Δευτέρα 10 Απριλίου 2017
Primary cutaneous nocardiosis caused by Nocardia brasiliensis following a wasp sting
Summary
We report a case of an 87-year-old woman who presented with painful erythema of her right forearm 10 days after she had been stung by a wasp on her right hand. The lesion had rapidly deteriorated during the week before presentation, and treatment with antibiotics and glucocorticoids did not improve the condition. After careful evaluation, we performed cultures from the lesion aspiration, and morphological and genetic analysis of bacteria cultures confirmed a bacterial infection with Nocardia brasiliensis. The patient recovered after 3 weeks. Primary cutaneous nocardiosis due to Nocardia spp. is relatively uncommon in clinics, but it was the distance of the lesions from the affected area of the wasp sting that has made this an even rarer case and of interest to report.
http://ift.tt/2nXyKlP
The role of fillers in the management of acne scars
Summary
Acne scars are present in 95% of patients with acne, and can cause profound psychosocial morbidity. Fillers are commonly used for facial soft tissue augmentation, and there is increasing interest in their use for the treatment of acne scars, particularly for the atrophic subtype. We review the evidence for the use of temporary, semi-permanent and permanent fillers for acne scars. The use of permanent methylmethacrylate fillers for acne scarring is supported by a randomized controlled trial, and is approved by the United States Food and Drug Administration. There is initial evidence supporting the use of poly-L-lactic acid and hyaluronic acid fillers, but evidence is still lacking about the use of polyacrylamide and polyalkylimide fillers.
http://ift.tt/2om0PXb
Extensive levamisole-induced vasculitis
Summary
Levamisole (an increasingly frequent contaminant of cocaine) can cause antineutrophil cytoplasmic antibody-associated vasculitis. Dermatologists should consider a diagnosis of cocaine/levamisole-associated cutaneous vasculopathy syndrome in cases of purpura of the ears and/or extensive retiform purpura in drug users. We report a case of particularly severe levamisole-induced necrotic purpura and immunological abnormalities in a 40-year-old woman.
http://ift.tt/2nXyJON
Role of nail bed methotrexate injections in isolated nail psoriasis: conventional drug via an unconventional route
Summary
Nail psoriasis can be a debilitating condition; however, in patients with isolated nail involvement, the use of toxic systemic therapies such as methotrexate may not be justified. We report on 4 patients (30 involved nails between them), who were treated with injections of methotrexate (0.1 mL of a 25 mg/mL solution) into the nail bed at 3-weekly intervals. Mean baseline Nail Psoriasis Severity Index (NAPSI) was 4.77 (range 2–8, cumulative score 143; n = 30); dropping successively at each visit to 2.43 (range 0–4, cumulative score 73; n = 30) at 15 weeks. The decline in mean NAPSI from 4.87 to 2.17 was statistically significant (P < 0.001; Friedman analysis). Reported adverse effects were pain, injection site pigmentation and nail bed haemorrhage. Administration of specific targeted therapy to the nail bed may help manage nail psoriasis effectively.
http://ift.tt/2nXNIrY
Primary cutaneous nocardiosis caused by Nocardia brasiliensis following a wasp sting
Summary
We report a case of an 87-year-old woman who presented with painful erythema of her right forearm 10 days after she had been stung by a wasp on her right hand. The lesion had rapidly deteriorated during the week before presentation, and treatment with antibiotics and glucocorticoids did not improve the condition. After careful evaluation, we performed cultures from the lesion aspiration, and morphological and genetic analysis of bacteria cultures confirmed a bacterial infection with Nocardia brasiliensis. The patient recovered after 3 weeks. Primary cutaneous nocardiosis due to Nocardia spp. is relatively uncommon in clinics, but it was the distance of the lesions from the affected area of the wasp sting that has made this an even rarer case and of interest to report.
http://ift.tt/2nXyKlP
The role of fillers in the management of acne scars
Summary
Acne scars are present in 95% of patients with acne, and can cause profound psychosocial morbidity. Fillers are commonly used for facial soft tissue augmentation, and there is increasing interest in their use for the treatment of acne scars, particularly for the atrophic subtype. We review the evidence for the use of temporary, semi-permanent and permanent fillers for acne scars. The use of permanent methylmethacrylate fillers for acne scarring is supported by a randomized controlled trial, and is approved by the United States Food and Drug Administration. There is initial evidence supporting the use of poly-L-lactic acid and hyaluronic acid fillers, but evidence is still lacking about the use of polyacrylamide and polyalkylimide fillers.
http://ift.tt/2om0PXb
Extensive levamisole-induced vasculitis
Summary
Levamisole (an increasingly frequent contaminant of cocaine) can cause antineutrophil cytoplasmic antibody-associated vasculitis. Dermatologists should consider a diagnosis of cocaine/levamisole-associated cutaneous vasculopathy syndrome in cases of purpura of the ears and/or extensive retiform purpura in drug users. We report a case of particularly severe levamisole-induced necrotic purpura and immunological abnormalities in a 40-year-old woman.
http://ift.tt/2nXyJON
Role of nail bed methotrexate injections in isolated nail psoriasis: conventional drug via an unconventional route
Summary
Nail psoriasis can be a debilitating condition; however, in patients with isolated nail involvement, the use of toxic systemic therapies such as methotrexate may not be justified. We report on 4 patients (30 involved nails between them), who were treated with injections of methotrexate (0.1 mL of a 25 mg/mL solution) into the nail bed at 3-weekly intervals. Mean baseline Nail Psoriasis Severity Index (NAPSI) was 4.77 (range 2–8, cumulative score 143; n = 30); dropping successively at each visit to 2.43 (range 0–4, cumulative score 73; n = 30) at 15 weeks. The decline in mean NAPSI from 4.87 to 2.17 was statistically significant (P < 0.001; Friedman analysis). Reported adverse effects were pain, injection site pigmentation and nail bed haemorrhage. Administration of specific targeted therapy to the nail bed may help manage nail psoriasis effectively.
http://ift.tt/2nXNIrY
Calculating the Tumor Volumes in Vestibular Schwannomas: Are the ABC/2 and Volumetric Methods Comparable?.
Purpose: To assess the efficacy of the ABC/2 method for calculating the volume of vestibular schwannomas as compared with 3-D planimetric method. Study Design: Retrospective. Methods: Fifty eight cases of pathologically confirmed sporadic vestibular schwannomas (VS) were analyzed. Tumors volumes were calculated for each tumor twice, once through semiautomated 3-D volumetric method and subsequently through ABC/2 (AP x ML x CC/2) methodology after calculating the maximal tumor dimensions in anteroposterior (AP), coronal (ML), and craniocaudal (CC) dimensions. Tumor volumes were initially correlated as a group and subsequently by dividing them into three groups using the Hannover classification. Results: The two methodologies were highly correlated when tumors were analyzed as a group (rho = 0.913, p
http://ift.tt/2om2H2t
http://ift.tt/2om2H2t
Sinus procedures in the Medicare population from 2000 to 2014: A recent balloon sinuplasty explosion
Objective
To describe sinus procedure trends from 2000 to 2014, particularly following the introduction of balloon sinuplasty Common Procedural Technology (CPT) codes in 2011.
Study Design
Retrospective review of Medicare billing data available to the public.
Methods
Procedure and beneficiary data from 2000 to 2014 and provider data from 2012 to 2014 were obtained online from the Centers for Medicare and Medicaid Services. Sinus CPT codes were classified as balloon sinus procedure (BSP) or nonballoon sinus procedure (nBSP). Providers billing for sinus procedures were categorized as BSP only, nBSP only, or both. For comparison, data on septoplasty procedures from 2000 to 2014 were obtained.
Results
From 2000 to 2014, the total number of sinus procedures per 10 thousand beneficiaries (PP10K) nationwide increased by 3.7% annually. From 2011 to 2014, nBSP PP10K decreased by 3.1% annually, and BSP PP10K increased by 59% annually. Septoplasty PP10K changed by < 1% annually between 2000 and 2014. States with the highest BSP PP10K from 2012 to 2014 were Kansas, Texas, and Louisiana. Providers performing sinus procedures increased by 30.9% from 2012 to 2014. There was a 244% increase in BSP-only providers, a 0.7% increase in nBSP-only providers, and an 83.3% increase in providers using both. Septoplasty providers increased by 4.1%.
Conclusion
Although the total number of sinus procedures increased from 2000 to 2014, the number of BSP increased at a substantially greater rate since the introduction of CPT codes for these procedures in 2011. Nationwide increases in sinus providers were driven by new providers performing balloon-guided procedures.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2p087Ry
Polydioxanone plates are safe and effective for L-strut support in functional septorhinoplasty
Objectives/Hypothesis
To evaluate the safety, efficacy, and result stability of polydioxanone (PDS) plate use for L-strut stabilization.
Study Design
Retrospective analysis of a prospective cohort.
Methods
Patients who underwent functional septorhinoplasty with the use of PDS plates between January 2013 and January 2017 were administered the Nasal Obstruction Symptom Evaluation (NOSE) scale pre- and postoperatively at 2, 4, 6, and 12 months. Patient demographics, reason for PDS use, graft type, complications, and outcomes were analyzed.
Results
Eighty-eight patients aged 34.3 years (standard deviation [SD] = 15.7 years; range, 7.5–71.5 years) were included. All patients were found to have a fracture and/or severe deviation of the L-strut for which the PDS plate was used for rigid support. Mean preoperative NOSE score 65.2 (SD = 22.1) significantly decreased to 19.6 (SD = 21.6) at 7.2 months (SD = 5.5 months) postoperatively. There were no significant differences in NOSE scores between follow-up time points. There was one complication, a septal abscess, and one revision.
Conclusions
A PDS plate is a safe and effective material to be utilized in functional septorhinoplasty for patients with a fracture or iatrogenic injury to the septal L-strut or poor quality septal cartilage that requires stability without additional width. Outcomes are stable at 6 and 12 months, after the plate has dissolved. The use of a PDS plate may decrease the need for rib grafting in patients with a history of previous septoplasty and persistent nasal obstruction with a dorsal or caudal C-shaped septal deformity or fracture of the L-strut.
Level of Evidence
2c Laryngoscope, 2017
http://ift.tt/2olypLm
Change of somatosensory function of the tongue caused by chorda tympani nerve disorder after stapes surgery
Objectives
Patients after middle ear surgery often complain of taste disturbance and a lingual numbness. The purpose of this study was to objectively assess changes in the somatosensation of the tongue and taste function in patients undergoing stapes surgery.
Study Design
Prospective study.
Methods
Symptoms of taste disturbance and tongue numbness after surgery were investigated before and after surgery in 41 patients (13 males, 28 females; mean age 41.8 years) who underwent stapes surgery. Twenty-eight patients (9 males, 19 females; mean age 43.1 years) underwent sensory and taste function tests before and after surgery. Sensory function of the tongue was measured at the operated side and the nonoperated side using the 2-point discrimination test and an electrostimulator test. Taste function was assessed with electrogustometry (EGM).
Results
The chorda tympani nerve (CTN) was gently touched or stretched in all patients. Postoperative thresholds on the operated side were significantly higher than preoperative thresholds in all tests in the patients who underwent all three kinds of tests. Tongue somatosensory symptoms improved significantly earlier than the taste disturbance postoperatively, and the sensory thresholds returned to the baseline along with recovery of symptoms.
Conclusion
These findings suggest that dysfunction of the CTN occurred following surgery even when the CTN was preserved, and that the sensory nerve threshold of the tongue correlated with the symptom of lingual numbness. The CTN may play a role not only in taste function but also in the somatosensory function of the tongue.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2oZTdeo
Recent trends in oropharyngeal cancer funding and public interest
Objectives/Hypothesis
The incidence of oropharyngeal cancer (OPC) has increased in the United States. This has been driven by an increase in human papillomavirus (HPV)-positive OPC. Our objective is to determine trends in National Institutes (NIH)-supported research funding and public interest in OPC.
Methods
The NIH Research Portfolio Online Reporting Tools database was evaluated for projects related to OPC between 2004 and 2015. Projects were evaluated for total funding, relation to HPV, principal investigator departmental affiliation and degree, and NIH agency or center responsible for grant. The Google Trends database was evaluated for relative Internet search popularity of oropharyngeal cancer and related search terms between 2004 and 2015.
Results
In terms of NIH funding, 100 OPC-related projects representing 242 grant years and $108.5 million were funded between 2004 and 2015. Total NIH funding for OPC projects increased from $167,406 in 2004 to $16.2 million in 2015. Funding for HPV-related OPC increased from less than $2 million yearly between 2004 and 2010 up to $12.7 million in 2015. Principal investigators related to radiation oncology ($41.8 million) and with doctor of medicine degrees ($52.8 million) received the largest share of total funding. Relative Internet search popularity for oropharyngeal cancer has increased from 2004 to 2015 compared to control cancer search terms.
Conclusion
Increased public interest and NIH funding has paralleled the rising incidence of OPC. NIH funding has been driven by projects related to the role of HPV in OPC.
Level of Evidence
2c. Laryngoscope, 2017
http://ift.tt/2olrKB1
MRI surveillance of vestibular schwannomas without contrast enhancement: Clinical and economic evaluation
Objectives
To determine if high-resolution T2-weighted (HRT2) magnetic resonance imaging (MRI) is a comparably accurate and economical alternative to the gold standard of contrast-enhanced T1-weighted (T1C) MRI for surveillance of know vestibular schwannomas (VSs).
Study Design
Retrospective case-control analysis, systematic review, and economic evaluation.
Methods
Vestibular schwannoma size in anteroposterior, mediolateral, and superoinferior axes were measured by two neuroradiologists, both blinded to previous measurements, for 50 randomized patients with T1C and HRT2 on two separate occasions. Measurements were assessed by Pearson product-moment correlation coefficients, and differences were analyzed by Student t test. Once the data were analyzed, appropriate economic evaluation was performed utilizing institutional-, federal-, and literature-based estimates of cost and incidence/prevalence.
Results
Pearson correlations (r) between T1C and HRT2 were 0.991 and 0.973 for radiologists 1 and 2, respectively, with no statistically significant differences (P ≤ 0.05) between imaging techniques. Intraobserver and interobserver reliability estimates (κ) were 0.88 to 1 for both T1C and HRT2, indicating very high reliability. Cost-minimization analysis demonstrated cost and charge differences of $148.02 and $1,284 per patient per scan, respectively. This represents an overall cost and charge savings for this 50-patient cohort of $7,401 and $64,200, respectively.
Conclusion
HRT2 imaging is a highly reliable and lower-cost alternative to T1C for follow-up surveillance scans in patients with VS.
Level of Evidence
2C. Laryngoscope, 2017
http://ift.tt/2p09Czs
Microbiomes of the normal middle ear and ears with chronic otitis media
Objective
The aim of this study was to profile and compare the middle ear microbiomes of human subjects with and without chronic otitis media.
Study Design
Prospective multicenter cohort study.
Methods
All consecutive patients undergoing tympanoplasty surgery for chronic otitis media or ear surgery for conditions other than otitis media were recruited. Sterile swab samples were collected from the middle ear mucosa during surgery. The variable region 4 of the 16S rRNA gene in each sample were amplified using region-specific primers adapted for the Illumina MiSeq sequencer (Illumina, CA, USA)). The sequences were subjected to local blast and classified using Metagenome@KIN (World Fusion, Tokyo, Japan).
Results
In total, 155 participants were recruited from seven medical centers. Of these, 88 and 67 had chronic otitis media and normal middle ears, respectively. The most abundant bacterial phyla on the mucosal surfaces of the normal middle ears were Proteobacteria, followed by Actinobacteria, Firmicutes, and Bacteroidetes. The children and adults with normal middle ears differed significantly in terms of middle ear microbiomes. Subjects with chronic otitis media without active inflammation (dry ear) had similar middle ear microbiomes as the normal middle ears group. Subjects with chronic otitis media with active inflammation (wet ear) had a lower prevalence of Proteobacteria and a higher prevalence of Firmicutes than the normal middle ears.
Conclusion
The human middle ear is inhabited by more diverse microbial communities than was previously thought. Alteration of the middle ear microbiome may contribute to the pathogenesis of chronic otitis media with active inflammation.
Level of Evidence
2b. Laryngoscope, 2017
http://ift.tt/2olK2lK
Oral sensory dysfunction following radiotherapy
Objectives/Hypothesis
To assess differences in oral tactile sensation between subjects who have undergone radiation therapy (XRT) compared to healthy controls.
Study Design
Cross-sectional cohort comparison.
Methods
Thirty-four subjects with a history of XRT were compared with 23 healthy controls. There was no difference in age (P = .23), but there were slightly more males in the XRT cohort (P = .03). The mean (standard deviation) time after XRT completion was 3.84 (4.84) years. Fifty-six percent of the XRT cohort received chemotherapy. Using our previously validated methodology to measure oral tactile sensory threshold quantitatively with Cheung-Bearelly monofilaments, sensory thresholds of four subsites (anterior tongue, buccal mucosa, posterior tongue, soft palate) were compared for the two cohorts.
Results
Site-by-site comparisons showed higher forces were required for stimulus detection at all four subsites among subjects in the XRT cohort compared to healthy controls. Mean force in grams for XRT versus control cohorts were: anterior tongue, 0.39 (1.0) versus 0.02 (0.01); buccal mucosa, 0.42 (0.95) versus 0.06 (0.05); posterior tongue, 0.76 (1.46) versus 0.10 (0.07); and soft palate, 0.86 (1.47) versus 0.08 (0.05) (P < .001 for all comparisons). Combining all four subsites into a single metric to assess an overall level of oral tactile dysfunction, the XRT cohort had reduced sensation by 18.7 dB (P < .001).
Conclusions
After radiation therapy, the oral cavity and oropharynx exhibit global tactile sensory dysfunction, manifested by increased tactile forces required for stimulus detection. The magnitude of sensory impairment is 18.7 dB.
Level of Evidence
3b. Laryngoscope, 2017
http://ift.tt/2oZVExg
Does incidental mastoid opacification on computerized tomography necessitate referral to ENT?
Objective
The prevalence of incidental temporal bone disease on magnetic resonance imaging has been widely reported in the medical literature. Despite this, there currently is little evidence regarding incidental otological disease on computerized tomography (CT). Thus, the study aimed to review the CT prevalence of asymptomatic adult ear disease and evaluate the appropriateness of ear, nose, and throat (ENT) referral following its discovery.
Study Design
Retrospective observational study of 468 CT scans.
Methods
All CT head scans performed between January 2015 and January 2016 containing the keyword mastoid in the radiological report initially were recruited for the study. Scans performed in the pediatric population following head trauma or for otological indications were excluded, leaving 468 eligible radiological images. The presence of prior otological disease or referral subsequently was established using electronic patient records.
Results
Mastoid and/or middle ear opacification was noted to be present in 62 patients (13%). Of these patients, 10 subsequently were found to have prior otological intervention or review. Following exclusion of these patients, the rate of incidental temporal bone disease was recorded as 11%.
Conclusion
Data from this study suggests that incidental findings in an asymptomatic individual do not necessitate referral or further intervention. Furthermore, it is the author's recommendation that radiological findings be closely correlated with clinical examination to reduce false diagnosis and inappropriate referral to ENT.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2olIlot
Asian and non-Asian disparities in outcomes of non-nasopharyngeal head and neck cancer
Objectives/Hypothesis
To evaluate disparities in overall survival (OS) between Asian and non-Asian patients diagnosed with non-nasopharyngeal head and neck cancer (HNC).
Study Design
This was a population-based, retrospective study of patients diagnosed with non-nasopharyngeal HNC of squamous cell carcinoma histology between 2001 and 2010 in British Columbia, Canada.
Methods
Using Kaplan-Meier methods and Cox regression models, we examined the relationship between race and OS.
Results
A total of 3,036 patients were included in the study. Median age was 64 years, 74% were men, and 7% were Asians. Asians had worse Eastern Cooperative Oncology Group (ECOG) status (29% vs. 23%, P = .07) and larger tumors (33% vs. 21%, P = .02), and were more likely to be diagnosed with oral cavity cancers (38% vs. 25%, P < .001) than non-Asians. Asians were also less likely to receive multimodality therapy than non-Asians (90% vs. 95%, P = .02). Asians were more likely to have never smoked (49% vs. 15%, P < .001) and to be married or with a partner (80% vs. 69%, P = .02). Multivariate models showed that Asians had better OS than non-Asians (hazard ratio [HR] = 0.50, 95% confidence interval [CI] = 0.25-0.99, P = .05). Three-year OS did not differ significantly between Asians and non-Asians (41% vs. 42%, P = .18); however, 5-year OS did (22% vs. 19% P = .03). Stratifying by treatment type, outcomes were comparable in both groups except for radiotherapy alone, where Asians showed significantly better OS (HR = 0.71, 95% CI = 0.51-0.99, P = .04). Advanced age, worse ECOG, greater tumor size, and lack of treatment also correlated with inferior OS.
Conclusions
Despite several worse prognostic features and less aggressive treatment, Asians tended to exhibit better OS than non-Asians.
Level of Evidence
2c. Laryngoscope, 2017
http://ift.tt/2oZSjyg
Head and neck sweat gland adenocarcinoma: A population-based perspective of a rare entity
Objectives
Head and neck sweat gland adenocarcinoma (HNSGA) is an extremely rare malignancy. We present the first population-based analysis regarding this entity.
Study Design
Retrospective population-based analysis.
Methods
Using the Surveillance, Epidemiology, and End Results registry from 2000 to 2013, we extracted 627 cases of HNSGA. Data were analyzed for incidence trends, demographic and clinicopathologic traits, and predictors of disease-specific survival (DSS).
Results
The majority HNSGA cases were white, male, and 60 to 79 years old. The incidence was 0.036 per 100,000 people. Tumors most often presented as localized disease and histological grade II/III. The skin of the face was the most common primary site (43.4%), followed by the scalp and neck (31.6%). Overall 5-, 10-, and 20-year DSS were 94.6%, 89.6%, and 79.8%, respectively. Ethnicity did not affect survival, whereas a younger age at diagnosis and female sex conferred an advantage at 10 years (P = 0.0386) and 5 years (P = 0.0191), respectively. The origin of the HNSGA (apocrine vs. eccrine) did not affect outcomes. Regional and distant disease predicted worse DSS at 5, 10, and 20 years (P = 0.0026, P < 0.001, P < 0.001, respectively). Compared to grade I/II disease, grade III/IV dramatically worsened 5-, 10-, and 20-year DSS (P = 0.0035, P < 0.0001, P = 0.0011, respectively). Scalp and neck HNSGA exhibited the poorest 20-year DSS compared to other primary sites (P = 0.0024).
Conclusion
We present the largest cohort of HNSGA. Significant poor prognostic indicators include older age, higher tumor grade, greater extent of invasion, and primary site of the scalp or neck.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2olwPsQ
Sinus procedures in the Medicare population from 2000 to 2014: A recent balloon sinuplasty explosion
Objective
To describe sinus procedure trends from 2000 to 2014, particularly following the introduction of balloon sinuplasty Common Procedural Technology (CPT) codes in 2011.
Study Design
Retrospective review of Medicare billing data available to the public.
Methods
Procedure and beneficiary data from 2000 to 2014 and provider data from 2012 to 2014 were obtained online from the Centers for Medicare and Medicaid Services. Sinus CPT codes were classified as balloon sinus procedure (BSP) or nonballoon sinus procedure (nBSP). Providers billing for sinus procedures were categorized as BSP only, nBSP only, or both. For comparison, data on septoplasty procedures from 2000 to 2014 were obtained.
Results
From 2000 to 2014, the total number of sinus procedures per 10 thousand beneficiaries (PP10K) nationwide increased by 3.7% annually. From 2011 to 2014, nBSP PP10K decreased by 3.1% annually, and BSP PP10K increased by 59% annually. Septoplasty PP10K changed by < 1% annually between 2000 and 2014. States with the highest BSP PP10K from 2012 to 2014 were Kansas, Texas, and Louisiana. Providers performing sinus procedures increased by 30.9% from 2012 to 2014. There was a 244% increase in BSP-only providers, a 0.7% increase in nBSP-only providers, and an 83.3% increase in providers using both. Septoplasty providers increased by 4.1%.
Conclusion
Although the total number of sinus procedures increased from 2000 to 2014, the number of BSP increased at a substantially greater rate since the introduction of CPT codes for these procedures in 2011. Nationwide increases in sinus providers were driven by new providers performing balloon-guided procedures.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2p087Ry
Polydioxanone plates are safe and effective for L-strut support in functional septorhinoplasty
Objectives/Hypothesis
To evaluate the safety, efficacy, and result stability of polydioxanone (PDS) plate use for L-strut stabilization.
Study Design
Retrospective analysis of a prospective cohort.
Methods
Patients who underwent functional septorhinoplasty with the use of PDS plates between January 2013 and January 2017 were administered the Nasal Obstruction Symptom Evaluation (NOSE) scale pre- and postoperatively at 2, 4, 6, and 12 months. Patient demographics, reason for PDS use, graft type, complications, and outcomes were analyzed.
Results
Eighty-eight patients aged 34.3 years (standard deviation [SD] = 15.7 years; range, 7.5–71.5 years) were included. All patients were found to have a fracture and/or severe deviation of the L-strut for which the PDS plate was used for rigid support. Mean preoperative NOSE score 65.2 (SD = 22.1) significantly decreased to 19.6 (SD = 21.6) at 7.2 months (SD = 5.5 months) postoperatively. There were no significant differences in NOSE scores between follow-up time points. There was one complication, a septal abscess, and one revision.
Conclusions
A PDS plate is a safe and effective material to be utilized in functional septorhinoplasty for patients with a fracture or iatrogenic injury to the septal L-strut or poor quality septal cartilage that requires stability without additional width. Outcomes are stable at 6 and 12 months, after the plate has dissolved. The use of a PDS plate may decrease the need for rib grafting in patients with a history of previous septoplasty and persistent nasal obstruction with a dorsal or caudal C-shaped septal deformity or fracture of the L-strut.
Level of Evidence
2c Laryngoscope, 2017
http://ift.tt/2olypLm
Change of somatosensory function of the tongue caused by chorda tympani nerve disorder after stapes surgery
Objectives
Patients after middle ear surgery often complain of taste disturbance and a lingual numbness. The purpose of this study was to objectively assess changes in the somatosensation of the tongue and taste function in patients undergoing stapes surgery.
Study Design
Prospective study.
Methods
Symptoms of taste disturbance and tongue numbness after surgery were investigated before and after surgery in 41 patients (13 males, 28 females; mean age 41.8 years) who underwent stapes surgery. Twenty-eight patients (9 males, 19 females; mean age 43.1 years) underwent sensory and taste function tests before and after surgery. Sensory function of the tongue was measured at the operated side and the nonoperated side using the 2-point discrimination test and an electrostimulator test. Taste function was assessed with electrogustometry (EGM).
Results
The chorda tympani nerve (CTN) was gently touched or stretched in all patients. Postoperative thresholds on the operated side were significantly higher than preoperative thresholds in all tests in the patients who underwent all three kinds of tests. Tongue somatosensory symptoms improved significantly earlier than the taste disturbance postoperatively, and the sensory thresholds returned to the baseline along with recovery of symptoms.
Conclusion
These findings suggest that dysfunction of the CTN occurred following surgery even when the CTN was preserved, and that the sensory nerve threshold of the tongue correlated with the symptom of lingual numbness. The CTN may play a role not only in taste function but also in the somatosensory function of the tongue.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2oZTdeo
Recent trends in oropharyngeal cancer funding and public interest
Objectives/Hypothesis
The incidence of oropharyngeal cancer (OPC) has increased in the United States. This has been driven by an increase in human papillomavirus (HPV)-positive OPC. Our objective is to determine trends in National Institutes (NIH)-supported research funding and public interest in OPC.
Methods
The NIH Research Portfolio Online Reporting Tools database was evaluated for projects related to OPC between 2004 and 2015. Projects were evaluated for total funding, relation to HPV, principal investigator departmental affiliation and degree, and NIH agency or center responsible for grant. The Google Trends database was evaluated for relative Internet search popularity of oropharyngeal cancer and related search terms between 2004 and 2015.
Results
In terms of NIH funding, 100 OPC-related projects representing 242 grant years and $108.5 million were funded between 2004 and 2015. Total NIH funding for OPC projects increased from $167,406 in 2004 to $16.2 million in 2015. Funding for HPV-related OPC increased from less than $2 million yearly between 2004 and 2010 up to $12.7 million in 2015. Principal investigators related to radiation oncology ($41.8 million) and with doctor of medicine degrees ($52.8 million) received the largest share of total funding. Relative Internet search popularity for oropharyngeal cancer has increased from 2004 to 2015 compared to control cancer search terms.
Conclusion
Increased public interest and NIH funding has paralleled the rising incidence of OPC. NIH funding has been driven by projects related to the role of HPV in OPC.
Level of Evidence
2c. Laryngoscope, 2017
http://ift.tt/2olrKB1
MRI surveillance of vestibular schwannomas without contrast enhancement: Clinical and economic evaluation
Objectives
To determine if high-resolution T2-weighted (HRT2) magnetic resonance imaging (MRI) is a comparably accurate and economical alternative to the gold standard of contrast-enhanced T1-weighted (T1C) MRI for surveillance of know vestibular schwannomas (VSs).
Study Design
Retrospective case-control analysis, systematic review, and economic evaluation.
Methods
Vestibular schwannoma size in anteroposterior, mediolateral, and superoinferior axes were measured by two neuroradiologists, both blinded to previous measurements, for 50 randomized patients with T1C and HRT2 on two separate occasions. Measurements were assessed by Pearson product-moment correlation coefficients, and differences were analyzed by Student t test. Once the data were analyzed, appropriate economic evaluation was performed utilizing institutional-, federal-, and literature-based estimates of cost and incidence/prevalence.
Results
Pearson correlations (r) between T1C and HRT2 were 0.991 and 0.973 for radiologists 1 and 2, respectively, with no statistically significant differences (P ≤ 0.05) between imaging techniques. Intraobserver and interobserver reliability estimates (κ) were 0.88 to 1 for both T1C and HRT2, indicating very high reliability. Cost-minimization analysis demonstrated cost and charge differences of $148.02 and $1,284 per patient per scan, respectively. This represents an overall cost and charge savings for this 50-patient cohort of $7,401 and $64,200, respectively.
Conclusion
HRT2 imaging is a highly reliable and lower-cost alternative to T1C for follow-up surveillance scans in patients with VS.
Level of Evidence
2C. Laryngoscope, 2017
http://ift.tt/2p09Czs
Microbiomes of the normal middle ear and ears with chronic otitis media
Objective
The aim of this study was to profile and compare the middle ear microbiomes of human subjects with and without chronic otitis media.
Study Design
Prospective multicenter cohort study.
Methods
All consecutive patients undergoing tympanoplasty surgery for chronic otitis media or ear surgery for conditions other than otitis media were recruited. Sterile swab samples were collected from the middle ear mucosa during surgery. The variable region 4 of the 16S rRNA gene in each sample were amplified using region-specific primers adapted for the Illumina MiSeq sequencer (Illumina, CA, USA)). The sequences were subjected to local blast and classified using Metagenome@KIN (World Fusion, Tokyo, Japan).
Results
In total, 155 participants were recruited from seven medical centers. Of these, 88 and 67 had chronic otitis media and normal middle ears, respectively. The most abundant bacterial phyla on the mucosal surfaces of the normal middle ears were Proteobacteria, followed by Actinobacteria, Firmicutes, and Bacteroidetes. The children and adults with normal middle ears differed significantly in terms of middle ear microbiomes. Subjects with chronic otitis media without active inflammation (dry ear) had similar middle ear microbiomes as the normal middle ears group. Subjects with chronic otitis media with active inflammation (wet ear) had a lower prevalence of Proteobacteria and a higher prevalence of Firmicutes than the normal middle ears.
Conclusion
The human middle ear is inhabited by more diverse microbial communities than was previously thought. Alteration of the middle ear microbiome may contribute to the pathogenesis of chronic otitis media with active inflammation.
Level of Evidence
2b. Laryngoscope, 2017
http://ift.tt/2olK2lK
Oral sensory dysfunction following radiotherapy
Objectives/Hypothesis
To assess differences in oral tactile sensation between subjects who have undergone radiation therapy (XRT) compared to healthy controls.
Study Design
Cross-sectional cohort comparison.
Methods
Thirty-four subjects with a history of XRT were compared with 23 healthy controls. There was no difference in age (P = .23), but there were slightly more males in the XRT cohort (P = .03). The mean (standard deviation) time after XRT completion was 3.84 (4.84) years. Fifty-six percent of the XRT cohort received chemotherapy. Using our previously validated methodology to measure oral tactile sensory threshold quantitatively with Cheung-Bearelly monofilaments, sensory thresholds of four subsites (anterior tongue, buccal mucosa, posterior tongue, soft palate) were compared for the two cohorts.
Results
Site-by-site comparisons showed higher forces were required for stimulus detection at all four subsites among subjects in the XRT cohort compared to healthy controls. Mean force in grams for XRT versus control cohorts were: anterior tongue, 0.39 (1.0) versus 0.02 (0.01); buccal mucosa, 0.42 (0.95) versus 0.06 (0.05); posterior tongue, 0.76 (1.46) versus 0.10 (0.07); and soft palate, 0.86 (1.47) versus 0.08 (0.05) (P < .001 for all comparisons). Combining all four subsites into a single metric to assess an overall level of oral tactile dysfunction, the XRT cohort had reduced sensation by 18.7 dB (P < .001).
Conclusions
After radiation therapy, the oral cavity and oropharynx exhibit global tactile sensory dysfunction, manifested by increased tactile forces required for stimulus detection. The magnitude of sensory impairment is 18.7 dB.
Level of Evidence
3b. Laryngoscope, 2017
http://ift.tt/2oZVExg
Does incidental mastoid opacification on computerized tomography necessitate referral to ENT?
Objective
The prevalence of incidental temporal bone disease on magnetic resonance imaging has been widely reported in the medical literature. Despite this, there currently is little evidence regarding incidental otological disease on computerized tomography (CT). Thus, the study aimed to review the CT prevalence of asymptomatic adult ear disease and evaluate the appropriateness of ear, nose, and throat (ENT) referral following its discovery.
Study Design
Retrospective observational study of 468 CT scans.
Methods
All CT head scans performed between January 2015 and January 2016 containing the keyword mastoid in the radiological report initially were recruited for the study. Scans performed in the pediatric population following head trauma or for otological indications were excluded, leaving 468 eligible radiological images. The presence of prior otological disease or referral subsequently was established using electronic patient records.
Results
Mastoid and/or middle ear opacification was noted to be present in 62 patients (13%). Of these patients, 10 subsequently were found to have prior otological intervention or review. Following exclusion of these patients, the rate of incidental temporal bone disease was recorded as 11%.
Conclusion
Data from this study suggests that incidental findings in an asymptomatic individual do not necessitate referral or further intervention. Furthermore, it is the author's recommendation that radiological findings be closely correlated with clinical examination to reduce false diagnosis and inappropriate referral to ENT.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2olIlot
Asian and non-Asian disparities in outcomes of non-nasopharyngeal head and neck cancer
Objectives/Hypothesis
To evaluate disparities in overall survival (OS) between Asian and non-Asian patients diagnosed with non-nasopharyngeal head and neck cancer (HNC).
Study Design
This was a population-based, retrospective study of patients diagnosed with non-nasopharyngeal HNC of squamous cell carcinoma histology between 2001 and 2010 in British Columbia, Canada.
Methods
Using Kaplan-Meier methods and Cox regression models, we examined the relationship between race and OS.
Results
A total of 3,036 patients were included in the study. Median age was 64 years, 74% were men, and 7% were Asians. Asians had worse Eastern Cooperative Oncology Group (ECOG) status (29% vs. 23%, P = .07) and larger tumors (33% vs. 21%, P = .02), and were more likely to be diagnosed with oral cavity cancers (38% vs. 25%, P < .001) than non-Asians. Asians were also less likely to receive multimodality therapy than non-Asians (90% vs. 95%, P = .02). Asians were more likely to have never smoked (49% vs. 15%, P < .001) and to be married or with a partner (80% vs. 69%, P = .02). Multivariate models showed that Asians had better OS than non-Asians (hazard ratio [HR] = 0.50, 95% confidence interval [CI] = 0.25-0.99, P = .05). Three-year OS did not differ significantly between Asians and non-Asians (41% vs. 42%, P = .18); however, 5-year OS did (22% vs. 19% P = .03). Stratifying by treatment type, outcomes were comparable in both groups except for radiotherapy alone, where Asians showed significantly better OS (HR = 0.71, 95% CI = 0.51-0.99, P = .04). Advanced age, worse ECOG, greater tumor size, and lack of treatment also correlated with inferior OS.
Conclusions
Despite several worse prognostic features and less aggressive treatment, Asians tended to exhibit better OS than non-Asians.
Level of Evidence
2c. Laryngoscope, 2017
http://ift.tt/2oZSjyg
Head and neck sweat gland adenocarcinoma: A population-based perspective of a rare entity
Objectives
Head and neck sweat gland adenocarcinoma (HNSGA) is an extremely rare malignancy. We present the first population-based analysis regarding this entity.
Study Design
Retrospective population-based analysis.
Methods
Using the Surveillance, Epidemiology, and End Results registry from 2000 to 2013, we extracted 627 cases of HNSGA. Data were analyzed for incidence trends, demographic and clinicopathologic traits, and predictors of disease-specific survival (DSS).
Results
The majority HNSGA cases were white, male, and 60 to 79 years old. The incidence was 0.036 per 100,000 people. Tumors most often presented as localized disease and histological grade II/III. The skin of the face was the most common primary site (43.4%), followed by the scalp and neck (31.6%). Overall 5-, 10-, and 20-year DSS were 94.6%, 89.6%, and 79.8%, respectively. Ethnicity did not affect survival, whereas a younger age at diagnosis and female sex conferred an advantage at 10 years (P = 0.0386) and 5 years (P = 0.0191), respectively. The origin of the HNSGA (apocrine vs. eccrine) did not affect outcomes. Regional and distant disease predicted worse DSS at 5, 10, and 20 years (P = 0.0026, P < 0.001, P < 0.001, respectively). Compared to grade I/II disease, grade III/IV dramatically worsened 5-, 10-, and 20-year DSS (P = 0.0035, P < 0.0001, P = 0.0011, respectively). Scalp and neck HNSGA exhibited the poorest 20-year DSS compared to other primary sites (P = 0.0024).
Conclusion
We present the largest cohort of HNSGA. Significant poor prognostic indicators include older age, higher tumor grade, greater extent of invasion, and primary site of the scalp or neck.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2olwPsQ
Preoperative Radiotherapy Is Not Associated with Increased Post-mastectomy Short-term Morbidity: Analysis of 77,902 Patients
Background: Neoadjuvant radiotherapy (NRT) enhances breast-conserving surgery outcomes, reducing local recurrence of breast cancer and increasing median survival. However, its effect on postoperative morbidity remains under-studied. We sought to assess the impact of NRT on 30-day postoperative morbidity after mastectomy. Methods: We analyzed data from women undergoing mastectomy (with or without immediate reconstruction) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2005–2011 datasets. ACS-NSQIP is a prospective, risk-adjusted, outcomes-based registry. Data included demographic and perioperative factors. Outcomes studied included surgical site (wound and prosthesis/flap complications), systemic (cardiac, respiratory, neurological, urinary, and venous thromboembolism events), and overall morbidity. Logistic regression was used to estimate the unadjusted odds ratio (uOR) and adjusted odds ratio (aOR) between NRT and postoperative 30-day morbidity. Results: The study population included 77,902 women, of which 61,039 (78.4%) underwent mastectomy only and 16,863 (21.6%) underwent mastectomy with immediate breast reconstruction. NRT was administered to 266 (0.4%) mastectomy-only and 75 (0.4%) immediate breast reconstruction patients. In the mastectomy-only group, there were no significant differences in the rates of postoperative surgical site morbidity (aOR = 1.41; 95% confidence interval (CI): 0.76–2.63; P = 0.276), systemic morbidity (aOR = 0.72; 95% CI: 0.40–1.26; P = 0.252), and overall morbidity (aOR = 0.85; 95% CI: 0.54–1.33; P = 0.477) between NRT and control groups. Similarly, no significant differences were found for these three outcomes in the immediate breast reconstruction population. Statistical power for every comparison was >80%. Conclusions: This study suggests that NRT is not associated with significantly higher 30-day postoperative complications among breast cancer patients undergoing mastectomy with or without immediate breast reconstruction.http://ift.tt/2nikgBk
Natural pomegranate juice reduces inflammation, muscle damage and increase platelets blood levels in active healthy Tunisian aged men
Publication date: Available online 7 April 2017
Source:Alexandria Journal of Medicine
Author(s): Ammar Achraf, Chtourou Hamdi, Mouna Turki, Osama Abdelkarim, Fatma Ayadi, Anita Hoekelmann, Sourou Yaich, Nizar Souissi
Currently, it's well established that aging is associated with various health problems that may interfere with the maintenance of a good nutritional status. Otherwise, pomegranate (POM) was shown to prevent or treat various disease risk factors in adults. However, its efficacy is still not well widespread in elderly population. Therefore, the purpose of the present study is to investigate the effect of natural pomegranate juice (POMj) rich in polyphenols on the blood levels of selected biochemical parameters using older adults.Twelve active healthy aged men (age: 60±5years) volunteered to participate in this randomized study. Before and after the supplementation period fasting blood samples were collected, heart rate (HR) and systolic arterial pressure (SAP) were recorded. Supplements of placebo (PLA) or POMj were taken twice daily (250ml×2) for 15days.Paired simple t-test showed a significant difference between PLA and POMj supplementation effects on systolic blood pressure (SAP), creatinine (CRE), hematological and muscle damage parameters and C-reactive protein (CRP) (p<0.01) with lower values using POMj. Similarly, a significant differences were shown for platelets PLT (p<0.01) with higher values using POMj supplementation. POMj rich in polyphenols seems to have a power anti-inflammatory effect and to be an effective treatment for patients who suffer from the thrombocyto-penia disease. Therefore, aged populations are advised to add natural POMj to their daily nutrition behavior.
http://ift.tt/2o2hUD6
Protective role of Spondias mombin leaf and Cola acuminata seed extracts against scopolamine-induced cognitive dysfunction
Publication date: Available online 6 April 2017
Source:Alexandria Journal of Medicine
Author(s): Ismail O. Ishola, Bukola O. Ikuomola, Olufunmilayo O. Adeyemi
The leaves of Spondias mombin L. (Anacardiaceae) when chewed with Cola acuminata (P. Beauv.) Schott & Endl. (Sterculiaceae) seeds have memory enhancing and anti-ageing properties. This study sought to investigate the protective effect of hydroethanolic leaf extract of Spondias mombin (SM) and Cola acuminata seed extract (CA) against scopolamine-induced cognitive dysfunction. SM or CA (50, 100 or 200mg/kg, p.o.) or SM+CA (50mg/kg, p.o.) was administered to rats for 3 consecutive days. One hour post-treatment on day 3, scopolamine (3mg/kg i.p) was administered and 5min later, the Y-maze test or Morris water maze test (MWM; days 3–7) was conducted. The rat's brains were isolated for the estimation of oxidative-nitritive stress status following the MWM task. The antioxidant capacity of SM and CA was also evaluated in vitro using the 1,1-diphenyl-2-picrylhydrazyl (DPPH), nitric oxide (NO) and ferric ion reducing power (FRAP) assays. Pretreatment of rats with SM, CA or SM+CA significantly ameliorated the learning and memory impairment induced with scopolamine as evidenced in Y-maze and MWM paradigms. Moreover, SM, CA or SM+CA significantly attenuated the oxidative-nitritive stress induced by scopolamine, evidenced in the decrease in malondialdehyde and nitrite levels and restoration of glutathione, catalase and superoxide dismutase levels. Furthermore, SM and CA showed promising free radical scavenging effect against DPPH and moderate antioxidant activity in NO and FRAP tests. This study showed that Spondias mombin and Cola acuminata have significant protective effect against scopolamine-induced memory deficit that could be attributed to their antioxidant properties.
http://ift.tt/2oTbVEC
Sexual function of pregnant women in the third trimester
Publication date: Available online 7 April 2017
Source:Alexandria Journal of Medicine
Author(s): Nülüfer Erbil
IntroductionPhysical, hormonal and psychological changes during pregnancy can affect a woman's sexuality as well as a couple's sexual relationship. The aim of this study was to examine sexual function of pregnant women in the third trimester of pregnancy.MethodsThe data of descriptive and cross-sectional study was collected via a questionnaire form and Female Sexual Function Index. A score≤26.55 is classified as female sexual dysfunction. A total of 125 volunteer healthy and married pregnant women in third trimester of pregnancy who admitted to the antenatal policlinics were included in this study.ResultsThe determined that 92% of participants had sexual dysfunction. The Female Sexual Function Index and domains scores in the 28th-31st, 32nd-35th and 36th and higher gestational weeks of pregnancy were as follows: sexual desire scores, 2.50, 2.77 and 2.40; sexual arousal scores, 2.26, 2.72 and 1.69; lubrication scores, 2.61, 3.42 and 1.97; orgasm scores, 2.51, 2.85 and 1.78; sexual satisfaction scores, 3.17, 3.77 and 2.66; pain scores, 2.44, 2.72 and 1.66, and total Female Sexual Function Index scores were 15.51, 18.29, 12.26, respectively. Sexual arousal (p=0.008), lubrication (p=0.001), orgasm (p=0.031), sexual satisfaction (p=0.005), pain (p=0.049) and total Female Sexual Function Index score (p=0.004) were the lowest in 36th and higher gestational weeks, and only sexual desire did not differ (p=0.191).ConclusionsSexual function of pregnant women in the third trimester were negatively effected. Health professionals should be trained to evaluate sexual difficulties in pregnant women and to recommend possible solutions.
http://ift.tt/2o2jTHs
Polμ deficiency induces moderate shortening of P53−/− mouse lifespan and modifies tumor spectrum
Source:DNA Repair
Author(s): Beatriz Escudero, Diego Herrero, Yaima Torres, Susana Cañón, Antonio Molina, Rosa M. Carmona, Javier Suela, Luis Blanco, Enrique Samper, Antonio Bernad
Non-homologous end joining (NHEJ) is the main mechanism for double strand break (DSB) DNA repair. The error-prone DNA polymerase mu (Polμ) is involved in immunoglobulin variable region rearrangement and in general, NHEJ in non-lymphoid cells. Deletion of NHEJ factors in P53−/− mice, which are highly prone to development of T cell lymphoma, generally increases cancer incidence and shifts the tumor spectrum towards aggressive pro-B lymphoma. In contrast, Polμ deletion increased sarcoma incidence, proportionally reducing pro-B lymphoma development on the P53-deficient background. Array comparative genomic hybridization (aCGH) analyses showed DNA copy number alterations in both P53−/− and Polμ−/−P53−/− lymphomas. Our results also indicate that the increase in sarcoma incidence in Polμ−/−P53−/− mice could be associated with Cdk4 and Kub3 amplification and overexpression. These results identify a role for Polμ in the prevention of sarcomagenesis on a murine P53-deficient background, in contrast to most other NHEJ factors.
http://ift.tt/2nXeZuF
Schwannoma response to interferon alpha
Publication date: Available online 11 April 2017
Source:Interdisciplinary Neurosurgery
Author(s): Jennifer Novak, Wendy J. Sherman, Todd Vitaz
While cranial nerve schwannomas are typically benign, slow growing tumors, they are associated with morbidity both from the neuropathies and neuralgias they can produce, as well as from the treatments used to address these tumors, typically surgery or radiation. Here we present a case report of a patient with trigeminal neuralgia secondary to schwannoma where tumor regression is seen incidentally after patient received interferon alpha for his metastatic melanoma.
http://ift.tt/2olt32L
Videosprechstunde darf persönlichen Kontakt nicht ersetzen
Die Videosprechstunde ist auf dem Weg in die Regelversorgung. Jetzt wurden technische Anforderungen veröffentlicht, ab Juli 2017 soll es eine eigene EBM-Ziffer geben. Alles andere als unmissverständlich sind jedoch die berufsrechtlichen Rahmenbedingungen.
http://ift.tt/2o29qvM
Bezolds Reisegepäck
Die medizinische Wissenschaft will messen, vergleichen und einordnen. Die ersten Höhepunkte der vergleichenden Hörprüfungen mit mechanischen Instrumenten verdanken wir Friedrich Bezold und seiner „kontinuierlichen Tonreihe", die im Münchener Physikalisch-Mechanischen Institut von Max T. Edelmann ab 1893 gefertigt wurden.
http://ift.tt/2olCCRa
„Es klappt ja doch mit Familie!“
Beruf und Familie – das funktioniert auch in eigener Praxis. Vielleicht sogar besser als im Krankenhaus. Diese Erkenntnis konnten junge Ärzte vom „Tag der Chancen" in Thüringen im März mitnehmen.
http://ift.tt/2o2dqw8
Moderne Wiederherstellungschirurgie mit freien Lappen
Moderne Kopf-Hals-Chirurgie wäre ohne die Einführung von freien, mikrovaskulären Transplantaten vor etwa vier Jahrzehnten in der heutigen Form nicht denkbar. Erst dadurch wurde der Verschluss großer Weichteildefekte möglich oder erheblich vereinfacht. Im Folgenden soll insbesondere auf Aspekte der modernen rekonstruktiven Möglichkeiten im Bereich des Pharynx und der Mundhöhle eingegangen werden.
http://ift.tt/2olBjBJ
Neue Optionen der Teamarbeit in Kommunen
Eine Versorgung chronisch Kranker über alle Sektoren und Betreuungsbereiche hinweg ist in Deutschland meist noch Utopie. Doch mancherorts gibt es Keimzellen für neue Modelle mit Vorbildcharakter.
http://ift.tt/2o23oLM
Praxischefs ziehen Lehren aus Online-Bewertungen
Patientenkritik an der Praxis auf Online-Portalen lassen Praxischefs meist nicht kalt. Mehr als die Hälfte hat bereits reagiert, um die Prozesse in ihrem Versorgungsalltag zu optimieren.
http://ift.tt/2o2hWLp
Otitis media: keine verkürzte Antibiose bei Babys
Gute Gründe sprechen einem US-Ärzteteam zufolge gegen die Abkürzung einer antibiotischen Therapie bei Babys mit Otitis media. In der randomisierten, placebokontrollierten Studie schlug die fünftägige Behandlung deutlich schlechter an als das Standardregime über zehn Tage, und die Kinder benötigten letztlich mehr Antibiotika pro Erkältungssaison.
http://ift.tt/2olICcn
SLIT: gute Lebensqualität und hohe Adhärenz
Die Adhärenz zu einer Behandlung mit sublingualer Immuntherapie wird umso besser sein, je mehr ein Patient einen Therapieeffekt etwa in Form einer verbesserten Lebensqualität spürt. Eine Praxisstudie liefert Daten zu diesem postulierten Zusammenhang.
http://ift.tt/2o2aQ9y
Larynx- und Hypopharynxkarzinom: Langzeitergebnisse zum Larynxerhalt
In der Studie EORTC 24954 wurden die sequenzielle und die alternierende Radiochemotherapie bei Patienten mit lokal fortgeschrittenem Larynx- und Hypopharynxkarzinom über einen Zeitraum von zehn Jahren verglichen.
http://ift.tt/2olupMu
ISDN-Abschied ohne Schrecken
2018 soll Schluss sein mit dem ISDN-Netz. Dann wollen die Telekom, 1&1 und andere große Telefonnetzanbieter ihre Leitungen endgültig auf „All-IP" umstellen. Gerade gewerbliche Kunden wie Arztpraxen kann es auch schon früher treffen. Welche Optionen haben Betroffene?
http://ift.tt/2olIObT
Videosprechstunde darf persönlichen Kontakt nicht ersetzen
Die Videosprechstunde ist auf dem Weg in die Regelversorgung. Jetzt wurden technische Anforderungen veröffentlicht, ab Juli 2017 soll es eine eigene EBM-Ziffer geben. Alles andere als unmissverständlich sind jedoch die berufsrechtlichen Rahmenbedingungen.
http://ift.tt/2o29qvM
Bezolds Reisegepäck
Die medizinische Wissenschaft will messen, vergleichen und einordnen. Die ersten Höhepunkte der vergleichenden Hörprüfungen mit mechanischen Instrumenten verdanken wir Friedrich Bezold und seiner „kontinuierlichen Tonreihe", die im Münchener Physikalisch-Mechanischen Institut von Max T. Edelmann ab 1893 gefertigt wurden.
http://ift.tt/2olCCRa
„Es klappt ja doch mit Familie!“
Beruf und Familie – das funktioniert auch in eigener Praxis. Vielleicht sogar besser als im Krankenhaus. Diese Erkenntnis konnten junge Ärzte vom „Tag der Chancen" in Thüringen im März mitnehmen.
http://ift.tt/2o2dqw8
Moderne Wiederherstellungschirurgie mit freien Lappen
Moderne Kopf-Hals-Chirurgie wäre ohne die Einführung von freien, mikrovaskulären Transplantaten vor etwa vier Jahrzehnten in der heutigen Form nicht denkbar. Erst dadurch wurde der Verschluss großer Weichteildefekte möglich oder erheblich vereinfacht. Im Folgenden soll insbesondere auf Aspekte der modernen rekonstruktiven Möglichkeiten im Bereich des Pharynx und der Mundhöhle eingegangen werden.
http://ift.tt/2olBjBJ
Neue Optionen der Teamarbeit in Kommunen
Eine Versorgung chronisch Kranker über alle Sektoren und Betreuungsbereiche hinweg ist in Deutschland meist noch Utopie. Doch mancherorts gibt es Keimzellen für neue Modelle mit Vorbildcharakter.
http://ift.tt/2o23oLM
Praxischefs ziehen Lehren aus Online-Bewertungen
Patientenkritik an der Praxis auf Online-Portalen lassen Praxischefs meist nicht kalt. Mehr als die Hälfte hat bereits reagiert, um die Prozesse in ihrem Versorgungsalltag zu optimieren.
http://ift.tt/2o2hWLp
Otitis media: keine verkürzte Antibiose bei Babys
Gute Gründe sprechen einem US-Ärzteteam zufolge gegen die Abkürzung einer antibiotischen Therapie bei Babys mit Otitis media. In der randomisierten, placebokontrollierten Studie schlug die fünftägige Behandlung deutlich schlechter an als das Standardregime über zehn Tage, und die Kinder benötigten letztlich mehr Antibiotika pro Erkältungssaison.
http://ift.tt/2olICcn
SLIT: gute Lebensqualität und hohe Adhärenz
Die Adhärenz zu einer Behandlung mit sublingualer Immuntherapie wird umso besser sein, je mehr ein Patient einen Therapieeffekt etwa in Form einer verbesserten Lebensqualität spürt. Eine Praxisstudie liefert Daten zu diesem postulierten Zusammenhang.
http://ift.tt/2o2aQ9y
Larynx- und Hypopharynxkarzinom: Langzeitergebnisse zum Larynxerhalt
In der Studie EORTC 24954 wurden die sequenzielle und die alternierende Radiochemotherapie bei Patienten mit lokal fortgeschrittenem Larynx- und Hypopharynxkarzinom über einen Zeitraum von zehn Jahren verglichen.
http://ift.tt/2olupMu
ISDN-Abschied ohne Schrecken
2018 soll Schluss sein mit dem ISDN-Netz. Dann wollen die Telekom, 1&1 und andere große Telefonnetzanbieter ihre Leitungen endgültig auf „All-IP" umstellen. Gerade gewerbliche Kunden wie Arztpraxen kann es auch schon früher treffen. Welche Optionen haben Betroffene?
http://ift.tt/2olIObT
Cardiotoxicity with Itraconazole
Itraconazole is a commonly used antifungal drug. In addition to commonly described adverse effects, there have been few reports of heart failure with its use. We present two cases that developed acute systolic heart failure with Itraconazole use. A man in his early 30s was admitted with worsening leg swelling and dyspnoea on exertion. He had been on Itraconazole for blastomyces skin ulcer. His ejection fraction (EF) was found to be 10%–15%. Another man in his 50s was admitted with similar symptoms; his EF was 40%–45%. He had been on Itraconazole for forearm cellulitis. No other aetiology was identified in both patients despite extensive work-up including cardiac catheterisation. Itraconazole was stopped in both the cases. Our first patient did not improve even months after cessation of therapy and was referred for heart transplant. Our second patient improved after a few weeks, and his ejection fraction had improved on repeat testing.
http://ift.tt/2nzlc4K
Gender differences in risk factors for cigarette smoking initiation in childhood
Source:Addictive Behaviors, Volume 72
Author(s): Marie-Pierre Sylvestre, Robert J. Wellman, Erin K. O'Loughlin, Erika N. Dugas, Jennifer O'Loughlin
IntroductionWe investigated whether established risk factors for initiating cigarette smoking during adolescence (parents, siblings, friends smoke; home smoking rules, smokers at home, exposure to smoking in cars, academic performance, susceptibility to smoking, depressive symptoms, self-esteem, school connectedness, use of other tobacco products) are associated with initiation in preadolescents, and whether the effects of these factors differ by gender.MethodsIn spring 2005, baseline data were collected in self-report questionnaires from 1801 5th grade students including 1553 never-smokers (mean age=10.7years), in the longitudinal AdoQuest I Study in Montréal, Canada. Follow-up data were collected in the fall and spring of 6th grade (2005–2006). Poisson regression analyses with robust variance estimated the effects of each risk factor on initiation and additive interactions with gender were computed to assess the excess risk of each risk factor in girls compared to boys.Results101 of 1399 participants in the analytic sample (6.7% of boys; 7.7% of girls) initiated smoking during follow-up. After adjustment for age, gender and maternal education, all risk factors except academic performance and school connectedness were statistically significantly associated with initiation. Paternal and sibling smoking were associated with initiation in girls only, and girls with lower self-esteem had a significant excess risk of initiating smoking in 6th grade.ConclusionsRisk factors for smoking initiation in preadolescents mirror those in adolescents; their effects do not differ markedly by gender. Preventive programs targeting children should focus on reducing smoking in the social environment and the dangers of poly-tobacco use.
http://ift.tt/2p1sH1a
Toxicity of triptolide and the molecular mechanisms involved
Publication date: June 2017
Source:Biomedicine & Pharmacotherapy, Volume 90
Author(s): Chen Xi, Shaojun Peng, Zhengping Wu, Qingping Zhou, Jie Zhou
Triptolide (TP), a major active and toxic ingredient isolated from the traditional Chinese herb Tripterygium wilfordii Hook f. (TWHF). A widespread application of TP raises the question on the safety of its use in clinical settings. The metabolism of TP is mediated by hepatic cytochrome P450s, and a strong correlation exists between TP toxicity and CPY3A. Toxicity of TP and the molecular mechanisms of its toxic effects have been studied in recent years. Studies have demonstrated that TP exposure results in injury of various organs, including the liver, kidney, testes, ovary, and heart in animals and even in humans, according to clinical case reports. Moreover, on the cellular level, TP has been reported to be associated with diverse toxic effects, encompassing membrane damage, mitochondrial disruption, metabolism dysfunction, endoplasmic reticulum stress, oxidative stress, apoptosis and autophagy. This review presents an overview of the current findings related to TP toxicity with an emphasis on biological targets and the molecular mechanisms that may be involved, thus providing a systematic understanding of the mechanisms by which TP affects cells and tissues in vitro and in vivo.
http://ift.tt/2otr3rd
Diabetes associated with male reproductive system damages: Onset of presentation, pathophysiological mechanisms and drug intervention
Publication date: June 2017
Source:Biomedicine & Pharmacotherapy, Volume 90
Author(s): Guang-Jiang Shi, Zhi-Mei Li, Jie Zheng, Jian Chen, Xiao-Xu Han, Jing Wu, Guang-Yong Li, Qing Chang, Yu-Xiang Li, Jian-Qiang Yu
Diabetes mellitus (DM) is a major health problem that affects patients' quality of life quality throughout the world due to its many complications. Reproductive dysfunction is one of the major secondary complications in both diabetic animals and human beings. Furthermore, DM has recently broken the age barrier and has been heavily diagnosed in children and young persons of reproductive age. In the past few years, many studies on DM in male reproductive functions in both diabetic men and experimental diabetic animals have been published. It is recognized that sustained hyperglycemia, which impairs reproductive function in diabetic men, is at risk of developing. DM harmfully affects male reproductive functions in multiple areas; these may include spermatogenesis, sperm maturation, fertility capability, penile erection, and ejaculation. Traditional medicine and folklore worldwide have used numerous medicinal plants to manage the diabetic reproductive dysfunction because bioactive phyto-constituents are affluent in many places. Unfortunately, the exact reasons for diabetic male reproductive dysfunction are not completely understood and currently there are no treatments in reproductive medicine specifically for such lesions. The aim of this review is to summarize current research findings of DM on reproductive functions, to elaborate the underlying mechanisms related to these diseases via in vivo and in vitro studies, and to describe the ameliorative effects of medicinal plants or their products. The review findings provide a systematic understanding of DM on the reproductive functions and lay the theoretical foundation for developing the direction of reproductive medicine.
http://ift.tt/2p1vA29
A peek into the drug development scenario of endometriosis – A systematic review
Publication date: June 2017
Source:Biomedicine & Pharmacotherapy, Volume 90
Author(s): Luxitaa Goenka, Melvin George, Maitrayee Sen
Purpose and objectiveEndometriosis is a gynaecological disease that is characterised by the presence of endometrium like tissue-epithelium and stroma that develops outside the uterine cavity, which is responsible for pelvic pain and infertility. Even though several medical therapies exist for the treatment of endometriosis, each of the drug class has its own limitations such as cost of treatment, side-effects and its short-term effect on the symptoms of endometriosis. In this review, we have attempted to summarize the current status and challenges of drug development for endometriosis.MethodsA systematic review was done and all the RCTs were selected from the identified hits. We included studies that explored the usage of therapeutic drugs on endometriosis patients from inception till November 2016. The search term used was 'Endometriosis' using PubMed and Clinicaltrials.gov. For the final analysis, 60 articles were analyzed and we identified the newly emerging drug therapies for endometriosis treatment and have briefed their current status and challenges in drug development for endometriosis. The quality of the selected studies was assessed based on the degree of bias.ResultsThe current classes of drugs that have shown promising therapeutic results include Gonadotropin- releasing hormone (GnRH) antagonists, aromatase inhibitors (AI), and selective progesterone and estrogen receptor modulators, dopamine receptor-2-agonists and statins. The drugs that failed midway during development include tanezumab, rosiglitazone, infliximab, pentoxifylline, telapristone acetate, asoprisnil and raloxifene.ConclusionFrom the literature review, it appears that the most promising molecules for the treatment of endometriosis in the near future include elagolix, mifepristone, TAK-385, KLH-2109 and ASP1707 and cabergoline. It remains to be seen if these molecules would succeed large phase 3 clinical trials and overcome the regulatory hurdles to become an essential tool in the gynaecologist's armamentarium against endometriosis.
http://ift.tt/2otzjHY
Comparison of self-reported signs of facial ageing among Caucasian women in Australia versus those in the USA, the UK and Canada
Abstract
Background/Objectives
Australians are more exposed to higher solar UV radiation levels that accelerate signs of facial ageing than individuals who live in temperate northern countries. The severity and course of self-reported facial ageing among fair-skinned Australian women were compared with those living in Canada, the UK and the USA.
Methods
Women voluntarily recruited into a proprietary opt-in survey panel completed an internet-based questionnaire about their facial ageing. Participants aged 18–75 years compared their features against photonumeric rating scales depicting degrees of severity for forehead, crow's feet and glabellar lines, tear troughs, midface volume loss, nasolabial folds, oral commissures and perioral lines. Data from Caucasian and Asian women with Fitzpatrick skin types I–III were analysed by linear regression for the impact of country (Australia versus Canada, the UK and the USA) on ageing severity for each feature, after controlling for age and race.
Results
Among 1472 women, Australians reported higher rates of change and significantly more severe facial lines (P ≤ 0.040) and volume-related features like tear troughs and nasolabial folds (P ≤ 0.03) than women from the other countries. More Australians also reported moderate to severe ageing for all features one to two decades earlier than US women.
Conclusions
Australian women reported more severe signs of facial ageing sooner than other women and volume-related changes up to 20 years earlier than those in the USA, which may suggest that environmental factors also impact volume-related ageing. These findings have implications for managing their facial aesthetic concerns.
http://ift.tt/2otEesf
Comparison of self-reported signs of facial ageing among Caucasian women in Australia versus those in the USA, the UK and Canada
Abstract
Background/Objectives
Australians are more exposed to higher solar UV radiation levels that accelerate signs of facial ageing than individuals who live in temperate northern countries. The severity and course of self-reported facial ageing among fair-skinned Australian women were compared with those living in Canada, the UK and the USA.
Methods
Women voluntarily recruited into a proprietary opt-in survey panel completed an internet-based questionnaire about their facial ageing. Participants aged 18–75 years compared their features against photonumeric rating scales depicting degrees of severity for forehead, crow's feet and glabellar lines, tear troughs, midface volume loss, nasolabial folds, oral commissures and perioral lines. Data from Caucasian and Asian women with Fitzpatrick skin types I–III were analysed by linear regression for the impact of country (Australia versus Canada, the UK and the USA) on ageing severity for each feature, after controlling for age and race.
Results
Among 1472 women, Australians reported higher rates of change and significantly more severe facial lines (P ≤ 0.040) and volume-related features like tear troughs and nasolabial folds (P ≤ 0.03) than women from the other countries. More Australians also reported moderate to severe ageing for all features one to two decades earlier than US women.
Conclusions
Australian women reported more severe signs of facial ageing sooner than other women and volume-related changes up to 20 years earlier than those in the USA, which may suggest that environmental factors also impact volume-related ageing. These findings have implications for managing their facial aesthetic concerns.
http://ift.tt/2otEesf
What Is the “Screening Effect” Six Years After the Fukushima Nuclear Power Plant Accident?
http://ift.tt/2nXfGUR
Effect of Laser-Activated Irrigations on Smear Layer Removal from the Root Canal Wall
Photomedicine and Laser Surgery , Vol. 0, No. 0.
http://ift.tt/2oly6lw
What Is the “Screening Effect” Six Years After the Fukushima Nuclear Power Plant Accident?
http://ift.tt/2nXfGUR
Ginkgo biloba L. attenuates spontaneous recurrent seizures and associated neurological conditions in lithium-pilocarpine rat model of temporal lobe epilepsy through inhibition of mammalian target of rapamycin pathway hyperactivation
Publication date: 23 May 2017
Source:Journal of Ethnopharmacology, Volume 204
Author(s): Arindam Ghosh Mazumder, Pallavi Sharma, Vikram Patial, Damanpreet Singh
Ethnopharmacological relevanceGinkgo biloba L. (Ginkgoaceae) has been widely used in traditional medicine for variety of neurological conditions particularly behavioral and memory impairments.Aim of the studyThe present study was envisaged to explore the effect of a standardized fraction of Ginkgo biloba leaves (GBbf) in rat model of lithium-pilocarpine induced spontaneous recurrent seizures, and associated behavioral impairments and cognitive deficit.Materials and methodsRats showing appearance of spontaneous recurrent seizures following lithium pilocarpine (LiPc)-induced status epilepticus (SE) were treated with different doses of GBbf or vehicle for subsequent 4 weeks. The severity of seizures and aggression in rats were scored following treatment with GBbf. Further, open field, forced swim, novel object recognition and Morris water maze tests were conducted. Histopathological, protein levels and gene expression studies were performed in the isolated brains.ResultsTreatment with GBbf reduced seizure severity score and aggression in epileptic animals. Improved spatial cognitive functions and recognition memory, along with reduction in anxiety-like behavior were also observed in the treated animals. Histopathological examination by Nissl staining showed reduction in neuronal damage in the hippocampal pyramidal layer. The dentate gyrus and Cornu Ammonis 3 regions of the hippocampus showed reduction in mossy fiber sprouting. GBbf treatment attenuated ribosomal S6 and pS6 proteins, and hippocampal mTOR, Rps6 and Rps6kb1 mRNA levels.ConclusionsThe results of present study concluded that GBbf treatment suppressed lithium-pilocarpine induced spontaneous recurrent seizures severity and incidence with improved cognitive functions, reduced anxiety-like behavior and aggression. The effect was found to be due to inhibition of mTOR pathway hyperactivation linked with recurrent seizures.
Graphical abstract
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Zukunft jetzt − Implementierung eines IT-gestützten Distress-Screenings
Zusammenfassung
Hintergrund
Eine bedarfsgerechte integrierte Mitbehandlung psychischer Belastungen und Störungen gehört zu den Herausforderungen einer modernen Krebsmedizin. Ohne standardmäßiges Screening auf psychischen Distress bleibt ein großer Teil der versorgungsbedürftigen Krebspatienten unerkannt. Mit der verpflichtenden Einführung von Distress-Screenings in die onkologische Routineversorgung entsteht für die deutschen Krebszentren ein erhöhter Dokumentationsaufwand. IT-gestützte Screening-Prozeduren können diesen kompensieren. Während die S3-Leitlinie Psychoonkologie Methoden und strukturelle Maßnahmen zur fachkundigen Umsetzung eines standardgemäßen Screenings beschreibt, fehlen bisher Handlungsempfehlungen zur Implementierung eines IT-gestützten Distress-Screenings.
Methoden
Es wurde ein Konsensusmeeting „IT-gestütztes Distress-Screening in der onkologischen Routineversorgung" durchgeführt.
Ergebnisse
Es wurden Konsensempfehlungen zur Implementierung und Nutzung IT-gestützter Distress-Screenings ausgearbeitet. Diese beziehen sich auf: 1) Vorbereitung der Implementierung, 2) IT-Ausstattung, 3) Implementierung, 4) Praktische Nutzung, 5) Qualitätssichernde Maßnahmen im Forschungskontext. Ausgewählte deutschsprachige Forschungsprojekte und aktuelle Entwicklungen in der klinischen Versorgungsforschung unterstreichen, welches Potenzial in der Zusammenführung von klinischer Expertise mit der Informationstechnologie steckt.
Schlussfolgerungen
Mit den Ergebnissen des Konsensusmeetings stehen nun ein Leitfaden und Kriterienkatalog für die Implementierung eines IT-basierten Distress-Screenings in der onkologischen Routineversorgung zur Verfügung. Die Umsetzung dieser Empfehlungen kann die Versorgungsqualität von Krebspatienten in Deutschland verbessern.
http://ift.tt/2oZKHJg
Treat the Patient, Not the Angiogram.
Author: Grantham, J. Aaron MD
Page: 1382-1384
http://ift.tt/2oSEMZQ
Percutaneous Coronary Interventions for Chronic Total Occlusions: As the Technology Expands, Our Responsibilities Increase.
Author: Bass, Theodore A. MD
Page: 1385-1387
http://ift.tt/2o1QugK
Risk of Heart Failure With Preserved Ejection Fraction in Older Women After Contemporary Radiotherapy for Breast Cancer.
Author: Saiki, Hirofumi MD, PhD; Petersen, Ivy A. MD; Scott, Christopher G. MS; Bailey, Kent R. PhD; Dunlay, Shannon M. MD, MS; Finley, Randi R. CMD, RTT; Ruddy, Kathryn J. MD, MPH; Yan, Elizabeth MD; Redfield, Margaret M. MD
Page: 1388-1396
http://ift.tt/2oSKMBU
Detailed Echocardiographic Phenotyping in Breast Cancer Patients: Associations With Ejection Fraction Decline, Recovery, and Heart Failure Symptoms Over 3 Years of Follow-Up.
Author: Narayan, Hari K. MD; Finkelman, Brian PhD; French, Benjamin PhD; Plappert, Theodore RCVS; Hyman, David BA; Smith, Amanda M. BA, MA; Margulies, Kenneth B. MD; Ky, Bonnie MD, MSCE
Page: 1397-1412
http://ift.tt/2o29PhG
Good News, Bad News, but Not Fake News.
Author: Plana, Juan Carlos MD; Barac, Ana MD, PhD
Page: 1413-1416
http://ift.tt/2oSQB2j
Evaluation of Cell Therapy on Exercise Performance and Limb Perfusion in Peripheral Artery Disease: The CCTRN PACE Trial (Patients With Intermittent Claudication Injected With ALDH Bright Cells).
Author: Perin, Emerson C. MD, PhD; Murphy, Michael P. MD; March, Keith L. MD, PhD; Bolli, Roberto MD; Loughran, John MD; Yang, Phillip C. MD; Leeper, Nicholas J. MD; Dalman, Ronald L. MD; Alexander, Jason MD; Henry, Timothy D. MD; Traverse, Jay H. MD; Pepine, Carl J. MD; Anderson, R. David MD; Berceli, Scott MD, PhD; Willerson, James T. MD; Muthupillai, Raja PhD; Gahremanpour, Amir MD; Raveendran, Ganesh MD, MPH; Velasquez, Omaida MD; Hare, Joshua M. MD; Hernandez Schulman, Ivonne MD; Kasi, Vijaykumar S. MD, PhD; Hiatt, William R. MD; Ambale-Venkatesh, Bharath PhD; Lima, Joao A. MD; Taylor, Doris A. PhD; Resende, Micheline PhD; Gee, Adrian P. PhD; Durett, April G. MS; Bloom, Jeanette MBA; Richman, Sara; G'Sell, Patricia RN; Williams, Shari RN; Khan, Fouzia MBBS; Gyang Ross, Elsie MD, MS; Santoso, Michelle R. BS; Goldman, JoAnne RT; Leach, Dana DNP; Handberg, Eileen PhD; Cheong, Benjamin MD; Piece, Nichole RN; DiFede, Darcy RN; Bruhn-Ding, Barb RN; Caldwell, Emily RN; Bettencourt, Judy MPH; Lai, Dejian PhD; Piller, Linda MD, MPH; Simpson, Lara PhD; Cohen, Michelle MPH; Sayre, Shelly L. MPH; Vojvodic, Rachel W. MPH; Moye, Lem MD, PhD; Ebert, Ray F. PhD; Simari, Robert D. MD; Hirsch, Alan T. MD; For the Cardiovascular Cell Therapy Research Network (CCTRN)
Page: 1417-1428
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Every PACE Counts: Learning About Blood Cells and Blood Flow in Peripheral Artery Disease.
Author: Breton-Romero, Rosa PhD; Hamburg, Naomi M. MD, MS
Page: 1429-1431
http://ift.tt/2oSM3ss
Predictors of Death in Contemporary Adult Patients With Eisenmenger Syndrome: A Multicenter Study.
Author: Kempny, Aleksander MD; Hjortshoj, Cristel Sorensen MD, PhD; Gu, Hong MD, PhD; Li, Wei MD, PhD; Opotowsky, Alexander R. MD; Landzberg, Michael J. MD; Jensen, Annette Schophuus PhD; Sondergaard, Lars MD, DMSc; Estensen, Mette-Elise MD, PhD; Thilen, Ulf MD, PhD; Budts, Werner MD; Mulder, Barbara J. MD, PhD; Blok, Ilja MD; Tomkiewicz-Pajak, Lidia MD, PhD; Szostek, Kamil MSc; D'Alto, Michele MD, PhD; Scognamiglio, Giancarlo MD; Prokselj, Katja MD; Diller, Gerhard-Paul MD, PhD, MSc; Dimopoulos, Konstantinos MD, PhD, MSc; Wort, Stephen J. MA, MBBS, PhD; Gatzoulis, Michael A. MD, PhD
Page: 1432-1440
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Improving Survival in Patients With Eisenmenger Syndrome: Are We Any Closer?.
Author: Lange, Richard A. MD, MBA; Brickner, M. Elizabeth MD
Page: 1441-1443
http://ift.tt/2oSTGzd
Infarcted Myocardium-Primed Dendritic Cells Improve Remodeling and Cardiac Function After Myocardial Infarction by Modulating the Regulatory T Cell and Macrophage Polarization.
Author: Choo, Eun Ho MD; Lee, Jun-Ho MS; Park, Eun-Hye MS; Park, Hyo Eun MS; Jung, Nam-Chul PhD; Kim, Tae-Hoon MD, PhD; Koh, Yoon-Seok MD, PhD; Kim, Eunmin PhD; Seung, Ki-Bae MD, PhD; Park, Cheongsoo PhD; Hong, Kwan-Soo PhD; Kang, Kwonyoon PhD; Song, Jie-Young PhD; Seo, Han Geuk PhD; Lim, Dae-Seog PhD; Chang, Kiyuk MD, PhD
Page: 1444-1457
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Permanent Leadless Cardiac Pacemaker Therapy: A Comprehensive Review.
Author: Tjong, Fleur V.Y. MD; Reddy, Vivek Y. MD
Page: 1458-1470
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Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association.
Author: Siscovick, David S. MD, MPH, FAHA, Chair; Barringer, Thomas A. MD, FAHA; Fretts, Amanda M. PhD, MPH; Wu, Jason H.Y. PhD, MSc, FAHA; Lichtenstein, Alice H. DSc, FAHA; Costello, Rebecca B. PhD, FAHA; Kris-Etherton, Penny M. PhD, RD, FAHA; Jacobson, Terry A. MD, FAHA; Engler, Mary B. PhD, RN, MS, FAHA; Alger, Heather M. PhD; Appel, Lawrence J. MD, MPH, FAHA; Mozaffarian, Dariush MD, DrPH, FAHA; On behalf of the American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology
Page: e867-e884
http://ift.tt/2o1MyMY
Daily Total Physical Activity and Incident Cardiovascular Disease in Japanese Men and Women: Japan Public Health Center-Based Prospective Study.
Author: Kubota, Yasuhiko MD; Iso, Hiroyasu MD, PhD, MPH; Yamagishi, Kazumasa MD, PhD; Sawada, Norie MD, PhD; Tsugane, Shoichiro MD, PhD; for the JPHC Study Group (Japan Public Health Center)
Page: 1471-1473
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Letter by Lozano et al Regarding Article, "Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Multicenter Randomized PRAGUE-18 Study".
Author: Lozano, Inigo MD, PhD; Rondan, Juan MD, PhD; Vegas, Jose M. MD
Page: e885-e886
http://ift.tt/2o22GOA
Response by Motovska et al to Letter Regarding Article, "Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Multicenter Randomized PRAGUE-18 Study".
Author: Motovska, Zuzana MD, PhD; Hlinomaz, Ota MD, CSc; Kala, Petr MD, PhD; On behalf of the PRAGUE-18 Investigators
Page: e887-e888
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Letter by Brown and Ezekowitz Regarding Article, "Development and Evolution of a Hierarchical Clinical Composite End Point for the Evaluation of Drugs and Devices for Acute and Chronic Heart Failure: A 20-Year Perspective".
Author: Brown, Paul M. MSc; Ezekowitz, Justin A. MBBCh, MSc
Page: e889-e891
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Response by Packer to Letter Regarding Article, "Development and Evolution of a Hierarchical Clinical Composite End Point for the Evaluation of Drugs and Devices for Acute and Chronic Heart Failure: A 20-Year Perspective".
Author: Packer, Milton MD
Page: e892-e893
http://ift.tt/2oSXJf7
Growth rates dependence of macro/microstructures and mechanical properties of Ti-47Al-2Nb-2Cr-0.2Er alloy directionally solidified by cold crucible
Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Qiang Wang, Hongsheng Ding, Hailong Zhang, Shiqiu Liu, Ruirun Chen, Jingjie Guo, Hengzhi Fu
IntermetallicsTi-47Al-2Nb-2Cr-0.2Er alloys are prepared at different growth rates ranging from 0.6mm/min to 1.2mm/min via cold crucible directional solidification with the power of 50kW. The macro/microstructure evolutions and mechanical properties of the directionally solidified ingots are studied in details. The angles between the columnar grains and the growth direction increase gradually from the center to the edge of the ingot. The lamellae orientations show no distinct variations under the growth rates of 0.6–1.0mm/min, while the lamellae orientation deviates significantly from the growth direction at the growth rate of 1.2mm/min. The interlamellar spacing is inverse proportional to the growth rate. The alloy with finer interlamellar spacing shows higher nanoindentation hardness. The corresponding relationship between nanoindentation hardness (HN) and interlamellar spacing (λ) can be fitted by HN=36.3λ−0.254. Hindrance of the semi-coherent interface to dislocation movement results in higher tensile strength of the alloy and the larger tensile elongation can be attributed to the improvement of the deformation uniformity.
Graphical abstract
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Shape evolution of 3D flower-like gold microstructures from gold nanosheets via oriented attachment
Publication date: 5 July 2017
Source:Materials & Design, Volume 125
Author(s): Supeera Nootchanat, Chutiparn Lertvachirapaiboon, Vittaya Amornkitbamrung, Pikaned Uppachai, Sanong Ekgasit, Kanet Wongravee
Herein, we present a shape evolution of 3D flower-like gold microstructures (3D-FLGMSs) from gold nanosheets induced by H2O2 with the presence of starch. A systematic investigation of the influence of the parameters on the size, morphology and structural evolution of 3D-FLGMSs was presented. Under the starch-stabilized environment, H2O2 plays a key role on the formation of 3D-FLGMSs as it promotes a rapid generation of small nanosheets with starch-bound {111} facet at the very early stage. At a high concentration of H2O2, the nanosheets undergo oriented attachment and transform into a large primary gold nanosheets with imperfect facet-binding. The oriented attachment (OA) and subsequent epitaxial growth of nanopetals from the imperfects turns the primary nanosheets into 3D-FLGMSs with lateral size as large as 30μm within 120min. Without starch, quasi-microspheres of gold with diameters of 5–7μm are the sole product. In addition, the 3D-FLGMSs can be employed as SERS substrates which allow the detection limit of Rhodamine 6G (R6G) at the concentration as low as 0.1μM. The developed green synthetic method utilizes non-toxic reducing and stabilizing agents while limiting the discharge of harmful chemical wastes.
Graphical abstract
http://ift.tt/2otbPCQ
An anatomical subunit-based outcome assessment scale for bilateral cleft lip and palate
As there is currently no internationally accepted outcome measurement tool available for complete bilateral cleft lip and palate (CBCLP), the goal of this prospective study was to develop a numerical evaluation scale that allows reliable scoring of this cleft deformity. Our cohort comprised 121 Indian subjects with CBCLP who underwent surgical repair (mean age at time of surgery 6.53 months) using a modified Millard technique. A panel of three professionals evaluated each subject's outcome of bilateral cleft lip repair 6 months postoperatively on two-dimensional (2D) full-face photographs in the frontal view and worm's eye view.
http://ift.tt/2nz7GxJ
The influence of mandibular third molar germectomy on the treatment time of impacted mandibular second molars using brass wire: a prospective clinical pilot study
The brass wire ligature is an efficient method to correct a moderately mesially impacted mandibular second molar (MM2). The aim of this prospective clinical pilot study was to evaluate the influence of mandibular third molar (MM3) germectomy on the treatment time for this procedure and to determine its impact on oral health-related quality of life (OHRQoL) using the short-form Oral Health Impact Profile (OHIP-14). The STROBE guidelines were followed. Impacted MM2 were assigned randomly to receive brass wire ligature treatment either with germectomy (group A) or without germectomy (group B).
http://ift.tt/2pnSQqe
Exploring parental behavior and child interactive engagement: A study on children with a significant cognitive and motor developmental delay
Source:Research in Developmental Disabilities, Volume 64
Author(s): Ines Van keer, Stephy Colla, Karla Van Leeuwen, Carla Vlaskamp, Eva Ceulemans, Karel Hoppenbrouwers, Annemie Desoete, Bea Maes
Background and aimsParenting factors are one of the most striking gaps in the current scientific literature on the development of young children with significant cognitive and motor disabilities. We aim to explore the characteristics of, and the association between, parental behavior and children's interactive engagement within this target group.Methods and proceduresTwenty-five parent-child dyads (with children aged 6–59 months) were video-taped during a 15-min unstructured play situation. Parents were also asked to complete the Parental Behavior Scale for toddlers. The video-taped observations were scored using the Child and Maternal Behavior Rating Scales.Outcomes and resultsLow levels of parental discipline and child initiation were found. Parental responsivity was positively related to child attention and initiation.Conclusions and implicationsCompared to children with no or other levels of disabilities, this target group exhibits large differences in frequency levels and, to a lesser extent, the concrete operationalization of parenting domains. Further, this study confirms the importance of sensitive responsivity as the primary variable in parenting research.
http://ift.tt/2oZwf76
Security “high-tech” individual extra-light device mask 2.0: CAD/CAM evolution
In 2008, we presented our security "high-tech" individual extra-light device mask (SHIELD), a protective shield based on the face cast of an injured soccer player that can be customised. It allows a shortened convalescent period, is comfortable, fits well, and allows the patient to continue to play at a professional level in their chosen sport or activity in the shortest time possible. It has been used often in both amateur and professional categories of many sports, and we now present an update.
http://ift.tt/2p15HzC
A new species of Scopulariopsis and its synergistic effect on pathogenicity of Verticillium dahliae on cotton plants
Source:Microbiological Research
Author(s): Xiao-Lin Li, Mohammad Reza Ojaghian, Jing-Ze Zhang, Shui-Jin Zhu
A new species, Scopulariopsis gossypii, was found to be present in the vascular bundles of cotton plants (Gossypium hirsutum) infected by Verticillium dahliae which is an economically important pathogen in Hangzhou, China. The fungus was only present in the diseased plants, but it never became isolated from the healthy plants. Scanning electron microscopy showed that the fungus was present in parenchyma cells enclosing vessels in dark brown vascular tissues of stems, and produced asexual conidia within the tissues. Phylogenetic analysis of combined nuclear ribosomal D1/D2 region of the 28S rDNA as well as translation elongation factor 1-alpha (TEF1) and beta-tubulin (TUB) gene showed that S. gossypii represents an undescribed species of Scopulariopsis, Microascaceae. In this study, characteristics of sexual and asexual stages of the fungus were described, illustrated and compared with similar taxa. In addition, the molecular and morphological analyses indicated that S. gossypii was a distinct species of Scopulariopsis. The pathogenicity tests proved by inoculation of wounded roots confirmed that S. gossypii was an opportunistic pathogen causing leaf interveinal chlorosis and vascular browning of cotton plants. However S. gossypii did not infect host with undamaged roots. Moreover, coinoculation with S. gossypii and V. dahliae significantly increased disease severity.
http://ift.tt/2oZx0wX
Lymph Node Central Necrosis on the Computed Tomography as the Predictor of the Extra Capsular Spread in Metastatic Head and Neck Squamous Cell Carcinoma
Abstract
The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.
http://ift.tt/2ojaldG
Septorhinoplasty: Our Experience
Abstract
Rhinoplasty is one of the oldest known surgeries to the human kind. However, being a cosmetic of surgery of utmost importance, it has been an attractive and fascinating surgery for the otolaryngologists and plastic surgeons. Along with the evolution of improved techniques and better surgical modalities, this surgery has been growing in panorama including its indications, needs and techniques. We present our experience with rhinoplasty in a tertiary care center of north India. We have included all cases operated with septorhinoplasty from 2001 to 2014 by the senior author in the manuscript. We reviewed their presentations, investigations, preoperative counselling records, operative details and post-operative clinical records to audit our results and hence to document our experiences in septorhinoplasties. A total of 53 cases including 37 males and 16 females had undergone rhinoplasty surgeries. The most common reason of disfigurement was road traffic accident (58.5%). All these patients included different deformities and required varied corrections. There were no major post-operative complications except persistent edema with longest lasting for 23 weeks. Thermal splints gave a better patient satisfaction in post-op compared to POP splints. Results were completely and partially satisfying for 50 patients and not satisfying for three. Unrealistic expectations from the procedure might be the reason for non-satisfactory results in rhinoplasty. Rhinoplasty is a delicate procedure and has greater aesthetic implications in planning surgical techniques and approaches. For better satisfaction of patients, adequate preoperative counseling and realistic expectations are warranted. Skillful surgical techniques null chances of complications.
http://ift.tt/2oZaSQk
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