Lingual abscess is a rare disorder, and current knowledge regarding clinical manifestations and treatment modalities has not been well established. This study presented 6 cases of lingual abscess patients between January 2012 and December 2017. There were three men and three women. Median age was 54 years. Odynophagia and local pain were the common presenting symptoms. Local trauma was the main predisposing factor of anterior abscess, while lingual tonsillitis or infected thyroglossal cyst was the predisposing factor of posterior abscess. An impending airway obstruction was identified in two patients, requiring tracheostomy. All patients achieved an excellent outcome with a combination of surgical drainage and proper antibiotics as well as using proper investigation for detecting unusual areas of lingual abscess. According to the data from the study's results and review of the relevant literature, an abscess located at the anterior two-thirds of the tongue is easy to diagnose while the posterior one-third of the tongue abscess is relative difficulty. Using contrast-enhanced computed tomography increases diagnostic accuracy, especially on the tongue base and deep space infection. The management strategies include (1) protecting the airway, (2) draining the abscess by needle aspiration or surgery, and (3) administering antibiotics early. Our series showed a superiority of surgical drainage when the patients present with marked tissue edema, deep loculated infection, and airway obstruction.
https://ift.tt/2Pbir7g
Τρίτη 6 Νοεμβρίου 2018
Lingual Abscess: Predisposing Factors, Pathophysiology, Clinical Manifestations, Diagnosis, and Management
Age and Periodontal Health—Immunological View
Abstract
Purpose of the Review
Aging clearly impacts a wide array of systems, in particular the breadth of the immune system leading to immunosenescence, altered immunoactivation, and coincident inflammaging processes. The net result of these changes leads to increased susceptibility to infections, increased neoplastic occurrences, and elevated frequency of autoimmune diseases with aging. However, as the bacteria in the oral microbiome that contribute to the chronic infection of periodontitis is acquired earlier in life, the characteristics of the innate and adaptive immune systems to regulate these members of the autochthonous microbiota across the lifespan remains ill-defined.
Recent Findings
Clear data demonstrate that both cells and molecules of the innate and adaptive immune response are adversely impacted by aging, including in the oral cavity, yielding a reasonable tenet that the increased periodontitis noted in aging populations is reflective of the age-associated immune dysregulation. Additionally, this facet of host-microbe interactions and disease needs to accommodate the population variation in disease onset and progression, which may also reflect an accumulation of environmental stressors and/or decreased protective nutrients that could function at the gene level (i.e., epigenetic) or translational level for production and secretion of immune system molecules.
Summary
Finally, the majority of studies of aging and periodontitis have emphasized the increased prevalence/severity of disease with aging, all based upon chronological age. However, evolving areas of study focusing on "biological aging" to help account for population variation in disease expression may suggest that chronic periodontitis represents a co-morbidity that contributes to "gerovulnerability" within the population.
https://ift.tt/2AQpHwJ
Modeling daily water temperature for rivers: comparison between adaptive neuro-fuzzy inference systems and artificial neural networks models
Abstract
River water temperature is a key control of many physical and bio-chemical processes in river systems, which theoretically depends on multiple factors. Here, four different machine learning models, including multilayer perceptron neural network models (MLPNN), adaptive neuro-fuzzy inference systems (ANFIS) with fuzzy c-mean clustering algorithm (ANFIS_FC), ANFIS with grid partition method (ANFIS_GP), and ANFIS with subtractive clustering method (ANFIS_SC), were implemented to simulate daily river water temperature, using air temperature (Ta), river flow discharge (Q), and the components of the Gregorian calendar (CGC) as predictors. The proposed models were tested in various river systems characterized by different hydrological conditions. Results showed that including the three inputs as predictors (Ta, Q, and the CGC) yielded the best accuracy among all the developed models. In particular, model performance improved considerably compared to the case where only Ta is used as predictor, which is the typical approach of most of previous machine learning applications. Additionally, it was found that Q played a relevant role mainly in snow-fed and regulated rivers with higher-altitude hydropower reservoirs, while it improved to a lower extent model performance in lowland rivers. In the validation phase, the MLPNN model was generally the one providing the highest performances, although in some river stations ANFIS_FC and ANFIS_GP were slightly more accurate. Overall, the results indicated that the machine learning models developed in this study can be effectively used for river water temperature simulation.
https://ift.tt/2QlNFFn
Cosmetics, Vol. 5, Pages 65: ES2 as a Novel Verbascoside-Derived Compound in the Treatment of Cutaneous Wound Healing
Cosmetics, Vol. 5, Pages 65: ES2 as a Novel Verbascoside-Derived Compound in the Treatment of Cutaneous Wound Healing
Cosmetics doi: 10.3390/cosmetics5040065
Authors: Ilaria Crivellari Silvia Vertuani Yunsook Lim Franco Cervellati Anna Baldisserotto Stefano Manfredini Giuseppe Valacchi
Several pathologies are characterized by chronic wounds and often resistant to many of the common therapies, leading to chronic infections that can become even life-threatening for patients. For this reason, the identification of new products able to ameliorate the healing process is still an on-going research. Natural compounds have been used to improve skin conditions due to their dermo-cosmetic and therapeutic activities including anti-inflammatory, antioxidant and cell-migratory properties. Among these compounds, it has been recently demonstrated that Verbascoside, a phenyl propanoid glycoside widely used in the cosmetic field, can improve keratinocytes proliferation. Because of its high hydrophilic character, Verbascoside has a limited range of possible topical applications and the synthesis of ES2, a semi-synthetic derivative of Verbascoside was performed to bypass some of the drawback aspects of this molecule. In the present study, the wound healing properties of Verbascoside and ES2 were compared in both keratinocytes “in vitro” wound scratch and in wounded SKH1 mice. The results showed that both compounds were not cytotoxic and ES2 showed an efficient ability to promote the proliferation of human keratinocytes compared to Verbascoside. The findings were also confirmed in vivo but only at early time points (2/3 days). Taken together, these data suggest that the Verbascoside-derivative ES2 could be considered a novel and promising candidate for the topical treatment of wounds.
https://ift.tt/2qvKxvg
Evaluation of the potential of sewage sludge as a valuable fertilizer for wheat ( Triticum aestivum L.) crops
Abstract
A greenhouse experiment was performed to assess the soil heavy metal pools, growth, yield, and heavy metal uptake of wheat plants (Triticum aestivum L.) that are grown at different rates in soils supplemented with sewage sludge (SS). The experimental design was completely randomized, with six replicates per treatment. The application of SS significantly increased the soil organic matter content. Generally, most growth parameters, as well as the biomass of treated wheat, were significantly increased with the amendment of SS, up to the addition rate of 40 g kg−1. The content of all heavy metals (except Cr in grains and Pb in spikes) significantly increased in different tissues of treated wheat with the increasing rate of SS application. However, all heavy metal concentrations (except for Al, Cr, Fe, and Mn in the roots) were normal and did not overcome the phytotoxic levels. The wheat was recognized by a bioaccumulation factor < 1.0 for most of the heavy metals. The translocation factor for all of the heavy metals was < 1.0. Therefore, the SS utilized in the present study could be used as a valuable organic fertilizer in wheat cultivation areas in Saudi Arabia and could also act as an eco-friendly method for the recycling of SS.
https://ift.tt/2qwkdkz
IEnhanced Topical Delivery of Non-complexed Molecular Iodine for Methicillin-Resistant Staphylococcus aureus Decolonization.
 | Related Articles |
IEnhanced Topical Delivery of Non-complexed Molecular Iodine for Methicillin-Resistant Staphylococcus aureus Decolonization.
Int J Pharm. 2018 Nov 02;:
Authors: Uchiyama S, Dahesh S, Nizet V, Kessler J
Abstract
Staphylococcus aureus, a leading cause of serious human infections in both healthcare and community settings, is increasingly difficult to control due to expanding resistance to multiple antibiotic classes. Methicillin-resistant S. aureus (MRSA) strains have disseminated on a global scale and are associated with adverse patient outcomes, increased hospital stays, and significant economic costs to the healthcare system. A proximal step in S. aureus infection is colonization of the nasal mucosa, and effective strategies to decolonize high risk patients to reduce the risk of invasive infection and nosocomial spread represent an important clinical priority. With rising resistance to mupirocin, the most common antibiotic utilized for nasal MRSA decontamination, we are examining the use of pure molecular iodine (I2)-based formulations for this indication. Recently, an iodophor formulation of povidone-iodine (PVP-I) has shown significant promise for nasal MRSA decontamination by swabbing the anterior nares of patients in hospital settings, but the I2 concentration in this treatment is less than 0.01% of total iodine species present and like all providone-iodine formulations causes skin staining. Here we determine that a novel non-staining formulation of I2 combined with the safe organic emollient glycerin, delivers high local concentrations of the active antimicrobial entity (I2) with minimal evaporative loss, exhibits activity at ∼1 part per million against MRSA and other important Gram-positive and -negative human pathogens. This formulation for I2 topical delivery produced similar reductions in mean bacterial burden and was associated with fewer treatment failures (< 2-logfold reduction) than PVP-I in a murine model of MRSA nasal decontamination. Formulations of I2 in glycerin emollient merit further exploration as topical disinfectants for human medical indications.
PMID: 30395958 [PubMed - as supplied by publisher]
https://ift.tt/2yUbi1e
Prevalence of antibiotic-resistant organisms in Canadian Hospitals. Comparison of point-prevalence survey results from 2010, 2012, and 2016.
| Related Articles |
Prevalence of antibiotic-resistant organisms in Canadian Hospitals. Comparison of point-prevalence survey results from 2010, 2012, and 2016.
Infect Control Hosp Epidemiol. 2018 Nov 05;:1-7
Authors: Martin P, Abou Chakra CN, Williams V, Bush K, Dyck M, Hirji Z, Kiss A, Larios OE, McGeer A, Moore C, Weiss K, Simor AE, Infection Prevention and Control Canada
Abstract
OBJECTIVE: Point-prevalence surveys for infection or colonization with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae (CREs), and for Clostridium difficile infection (CDI) were conducted in Canadian hospitals in 2010 and 2012 to better understanding changes in the epidemiology of antimicrobial-resistant organisms (AROs), which is crucial for public health and care management.
METHODS: A third survey of the same AROs in adult inpatients in Canadian hospitals with ≥50 beds was performed in February 2016. Data on participating hospitals and patient cases were obtained using standard criteria and case definitions. Associations between ARO prevalence and institutional characteristics were assessed using logistic regression models.
RESULTS: In total, 160 hospitals from 9 of the 10 provinces with 35,018 adult inpatients participated in the survey. Median prevalence per 100 inpatients was 4.1 for MRSA, 0.8 for VRE, 1.1 for CDI, 0.8 for ESBLs, and 0 for CREs. No significant change occurred compared to 2012. CREs were reported from 24 hospitals (15%) in 2016 compared to 10 hospitals (7%) in 2012. Routine universal or targeted admission screening for VRE decreased from 94% in 2010 to 74% in 2016. Targeted screening for MRSA on admission was associated with a lower prevalence of MRSA infection. Large hospitals (>500 beds) had higher prevalences of CDI.
CONCLUSION: This survey provides national prevalence rates for AROs in Canadian hospitals. Changes in infection control and prevention policies might lead to changes in the epidemiology of AROs and our capacity to detect them.
PMID: 30394232 [PubMed - as supplied by publisher]
https://ift.tt/2OvgNYX
Higher Interleukin-7 serum concentrations in patients with cystic fibrosis correlate with impaired lung function.
| Related Articles |
Higher Interleukin-7 serum concentrations in patients with cystic fibrosis correlate with impaired lung function.
J Cyst Fibros. 2018 Oct 31;:
Authors: Seyfarth J, Sivagurunathan S, Ricken S, Weinreich G, Olbrich L, Taube C, Mayatepek E, Schramm D, Jacobsen M
Abstract
BACKGROUND: Patients with cystic fibrosis (CF) are highly susceptible to infection and colonization of pulmonary epithelia. Repeated and chronic infections may affect disease course and efficacy of host immune protection. Higher Interleukin (IL)-7 serum levels, indicating impaired T-cell response to IL-7, have been described for chronic viral and mycobacterial infections.
METHODS: Time course measures of IL-7 serum concentrations in patients with CF (n = 164; n = 78 for the second time point) and healthy controls (n = 60) were done. CF patients were characterized for disease severity parameters as well as infection status and association with IL-7 serum levels was determined.
RESULTS: CF patients had significantly higher IL-7 serum concentrations as compared to healthy controls (9.79 pg/ml, IQR 6.76-13.6 versus 4.55 pg/ml, IQR 2.76-9.51, p < .001). IL-7 serum levels were negatively correlated with individual CF patient's BMI (r = -0.19, p = .021) and a tendency of increased IL-7 levels in Staphylococcus aureus infected CF patients was found. Linear regression of multiple parameters revealed significant negative correlation of FEV1%pred with IL-7 serum concentrations in patients with CF (ß-coefficient: -0.04, 95% confidence interval [-0.08; -0.003], p = .034). Time course analyses after 1 year +/- 6 months showed increased IL-7 serum levels (time point 1:9.26 pg/ml, IQR 6.94-13.12 time point 2:10.86 pg/ml, IQR 9.14-14.76, p = .016) that correlated negatively with decreased FEV1%pred during CF disease course.
CONCLUSIONS: High IL-7 serum levels were found in CF patients and correlated with impaired lung function during CF disease course. As a candidate biomarker of T-cell dysfunction, higher IL-7 serum level may also indicate worsened immune competence of patients with CF.
PMID: 30389600 [PubMed - as supplied by publisher]
https://ift.tt/2yTjWwQ
Course of colonization by multidrug-resistant organisms after allogeneic hematopoietic cell transplantation.
 | Related Articles |
Course of colonization by multidrug-resistant organisms after allogeneic hematopoietic cell transplantation.
Ann Hematol. 2018 Dec;97(12):2501-2508
Authors: Heidenreich D, Kreil S, Jawhar M, Müller N, Nolte F, Becker KP, Miethke T, Hofmann WK, Klein SA
Abstract
Multidrug-resistant organisms (MDRO) have been developing as an emerging problem in allogeneic hematopoietic cell transplantation (HCT). Since no data are available on the course of MDRO colonization after HCT, we investigated in this retrospective, single-center study, persistence and clearance of MDRO after HCT. From June 2010 to December 2015, 121 consecutive HCT patients were included. Patients received a MDRO screening before conditioning as well as surveillance cultures after HCT. In MDRO-colonized patients, surveillance specimens were taken until MDRO were no longer detectable. Thirty-three patients (27%) were found to be colonized by at least one MDRO at any time point until day 100 post HCT. Day 100 (2-year) non-relapse mortality (NRM) and overall survival (OS) of MDRO-colonized (MDRO+) versus non-colonized (MDRO-) patients were essentially the same. NRM is 15% (21%) versus 15% (24%). Two-year OS is 60 versus 55% for MDRO+ versus MDRO- patients. Out of the 33 MDRO+ patients, 21 cleared the MDRO. Median time to non-detectability of MDRO was 6 months. In 12 patients, the MDRO persisted. There was a significant (p < 0.0001) survival difference between patients who cleared the MDRO versus those with MDRO persistence (2-year OS 80 vs 40%). Except for the length of antibiotic therapy as a potential risk factor for MDRO persistence after HCT, no other conventional factors could be identified. (a) colonization by MDRO per se had no negative impact on the outcome, (b) MDRO can be cleared by the majority of patients after allogeneic HCT, and (c) to increase the probability to clear MDRO, the use of antibiotics in MDRO+ patients should be reviewed critically.
PMID: 30121845 [PubMed - indexed for MEDLINE]
https://ift.tt/2OvgMEn
Microscopic approach for repairing nasal septal perforations using bilateral advancement flaps
Abstract
Background
Septal perforations consist in an anatomic defect of the mucosal, cartilaginous and/or bone tissues of the nasal septum. A huge variety of approaches and techniques for nasal perforation repair have been reported.
Methodology/principal
Between January 2008 and January 2017, 38 patients were treated for nasal septal perforation in Department of Otorhinolaryngology Head and Neck Surgery, Fundación Jiménez Díaz University Hospital, Madrid, Spain. A novel approach is presented based on microscope. Septal perforation closure was performed with endonasal bilateral advancement flaps-established technique and autologous cartilage and muscle temporal fascia grafts. We performed a retrospective review of closure rates and complications.
Results
A postoperative follow-up of at least 12 months was performed in 37 patients. The mean size of perforation was 1.33 cm. After the withdrawal of the silicone splints, perforations were completely closed in all cases. However, during the follow-up, four patients resulted in a reperforation, so our closure rate was 89.19%. For all cases, symptoms related to septal defect were solved. Only one case was reported of local infections that was resolved with antibiotics in a few days.
Conclusions
Microscopic approach of septal perforation closure using bilateral advancement flaps can be an affordable technique with a high percent of success and low rate of complications.
https://ift.tt/2qx6WIw
Effect of spraying of fine water particles on facial skin moisture and viscoelasticity in adult women
Abstract
Background/purpose
It is known that the elderly and adult women with reduction in sebum secretion have reduced skin barrier function, drying of the skin in a low humidity environment is accompanied by physiological distress. As our hypothesis, when fine water particles are sprayed on the skin, the water content of the corneal layer is significantly increased. In the present study, we examined the ability of fine water particles to improve facial skin moisture levels in adult women.
Methods
We examined skin conductance, transepidermal water loss (TEWL), and skin elasticity as an index of skin barrier function at the cheek in 17 healthy adult women in the spraying of fine water particles, in the environment temperature at 24°C and 34.5% relative humidity.
Results
The skin conductance of stratum corneum after 120 minute of spraying, A condition (peak particle size below 0.5 μm) was 119.7 ± 25.1%, B condition (peak particle size 1.8 μm) was 100.4 ± 31.7%, C condition (peak particle size 5.4 μm) was 110.1 ± 25.0%, and the A condition was significantly higher than the B condition. Also, skin elasticity in the A condition tended to be higher value than in the other conditions. Transepidermal water loss (TEWL) after 120 minute of spraying showed a lower value in the A condition than in the other conditions. In the A condition, the skin conductance steadily maintained their initial levels up to 360 minute after spraying.
Conclusion
Especially, by spraying smallest fine water particles, skin barrier function at the cheek was improved. These data indicated that non‐charged fine water particles played an important role on moisten skin in a low humidity environment.
https://ift.tt/2Fh8kJQ
A dose-escalation study of docetaxel, oxaliplatin, and S-1 (DOS) as a first-line therapy for patients with unresectable metastatic gastric cancer
Abstract
Purpose
The aim of this study was to determine the recommended dose (RD) for a docetaxel/oxaliplatin/S-1 (DOS) regimen in patients with unresectable gastric cancer and to preliminarily evaluate its efficacy.
Methods
Previously untreated patients with histologically proven unresectable metastatic gastric cancer were enrolled (n = 16). Docetaxel and oxaliplatin were administered intravenously on day 8 and S-1 was administered orally twice a day on days 1–14. Each cycle was repeated every 3 weeks. Dose-limiting toxicities (DLTs) were evaluated during the first treatment cycle. Three dose escalations of DOS were employed in this study: level 1 (50/100/80 mg/m2), level 2 (50/130/80 mg/m2), and level 3 (60/130/80 mg/m2).
Results
According to the 3 + 3 dose-escalating schedule, we determined that the RD and maximum tolerated dose for this regimen were level 1 and level 2, respectively. The DLTs were grade 3 diarrhea and febrile neutropenia. The overall response rate was 78% (7/9) for patients with measurable lesions and consisted of two complete responses and five partial responses. Five patients underwent conversion surgery. The median follow-up time was 19 months with median survival time and progression-free survival being 19.6 months and 7.6 months, respectively.
Conclusions
The results from this study demonstrated the safety and tolerability of DOS in unresectable metastatic gastric cancer patients and revealed promising preliminary efficacy with a high conversion rate. A phase II trial of DOS regimen using the identified RD is ongoing.
https://ift.tt/2JKS7Lb
Impact of age on elderly patients with oral cancer
Abstract
Introduction
In this study we have tried to analyze the impact of age on various clinico-pathological parameters, treatment completion and subsequent survival in older patients.
Materials and methods
This is a retrospective analysis of 140 elderly (> 65 years) patients of oral cancer operated between January 2012 and December 2013. The patients were divided into two groups based upon their age that ≤ 70 years and > 70 years.Association of distribution of various clinico-pathological factors between different groups was assessed by using Chi-square test. Survival analysis was done using Kaplan Meir analysis. Univariate and multivariate analysis were performed.
Results
The two groups had similar distribution of various clinico-pathological factors. Disease free survival for the group ≤ 70 and > 70 years was 37.6 months and 36.4 months (p < 0.594). 13.5% and 7.8% patients > 70 years and ≤ 70 years were either advised or received sub-optimal adjuvant therapy (p < 0.002).
Conclusion
There is no difference distribution of various clinico-pathological factors and survival in patients of oral cancer ≤ 70 and > 70 years of age. Age did not affect survival. Majority of patients could complete the adjuvant therapy advised. Still, significantly more number of patients > 70 years could not receive/complete appropriate adjuvant therapy. Thus treatment needs to be tailored keeping in mind the individual's performance status and the co-morbidities.
https://ift.tt/2yUYoA6
Tranexamic acid and post-tonsillectomy hemorrhage: propensity score and instrumental variable analyses
Abstract
Purpose
Although post-tonsillectomy hemorrhage occurs rarely, it can be life-threatening. Previous studies showed that tranexamic acid (TXA) had insignificant association with the rate of post-tonsillectomy hemorrhage, but those findings were limited by small sample sizes. The purpose of this study was to examine the effectiveness of TXA in preventing post-tonsillectomy hemorrhage using nationwide database.
Methods
Data of a retrospective cohort of 117,598 patients from 750 hospitals, who had undergone tonsillectomy between 2010 and 2016, were drawn from the Diagnosis Procedure Combination database in Japan and studied.
Results
Propensity score-matched analysis showed no significant differences in proportions of reoperation or blood transfusion after tonsillectomy between the treatment (TXA from the day of tonsillectomy) and control groups (1.50% vs. 1.47%, p = 0.64). Instrumental variable analysis also showed no significant differences (odds ratio, 0.98; 95% confidence interval, 0.86–1.13; p = 0.82). Higher proportions of reoperation or blood transfusion were significantly associated with male sex, older age, emergency hospitalization, prolonged anesthesia, and medium hospital volume (annual number of tonsillectomies).
Conclusions
Administration of TXA from the day of tonsillectomy is not associated with reduction in reoperation or blood transfusion rates.
https://ift.tt/2JK2Tl8
Hemorrhage within the tympanic membrane without perforation
Hemotympanum refers to both the presence of blood in the middle ear cavity and to ecchymosis of the tympanic membrane (TM), and a systematic study of intra-TM (iTM) hemorrhage without bleeding in the middle ea...
https://ift.tt/2qykO5e
Osteomyelitis des Gesichtsschädels
Laryngo-Rhino-Otol
DOI: 10.1055/a-0762-3967
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2QqznmL
In vivo Raman spectroscopic characteristics of different sites of the oral mucosa in healthy volunteers
Abstract
Objectives
Investigate the biochemistry of in vivo healthy oral tissues through Raman spectroscopy. We aimed to characterize the biochemical features of healthy condition in oral subsites (buccal mucosa, lip, tongue, and gingiva) of healthy subjects. More specifically, we investigated Raman spectral characteristics and biochemical content of in vivo healthy tissues on Brazilian population. This characterization can be used to better define normal tissue and improve the detection of oral premalignant conditions in future studies.
Materials and methods
For spectroscopic analysis a Raman spectrometer (Kaiser Optical Systems imaging spectrograph Holospec, f / 1.8i-NIR) coupled with a laser 785 nm, 60 mW was used. Raman measurements were obtained by means of an optical fiber (EMVision fiber optic probe) coupled between the laser and the spectrometer. Three spectra per site were acquired from the lip, buccal mucosa, tongue, and gingiva of ten healthy volunteers. This resulted in 30 spectra per oral sub-site and in total 120 spectra.
Results
We report detailed biochemical information on these subsites and their relative composition based on deconvolution studies of their spectra. Finally, we also report classification efficiency of 61, 83, 41, and 93% for buccal, gingiva, lip, and tongue respectively after applying multivariate statistical tools.
Conclusions
We quantitated the contribution of various biochemicals in terms of percentage, and this will enable comparison not only across anatomical sites but also across studies. Raman spectroscopy can rapidly probe tissue biochemistry of healthy oral regions. Moreover, the study suggests the possibility of using Raman spectroscopy combined with signal processing and multivariate analysis methods to differentiate the oral sites in healthy conditions and compare with pathological conditions in future studies.
Clinical relevance
The spectral characterization of the healthy condition of oral tissues by a noninvasive, label-free, and real-time analytical techniques is important to create a spectral reference for future diagnosis of pathological conditions.
https://ift.tt/2AQyrmg
Analysis of swale factors implicated in pollutant removal efficiency using a swale database
Abstract
Swales are traditional basic open-drainage systems which are able to remove stormwater-borne pollutants. In spite of numerous case studies devoted to their performances, parameters influencing the reduction of pollutant concentrations by swales remain elusive. In order to better characterize them, a database was set up by collecting performance results and design characteristics from 59 swales reported in the literature. Investigations on correlations among pollutant efficiency ratios (ERs) indicated that total trace metals (copper (Cu), zinc (Zn), cadmium (Cd), and lead (Pb)), total suspended solids (TSS), total phosphorus (TP), and total Kjeldahl nitrogen (TKN) exhibited many cross-correlated ERs. High ERs were observed for pollutants including a particulate form such as TSS (median ERs = 56%) and total trace metals (median ERs ≥ 62%), suggesting that these pollutants are efficiently trapped by sedimentation in swale bed and/or filtered within swale soil. Medium to high ERs were found for dissolved trace metals (median ERs ≥ 44%), whereas ERs for nutrient species were lower (median ERs ≤ 30%). The inflow concentration was identified as a major factor correlated to ER for most pollutants. For some pollutants, there is also a trend to get higher ER when the geometrical design of the swale increases the hydraulic residence time. Overall, this database may help to better understand swale systems and to optimize their design for improving pollutant removal.
https://ift.tt/2QoGPyK
Recurrent respiratory papillomatosis: update 2018
Purpose of review Recurrent respiratory papillomatosis (RRP) is the most common as well as the costliest benign airway neoplasm in the United States [Ivancic et al. (2018). Laryngoscope Investig Otolaryngol 3:22; Derkay (1995). Arch Otolaryngol Head Neck Surg 121:1386]. In addition, it is potentially deadly, with risk of airway obstruction as well as a 3–7% risk of malignant conversion [Schraff et al. (2004). Arch Otolaryngol Head Neck Surg 130:1039]. This review highlights exciting advancements over the past 1–2 years in scientific understanding of the pathophysiology, epidemiology, natural history, prevention, and treatment of this difficult disease. Recent findings Recent studies have yielded the following findings: The primary quality of life reduction that patients perceive is voice-related; the membranous vocal folds are the most frequently involved anatomic subsite in adult-onset RRP; there may be a correlation between laryngopharyngeal reflux, herpes simplex virus type 2, and adult-onset RRP; there has been a decline in RRP incidence in Australia following the implementation of a national vaccination program; addition of educational audiovisual aids assists in vaccine acceptance rates; preventive vaccination can be used as treatment for pediatric as well as adult RRP patients with demonstrable effects on antibody titers and reoperation rates; calreticulin-linked DNA vaccines show promise in reducing the growth rate of human papilloma virus (HPV)11 E6/E7-expressing tumors in mice; injection of bevacizumab is associated with no adverse tissue affects; systemic bevacizumab is effective as a treatment for severe uncontrolled disease; pegylated interferon treatment is effective in select severe pediatric RRP disease; and finally, increased rates of programed death 1 T-lymphocyte infiltration and programed death-ligand 1 expression are seen on both papilloma and infiltrating immune cells. Summary RRP is declining in incidence but remains a challenging disease to treat with great costs to patients, families, and the healthcare system. As the disease continues to be better understood, new frontiers are opening in treatment, particularly for severe or poorly controlled disease. Until the disease can be eradicated, it remains a vital area of research to help prevent new cases and treat afflicted patients.https://ift.tt/2RG46N8
Current approaches to instrumental assessment of swallowing in children
Purpose of the review This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018. Recent findings Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders. Summary Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging.https://ift.tt/2SOlz7k
Techniques for evaluation and management of tongue-base obstruction in pediatric obstructive sleep apnea
Purpose of review Tongue-base obstruction (TBO) is a common cause of persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy in children. This review discusses available diagnostic modalities and surgical treatment options for the management of TBO. Recent findings Recently, a systematic review that included nine studies using drug-induced sleep endoscopy (DISE) in the evaluation of children with persistent OSA after tonsillectomy and adenoidectomy identified the tongue-base as the most common site of obstruction. Summary TBO is a common and correctable cause of persistent OSA in children. Diagnostic modalities include awake flexible laryngoscopy, plain neck films, DISE, and cine MRI. Because DISE and cine MRI are performed in a sleep-like state, they are fairly reliable in identifying the site of obstruction. As continuous positive airway pressure is often poorly tolerated in the pediatric population, there is considerable interest in surgical options for TBO. Depending on the location and the severity of the obstruction, interventions such as lingual tonsillectomy, posterior midline glossectomy, tongue suspension suture, epiglottopexy, hypoglossal nerve stimulation, tongue–lip adhesion, and hyoid suspension may play a role in management.https://ift.tt/2RHTSMf
Velopharyngeal incompetence: role in paediatric swallowing deficits
Purpose of review The purpose of this manuscript is to highlight the latest advances in diagnosis and management of velopharyngeal incompetence (VPI) as it pertains to swallowing deficits in children. This is timely and relevant as otolaryngologists are often amongst the first to diagnose and treat VPI. Although nasal regurgitation of a bolus is frequently transient, persistent problems can be associated with other swallowing problems and other significant medical problems. Furthermore, velopharyngeal incompetence has implications for speech production. Recent findings Persistent VPI associated with a swallowing deficit can be an isolated anomaly with or without a cleft palate or submucous cleft palate. VPI may be secondary to a cranial neuropathy, esophageal abnormality or associated with another airway anomaly, any of which may further contribute to dysphagia. Findings of additional anomalies may be suggestive of a syndrome. Workup should explore these potential causes. When velopharyngeal incompetence is associated with dysphagia, fiberoptic endoscopic evaluation of swallow (FEES) and videofluoroscopic swallow study (VFSS) can be helpful in diagnosis and management. The advantages and disadvantages of FEES and VFSS have been well delineated over the past few years. Similarly, nasopharyngoscopy and fluoroscopy are increasingly used in diagnosis and management of VPI that is associated with hypernasal resonance disorders. Summary Concurrent medical diagnoses or syndrome manifestations are often associated with or contribute significantly to the cause of dysphagia in children with VPI. As VPI can be a sign of brainstem vagal neuropathy, the clinician should investigate by imaging the CNS if other correlative symptoms of dysphagia and examination findings are present. Endoscopy is advocated for evaluation of vocal fold function. Fluoroscopy is best for further assessment of airway protection or safety of swallow. And, whenever indicated, additional workup is recommended to determine an underlying cause of the swallowing disorder.https://ift.tt/2SS5Sfd
Recurrent laryngeal nerve reinnervation: is this the standard of care for pediatric unilateral vocal cord paralysis?
Purpose of review Ansa to recurrent laryngeal nerve reinnervation, otherwise known as a nonselective laryngeal reinnervation (NSLR), is growing in popularity for the management of pediatric unilateral neuronal vocal fold movement impairment (VFMI). In this chapter, we will review the current treatment options for neuronal VFMI and role that NSLR plays in the treatment algorithm. Recent findings In 2018, Bouhabel and Hartnick published a survey of fellowship trained pediatric otolaryngologists and found an increasing comfort level with NSLR. Respondents felt that NSLR resulted in favorable subjective and objective postsurgical voice outcomes. Furthermore, NSLR may decrease the risk of aspiration in children with neuronal VFMI. Although NSLR appears to work, the voice results are not perfect for all children. Further work is being done to understand which preoperative variables, such as age, time from injury, and preop laryngeal electromyography, may predict a better voice outcome. Summary A variety of treatment options exist for unilateral neuronal VFMI. Recent data and developments demonstrate the effectiveness of reinnervation as a potential first-line surgical intervention in children with unilateral neuronal VFMI.https://ift.tt/2RHTPA3
Swallowing function in advanced age
Purpose of review To present current literature regarding swallowing function in advanced age, including healthy ageing, dysphagia and trends in multidisciplinary team service delivery. Recent findings Normative studies support swallowing efficiency but greater variability in healthy advanced age, through to 100 years old. Deviations from normative data and symptoms of dysphagia leading to aspiration or nutritional risk, imply swallowing disorder, rather than simply the ageing process. Quantitative and qualitative studies are emerging that promote management of swallow dysfunction for an ageing society, including innovative assessment, home treatment, swallowing exercise and optimized mealtimes. Summary Current literature on swallowing function in advanced age provides multidisciplinary perspectives and initiatives, with clear commitment to improving quality of life for older adults. The diversity of the older population and serious consequences of swallowing difficulties calls for routine screening tools for swallowing impairment and malnutrition risk. Representation of 'oldest old' in future normative studies is essential to guide swallowing management in adults over 85 years old.https://ift.tt/2SMJT9A
IgG4-related disease in the head and neck
Purpose of review To summarize current evidence regarding the pathophysiology, diagnostic criteria, and management of IgG4 disease in the head and neck. Recent findings The anti-CD20 antibody, rituximab is being used increasingly as a primary treatment modality in cases with a definitive diagnosis. Despite the favorable prognosis, it is now recognized that the incidence of cancer development within 3 years of diagnosis is higher than that of the general population. Summary IgG4-related disease is a sclerosing, chronic inflammatory disease, that is benign, and usually occurs in middle-aged to elderly individuals. Definitive diagnosis of IgG4-related disease requires radiological confirmation of enlargement of the affected organ, elevated serum IgG4 levels, and characteristic histopathological findings. Treatment is primarily with systemic corticosteroids or the monoclonal anti-CD20 antibody rituximab, surgical excision, or a combination of treatment modalities. Prognosis is good with complete remission in up to 90% of patients.https://ift.tt/2RHTJIH
Cervical osteophytosis and spine posture: contribution to swallow disorders and symptoms
Purpose of review The article reviews the effects of cervical osteophytosis and spine posture on swallowing, and how they can cause dysphagia. Recent findings Cerivical osteophytosis which is a bony overgrowth of the cervical spines, it affects the swallowing through different mechanisms, including direct mechanical compression of the pharynx and esophagus, disturbances of normal epiglottic tilt over the inlet of the larynx by the osteophytes at C3–C4 level, inflammatory reactions in the tissues around the esophagus and cricopharyngeal spasm. Also, cervical spine posture in normal individuals could affect the swallowing mechanism by disturbance of the sphincteric action of the larynx and upper esophageal sphincter. Summary Cervical osteophytosis and abnormal cervical curvature may be overlooked by the Otolaryngologists as causes of swallowing disorders. The diagnosis is usually confirmed by radiologic study for the cervical spine. Cervical abnormality should be kept in mind while we are investigating patients with swallowing problem, and postural modification may help in treatment of such cases.https://ift.tt/2SRPVWH
Update on sinus disease in children with cystic fibrosis: advances in treatment modalities, microbiology, and health-related quality-of-life instruments
Purpose of review There is a lack of consensus with regards to the diagnosis and treatment of sinus disease in children with cystic fibrosis. Here, we review literature from the past 18 months in order to highlight the way forward in this contentious field. Recent findings Most of the literature (from the past 18 months) on sinus disease in pediatric cystic fibrosis focused on treatment approaches, bacteriology and immunology, and health-related quality-of-life (HRQOL) instruments. Quality studies have demonstrated that functional endoscopic sinus surgery (FESS) is as safe in children with or without cystic fibrosis; that the microbiology of the paranasal sinus in children with cystic fibrosis is different than that of their lungs; and, that HRQOL instruments may prove useful in determining sinonasal disease severity in children with cystic fibrosis. Summary Medical and surgical approaches appear to be viable in the treatment of sinonasal disease in pediatric cystic fibrosis; the microbiology and immunology of pediatric cystic fibrosis is proving more complex and nuanced than initially believed; and, HRQOL instruments show promise in reconciling differences between observable and clinically relevant sinus disease in pediatric cystic fibrosis patients.https://ift.tt/2RHTCgf
High-resolution manometry: what about the pharynx?
Purpose of review High-resolution pharyngeal manometry (HRPM) is a well tolerated, catheter-based, method for recording the pressures and bolus flow generated by the pharyngeal muscles during swallowing. Despite a body of published evidence and a critical mass of investigators in the field, there is a lack of consensus surrounding what biomechanical phenomena to measure. The purpose of this review is to provide some insights into the information on swallowing physiology that can be gathered using HRPM. Recent findings HRPM literature has focused on measuring biomechanical phenomena that may be relevant to measure in relation to dysphagia research. This review focuses on the measurement of pharyngeal luminal occlusive forces, intrabolus distension pressure, bolus presence and bolus flow timing as key features of pharyngeal swallowing that require measurement and allow for derivation of the Swallow Risk Index, a global measure of swallow function indicative of swallowing functional reserve. Summary HRPM allows objective derivation of measures of swallow function that may have value for diagnosis and research in relation to swallowing disorders. HRPM has demonstrated clinical applicability in specific patient populations and offers unique advantages that compliment current assessment methods.https://ift.tt/2SS50re
Vocal fold nodules in children
Purpose of review Vocal nodules are a common presentation in children, representing the most common cause of dysphonia. Recent findings Children with siblings, ADHD, and of male sex are most likely to be affected. Female children, however, tend to have more likely progression into adolescence. Quality-of-life indices can aid in screening for vocal nodules whereas stroboscopy, and possibly, ultrasound are required for definitive diagnosis. Summary Management has not significantly changed over time and should begin with conservative behavioral and environmental modifications along with voice therapy in those more severely impacted. Though immediate outcomes vary somewhat depending on management direction, the overall prognosis seems to be good even with lack of intervention. It is most critical to ensure a definitive diagnosis, and offer management therapies that are appropriate for the level of impact the vocal nodules have on communication and voice production in the child.https://ift.tt/2RHTu0f
Laryngopharyngeal reflux disease: clinical presentation, diagnosis and therapeutic challenges in 2018
Purpose of review To review the recent literature on presentation, diagnosis and treatment of laryngopharyngeal reflux. Recent findings Patients with laryngopharyngeal reflux have a higher risk for gastroesophageal reflux and respiratory-related diseases. Many symptoms and findings are underestimated, contributing to the inconclusive results of many therapeutic trials. Additionally, little significance is given to nonacid and mixed refluxates, although a significant prevalence. The association between symptoms, signs, impedance-pH studies and pepsin detection could be the most accurate way for a clear diagnosis. 'Reflux profiling' is also important for the administration of a personalized treatment based on diet, proton pump inhibitors, alginate, magaldrate and other second-line drugs. There are only a handful of studies focusing on the addition of alginate or magaldrate to the treatment of laryngopharyngeal reflux, although their contribution has extensively been demonstrated. Summary Diagnosis remains controversial despite improvement in impedance and availability of pepsin detection in daily practice. With recent studies exhibiting a significant prevalence of nonacid or mixed refluxes, the addition of alginate or magaldrate to proton pump inhibitors should be considered. Future studies are needed to assess these new therapeutic schemes in moderate and severe laryngopharyngeal reflux.https://ift.tt/2SRejYn
Tympanostomy tube otorrhea in children: prevention and treatment
Purpose of review One in two children treated with tympanostomy tubes, experience episodes of otorrhea whilst their tubes are in place. In this review, we present the results of the most recent publications on prevention and treatment of tympanostomy tube otorrhea (TTO). Recent findings Recent systematic reviews on water precautions for children with tympanostomy tubes support the American Academy of Otolaryngology – Head and Neck Surgery guideline recommendation against such preventive measures as there is no evidence that it protects against TTO. Studies on tympanostomy tube design and material suggest that silicone tubes have a lower TTO risk and that biofilms appear to be mainly located in the perpendicular junction of the T-tubes and the round rims of the Paparella-type tubes. Another study shows that the biofilm-component DNAB-II protein is present in otorrhea of half of children with TTO. Targeting this protein could lead to a collapse of the biofilm structure and as such a potential new treatment for chronic TTO. New systematic reviews show that antibiotic eardrops are the most effective first-line treatment of acute TTO and suggest that an antibiotic–corticosteroid combination is more effective than antibiotic only. Although in many countries, quinolone eardrops are the preferred choice because of being non-ototoxic, one study found a higher risk of persistent perforation after tube extrusion in children treated with quinolone eardrops as compared with children treated with aminoglycoside eardrops. Summary Recent evidence confirms that water precautions for children with tympanostomy tubes are not effective in preventing TTO. Antibiotic–corticosteroid eardrops are the most effective treatment of acute TTO.https://ift.tt/2RHTo8T
Lead uptake by the symbiotic Daucus carota L.– Glomus intraradices system and its effect on the morphology of extra- and intraradical fungal microstructures
Abstract
This work examines the strategies adopted by an arbuscular mycorrhizal symbiotic system to ameliorate environmental Pb stress by examining the concentrations of P, Fe, and Pb in the fungal microstructures and the host's root. In vitro cultures of Ri-T DNA-transformed carrot (Daucus carota L.) roots were inoculated with Glomus intraradices and treated with Pb(NO3)2 solution and the extraradical spores and mycelia (S/M) and the root with the vesicles, mycelia, and root cells were subsequently analyzed by polarized energy dispersive x-ray fluorescence (PEDXRF) spectrometry. Upon Pb treatment, within the root, the percentages of mycorrhizal colonization, the vesicles, and mycelia increased as well as the areas of the vesicles and the (extraradical) spores, although the number of spores and arbuscules decreased. The S/M and the mycorrhizal root showed enhanced concentrations of Pb, Fe, and P. These were particularly marked for Fe in the Pb-treated cultures. This indicates a synergistic relationship between the arbuscular mycorrhizal fungus and the host that confers a higher Pb tolerance to the latter by the induction of higher Fe absorption in the host. The intraradical vesicle, mycelia, and arbuscule numbers are interpreted as a "tactic to divert" the intraradical Pb traffic away from the root cells to the higher affinity cell walls of the arbuscular mycorrhizal fungi (AMF) microstructures in the apoplast. The results of this work show that the symbiosis between the AMF G. intraradices and the host plant D. carota distinctly improves the latter's Pb tolerance, and imply that the appropriate metal tolerant host-AMF combinations could be employed in process designs for the phytoremediation of Pb.
https://ift.tt/2zBVlfI
Comparison of the contents of selected elements and pesticides in honey bees with regard to their habitat
Abstract
The inspiration for this study was the anxiety of Warsaw beekeepers, who raised the question whether location of hives in large urban agglomerations results in changes in concentrations of xenobiotics, toxic elements, and micronutrients in honey bees. Preliminary studies required elaboration of the research methodology, as the studied object is characterized by a low degree of homogeneity and the method of sample preparation affects obtained results. From many tested approaches, the use of washed and milled abdomens of the bees is recommended. Results obtained for such prepared samples are slightly lower than for whole bees, but their repeatability is higher, which enables easier interpretation of the trends and comparison of different locations. The contents of selected elements (As, Al, Cd, Co, Cr, Cu, Mn, Pb, and Zn) were compared in bees from urban and rural areas. The studies were supported by pesticides analysis. Also, it was checked whether these substances are accumulated on the surface or inside the bee's body. The research indicates the markers of contamination: Al, As, and Cr on the surface and Cd inside the bodies of honey bees. The location of the hives does not influence significantly the content of "toxic," nutrient metals and metalloids in bees (slightly higher levels of As, Al, Pb, and Cd were found in bees from urban areas). In terms of exposure to these elements and pesticides, the large city environment is not harmful for honey bees.
https://ift.tt/2AOT7vc
Probiotics as treatment for food allergies among pediatric patients: a meta-analysis
The burden of disease of food allergy is increasing worldwide. The standard of management is allergen avoidance and symptomatic treatment. Probiotics have been proposed to be beneficial for treatment and preve...
https://ift.tt/2F3TeqD
Revision Parathyroidectomy Using 4D CT for Localization
Finding a tiny tumor in a field of scar or localizing an ectopic parathyroid before primary surgery is like searching...https://ift.tt/2PMh924
Otologist-Neurotologist Joins Memorial Hermann and UTHealth
Aniruddha ("Alok") Patki, MD, has joined the Department of Otolaryngology-Head and Neck Surgery as assistant professor of otology-neurotology at McGovern...https://ift.tt/2RCyZ4R
Meet Amy Martin, MSN, APRN, ACNP-BC, CCRN, Newest Member of the ORL Team
Amy Martin chose nursing as a career when she was 8 years old, dressed as a pumpkin. "It was Halloween...https://ift.tt/2D6uZph
Two ORL Specialists Named Super Doctors Rising Stars
William Yao, MD, and Kunal Jain, MD, were named by their peers as Super Doctors Rising Stars® in Texas. Following...https://ift.tt/2PhyxMZ
Differenzialdiagnostik von Lipödem und Lymphödem
Zusammenfassung
Das Lipödem ist eine Erkrankung des subkutanen Fettgewebes der Extremitäten, die nahezu ausschließlich Frauen im postpubertären Alter betrifft. Charakteristisch ist die Kombination aus disfigurierender Fettgewebshypertrophie der proximalen Extremitäten, zunehmender Schmerzhaftigkeit und Hämatomneigung. Lymphödeme können primär oder sekundär bei beiden Geschlechtern auftreten. Typisch ist das Missverhältnis von Lymphlast und Kapazität der lymphatischen Gefäße. Stets sind die distalen Abschnitte des Körpers stärker betroffen als die proximalen. Zu Beginn ist das Lymphödem schmerzlos, im fortgeschrittenen Stadium kann ein Spannungsschmerz hinzutreten. Die Kombination beider Erkrankungen ist beschrieben, jedoch ist das Lipödem nicht als Ursache eines Lymphödems anzusehen, ganz im Gegenteil zur zentralen Adipositas. Diese erhöht das Risiko für Lymphödeme beträchtlich. Die Differenzierung der Diagnosen ist für eine sinnvolle Therapieplanung essenziell.
https://ift.tt/2PhybG9
Epidemiologie des nichtkleinzelligen Lungenkarzinoms in Deutschland
Zusammenfassung
Bei etwa 80 % der bösartigen Lungentumoren handelt es sich um nichtkleinzellige Lungenkarzinome (NSCLC). Im Jahr 2014 wurden in Deutschland rund 43.000 Neuerkrankungen am NSCLS diagnostiziert, davon etwas mehr als ein Drittel bei Frauen (15.000). Adeno- und Plattenepithelkarzinome sind die beiden am häufigsten vorkommenden Subtypen. Der Anteil der Adenokarzinome steigt in den letzten Jahren bei beiden Geschlechtern an − ein Trend, der auch international beobachtet werden kann. Als wichtigster Risikofaktor gilt das Tabakrauchen, wobei Adenokarzinome häufiger bei Nichtrauchern auftreten als andere histologische Subtypen. Daher spielen hier wahrscheinlich andere Risikofaktoren wie Radon- oder Feinstaubbelastung − relativ gesehen − eine größere Rolle. Zwischen den Subtypen des NSCLS finden sich teilweise deutliche Unterschiede in der Verteilung der Tumorstadien und in den Überlebensraten.
https://ift.tt/2PDboUz
Lebensqualität von Überlebenden eines nichtkleinzelligen Lungenkarzinoms
Zusammenfassung
Hintergrund
Eine Erkrankung an nichtkleinzelligem Lungenkarzinom (NSCLC) bringt eine Vielzahl von körperlichen, psychischen und sozialen Belastungen mit sich. Diese können auch noch lange Zeit nach der Erkrankung Auswirkungen auf die Lebensqualität der Betroffenen haben.
Ziel
Es erfolgt eine Beschreibung von Faktoren, die mit der Lebensqualität von NSCLC-Überlebenden assoziiert sind sowie eine Übersicht über erforderliche Bestandteile der Nachsorge und Möglichkeiten von Survivorship-Care-Plänen.
Methoden
Ein narratives Literaturreview wurde auf der Basis einer PubMed-Recherche durchgeführt.
Ergebnisse
NSCLC-Überlebende haben häufig persistierende Symptome und psychosoziale Auswirkungen der Erkrankung und Therapie. Besonders häufig beeinträchtigte Bereiche der Lebensqualität sind die körperliche und Rollenfunktion. Faktoren, die sich auf die Lebensqualität auswirken umfassen u. a. physische Symptome (Atemnot, Fatigue, Schmerzen, Husten, Schlafstörungen), Therapie, Rezidive/Zweittumoren, Komorbiditäten, psychische Belastung (Ängstlichkeit, Depressivität) sowie soziodemografische Faktoren (Alter, Geschlecht, Alleinleben). Eine patientenzentrierte Nachsorgeplanung sollte möglichst frühzeitig den Zugang zu supportiven Therapien, palliativmedizinischer Intervention, psychosozialer Unterstützung, Unterstützung zur Lebensstiländerung und regelmäßigen Nachsorgeuntersuchungen sicherstellen. Eine besondere Bedeutung kommt der Entwicklung und Implementierung von Survivorship-Care-Plänen zu, die darauf abzielen, die Versorgungskontinuität zu gewährleisten sowie Langzeiteffekten und Spätfolgen vorzubeugen oder diese zu lindern.
Schlussfolgerung
NSCLC-Überlebende haben vielfältige Einschränkungen der Lebensqualität. Patientenzentrierte, strukturierte Versorgungsmodelle könnten einen wichtigen Beitrag zur langfristigen Erhaltung ihrer Lebensqualität leisten.
https://ift.tt/2RyGiL0
Psychoonkologische Versorgung von Hirntumorpatienten
Zusammenfassung
Hintergrund
Die Diagnose Hirntumor löst nicht nur beim Betroffenen selbst, sondern auch bei den Angehörigen existenzielle Ängste und größte Unsicherheit aus und ist eine enorme Herausforderung für alle Beteiligten.
Ziel
Psychoonkologische Screeningverfahren und Ergebnisse werden diskutiert sowie Interventionen für Hirntumorpatienten vorgestellt.
Material und Methoden
Nach einer Literaturrecherche und Diskussion der besonderen Belastung von Hirntumorpatienten und ihren Angehörigen werden psychoonkologische Interventionsmöglichkeiten vorgestellt.
Ergebnisse
Die Mehrheit der Patienten fühlt sich zu Erkrankungsbeginn überschwellig belastet. Im längerfristigen Krankheitsverlauf treten bei ca. 20 % Depressionen auf, wobei Patienten mit psychiatrischen Vorerkrankungen häufiger betroffen sind. Als psychoonkologische Screeningverfahren können die Hospital Anxiety and Depression Scale (HADS) oder das Distress-Thermometer (DT) eingesetzt werden. Bei überschwelligen Werten in der HADS oder DT ≥ 5 und emotionale Probleme ≥2 sollte ein psychoonkologisches Gespräch erfolgen. Insbesondere DKG-zertifizierten neuroonkologischen Tumorzentren halten ein psychoonkologisches Gesprächsangebot für Patienten und Angehörige vor. Die Angebote sollten zeitnah und niederschwellig sein, um die psychosozialen Belastungen zu reduzieren, die Lebensqualität zu erhöhen und subsyndromale Krankheitssymptome zu erkennen.
Diskussion
Spezifische Interventionen für Hirntumorpatienten gibt es bislang kaum. Wirksame psychoonkologische Interventionen sind Psychoedukation, psychotherapeutische Gespräche und Entspannungsverfahren. Zusätzlich sollten die Betroffenen zu körperlicher Aktivität und kultureller und gesellschaftlicher Teilhabe ermutigt werden.
https://ift.tt/2PO0s6E
Neue Aspekte in der Therapie von Schilddrüsenkarzinomen
Zusammenfassung
Während die chirurgische Therapie beim Schilddrüsenkarzinom v. a. in frühen Stadien eine wichtige Rolle einnimmt, wird im palliativen Setting ein multimodaler Ansatz verfolgt, der neben der klassischen Chemotherapie v. a. die Therapie mit Tyrosinkinaseinhibitoren beinhaltet. Es erfolgt eine Analyse der auf dem ASCO-Kongress 2018 präsentierten Studien zum Schilddrüsenkarzinom. Es wurden v. a. Studien zur Therapie des radiojodrefraktären differenzierten Schilddrüsenkarzinoms, des anaplastischen Schilddrüsenkarzinoms sowie zur Immuntherapie ausgewählt und analysiert. Klinisch und präklinisch relevante Studien werden in diesem Review vorgestellt und kritisch interpretiert.
https://ift.tt/2SJQMsp
Highlights der ASCO Jahrestagung 2018 zur Immuntherapie von Kopf-Hals-Tumoren
Zusammenfassung
Hintergrund
In der Kopf-Hals-Onkologie gewinnen immuntherapeutische Konzepte an Bedeutung und wurden bei dem diesjährigen amerikanischen Krebskongress in relevanter Anzahl präsentiert.
Ziel der Arbeit
In dieser Arbeit sollen die interessantesten Studien und Studienergebnisse der Immuntherapie von Kopf-Hals-Tumoren zusammengefasst werden.
Material und Methoden
Alle ASCO Abstracts und Präsentationen zur Immuntherapie von Kopf-Halstumoren wurden beurteilt und die interessantesten Studien aufgearbeitet.
Ergebnisse
Auch wenn unmittelbar praxisverändernde Ergebnisse großer Phase-III-Studien ausblieben, wurden einige nennenswerte Ansätze und neue Erkenntnisse für die Immuntherapie von Kopf-Hals-Tumoren präsentiert. Neoadjuvante Immuntherapiestudien, Ergebnisse zur Immuntherapie im Alter, zum prognostischen Einfluss immunvermittelter Nebenwirkungen und neue Immuntherapiekombinationen werden hier zusammengefasst.
Schlussfolgerung
Die Rolle der Immuntherapie erreicht in der Behandlung von Kopf-Hals-Tumoren einen zunehmenden Stellenwert. Viele wegweisende Studien befinden sich derzeit in der Durchführung, Auswertung oder Planung.
https://ift.tt/2zvZQbo
MERRF syndrome (Myoclonic Epilepsy with Ragged Red Fibres) presenting with cervicothoracic lipomatosis
Publication date: Available online 5 November 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Carré, R. Hervochon, C. Foirest, F. Tankéré
Abstract
Introduction
Patients with MERRF syndrome (Myoclonic Epilepsy with Ragged Red Fibres) usually present with encephalomyopathy. However, progressive, recurrent cervicothoracic lipomatosis may be rarely observed.
Case report
The authors report 4 cases of MERRF syndrome associated with lipomatosis. In 3 patients, the diagnosis of MERRF syndrome was established on the basis of the clinical features of the lipomas and clinical interview revealing a personal or family history of lipomas and myopathy.
Discussion
In the presence of extensive spinal lipomatosis, the presence of other clinical signs of MERRF syndrome in the patient or the patient's family must be investigated. A diagnosis of MERRF syndrome can guide appropriate genetic counselling.
https://ift.tt/2AO43Jj
Salvage Chemoradiation Therapy for Recurrence After Radical Surgery or Palliative Surgery in Esophageal Cancer Patients
Interventions: Radiation: Involved field irradiation; Radiation: Elective field irradiation; Drug: Paclitaxel; Drug: Lobaplatin; Drug: PEG-rhG-CSF
Sponsors: Chinese Academy of Medical Sciences; The First Affiliated Hospital with Nanjing Medical University; Tianjin Medical University Cancer Institute and Hospital; Anyang Cancer Hospital; Fujian Cancer Hospital; Beijing Cancer Hospital; Hebei Medical University Fourth Hospital
Recruiting
https://ift.tt/2PPJPHL
SHR-1316 in Combination With Chemotherapy in Patients With Esophageal Squamous Cell Cancer
Interventions: Drug: Irinotecan liposome; Drug: SHR-1316; Drug: Fluorouracil
Sponsor: Jiangsu HengRui Medicine Co., Ltd.
Recruiting
https://ift.tt/2RAyM2b
Study of the Efficacy of Lenvatinib Combined With Denosumab in the Treatment of Patients With Predominant Bone Metastatic Radioiodine Refractory Differentiated Thyroid Carcinomas
Intervention: Drug: Lenvatinib + Denosumab
Sponsor: Centre Leon Berard
Not yet recruiting
https://ift.tt/2PGmKHm
Stretching of the Diaphragm and Cervical Impulse Technique and Its Possible Spirometric Changes
Interventions: Procedure: Stretching the diaphragm muscle; Procedure: Impulse technique in rotation of cervical level 3 and 4; Procedure: Combined technique of diaphragm muscle stretch and cervical rotation impulse technique level 3 and 4
Sponsor: Cardenal Herrera University
Not yet recruiting
https://ift.tt/2RFe1Tc
Lidocaine to Prevent Cough and Hemodynamic Changes in Tracheal Extubation
Interventions: Drug: Lidocaine; Drug: Saline Solution
Sponsor: Hospital Fernandez
Not yet recruiting
https://ift.tt/2PHjCuz
Salvage Chemoradiation Therapy for Recurrence After Radical Surgery or Palliative Surgery in Esophageal Cancer Patients
Interventions: Radiation: Involved field irradiation; Radiation: Elective field irradiation; Drug: Paclitaxel; Drug: Lobaplatin; Drug: PEG-rhG-CSF
Sponsors: Chinese Academy of Medical Sciences; The First Affiliated Hospital with Nanjing Medical University; Tianjin Medical University Cancer Institute and Hospital; Anyang Cancer Hospital; Fujian Cancer Hospital; Beijing Cancer Hospital; Hebei Medical University Fourth Hospital
Recruiting
https://ift.tt/2PPJPHL
SHR-1316 in Combination With Chemotherapy in Patients With Esophageal Squamous Cell Cancer
Interventions: Drug: Irinotecan liposome; Drug: SHR-1316; Drug: Fluorouracil
Sponsor: Jiangsu HengRui Medicine Co., Ltd.
Recruiting
https://ift.tt/2RAyM2b
Study of the Efficacy of Lenvatinib Combined With Denosumab in the Treatment of Patients With Predominant Bone Metastatic Radioiodine Refractory Differentiated Thyroid Carcinomas
Intervention: Drug: Lenvatinib + Denosumab
Sponsor: Centre Leon Berard
Not yet recruiting
https://ift.tt/2PGmKHm
Stretching of the Diaphragm and Cervical Impulse Technique and Its Possible Spirometric Changes
Interventions: Procedure: Stretching the diaphragm muscle; Procedure: Impulse technique in rotation of cervical level 3 and 4; Procedure: Combined technique of diaphragm muscle stretch and cervical rotation impulse technique level 3 and 4
Sponsor: Cardenal Herrera University
Not yet recruiting
https://ift.tt/2RFe1Tc
Lidocaine to Prevent Cough and Hemodynamic Changes in Tracheal Extubation
Interventions: Drug: Lidocaine; Drug: Saline Solution
Sponsor: Hospital Fernandez
Not yet recruiting
https://ift.tt/2PHjCuz
The characteristics and pivotal roles of triggering receptor expressed on myeloid cells-1 in autoimmune diseases
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Sheng Gao, Yongdong Yi, Guojun Xia, Chengyang Yu, Chenmin Ye, Fuyang Tu, Leibin Shen, Wenqian Wang, Chunyan Hua
Abstract
Triggering receptor expressed on myeloid cells-1 (TREM-1) engagement can directly trigger inflammation or amplify an inflammatory response by synergizing with TLRs or NLRs. Autoimmune diseases are a family of chronic systemic inflammatory disorders. The pivotal role of TREM-1 in inflammation makes it important to explore its immunological effects in autoimmune diseases. In this review, we summarize the structural and functional characteristics of TREM-1. Particularly, we discuss recent findings on TREM-1 pathway regulation in various autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), type 1 diabetes (T1D), and psoriasis. This receptor may potentially be manipulated to alter the inflammatory response to chronic inflammation and possible therapies are explored in this review.
https://ift.tt/2D68LDK
Target Therapy in SLE
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Matthias Schneider
Abstract
The intention of this paper is to review actual developments in target therapy in SLE. Target therapy includes both the objective of intervention and the aim of treatment. The objective should be linked to the pathophysiologic process of SLE; the aim has to be in any case an improved outcome.
The current therapeutic in SLE is guided mostly by secondary prevention. In SLE, besides a BASIC concept with antimalarials, bone and sun protection, vaccination and cardiovascular risk minimising, treatment waits for new manifestations to be started to prevent secondarily damage. With the new treatment target remission, treatment should aim at ensuring long-term survival, preventing organ damage and optimizing health-related quality-of-life by controlling disease activity and minimising comorbidities and drug toxicity. First examples show that some patients are in remission and that those patients have a better outcome. But for treat-to-target a strategy needs to be developed that needs to be evaluated.
https://ift.tt/2Pf0EvS
Dampness and mold hypersensitivity syndrome and vaccination as risk factors for chronic fatigue syndrome
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Tamara Tuuminen, Tiina Jääskeläinen, Kirsi Vaali, Olli Polo
https://ift.tt/2D3nFdY
Adrenal Insufficiency in Systematic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS): A Systematic Review
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Keum Hwa Lee, HyunJeong Lee, Cheol-hun Lee, Jin Yeong Kim, Jong Min Kim, Se Seung Kim, Seungmin Jeong, In Sung Hwang, Namsoo Kim, Na Eun Kim, Soogeun Shin, Dongkwan Shin, Joo Sang Song, Dong Hyun Shin, Jung Dong Kim, Jeehoon Kim, Yong Seok Lee, Hansung Kang, Dong Ha Kim, So Hyun Moon
Abstract
Background: Adrenal insufficiency (AI) is associated with high morbidity and mortality. The aim of this systematic review was to enhance diagnostic approaches and summarize therapeutic strategies in the management of AI in patients with an underlying prior disease history.
Methods: A literature search of PubMed and EMBASE databases was performed and 91 publications containing 105 cases were included for the final analysis.
Results: The following frequency of clinical signs and symptoms was noted: abdominal pain (39.04%) was the leading symptom, followed by fever (33.33%), vomiting (23.81%), and nausea (19.05%). Antiphospholipid syndrome (APS) was present in 73%, systematic lupus erythematosus (SLE) in 17% of the patients, while 2% had a diagnosis of both, SLE and APS. ACTH stimulation test (ACTHst) was performed in 18% of cases and 76.6% of them were unresponsive towards stimulation. Variable treatment approaches were used: hydrocortisone was most commonly used (38.09%), followed by fludrocortisone (26.67%), prednisolone (20.00%) and volume replacement treatment (11.43%), respectively.
Conclusions: This analysis highlights the importance of an early diagnosis and initiation of therapeutic management when AI is suspected. In line, signs and symptoms related to autoimmune diseases in patients with AI should be reviewed crtitically.
https://ift.tt/2P9niWy
Liver-Associated Immune Abnormalities
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Eyal Grunebaum, Yaron Avitzur
Abstract
In recent years, the cross talk between the liver and the immune system is being uncovered, in part by studying liver involvement in primary immune deficiencies (PID) and in part by investigating the alterations of the immune system following orthotic liver transplantation (OLT). Here we review some of the reciprocal interactions between the liver and the immune system. Patients with PID, particularly those involving inherited defects in T and B cells or innate immunity are prone to infections and inflammatory responses that often involve the liver. Omenn's syndrome, familial hemophagocytic lymphohistiocytosis, AIRE, FOXP3 and CD25 deficiencies, common variable immunodeficiency, CD40 ligand deficiency, chronic granulomatous disease and autoimmune lymphoproliferative syndrome are some of the notable PID associated with typical hepatobiliary abnormalities. Knowledge gained from studying these PID together with laboratory and histological evaluations can assist in managing PID-associated liver dysfunction. The liver itself also has important effects on the immune system, as evident from the growing experience with patients surviving OLT. Up to 40% of pediatric patients who receive OLT suffer from post transplantation allergy, autoimmunity, and immune-mediated disorders (PTAA). PTAA is more common after liver and heart transplantations than kidney transplantations. Potential contributing factors for the increased frequency of PTAA after OLT include the age of the patients, the prolonged use of tacrolimus and the reduced regulatory immune function with a shift towards a TH2 immune response. Better understanding of the mechanisms leading to the development of PTAA after OLT will also improve the management of these conditions.
https://ift.tt/2D9w8g3
Arthritis in primary Sjögren's syndrome: Characteristics, outcome and treatment from French multicenter retrospective study
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Adrien Mirouse, Raphaèle Seror, Eric Vicaut, Xavier Mariette, Maxime Dougados, Anne-Laure Fauchais, Alban Deroux, Azeddine Dellal, Nathalie Costedoat-Chalumeau, Guillaume Denis, Jérémie Sellam, Jean-Benoît Arlet, Christian Lavigne, Geoffrey Urbanski, Dominique Fischer-Dumont, Abdou Diallo, Olivier Fain, Arsène Mékinian, on behalf of Club Rhumatismes Inflammation and SNFMI
Abstract
Objective
To describe the characteristics and the outcome of primary Sjögren Syndrome (pSS) associated arthritis and to compare the efficacy of different therapeutic regimen.
Methods
We conducted a retrospective study using Club Rhumatisme and Inflammation (CRI) and French Internal Medicine Society (SNFMI) networks. All patients with a diagnosis of pSS and at least one episode of clinical and/or echographic synovitis were included. Patients with synovitis (cases) were compared to pSS patients without synovitis (controls).
Results
57 patients (93% women) were included with a median age of 54 years [45–63]. Patients with synovitis had more frequently lymph node enlargement (12.3% vs. 1.8%, p = .007) and a higher ESSDAI score (8 [[6], [7], [8], [9], [10], [11], [12]] vs. 2 [[1], [2], [3], [4]], p < .0001). There was no difference concerning CRP levels, rheumatoid factor and cyclic citrullinated peptide (CCP)-antibodies positivity. Among 57 patients with synovitis, 101 various treatment courses have been used during the follow-up of 40 [22.5–77] months. First treatment course consisted in steroids alone (3.5%), steroids in association (79%) with hydroxychloroquine (HCQ) (49%), methotrexate (MTX) (35%), rituximab (RTX) (5.3%) or other immunosuppressive drugs (7%). HCQ, MTX, and RTX were associated with a significant reduction of tender and swollen joint count, and a significant steroids-sparing effect. No difference could be shown for the joint response between these treatment regimens.
Conclusion
pSS articular manifestations may include synovitis which could mimic rheumatoid arthritis but differ by the absence of structural damage. Even if the use of HCQ, MTX, and RTX seem to be effective for joint involvement, the best regimen remains to be determined.
https://ift.tt/2PhY7kY
VALIDATION and meta-analysis of kappa index biomarker in multiple sclerosis diagnosis
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Paloma Menéndez-Valladares, Maria Isabel García-Sánchez, Myriam Adorna Martínez, Jose Luis García De Veas Silva, Carmen Bermudo Guitarte, Guillermo Izquierdo Ayuso
Abstract
The importance of studying the cerebrospinal fluid (CSF) in Multiple Sclerosis (MS) is included in the last McDonald criteria (2018). The study of oligoclonal IgG bands (OCGB) assay is strongly recommended in some situations in which MS diagnosis is uncertain. New biomarkers are developed during the last years. Kappa free light chains (FLC) can predict conversion to MS in patients with Clinically Isolated Syndrome (CIS).
The aim of this work is to validate the clinical usefulness of the kappa index, and to establish the actual state of knowledge for kappa index as a biomarker of conversion in CIS patients by a meta-analysis. Kappa index seems more relevant than the mere concentration of kappa FLC in CSF.
In the validation study, 334 patients were included; in which 100 were CIS patients. Patients were divided in two groups according kappa index cut-off of 10.62: group 1 (kappa index>10.62); group 2 (kappa index<10.62). In group 1 more patients had positive OCGB, IgG index>0.56 and fulfilled magnetic resonance imaging (MRI) criteria. In contrast, in group 2, more patients showed negative OCGB, IgG index<0.56 and did not fulfilled MRI criteria. While 67.6% of patients from group 1 converted to MS, only 12.5% of patients from group 2 converted to MS. An HR of 6.02 was obtained in the Kaplan-Meier analysis.
In the meta-analysis, 8 studies were finally included. The SROC curve revealed a high diagnostic performance for the kappa index as a MS diagnostic biomarker. Despite heterogeneity found between studies, the global OR revealed a good discriminatory capacity of kappa index.
In conclusion, kappa index has a great clinical sensitivity and specificity as a support in MS diagnosis. High kappa index increase the probability of CIS to MS conversion. A correct sample processing in the preanalytical stage is key to obtain right results and to allow establishing comparison between laboratories.
https://ift.tt/2D4C7Tg
X chromosome and female bias in systemic lupus erythematosus: Focus on population-based evidence
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Dongsheng Di, Hui Yuan, Linlin Zhang, Xiaoxiao Wu, Haifeng Pan, Dongqing Ye, Ruixue Leng
https://ift.tt/2D1Pi7r
The characteristics and pivotal roles of triggering receptor expressed on myeloid cells-1 in autoimmune diseases
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Sheng Gao, Yongdong Yi, Guojun Xia, Chengyang Yu, Chenmin Ye, Fuyang Tu, Leibin Shen, Wenqian Wang, Chunyan Hua
Abstract
Triggering receptor expressed on myeloid cells-1 (TREM-1) engagement can directly trigger inflammation or amplify an inflammatory response by synergizing with TLRs or NLRs. Autoimmune diseases are a family of chronic systemic inflammatory disorders. The pivotal role of TREM-1 in inflammation makes it important to explore its immunological effects in autoimmune diseases. In this review, we summarize the structural and functional characteristics of TREM-1. Particularly, we discuss recent findings on TREM-1 pathway regulation in various autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), type 1 diabetes (T1D), and psoriasis. This receptor may potentially be manipulated to alter the inflammatory response to chronic inflammation and possible therapies are explored in this review.
https://ift.tt/2D68LDK
Target Therapy in SLE
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Matthias Schneider
Abstract
The intention of this paper is to review actual developments in target therapy in SLE. Target therapy includes both the objective of intervention and the aim of treatment. The objective should be linked to the pathophysiologic process of SLE; the aim has to be in any case an improved outcome.
The current therapeutic in SLE is guided mostly by secondary prevention. In SLE, besides a BASIC concept with antimalarials, bone and sun protection, vaccination and cardiovascular risk minimising, treatment waits for new manifestations to be started to prevent secondarily damage. With the new treatment target remission, treatment should aim at ensuring long-term survival, preventing organ damage and optimizing health-related quality-of-life by controlling disease activity and minimising comorbidities and drug toxicity. First examples show that some patients are in remission and that those patients have a better outcome. But for treat-to-target a strategy needs to be developed that needs to be evaluated.
https://ift.tt/2Pf0EvS
Dampness and mold hypersensitivity syndrome and vaccination as risk factors for chronic fatigue syndrome
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Tamara Tuuminen, Tiina Jääskeläinen, Kirsi Vaali, Olli Polo
https://ift.tt/2D3nFdY
Adrenal Insufficiency in Systematic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS): A Systematic Review
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Keum Hwa Lee, HyunJeong Lee, Cheol-hun Lee, Jin Yeong Kim, Jong Min Kim, Se Seung Kim, Seungmin Jeong, In Sung Hwang, Namsoo Kim, Na Eun Kim, Soogeun Shin, Dongkwan Shin, Joo Sang Song, Dong Hyun Shin, Jung Dong Kim, Jeehoon Kim, Yong Seok Lee, Hansung Kang, Dong Ha Kim, So Hyun Moon
Abstract
Background: Adrenal insufficiency (AI) is associated with high morbidity and mortality. The aim of this systematic review was to enhance diagnostic approaches and summarize therapeutic strategies in the management of AI in patients with an underlying prior disease history.
Methods: A literature search of PubMed and EMBASE databases was performed and 91 publications containing 105 cases were included for the final analysis.
Results: The following frequency of clinical signs and symptoms was noted: abdominal pain (39.04%) was the leading symptom, followed by fever (33.33%), vomiting (23.81%), and nausea (19.05%). Antiphospholipid syndrome (APS) was present in 73%, systematic lupus erythematosus (SLE) in 17% of the patients, while 2% had a diagnosis of both, SLE and APS. ACTH stimulation test (ACTHst) was performed in 18% of cases and 76.6% of them were unresponsive towards stimulation. Variable treatment approaches were used: hydrocortisone was most commonly used (38.09%), followed by fludrocortisone (26.67%), prednisolone (20.00%) and volume replacement treatment (11.43%), respectively.
Conclusions: This analysis highlights the importance of an early diagnosis and initiation of therapeutic management when AI is suspected. In line, signs and symptoms related to autoimmune diseases in patients with AI should be reviewed crtitically.
https://ift.tt/2P9niWy
Liver-Associated Immune Abnormalities
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Eyal Grunebaum, Yaron Avitzur
Abstract
In recent years, the cross talk between the liver and the immune system is being uncovered, in part by studying liver involvement in primary immune deficiencies (PID) and in part by investigating the alterations of the immune system following orthotic liver transplantation (OLT). Here we review some of the reciprocal interactions between the liver and the immune system. Patients with PID, particularly those involving inherited defects in T and B cells or innate immunity are prone to infections and inflammatory responses that often involve the liver. Omenn's syndrome, familial hemophagocytic lymphohistiocytosis, AIRE, FOXP3 and CD25 deficiencies, common variable immunodeficiency, CD40 ligand deficiency, chronic granulomatous disease and autoimmune lymphoproliferative syndrome are some of the notable PID associated with typical hepatobiliary abnormalities. Knowledge gained from studying these PID together with laboratory and histological evaluations can assist in managing PID-associated liver dysfunction. The liver itself also has important effects on the immune system, as evident from the growing experience with patients surviving OLT. Up to 40% of pediatric patients who receive OLT suffer from post transplantation allergy, autoimmunity, and immune-mediated disorders (PTAA). PTAA is more common after liver and heart transplantations than kidney transplantations. Potential contributing factors for the increased frequency of PTAA after OLT include the age of the patients, the prolonged use of tacrolimus and the reduced regulatory immune function with a shift towards a TH2 immune response. Better understanding of the mechanisms leading to the development of PTAA after OLT will also improve the management of these conditions.
https://ift.tt/2D9w8g3
Arthritis in primary Sjögren's syndrome: Characteristics, outcome and treatment from French multicenter retrospective study
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Adrien Mirouse, Raphaèle Seror, Eric Vicaut, Xavier Mariette, Maxime Dougados, Anne-Laure Fauchais, Alban Deroux, Azeddine Dellal, Nathalie Costedoat-Chalumeau, Guillaume Denis, Jérémie Sellam, Jean-Benoît Arlet, Christian Lavigne, Geoffrey Urbanski, Dominique Fischer-Dumont, Abdou Diallo, Olivier Fain, Arsène Mékinian, on behalf of Club Rhumatismes Inflammation and SNFMI
Abstract
Objective
To describe the characteristics and the outcome of primary Sjögren Syndrome (pSS) associated arthritis and to compare the efficacy of different therapeutic regimen.
Methods
We conducted a retrospective study using Club Rhumatisme and Inflammation (CRI) and French Internal Medicine Society (SNFMI) networks. All patients with a diagnosis of pSS and at least one episode of clinical and/or echographic synovitis were included. Patients with synovitis (cases) were compared to pSS patients without synovitis (controls).
Results
57 patients (93% women) were included with a median age of 54 years [45–63]. Patients with synovitis had more frequently lymph node enlargement (12.3% vs. 1.8%, p = .007) and a higher ESSDAI score (8 [[6], [7], [8], [9], [10], [11], [12]] vs. 2 [[1], [2], [3], [4]], p < .0001). There was no difference concerning CRP levels, rheumatoid factor and cyclic citrullinated peptide (CCP)-antibodies positivity. Among 57 patients with synovitis, 101 various treatment courses have been used during the follow-up of 40 [22.5–77] months. First treatment course consisted in steroids alone (3.5%), steroids in association (79%) with hydroxychloroquine (HCQ) (49%), methotrexate (MTX) (35%), rituximab (RTX) (5.3%) or other immunosuppressive drugs (7%). HCQ, MTX, and RTX were associated with a significant reduction of tender and swollen joint count, and a significant steroids-sparing effect. No difference could be shown for the joint response between these treatment regimens.
Conclusion
pSS articular manifestations may include synovitis which could mimic rheumatoid arthritis but differ by the absence of structural damage. Even if the use of HCQ, MTX, and RTX seem to be effective for joint involvement, the best regimen remains to be determined.
https://ift.tt/2PhY7kY
VALIDATION and meta-analysis of kappa index biomarker in multiple sclerosis diagnosis
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Paloma Menéndez-Valladares, Maria Isabel García-Sánchez, Myriam Adorna Martínez, Jose Luis García De Veas Silva, Carmen Bermudo Guitarte, Guillermo Izquierdo Ayuso
Abstract
The importance of studying the cerebrospinal fluid (CSF) in Multiple Sclerosis (MS) is included in the last McDonald criteria (2018). The study of oligoclonal IgG bands (OCGB) assay is strongly recommended in some situations in which MS diagnosis is uncertain. New biomarkers are developed during the last years. Kappa free light chains (FLC) can predict conversion to MS in patients with Clinically Isolated Syndrome (CIS).
The aim of this work is to validate the clinical usefulness of the kappa index, and to establish the actual state of knowledge for kappa index as a biomarker of conversion in CIS patients by a meta-analysis. Kappa index seems more relevant than the mere concentration of kappa FLC in CSF.
In the validation study, 334 patients were included; in which 100 were CIS patients. Patients were divided in two groups according kappa index cut-off of 10.62: group 1 (kappa index>10.62); group 2 (kappa index<10.62). In group 1 more patients had positive OCGB, IgG index>0.56 and fulfilled magnetic resonance imaging (MRI) criteria. In contrast, in group 2, more patients showed negative OCGB, IgG index<0.56 and did not fulfilled MRI criteria. While 67.6% of patients from group 1 converted to MS, only 12.5% of patients from group 2 converted to MS. An HR of 6.02 was obtained in the Kaplan-Meier analysis.
In the meta-analysis, 8 studies were finally included. The SROC curve revealed a high diagnostic performance for the kappa index as a MS diagnostic biomarker. Despite heterogeneity found between studies, the global OR revealed a good discriminatory capacity of kappa index.
In conclusion, kappa index has a great clinical sensitivity and specificity as a support in MS diagnosis. High kappa index increase the probability of CIS to MS conversion. A correct sample processing in the preanalytical stage is key to obtain right results and to allow establishing comparison between laboratories.
https://ift.tt/2D4C7Tg
X chromosome and female bias in systemic lupus erythematosus: Focus on population-based evidence
Publication date: Available online 5 November 2018
Source: Autoimmunity Reviews
Author(s): Dongsheng Di, Hui Yuan, Linlin Zhang, Xiaoxiao Wu, Haifeng Pan, Dongqing Ye, Ruixue Leng
https://ift.tt/2D1Pi7r
Hemorrhage within the tympanic membrane without perforation
Abstract
Background
Hemotympanum refers to both the presence of blood in the middle ear cavity and to ecchymosis of the tympanic membrane (TM), and a systematic study of intra-TM (iTM) hemorrhage without bleeding in the middle ear cavity has not been conducted. The goals of our study were to analyze the causes of iTM hemorrhage without TM perforation or bleeding in the middle ear cavity, and to demonstrate the clinical characteristics of the disease.
Methods
This Case series study included five patients with iTM hemorrhage between August 2014 and August 2017. An iTM hemorrhage was diagnosed when otoendoscopic examination demonstrated minor bleeding behind the intact TM, a hemorrhage was observed between the TM annulus and the epidermal layer, and temporal bone computed tomography revealed thickening of the TM without soft tissue density within the tympanic cavity or temporal bone fracture. Initial symptoms, and serial findings of otoendoscopy and pure tone audiometry (PTA) were investigated.
Results
iTM hemorrhage developed due to blunt head trauma in two patients, descent barotrauma during scuba diving in two patients, and spontaneous epistaxis in one patient. Otalgia and ear fullness were the most common symptoms, but PTA showed no or minimal conductive hearing loss in all patients.
Conclusions
An iTM hemorrhage may develop after blunt head trauma, barotrauma due to scuba diving, or spontaneous epistaxis; otological symptoms included otalgia, tinnitus, and aural fullness. An iTM hemorrhage resolved spontaneously without specific treatment, usually within 1 month.
https://ift.tt/2zvJ2kR
Clinical features of laryngeal myasthenia gravis: A case series
Publication date: Available online 5 November 2018
Source: American Journal of Otolaryngology
Author(s): XiangLi Yang, Liu Niu, ChunWei Yang, Lin Wang, JiXiang Liu, GuoYing He
Abstract
Background
Myasthenia gravis (MG) is an autoimmune disease. Dysarthria, dysphagia, and difficulty swallowing as exclusive initial and primary complaints in MG (laryngeal MG) are rare and seldom reported.
Methods
Here we review and analyze the largest series of laryngeal MG patients.
Results
A total of 30 patients with laryngeal MG as primary manifestation were found in 20 case reports/series. Dysarthria was the most frequent primary symptom (14/30), followed by dysphagia (11/30), slurred speech (4/30) and dysphonia (1/30). Sixty-three percent visited the otolaryngology department first. Only 23.33% of patients were diagnosed with MG at the first clinic visit. Forty-five percent laryngeal MG patients were acetylcholine receptor (AChR) antibody positive, 52.9% showed decremental response in the repetitive nerve stimulation (RNS) test, and 92.6% were positive in the neostigmine/edrophonium test. Fluctuating weakness was examined in 16 of 30 patients and observed in 14/16 patients.
Conclusion
Laryngeal MG is a rare and possibly under-diagnosed condition. The patients can present with dysarthria, dysphagia, or difficulty swallowing. Fluctuation in severity of disease by neostigmine/edrophonium test is a typical feature for MG patients. AChR antibody and RNS tests should be included to evaluate the pathologic changes in the neuromuscular junction.
https://ift.tt/2D5xeJu