Head and Neck Diseases by Alexandros G.Sfakianakis: 01/19/19

Σάββατο 19 Ιανουαρίου 2019

Light-absorbing impurities in snow of the Indian Western Himalayas: impact on snow albedo, radiative forcing, and enhanced melting

Abstract

Seasonal snow cover in the Himalayas acts as source of fresh water for several Asian rivers such as Indus, Ganges, Brahmaputra, and Yangtze. Early loss of seasonal snow exposes the ice layer of the glaciers directly to sunlight, consequently leading to their ablation and alterations in discharge of glacier-fed rivers. Therefore, any alteration in the melting rate of the Himalayan snow pack can significantly affect the ecological balance in the region. Besides global warming, enhanced melting of snow, caused by light-absorbing impurities (LAIs) such as dust and elemental carbon (EC), has also been recognized as prominent cause of enhanced melting of snow in the Himalayas of China and Nepal. However, in light of vast area of the Himalayas and persistent emissions from India, studies, emphasizing the potential of LAIs to substantially affect the snow radiation budget of snow cover in IWHs, are still scanty. Therefore, in this study, field campaigns were made on three glaciers, i.e., Hamta, Beas Kund, and Deo Tibba, in IWHs to collect snow samples for estimation of LAIs. Snow of the studied glaciers was observed to be contaminated with 13.02 to 74.57 ng/g of EC and 32.14 to 216.54 μg/g of dust. Albedo simulations done using SNow and ICe Aerosol Radiation (SNICAR) model indicated that besides the changes caused by increased grain size, EC and dust, cumulatively induced 0.60 to 32.65% reduction in albedo of snow. Further assessment, constrained by measurements, illustrated that radiative forcing (RF), of 1.8 to 80 W/m², was instigated due to enhanced thermal absorption of snow. Ten hours of daily mean RFs in this range could correspond to 3 to 9.65 mm/d of snow melt and contribute significantly in reducing the seasonal snow cover in IWHs. Considering the consequences of LAIs-induced snow melt and lack of in situ observations in the IWHs, the outcomes of this study could assist researchers and policy makers in developing efficient climate models and framing mitigation measures, respectively.

http://bit.ly/2TWR3bc

The Impact of Immunodeficiency on NK Cell Maturation and Function

Abstract

Purpose of Review

Natural killer cells are innate lymphoid cells (ILCs) that play critical roles in human host defense and are especially useful in combating viral pathogens and malignancy.

Recent Findings

The NK cell deficiency (NKD) is particularly underscored in patients with a congenital immunodeficiency in which NK cell development or function is affected. The classical NK cell deficiency (cNKD) is a result of absent or a profound decrease in the number of circulating NK cells. In contrast, functional NKD (fNKD) is characterized by abnormal NK cell function but with normal number of NK cells. The combined immune deficiencies with significant impact on NK cells are not considered classical or functional NK cell deficiencies. In these disorders, the impairment of NK cells represents an important aspect of the overall immunodeficiency. In turn, this leads to improved insights on the NK cell development and function.

Summary

Here, we detail the NK cell biology based upon recent natural killer cell defects described in combined immune deficiencies.

http://bit.ly/2T6b0ME

Direct to Consumer Telemedicine

Abstract

Purpose of Review

Telemedicine uses technology to connect patients and data with providers at a distance. Direct to consumer telemedicine is a rapidly growing segment of the industry.

Recent Findings

The telehealth market has skyrocketed in recent years, making it a multi-billion dollar industry. Direct to consumer telehealth, dominated by the for-profit private sector, is the most popular form.

Summary

Direct to consumer telemedicine is a subset of telehealth that shows promise in increasing access to and engagement in medical care. Quality assurance, reimbursement, and regulatory oversight are important factors in assuring appropriate widespread adoption.

http://bit.ly/2AS1sOg

Low-Income Children with Neonatal Hypothyroidism Are at Increased Risk for Intellectual Disability

Clinical Thyroidology, Volume 31, Issue 1, Page 14-16, January 2019.

http://bit.ly/2sAVAEo

How Can Levothyroxine Overuse Be Reduced?

Clinical Thyroidology, Volume 31, Issue 1, Page 5-7, January 2019.

http://bit.ly/2Mlx0ke

An Increased Relative but Small Absolute Risk of Leukemia Can Be Attributed to I-131 Ablation

Clinical Thyroidology, Volume 31, Issue 1, Page 30-32, January 2019.

http://bit.ly/2szTJ2L

New miRNA-Based Classifier Test Uses FNA Cytology to Evaluate Cytologically Indeterminate Thyroid Nodules

Clinical Thyroidology, Volume 31, Issue 1, Page 23-26, January 2019.

http://bit.ly/2MoRQ28

Fear of Recurrence Affects Health-Related Quality of Life in Thyroid Cancer Patients

Clinical Thyroidology, Volume 31, Issue 1, Page 27-29, January 2019.

http://bit.ly/2sB9DtN

Clinical Validation of ThyroSeq V3 Shows High Sensitivity and Specificity

Clinical Thyroidology, Volume 31, Issue 1, Page 20-22, January 2019.

http://bit.ly/2MioqT4

A Mild Risk of Neonatal Hyperthyroidism Follows Preconception Radioactive Iodine Treatment for Graves’ Disease

Clinical Thyroidology, Volume 31, Issue 1, Page 11-13, January 2019.

http://bit.ly/2sKl2Yt

More Hürthle-Cell Aspirations Will Be Identified as Benign by the New Afirma GSC Test

Clinical Thyroidology, Volume 31, Issue 1, Page 17-19, January 2019.

http://bit.ly/2MmKaNz

Dyslipidemia Is Common in Patients with Hypothyroidism Despite Correction of Abnormal TSH: A Systematic Review and Meta-Analysis

Clinical Thyroidology, Volume 31, Issue 1, Page 8-10, January 2019.

http://bit.ly/2sB3ein

The Difficult to Access “Right-To-Try” U.S. Health Care Law

Clinical Thyroidology, Volume 31, Issue 1, Page 33-36, January 2019.

http://bit.ly/2MoJ5VS

Greetings From the New Editor of Clinical Thyroidology

Clinical Thyroidology, Volume 31, Issue 1, Page 4-4, January 2019.

http://bit.ly/2szOb8B

A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain

Abstract

Background

Chronic pain of the lower extremity remains challenging to manage. Radiofrequency treatment applies heat to nerve fibers with the goal of mitigating chronic pain conditions. The clinical efficacy has not yet been adequately established for pathologies of the ankle and foot. In this review paper, we report the use and efficacy of radiofrequency treatment applied to foot and ankle pain.

Recent Findings

PubMed and the Cochrane Controlled Trials Register were searched (final search 30 March 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," "plantar heel pain," "plantar fascitis," and "chronic pain" in the English literature. Of the 23 papers screened, 18 were further investigated for relevance. Our final search methodology yielded 15 studies that investigated the use of radiofrequency treatment at the ankle. Of these 15 studies, there were three randomized control trials, four prospective studies, three retrospective studies, and five case reports. The quality of selected publications was assessed using the Cochrane risk of bias instrument.

Summary

The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.

Conclusion

http://bit.ly/2MldDro

Adherence to Behavioral Therapy for Migraine: Knowledge to Date, Mechanisms for Assessing Adherence, and Methods for Improving Adherence

Abstract

Purpose of Review

In other disease states, adherence to behavioral therapies has gained attention, with a greater amount of studies discussing, defining, and optimizing adherence. For example, a meta-analysis formally discussed adherence in 25 studies of CBT for 11 different disorders, with only 6 of the 25 omitting addressing or defining adherence. Many studies have discussed the use of text messages, graph-based adherence rates, and email/telephone reminders to improve adherence. This paper examined the available literature regarding adherence to behavioral therapy for migraine as well as adherence to similar therapies in other disease states. The goal of this research is to apply lessons learned from adherence to behavioral therapy for other diseases in better understanding how we can improve adherence to behavioral therapy for migraine.

Recent Findings

Treatment for migraine typically includes both pharmacologic and non-pharmacologic therapies, including progressive muscle relaxation (PMR), cognitive behavioral therapy (CBT), and biofeedback. Behavioral therapies have been shown to significantly reduce headache frequency and intensity, but high attrition rates and suboptimal adherence can undermine their efficacy. Traditionally, adherence to behavioral therapy has been defined by self-report, including paper headache diaries and assignments. In person attendance has also been employed as a method of defining and monitoring adherence. With the advent of personal electronics, measurements of adherence have shifted to include electronic-based methods such as computer-based programs and mobile-based therapies. Furthermore, some studies have taken advantage of electronic methods such as email reminders, push notifications, and other mobile-based reminders to optimize adherence. The JITA-I, a novel method of engaging individual patient adherence, has also been suggested as a possible method to improve adherence by tailoring engagement with a mobile health app-based on patient input. These novel methods may be utilized in behavioral therapy for migraine for further optimizing adherence.

Summary

Few intervention studies to date have addressed the optimal ways to impact adherence to migraine behavioral therapy. Further research is required regarding adherence with behavioral therapies, specifically via mobile health interventions to better understand how to define and improve adherence via this novel forum. Once we are able to understand optimal methods of tracking adherence, we will be better equipped to understand the role of adherence in shaping outcomes for behavioral therapy in migraine.

http://bit.ly/2szdOGz

The Status of Pain Research in Academia and how We Are Doing in the United States

http://bit.ly/2MoRPv6

Imaging of Carotid Dissection

Abstract

Purpose of Review

Here, we describe the four primary imaging modalities for identification of carotid artery dissection, advantages, limitations, and clinical considerations. In addition, imaging characteristics of carotid dissection associated with each modality will be described.

Recent Findings

Recent advances in etiopathogenesis describe the genetic factors implicated in cervical artery dissection. MRI/MRA (magnetic resonance angiography) with fat suppression is regarded as the best initial screening test to detect dissection. Advances in magnetic resonance imaging for the diagnosis of dissection include the use of susceptibility-weighted imaging (SWI) for the detection of intramural hematoma and multisection motion-sensitized driven equilibrium (MSDE), which causes phase dispersion of blood spin using a magnetic field to suppress blood flow signal and obtain 3D T1- or T2*-weighted images. Digital subtraction angiography (DSA) remains the gold standard for identifying and characterizing carotid artery dissections.

Summary

Carotid artery dissection is the result of a tear in the intimal layer of the carotid artery. This leads to a "double lumen" sign comprised of the true vessel lumen and the false lumen created by the tear. The most common presentation of carotid artery dissection is cranial and/or cervical pain ipsilateral to the dissection. However, severe neurological sequelae such as embolic ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage can also result from carotid artery dissection. Carotid artery dissection can be identified by a variety of different imaging modalities including computed tomographic angiography (CTA), MRI, carotid duplex imaging (CDI), and digital subtraction angiography (DSA).

http://bit.ly/2szdKGP

Different Types of Maculopathy in Eyes after a High-Voltage Electrical Shock Injury

Background: We report a case of different types of maculopathy in eyes after a high-voltage electrical shock injury. Case Report: A 43-year-old male suffered high-voltage electrical injury through his left arm. He underwent cataract surgery in both eyes 3 months after the injury, but there was no vision improvement. Ocular examination, including spectral domain optical coherence tomography, revealed diffuse retinal atrophy in the left eye which did not change until the final visit. In the right eye, an impending macular hole was observed but regressed spontaneously 9 months after the injury, and the visual acuity improved to 20/32 at the final visit. Conclusion: Two different types of maculopathy can occur in each eye after high-voltage electrical shock injury, and this might be due to asymmetric pathogenesis of the eyes according to the proximity to the route of electrical current.
Case Rep Ophthalmol 2019;10:19–23

http://bit.ly/2RYYXDx

The Difficulty of Diagnosing Invasive Aspergillosis Initially Manifesting as Optic Neuropathy

Background: Invasive aspergillosis is often fatal. Here, we report a patient with invasive aspergillosis primarily involving the optic nerve diagnosed on autopsy. Case Presentation: A 77-year-old female with underlying diabetes mellitus, hyperlipidemia, and hypertension presented with disc swelling of the left eye. Although mini-pulse steroid therapy improved visual acuity (VA) of the left eye, it abruptly decreased to no light perception within a month, followed by a decrease in VA of the right eye to 0.5. At referral, VA was 0.3 in the right eye, and there was no light perception in the left eye. Results: Fundus examination revealed optic disc swelling of both eyes. Goldmann perimetry showed irregular visual field defects, whereas magnetic resonance imaging (MRI), general, and cerebrospinal fluid (CSF) examinations revealed no distinct abnormalities. We suspected anterior ischemic optic neuropathy and invasive optic neuropathy. As with the left eye, steroid pulse therapy temporarily improved VA of the right eye and then decreased to 0.2. Additional anticoagulant therapy did not improve VA. Concurrent to therapy, the patient became febrile with depressed consciousness. Repeat MRI identified suspected midbrain infarction, and CSF examination indicated cerebral meningitis. In spite of administering transfusions and antibiotics, she died on hospital day 40. Autopsy revealed large amounts of Aspergillus hyphae mainly localized in the dura mater of the optic nerve and destruction of the cerebral artery wall, suggesting an etiology of subarachnoid hemorrhage. Conclusions: When examining refractory and persistent disc swelling, we should rule out fungal infections of the optic nerve.
Case Rep Ophthalmol 2019;10:11–18

http://bit.ly/2Hn8ksN

Tonsillectomy plus steroid pulse therapy is the most effective treatment in adult patients with C-Grade I IgA nephropathy, and the weight of the extracted palatine tonsils and Yamamoto scale have no significant correlation with the effects of this treatment

Publication date: Available online 18 January 2019

Source: Auris Nasus Larynx

Author(s): Norio Kondo, Takahito Moriyama, Mayako Tachikawa, Erika Tomita, Ai Hattori, Yukie Yamamura, Manabu Nonaka

Abstract

Objective

We studied patients who underwent tonsillectomy plus steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN), in order to investigate the clinical factors associated with a positive response to this treatment.

Methods

We analyzed 118 IgAN patients who underwent TSP. We collected patients' data retrospectively, including age, sex, blood pressure, onset of IgAN, pathological findings of a renal biopsy, serum concentration of creatinine, estimated glomerular filtration rate, serum concentration of protein, urinary protein, hematuria, past history of tonsillitis, the Yamamoto scale, the weight and pathological findings of the extracted palatine tonsils, and the presence or absence of anti-platelet drugs and renin-angiotensin system inhibitors (RAS-I) usage. This study included participants who were over 18 years of age, had undergone tonsillectomy within three months of steroid pulse therapy administered thrice, in whom renal biopsy was performed within a year before treatment, and with follow-up period of over 3 years. Clinical remission (CR) of urinary abnormalities was defined as remission of both proteinuria and hematuria: three consecutive negative results over a 6-month period, with a urinary sediment red blood cell count of <5/HPF, and a proteinuria qualitative reaction of (−) to (±).

Results

The CR rate of all cases was 56.8% and statistical significance was observed with respect to the C-Grade (P = 0.0003, P = 0.028) using both univariate and multivariate analysis. The CR rate of C-Grade І (73.4%) patients was significantly higher than that of C-Grade II patients (39.0%; P = 0.0004) and C-Grade III patients (30.8%; P = 0.003). We analyzed clinical factors in each C-Grade patient. No statistical significance was observed with respect to any of the factors using univariate analysis in C-Grade I patients. The weight of the extracted palatine tonsils and Yamamoto scale showed no statistical significance in every analysis. Fibrosis or hyalinization of the stroma of the palatine tonsils showed statistical significance (P = 0.026) only in the univariate analysis of C-Grade III patients. However, the patient number of C-Grade III was small.

Conclusion

Our results indicate that TSP is mostly effective in patients with of C-Grade I IgAN and that the C-Grade reflects the clinical indication for TSP. The weight of the extracted palatine tonsils and Yamamoto scale did not show obvious correlations with the clinical effect of TSP.

http://bit.ly/2T4QDiO

Production, purification, and evaluation of quail immunoglobulin Y against Salmonella typhimurium and Salmonella enteritidis

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s): Atefeh Esmailnejad, Bahman Abdi-Hachesoo, Elhamsadat Hosseini Nasab, Maryam Shakoori

Abstract

Salmonella species have been the major foodborne problems in food production systems, with Salmonella enterica serovars typhimurium (S. typhimurium) and enteritidis (S. enteritidis) being among the more common isolates. The oral administration of chicken egg yolk specific antibodies (IgYs) has been established as an efficient alternative for treatment and prevention of gastrointestinal pathogens including Salmonella. The present study was aimed to investigate the possible production of specific IgYs against Salmonella typhimurium and Salmonella enteritidis in quail egg yolks. Salmonella spp.-free female Japanese quails (Coturnix coturnix japonica) were intramuscularly immunized with formalin or heat-inactivated Salmonella immunogens (1.0 × 10⁹ CFU/mL) emulsified with Freund adjuvants. Egg yolk IgYs were purified using ammonium sulfate precipitation method. Anti-Salmonella IgYs titer and specificity were determined using enzyme-linked immunosorbent assay (ELISA) and western blot analysis. Salmonella specific IgYs detected in the immunized quails were significantly higher than those of the control group, which confirmed the immunization procedure. Specific IgYs against S. typhimurium and S. enteritidis were identified in both groups immunized with heat or formalin-inactivated immunogens. However, formalin-inactivated immunogens induced relatively higher immune responses over the heat-inactivated ones. Quail anti-Salmonella IgYs showed a high specificity to their corresponding immunogens, with moderate cross-reactivity to other members of Enterobacteriaceae family. Quail can be regarded as a valuable and inexpensive source for producing large-scale of specific antibodies that can be used for immunodiagnostic and immunotherapeutic purposes.

http://bit.ly/2RVIoZf

Role of interleukin-17 in acute myocardial infarction

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s): Mónica Daniela Mora-Ruíz, Francisco Blanco-Favela, Adriana Karina Chávez Rueda, María Victoria Legorreta-Haquet, Luis Chávez-Sánchez

Abstract

Acute myocardial infarction (AMI) is a leading cause of death worldwide. Myocardial necrosis generates damage signals and triggers an intense inflammatory response. Many cytokines that contribute to repair tissue can also cause adverse left ventricular remodeling and heart failure. Several studies have revealed that interleukin-17 (IL-17) is a cytokine with a potential role in AMI. IL-17 plays an important role in the immune response and affects the production of different inflammatory mediators in several types of cells, involved in the damage or scar process in myocardial tissue. In this review, we will discuss the current knowledge of the role of IL-17 in AMI and the effect of IL-17 in different cells, such as cardiomyocytes, smooth muscle cells and immune system cells, in AMI pathogenesis.

http://bit.ly/2HmA5S8

Adverse events need for hospitalization and systemic immunosuppression in very elderly patients (over 80 years) treated with ipilimumab for metastatic melanoma

Abstract

Background

Checkpoint inhibitors are first-line therapies in melanoma, but safety in older adults has not yet been assessed. Ipilimumab improves survival, but immunologic-related adverse events (AEs) can be threatening, and its use in elderly people raises questions.

Aim

To assess safety in a cohort of very elderly patients treated with ipilimumab.

Methods

All patients over 80 years treated with ipilimumab for melanoma were retrospectively included. AE occurrence, management, and outcome, as well as response rate at week 16 and overall survival were recorded, and compared to data for a group of younger patients treated in our institution during the same period.

Results

In the elderly group, 23 patients were included with a median age of 82 years [80–90]. AEs amounting to 23 occurred in 15 patients (65%) with 5 grade 3 (22%) and 1 grade 5 (opportunistic infection) AEs. Corticosteroids were required for five (22%) patients, additive immunosuppressive therapy for two, hospitalization for four, and definitive interruption of ipilimumab for three. Median overall survival was 14 months. In the younger group, 29 patients were included with a median age of 58 years. AEs occurred in 15/29 (52%) with 4 grade 3 (19%) and 1 grade 4 (7%). Median OS was 17 months.

Conclusion

Serious AEs occurred in 80 + adults at the same rate as observed in our younger patients and as previously reported in younger populations. Ipilimumab can be an option in elderly patients, as patients may benefit from therapy and safety seems to be manageable.

http://bit.ly/2Taeiyg

The effect of everolimus and low-dose cyclophosphamide on immune cell subsets in patients with metastatic renal cell carcinoma: results from a phase I clinical trial

Abstract

For the treatment of metastatic renal cell cancer several strategies are used among which the mTOR inhibitor everolimus. As mTOR plays an important role in the immune system, e.g., by controlling the expression of the transcription factor FoxP3 thereby regulating regulatory T cells (Tregs), it plays a key role in the balance between tolerance and inflammation. Previous reports showed stimulatory effects of mTOR inhibition on the expansion of Tregs, an effect that can be considered detrimental in terms of cancer control. Since metronomic cyclophosphamide (CTX) was shown to selectively deplete Tregs, a phase 1 clinical trial was conducted to comprehensively investigate the immune-modulating effects of several dosages and schedules of CTX in combination with the standard dose of everolimus, with the explicit aim to achieve selective Treg depletion. Our data show that 50 mg of CTX once daily and continuously administered, in combination with the standard dose of 10 mg everolimus once daily, not only results in depletion of Tregs, but also leads to a reduction in MDSC, a sustained level of the CD8⁺ T-cell population accompanied by an increased effector to suppressor ratio, and reversal of negative effects on three peripheral blood DC subsets. These positive effects on the immune response may contribute to improved survival, and therefore this combination therapy is further evaluated in a phase II clinical trial.

http://bit.ly/2QUmxN5

Strong antigen-specific T-cell immunity induced by a recombinant human TERT measles virus vaccine and amplified by a DNA/viral vector prime boost in IFNAR/CD46 mice

Abstract

Cancer immunotherapy is seeing an increasing focus on vaccination with tumor-associated antigens (TAAs). Human telomerase (hTERT) is a TAA expressed by most tumors to overcome telomere shortening. Tolerance to hTERT can be easily broken both naturally and experimentally and hTERT DNA vaccine candidates have been introduced in clinical trials. DNA prime/boost strategies have been widely developed to immunize efficiently against infectious diseases. We explored the use of a recombinant measles virus (MV) hTERT vector to boost DNA priming as recombinant live attenuated measles virus has an impressive safety and efficacy record. Here, we show that a MV-TERT vector can rapidly and strongly boost DNA hTERT priming in MV susceptible IFNAR/CD46 mouse models. The cellular immune responses were Th1 polarized. No humoral responses were elicited. The 4 kb hTERT transgene did not impact MV replication or induction of cell-mediated responses. These findings validate the MV-TERT vector to boost cell-mediated responses following DNA priming in humans.

http://bit.ly/2RU1ezP

STAT3 inhibition specifically in human monocytes and macrophages by CD163-targeted corosolic acid-containing liposomes

Abstract

Tumor-associated macrophages (TAMs) are of major importance in cancer-related immune suppression, and tumor infiltration by CD163^pos TAMs is associated with poor outcome in most human cancers. Therefore, therapeutic strategies for reprogramming TAMs from a tumor-supporting (M2-like) phenotype towards a tumoricidal (M1-like) phenotype are of great interest. Activation of the transcription factor STAT3 within the tumor microenvironment is associated with worse prognosis, and STAT3 activation promotes the immunosuppressive phenotype of TAMs. Therefore, we aimed to develop a drug for inhibition of STAT3 specifically within human TAMs by targeting the endocytic CD163 scavenger receptor, which is highly expressed on TAMs. Here, we report the first data on a CD163-targeted STAT3-inhibitory drug consisting of corosolic acid (CA) packaged within long-circulating liposomes (LCLs), which are CD163-targeted by modification with monoclonal anti-CD163 antibodies (αCD163)—CA-LCL-αCD163. We show, that activation of STAT3 (by phosphorylation) was inhibited by CA-LCL-αCD163 specifically within CD163^pos cells, with minor effect on CD163^neg cells. Furthermore, CA-LCL-αCD163 inhibited STAT3-regulated gene expression of IL-10, and increased expression of TNFα, thus indicating a pro-inflammatory effect of the drug on human macrophages. This M1-like reprogramming at the mRNA level was confirmed by significantly elevated levels of pro-inflammatory cytokines (IFNγ, IL-12, TNFα, IL-2) in the culture medium. Since liposomes are attractive vehicles for novel anti-cancer drugs, and since direct TAM-targeting may decrease adverse effects of systemic inhibition of STAT3, the present results encourage future investigation of CA-LCL-αCD163 in the in vivo setting.

http://bit.ly/2RKg6ki

First in Houston to Offer a New Treatment for Obtructive Sleep Apnea

UT Physicians is now offering an alternative therapy for obstructive sleep apnea (OSA) when traditional approaches fail. The first six...

http://bit.ly/2ASN74f

Head and Neck Surgical Oncology: How Do We Make the Experience Better for the Patient?

By asking cancer patients what they want, physicians in the Head and Neck Surgical Oncology Program at Memorial Hermann and...

http://bit.ly/2T68Bl6

On a Mission: Dr. Yuksel Returns to Nicaragua

Pediatric otolaryngologist Sancak Yuksel, MD joined a team of otolaryngologists, nurses, audiologists, and speech pathologists supported by Oklahoma-based Mayflower Medical Outreach...

http://bit.ly/2ATqkFk

Radioguided Surgery of Non-palpable Neck Lymph Node in Lymphoma Patients

Abstract

Lymphomas have frequent relapses; early diagnosis is important to treat and improve outcomes. Clinical exam and imaging are useful but confirmation with biopsy is always required. Minimally exploratory surgery is a tool to take good samples with precision and safety. Evaluate the use of ROLL technique to track non-palpable lesions on the neck which were suspicious of recurrence in lymphoma patients. A retrospective review of the patients with high probability of lymphoma relapse who were biopsied using ROLL technique. Suspicious lesions on the neck where identified on the follow up of five lymphoma patients. Roll technique was used successfully to guide the biopsy. There were no complications. Relapse was confirmed in two patients; the other three was reactive follicular hyperplasia. Management was redirected on relapsing patients. ROLL technique proved to be a simple, safe and effective method to detect and biopsy non- palpable lesions on the neck of patients with suspicious relapsing lymphoma.

http://bit.ly/2R1fN0a

Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

Abstract

Fourth branchial pouch anomalies represent one of the rarest types of all branchial apparatus anomalies. They appear in the first lifedecade in a form of recurrent left-sided neck masses which demands surgical treatment. Accidental finding, appearance later in life and spontaneous resolving are really rare. We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spontaneously and that conservative approach is an alternative to multiple surgical procedures.

http://bit.ly/2DjX8ZQ

CNPAS: A Differential to Choanal Atresia

Abstract

A case of 7 day old male child, born at 36 weeks, presented with feeding difficulties, hypothermia and failure to thrive. After clinical examination to rule out any gross congenital anomalies, CT scan was done which was suggestive of pyriform aperture stenosis. It was surgically dilated and stented successfully.

http://bit.ly/2Mjur1U

“Sinus Headache”: Diagnosis and Dilemma?? An Analytical and Prospective Study

Abstract

To evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosis.

http://bit.ly/2RCF8Cv

Reconstruction of Orbital Suprastructure Maxillectomy Defects by Temporalis Myofascial Flap

Abstract

Oncological surgery being radical is often mutilating in form and function especially in the maxillary/orbit region reconstruction of maxillo-orbit defects are challenging due to the complex three dimensional anatomy. Free flaps are de-rigueur but a technical resource with constraints. The temporalis myofascial flap (TMFF) is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. To study the use of the temporalis myofascial flap in the reconstruction of various orbital and supramaxillary facial defects. Temporalis myofascial flap was harvested and successfully used in reconstruction of three patients who had undergone orbital exenteration with or without suprastructural maxillectomy. There was no morbidity related to flap loss. Temporalis flap (TMFF) can be considered as a first line reconstructive option for limited resection of upper maxilla with palatal preservation. Its proximity to the oral cavity, palate and mid third face and the technical ease makes the TMFF valuable for reconstruction. The techniques and outcomes of TMFF are discussed.

http://bit.ly/2sz246Z

Ewing’s Sarcoma of the Sinonasal Tract: A Report of Two Challenging Cases

Abstract

Ewing's sarcoma (ES) is a malignant small round cell tumor that belongs to the primitive neuroectodermal tumor class. ES generally arises in the long bones of the extremities (skeletal form) and less frequently in the soft tissue of the trunk and extremities (extra-skeletal form). Sinonasal localization of ES is an extremely rare event. About 80% of the patients are less than 20 years old with the highest incidence in the second decade of life. The combination of histopathological examination and ancillary methods (such as immunohistochemistry and molecular genetics) is extremely important to establish the diagnosis of ES. The most effective treatment plan for ES includes a multidisciplinary approach with surgery, radiotherapy and chemotherapy. This is a report of two challenging cases of sinonasal ES in two different age groups. The first case is a 13-years old female patient who presented with right nasal obstruction, anosmia, intermittent epistaxis and hearing loss. The second case is a 24-years old male patient who presented with a history of right nasal obstruction, right eye pain and periorbital edema. We present these cases due to the rarity of the disease and the difficulty of diagnosis.

http://bit.ly/2ARXrcJ

Dual Infection with Hepatitis B Virus and Hepatitis C Virus Correlated with Type 2 Diabetes Mellitus

09-2018-0376-dia_10-1055-a-0794-6135-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0794-6135

Background Conflicting data exist regarding the relationship between dual infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) with type 2 diabetes mellitus (T2DM). We assessed dual infection of HBV and HCV with the levels of blood glucose and development of DM. Methods A total of 9621 participants in a community-based study were enrolled from 18 towns in Maoli county of Taiwan. Blood samples were collected and tested for hepatitis B surface antigen (HBsAg) and antibodies (HBsAb), antibodies against hepatitis C virus (anti-HCV) and fasting plasma glucose. DM was defined as fasting plasma glucose≥126 mg per 100 ml. Results Only 0.7% of total participants had HBV/HCV coinfection. The prevalence of HBV and HCV monoinfection were 9.9 and 5.7%, respectively. Adjusted blood glucose levels and development risk of T2DM (odds ratio [OR], 2.55; p<0.001) were significantly high among HBV/HCV coinfection group using multivariate linear regression adjusted for age, gender, education, race and BMI. Furthermore, using multivariate logistic regression models adjusted for covariates, HCV mono-and HBV/ HCV coinfection significantly increased on blood glucose levels. Conclusions Our study shows HBV/HCV coinfection was significantly correlated with blood glucose levels. A significant proportion (28%) of participants with HBV/HCV coinfection developed T2DM. Although the precise mechanisms of dual positive infection of HBV and HCV are unclear, there is increasing evidence that dual infection of HCV and HBV is strongly associated with the development of T2DM.
[...]

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Association of ACE I/D Polymorphism with Risk of Diabetes in Cardiovascular Disease Patients

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0824-6515

Angiotensin converting enzyme (ACE), as part of renin angiotensin aldosterone system, is involved in blood pressure regulation and control several physiological functions. Insertion/Deletion (I/D) polymorphism of ACE has pronounced effects on development of metabolic diseases like diabetes, cardiovascular diseases (CVDs) and hypertension. However, association of I/D polymorphism with risk of diabetes in CVD patients is not known. The aim of present study was to check the association of ACE I/D polymorphism with risk of diabetes in subjects with CVD. For this, 531 subjects were sampled and divided into 3 groups; G1-H (healthy controls, n=117), G2-CN (cardiac patients without diabetes, n=271) and G3-CD (cardiac patients with diabetes, n=143). Genotyping of ACE I/D polymorphism was done by polymerase chain reaction. Allelic and genotypic frequencies were in Hardy Weinberg Equilibrium (χ2=0.11, p>0.05) and revealed high prevalence of I allele (55%) among all groups. However, II genotype was more common (37%) in G3-CD group. Level of glucose was also higher in subjects with II genotype than DD genotype (12.6±6.3 mmol/L vs. 9.7±5.1 mmol/L). Logistic regression analysis revealed that ACE II genotype increase the risk of diabetes in CVD patients by ~2 times [OR=1.94, CI: 1.24–3.01, p=0.03]; however, this association did not reach the significance level when adjusted for age and gender. In conclusion, ACE I/D polymorphism influence the risk of diabetes in CVD patients and ACE II increases this risk by ~2 fold.
[...]

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Ultrasonographic Evaluation of Glycemic Control Effect on Placental Vascularization in Pregnancy with Type 1 Diabetes Mellitus

09-2018-0394-dia_10-1055-a-0824-6362-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0824-6362

Aims The aim of our study was to assess the effect of glycemic control on placental vascularization in pregnancies complicated by type 1 diabetes mellitus (T1DM) and to compare dataset of optimal/suboptimal glycemic control to normal placental 3-dimensional power Doppler (3-DPD) indices in 2nd and 3rd trimester. Methods Placental vascularization of pregnant women was prospectively evaluated by 3-DPD ((vascularization-index (VI); flow-index (FI); vascularization-flow-index (VFI)) ultrasound technique. The normal pregnancies (n=214) were compared to those complicated by T1DM (n=53) with optimal (HbA1C≤6%;≤ 42 mmol/mol) and suboptimal (HbA1C>6%;>42 mmol/mol) glycemic control. Results Pregnancies complicated by T1DM expressed lower placental vascularization indices as compared with normal pregnancies (adjusted odds ratio (AOR) for VI:0.86; FI:0.94; VFI:0.76). Placental 3-DPD indices have a significant correlation with HbA1C and optimal glycemic control is associated with lower placental perfusion (AOR for VI:1.64; FI:1.13; VFI:2.34). Short-term adverse neonatal outcome was predicted by lower 3-DPD indices (AORVI:0.83, AORFI:0.93, AORVFI:0.66, p<0.05 for each index). Besides the glycemic control, the pregestational body mass index (BMI), had significant influences on placental perfusion. Conclusions VI displayed the best screening ability for suboptimal glycemic control with a sensitivity of 90.9%. The suboptimal glycemic control has a direct deteriorating effect on placental vasculature. Therefore the ultrasound examination could be an adjunct diagnostic modality for pregnant women with T1DM.
[...]

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Interleukin-10 Protects Schwann Cells against Advanced Glycation End Products-Induced Apoptosis via NF-κB Suppression

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0826-4374

Demyelination resulting from Schwann cell injury is a main pathological feature of diabetic neuropathy, and a key contributor to this process may be inflammation due to advanced glycation end products (AGEs). Therefore, protection by anti-inflammation agents is anticipated. In this study, we showed that interleukin-10 (IL-10), an anti-inflammatory cytokine, inhibits apoptosis of Schwann cells induced by AGEs in vitro. We isolated and cultured Schwann cells from rat sciatic nerves. As detected by flow cytometry, apoptosis of Schwann cells markedly increased following incubation with AGEs for 48 h. However, pretreatment with IL-10 inhibited AGE-induced apoptosis. The effect of IL-10 on NF-κB, which is a very important regulator of inflammation, was also evaluated, and results showed high levels of phospho-NF-κB and nuclear localization of NF-κB in cells incubated with AGEs but low levels of phospho-NF-κB and cytoplasmic localization in the cells incubated with IL-10, indicating the activation of NF-κB by AGEs and inhibition of NF-κB by IL-10. Moreover, incubating Schwann cells with an NF-κB inhibitor (caffeic acid phenethyl ester) for 30 min before adding AGEs mimicked IL-10, lowering the amount of reactive oxygen species and activity of caspase-3 and also decreasing apoptosis in Schwann cells. These results indicate that IL-10 may protect Schwann cells against AGE-induced apoptosis by attenuating oxidative stress via the inhibition of activation of NF-κB.
[...]

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The effect of low-level laser radiation on improving inferior alveolar nerve damage after sagittal split osteotomy: a systematic review

Abstract

Inferior alveolar nerve (IAN) damage is a common complication occurring after sagittal split osteotomy (SSO) and results in sensory disorders of the jaw region. In recent years, published experimental and clinical evidence suggests that low-level laser (LLL) radiation is effective in nerve recovery. Therefore, the aim of the present study was to review clinical trial studies investigating the effect of LLL radiation on improving the sensory defects of IAN after SSO. The keywords associated with SSO and LLL were searched in PubMed, Medline (via Ovid), Web of Science (WOS), Scopus, and Cochrane Library databases. Then, controlled clinical trial studies published before November 2017 regarding LLL radiation conducted on patients with IAN neuropathy due to SSO were investigated. The articles fulfilling the study criteria were further scrutinized and the necessary information was extracted from them. A total of seven papers were included in the study. The diode laser used had a wavelength range of 760–930 nm, radiation power of 20–200 mw, and radiation energy of 10.2–95 J (per point of radiation). In the mentioned studies, the patients underwent 3–20 sessions of laser irradiation and were monitored for an additional 0–23 months after completion of the laser intervention. The tests performed in the mentioned studies dealt with examining the perceptions of superficial touch and pressure, two-point discrimination, stimulus movement on skin, temperature, and pain. Furthermore, the patients' general awareness regarding sensory perception in the mandibular region was gauged. In six studies, laser irradiation caused relative improvement in the IAN sensory disorder for a subjective test as well as for one or more objective tests. In the reviewed clinical trial studies, LLL was generally found to be effective in improving the IAN sensory disturbance resulting from SSO, though there was no placebo effect.

http://bit.ly/2U4kYOM

In vivo detection of oral precancer using a fluorescence-based, in-house-fabricated device: a Mahalanobis distance-based classification

Abstract

In vivo detection of oral precancer has been carried out by a fluorescence-based, in-house-developed handheld probe on three groups: oral squamous cell carcinoma (OSCC), dysplastic (precancer), and control (normal). Measurements have been performed on a total of 141 patients and volunteers of different age groups. Excitation wavelength of 405 nm was used and fluorescence emission spectra were recorded in the scan range of 450.14 to 763.41 nm at very low incident power (122 μW) from different oral sites buccal mucosa (BM), lateral boarder of tongue (LBT), and dorsal surface of tongue (DST). Spectral profiles are found to vary among the three groups as well as among the different oral sites. Major and minor bands of flavin adenine dinucleotide (FAD) and porphyrins near 500, 634, 676, 689, and 703 nm have been obtained. Porphyrin contribution is found to be more dominant than the FAD in OSCC and dysplastic groups as compared to the control group. A better classification has been observed using the entire spectral range rather than restricting to individual bands, by application of principal component analysis (PCA), Mahalanobis distance model, and receiver operating characteristic analysis (ROC). ROC on Mahalanobis distance differentiates OSCC to normal, dysplastic to normal, and OSCC to dysplastic with sensitivities from 71% to 98%, 92% to 94% and 81% to 93% and specificities 91% to 100%, 86% to 100% and 79% to 97% for oral sites BM, LBT and DST. LBT and DST appear to be more sensitive to dysplasia detection as compared to BM.

http://bit.ly/2Dmkyxx

Impact of lens density and lens thickness on cumulative dissipated energy in femtosecond laser–assisted cataract surgery

Abstract

To evaluate the required cumulative dissipated energy (CDE) to fragment the crystalline lens in femtosecond laser–assisted cataract surgery (FLACS) in relation to lens density and lens thickness. Consecutive eyes that underwent FLACS between September 2014 and March 2017 by a single surgeon using in all cases the same femtosecond laser and phacoemulsification platform were included in our retrospective study. Prior to surgery, corrected distance visual acuity (CDVA), optical biometry corneal, and crystalline lens tomographies were performed to assess anterior chamber depth (ACD), axial length (AL), and crystalline lens parameters (i.e., lens density, thickness, and nucleus staging (NS)). After surgery, CDE was calculated and analyzed in relation to lens density (LD) and lens thickness (LT). Zero ultrasound expenditure cases were recorded and their occurrence analyzed. The chart review identified 236 eyes of 200 patients, 98 males and 102 females aged 65± 15 years which were included in the study. Mean LD was 11.26 ± 2.05 pixel intensity units (range 7.30–18.80), and the mean LT was 3417 ± 405.17 μm (range 2545–4701). LD and LT correlated moderately (r = 0.50, p < 0.001) and weakly (r = 0.23, p < 0.001), with post-laser CDE. Higher LD and LT were also associated with lower rates of zero phaco (eyes in which no phacoemulsification energy was necessary). Furthermore, NS (r = 0.528, p < 0.001) and CDVA (r = − 0.3524, p < 0.001) also correlated with CDE. Higher LD, LT, NS values, and low CDVA are associated with higher ultrasound expenditure (CDE—cumulative dissipated energy) and with lower rates of zero ultrasound expenditure during FLACS.

http://bit.ly/2U4biUb

Symptom-based patient-reported outcomes in adults with eosinophilic esophagitis: value for treatment monitoring and randomized controlled trial design

Purpose of review In adults with eosinophilic esophagitis (EoE), a chronic, inflammatory immune-mediated condition of the esophagus, both inflammation and fibrosis are likely associated with symptom generation. Therefore, assessing symptom-based patient-reported outcomes (PROs), defined by US Food and Drug Administration as 'any report of the status of a patient's health condition that comes directly from the patients, without interpretation of the patient's response by a clinician or anyone else', is important in the context of trials and observational studies of emerging therapies. Recent findings For purposes of treatment monitoring, lack of symptoms does not predict the absence of biologic inflammation; hence, endoscopy with esophageal biopsies should be performed to check for residual inflammation. Lack of inflammation does not predict lack of symptoms, and the presence of subepithelial fibrosis cannot be excluded. No published instrument currently measures the frequency of dysphagia described all possible ways, strategies of living with this symptom and various pain types. In randomized controlled trials, in which symptom response was detected using validated PRO measures, only modest decreases in symptom scores were observed. Summary Accessing full EoE symptom spectrum and optimizing PRO measures remains a challenge that should be tackled to reliably assess response to existing and emerging therapies. Correspondence to Ekaterina Safroneeva, PhD, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland. E-mail: ekaterina.safroneeva@ispm.unibe.ch Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2QZ7SQY

Diagnosis of occupational hypersensitivity pneumonitis

Purpose of review To discuss the diagnostic methods currently used in the study of patients with hypersensitivity pneumonitis, with special emphasis on the most recent contributions published in the medical literature regarding the diagnosis of occupational hypersensitivity pneumonitis (OHP). This review presents an update of the use of these diagnostic tests, a controversial issue among experts. Recent findings In spite of the multiple attempts at systematization and the publication of expert consensus statements, standardizing and diagnostic methods and criteria remain particularly difficult. As a result, centers tend to rely on their own experience and establish diagnosis by consensus among their multidisciplinary teams. Though recommendable in many ways, this method presents significant limitations. Summary Diagnosis of OHP should be made with a thorough clinical history of the symptoms and clinical signs as well as a meticulous review, if possible by an expert, of possible exposures in the working environment; a meticulous physical examination; high-resolution computed tomography of the thorax; serum determination of specific immunoglobuline Gs; bronchoalveolar lavage and possibly cryobiopsy; fungal culture; and, when appropriate, a specific inhalation challenge test with the suspected antigen. Correspondence to Ferran Morell, MD, PhD, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Catalonia, Spain. Tel: +34 932746157; fax: +34 932746083; e-mail: fmorell@vhebron.net Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2W4pFtO

Management of acute loss of asthma control: yellow zone strategies

Purpose of review Asthma exacerbations are associated with a significant burden to both the individual patient and to the healthcare system. Patients often step-up home therapies in response to increased asthma symptoms, and the asthma action plan was created to empower patients to self-manage their asthma care. The yellow (intermediate) zone of the asthma action plan is frequently poorly defined, and current Expert Panel Report 3 guideline recommendations are not effective for all patients. This article reviews the evidence behind various recommended yellow zone intervention strategies. Recent findings There are many potential methods of delivering yellow zone therapy, and recent studies have assessed preventive efficacy of a scheduled increase in controller medication(s), reliever medication(s), or a symptom-driven combination of both. The literature suggests that, in certain asthma subpopulations, some methods may be more efficacious than others. Summary Multiple yellow zone approaches may be beneficial, and the yellow zone is not a 'one size fits all' narrative. Correspondence to Brooke I. Polk, MD, Division of Allergy, Immunology, and Pulmonary Medicine, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, 1 Children's Place, Campus Box 8116, St. Louis, MO 63110, USA. Tel: +1 314 454 2694; fax: +1 314 454 2694; e-mail: bpolk@wustl.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2R0AGIz

Precision medicine in childhood asthma

Purpose of review Childhood asthma is a heterogeneous disease and many children have uncontrolled disease. Therefore an individualized approach is needed to improve asthma outcomes in children. Precision medicine using clinical characteristics, biomarkers, and the rapidly involving field of genomics and pharmacogenomics aims to achieve asthma control and reduce future risks with less side-effects in individual children with asthma. Recent findings It is not yet possible to select treatment options on clinical characteristics. Novel monoclonal antibodies are efficacious in patients with severe, eosinophilic asthma. Reduced lung function growth and early decline is a prevalent finding in children with persistent asthma. Pharmacogenetic studies have identified children at risk for cortisol suppression when using inhaled corticosteroids. Summary Clinical characteristics and simple biomarkers like eosinophils, IgE, and the fraction of exhaled nitric oxide may be used in clinical practice for a basic precision medicine approach, deciding which children will have the best chance to respond to inhaled corticosteroids and to the biologicals omalizumab and mepolizumab. Further application of pharmacogenomics and breathomics needs additional studies before they can be applied as tools for precision medicine in individual children with asthma. Correspondence to Mariëlle W. Pijnenburg, MD, PhD, Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC – Sophia, University Medical Center Rotterdam, PO Box 2060, 3000 CB Rotterdam, The Netherlands. Tel: +31 107036263; e-mail: m.pijnenburg@erasmusmc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2W4pAX2

Eine seltene Ursache der peripheren Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/a-0821-5850

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ICRU report 91 on prescribing, recording, and reporting of stereotactic treatments with small photon beams

Abstract

The International Commission on Radiation Units and Measurements (ICRU) report 91 with the title "prescribing, recording, and reporting of stereotactic treatments with small photon beams" was published in 2017. This extensive publication covers different relevant aspects of stereotactic radiotherapy such as small field dosimetry, accuracy requirements for volume definition and planning algorithms, and the precise application of treatment by means of image guidance. Finally, recommendations for prescribing, recording and reporting are given.

http://bit.ly/2FM3eUd

Radioguided Surgery of Non-palpable Neck Lymph Node in Lymphoma Patients

Abstract

http://bit.ly/2R1fN0a

Synthesis and characterization of exfoliated biochar from four agricultural feedstock

Abstract

Highly porous biochar (BC) structures have been prepared from inexpensive biomasses like rice straw, bamboo, sugarcane waste, and corn cob via a slow pyrolysis technique in nitrogenous atmosphere. A surface engineering technique has been applied to enhance the surface-to-volume ratio of each biochar sample and finally compared its characteristics through standard surface and elemental characterization techniques, viz. CHN (carbon, hydrogen, and nitrogen), FTIR (Fourier transform infrared spectroscopy), BET (Brunauer–Emmett–Teller), and SEM (scanning electron microscopy). All the biochar samples were observed to be highly carbonized and aromatized. Exfoliated structures were found to contain more elemental carbon (34.14–77.32%) than its native form (30.92–74.46%). Aromatic hydrocarbon, aromatic C=C, aromatics, aliphatic C–O, aliphatic hydrocarbon, and H-bonded OH groups were found to predominate in the surface of biochar structures independent of their precursor composition and extent of exfoliation. SEM micrographic images clearly ensured about the unoriented sheets like the morphology of different biochar samples. Although no significant structural difference was found to exist depending on their precursor compositions, quantitative enhancement of porosity was found to be observed after exfoliation. Both native (240.65 m²/g) and exfoliated (712.89 m²/g) biochars derived from sugarcane wastes were observed to have a maximum surface area in comparison to the biochars derived from rice straw (native, 22.08 m²/g; exfoliated, 29.92 m²/g), bamboo (native, 42.08 m²/g; exfoliated, 248.38 m²/g), and corn cob (native, 136.62 m²/g; exfoliated, 221.71 m²/g). Exfoliated biochars were found to be consistently more potent in comparison to its native form as per our comparative characterizations performed so far.

http://bit.ly/2FBa003

Frequency characteristics and speech recognition in cartilage conduction

Cartilage conduction (CC) is a new transduction form, and hearing devices that utilize CC present a new option for patients with aural atresia. However, in occluded ears, low-tone sounds are transmitted very effectively, resulting in excessive low-tone sound emphasis and speech recognition reduction. This study aimed to clarify low-tone speech recognition for CC in occluded ears, and determine if excessive low-tone sound emphasis decreases maximum speech recognition scores.

http://bit.ly/2U0GzHG

A novel approach to outpatient clinic management

Abstract

I read with great interest the study by Khoury et al¹ in the BJD on the safety of patient‐initiated care consultations (PICC) for psoriasis patients, though has wider implications for all patients with chronic conditions. There are over 15 million people in England with chronic conditions, accounting for 64% of outpatient appointments, and with future trends suggesting a further increase.

http://bit.ly/2MjWaj0

Anti‐TNF‐associated cutaneous leishmaniasis: a single‐institution experience

Abstract

Leishmaniasis is an infection by protozoa Leishmania, vector‐transmitted by sandflies. There are three major forms: cutaneous (CL), mucocutaneous and visceral (VL). It is endemic on the European Mediterranean basin, where mostly Leishmania infantum produces CL. Over the last decade, cases in patients undergoing tumor necrosis factor (TNF) inhibitor (anti‐TNF) have been reported. This could result from increasingly widespread anti‐TNF use coupled with a rising global incidence¹. Notably, 80% of all reported cases are related to residence or travel to European Mediterranean countries, particularly Spain.

http://bit.ly/2sK6Oqx

A novel approach to outpatient clinic management

Abstract

http://bit.ly/2MjWaj0

Anti‐TNF‐associated cutaneous leishmaniasis: a single‐institution experience

Abstract

http://bit.ly/2sK6Oqx

A re‐introduction of environmental mite allergen control strategies for asthma treatment and the debate on their effectiveness

Abstract

Asthma affects three hundred million people worldwide. The effectiveness of house dust mite allergen control for asthma treatment is debatable. One aspect that has been little discussed in existing meta‐analyses is the possible role of environmental strategies. Here, we re‐introduce the previously defined strategies for mite allergen control and discuss their importance to the debate on clinical effectiveness. The strategy of concurrent bedroom interventions is related to the combined use of a priori defined interventions, while the strategy of exposure‐based control relates to the treatment of relevant textiles after assessing exposure. The air purification strategy aims to purify the human breathing zone of airborne allergens. In Western European patient practice, the use of these strategies differs. A post hoc study of the dominant Cochrane review by Gøtzsche and Johansen (Cochrane Database of Systematic Reviews, 2008, Art. No: CD001187) appears to indicate that a majority of the underlying trials reported on the strategy of concurrent bedroom interventions, which were mainly executed in a minimal manner. Some trials have reported on the air purification strategy and may potentially alter the debate on effectiveness. No trial has reported on the strategy of exposure‐based control. We therefore hypothesize that the absence of evidence for the effectiveness of mite allergen control for asthma treatment applies to the strategy of concurrent bedroom interventions. The evidence‐based effectiveness of the exposure‐based control strategy appears to be undetermined. The results of our post hoc re‐analysis urge that future meta‐analyses of mite allergen control should a priori define the environmental strategy under study. Future trials of mite allergen control are warranted to test the exposure‐based strategy as well as the sparsely tested strategy of air purification.

http://bit.ly/2ASB5b5

Skin lesions, differential diagnosis and practical approach to potential survivors of torture

Abstract

As the international refugee crisis has reached new proportions,¹ survivors of torture increasingly present to treating physicians with an array of acute or chronic skin lesions. Physicians should be aware of common presentations and likely differential diagnoses in order to avoid mislabeling or underrecognizing torture. Survivors of torture also frequently suffer from psychological sequelae, such as post‐ traumatic stress disorder, and appropriate referrals are essential in order to improve recovery trajectory. Skin sequelae are the most common physical findings of torture. Not all skin lesions seen in tortured survivors are due to perpetrator inflicted injuries, and many dermatological conditions can mimic lesions typical of torture, as can scars as a result of folk remedies or cultural practices specific to geographical regions. Medical documentation of torture includes injury and lesion description. While forensic dermatology and other forensic specialties use an injury description taxonomy, and the standard dermatologic taxonomy uses an anatomic description, they are complementary sciences for lesions inflicted by torture. This results in an opportunity for learning across disciplines in order to improve evidence documentation for survivors of torture. This article describes features of common skin lesions consistent with torture, including their clinical appearances, differential diagnoses, patterns of injury and appropriate clinical descriptions.

http://bit.ly/2U3PYhP

DNA copy number imbalances in primary cutaneous lymphomas (PCL)

Abstract

Background

Cutaneous lymphomas (CL) represent a clinically defined group of extran‐ odal non‐Hodgkin lymphomas harbouring heterogeneous and incompletely delineated molecular aberrations. Over the past decades, molecular stud‐ ies have identified several chromosomal aberrations, but the interpreta‐ tion of individual genomic studies can be challenging.

Objective

With a comprehensive meta‐analysis, we aim to delineate genomic alter‐ ations for different types of CL and propose a more accurate classifica‐ tion in line with their various pathogenicity.

Methods

We searched PubMed and ISI Web of Knowledge for publications from 1996 to 2016 reporting the investigation of CL for genome‐wide copy number alterations, by means of comparative genomic hybridisation tech‐ niques and whole genome and exome sequencing. We then extracted and re‐mapped the available copy number variation (CNV) data from these publications with the same pipeline and performed clustering and visuali‐ sation to aggregate samples of similar CNV profiles.

Results

For 449 samples from 22 publications, copy number variation data was accessible for sample based meta‐analysis. Our findings illustrate struc‐ tural and numerical chromosomal imbalance patterns. Most frequent CNAs were linked to oncogenes or tumour suppressor genes with important roles in the course of the disease.

Conclusion

Summary profiles for genomic imbalances, generated from case‐specific data, identified complex genomic imbalances, which could discriminate between different subtypes of CL and promise a more accurate classifi‐ cation. The collected data presented in this study are publicly available through the "Progenetix" online repository.

http://bit.ly/2DmzeNh

Accuracy of a TaqMan‐based real‐time polymerase chain reaction combined to a Novy‐MacNeal‐Nicolle medium culture for the diagnosis of American tegumentary leishmaniasis

Abstract

Dear editor, tests used for the diagnosis of tegumentary leishmaniasis (TL) have variable accuracy and in classic parasitological methods, sensitivity tends to vary according to examiner‐dependent factors¹. In vitro culture is a highly specific method but its sensitivity is limited^1,2. Real‐time PCR (qPCR) is considered a very efficient technique and it adds quantitative results to clinical analyses^3‐5. We aimed to test the accuracy of the combination of a Novy‐MacNeal‐Nicolle (NNN) medium culture and TaqMan‐based qPCR analysis for the diagnosis of TL.

http://bit.ly/2TX7qUY

Replicative senescence of human dermal fibroblasts affects structural and functional aspects of the golgi apparatus

Abstract

It is well recognized that the world population is aging rapidly. Therefore, it is important to understand aging processes at the cellular and molecular levels to predict the onset of age‐related diseases and prevent them. Recent research has focused on the identification of aging biomarkers, including those associated with the properties of the Golgi apparatus. In this context, Golgi‐mediated glycosylation of proteins has been well characterized. Additionally, other studies show that the secretion of many compounds, including pro‐inflammatory cytokines and extracellular matrix degrading enzymes, is modified during aging, resulting in physical and functional skin degradation. Since the Golgi apparatus is a central organelle of the secretory pathway, we investigated its structural organization in senescent primary human dermal fibroblasts using confocal and electron microscopy. In addition, we monitored the expression of Golgi‐related genes in the same cells. Our data showed a marked alteration in the Golgi morphology during replicative senescence. In contrast to its small and compact structure in non‐senescent cells, the Golgi apparatus exhibited a large and expanded morphology in senescent fibroblasts. Our data also demonstrated that the expression of many genes related to Golgi structural integrity and function was significantly modified in senescent cells, suggesting a relationship between Golgi apparatus function and aging.

http://bit.ly/2SYHUyQ

Double transcranial direct current stimulation of the brain increases cerebral energy levels and systemic glucose tolerance in men

Abstract

Transcranial direct current stimulation (tDCS) is a neuromodulatory method, which has been experimentally tested and is already used as an adjuvant therapeutic option to treat a number of neurological disorders and neuropsychiatric diseases. Beyond its well‐known local effects within the brain, tDCS also transiently promotes systemic glucose uptake and reduces the activity of the neurohormonal stress axes. We aimed to test if the effects of a single tDCS application could be replicated upon double stimulation to persistently improve systemic glucose tolerance and stress axes activity in humans. In a single‐blinded crossover study, we examined 15 healthy male volunteers. Anodal tDCS vs. sham was applied twice in series. Systemic glucose tolerance was investigated by the standard hyperinsulinaemic‐euglycaemic glucose clamp procedure and parameters of neurohormonal stress axes activity were measured. Because tDCS‐induced brain energy consumption has been shown to be part of the mechanism underlying the assumed effects, we monitored the cerebral high‐energy phosphates adenosinetriphosphate (ATP) and phosphocreatine (PCr) by ³¹phosphorus magnetic resonance spectroscopy (³¹P‐MRS). As hypothesized, analyses revealed that double anodal tDCS persistently increases glucose tolerance compared with sham. Moreover, we observed a significant rise in cerebral high‐energy phosphate content upon double tDCS. Accordingly, activity of the neurohormonal stress axes was reduced upon tDCS compared with sham. Our data demonstrate that double tDCS promotes systemic glucose uptake and reduces stress axes activity in healthy humans. These effects raise hope that repetitive tDCS may be a future non‐pharmacological option to combat glucose intolerance in type 2 diabetes patients.

http://bit.ly/2FIY3EJ

Regulation of water‐soluble glucan synthesis by the Streptococcus mutans dexA gene effects biofilm aggregation and cariogenic pathogenicity

Abstract

The cariogenic pathogen Streptococcus mutans (S. mutans) effectively utilizes dietary sucrose for the synthesis of exopolysaccharides (EPS), which act as a scaffold for its biofilm and thus contribute to its cariogenic pathogenicity. Dextranase (Dex), which is a type of glucanase, participates in the degradation of water‐soluble glucan; however, the structural features of the exopolysaccharides regulated by the dexA gene have received limited attention. Our recent studies reported novel protocols to fractionate and analyzed the structural characteristics of glucans from S. mutans biofilms. In this study, we identify the role of the S. mutans dexA gene in dextran‐dependent aggregation in biofilm formation. Our results show that deletion of dexA (SmudexA) results in increased transcription of exopolysaccharide synthesis‐related genes, including gtfB, gtfD, and ftf. Interestingly, we reveal that inactivating the dexA gene may lead to elevated water‐soluble glucan (WSG) synthesis in S. mutans, which results in dysregulated cariogenicity in vivo. Furthermore, structural analysis provides new insights regarding the lack of mannose monosaccharides, especially in the water‐soluble glucan synthesis of the SmudexA mutants. The biofilm phenotypes that are associated with the reduced glucose monosaccharide composition in both WSG and water‐insoluble glucan (WIG) shift the dental biofilm to reduce the cariogenic incidence of the SmudexA mutants. Taken together, these data reveal that exopolysaccharide synthesis fine‐tuning by the dexA gene results in a densely packed EPS matrix that may impede the glucose metabolism of WSG, thereby leading to the lack of an energy source for the bacteria. These results highlight dexA targeting as a potentially effective tool in dental caries management.

http://bit.ly/2CGVrEn

A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck

Abstract

Background

The 8th edition AJCC staging of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) incorporated extranodal extension (ENE) for the first time. This study compared the prognostic performance of the 7th and 8th edition staging for cSCCHN with nodal metastases.

Methods

Retrospective analysis of 96 patients with metastatic cSCCHN, comparing the ability of staging systems to predict disease‐specific and overall survival (OS) using the proportion of variation explained and Harrell's C‐index.

Results

In AJCC8, the N classification was upstaged in 77% of patients due to the presence of ENE and 88% of patients were classified as TNM stage IV. AJCC8 was inferior to AJCC7 in predicting disease‐specific survival for both N and TNM stages, and OS by TNM stage.

Conclusions

The majority of patients with metastatic cSCCHN have ENE and are classified as TNM stage IV based on the 8th edition staging, resulting in poor prognostic performance.

http://bit.ly/2szpIQD

Impact of tumor‐associated macrophages and BRAFV600E mutation on clinical outcomes in patients with various thyroid cancers

Abstract

Background

Tumor‐associated macrophages (TAMs) play a role in thyroid cancer tumor progression and metastasis. This study aimed to investigate the association of TAM density and cluster of differentiation 68 (CD68) expression with thyroid tumors as a prognostic marker and the relationship of these factors with BRAF^V600E mutations.

Methods

This study included 275 thyroid specimen tissues, including benign and malignant lesions. We compared the clinicopathological features according to thyroid tumor types and evaluated the presence of CD68 expression and BRAF^V600E mutations.

Results

CD68 positive expression increased with aggressiveness of thyroid tumor histologic grades (P < 0.001). In patients with poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC), CD68 positivity was associated with aggressive adverse clinical outcomes such as extrathyroidal extension, cervical lymph node metastases, and distant metastases (P < 0.05).

Conclusions

CD68 positivity was more frequent in advanced and aggressive thyroid cancer types such as PDTC/ATC.

http://bit.ly/2MizKi5

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Abstract

Background

The purpose of this study was to analyze and compare ipsilateral and bilateral adjuvant radiotherapy in patients with cancer of unknown primary (CUP) of the head and neck.

Methods

Overall survival, recurrence‐free survival, and radiation‐induced side effects were assessed in 76 patients with CUP who underwent ipsilateral (n = 29) or bilateral (n = 47) radiotherapy.

Results

At a median follow‐up of 41 months, the 5‐year overall survival and recurrence‐free rate were 67.9% and 71.5%, respectively. No statistically significant difference between ipsilateral and bilateral radiotherapy could be found regarding 5‐year overall survival, recurrence‐free survival, occurrence of a primary tumor, and distant metastasis. The analysis of radiation‐induced acute side effects showed a significant benefit of ipsilateral radiotherapy.

Conclusion

As the main parameters of the study regarding the outcome and radiation‐induced side effects showed no advantages of bilateral radiotherapy, the strategy of ipsilateral radiotherapy can be recommended for the adjuvant treatment of CUP patients.

http://bit.ly/2szpHfx

Issue Information

http://bit.ly/2MizDDb

Cover Image

The cover image, by David H. Yeh et al., is based on the Original Article Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap, DOI: 10.1002/hed.25342.

http://bit.ly/2sAB0UJ

Competence of final year otolaryngology residents with the bedside head impulse test

The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex (VOR). It is a critical component of the bedside assessment of dizzy patients, and can help differentiate acut...

http://bit.ly/2sAfW0A

Human telomerase reverse transcriptase in papillary thyroid cancer: gene expression, effects of silencing and regulation by BET inhibitors in thyroid cancer cells

Abstract

Purpose

Mutations in TERT promoter have been detected in the more aggressive papillary thyroid cancers (PTCs). To elucidate the role of TERT as an eligible molecular target in these tumors, the expression of hTERT was analyzed in a series of PTCs and the effects of both pharmacological and RNA-interference-induced hTERT silencing were investigated in two human PTC cell lines (K1 and BCPAP).

Methods

The expression levels of hTERT mRNA and protein were evaluated by real-time PCR and western blot assays, respectively. Effects of hTERT silencing on PTC cell lines were analyzed by MTT, migration and western blot assays. Pharmacological inhibition of hTERT was performed using two bromodomain and extra-terminal (BET) inhibitors, JQ1 and I-BET762.

Results

hTERT expression results increased in 20 out of 48 PTCs, including tumors either positive or negative for the presence of hTERT promoter and/or BRAF mutations. In K1 and BCPAP cells, hTERT silencing determined a reduction in cell viability (~50% for K1 and ~70%, for BCPAP, vs control) and migration properties that were associated with a decrease of AKT phosphorylation and β-Catenin expression. Moreover, hTERT mRNA levels were down-regulated by two BET inhibitors, JQ1 and I-BET762, which at the same dosage (0.5 and 5 µM) reduced the growth of these thyroid cancer cells.

Conclusions

These findings demonstrate that hTERT may represent an excellent therapeutic target in subgroups of aggressive PTCs.

http://bit.ly/2DmdIbA

CNPAS: A Differential to Choanal Atresia

Abstract

http://bit.ly/2Mjur1U

Reconstruction of Orbital Suprastructure Maxillectomy Defects by Temporalis Myofascial Flap

Abstract

http://bit.ly/2sz246Z

Human telomerase reverse transcriptase in papillary thyroid cancer: gene expression, effects of silencing and regulation by BET inhibitors in thyroid cancer cells

Abstract

Purpose

Methods

Results

Conclusions

These findings demonstrate that hTERT may represent an excellent therapeutic target in subgroups of aggressive PTCs.

http://bit.ly/2DmdIbA

Reconstructive surgery for mycetoma: a case series

Abstract

Background

Mycetoma is an under recognised but significant disease endemic in various countries and associated with high morbidity. Treatment is a combination of antimicrobial therapy, with surgery often reserved for refractory or delayed cases where functional sequelae are often ignored. This case series aimed to provide preliminary evidence for the role of reconstructive surgery in treating mycetoma.

Methods

Twenty-six cases of eumycetoma suitable for reconstruction post-excision were identified between 2013 and 2016 in three centres in Sudan. The choice of reconstruction was based on consensus of the treating team, and relevant end-points noted including patient satisfaction, mobility and complication rate.

Results

Mycetoma lesions affected primarily the limbs (n = 23), with three cases involving the gluteal region. A range of reconstructive options was used including skin grafting (n = 14), local flaps (n = 5) and regional flaps (n = 4). Three cases were closed primarily. No complications were noted, and disease recurrence was not found in any of the patients. Subjective interviewing revealed adequate patient satisfaction with cosmesis, and all patients reached a post-operative mobility status at least equivalent to their pre-morbid state.

Conclusions

This study demonstrates the feasibility of reconstructive surgery in selective patients with mycetoma as part of their treatment protocol.

Level of Evidence: Level IV, therapeutic study.

http://bit.ly/2Crv4BS

Cosmetics, Vol. 6, Pages 5: Design of Prototype Formulations for In Vitro Dermal Delivery of the Natural Antioxidant Ferulic Acid Based on Ethosomal Colloidal Systems

Cosmetics, Vol. 6, Pages 5: Design of Prototype Formulations for In Vitro Dermal Delivery of the Natural Antioxidant Ferulic Acid Based on Ethosomal Colloidal Systems

Cosmetics doi: 10.3390/cosmetics6010005

Authors: Cesar A. Londoño John Rojas Cristhian J. Yarce Constain H. Salamanca

Ferulic acid (FA), a naturally occurring antioxidant, is currently used to prevent skin damage. However, FA is very unstable upon exposure to UV radiation and other factors, which decrease its shelf-life and effectiveness. Therefore, in this work, different prototypes of ethosomal FA vesicular systems were designed and developed to provide protection against different environmental factors. A two-level fractional factorial design was employed using particle size, zeta potential (ZP), incorporation efficiency (EE), polydispersity index (PDI), and the existing relationship between length and width of vesicles or aspect ratio (AR) as response variables. The optimal formulation was characterized using differential scanning calorimetry (DSC), infrared analysis, UV-Vis absorption, in-vitro permeability, and thermal degradation studies. Depending on the processing conditions, the EE and particle size varied between 3 and 87% and 470 and 1208 nm, respectively. Membrane studies indicated that the free product released ~4.8% of the compound, whereas the encapsulated material released ~7.1%. Because of their enhanced permeability, ethosomes could be a promising alternative for the topical administration of antioxidants to reduce the oxidative damage caused by solar radiation.

http://bit.ly/2DlkRIX

Seed priming with silicon nanoparticles improved the biomass and yield while reduced the oxidative stress and cadmium concentration in wheat grains

Abstract

Cadmium (Cd) is among the non-essential elements for the growth of crops while silicon (Si) is a beneficial element for plant growth. There is little evidence regarding the use of silicon nanoparticles (Si NPs) on the reduction of Cd accumulation in crops especially wheat. The present study determined the impact of seed priming with Si NPs on Cd-induced responses in wheat in terms of growth, yield, photosynthesis, oxidative stress, and Si and Cd accumulation in wheat. Seed priming was done by different levels of Si NPs (0, 300, 600, 900, 1200 mg/L) for 24 h by providing continuous aeration. Afterwards, seeds were sown in soil contaminated with Cd. The results depicted that Si NPs positively affected the wheat growth and chlorophyll contents over the control. The Si NPs diminished the oxidative stress and positively affected the antioxidant enzyme activity. The Si NPs decreased the Cd concentrations in wheat, especially in grains, and increased the Si concentrations in plants. The Si NPs reduced the Cd contents by 10–52% in shoot, by 11–60% in roots, and by 12–75% in grains as compared with respective controls. The study suggested that the use of Si NPs may be a tool for reducing the Cd toxicity in wheat and declining its concentration in grains. Thus, Si NPs application by seed priming method might be helpful in increasing plants biomass and yield while reducing the oxidative stress and Cd uptake in wheat grains.

http://bit.ly/2W11ZX2

Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

Abstract

http://bit.ly/2DjX8ZQ

A Case of Pityriasis Lichenoides et Varioliformis Acuta Pemphigoides Successfully Treated with Methotrexate and Corticosteroids

Abstract

Pityriasis lichenoides et varioliformis acuta(PLEVA) pemphigoides is an uncommon skin disease, which is characterized by the appearance of blistering skin lesions in patients with PLEVA. We present a 3‐year‐old boy, who was diagnosed PLEVA pemphigoides. Combined treatment of oral methotrexate and corticosteroids was more effective than corticosteroids alone on this patient.

http://bit.ly/2FCHBXb

Impressive response of CD30‐negative, treatment‐refractory mycosis fungoides to brentuximab vedotin

Abstract

Brentuximab vedotin is a CD30‐antibody/drug conjugate which has demonstrated excellent response in treating CD30‐positive mycosis fungoides (MF) and anaplastic large cell lymphoma (ALCL). In this report, we present a patient with CD30‐negative MF refractory to multiple other lines of therapy who demonstrated a dramatic response to brentuximab. This paradoxical response may be due to inadequate detection of CD30 expression by immunohistochemical techniques. From this case we see that even in the setting of apparent CD30 negativity, brentuximab may be a viable treatment option for patients who require bridging to stem cell transplant or seek successful palliation. This case highlights the point that rigid inclusion criteria for MF trials without use of more sensitive techniques to confirm lack of CD30 expression may inappropriate.

http://bit.ly/2FJ9DQ9

Acitretin Combined with NB‐UVB in the Treatment of Cutaneous CD30‐positive Anaplastic Large Cell Lymphoma

Abstract

Cutaneous CD30⁺ lymphoproliferative disorders represent a spectrum of skin lymphatic reticular proliferative diseases, including lymphomatoid papulosis (LYP), primary cutaneous anaplastic large cell lymphoma (PC‐ALCL), and borderline lesions between them. Although they all express CD30 as a phenotypic marker and share overlapping immunophenotypic features, they differ in clinical manifestations, pathological features, treatment, and prognosis. LYP is a kind of benign disease characterized by recurrent papules and nodules and may spontaneously regress. PC‐ALCL presents with solitary tumor or local grouped nodules characterized by large T‐cells and may completely or partially resolve in fewer than half of cases. We reported a case of patient with clinical manifestation and pathologic features consistent with LYP in its early stages, which later turned into PC‐ALCL. This patient was treated with acitretin combined with NB‐UVB and had an obvious response.

http://bit.ly/2FCHyKZ

Rapid remission of Stevens‐Johnson syndrome by combination therapy using etanercept and intravenous immunoglobulin and a review of the literature

Abstract

SJS/TEN are spectrum of rare, acute and life‐threatening delayed‐type drug hypersensitivity reactions that are associated with high mortality rates. However, no therapeutic standard has been proposed for SJS/TEN. Here, we report a case of a patient diagnosed with Stevens‐Johnson syndrome whose disease progression was halted by a single dose of etanercept and was treated successfully. In addition, we reviewed the literature reporting patients with SJS/TEN treated with similar regimens.

http://bit.ly/2FPr2a7

“Intramatricial Platelet Rich Plasma Therapy: A Novel Treatment Modality in Refractory Nail Disorders”

Abstract

Background

Platelet rich plasma (PRP) is essentially an increased concentration of autologous platelets (growth factors) suspended in small amount of plasma. These factors have a proliferative and regenerative effect on a number of tissues in body and have been extensively used in dermatology, surgery, orthopedics and dentistry.

Case report

Two patients, one with nail lichen striatus and second with idiopathic trachyonychia were treated with intramatriceal injections of platelet rich plasma. 0.1ml of the plasma solution was injected into the matrix of the involved nails at 3 weekly intervals. Follow up was done at each sitting and thereafter at 16 and 20 weeks. Assessment was done both photographically and by dermoscopy. Case 1 showed marked improvement within 3 weeks and case 2 showed improvement within 6 weeks. No relapses were seen at 16weeks and 20 weeks of follow up.

Conclusion

Intramatricial PRP is a safe and effective therapeutic modality in nail lichen striatus and idiopathic trachyonychia refractory to other treatment options. Further studies with larger sample size and controls are required to validate the results.

http://bit.ly/2FEPDz9

Successful treatment of porocarcinoma with maxacalcitol and imiquimod

http://bit.ly/2FKURIG

Omalizumab as an alternative therapeutic tool in the treatment of Bullous Pemphigoid: a case report

http://bit.ly/2FEPA6r

Scalp basal cell carcinoma: a different entity?

Abstract

Basal cell carcinoma is the most frequent malignant neoplasm in white‐skinned individuals. It develops in different body areas, including in the scalp, which is a unique anatomical region due to the high number of pilosebaceous follicles; the scalp is protected from UV exposure, a main risk factor for basal cell carcinoma development. Moreover, scalp basal cell carcinoma has been described as more aggressive and difficult to treat than other forms of basal cell carcinoma. In this study, we reviewed the clinical and pathological characteristics, risk factors, genetics, and treatment options for scalp basal cell carcinoma to better understand this special type of cancer. Even though it is not yet clear whether scalp basal cell carcinomas represent a different entity, it seems important to give them special attention due to their potential aggressiveness, invasion capacities, tendency to relapse, and treatment difficulties.

http://bit.ly/2FIQeig

“Change over time in the treatment of pemphigus vulgaris between 2004 and 2016 in Iran”: A multiple cross‐sectional study

http://bit.ly/2FEPvQb

Kaposi varicelliform eruption induced by methotrexate in an adult atopic dermatitis patient

http://bit.ly/2FHVti6

A Case of Pityriasis Lichenoides et Varioliformis Acuta Pemphigoides Successfully Treated with Methotrexate and Corticosteroids

Abstract

http://bit.ly/2FCHBXb

Impressive response of CD30‐negative, treatment‐refractory mycosis fungoides to brentuximab vedotin

Abstract

http://bit.ly/2FJ9DQ9

Acitretin Combined with NB‐UVB in the Treatment of Cutaneous CD30‐positive Anaplastic Large Cell Lymphoma

Abstract

http://bit.ly/2FCHyKZ

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Σάββατο 19 Ιανουαρίου 2019

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