analysis showed that there is no significant difference between hearing aid (HA) and cochlear implant (CI) groups in term of self-efficacy and parent-involvement except for question 21 (comfortable in participating in individualized program) that score in HA group was significantly higher than CI group. Results of present study has practical implications for early interventionists working with families. Every early intervention program should consider families to reach maximum outcome. Early interventionists can use SPISE to evaluate parental selfefficacy and involvement and work on parents with low score to achieve the best results.
https://ift.tt/2qqnwtI
Correlation of Eustachian Tube Dysfunction with Results of Tympanoplasty in Mucosal Type of Chronic Suppurative Otitis Media
Abstract
To Assess the relation between eustachian tube function and outcome of tympanoplasty in mucosal type of chronic suppurative otitis media, a prospective study was carried out over a period of one and half years (January 2016–July 2017) at a tertiary referral centre (Gujarat Cancer Society Medical College and Research Institute, Ahmedabad). Total 90 Patients of any age and sex and with Mucosal type of chronic suppurative otitis media and Patients with follow up of 12 months were selected. The Eustachian Tube function was assessed preoperatively by pressure swallow equalization test and impedance audiometry. All patients were categorized based on function of eustachian tube. All patients were operated by type 1 tympanoplasty with or without mastoidectomy. We measure the Graft uptake rate after type 1 tympanoplasty (with or without mastoidectomy) in patients with or without eustachian tube dysfunction. Graft uptake rate is higher in patients with normal or mild eustachian dysfunction compared to severe eustachian tube dysfunction. In our study we found 87% success rate in patients with normal Eustachian tube function, 80% in partially impaired Eustachian tube function, and 70% in totally impaired Eustachian tube. So, pre-operative planning in tympanoplasty surgery eustachian tube function assessment is must to increase graft uptake rate by preoperative utilization of decongestant. It is also important to comment outcome of surgery.
https://ift.tt/2Qe0kKB
Bilateral Pneumothorax Post Emergency Airway Intervention
Abstract
A patient with diffuse axonal injury, with compound type 2 fracture of left tibia and fat embolism, post road traffic accident, was taken up for tracheostomy. He was diagnosed to have developed bilateral pneumothorax following the procedure, which according to literature has been of rare incidence. The causes of the pneumothorax following the procedure could be attributed to a tear or trauma in the posterior tracheal wall while inserting the tube or due to the rupture of alveolar bullae or bleb.
https://ift.tt/2P4PGcr
Pulmonary cryptococcosis coexisting with adenocarcinoma: a case report and review of the literature
Pulmonary cryptococcosis is a common fungal infection frequently seen in immunocompromised patients. Owing to its nonspecific clinical and radiographic features, the differential diagnosis with secondary tuber...
https://ift.tt/2Qe1llA
High‐dose preoperative cholecalciferol to prevent post‐thyroidectomy hypocalcaemia: a randomized, double‐blind placebo‐controlled trial
Clinical Endocrinology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2P5xkrF
Blocking antibodies induced by peanut oral and sublingual immunotherapy suppress basophil activation and are associated with sustained unresponsiveness
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2P5O2r8
Low expression of pRB predicts disease relapse in early glottic cancer treated with transoral laser microsurgery
The Laryngoscope, EarlyView.
https://ift.tt/2CYexYk
Exploring the association between parental psychiatric disease and childhood atopic dermatitis: a matched case‐control study
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2qrq1Mp
Confocal microscopy features of patch‐stage mycosis fungoides and its correlation with horizontal histopathologic sections. A case series
Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2JwY0vF
Dermoscopy of patch test reactions. Study of applicability in differential diagnosis between allergic and irritant reactions
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PD5wdC
Loss of function desmoplakin I and II mutations underlie dominant arrhythmogenic cardiomyopathy with a hair and skin phenotype
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Rt82kg
Dermoscopy of patch test reactions. Study of applicability in differential diagnosis between allergic and irritant reactions
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2PD5wdC
Loss of function desmoplakin I and II mutations underlie dominant arrhythmogenic cardiomyopathy with a hair and skin phenotype
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Rt82kg
Adenoid Cystic Carcinoma of the Nasopharynx: A Case Series
Abstract
Adenoid cystic carcinomas are tumors that are more commonly seen in the salivary glands than in the nasopharynx. Nasopharyngeal adenoid cystic carcinomas are rare and cases that are reported in the literatures are few. Treatment is mainly by surgical resection. Here, we report 2 cases of nasopharyngeal adenoid cystic carcinoma.
https://ift.tt/2CV2ESW
Bilateral Pneumothorax Post Emergency Airway Intervention
Abstract
A patient with diffuse axonal injury, with compound type 2 fracture of left tibia and fat embolism, post road traffic accident, was taken up for tracheostomy. He was diagnosed to have developed bilateral pneumothorax following the procedure, which according to literature has been of rare incidence. The causes of the pneumothorax following the procedure could be attributed to a tear or trauma in the posterior tracheal wall while inserting the tube or due to the rupture of alveolar bullae or bleb.
https://ift.tt/2P4PGcr
Hyper IgE recurrent infection syndrome in South Asia: is there a different outcome?
Hyper IgE recurrent infection syndrome (HIES) is a rare immune deficiency, characterized by recurrent staphylococcal skin and lung abscesses, pneumonia and increased IgE levels. The majority of autosomal domin...
https://ift.tt/2CVGz6y
Chronic cutaneous miliary tuberculosis – a forgotten entity
International Journal of Dermatology, EarlyView.
https://ift.tt/2qpcR2h
An unusual deep fungal infection with Nigrospora sphaerica in HIV positive patient
International Journal of Dermatology, EarlyView.
https://ift.tt/2Q8RPAi
Issue Information
The Journal of Dermatology, Volume 45, Issue 11, Page i, 1233-1234, November 2018.
https://ift.tt/2PDmvwG
Issue Information
The Journal of Dermatology, Volume 45, Issue 11, Page 1367-1367, November 2018.
https://ift.tt/2Rvsp02
Improvement of patient-reported outcomes in severe allergic asthma by omalizumab treatment: the real life observational PROXIMA study
Data on the prevalence of perennial versus seasonal allergic asthma in Italy are lacking; moreover, there is limited evidence on the effect of omalizumab on patient-reported outcomes in Italian patients with s...
https://ift.tt/2CWDAuA
Near-infrared spectroscopy in vegetables and humans: An observational study
BACKGROUND Cerebral near-infrared spectroscopy (NIRS) of tissue oxygen saturation is claimed to be a surrogate marker for global cerebral perfusion. Increasingly, NIRS target-based therapy has been used during cardiac surgery in the hope of decreasing the incidence of adverse neurological outcome. OBJECTIVES We report NIRS values for some common vegetables and faculty at a world-class medical institution. DESIGN Observational nonblinded study. SETTING Single tertiary care institution and local urban vegetable market. PARTICIPANTS Five yams (Dioscorea cayenensis), five courgettes (Cucurbita pepo) and five butternut squashes (Cucurbita moschata) were studied. Five cardiothoracic surgeons and anaesthesiologists were the control group. INTERVENTIONS None. MAIN OUTCOME MEASURES NIRS value of each species. RESULTS Mean NIRS value for the control group was 71% [95% confidence interval (CI) 68 to 74] and was similar to that of the yellow squashes [75% (95% CI 74 to 76)]. These values were significantly greater than the NIRS measurements of both the butternut squash and yam [63% (95% CI 62 to 64) and 64% (95% CI 63 to 65), respectively, P https://ift.tt/2P1IEVQ
Peri-operative oral caffeine does not prevent postoperative atrial fibrillation after heart valve surgery with cardiopulmonary bypass: A randomised controlled clinical trial
BACKGROUND Raised plasma levels of endogenous adenosine after cardiac surgery using cardiopulmonary bypass (CPB) have been related to the incidence of postoperative atrial fibrillation (POAF). OBJECTIVE We wished to assess if caffeine, an adenosine receptor antagonist could have a beneficial effect on the incidence of POAF. DESIGN A randomised controlled study. SETTING Single University Hospital. PATIENTS One hundred and ten patients scheduled for heart valve surgery with CPB. INTERVENTIONS We randomly assigned patients to receive peri-operative oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma concentrations and caffeine pharmacokinetic profile were evaluated in a subgroup of 50 patients. MAIN OUTCOME MEASURES The primary endpoint was the rate of atrial fibrillation during postoperative hospital stay. RESULTS The current study was stopped for futility by the data monitoring board after an interim analysis. The incidence of atrial fibrillation was similar in the caffeine and in the placebo group during hospital stay (33 vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P = 0.60). Basal and postoperative adenosine plasma levels were significantly associated with the primary outcome. Adenosine plasma levels were similar in the two treatment groups. Caffeine administration was associated with a higher incidence of postoperative nausea and vomiting (27 vs. 7%, P = 0.005). CONCLUSION Oral caffeine does not prevent POAF after heart valve surgery with CPB but increased the incidence of postoperative nausea and vomiting. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, no.: NCT01999829.https://ift.tt/2P6ch8s
Εγγραφή σε:
Αναρτήσεις (Atom)