Evoked versus spontaneous high frequency oscillations in the chronic electrocorticogram in focal epilepsy

Publication date: Available online 6 February 2017
Source:Clinical Neurophysiology
Author(s): M.A. van't Klooster, N.E.C. van Klink, D. van Blooijs, C.H. Ferrier, K.P.J. Braun, F.S.S. Leijten, G.J.M. Huiskamp, M. Zijlmans
ObjectiveSpontaneous high frequency oscillations (HFOs; ripples 80-250Hz, fast ripples (FRs) 250-500Hz) are biomarkers for epileptogenic tissue in focal epilepsy. Single pulse electrical stimulation (SPES) can evoke HFOs. We hypothesized that stimulation distinguishes pathological from physiological ripples and compared the occurrence of evoked and spontaneous HFOs within the seizure onset zone (SOZ) and eloquent functional areas.MethodsTen patients underwent SPES during 2048Hz electrocorticography (ECoG). Evoked HFOs in time-frequency plots and spontaneous HFOs were visually analyzed. We compared electrodes with evoked and spontaneous HFOs for: percentages in the SOZ, sensitivity and specificity for the SOZ, percentages in functional areas outside the SOZ.ResultsTwo patients without spontaneous FRs showed evoked FRs in the SOZ. Percentages of evoked and spontaneous HFOs in the SOZ were similar (ripples 32:33%,p=0.77;FRs 43:48%,p=0.63), but evoked HFOs had generally a lower specificity (ripples 45:69%,p=0.02;FRs 83:92%,p=0.04) and higher sensitivity(ripples 85:70%,p=0.27; FRs 52:37%,p=0.05). More electrodes with evoked than spontaneous ripples were found in functional (54:30%,p=0.03) and 'silent' areas (57:27%,p=0.01) outside the SOZ.ConclusionsSPES can elicit SOZ-specific FRs in patients without spontaneous FRs, but activates ripples in all areas.SignificanceSPES is an alternative for waiting for spontaneous HFOs, but does not warrant exclusively pathological ripples.



http://ift.tt/2kN97pX

Positive and Negative Somatotopic BOLD Responses in Contralateral Versus Ipsilateral Penfield Homunculus

<span class="paragraphSection"><div class="boxTitle">Abstract</div>One of the basic properties of sensory cortices is their topographical organization. Most imaging studies explored this organization using the positive blood oxygenation level-dependent (BOLD) signal. Here, we studied the topographical organization of both positive and negative BOLD in contralateral and ipsilateral primary somatosensory cortex (S1). Using phase-locking mapping methods, we verified the topographical organization of contralateral S1, and further showed that different body segments elicit pronounced negative BOLD responses in both hemispheres. In the contralateral hemisphere, we found a sharpening mechanism in which stimulation of a given body segment triggered a gradient of activation with a significant deactivation in more remote areas. In the ipsilateral cortex, deactivation was not only located in the homolog area of the stimulated parts but rather was widespread across many parts of S1. Additionally, analysis of resting-state functional magnetic resonance imaging signal showed a gradient of connectivity to the neighboring contralateral body parts as well as to the ipsilateral homologous area for each body part. Taken together, our results indicate a complex pattern of baseline and activity-dependent responses in the contralateral and ipsilateral sides. Both primary sensory areas were characterized by unique negative BOLD responses, suggesting that they are an important component in topographic organization of sensory cortices.</span>

http://ift.tt/2jWHM0e

Different Effects of Sleep Deprivation and Torpor on EEG Slow-Wave Characteristics in Djungarian Hamsters

<span class="paragraphSection"><div class="boxTitle">Abstract</div>It has been shown previously in Djungarian hamsters that the initial electroencephalography (EEG) slow-wave activity (power in the 0.5–4.0 Hz band; SWA) in non-rapid eye movement (NREM) sleep following an episode of daily torpor is consistently enhanced, similar to the SWA increase after sleep deprivation (SD). However, it is unknown whether the network mechanisms underlying the SWA increase after torpor and SD are similar. EEG slow waves recorded in the neocortex during sleep reflect synchronized transitions between periods of activity and silence among large neuronal populations. We therefore set out to investigate characteristics of individual cortical EEG slow waves recorded during NREM sleep after 4 h SD and during sleep after emergence from an episode of daily torpor in adult male Djungarian hamsters. We found that during the first hour after both SD and torpor, the SWA increase was associated with an increase in slow-wave incidence and amplitude. However, the slopes of single slow waves during NREM sleep were steeper in the first hour after SD but not after torpor, and, in contrast to sleep after SD, the magnitude of change in slopes after torpor was unrelated to the changes in SWA. Furthermore, slow-wave slopes decreased progressively within the first 2 h after SD, while a progressive increase in slow-wave slopes was apparent during the first 2 h after torpor. The data suggest that prolonged waking and torpor have different effects on cortical network activity underlying slow-wave characteristics, while resulting in a similar homeostatic sleep response of SWA. We suggest that sleep plays an important role in network homeostasis after both waking and torpor, consistent with a recovery function for both states.</span>

http://ift.tt/2kHAZfj

Global and Local Connectivity Differences Converge With Gene Expression in a Neurodevelopmental Disorder of Known Genetic Origin

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Knowledge of genetic cause in neurodevelopmental disorders can highlight molecular and cellular processes critical for typical development. Furthermore, the relative homogeneity of neurodevelopmental disorders of known genetic origin allows the researcher to establish the subsequent neurobiological processes that mediate cognitive and behavioral outcomes. The current study investigated white matter structural connectivity in a group of individuals with intellectual disability due to mutations in <span style="font-style:italic;">ZDHHC9</span>. In addition to shared cause of cognitive impairment, these individuals have a shared cognitive profile, involving oromotor control difficulties and expressive language impairment. Analysis of structural network properties using graph theory measures showed global reductions in mean clustering coefficient and efficiency in the <span style="font-style:italic;">ZDHHC9</span> group, with maximal differences in frontal and parietal areas. Regional variation in clustering coefficient across cortical regions in <span style="font-style:italic;">ZDHHC9</span> mutation cases was significantly associated with known pattern of expression of <span style="font-style:italic;">ZDHHC9</span> in the normal adult human brain. The results demonstrate that a mutation in a single gene impacts upon white matter organization across the whole-brain, but also shows regionally specific effects, according to variation in gene expression. Furthermore, these regionally specific patterns may link to specific developmental mechanisms, and correspond to specific cognitive deficits.</span>

http://ift.tt/2jWPY0o

Influences of Age, Sex, and Moderate Alcohol Drinking on the Intrinsic Functional Architecture of Adolescent Brains

<span class="paragraphSection"><div class="boxTitle">Abstract</div>The transition from adolescent to adult cognition and emotional control requires neurodevelopmental maturation likely involving intrinsic functional networks (IFNs). Normal neurodevelopment may be vulnerable to disruption from environmental insult such as alcohol consumption commonly initiated during adolescence. To test potential disruption to IFN maturation, we used resting-state functional magnetic resonance imaging (rs-fMRI) in 581 no-to-low alcohol-consuming and 117 moderate-to-high-drinking youth. Functional seed-to-voxel connectivity analysis assessed age, sex, and moderate alcohol drinking on default-mode, executive-control, salience, reward, and emotion networks and tested cognitive and motor coordination correlates of network connectivity. Among no-to-low alcohol-consuming adolescents, executive-control frontolimbicstriatal connectivity was stronger in older than younger adolescents, particularly boys, and predicted better ability in balance, memory, and impulse control. Connectivity patterns in moderate-to-high-drinking youth were tested mainly in late adolescence when drinking was initiated. Implicated was the emotion network with attenuated connectivity to default-mode network regions. Our cross-sectional rs-fMRI findings from this large cohort of adolescents show sexual dimorphism in connectivity and suggest neurodevelopmental rewiring toward stronger and spatially more distributed executive-control networking in older than younger adolescents. Functional network rewiring in moderate-to-high-drinking adolescents may impede maturation of affective and self-reflection systems and obscure maturation of complex social and emotional behaviors.</span>

http://ift.tt/2kBV6cD

Differential induction of anti-V3 crown antibodies with cradle- and ladle-binding modes in response to HIV-1 envelope vaccination

Publication date: Available online 6 February 2017
Source:Vaccine
Author(s): Preetha Balasubramanian, Rajnish Kumar, Constance Williams, Vincenza Itri, Shixia Wang, Shan Lu, Ann J. Hessell, Nancy L. Haigwood, Faruk Sinangil, Keith W. Higgins, Lily Liu, Liuzhe Li , Phillipe Nyambi, Miroslaw K. Gorny, Maxim Totrov, Arthur Nadas, Xiang-Peng Kong, Susan Zolla-Pazner, Catarina E. Hioe
The V3 loop in the HIV envelope gp120 is one of the immunogenic sites targeted by Abs. The V3 crown in particular has conserved structural elements recognized by cross-reactive neutralizing Abs, indicating its potential contribution in protection against HIV. Crystallographic analyses of anti-V3 crown mAbs in complex with the V3 peptides have revealed that these mAbs recognize the conserved sites on the V3 crown via two distinct strategies: a cradle-binding mode (V3C) and a ladle-binding (V3L) mode. However, almost all of the anti-V3 crown mAbs studied in the past were isolated from chronically HIV-infected individuals. The extents to which the two types of anti-V3 crown Abs are generated by vaccination are unknown. This study analyzed the prevalence of V3C-type and V3L-type Ab responses in HIV-infected individuals and in HIV envelope-immunized humans and animals using peptide mimotopes that distinguish the two Ab types. The results show that both V3L-type and V3C-type Abs were generated by the vast majority of chronically HIV-infected humans, although the V3L-type were more prevalent. In contrast, only one of the two V3 Ab types was elicited in vaccinated humans or animal models, irrespective of HIV-1 envelope clades, envelope constructs (oligomeric or monomeric), and protocols (DNA plus protein or protein alone) used for vaccinations. The V3C-type Abs were produced by vaccinated humans, macaques, and rabbits, whereas the V3L-type Abs were made by mice. The V3C-type and V3L-type Abs generated by the vaccinations were able to mediate virus neutralization. These data indicate the restricted repertoires and the species-specific differences in the functional V3-specific Ab responses induced by the HIV envelope vaccines. The study implies the need for improving immunogen designs and vaccination strategies to broaden the diversity of Abs in order to target the different conserved epitopes in the V3 loop and, by extension, in the entire HIV envelope.



http://ift.tt/2liBVn7

Do we need a vaccine against Moraxella catarrhalis in chronic lung disease? What are the options and opportunities?

Publication date: Available online 6 February 2017
Source:Vaccine
Author(s): Antonia C. Perez, Timothy F. Murphy
Moraxella catarrhalis is the second most common cause of exacerbations in adults with COPD, resulting in enormous morbidity and mortality in this clinical setting. Vaccine development for M. catarrhalis has lagged behind the other two important causes of exacerbations in COPD, nontypeable Haemophilus influenzae and Streptococcus pneumoniae. While no licensed vaccine is currently available for M. catarrhalis, several promising candidate vaccine antigens have been identified and characterized and are close to entering clinical trials. Key steps that are required to advance vaccines for M. catarrhalis along the translational pipeline include standardization of assay systems to assess candidate antigens, identification of a reliable correlate of protection and expansion of partnerships between industry, academia and government to overcome regulatory hurdles. A vaccine to prevent M. catarrhalis infections in COPD would have a major impact in reducing morbidity, mortality and healthcare costs in COPD.



http://ift.tt/2liuNHq

Clearance of Tritrichomonas foetus in experimentally infected heifers protected with vaccines based on killed-T. foetus with different adjuvants

Publication date: Available online 6 February 2017
Source:Vaccine
Author(s): Lumila I. Fuchs, Marcelo C. Fort, Dora Cano, Carina M. Bonetti, Hugo D. Giménez, Pablo M. Vázquez, Diana Bacigalupe, Javier D. Breccia, Carlos M. Campero, Jorge A. Oyhenart
Tritrichomonas foetus is a flagellated protozoan that causes a sexually transmitted disease in cattle. Trichomonosis is characterized by early abortions, subfertility and a significant decrease in productivity. Vaccine preparations containing whole T. foetus can reduce the time of residence of the pathogen in the host cervix after experimental infection. Here, T. foetus vaccines prepared with different adjuvants were tested, in parallel with a commercial vaccine, for their efficacy to clear the infection. The median time for clearance of infection was 69days in non-immunized animals, 55days in animals treated with aluminum hydroxide, 41days with oil-in-water or saponin based vaccines or with a commercial vaccine and 27days in animals treated with saponin plus aluminum hydroxide. A slight increase in the risk of T. foetus clearance from the genital tract was found with the saponin based vaccine (hazard ratio, 2.52; 95% confidence interval, 1.03–6.17) or the commercial vaccine (hazard ratio, 2.61; 95% confidence interval, 1.07–6.38). A significant increase in the risk of T. foetus clearance was found with the combination of saponin plus aluminum hydroxide based vaccine (hazard ratio, 5.12; 95% confidence interval, 2.04–12.83).



http://ift.tt/2kN80GT

Vaccine adverse events in a safety net healthcare system and a managed care organization

Publication date: Available online 6 February 2017
Source:Vaccine
Author(s): Komal J. Narwaney, Kristin Breslin, Colleen A. Ross, Jo Ann Shoup, Kris F. Wain, Eric S. Weintraub, Michael M. McNeil, Simon J. Hambidge
BackgroundThe Institute of Medicine, in a 2013 report, recommended that the Vaccine Safety Datalink (VSD) expand collaborations to include more diversity in the study population. Kaiser Permanente Colorado (KPCO), an established VSD site, partnered with Denver Health (DH), an integrated safety net healthcare system, to demonstrate the feasibility of integrating DH data within the VSD. Prior to incorporating the data, we examined the identification of specific vaccine associated adverse events (VAEs) in these two distinct healthcare systems.MethodsWe conducted retrospective cohort analyses within KPCO and DH to compare select VAEs between the two populations. We examined the following associations between January 1, 2004 and December 31, 2013: Measles, Mumps, and Rubella (MMR) vaccine and febrile seizures in children 2years and younger, intussusception after rotavirus vaccine in infants 4–34weeks, syncope after adolescent vaccines (Tetanus, Diphtheria, acellular Pertussis; Meningococcal and Human Papillomavirus) in adolescents 13–17years and medically attended local reactions after pneumococcal polysaccharide (PPSV23) vaccine in adults 65years and older. Both sites used similar data procurement methods and chart review processes.ResultsFor seizures after MMR vaccine (KPCO – 3.15vs. DH – 2.97/10,000 doses) and syncope after all adolescent vaccines (KPCO – 3.0vs. DH – 2.37/10,000 doses), the chart confirmed rates were comparable at the two sites. However, for medically attended local reactions after PPSV23, there were differences in chart confirmed rates between the sites (KPCO – 31.65vs. DH – 14.90/10,000 doses). For intussusception after rotavirus vaccine, the number of cases was too low to make a valid comparison (KPCO – 0vs. DH – 0.13/10,000 doses).ConclusionWe demonstrated that data on important targeted VAEs can be captured at DH and rates appear similar to those at KPCO. Work is ongoing on the optimal approach to assimilate DH data as a potential safety net healthcare system in the VSD.



http://ift.tt/2lir2Sr

Dengue vaccine: WHO position paper, July 2016 – recommendations

Publication date: Available online 6 February 2017
Source:Vaccine

This article presents the World Health Organization's (WHO) recommendations on the use of dengue vaccine excerpted from the WHO position paper on dengue vaccine published in the Weekly epidemiological Record in July 2016 (Dengue vaccine: WHO position paper, 2016) [1]. The current document is the first WHO position paper on dengue vaccination and focuses primarily on the available evidence concerning the only dengue vaccine to have been registered by National Regulatory Authorities. The position paper gives consideration to the epidemiological features of the disease and assesses the potential use of the vaccine for public health benefits.Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. This paper reflects the recommendations of the WHO's Strategic Advisory Group of Experts (SAGE) on immunization. Recommendations on the use of this dengue vaccine were discussed by SAGE in April 2016; evidence presented at that SAGE meeting can be accessed at: http://ift.tt/1J6kSPV.



http://ift.tt/2kMUqTC

An Efficient Synthesis of 1α,25-Dihydroxyvitamin D3 LC-Biotin

Publication date: Available online 6 February 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Lars Kattner, Dan Bernardi
In recent years the apparent impact of vitamin D deficiency on human health has gained increased awareness. Consequently, the development of appropriate assays to measure the status of medicinally most relevant vitamin D metabolites in human blood, serum or relevant tissue is continuously being improved. Particularly, assaying of 1α,25-dihydroxyvitamin D3, in turn considered as the most active metabolite, is mainly indicated in disorders leading to calcaemia or those resulting from an impaired 1α-hydroxylation of 25-hydroxyvitamin D3. Thus, in some competitive protein binding and ELISA assays, biotin-linked 1α,25-dihydroxyvitamin D3 (1α,25-dihydroxyvitamin D3 LC-biotin) is employed for measurement of actual calicitriol concentration. A new efficient synthesis of 1α,25-dihydroxyvitamin D3 LC-biotin is described, starting with readily available vitamin D2, and combining a classical approach to access 1α,25-dihydroxyvitamin D3, appropriate OH-protective group transformations, and a C-3-O-alkylation, suitable to connect the biotin-linker in a reliable, selective and high yielding strategy. The developed methodology is applicable to the synthesis of a wide variety of C-3-OH-linked vitamin D3 and D2 derivatives.



http://ift.tt/2jWMUqc

Image-guided adaptive brachytherapy dose escalation for cervix cancer via fractionation compensation

Publication date: Available online 6 February 2017
Source:Brachytherapy
Author(s): William Shaw, William I.D. Rae, Markus L. Alber
PurposeIn image-guided adaptive brachytherapy (IGABT), dose distributions are optimized for each fraction. Optimum fractional dose can be constant or adapted to previous fractions and a conjecture about the future ones. We evaluate the efficacy of different fraction size schemes, derived from total IGABT dose constraints, against constant per-fraction constraints.Methods and MaterialsThis retrospective planning study included 20 IGABT patients where four different fractionation schedules were compared based on modern planning recommendations. A total high-risk–clinical target volume D90 (minimum dose in 90% of the volume) dose aim of 90.0 Gy with constant per-fraction organs at risk (OARs) dose constraint planning (CONST) was compared with conservative and aggressive fractionation compensation (COMP) techniques. COMP allows variations in the per-fraction dose constraints. Dose accumulation was performed through dose summation at a given volume and equivalent uniform dose (EUD) worst-case dose estimates.ResultsNo significant differences were identifiable between dose metrics of CONST and COMP in the total patient population. However, a subgroup of patients with alternating dose-limiting OARs had significant benefit from COMP. Median high-risk–clinical target volume dose escalation ranged from 5% to 12%, whereas OAR dose increases were lower and ranged from 3% to 8%. EUD-based planning delivered similar tumor doses, although slightly lower OAR doses. By distributing the treatment aim over an increased number of treatment fractions, median tumor dose could be increased by a further 8% per additional treatment fraction at the same OAR dose levels for both CONST and COMP.ConclusionsCOMP is effective in patients with alternating dose-limiting OARs and is enhanced using more treatment fractions and EUD constraints.



http://ift.tt/2kBXiRr

Topical tacrolimus, triamcinolone acetonide and placebo in oral lichen planus: A pilot randomized controlled trial

Abstract

Objective

To carry out a double-blind RCT to compare the effectiveness of topical tacrolimus (TAC), triamcinolone acetonide (TRI) and placebo (PLA) in symptomatic OLP.

Subjects and methods

A clinical score (CS, range 0-130) was developed to measure the clinical signs and symptoms of OLP. Twenty-seven OLP patients with a CS of ≥ 20 were randomly allocated to receive 0.1% TAC ointment (n=11), 0.1% TRI paste (n=7) or Orabase^® paste as PLA (n=9) for 3 weeks. If the CS dropped ≥ 20% (interpreted as response), the patients continued the same medication for another 3 weeks. If the CS dropped < 20% or increased (non-response), the patients were switched to TAC for 6 weeks. A 6-month follow-up period ensued. The primary outcome variable was the change in CS from baseline to week 3. In primary outcome analysis, CS values between the treatment arms were compared.

Results

TAC and TRI were more effective (p=0.012 and 0.031, respectively) than PLA in reducing the CS at week 3. No difference in the efficacy was noted between TAC and TRI (p=0.997).

Conclusions

This pilot RCT provides evidence for the effectiveness of TAC and TRI over PLA in the management of OLP.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ljtatH

Recent Updates on Electronic Cigarette Aerosol and Inhaled Nicotine Effects on Periodontal and Pulmonary Tissues

Abstract

E-cigarette derived inhaled nicotine may contribute to the pathogenesis of periodontal and pulmonary diseases in particular via lung inflammation, injurious and dysregulated repair responses. Nicotine is shown to have anti-proliferative properties and affects fibroblasts in vitro, which may interfere in tissue myofibroblast differentiation in e-cig users. This will affect the ability to heal wounds by decreasing wound contraction. In periodontics, direct exposure to e-vapor has been shown to produce harmful effects in periodontal ligament and gingival fibroblasts in culture. This is due to the generation of reactive oxygen species/aldehydes/carbonyls from e-cig aerosol, leading to protein carbonylation of extracellular matrix and DNA adducts/damage. A limited number of studies regarding the effects of e-cig in oral and lung health are available. However, no reports are available to directly link the deleterious effects on e-cigs, inhaled nicotine, and flavorings aerosol on oral periodontal and pulmonary health in particular to identify the risk of oral diseases by e-cigarettes and nicotine aerosols. This mini-review summarizes the recent perspectives on e-cigarettes including inhaled nicotine effects on several pathophysiological events, such as oxidative stress, DNA damage, innate host response, inflammation, cellular senescence, pro-fibrogenic and dysregulated repair, leading to lung remodeling, oral submucous fibrosis and periodontal diseases.

This article is protected by copyright. All rights reserved.

http://ift.tt/2le1TMz

Comparative Effectiveness of Treatment Choices for Graves' Hyperthyroidism: A Historical Cohort Study

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kBOY3L

Biochemical Markers Reflecting Thyroid Function in Athyreotic Patients on Levothyroxine Monotherapy

Thyroid , Vol. 0, No. 0.


http://ift.tt/2klLTq5

Comparative Effectiveness of Treatment Choices for Graves' Hyperthyroidism: A Historical Cohort Study

Thyroid , Vol. 0, No. 0.


http://ift.tt/2kBOY3L

Biochemical Markers Reflecting Thyroid Function in Athyreotic Patients on Levothyroxine Monotherapy

Thyroid , Vol. 0, No. 0.


http://ift.tt/2klLTq5

Response to: “If the Metabolic Winter Is Coming, When Will It Be Summer?” (Metab Syndr Relat Disord 2017;15:3)

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2klQIQj

Characterization and Management of Cutaneous Side Effects Related to the Immunosuppressive Treatment in Solid Organ Recipients

Patients who underwent solid organ transplantation frequently suffer from different skin diseases, as consequence of the immunosuppressive treatment. Specific cutaneous side effects such as acne, hypertricosis or other pilosebaceous unit disorders, gingival hyperplasia, purpura or teleangiectasies are commonly associated to immunosuppressive medications. The majority of these conditions are benign, but the aesthetic concern may affect the patient is quality of life and reduce the adherence to the therapy. Moreover, solid organ transplant recipients frequently develop skin infections, as an indirect consequence of the immunosuppressive regimens. Herpes virus reactivation is more common few months after transplantation, whereas when the immunosuppression is reduced, the skin infections are mainly represented by human papilloma virus infections and localized mycosis. Bacterial infections are relatively rare. Long-term consequences of the immunosuppressive therapy are represented by development of precancerosis and skin cancers, with a risk that enhances over the time and a significant impact on patient survival. The aim of this paper is to provide an overview of the data published in the recent literature about this topic, in order to characterize the main skin disorders associated to the use of immunosuppressive drugs in solid organ recipients, giving information about their risk, epidemiology, clinical manifestations and management.

http://ift.tt/2ljrVen

Early Identification of Cardiovascular Diseases in People With Spinal Cord Injury: Key Information for Primary Care Providers

Publication date: Available online 6 February 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ceren Yarar-Fisher, Patricia Heyn, Jeanne M. Zanca, Susie Charlifue, Jean Hsieh, David M. Brienza




http://ift.tt/2kgjZt4

Effects of antioxidants on DNA double-strand breaks in human gingival fibroblasts exposed to dental resin co-monomer epoxy metabolites

Publication date: Available online 6 February 2017
Source:Dental Materials
Author(s): Yang Yang, Xiuli He, Jianwei Shi, Reinhard Hickel, Franz-Xaver Reichl, Christof Högg
ObjectiveEluted dental resin co-monomers can be metabolized to intermediate methacrylic acid (MA) and, further, to epoxy metabolites. Antioxidants have been studied previously, with the intention of decreasing the DNA double-strand breaks (DNA-DSBs) in human gingival fibroblasts (HGFs). In this study, the effects of the antioxidants, ascorbic acid (Asc) and N-acetylcysteine (NAC), were investigated on co-monomer metabolite-induced DNA-DSBs.MethodsHGFs were incubated with MA, 2,3-epoxy-2-methyl-propionicacid-methylester (EMPME) and 2,3-epoxy-2-methylpropionic acid (EMPA), respectively, in the presence or absence of antioxidants (Asc or NAC). EC50 Values were obtained from an XTT-based viability assay. DNA-DSBs were determined using a γ-H2AX assay.ResultsThe cytotoxicity of the compounds could be ranked in the following order (mean±SEM; n=4): EMPA>EMPME>MA. The average number of DSBs-foci/cell induced by each substance at EC50-concentration could be ranked in the following order (mean±SD; n=4): EMPA>EMPME>MA. EMPA (1.72mM) and EMPME (2.58mM) induced the highest number of DSBs-foci, that is 21-fold and 13-fold, respectively, compared to control (0.48±0.08 foci/cell). The addition of Asc (50; 100; 200μM) or NAC (50; 100; 200; 500μM) to MA (15.64; 5.21mM), EMPME (2.58mM), and EMPA (1.72; 0.57mM) significantly reduced the number of foci/cell in HGFs. The highest reduction could be found in HGFs with 1.72mM EMPA, the addition of NAC (50; 100; 200; 500μM) induced a 15-fold, 17-fold, 14-fold and 14-fold lower number of DSBs-foci/cell, respectively.SignificanceDental co-monomer epoxy metabolites, EMPME and EMPA, can induce DNA-DSBs. The addition of antioxidants (Asc or NAC) leads to reduction of DNA-DSBs, and NAC leads to more prominent reduction of DNA-DSBs compared to Asc.



http://ift.tt/2ljkIe8

In-vitro fatigue and fracture testing of CAD/CAM-materials in implant-supported molar crowns

Publication date: Available online 6 February 2017
Source:Dental Materials
Author(s): Verena Preis, Sebastian Hahnel, Michael Behr, Laila Bein, Martin Rosentritt
ObjectiveTo investigate the fatigue and fracture resistance of different CAD/CAM-materials as implant- or tooth-supported molar crowns with respect to the clinical procedure (screwed/bonded restoration).Methods168 crowns were fabricated from different CAD/CAM-materials (n=8/material): ZLS (zirconia-reinforced lithium silicate ceramic; Suprinity, Vita-Zahnfabrik), COB (composite; Brilliant Crios, Coltene), COL (composite; Lava Ultimate, 3M Espe), PMV/PPV (polyether ether ketone (PEEK)+milled composite veneer/composite paste veneer; BioHPP+HIPC veneer/Crealign veneer, Bredent), COH (composite; Block HC, Shofu), and ZIR (zirconia; IPS e.max ZirCAD, Ivoclar-Vivadent) as reference. Three groups were designed simulating the following clinical procedures: (a) chairside procedure ([CHAIR] implant crown bonded to abutment), (b) labside procedure ([LAB] abutment and implant crown bonded in laboratory, screwed chairside), and (c) reference ([TOOTH] crowns bonded on human teeth). Combined thermal cycling and mechanical loading (TCML) were performed simulating a 5-year clinical situation. Fracture force was determined and failures were documented. Data were statistically analyzed (Kolmogorov–Smirnov-test, one-way-ANOVA; post-hoc-Bonferroni, α=0.05).ResultsAll crowns of group LAB-PPV showed cracks after TCML. The other groups survived fatigue testing without failures. Fracture forces varied between 921.3N (PPV) and 4817.8N (ZIR) [CHAIR], 978.0N (COH) and 5081.4N (ZIR) [LAB], 746.7N (PPV) and 3313.5N (ZIR) [TOOTH]. Significantly (p<0.05) different fracture values were found between materials in all three groups. Only ZLS crowns provided no significant (p>0.05) differences between the individual groups.SignificanceDifferent ceramic and resin-based materials partly performed differently in implant or tooth situations. Individual resin-based materials (PPV, COB, COH) were weakened by inserting a screw channel. Most CAD/CAM-materials may be clinically applied in implant-supported crowns without restrictions. ​



http://ift.tt/2ldKsf1

Role of Bowel Ultrasound in the Diagnosis and Follow-up of Patients with Crohn's Disease

Publication date: Available online 6 February 2017
Source:Ultrasound in Medicine & Biology
Author(s): Clara Benedetta Conti, Mariangela Giunta, Daniele Gridavilla, Dario Conte, Mirella Fraquelli
Crohn's disease (CD) is an inflammatory chronic bowel disorder; it can involve the whole gastrointestinal tract, but its localization in the ileum or colon is most common. The reference standard for the diagnosis of CD is ileocolonoscopy with histologic assessment. The reference standard for the detection of any complications is surgery. However, imaging techniques have an important role both in the detection/localization of CD and in the follow-up of CD patients. In the last few years, the technical development of ultrasound equipment, the advent of new technologies such as elastography and mostly the increased expertise of sonographers have boosted the role of bowel ultrasound in assessment of the gastrointestinal tract. In fact, bowel ultrasound is particularly attractive thanks to its widespread availability, non-invasiveness, low cost and good reproducibility, as it can be easily repeated during follow-up. The aim of this article is to provide an extensive overview of the actual role of bowel ultrasound in the detection and follow-up of patients with CD.



http://ift.tt/2li6DNi

Diamond-based electrochemical aptasensor realizing a femtomolar detection limit of bisphenol A

Publication date: 15 June 2017
Source:Biosensors and Bioelectronics, Volume 92
Author(s): Yibo Ma, Junsong Liu, Hongdong Li
In this study, we designed and fabricated an electrochemical impedance aptasensor based on Au nanoparticles (Au-NPs) coated boron-doped diamond (BDD) modified with aptamers, and 6-mercapto-1-hexanol (MCH) for the detection of bisphenol A (BPA). The constructed BPA aptasensor exhibits good linearity from 1.0×10^–14 to 1.0×10⁻⁹molL⁻¹. The detection limitation of 7.2×10^–15molL⁻¹ was achieved, which can be attributed to the synergistic effect of combining BDD with Au-NPs, aptamers, and MCH. The examine results of BPA traces in Tris-HCl buffer and in milk, UV spectra of aptamer/BPA and interference test revealed that the novel aptasensors are of high sensitivity, specificity, stability and repeatability, which could be promising in practical applications.



http://ift.tt/2kfRw6O

Fluorescent “on-off-on” switching sensor based on CdTe quantum dots coupled with multiwalled carbon nanotubes@graphene oxide nanoribbons for simultaneous monitoring of dual foreign DNAs in transgenic soybean

Publication date: 15 June 2017
Source:Biosensors and Bioelectronics, Volume 92
Author(s): Yaqi Li, Li Sun, Jing Qian, Lingliang Long, Henan Li, Qian Liu, Jianrong Cai, Kun Wang
With the increasing concern of potential health and environmental risk, it is essential to develop reliable methods for transgenic soybean detection. Herein, a simple, sensitive and selective assay was constructed based on homogeneous fluorescence resonance energy transfer (FRET) between CdTe quantum dots (QDs) and multiwalled carbon nanotubes@graphene oxide nanoribbons (MWCNTs@GONRs) to form the fluorescent "on-off-on" switching for simultaneous monitoring dual target DNAs of promoter cauliflower mosaic virus 35s (P35s) and terminator nopaline synthase (TNOS) from transgenic soybean. The capture DNAs were immobilized with corresponding QDs to obtain strong fluorescent signals (turning on). The strong π–π stacking interaction between single-stranded DNA (ssDNA) probes and MWCNTs@GONRs led to minimal background fluorescence due to the FRET process (turning off). The targets of P35s and TNOS were recognized by dual fluorescent probes to form double-stranded DNA (dsDNA) through the specific hybridization between target DNAs and ssDNA probes. And the dsDNA were released from the surface of MWCNTs@GONRs, which leaded the dual fluorescent probes to generate the strong fluorescent emissions (turning on). Therefore, this proposed homogeneous assay can be achieved to detect P35s and TNOS simultaneously by monitoring the relevant fluorescent emissions. Moreover, this assay can distinguish complementary and mismatched nucleic acid sequences with high sensitivity. The constructed approach has the potential to be a tool for daily detection of genetically modified organism with the merits of feasibility and reliability.



http://ift.tt/2jWxWjX

Ultrasensitive electrochemical immunosensor for quantitative detection of SCCA using Co3O4@CeO2-Au@Pt nanocomposite as enzyme-mimetic labels

Publication date: 15 June 2017
Source:Biosensors and Bioelectronics, Volume 92
Author(s): Yueyun Li, Yihe Zhang, Faying Li, Jinhui Feng, Mingdang Li, Lei Chen, Yunhui Dong
Recently early diagnosis of squamous cell carcinoma antigen (SCCA) as a tumor maker of various cancers has increasingly attracted a lot of attention with heightening of incidence rate of cancer. The SCCA with low concentration in human serum should be diluted before detecting. Thus, an immunoassay with high sensitivity is significant for early detecting SCCA. Therefore, a nonenzymatic sandwich-type electrochemical immunosensor herein was conducted to quantitative detection of squamous cell carcinoma antigen (SCCA). The amino functionalized cobaltosic oxide @ ceric dioxide nanocubes with core-shell morphology were prepared to combine sea-urchin like gold @ platinum nanoparticles (Co3O4@CeO2-Au@Pt), and used as labels to conjugate with secondary antibodies for signal amplification. Due to the synergetic effect, excellent electrochemical property and superior auxiliary catalytic activity of Co3O4@CeO2-Au@Pt, high electrocatalytic current responses toward the reduction of hydrogen peroxide (H2O2) were achieved. Besides, the electrodeposited gold nanoparticles (D-Au NPs) which were modified on glassy carbon electrodes (GCE) were used as antibodies carriers and sensing platforms. With the well cooperation of Co3O4@CeO2-Au@Pt and D-Au NPs, a broad linear range from 100fg/mL to 80ng/mL with a low detection limit of 33 fg/mL for detecting SCCA was achieved. In addition, the immunosensor displayed with good reproducibility, high selectivity and stability. The results are satisfactory when the proposed method has been applied to analyze human serum samples, indicating that the potential application is promising in clinical monitoring of tumor markers.



http://ift.tt/2kMFEwh

The relationship between a dolichofacial morphology and bone adaptation of the articular tubercle

Publication date: Available online 6 February 2017
Source:Archives of Oral Biology
Author(s): J.H. Koolstra, M.C.M. Jongenburger, G.R. Landweer, N.M.B.K. Willems
ObjectivesAgainst the background of a possibly compromised functional adaptation, the relationship between the height of the articular tubercle was analyzed as a function of the amount of divergence between the maxilla and the mandible.DesignThese parameters were obtained retrospectively from orthopantomograms and lateral radiographs produced in a standard procedure before orthodontic treatment.ResultsThe height of the articular tubercle appeared to be significantly smaller in a group of patients with a dolichofacial morphology, with respect of those with an average (mesofacial) morphology. Furthermore, there was a significant correlation between the height of the articular tubercle and the mandibular angle.ConclusionsThese results suggest that bone remodeling in selected parts of the orofacial skeleton can be compromised giving rise to an altered craniofacial morphology.



http://ift.tt/2jWxvpC

Differential human Th22-lymphocyte response triggered by Aggregatibacter actinomycetemcomitans serotypes

Publication date: Available online 6 February 2017
Source:Archives of Oral Biology
Author(s): Jaime Díaz-Zúñiga, Samanta Melgar-Rodríguez, Gustavo Monasterio, Myriam Pujol, Leticia Rojas, Carla Alvarez, Paola Carvajal, Rolando Vernal
Objective: In Aggregatibacter actinomycetemcomitans, different serotypes have been described based on lipopolysaccharide (LPS) antigenicity. When T lymphocytes were stimulated with these serotypes, different patterns of T-helper (Th)1 and Th17-type of immune responses were reported. Recently, two new Th phenotypes have been described and named Th9 and Th22 lymphocytes; however, their role in the pathogenesis of periodontitis remains unclear. This study aimed to investigate the potential Th9 and/or Th22 lymphocyte responses when stimulated with autologous dendritic cells infected with different A. actinomycetemcomitans serotypes.MethodsMonocyte-derived dendritic cells and naïve CD4⁺ T lymphocytes were obtained from healthy donors and stimulated with different serotypes of A. actinomycetemcomitans at a multiplicity of infection MOI=10² or their purified LPS (10–50ng/ml). The levels for the Th9 and Th22-associated cytokines, as well as the transcription factor master-switch genes implied in their differentiation Spi-B and AhR, were quantified by qPCR and ELISA.ResultsWhen stimulated with the serotype b of A. actinomycetemcomitans, higher levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were detected in dendritic cells, as well as higher levels of IL-22 and AhR were detected in T lymphocytes, when compared with stimulation with the other serotypes.ConclusionsThe serotype b of A. actinomycetemcomitans has a higher capacity of trigger Th22-type of immune response in both dendritic cells and T lymphocytes. These data allow us to suggest that, when the serotype b of A. actinomycetemcomitans is a significant part of the subgingival biofilm, the Th22 polarization might be triggered within the periodontal lesion.



http://ift.tt/2kg5cyQ

Analysis of the Expression of NLRP3 and AIM2 in Periapical Lesions with Apical Periodontitis and Microbial Analysis Outside the Apical Segment of Teeth

Publication date: Available online 6 February 2017
Source:Archives of Oral Biology
Author(s): Shujun Ran, Bin Liu, Shensheng Gu, Zhe Sun, Jingping Liang
ObjectiveTo detect the distribution and expression levels of the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) and the absent in Melanoma 2 (AIM2) inflammasomes in periapical lesions and to analyse the possible microbial stimuli outside of teeth.DesignThe distribution of NLRP3 and AIM2 inflammasomes in sixteen periapical lesions was investigated by immunohistochemistry. Meanwhile, the relative gene expression levels of NLRP3 and AIM2 in sixteen periapical lesions and three health periodontal tissue were quantified by real-time polymerase chain reaction (PCR). Moreover, forty-seven teeth without sinus tracts were obtained in the clinic and included in bacterial analysis using PCR. Then, the mRNA levels of apoptosis-associated speck-like protein (ASC), caspase-1, interleukin-1β (IL-1β), NLRP3 and AIM2 in THP-1-derived macrophages treated with lipopolysaccharides (LPS) of Porphyromonas were also quantified by real-time PCR, and the IL-1β secretion level was investigated using enzyme-linked immunosorbent assay (ELISA).ResultsNLRP3 and AIM2 were positively expressed in periapical lesions and were mainly distributed in inflammatory cells. Most of the samples that demonstrated up-regulation of NLRP3 mRNA also demonstrated up-regulation of caspase-1 mRNA. Microbial analysis revealed that Porphyromonas endodontalis was the most commonly detected species and was detected in 27 of 47 cases (57.4%), followed by Fusobacterium nucleatum (20/47, 42.6%), Porphyromonas gingivalis (19/47, 40.4%), Tannerella forsythia (19/47, 40.4%), Actinomyces sp (17/47, 36.17%), Treponema denticola (10/47,21.28%), Actinomyces israelii (9/47,19.15%), Prevotella intermedia (6/47, 12.77%), Enterococcus faecalis (1/47,2.13%) and Enterococcus faecium (0/47,0). Furthermore, we found that LPS of P. gingivalis induced THP-1 cells to produce IL-1β and to activate NLRP3 and AIM2 inflammasomes.ConclusionsOur results suggest that the NLRP3 and AIM2 proteins play a part in the pathogenesis of periapical periodontitis. Anaerobes, such as P. endodontalis, P. gingivalis, F. nucleatum and T. forsythia, were the main detected microbial stimuli that activate inflammasomes in periapical tissues.



http://ift.tt/2jWmOUa

Increased melatonin in oral mucosal tissue of oral lichen planus (OLP) patients: A possible link between melatonin and its role in oral mucosal inflammation

Publication date: Available online 6 February 2017
Source:Archives of Oral Biology
Author(s): Kirawut Luengtrakoon, Worraned Wannakasemsuk, Vilasinee Vichitrananda, Poramaporn Klanrit, Doosadee Hormdee, Rajda Noisombut, Ponlatham Chaiyarit
ObjectiveThe existence of extra-pineal melatonin has been observed in various tissues. No prior studies of melatonin in human oral mucosal tissue under the condition of chronic inflammation have been reported. The aim of this study was to investigate the presence of melatonin in oral mucosal tissue of patients with oral lichen planus (OLP) which was considered as a chronic inflammatory immune-mediated disease causing oral mucosal damage and ulcerations.Materials and methodsSections from formalin-fixed and paraffin-embedded oral mucosal tissue of OLP patients (n=30), and control subjects (n=30) were used in this study. Immunohistochemical staining was performed and the semiquantitative scoring system was used to assess the levels of arylalkylamine-N-acetyltransferase (AANAT: a rate-limiting enzyme in the biosynthesis pathway of melatonin), melatonin, and melatonin receptor 1 (MT1) in oral mucosa of OLP patients and normal oral mucosa of control subjects.ResultsAANAT, melatonin, and MT1were detected in oral mucosal tissue of OLP patients and control subjects. Immunostaining scores of AANAT, melatonin, and MT1 in oral mucosal tissue of OLP patients were significantly higher than those in control subjects (p=0.002, p < 0.001, and p=0.031, respectively).ConclusionsIncreased levels of AANAT, melatonin, and MT1 in the inflamed oral mucosal tissue of OLP patients imply that chronic inflammation may induce the local biosynthesis of melatonin via AANAT, and may enhance the action of melatonin via MT1.



http://ift.tt/2kg5nKe

The role of hydroxychloroquine in the treatment of lichen planopilaris: A retrospective case series and review

Abstract

A variety of systemic agents are used to treat lichen planopilaris (LPP) with a limited evidence base. The aim of our study was to retrospectively review the response rate to and tolerability of hydroxychloroquine in a cohort of patients with LPP in an effort to add to the evidence base for its use. Twenty-three patients with a clinical and histopathological diagnosis of LPP who had been treated with hydroxychloroquine for their disease in a single center were identified. A retrospective review of these patients' medical records was performed and physician rated response was documented. Complete response was observed in 61% of our patients, and a further 9% of patients demonstrated partial response. Thirteen percent of patients withdrew from treatment because of suspected adverse effects. Our sample size was small, and data was collected retrospectively. We found hydroxychloroquine to be a reasonable therapeutic choice in LPP.

http://ift.tt/2kfVOLi

Pregabalin treatment of three cases with brachioradial pruritus

Abstract

Brachioradial pruritus (BRP) is a rare type of chronic pruritus that usually localized at the dorsolateral part of the forearms. Itching, burning, or pain are common symptoms at the involved areas. The etiological factors are still unknown but sun exposure and/or cervical spine lesions seem to be trigerring or precipiting factors. Neuropathogenic mechanism plays role in etiopathogenesis of BRP, therefore, antiepileptic drugs such as gabapentin, oxcarbazepine. and pregabalin are suggested medications for BRP. Herein, we report three cases with BRP successfully treated with pregabaline.

http://ift.tt/2jWzfj1

Unilesional plantar mycosis fungoides treated with topical photodynamic therapy - case report and review of the literature

Abstract

Background

Unilesional mycosis fungoides (UMF) and pagetoid reticulosis (PR) are variants of mycosis fungoides. Conventional therapy comprises surgical excision or radiotherapy which may be associated with long-term side effects, especially when the lesion is located at a special site like the palms and soles. Therefore, alternative treatment options are needed to treat solitary lesions in the case of UMF or PR. Recently topical photodynamic therapy (PDT) has been described to be an efficient and non-invasive therapeutical option with excellent clinical outcome.

Objective

The objective of this paper is to report a 43-year old woman with plantar UMF treated successfully with PDT, and to compare our findings with the data on PDT in UMF and PR reported in the literature.

Methods

The literature was analyzed for articles on UMF and PR, respectively, treated with topical PDT. Various parameters including form of PDT and response to treatment were analyzed and compared with our case.

Results

A total of 24 patients were documented with 24 lesions treated with PDT, either using aminolevulinic acid (ALA) or methylaminolevulinate (MAL). In average a single lesion was treated 19 times with PDT. In 21 cases (88%) complete response could be achieved, whereas 3 cases (13%) showed partial remission. None of the cases showed a stable or progression of the disease.

Conclusions

PDT is a safe, efficient and non-invasive therapeutical approach for the treatment of UMF and PR. It has no longstanding adverse events and therefore is of high therapeutic value especially in cases of UMF and PR located at special sites like the palms and soles. We propose to include topical PDT as therapeutic options for the treatment of UMF and PR in future guidelines on MF.

This article is protected by copyright. All rights reserved.

http://ift.tt/2kBxwN8

A case of linear basal cell carcinoma: evaluation of proliferative activity by immunohistochemical staining of PCTAIRE1 and p27

Abstract

Linear basal cell carcinoma (LBCC) is a unique morphological variant of basal cell carcinoma (BCC)^1-3, and the mechanism behind the linear form has yet to be fully elucidated. To date, we have investigated the functions of p27 (Kip1) and PCTAIRE1 (also known as PCTK1, Cdk16) in tumorigenesis.^{4, 5} PCTAIRE1 is a member of the PCTAIRE family, which is related to the Cdk family, and it phosphorylates p27, leading to ubiquitination/degradation of this tumor suppressor.^{6, 7} An inverse correlation between p27 and PCTAIRE1 expressions has been observed in malignant tumors.

This article is protected by copyright. All rights reserved.

http://ift.tt/2kllb16

Small infantile hemangioma and breast hypoplasia

Abstract

Large and/or segmental infantile hemangiomas (IH) are sometimes associated with other localized and/or more widespread malformations such as those occurring in the PHACES (1). Breast hypoplasia occurring after IH has been barely reported (2). We report the case of a small IH of the breast, associated with a homolateral breast hypoplasia and we raise the question of a potential link between the 2 findings.

This article is protected by copyright. All rights reserved.

http://ift.tt/2kBFFBb

New-onset inflammatory bowel disease in adults with atopic dermatitis

Abstract

Atopic dermatitis (AD) is a common chronic and remitting inflammatory skin disease that affects children and adults. While some studies have reported an increased risk of Crohn's disease (CD), but not ulcerative colitis (UC), others have associated both conditions with AD. Notably, most studies have focused on IBD in childhood and adolescence.

This article is protected by copyright. All rights reserved.

http://ift.tt/2klonJK

The role of hydroxychloroquine in the treatment of lichen planopilaris: A retrospective case series and review

Abstract

A variety of systemic agents are used to treat lichen planopilaris (LPP) with a limited evidence base. The aim of our study was to retrospectively review the response rate to and tolerability of hydroxychloroquine in a cohort of patients with LPP in an effort to add to the evidence base for its use. Twenty-three patients with a clinical and histopathological diagnosis of LPP who had been treated with hydroxychloroquine for their disease in a single center were identified. A retrospective review of these patients' medical records was performed and physician rated response was documented. Complete response was observed in 61% of our patients, and a further 9% of patients demonstrated partial response. Thirteen percent of patients withdrew from treatment because of suspected adverse effects. Our sample size was small, and data was collected retrospectively. We found hydroxychloroquine to be a reasonable therapeutic choice in LPP.

http://ift.tt/2kfVOLi

Treatment history of patients receiving biologic therapy for psoriasis - a Danish nationwide study

Abstract

Psoriasis is a common skin disease affecting approximately 2-4% of the world's population.[1] Management of psoriasis often involves prolonged treatment with topical-, systemic-, and biologic agents. Topical agents, i.e. topical corticosteroids or topical vitamin D analogues, are considered first-line of treatment for psoriasis, whereas biologics are predominantly used as a last resort, often as the result of treatment failure of conventional systemic agents. However, the specific treatment algorithms may differ between patients and countries, and certain therapies may be used off-label.

This article is protected by copyright. All rights reserved.

http://ift.tt/2kBDwFv

Pregabalin treatment of three cases with brachioradial pruritus

Abstract

Brachioradial pruritus (BRP) is a rare type of chronic pruritus that usually localized at the dorsolateral part of the forearms. Itching, burning, or pain are common symptoms at the involved areas. The etiological factors are still unknown but sun exposure and/or cervical spine lesions seem to be trigerring or precipiting factors. Neuropathogenic mechanism plays role in etiopathogenesis of BRP, therefore, antiepileptic drugs such as gabapentin, oxcarbazepine. and pregabalin are suggested medications for BRP. Herein, we report three cases with BRP successfully treated with pregabaline.

http://ift.tt/2jWzfj1

Assessment of a 3-Dimensional Computerised PASI Tool for calculating and documenting psoriasis area and severity index scores

Abstract

Psoriasis Area and Severity Index(PASI) scoring was initially developed by Fredriksson and Pettersson in 1978[1], as a method to clinically evaluate and quantitate the amount and severity of psoriasis, and therefore the responses to a new treatment. Despite its advantages, there are numerous limitations such as high intra- and inter-observer variability and reproducibility in assessment of each of the PASI parameters[2], with scores varying two or three fold between scorers[2-5].

This article is protected by copyright. All rights reserved.

http://ift.tt/2klvhPr

Policy and priorities for national cancer control planning in low- and middle-income countries: Lessons from the Association of Southeast Asian Nations (ASEAN) Costs in Oncology prospective cohort study

Publication date: March 2017
Source:European Journal of Cancer, Volume 74
Author(s): The ACTION Study GroupWriting committeNirmalaBhoo-PathyCheng-HarYipSanne A.E.PetersMerelKimmanRichardSullivanStephenJanMarkWoodwardChiu-WanNg: Julius Centre University of Malaya Department of Social and Preventive Medicine Faculty of Medicine University of Malaya 50603 Lembah Pantai Kuala Lumpur Malaysia. Fax: +60 3 7967 4975.Principal investigatorsPhetsamoneArounlangsySoeAungSoledad L.BaleteNirmalaBhoo-PathyBounthaphanyBounxoueiDieuBuiJayDatukanAgnes E.GorospeCheng HarYipPrasitKhopaibulThanutKhuayjarernpanishkThiravudKhuhapremaMyoKhinTawinKlinwimolSomkietLalitwongsaDhanooLawbundisConradoLolaGloriaCristal-LunaLeoMarbellaKhoa MaiTrongSoe OoMaungShuMonWin PaPa NaingCorazon A.NgelangelHtun LwinNyeinAnnielyn BerylOng-CornelKhin MayOoIrisylOrolfo-RealDung PhamXuanSeangPharinPujiantoOudayvoneRattanavongKouySamnangSomphobSangkittipaiboonSuleepornSangrajrangCherelinaSantiago-FerrerasPrihSarniantoSanShweEavSokhaThanadejSinthusakeDaruneeSuanpluJitrapornTanabodeeHasbullahThabranyKitisakThepsuwanYin YinHtunHengViroathLeLe WinSwe SweWinTin MoeWinOther contributorsAmiAshariatiDjumhanaAtmakusumaI.MadeBaktaLoan DangThi KimPhung DangThi NgocTuan DiepBaoArioDjatmikoAndiFachruddinPik-PinGohJohanKurniandaHelenMonaghanAbdulMuthalibTrang NgoThuyThao NguyenHoangNga NguyenThi HoaiSonar S.PanigoroHuy PhạmQuangKhanh QuachThanhDradjat R.SuardiShriDeviSubramaniamAru W.SudoyoKhoa TranDangHa TranDinhCatharinaSuhartiSuyatno
BackgroundEvidence to guide policymakers in developing affordable and equitable cancer control plans are scarce in low- and middle-income countries (LMIC).MethodsThe 2012–2014 ASEAN Costs in Oncology Study prospectively followed-up 9513 newly diagnosed cancer patients from eight LMIC in Southeast Asia for 12 months. Overall and country-specific incidence of financial catastrophe (out-of-pocket health costs ≥ 30% of annual household income), economic hardship (inability to make necessary household payments), poverty (living below national poverty line), and all-cause mortality were determined. Stepwise multinomial regression was used to estimate the extent to which health insurance, cancer stage and treatment explained these outcomes.ResultsThe one-year incidence of mortality (12% in Malaysia to 45% in Myanmar) and financial catastrophe (24% in Thailand to 68% in Vietnam) were high. Economic hardship was reported by a third of families, including inability to pay for medicines (45%), mortgages (18%) and utilities (12%), with 28% taking personal loans, and 20% selling assets (not mutually exclusive). Out of households that initially reported incomes above the national poverty levels, 4·9% were pushed into poverty at one year. The adverse economic outcomes in this study were mainly attributed to medical costs for inpatient/outpatient care, and purchase of drugs and medical supplies. In all the countries, cancer stage largely explained the risk of adverse outcomes. Stage-stratified analysis however showed that low-income patients remained vulnerable to adverse outcomes even when diagnosed with earlier cancer stages.ConclusionThe LMIC need to realign their focus on early detection of cancer and provision of affordable cancer care, while ensuring adequate financial risk protection, particularly for the poor.



http://ift.tt/2jWkRY2

Prognostic factors and survival according to tumour subtype in women presenting with breast cancer brain metastases at initial diagnosis

Publication date: March 2017
Source:European Journal of Cancer, Volume 74
Author(s): José Pablo Leone, Julieta Leone, Ariel Osvaldo Zwenger, Julián Iturbe, Bernardo Amadeo Leone, Carlos Teodoro Vallejo
BackgroundThe presence of brain metastases at the time of initial breast cancer diagnosis (BMIBCD) is uncommon. Hence, the prognostic assessment and management of these patients is very challenging. The aim of this study was to analyse the influence of tumour subtype compared with other prognostic factors in the survival of patients with BMIBCD.MethodsWe evaluated women with BMIBCD, reported to Surveillance, Epidemiology and End Results program from 2010 to 2013. Patients with other primary malignancy were excluded. Univariate and multivariate analyses were performed to determine the effects of each variable on overall survival (OS).ResultsWe included 740 patients. Median OS for the whole population was 10 months, and 20.7% of patients were alive at 36 months. Tumour subtype distribution was: 46.6% hormone receptor (HR)+/HER2−, 17% HR+/HER2+, 14.1% HR−/HER2+ and 22.3% triple-negative. Univariate analysis showed that the presence of liver metastases, lung metastases and triple-negative patients (median OS 6 months) had worse prognosis. The HR+/HER2+ subtype had the longest OS with a median of 22 months. In multivariate analysis, older age (hazard ratio 1.8), lobular histology (hazard ratio 2.08), triple-negative subtype (hazard ratio 2.25), liver metastases (hazard ratio 1.6) and unmarried patients (hazard ratio 1.39) had significantly shorter OS.ConclusionsAlthough the prognosis of patients with BMIBCD is generally poor, 20.7% were still alive 3 years after the diagnosis. There were substantial differences in OS according to tumour subtype. In addition to tumour subtype, other independent predictors of OS are age at diagnosis, marital status, histology and liver metastases.



http://ift.tt/2kfUtV3

Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya

Background.

Cervical cancer is the second most commonly diagnosed cancer in females and is a leading cause of cancer-related mortality in Kenya; limited cervical cancer screening services may be a factor. Few studies have examined men's and women's perceptions on environmental and psychosocial barriers and benefits related to screening.

Materials and Methods

In 2014, 60 women aged 25–49 years and 40 male partners participated in 10 focus groups (6 female and 4 male), in both rural and urban settings (Nairobi and Nyanza, Kenya), to explore perceptions about barriers to and benefits of cervical cancer screening. Focus groups were segmented by sex, language, geographic location, and screening status. Data were transcribed, translated into English, and analyzed by using qualitative software.

Results.

Participants identified screening as beneficial for initiating provider discussions about cancer but did not report it as a beneficial method for detecting precancers. Perceived screening barriers included access (transportation, cost), spousal approval, stigma, embarrassment during screening, concerns about speculum use causing infertility, fear of residual effects of test results, lack of knowledge, and religious or cultural beliefs. All participants reported concerns with having a male doctor perform screening tests; however, men uniquely reported the young age of a doctor as a barrier.

Conclusion.

Identifying perceived barriers and benefits among people in low- and middle-income countries is important to successfully implementing emerging screening programs. The novel findings on barriers and benefits from this study can inform the development of targeted community outreach activities, communication strategies, and educational messages for patients, families, and providers. The Oncologist 2017;22: 000–000

Implications for Practice: This article provides important information for stakeholders in clinical practice and research when assessing knowledge, beliefs, and acceptability of cervical cancer screening and treatment services in low- and middle-resourced countries. Formative research findings provide information that could be used in the development of health interventions, community education messages, and materials. Additionally, this study illuminates the importance of understanding psychosocial barriers and facilitators to cervical cancer screening, community education, and reduction of stigma as important methods of improving prevention programs and increasing rates of screening among women.

http://ift.tt/2kBmszx

An Oncogenic ALK Fusion and an RRAS Mutation in KRAS Mutation-Negative Pancreatic Ductal Adenocarcinoma

Purpose.

Oncogenic mutations in the KRAS gene are a well-known driver event, occurring in >95% of pancreatic cancers. The objective of this study was to identify driver oncogene aberrations in pancreatic cancers without the KRAS mutation.

Methods.

Whole-exome and transcriptome sequencing was performed on four cases of KRAS mutation-negative pancreatic ductal adenocarcinoma, which were identified in a cohort of 100 cases.

Results.

One case harbored an oncogenic DCTN1-ALK fusion. The fusion gene enabled interleukin-3-independent growth of Ba/F3 cells and rendered them susceptible to the anaplastic lymphoma kinase tyrosine kinase inhibitors crizotinib and alectinib. The structure of the breakpoint junction indicated that the fusion was generated by nonhomologous end joining between a segment of DCTN1 exon DNA and a segment of ALK intron DNA, resulting in the generation of a cryptic splicing site. Another case harbored an oncogenic RRAS mutation that activated the GTPase of the RRAS protein.

Conclusion.

Rare oncogenic aberrations, such as the ALK fusion and RRAS mutation, may drive pancreatic carcinogenesis independent of the KRAS mutation. The Oncologist 2017;22:000–000

Implications for Practice: The oncogenic DCTN1-ALK fusion and the RRAS mutation were associated with the development of pancreatic ductal adenocarcinoma (PDAC) in the absence of the KRAS mutation. Constitutional activation of DCTN1-ALK fusion protein was suppressed by the anaplastic lymphoma kinase tyrosine kinase inhibitors crizotinib and alectinib. Thus, a small subset of PDAC patients might benefit from therapy using these inhibitors.

http://ift.tt/2kBeztR

Pharmacoepidemiology of Clinically Relevant Hypothyroidism and Hypertension from Sunitinib and Sorafenib

Background.

Thyroid dysfunction and hypertension (HTN) have been sporadically reported with sunitinib (SUN) and sorafenib (SOR). Determination of the side effect incidence will enhance monitoring and management recommendations.

Methods.

An observational cohort study was performed using deidentified pharmacy claims data from a 3-year period to evaluate patients prescribed SUN, SOR, or capecitabine (CAP; comparison group). The primary outcome was time to first prescription for thyroid replacement or HTN treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by Cox proportional hazards models.

Results.

A total of 20,061 patients were eligible for evaluation of thyroid replacement therapy, which was initiated in 11.6% of those receiving SUN (HR, 16.77; 95% CI, 13.54–20.76), 2.6% of those receiving SOR (HR, 3.47; 95% CI, 2.46–4.98), and 1% of those receiving CAP, with median time to initiation of 4 months (range, 1–35 months). A total of 14,468 patients were eligible for evaluation of HTN therapy, which was initiated in 21% of SUN recipients (HR, 4.91; 95% CI, 4.19–5.74), 14% of SOR recipients (HR, 3.25; 95% CI, 2.69–3.91), and 5% of CAP recipients, with median time to initiation of 1 month (range, 1–18 months) for SOR and 2 months (range, 1–25 months) for SUN.

Conclusion.

SUN and SOR significantly increased the risk for clinically relevant hypothyroidism; the risk was at least 4 times greater with SUN than with SOR. Patients receiving SUN and SOR had a similar elevated risk for clinically relevant HTN. These data provide robust measures of the incidence and time to onset of these clinically actionable adverse events. The Oncologist 2017;22:000–000

Implications for Practice: The side effect profiles for novel therapies are typically used to create monitoring and management recommendations using clinical trial data from patient populations that may not represent those seen in standard clinical practice. This analysis using a large pharmacy claims database better reflects typical patients treated with sorafenib or sunitinib outside of a clinical trial. The findings of increased need for thyroid replacement in patients receiving sunitinib compared with sorafenib and a similar increase in need for hypertension therapy with both agents can be used to form clinically relevant monitoring recommendations for these agents.

http://ift.tt/2klebRE

Financial Toxicity and Societal Costs of Cancer Care: Distinct Problems Require Distinct Solutions

http://ift.tt/2kls6Hp

Pathologic Complete Response with Neoadjuvant Doxorubicin and Cyclophosphamide Followed by Paclitaxel with Trastuzumab and Pertuzumab in Patients with HER2-Positive Early Stage Breast Cancer: A Single Center Experience

Objectives

Trastuzumab (H) and pertuzumab (P) with standard chemotherapy is approved for use in the neoadjuvant setting for human epidermal growth receptor 2 -positive patients. A retrospective analysis was performed of patients treated with dose-dense (dd) doxorubicin and cyclophosphamide (AC) followed by paclitaxel (T), trastuzumab, and pertuzumab (THP) in the neoadjuvant setting. Here, the pathologic complete response (pCR) rates are reported.

Methods.

An electronic medical record review was conducted of patients treated with HP-based therapy in the neoadjuvant setting from September 1, 2013, to March 1, 2015. Data on patient demographics, stage of breast cancer, pathology reports, surgical data, and information on systemic therapy were collected. The pCR was defined as total (tpCR, ypT0/is ypN0), German Breast Group (GBG) pCR (ypT0 ypN0), breast pCR (bpCR) with in situ disease (ypT0/is) and without in situ disease (ypT0), and explored axillary pCR (ypN0).

Results.

Charts from 66 patients were reviewed, and 57 patients were evaluable for pCR. Median age was 46 years (range 26–68 years). Median tumor size was 4 cm. Of 57 patients, 53 (93%) had operable breast cancer (T1-3, N0-1, M0). Three patients (5.3%) had locally advanced disease (T2-3, N2-3, M0 or T4a-c, any N, M0), and 1 (1.7%) had inflammatory breast cancer (T4d, any N, M0). Overall, 44 (77%) and 13 (23%) had hormone receptor (HR)-positive and negative diseases, respectively. Median numbers of cycles of neoadjuvant treatment were as follows: AC (4, range 1–4), T (4, range 1–4), trastuzumab (6, range 3–8), and pertuzumab (6, range 2–8). In these 57 patients, the rates of tpCR and bpCR with in situ disease were demonstrated in 41/57 (72%) patients, and the rates of GBG pCR and bpCR without in situ disease were found in 30/57 (53%) patients. Of 26 patients with biopsy-proven lymph nodal involvement, axillary pCR occurred in 22 (85%) patients.

Conclusion.

At a single center, the tpCR and GBG pCR rates of dd AC followed by THP are high at 72% and 53%, respectively. The Oncologist 2017;22:000–000

Implications for Practice: This is the first study describing the role of doxorubicin and cyclophosphamide followed by paclitaxel and dual anti-HER2 therapy with trastuzumab and pertuzumab (ACTHP) in patients with early stage HER2-positive breast cancer. Total (breast + lymph node) pathological complete remission (pCR) remission (ypT0/is ypN0) and German Breast Group pCR rates (ypT0/ ypN0) were high at 72% and 53%, respectively, with the ACTHP regimen. Rate of axillary clearance in patients with known axillary involvement was high at 85%, which may translate into less extensive axillary surgeries in this subset in the future.

http://ift.tt/2kBuwA2

Use of Systemic Therapy Concurrent With Cranial Radiotherapy for Cerebral Metastases of Solid Tumors

The incidence of brain metastases of solid tumors is increasing. Local treatment of brain metastases is generally straightforward: cranial radiotherapy (e.g., whole-brain radiotherapy or stereotactic radiosurgery) or resection when feasible. However, treatment becomes more complex when brain metastases occur while other metastases, outside of the central nervous system, are being controlled with systemic therapy (chemotherapeutics, molecular targeted agents, or monoclonal antibodies). It is known that some anticancer agents can increase the risk for neurotoxicity when used concurrently with radiotherapy. Increased neurotoxicity decreases quality of life, which is undesirable in this predominantly palliative patient group. Therefore, it is of utmost importance to identify the compounds that should be temporarily discontinued when cranial radiotherapy is needed.

This review summarizes the (neuro)toxicity data for combining systemic therapy (chemotherapeutics, molecular targeted agents, or monoclonal antibodies) with concurrent radiotherapy of brain metastases. Because only a limited amount of high-level data has been published, a risk assessment of each agent was done, taking into account the characteristics of each compound (e.g., lipophilicity) and the microenvironment of brain metastasis. The available trials suggest that only gemcitabine, erlotinib, and vemurafenib induce significant neurotoxicity when used concurrently with cranial radiotherapy. We conclude that for most systemic therapies, the currently available literature does not show an increase in neurotoxicity when these therapies are used concurrently with cranial radiotherapy. However, further studies are needed to confirm safety because there is no high-level evidence to permit definitive conclusions. The Oncologist 2017;22:000–000

Implications for Practice: The treatment of symptomatic brain metastases diagnosed while patients are receiving systemic therapy continues to pose a dilemma to clinicians. Will concurrent treatment with cranial radiotherapy and systemic therapy (chemotherapeutics, molecular targeted agents, and monoclonal antibodies), used to control intra- and extracranial tumor load, increase the risk for neurotoxicity? This review addresses this clinically relevant question and evaluates the toxicity of combining systemic therapies with cranial radiotherapy, based on currently available literature, in order to determine the need to and interval to interrupt systemic treatment.

http://ift.tt/2klmVXT

A Clinical Review of Laser and Light Therapy for Nail Psoriasis and Onychomycosis

BACKGROUND: There are considerable emerging data in the use of lasers and lights to treat onychomycosis and psoriasis of the nail subunit. OBJECTIVE: We aimed to review all of the medical literature on laser therapy of nail psoriasis and onychomycosis published since 1992. METHODS AND MATERIALS: We performed a PubMed literature search using the search terms "nail," "laser therapy," "laser surgery," "light," with search terms "psoriasis" and "onychomycosis." In addition, we performed extensive MeSH and bibliographic searches as delineated in the manuscript. Because of the poor quality of evidence, we were not able to complete a quantitative review and thus present our findings qualitatively. RESULTS: Although the trials are small, PDL (595 nm) and IPL with a 550-nm filter demonstrate compelling data in treating nail psoriasis. Laser studies of onychomycosis fall short on many levels. Q-switched Nd:YAG lasers with very short pulse durations and fractionated CO2 demonstrate the most promise for the treatment of onychomycosis. CONCLUSION: The data for treating nail psoriasis and onychomycosis with laser and light therapy are rapidly emerging. With increased subject data, improved study methodology, and more precise output parameters, lasers may become an important modality in the treatment of nail psoriasis and onychomycosis.

http://ift.tt/2jWdn2c

Time Course Analysis of Upper Blepharoplasty Complications

No abstract available

http://ift.tt/2jWbDWQ

A Review of Local Anesthetics: Minimizing Risk and Side Effects in Cutaneous Surgery

BACKGROUND: The specialty of dermatology relies heavily on local anesthesia for diagnosis and management of skin disease. The appropriate selection, preparation, administration, and monitoring of these medications affect surgical outcome and patient safety and satisfaction. OBJECTIVE: To perform a comprehensive literature review of the side effects and risks associated with local anesthetics used in cutaneous surgery. Current recommendations to reduce risk and minimize side effects are reviewed. MATERIALS AND METHODS: A comprehensive review of the English-language medical literature search was performed. RESULTS: No current review articles of the side effects and risks of local anesthetics were identified. This review serves to discuss local anesthetics commonly used in dermatology and cutaneous surgery along with practical information regarding prevention of adverse outcomes and addressing local and systemic reactions when they arise. CONCLUSION: Local anesthetics commonly used in cutaneous surgery have potential risks and side effects. Appropriate selection and utilization of local anesthetics and knowledge of the means to prevent and address these risks can impact surgical outcomes, patient satisfaction and safety, and ultimately patient experience in the dermatology clinic.

http://ift.tt/2jWgGXl

Effect of Phenol and Sodium Hydroxide in the Bacterial Load at Nail Fold After Partial Matricectomy

No abstract available

http://ift.tt/2jWfxiu

Squamous Cell Carcinoma Versus Hypertrophic Lichen Planus; a Difficult Differential Diagnosis of Great Significance in Approach to Treatment

No abstract available

http://ift.tt/2jWldbW

A Critical Assessment of the Evidence for Low-Level Laser Therapy in the Treatment of Hair Loss

BACKGROUND: Low-level laser therapy (LLLT) is currently in use to stimulate hair growth and is quickly gaining in popularity due to the ease of use and absence of side effects. In 2015 alone, the number of LLLT devices with the Food and Drug Administration clearance has doubled. OBJECTIVE: To consolidate evidence and establish which data are still required for the widespread acceptance of LLLT for hair loss therapy. METHODS AND MATERIALS: A thorough search of the PubMed database was conducted to obtain studies investigating LLLT for androgenetic alopecia in men and women. RESULTS: Nine trials were identified for comb and helmet/cap devices, five of which were randomized controlled trials. Data comparison across LLLT trials and with traditional hair loss therapy (minoxidil, finasteride) was not straight forward because there was a lack of visual evidence, sample sizes were low, and there were large variations in study duration and efficacy measurements. CONCLUSION: There are a number of unanswered questions about the optimum treatment regimen, including maintenance treatment and the long-term consequences of LLLT use. Moving forward, protocols should be standardized across trials. Moreover, it is recommended that future trials include visual evidence and trial duration be expanded to 12 months.

http://ift.tt/2jWdbQq

Trial Designs and Characteristics in Laser Studies in Dermatology: A Systematic Review

BACKGROUND: Lasers are increasingly used in Dermatology. Clinical studies are among the best means to assess their efficacy. OBJECTIVE: To obtain an overview of therapeutic laser studies in the field of Dermatology, the authors conducted a systematic review to describe the types of study published over the past 25 years, and their reporting in the abstracts. METHODS: The authors selected interventional studies that evaluated laser treatment on human subjects with skin diseases. Reviews or single-case reports were excluded. Journal characteristics, study design, and trial characteristics were recorded and analyzed according to trends over time and journal impact factor ratings. RESULTS: Of the 681 studies included, 57% were comparative, of which 46% were randomized, controlled studies. Trial duration was clearly mentioned in 63% of the abstracts. Trial duration was generally under 6 months (78%). Some parameters were rarely mentioned as follows: the number of patients lost to follow-up (only 12%), blinding (21%), and a clearly stated main outcome (36%). Over the 25 years, there was a significant trend toward an increased proportion of randomized, controlled trials, from 15% between 1990 and 2000 to 41% between 2010 and 2015 (p

http://ift.tt/2jWsg4t

Eight Years' Experience of Sentinel Lymph Node Biopsy in Melanoma Using Lymphoscintigraphy and Gamma Probe Detection After Radiocolloid Mapping

BACKGROUND: Isosulfan blue dye peripheral injection is used in preoperative sentinel lymph node (SLN) identification alone or, to increase sensitivity, in conjunction with radiocolloid mapping. However, isosulfan blue dye has certain drawbacks and limitations. OBJECTIVE: This study assesses the authors' experience of SLN biopsy using only radiocolloid tracer. MATERIALS AND METHODS: Between 2000 and 2008, 218 patients underwent SLN biopsy with radiocolloid mapping, preoperative localization by lymphoscintigraphy and intraoperative confirmation by gamma probe in primary malignant cutaneous melanoma. RESULTS: Mean Breslow index was 2.1 mm. The SLN biopsy success rate was above 98% at all sites and 87% in head and neck locations. The 5-year overall survival rate was 90% and that of 5-year disease-free survival was 80%. False-negative rate, with a mean follow-up time of 41 months, was 5.5%. CONCLUSION: Sentinel lymph node biopsy can be successfully performed in patients with melanoma using only radiocolloid tracer without blue dye staining. In circumstances where blue dye cannot be used such as head and neck tumors, allergic reactions and pregnancy, radiocolloid tracer mapping alone is not a loss of chance for patients with melanoma.

http://ift.tt/2jWcNBA

Dermatologic Surgery Needs in Low-Income, Uninsured, and Minority Communities

No abstract available

http://ift.tt/2jWgGGP

Comparative Efficacy of Radiofrequency and Pulsed Dye Laser in the Treatment of Rosacea

BACKGROUND: Laser and light-based therapies have been used successfully in the treatment of rosacea; however, evidence is lacking regarding the efficacy of radiofrequency (RF). OBJECTIVE: This study evaluated the efficacy of RF in the treatment of rosacea compared with pulsed dye laser (PDL). METHODS: Thirty patients with rosacea (erythematotelangiectatic rosacea [ETR], n = 20; papulopustular rosacea [PPR], n = 10) were enrolled in a randomized, controlled, split-face study. The patients were treated with RF on one side and PDL on the other side. Each treatment consisted of 3 sessions at 4-week intervals and followed up until 4 weeks after the last treatment. Efficacy was assessed by rosacea severity score, erythema index, lesion counts, physician's subjective evaluation, and patient's satisfaction. RESULTS: Radiofrequency and PDL resulted in significant improvement in severity scores and erythema and 70% of the patients receiving RF treatment showed a clinical improvement of >50%. No significant difference was noted between RF and PDL treatment in ETR. However, RF treatment led to a significantly greater decrease in papulopustular lesion count and rosacea severity score in PPR compared with PDL treatment. CONCLUSION: RF therapy was effective in the treatment of rosacea. It should be considered an alternative therapeutic option, especially in PPR.

http://ift.tt/2jWgjMn

Reliability, Validity, and Sensitivity to Change Overtime of the Modified Melasma Area and Severity Index Score

BACKGROUND: The new modified Melasma Area and Severity Index (mMASI) score, the recently used outcome measure for melasma, has not been tested to determine its sensitivity to change in melasma. OBJECTIVE: To determine the reliability, validity, and sensitivity to change overtime of the mMASI score in assessment of the severity of melasma. METHODS: Pearson correlation, Cronbach alpha, and intraclass correlation coefficient were calculated to assess the reliability of the mMASI score. Validity of the mMASI scale was carried out using Spearman correlation between mMASI total score (before and after treatment), clinical data, and patient's responses. RESULTS: The mMASI score showed excellent reliability and good validity for assessment of the severity of melasma. The authors also determined that the mMASI score demonstrated sensitivity to change over time. CONCLUSION: An excellent degree of agreement between the mMSAI and MASI scores was revealed. The mMASI score is reliable, valid, and responsive to change in the assessment of severity of melasma. Moreover, the mMASI score was found to be easier to learn and perform and simpler in calculation compared with the MASI score. Overall, the mMASI score can effectively replace the MASI score.

http://ift.tt/2jWiDCN

Resistant and Recurrent Late Reaction to Hyaluronic Acid-Based Gel

No abstract available

http://ift.tt/2kH1lhq

Sebaceous Carcinoma Treated With Mohs Micrographic Surgery

BACKGROUND: Sebaceous carcinoma is a rare and potentially aggressive adnexal neoplasm with historic data indicating high rates of recurrence, metastasis, and cancer-specific mortality. OBJECTIVE: To evaluate the incidence of local recurrence, metastasis, disease-specific mortality, and all-cause mortality and to identify work-up approaches. PATIENTS AND METHODS/MATERIALS: Retrospective review of patients with sebaceous carcinoma treated with Mohs micrographic surgery between 2001 and 2013 at one institution. RESULTS: Thirty-seven patients had 45 sebaceous carcinomas located on the periocular region (13%), non-periocular face (47%), scalp (7%), neck (4%), trunk (9%), and extremities (20%). The mean age was 66.1 years, and 24 (65%) patients were male. Five patients had Muir–Torre syndrome (MTS) or Lynch syndrome. Seven of 12 tumors showed loss of expression of ≥1 mismatch repair gene. The most common work-up involved taking a detailed personal and family medical history. No local recurrences, metastases, or disease-specific deaths occurred during an average follow-up of 3.6 years. CONCLUSION: Mohs micrographic surgery is an effective treatment for sebaceous carcinoma. Detailed history taking, age-appropriate cancer screening, and immunohistochemical staining with MLH1, MSH2, or MSH6 is helpful in identifying which patients should be referred to a geneticist for work-up of MTS.

http://ift.tt/2kGQXqk

Commentary on Effect of Procedural-Related Variables on Melanocyte-Keratinocyte Suspension Transplantation in Nonsegmental Stable Vitiligo

No abstract available

http://ift.tt/2jWbFhq

Ultrathin Skin Grafting in Resistant Stable Vitiligo: A Follow-up Study of 8 Years in 370 Patients

BACKGROUND: Ultrathin skin grafting (UTSG) is a tissue grafting technique used in resistant stable vitiligo. OBJECTIVE: To assess long-term follow-up results achieved with UTSG in vitiligo. METHODS: Over a span of 8 years, a total of 415 patients with stable vitiligo were treated with UTSG at the authors' institute. Retrospective analysis of results achieved in these patients was performed, and primary end points assessed included the extent and quality of repigmentation achieved and adverse effects from the procedure. Results were correlated with the site, morphological type of vitiligo, duration of stability, postprocedure treatment used, and the age and sex of the patient. RESULTS: Follow-up results were available with 554 lesions in 370 patients. Excellent response (≥90% repigmentation) was documented in 78.9% (437/554) lesions whereas 8.67% (48/554) lesions demonstrated poor results. Pigmentation was retained in >98% (112/114) cases over 4-year follow-up. The commonest adverse effect noted was "perigraft halo" in 12.3% (68/554) lesions. Site and morphological type of vitiligo as well as the postoperative use of phototherapy showed statistically significant correlation with response. Age and sex of the patient and duration of stability beyond 1 year did not influence the outcome. CONCLUSION: Ultrathin skin grafting provides long-term beneficial results in stable resistant vitiligo.

http://ift.tt/2kGQYdS

Photodynamic Therapy: A Clinical Consensus Guide: ERRATUM

No abstract available

http://ift.tt/2kH6yG5

Effect of Procedural-Related Variables on Melanocyte–Keratinocyte Suspension Transplantation in Nonsegmental Stable Vitiligo: A Clinical and Immunocytochemical Study

BACKGROUND: Melanocyte–keratinocyte suspension (M–K susp) is gaining popularity for vitiligo treatment. Few studies have addressed procedure-related variables. OBJECTIVE: To assess the effect of different M–K susp procedure-related variables on the clinical outcome in stable vitiligo. METHODS: This prospective multicenter comparative study included 40 cases with nonsegmental stable vitiligo. Donor site was either a skin graft in noncultured epidermal cell suspension (NCECS) or hair follicle units in outer root sheath hair follicle suspension (ORSHFS). Recipient site was prepared by either cryoblebbing or CO2 laser resurfacing. Cell counts and viability were recorded in the cell suspensions. Tissue melanocytes and keratinocytes were examined by melan-A and cytokeratin, respectively. Assessment of repigmentation was performed 18 months after the procedure. RESULTS: Thirty-seven subjects completed the study. Cell count was significantly lower in the ORSHFS compared with NCECS with no significant difference in the repigmentation outcome. On comparing techniques of recipient site preparation, homogenicity was better in the CO2 group. Elbows and knees responded better to CO2 resurfacing, whereas distal fingers responded better to combination of cryoblebbing with NCECS. CONCLUSION: Using different techniques in M–K susp produces comparable results. However, the distal fingers showed better results using combination of donor NCECS and recipient cryoblebs.

http://ift.tt/2kGQ6FM

Reconstruction of a Multi-Subunit Defect on the Lip, Nose, and Cheek

No abstract available

http://ift.tt/2jW6H46

A Prospective, Open-Label, Observational, Postmarket Study Evaluating VYC-17.5L for the Correction of Moderate to Severe Nasolabial Folds Over 12 Months

BACKGROUND: VYC-17.5L (17.5 mg/mL hyaluronic acid, 0.3% lidocaine) is a dermal filler intended for deep dermis injection for the treatment of skin depressions. OBJECTIVE: To evaluate 12-month effectiveness and safety of VYC-17.5L for the treatment of moderate/severe nasolabial folds (NLFs). METHODS: Subjects ≥18 years old with moderate/severe NLFs were recruited (N = 70). Injected volume was aimed at achieving optimum correction; top-up treatment was given at 2 weeks if needed. The primary endpoint was investigator-assessed change in NLF severity over 12 months using the validated photonumeric NLF Severity Scale. Secondary endpoints included investigator- and subject-assessed satisfaction and safety. Adverse events judged to be more severe or prolonged than routinely observed were recorded. RESULTS: Sixty-five subjects completed study requirements. Mean volume injected was 3.0 ± 1.0 mL for both NLFs combined. Significant improvement was maintained in investigator-assessed NLF severity at 12 months, and investigators and subjects reported high satisfaction with VYC-17.5L throughout the study. Two unexpected adverse events were reported: (1) redness, swelling, and decreased sensitivity (resolved after 4 days) and (2) swelling (resolved after 48 hours); neither event was serious or life threatening. CONCLUSION: VYC-17.5L is effective and well tolerated for the treatment of moderate to severe NLFs for 1 year.

http://ift.tt/2jW61Md

Validation of a Melanoma Risk Assessment Smartphone Application

No abstract available

http://ift.tt/2jWfwuW

Congenital absence of stapedius muscle and tendon: Rare finding in two cases

Deepak Dalmia, Sanjaya Kumar Behera

Indian Journal of Otology 2017 23(1):43-45

During surgery for otosclerosis, the surgeon cut the stapedius tendon before removing stapes suprastructure. The absence of the stapedius tendon is uncommon. In this case report, we present two cases of the absence of the unilateral stapedius tendon with muscle. During exploratory tympanotomy of the right ear in the first patient and left ear in the second patient with moderately severe mixed hearing loss, the absence of the stapedius tendon was found. The tympanic cavity was explored with the help of a Zeiss microscope by endomeatal route. The pyramidal process and stapedius muscle with its tendon were absent. Awareness of the variations or anomalies of the stapedius muscle and tendon is important for surgeons who operate upon the tympanic cavity, especially during surgery for ossicular fixation or ossicular discontinuity. As most of the time, these anomalies may be associated with the other middle ear anomalies.

http://ift.tt/2jWeWxh

The effect of mobile phone usage on hearing in adult population

Punnoose Philip, Satheesh Kumar Bhandary, Rajeswary Aroor, Vadish Bhat, Deepika Pratap

Indian Journal of Otology 2017 23(1):1-6

Background and Objective: The widespread use of mobile phones in recent years, especially among young people, has given rise to concerns about the potential influences of its electromagnetic fields (EMFs) on human health. The present study is conducted to investigate the adverse effects of mobile phone usage on auditory functions and to study the pattern of hearing threshold in mobile phone users. Materials and Methods: The study group consisted of 150 healthy volunteers between the age group of 21 and 45 years. They were divided into three groups; Group A consists of fifty participants who were using mobile phones for more than 1 h per day, Group B consists of fifty participants who were using mobile phones for <1 h per day, (both groups for a minimum period of 4 years), and Group C consists of fifty participants who did not use mobile phones or very occasional users (<1 h per week), being taken as control group. All participants underwent tympanometry and distortion product otoacoustic emission (DPOAE) tests and the results were compared among groups. Results: It is found that the prevalence of sensorineural hearing loss was seen in 10% participants of Group A and only 2% participants of Group B, but none among Group C had hearing loss, but this was statistically insignificant. The changes in DPOAEs were studied among groups and found significant difference between Group A (>1 h/day) and Group C (control group). Conclusion: The present study revealed that prolonged and frequent exposure to EMFs from mobile phone use can cause damage to the outer hair cells, especially in the basal turn of the cochlea, which can be detected by otoacoustic emission test and can subsequently lead to high frequency hearing loss.

http://ift.tt/2kH5tOz

Not a chondroma, but a cartilaginous choristoma of the bony external auditory canal

Jeong Hwan Choi

Indian Journal of Otology 2017 23(1):49-51

When the small white mass is found at the anterior wall of the bony external auditory canal (EAC) just in front of the short process of the malleus, the differential diagnosis of cartilaginous choristoma (CC) besides exostosis, osteoma, and keratoma should be included. CC of bony EAC is not as rare as it has been thought to be. Furthermore, it is very surprising that the term chondroma has been wrongly used to describe CC in many previous studies. In this report, I present my clinical experience with four patients with CC in the bony EAC and discuss the clinical importance of CC in differential diagnosis.

http://ift.tt/2jWkYxB

Disability certificate for individuals with hearing impairment – Time to rethink

Hemanth Narayan Shetty, Jijo Pottackal Mathai, Ajith Kumar Uppunda

Indian Journal of Otology 2017 23(1):7-12

Background: A retrospective research design was used to investigate the effect of degree of hearing loss on speech identification scores (SISs) and aided improvement in individuals with sensorineural hearing loss (SNHL) and auditory neuropathy spectrum disorder (ANSD). The present criteria (PWD Act, 2001) to issue disability certificate is suitable for individuals with SNHL, as there is a good agreement between their degree of hearing loss and speech understanding. In contrast, individuals with ANSD show severe speech understanding problems irrespective of their degree of hearing loss. Despite their problem, there are denied in giving disability certificate. The study also analyzed number of clients who have received the certificate of hearing disability, in both groups. Subjects and Methods: Clinical records of 165 clients who visited the Department of Audiology, All India Institute of Speech and Hearing, Mysore, India between October 2011 and October 2013 were reviewed. Results: Revealed that unlike SNHL, those with ANSD had no relation between the degree of hearing loss and SIS. In addition, aided improvement in ANSD was very limited and was not related to degree of hearing loss. All the individuals with SNHL, who had hearing loss above moderately severe degree received disability certificate. However, only 2 of the 36 clients with ANSD received disability certificate, although their hearing thresholds were above moderately severe degree. Conclusion: Pure-tone thresholds are not a deciding factor of speech understanding in ANSD. Thus, issue of disability certificate for ANSD should be based on SIS rather than pure-tone thresholds.

http://ift.tt/2kGX5Pg

Meniere's disease: A mystery! Our way to diagnose

Haris Manzoor Qadri, Arun Dehadaray, Maitri Kaushik, Danish Zamir Andrabi

Indian Journal of Otology 2017 23(1):13-16

Introduction: Meniere's disease (MD) has long posed a diagnostic challenge. Characterized by recurrent vertigo, tinnitus, and fluctuant sensorineural hearing loss (SNHL), its presentation may limit initially to merely one or two of the above symptoms. Inability to obtain a fresh inner ear tissue leaves us to rely on hypothetical choices. Materials and Methods: Two adjuvants, glycerol test, and intratympanic gentamycin, were analyzed in our study, for their efficacy in diagnosing MD. Patients with symptoms of vertigo, tinnitus, and SNHL were evaluated. Those with presbycusis, conductive hearing loss (on pure tone audiogram [PTA]), benign paroxysmal positional vertigo (diagnosed by Dix Hallpike), retrocochlear pathology (short increment sensitivity index score below 70%), and central cause (magnetic resonance imaging angiography and neurology opinion) were excluded. Rest were subjected to glycerol test and subsequently intratympanic gentamicin. After a 6 month follow up, evaluation was performed for tinnitus and vertigo through a visual analog scale. Repeat PTA was done to look for any hearing deterioration due to gentamicin. Results: It was found that not only did glycerol positive patients get completely relieved of vertigo but also those who tested negative got completely or partially relieved of it. This shows a higher efficacy of intratympanic gentamycin as well as its significant association with glycerol test. Conclusion: This study lead us to form a strong diagnostic criterion which has already proven to be therapeutic in the management of MD.

http://ift.tt/2kGUswI

Kyasanur forest disease

Pranathi Kavi, PG Bhargavi

Indian Journal of Otology 2017 23(1):56-58

Kyasanur forest disease (KFD) a rare viral disease found to be related to the Russian-spring summer virus but differs only because of its hemorrhagic form. KFD is known to be prevalent in the Shimoga District of Karnataka, and it was first identified in the year 1957. Victims of this disease would be those who have been exposed to deceased monkeys in forests or otherwise, have been bitten by an infected tick. Some of the initial phase symptoms include persistent headaches, fever, and muscle weakness. However, the neurological symptoms begin to appear only in the second phase of the viral attack. At this stage, viral encephalopathy, meningoencephalitis, or even meningitis could manifest and lead to vast deficits. Previous literature reviews of this disease have shown no signs of language deficits. A case of a 5-year-old child, confirmed with the KFD, with diffuse encephalopathy as well as other organ functioning deficits, showed deficits in language skills.

http://ift.tt/2jWgTcJ

Silver cauterization: An office procedure for repair of small tympanic membrane perforation

Mohammad Waheed El-Anwar, Mohammad El-Sayed Abd Elbary, Ibrahim Mohammad Saber

Indian Journal of Otology 2017 23(1):17-20

Introduction: Patients with small tympanic membrane (TM) perforations often suffer from repeated infections rather than hearing loss. Repair of TM perforations is required regardless of its size, as without closure, morbidity may include hearing loss, chronic otorrhea, and cholesteatoma formation. Objective: To assess the effectiveness of the topical silver cauterization to refresh and close small TM perforation as an office-based procedure. Materials and Methods: Thirteen patients with small TM perforations were enrolled in the study. The margin of the perforation was cauterized using silver nitrate 10% that was repeated up to six times. The procedure was considered successful if there was no residual perforation within the follow-up period. Postoperative audiometry was performed before cauterization then at 3 months after. Results: Successful perforation repair was achieved in ten ears (76.9%). Mean hearing gain was 11.5 ± 8 for all cases and 15 ± 5.27 for succeeded cases. None of the patients developed infection, hearing impairment, tinnitus, vertigo, bleeding, taste disturbance, or hyperkeratosis. Conclusion: Office-based silver cautery is a safe, effective, and minimally invasive procedure. It is suitable for repairing small TM perforations with comparable success rate to conventional myringoplasty.

http://ift.tt/2jWkYh5

To study the results of àWengen titanium clip piston prosthesis in stapedotomy

Raman Wadhera, Madhuri Kaintura, Sharad Hernot, Sandeep Bhukar, S Dheeraj, Usha Sehrawat, Jitu Sam George

Indian Journal of Otology 2017 23(1):36-42

Objective: To study the hearing results in patients implanted with àWengen titanium clip piston prosthesis after stapedotomy. Methods: In this prospective study, 15 patients of either sex in the age group of 18–50 years having conductive hearing loss with an air-bone gap (ABG) of 30 dB or more, with an intact tympanic membrane, and A or As type of curve in tympanometry were recruited. All patients underwent stapedotomy using àWengen titanium clip piston (Kurz, Germany) which was designed to avoid the scrupulous task of crimping a piston onto the long process of incus. The results were tabulated in accordance with the guidelines set by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (1994) at frequencies of 0.5, 1, 2 and 3 kHz. The follow-up period was 3 months. Results: The mean preoperative bone conduction (BC) was 16.00 ± 6.02 dB, at 6 weeks postoperative was 16.58 ± 12.40 dB, and at 3 months was 16.00 ± 10.80 dB. The mean preoperative ABG was 42 ± 7.26 dB, at 6 weeks postoperative was 20.5 ± 9.77 dB, and at 3 months was 17.25 ± 10.59 dB. There was improvement in postoperative BC, as well as ABG in 14 patients (except one). Conclusion: The use of the àWengen titanium clip stapes piston gives good results in cases of stapedotomy for otosclerosis. It is easy to insert onto the long process of incus and evades the complex step of crimping. The gain in hearing post surgery is comparable with the other types of pistons reported in literature.

http://ift.tt/2kGVY27