Differential Motivations for Pursuing Diagnostic Radiology by Gender

Publication date: Available online 25 May 2017
Source:Academic Radiology
Author(s): Lars J. Grimm, Dorothy A. Lowell, Sarah W. Cater, Sora C. Yoon
Rationale and ObjectivesThe purpose of this study is to determine how the motivations to pursue a career in radiology differ by gender. In addition, the influence of medical school radiology education will be assessed.Materials and MethodsRadiology applicants to our institution from the 2015–2016 interview season were offered an online survey in February 2016. Respondents scored the influence of 24 aspects of radiology on their decision to pursue radiology. Comparisons were made between male and female respondents. Respondents were also asked the type of medical school radiology education they received and to score the influence this experience had on their decision to pursue radiology.ResultsThere were 202 total respondents (202/657) including 47 women and 155 men. Compared to men, the following factors had a more negative impact on women: flexible work hours (P = 0.04), work environment (P = 0.04), lifestyle (P = 0.04), impact on patient care (P = 0.05), high current debt load (P = 0.02), gender distribution of the field (P = 0.04), and use of emerging/advanced technology (P = 0.02). In contrast, women felt more favorably about the opportunities for leadership (P = 0.04) and research (P < 0.01).Dedicated radiology exposure was as follows: 20% (n = 20) none, 48% (n = 96) preclinical exposure, 55% (n = 111) elective rotation, and 18% (n = 37) core rotation. More intensive radiology exposure via a core rotation had a significantly positive impact on the decision to pursue radiology (P < 0.01).ConclusionsMale and female radiology applicants are motivated by different aspects of radiology, which may influence residency recruitment practices. In addition, more intensive radiology exposure has a net positive impact on the decision to pursue radiology.



http://ift.tt/2r3MOiI

Lymphocytic Thrombophilic Arteritis: A Possible Association with Minocycline

Abstract

We describe a case of lymphocytic thrombophilic arteritis in a 15-year-old girl who had previously taken minocycline for a year. Cutaneous polyarteritis nodosa and lymphocytic thrombophilic arteritis share many features and may both be triggered by minocycline. There may be a long latency between drug exposure to minocycline and development of disease.

http://ift.tt/2s1KTbW

Primary Cutaneous B-Cell Lymphoblastic Lymphoma Arising from a Long-Standing Lesion in a Child and Review of the Literature

Abstract

Precursor B-cell lymphoblastic lymphoma (B-LBL) is a rare entity and primary cutaneous B-LBL is an even more uncommon diagnosis that typically affects children. A 4-year-old boy presented with a persistent rash on his left cheek for almost 2 years and was found to have primary cutaneous B-LBL. We report this case to emphasize that B-LBL should be in the differential diagnosis for an otherwise unimpressive persistent lesion in the head and neck region and review all reported pediatric cases of primary cutaneous B-LBL without extracutaneous involvement.

http://ift.tt/2r3rDxm

Synthesis and study of nanostructured Ce-Zr-La-RE-O (RE=Y, Nd and Pr) quaternary solid solutions and their supported three-way catalysts

Publication date: 15 September 2017
Source:Materials & Design, Volume 130
Author(s): Yi Zhou, Jie Deng, Lei Xiong, Jianli Wang, Shandong Yuan, Hailong Zhang, Yaoqiang Chen
In this work, a series of nanostructured Ce-Zr-La-RE-O (RE=Y, Nd and Pr) quaternary solid solutions (CZLY, CZLN and CZLP) were synthesized via simultaneous co-precipitation with the assistance of lauric acid. The corresponding supported Pd-only three-way catalysts (Pd/CZLY, Pd/CZLN and Pd/CZLP) were also prepared by wet-impregnation method. The effects of Y, Nd and Pr on CeO2-ZrO2-La2O3-RE2O3 system and corresponding supported Pd-only three-way catalysts were investigated by X-ray diffraction (XRD), Raman, hydrogen-temperature programmed reduction (H2-TPR), N2 adsorption-desorption and X-ray photoelectron spectroscopy (XPS) characterizations. The results show that all the fresh samples form single phase structure, however, after being thermal aged at 1000°C, CZLN-a exhibits the best thermal stability which presents a remarkably low reduction peak temperature of 395°C and a high surface area of 42.6m²/g. The study of the interactions between Pd metal particles and supports indicates that Pd could selectively adsorb onto the surface Ce sites of different supporting materials by forming different chemical bonds. Pd/CZLN also exhibits superior three-way catalytic activity with respect to others, particularly, the light-off temperatures (T50) of C3H8, CO and NO for Pd/CZLN-a are as low as 339, 175 and 198°C, respectively.

Graphical abstract

http://ift.tt/2r3D3Bg

Partitioning and diffusion of transition metal solutes in ternary model Ni-based single crystal superalloys

Publication date: 15 September 2017
Source:Materials & Design, Volume 130
Author(s): Shaohua Liu, Minru Wen, Zi Li, Wenqing Liu, Ping Yan, Chongyu Wang
Partitioning and diffusion of transition metal solutes can significantly affect the coarsening rate of γ′ precipitates in Ni-based single crystal superalloys. Using first-principles density-functional calculations and atom probe tomography, we investigated the partitioning coefficient and diffusion rate of 3d (TiNi), 4d (ZrPd), and 5d (HfPt) transition metal solutes. For ternary model Ni-based single crystal superalloys, the 3d solutes (except Ti) partition to the matrix phase, whereas 4d and 5d solutes (except Ru, Rh, and Ir) prefer γ′ precipitates. The existing atom probe tomography results are consistent with the calculation results. Across the periodic table, middle-row elements have a higher (lower) diffusion activation energy (diffusion rate) than early and late row elements. The band-filling effect that is coupled with electronic structure analysis can explain the parabolic behavior of energetics that involves bond breaking. To minimize the coarsening rate, we have screened alloying elements that both have a low diffusion rate in the γ matrix and partition to the γ′ phase. These alloying elements will suppress the coarsening behavior of the precipitates and are expected to contribute to the stability of precipitates at elevated temperature.

Graphical abstract

http://ift.tt/2r3E5gx

Effects of annealing on microstructure and deformation uniformity of Ti-22Al-24Nb-0.5Mo laser-welded joints

Publication date: 15 September 2017
Source:Materials & Design, Volume 130
Author(s): Xueyan Jiao, Beibei Kong, Wang Tao, Gang Liu, Hanwei Ning
In order to improve the deformation uniformity between base metal and weld zone, the laser-welded joints of Ti-22Al-24Nb-0.5Mo alloy were subjected to different annealing treatments at 980°C, 1030°C and 1080°C, respectively. The microstructure and tensile behavior of the joints under as-welded and annealed conditions were systematically investigated. Results show that the microstructure and mechanical properties of the laser-welded joints are found sensitive to the annealing conditions. During the annealing processes, the static recrystallization of B2 phase occurred in base metal with the phase transformations from O to B2 and α2 to B2. In fusion zone, the α2 phase precipitated within the columnar B2 grains except the annealing at 1080°C. The microstructural inhomogeneity between base metal and weld zone has been effectively reduced by the annealing above 1030°C. Besides, the tensile tests at 970°C reveal that annealing treatment has significantly improved the deformation uniformity in weld joints, for example the maximum deviation rate from average effective strain for the joints annealed at 1030°C was reduced to 0.15. Overall, the annealing process at 1030°C is suggested as the appropriate heat treatment to obtain the uniform deformability in laser-welded joints.

Graphical abstract

http://ift.tt/2r3gCfp

Food transit duration is associated with the number of stage II transport cycles when eating solid food

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Takashi Hiraoka, Jeffrey B. Palmer, Martin B. Brodsky, Mitsumasa Yoda, Haruhi Inokuchi, Akio Tsubahara
ObjectiveWhen eating solids, stage II transport (St2Tr) propels triturated food into the pharynx for bolus formation and storage before swallowing. Although the existence of St2Tr is acknowledged, the reason for its existence remains unclear. Understanding it may facilitate development of food appropriate for individuals with dysphagia. The purpose of this study was to explore how measures of duration of eating and swallowing affect the number of St2Tr cycles.DesignVideofluorography was performed on 13 healthy subjects eating 6-g squares of banana, tofu, and cookies. Measurements included the number of St2Tr cycles, duration of processing (from food entering the mouth to onset of swallowing), pre-upper esophageal sphincter (UES) transit duration (from onset of swallowing to onset of UES transit), UES transit duration (leading edge to trailing edge passing the UES), and total sequence duration (from onset of swallowing to terminal swallow). Principal component (PC) analysis was used to identify factors affecting the number of St2Tr cycles. Analysis of covariance was performed using the 1st PC as an independent variable for predicting the number of St2Tr cycles.ResultsAll four duration measures were significantly positively correlated with the number of St2Tr cycles. Analysis revealed two orthogonal PCs with variable loading. The 1st PC was a function of the timing variables. The 2nd PC was a function of the number of swallows.ConclusionsThe number of St2Tr cycles was associated with measures of food transit duration and was greater with harder foods before processing and more viscous foods just before swallowing.



http://ift.tt/2rWnYPT

Flu-like illness, fever, malaise and chills, followed by severe nonpleuritic chest pain and shortness of breath

Chronic migraine headache and acute shortness of breath associated with nausea, vomiting, diaphoresis and increasing retrosternal chest pain..Increased frequency of his migraine headaches associated with vague retrosternal chest pain and epigastric pain...................................................................................................................Flu-like illness, fever, malaise and chills, followed by severe nonpleuritic chest pain and shortness of breath................................................................................Palpitations, fatigue, vague chest discomfort, and cardiomegaly and pulmonary congestion visible on chest radiograph. He had developed a flu-like illness with low-grade fever, chills, myalgia and headache a week earlier. There had been no preceding cough, hemoptysis, orthopnea, paroxysmal nocturnal dyspnea or ankle edema. .....................................................................................................................................Eosinophilic myocarditis (EM)........................................................................................................Therapeutic effect of anti-IL-5 on eosinophilic myocarditis with large pericardial effusion

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

13. Akademia Dermatologii i Alergologii Słupsk − Ustka − Dolina Charlotty 09−12 lutego 2017 roku

Publication date: Available online 24 May 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Maciej Kaczmarski




http://ift.tt/2r1WDeX

Neglected Australian arboviruses: quam gravis?

Publication date: Available online 25 May 2017
Source:Microbes and Infection
Author(s): Narayan Gyawali, Richard S. Bradbury, John G. Aaskov, Andrew W. Taylor-Robinson
At least 75 arboviruses have been identified from Australia. Most have a zoonotic transmission cycle, maintained in the environment by cycling between arthropod vectors and susceptible mammalian or avian hosts. The primary arboviruses that cause human disease in Australia are Ross River, Barmah Forest, Murray Valley encephalitis, Kunjin and dengue. Several other arboviruses are associated with human disease but little is known about their clinical course and diagnostic testing is not routinely available. Given the significant prevalence of undifferentiated febrile illness in Australia, investigation of the potential threat to public health presented by these viruses is required.



http://ift.tt/2qm1fvv

Distribution of white spot lesions among orthodontic patients attending teaching institutes in Khartoum

Abstract

Background

Fixed orthodontic appliances render teeth cleaning arduous, thus when orthodontic treatment is associated with inadequate oral hygiene practice, development of white spot lesions (WSLs) imposes a significant risk on the dentition. Salivary reservoir of calcium, magnesium, phosphorous and fluoride counteracts demineralization and encourages remineralization providing protection against caries challenge. The investigation of the factors leading to WSLs' development is mandatory for appropriate prevention strategies planning. The present study aimed at evaluating the prevalence, pattern of distribution and contributing factors to WSLs' development, among orthodontic patients attending orthodontic departments in teaching institutes in Khartoum.

Methods

This cross-sectional descriptive, analytical clinical based study was carried out among fixed orthodontic patients attending teaching institutes in Khartoum State. All patients visiting the clinics for their follow up during a 3 months period and fulfilling the inclusion criteria were included. The International Caries Detection and Assessment System (ICDAS) served as a guide for standardized visual caries assessment. Saliva samples were collected from a sample of patients and the levels of calcium and phosphorus were measured. Patients were interviewed regarding their oral hygiene habits (frequency of tooth brushing, use of interdental brushes and mouth washes). Frequency distribution tables as well as graphs, Pearson's correlations and Spearman's correlation were used in the statistical analysis.

Results

The overall prevalence of WSLs was 61.4%. The prevalence for each tooth was: 48.1% in the canine, 32.3% in the lateral incisor, 31.6% in both the central incisor and the first premolar, 27.2% in the second premolar and 8.9% in the first molar. No significant relationship between WSLs prevalence, age and gender or oral hygiene measures was found. There was no significant difference in calcium and phosphorus level between participants with WSLs or those with sound teeth (p-values for calcium and phosphorus were 0.154 and 0.567 respectively).

Conclusions

Within the limitations of this study it was found that WSLs among fixed orthodontic patients represented an issue of concern. High prevalence of WSLs was recorded among orthodontic patients in Sudan, indicating a need for more stringent prevention programmes and oral hygiene practices prior to initiation of orthodontic treatment.

http://ift.tt/2r1ecMo

Post endodontic pain following single-visit root canal preparation with rotary vs reciprocating instruments: a meta-analysis of randomized clinical trials

Abstract

Background

In endodontic therapy, continuous rotary instrumentation reduced debris compared to reciprocal instrumentation, which might affect the incidence of post-endodontic pain (PP). The aim of our study was to assess whether PP incidence and levels were influenced by the choice of rotary or reciprocal instruments.

Methods

In this meta-analysis the Pubmed and EM databases were searched for prospective clinical randomized trials published before April 20, 2016, using combinations of the keywords: root canal preparation/instrumentation/treatment/therapy; post-operative/endodontic pain; reciprocal and rotary instruments.

Results

Three studies were included, involving a total of 1,317 patients, 659 treated with reciprocating instruments and 658 treated with rotary instruments. PP was reported in 139 patients in the reciprocating group and 172 in the rotary group. The PP incidence odds ratio was 1.27 with 95% confidence interval (CI) (0.25, 6.52) favoring rotary instruments. The mild, moderate and severe PP levels odds ratios were 0.31 (0.11, 0.84), 2.24 (0.66, 7.59) and 11.71 (0.63, 218.15), respectively. No evidence of publication bias was found.

Conclusions

Rotary instrument choice in endodontic therapy is associated with a lower incidence of PP than reciprocating instruments, while reciprocating instruments are associated with less mild PP incidence.

http://ift.tt/2qh4DvM

L-mimosine and hypoxia can increase angiogenin production in dental pulp-derived cells

Abstract

Background

Angiogenin is a key molecule in the healing process which has been successfully applied in the field of regenerative medicine. The role of angiogenin in dental pulp regeneration is unclear. Here we aimed to reveal the impact of the hypoxia mimetic agent L-mimosine (L-MIM) and hypoxia on angiogenin in the dental pulp.

Methods

Human dental pulp-derived cells (DPC) were cultured in monolayer and spheroid cultures and treated with L-MIM or hypoxia. In addition, tooth slice organ cultures were applied to mimic the pulp-dentin complex. We measured angiogenin mRNA and protein levels using qPCR and ELISA, respectively. Inhibitor studies with echinomycin were performed to reveal the role of hypoxia-inducible factor (HIF)-1 signaling.

Results

Both, L-MIM and hypoxia increased the production of angiogenin at the protein level in monolayer cultures of DPC, while the increase at the mRNA level did not reach the level of significance. The increase of angiogenin in response to treatment with L-MIM or hypoxia was reduced by echinomycin. In spheroid cultures, L-MIM increased angiogenin at protein levels while the effect of hypoxia was not significant. Angiogenin was also expressed and released in tooth slice organ cultures under normoxic and hypoxic conditions and in the presence of L-MIM.

Conclusions

L-MIM and hypoxia modulate production of angiogenin via HIF-1 differentially and the response depends on the culture model. Given the role of angiogenin in regeneration the here presented results are of high relevance for pre-conditioning approaches for cell therapy and tissue engineering in the field of regenerative endodontics.

http://ift.tt/2r1b4jp

A Story in Black and White

Strong engagement from expert radiologists is essential in ensuring the optimal function of a multidisciplinary group focused on the treatment of head and neck cancer. Active participation in multidisciplinary conference can be among the most rewarding roles for radiologists. Despite many benefits to radiologist involvement in multidisciplinary teams, there are obstacles and challenges that can prevent full participation. This article highlights the key issues that should be considered by radiologists and multidisciplinary team leaders when planning participation in a new or existing multidisciplinary group that focuses on the care of patients with head and neck cancer.

http://ift.tt/2qlqtdc

A Story in Black and White

Strong engagement from expert radiologists is essential in ensuring the optimal function of a multidisciplinary group focused on the treatment of head and neck cancer. Active participation in multidisciplinary conference can be among the most rewarding roles for radiologists. Despite many benefits to radiologist involvement in multidisciplinary teams, there are obstacles and challenges that can prevent full participation. This article highlights the key issues that should be considered by radiologists and multidisciplinary team leaders when planning participation in a new or existing multidisciplinary group that focuses on the care of patients with head and neck cancer.

http://ift.tt/2qlqtdc

Cutaneous Manifestations of Medium- and Large-Vessel Vasculitis

Abstract

Dermatologic manifestations are observed in almost all systemic vasculitides, even in large-and medium-vessel vasculitides, although such vessels are not found in the skin. Cutaneous manifestations may be related to a direct skin localization of the systemic vasculitis or a non-specific process associated with the vasculitis. According to the 2012 International Chapel Hill consensus, the two major variants of large-vessel vasculitides are Takayasu arteritis and giant-cell arteritis. In Europe and North America, acute inflammatory nodules or erythema nodosum-like lesions are the most commonly observed skin lesions with Takayasu arteritis. Medium-sized arteriole vasculitis of the dermis or subcutis but also septal or lobular panniculitis may be found during pathological examination. In Japan, widespread pyoderma gangrenosum-like lesions are more frequent. Cutaneous manifestations of giant-cell arteritis are rare; they are ischemic, linked to arterial occlusions, or non-ischemic, with various mechanisms. The two major medium-vessel vasculitides are Kawasaki disease and polyarteritis nodosa. Kawasaki disease is characterized by a mucocutaneous lymph node syndrome without skin vasculitis. Two subsets of polyarteritis nodosa with different skin manifestations are described, without transition from one to the other. In the systemic subset, the most frequent skin lesions are in the order of frequency purpura, livedo, and nodules. Cutaneous polyarteritis nodosa mainly features nodules, livedo racemosa, and ulcerations. Genetic screening and measurement of plasma levels of adenosine deaminase 2 should be considered for patients with uncommon systemic polyarteritis nodosa or early-onset cutaneous polyarteritis nodosa.

http://ift.tt/2rWWBVN

Chronicles of a reductase: Biochemistry, genetics and physio-pathological role of GSNOR

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): Salvatore Rizza, Giuseppe Filomeni
S-nitrosylation is a major redox posttranslational modification involved in cell signaling. The steady state concentration of S-nitrosylated proteins depends on the balance between the relative ability to generate nitric oxide (NO) via NO synthase and to reduce nitrosothiols by denitrosylases. Numerous works have been published in last decades regarding the role of NO and S-nitrosylation in the regulation of protein structure and function, and in driving cellular activities in vertebrates. Notwithstanding an increasing number of observations indicates that impairment of denitrosylation equally affects cellular homeostasis, there is still no report providing comprehensive knowledge on the impact that denitrosylation has on maintaining correct physiological processes and organ activities.Among denitrosylases, S-nitrosoglutathione reductase (GSNOR) represents the prototype enzyme to disclose how denitrosylation plays a crucial role in tuning NO-bioactivity and how much it deeply impacts on cell homeostasis and human patho-physiology.In this review we attempt to illustrate the history of GSNOR discovery and provide the evidence so far reported in support of GSNOR implications in development and human disease.

Graphical abstract

http://ift.tt/2qV0YCu

Cyclophosphamide and acrolein induced oxidative stress leading to deterioration of metaphase II mouse oocyte quality

Publication date: September 2017
Source:Free Radical Biology and Medicine, Volume 110
Author(s): Roohi Jeelani, Sana N. Khan, Faten Shaeib, Hamid-Reza Kohan-Ghadr, Sarah R. Aldhaheri, Tohid Najafi, Mili Thakur, Robert Morris, Husam M. Abu-Soud
Cyclophosphamide (CTX) is a chemotherapeutic agent widely used to treat ovarian, breast, and hematological cancers as well as autoimmune disorders. Such chemotherapy is associated with reproductive failure and premature ovarian insufficiency. The mechanism by which CTX and/or its main metabolite, acrolein, affect female fertility remains unclear, but it is thought to be caused by an overproduction of reactive oxygen species (ROS). Here, we investigated the effect of CTX on metaphase II mouse oocytes obtained from treated animals (120mg/kg, 24h of single treatment), and oocytes directly exposed to increasing concentrations of CTX and acrolein (n=480; 0, 5, 10, 25, 50, and 100μM) with and without cumulus cells (CCs) for 45min which correlates to the time of maximum peak plasma concentrations after administration. Oocytes were fixed and subjected to indirect immunofluorescence and were scored based on microtubule spindle structure (MT) and chromosomal alignment (CH). Generation of ROS was evaluated using the Cellular Reactive Oxygen Species Detection Assay Kit. Deterioration of oocyte quality was noted when oocytes were obtained from CTX treated mice along with CTX and acrolein treated oocytes in a dose-dependent manner as shown by an increase in poor scores. Acrolein had an impact at a significantly lower level as compared to CTX, plateau at 10μM versus 50μM, respectively. These variation is are associated with the higher amount of ROS generated with acrolein exposure as compared to CTX (p<0.05). Utilization of antioxidant therapy and acrolein scavengers may mitigate the damaging effects of these compounds and help women undergoing such treatment.

Graphical abstract

http://ift.tt/2qULmyM

Alternative Donor Graft Sources for Adults with Hematologic Malignancies: A Donor for All Patients in 2017!

Hematopoietic stem cell transplant (HSCT) is potentially curative for a wide variety of malignant diseases, including acute and leukemias, lymphoma, and myelodysplasia. Choice of a stem cell donor is dependent on donor availability, donor compatibility and health, recipient disease type, and recipient condition. Current sources of stem cell donation for HSCT are matched sibling donors (MSDs), matched unrelated donors (MUDs), 1-antigen mismatched unrelated donors (MMUDs), haploidentical donors (haplo), and umbilical cord blood (UCB) units. Historically, preferred donors for HSCT have been human leukocyte antigen (HLA)-matched sibling donors; however, only about 30% of U.S. patients will have a MSD available. The majority of patients referred for HSCT will require an alternative donor graft: MUD, MMUD, UCB, or haplo. The likelihood of finding a MUD varies depending on the ethnicity of the recipient. White Caucasians of European descent have the greatest chance of finding a MUD. Chances of finding a MUD are significantly less for African-American or Hispanic recipients due to HLA polymorphisms. Therefore, MMUD, UCB, and haplo donor graft sources expand the donor pool for recipients who do not have a MSD or MUD available. Given the variety of different donor stem cell sources available today, nearly every patient who needs an allogeneic HSCT has a potential donor in 2017. All transplant-eligible patients with hematologic malignancies should be evaluated by a transplant center to determine if HSCT is a viable treatment option for their underlying disease process. The Oncologist 2017;22:1–10

Implications for Practice.

The goal of this review is to increase the awareness of oncology practitioners to the availability of alternative donor stem cell transplants for patients with hematologic malignancies. Despite new agents, stem cell transplant remains the only curative therapy for many patients with acute and chronic leukemia, myelodysplasia, and lymphoma. Given the variety of different donor stem cell sources available today, nearly every patient who needs an allogeneic stem cell transplant will have a donor.

http://ift.tt/2r3797W

A Phase II Study of Everolimus Plus Oral Prednisone in Patients with Metastatic Renal Cell Cancer

Lessons Learned.

The combination of everolimus and low-dose prednisone administered daily was hypothesized to prevent noninfectious pneumonitis (NIP) and mucositis, two common adverse events related to everolimus. Although mucositis was detected in only one case, all-grade NIP occurred in four of eight cases (50%), and this was considered enough to stop accrual of the study.

These data suggest the need for careful monitoring of patients receiving everolimus who are treated with corticosteroids.

Background.

Everolimus is standard of care in the treatment of patients affected by metastatic renal cell carcinoma (mRCC) that has progressed after at least one previous line of treatment. Stomatitis and noninfectious pneumonitis (NIP) are common adverse events (AEs) in patients treated with everolimus. Prednisone could reduce the incidence of stomatitis, and it is commonly used to treat NIP. We hypothesized that low doses of prednisone could reduce the incidence and/or the severity of everolimus-induced NIP and stomatitis.

Methods.

We have conducted an open-label, single-arm, phase II trial of prednisone 5 mg b.i.d. added to everolimus 10 mg/day in patients with mRCC. We planned to evaluate the safety, tolerability, and activity of this combination in mRCC patients. We aimed to reduce incidence of drug discontinuations due to stomatitis or NIP from 25% to 10%.

Results.

Three (38%) of the first eight patients enrolled experienced grade ≥2 pneumonitis and stopped treatment. Grade 1 stomatitis occurred in only one patient (13%). Five of eight patients experienced disease progression at the 2-month evaluation. Two patients (25%) were reported free of disease progression at 1 year of treatment.

Conclusion.

The incidence of NIP in these patients was considered too high for completing accrual of this study. These results may be of interest for investigating the pathogenesis of NIP and suggest that patients should be carefully followed if treated with chronic corticosteroids while receiving everolimus. The Oncologist 2017;22:1–8

http://ift.tt/2qUWqff

Default Rules Are Better Than Active Choosing (Often)

Publication date: Available online 25 May 2017
Source:Trends in Cognitive Sciences
Author(s): Cass R. Sunstein
In recent years, governments have become keenly interested in behavioral science; new findings in psychology and behavioral economics have led to bold initiatives in areas that involve poverty, consumer protection, savings, health, the environment, and much more. Private institutions have used behavioral findings as well. But there is a pervasive and insufficiently explored question: when is it best to ask people to make active choices, and when is it best to use a default rule, which means that people need not make any choice at all? The answer depends on a form of cost–benefit analysis, which means that it is necessary to investigate whether choosing is a burden or a pleasure, whether learning is important, and whether a default rule would satisfy the informed preferences or all of most people.



http://ift.tt/2qlpMRf

Why Sex Education Matters for Adolescents with Autism Spectrum Disorder.

Author: Curtis, Anya MSN, RN, FNP-BC

Page: 11

http://ift.tt/2qUOF9g

How Will We Care for the Mentally Ill?.

Author: Kennedy, Maureen Shawn MA, RN, FAAN

Page: 7

http://ift.tt/2qpPtiU

Electronic Health Records.

Author: Frazier, Karen RN, VA-BC

Page: 10

http://ift.tt/2qUWVpR

Multimodal Analgesia for Acute Pain.

Author: Overdyk, Frank J. MD, MSEE; Verillo, Susan Carol DNP(c), RN, CRRN; Hofmeister, Nancee MSN, RN, NE-BC; Painter, Julie MSN, RN, OCN; Bennion, Kim MHS, BSRT, RRT, CHC; Zack, Jeanne PhD, RN, CIC

Page: 10

http://ift.tt/2qpvRLJ

Canadian Nurses Caught Up in Immigration Policy Confusion.

Author: Carter, David

Page: 12

http://ift.tt/2qpDnXb

ANA Expands Opposition to Capital Punishment.

Author: Potera, Carol

Page: 13

http://ift.tt/2qUB2Hc

NewsCAP: New guidelines for syncope issued.

Author:

Page: 13

http://ift.tt/2qpKH4K

Replacing the ACA.

Author: McSpedon, Corinne Senior Editor

Page: 19-20

http://ift.tt/2qUB7L0

From the Agencies.

Author:

Page: 15

http://ift.tt/2qUM0w3

NewsCAP: 12-to-34-year-olds have the highest rate of being sexually assaulted.

Author:

Page: 14

http://ift.tt/2qpBfOS

Telemedicine and Telehealth: The Potential to Improve Rural Access to Care.

Author: Nelson, Roxanne

Page: 17-18

http://ift.tt/2qpxBED

AJN On the Cover.

Author: Szulecki, Diane Editor

Page: 21

http://ift.tt/2qpm5t0

AJN On the Web.

Author:

Page: 21

http://ift.tt/2qUM3rJ

Ohio Collaborative Model Proactively Addresses the Looming Nursing Shortage.

Author: Zolot, Joan PA

Page: 14

http://ift.tt/2qUWWtV

NewsCAP: Diagnostics and treatment options for adult diabetic retinopathy have significantly improved.

Author:

Page: 14

http://ift.tt/2qUQDGM

Early Ambulation Is Crucial for Improving Patient Health.

Author: Halpern, Lucy Wang

Page: 15

http://ift.tt/2qpAncY

New Warnings About Protecting Children from Dangerous Substances.

Author: Stockwell, Serena

Page: 16

http://ift.tt/2qpJ9aV

NewsCAP: In May, the International Council of Nurses awarded the Christiane Reimann Prize to Linda Aiken, PhD, RN, FAAN, FRCN.

Author:

Page: 16

http://ift.tt/2qULZbt

New Treatment for Duchenne Muscular Dystrophy.

Author: Aschenbrenner, Diane S. MS, RN

Page: 22,23

http://ift.tt/2qpilI6

New Injectable Drug Treats Moderate-To-Severe Plaque Psoriasis.

Author: Aschenbrenner, Diane S. MS, RN

Page: 23

http://ift.tt/2qUW2gP

Involvement of hippocampal NMDA receptors in encoding and consolidation, but not retrieval, processes of spontaneous object location memory in rats

Publication date: 28 July 2017
Source:Behavioural Brain Research, Volume 331
Author(s): Kazuo Yamada, Misaki Arai, Toshiko Suenaga, Yukio Ichitani
The hippocampus is thought to be involved in object location recognition memory, yet the contribution of hippocampal NMDA receptors to the memory processes, such as encoding, retention and retrieval, is unknown. First, we confirmed that hippocampal infusion of a competitive NMDA receptor antagonist, AP5 (2-amino-5-phosphonopentanoic acid, 20–40nmol), impaired performance of spontaneous object location recognition test but not that of novel object recognition test in Wistar rats. Next, the effects of hippocampal AP5 treatment on each process of object location recognition memory were examined with three different injection times using a 120min delay-interposed test: 15min before the sample phase (Time I), immediately after the sample phase (Time II), and 15min before the test phase (Time III). The blockade of hippocampal NMDA receptors before and immediately after the sample phase, but not before the test phase, markedly impaired performance of object location recognition test, suggesting that hippocampal NMDA receptors play an important role in encoding and consolidation/retention, but not retrieval, of spontaneous object location memory.



http://ift.tt/2qUOuKY

Bombesin administration impairs memory and does not reverse memory deficit caused by sleep deprivation

Publication date: 28 July 2017
Source:Behavioural Brain Research, Volume 331
Author(s): L.B.T. Ferreira, S.L.B. Oliveira, J. Raya, L.A. Esumi, D.C. Hipolide
Sleep deprivation impairs performance in emotional memory tasks, however this effect on memory is not completely understood. Possible mechanisms may involve an alteration in neurotransmission systems, as shown by the fact that many drugs that modulate neural pathways can prevent memory impairment by sleep loss. Gastrin releasing peptide (GRP) is a neuropeptide that emerged as a regulatory molecule of emotional memory through the modulation of other neurotransmission systems. Thus, the present study addressed the effect of intraperitoneal (IP) administration of bombesin (BB) (2.5, 5.0 and 10.0μg/kg), a GRP agonist, on the performance of Wistar rats in a multiple trail inhibitory avoidance (MTIA) task, after sleep deprivation, using the modified multiple platforms method (MMPM). Sleep deprived animals exhibited acquisition and retention impairment that was not prevented by BB injection. In addition, non-sleep deprived animals treated with BB before and after the training session, but not before the test, have shown a retention deficit. In summary, BB did not improve the memory impairment by sleep loss and, under normal conditions, produced a memory consolidation deficit.



http://ift.tt/2qpry2V

Prenatal lipopolysaccharide induces hypothalamic dopaminergic hypoactivity and autistic-like behaviors: Repetitive self-grooming and stereotypies

Publication date: 28 July 2017
Source:Behavioural Brain Research, Volume 331
Author(s): Thiago B. Kirsten, Maria M. Bernardi
Previous investigations by our group have shown that prenatal exposure to lipopolysaccharide (LPS), which mimics infection by gram-negative bacteria, induces social, cognitive, and communication deficits. For a complete screening of autistic-like behaviors, the objective of this study was to evaluate if our rat model also induces restricted and repetitive stereotyped behaviors. Thus, we studied the self-grooming microstructure. We also studied the neurochemistry of hypothalamus and frontal cortex, which are brain areas related to autism to better understand central mechanisms involved in our model. Prenatal LPS exposure on gestational day 9.5 increased the head washing episodes (frequency and time), as well as the total self-grooming. However, body grooming, paw/leg licking, tail/genital grooming, and circling behavior/tail chasing did not vary significantly among the groups. Moreover, prenatal LPS induced dopaminergic hypoactivity (HVA metabolite and turnover) in the hypothalamus. Therefore, our rat model induced restricted and repetitive stereotyped behaviors and the other main symptoms of autism experimentally studied in rodent models and also found in patients. The hypothalamic dopaminergic impairments seem to be associated with the autistic-like behaviors.



http://ift.tt/2qUWc7Z

Two-hit model of schizophrenia induced by neonatal immune activation and peripubertal stress in rats: Study of sex differences and brain oxidative alterations

Publication date: 28 July 2017
Source:Behavioural Brain Research, Volume 331
Author(s): Aline Santos Monte, Bruna Stefânia Ferreira Mello, Vládia Célia Moreira Borella, Tatiane da Silva Araujo, Francisco Eliclécio Rodrigues da Silva, Francisca Cléa F de Sousa, Antônio Carlos Pinheiro de Oliveira, Clarissa Severino Gama, Mary V. Seeman, Silvânia Maria Mendes Vasconcelos, David Freitas De Lucena, Danielle Macêdo
Schizophrenia is considered to be a developmental disorder with distinctive sex differences. Aiming to simulate the vulnerability of the third trimester of human pregnancy to the developmental course of schizophrenia, an animal model was developed, using neonatal poly(I:C) as a first-hit, and peripubertal stress as a second-hit, i.e. a two-hit model. Since, to date, there have been no references to sex differences in the two-hit model, our study sought to determine sex influences on the development of behavior and brain oxidative change in adult rats submitted to neonatal exposure to poly(I:C) on postnatal days 5–7 as well as peripubertal unpredictable stress (PUS). Our results showed that adult two-hit rats present sex-specific behavioral alterations, with females showing more pronounced deficits in prepulse inhibition of the startle reflex and hyperlocomotion, while males showing more deficits in social interaction. Male and female animals exhibited similar working memory deficits. The levels of the endogenous antioxidant, reduced glutathione, were decreased in the prefrontal cortex (PFC) of both male and female animals exposed to both poly(I:C) and poly(I:C)+PUS. Only females presented decrements in GSH levels in the striatum. Nitrite levels were increased in the PFC of male and in the striatum of female poly(I:C)+PUS rats. Increased lipid peroxidation was observed in the PFC of females and in the striatum of males and females exposed to poly(I:C) and poly(I:C)+PUS. Thus, the present study presents evidence for sex differences in behavior and oxidative brain change induced by a two-hit model of schizophrenia.



http://ift.tt/2qpyE7B

Comparing the effect of temporal delay on the availability of egocentric and allocentric information in visual search

Publication date: 28 July 2017
Source:Behavioural Brain Research, Volume 331
Author(s): Keira Ball, Yan Birch, Alison Lane, Amanda Ellison, Thomas Schenk
Frames of reference play a central role in perceiving an object's location and reaching to pick that object up. It is thought that the ventral stream, believed to subserve vision for perception, utilises allocentric coding, while the dorsal stream, argued to be responsible for vision for action, primarily uses an egocentric reference frame. We have previously shown that egocentric representations can survive a delay; however, it is possible that in comparison to allocentric information, egocentric information decays more rapidly. Here we directly compare the effect of delay on the availability of egocentric and allocentric representations. We used spatial priming in visual search and repeated the location of the target relative to either a landmark in the search array (allocentric condition) or the observer's body (egocentric condition). Three inter-trial intervals created minimum delays between two consecutive trials of 2, 4, or 8seconds. In both conditions, search times to primed locations were faster than search times to un-primed locations. In the egocentric condition the effects were driven by a reduction in search times when egocentric information was repeated, an effect that was observed at all three delays. In the allocentric condition while search times did not change when the allocentric information was repeated, search times to un-primed target locations became slower. We conclude that egocentric representations are not as transient as previously thought but instead this information is still available, and can influence behaviour, after lengthy periods of delay. We also discuss the possible origins of the differences between allocentric and egocentric priming effects.



http://ift.tt/2qUS0VD

Swimming exercise prevents behavioural disturbances induced by an intracerebroventricular injection of amyloid-β1-42 peptide through modulation of cytokine/NF-kappaB pathway and indoleamine-2,3-dioxygenase in mouse brain

Publication date: 28 July 2017
Source:Behavioural Brain Research, Volume 331
Author(s): Leandro Cattelan Souza, Cristiano R. Jesse, Lucian Del Fabbro, Marcelo Gomes de Gomes, André Tiago Rossito Goes, Carlos Borges Filho, Cristiane Luchese, Albanin Aparecida Mielniczki Pereira, Silvana Peterini Boeira
Emerging evidence indicates that the activation of indoleamine-2,3-dioxygenase (IDO), a first and rate-limiting enzyme in the kynurenine (KYN) pathway, is involved in amyloid-beta (Aβ1-42)-neurotoxicity and Alzheimer's disease (AD) pathogenesis. Physical exercise has been considered an effective intervention in AD, attenuating or limiting their progression. Nevertheless, the neurobiological mechanisms underlying the neuroprotective effects of exercise have not yet been fully elucidated. In present study, we investigated the protective effect of an 8-week swimming training (ST) exercise on cognitive and non-cognitive functions and its role in modulating biomarkers of KYN pathway, before an intracerebroventricular (i.c.v.) injection of Aβ1-42 (400pmol/animal; 3μl/site) peptide in mice. Our results demonstrated that ST was effective in preventing the following behavioural disturbances caused by Aβ1-42 injection: memory impairment in the object recognition test and depressive/anxiety-like behaviour in the tail suspension test and elevated plus-maze test, respectively. ST abrogated the neuroinflammatory response and neurotrophic deficiency in the prefrontal cortex and hippocampus induced by Aβ1-42. Also, Aβ1-42 increased IDO activity, KYN and tryptophan (TRP) levels and KYN:TRP ratio in the prefrontal cortex and hippocampus − alterations that were blocked by ST. It can be concluded that ST prevented behavioural and neurobiological deficits induced by Aβ1-42, and suggest that these neuroprotective effects are likely to involve the inhibition of inflammation/IDO activation and up-regulation of neurotrophic factors in brain of mice. Thus, it is possible that physical exercise can be used as a non-pharmacological approach to alleviates both cognitive and non-cognitive symptoms of AD.



http://ift.tt/2qpCe1z

The PTZ kindling mouse model of epilepsy exhibits exploratory drive deficits and aberrant activity amongst VTA dopamine neurons in both familiar and novel space

Publication date: 14 July 2017
Source:Behavioural Brain Research, Volume 330
Author(s): Mahboubeh Ahmadi, Jean-Philippe Dufour, Erich Seifritz, Javad Mirnajafi-Zadeh, Bechara J. Saab
Recurrent seizures that define epilepsy are often accompanied by psychosocial problems and cognitive deficits with incompletely understood aetiology. We therefore used the pentylenetetrazol (PTZ) kindling model of epilepsy in mice to examine potential seizure-associated neuropathologies, focusing on motivation, memory and novel-environment-induced activation of midbrain dopaminergic neurons. In addition to recurrent seizures, we found that PTZ kindling led to a strong suppression of novelty-driven exploration while largely sparing fear-driven exploration. The deficits in exploratory drive may be relevant for other cognitive impairments since reduced unassisted rearing in a learning arena correlated with poorer spatial memory of object location. Using c-Fos immunofluorescence as a marker of neuronal activity, we observed that dopamine neurons within the ventral tegmental area (VTA) of PTZ kindled mice demonstrate hyperactivity at baseline and hypoactivity in response to a novel environment compared to saline-injected cagemate controls. These data extend previous findings of PTZ kindling-mediated disruptions of hippocampal processes important for novel environment recognition and learning by demonstrating PTZ kindling also induces motivational deficits that are associated with reduced stimulus-evoked activation of VTA dopamine neurons. More broadly, these data help understand the aetiology of complex behavioural changes in the PTZ kindling model, and may assist in the development of superior diagnoses and treatments for epilepsy.



http://ift.tt/2qUJZAe

Neuroprotective effects of ceftriaxone treatment on cognitive and neuronal deficits in a rat model of accelerated senescence

Publication date: 14 July 2017
Source:Behavioural Brain Research, Volume 330
Author(s): Maria A. Tikhonova, Shih-Chun Ho, Anna A. Akopyan, Nataliya G. Kolosova, Jun-Cheng Weng, Wan-Yun Meng, Chih-Li Lin, Tamara G. Amstislavskaya, Ying-Jui Ho
Rats of OXYS strain are characterized by genetically defined accelerated senescence. Ceftriaxone (CEF) exerts neuroprotective effects by decreasing the excitotoxicity and activation of antioxidant system. Here, we studied the effects of CEF (50 or 100mg/kg/day, i.p., 36 days) on cognitive and neuronal deficits in 5-month-old OXYS rats. Chronic CEF administration in a dose of 100mg/kg partially inhibited impairments of movement and restored the deficit in the novel object recognition in OXYS rats. Neuromorphologically, control OXYS rats exhibited a lowered neuronal density in the hippocampal CA1 area and there was a tendency to decrease in the substantia nigra pars compacta compared to Wistar controls. Both doses of CEF increased the density of pyramidal neurons in the CA1 area in OXYS rats. Control OXYS rats demonstrated a tendency to lower tyrosine hydroxylase (TH) immunoreactivity in the striatum compared with Wistar rats, while CEF treatment at a dose of 50mg/kg significantly augmented this parameter. In control OXYS rats, the levels of neurogenesis in the subgranular zone of the dentate gyrus of the hippocampus were significantly higher than in Wistar rats indicating compensatory processes that probably prevented the further induction of neurogenesis by CEF. Restoration of the recognition function and neuronal density in the CA1 area in OXYS rats after CEF treatment might be related to activation of the mechanisms that provide survival of newborn and mature neurons. The data suggested CEF as a promising pharmacological tool for the prevention of cognitive decline at accelerated aging.



http://ift.tt/2qpduXo

Voluntary wheel running ameliorates depression-like behaviors and brain blood oxygen level-dependent signals in chronic unpredictable mild stress mice

Publication date: 14 July 2017
Source:Behavioural Brain Research, Volume 330
Author(s): Peng Huang, Zhaoyang Dong, Weiliang Huang, Chuying Zhou, Weichao Zhong, Peiqian Hu, Ge Wen, Xuegang Sun, Heyu Hua, Huihui Cao, Lei Gao, Zhiping Lv
BackgroundPhysical exercise has been long recognized for its therapeutic effects on depressive disorders, but the underlying mechanisms remain largely unknown. In the study, we investigated whether the physical exercise by voluntary wheel running (VWR) alters depression-like behaviors and its impact on brain blood oxygen level-dependent (BOLD) signals in mice.MethodsAdult male C57BL/6 mice were assigned to one of the following groups; (1) no exercise control (noEx), housed in a standard cage; (2) exercise (Ex), 2h/day in a running wheel apparatus; (3) chronic unpredictable mild stress (CUMS), which was imitating adult stress; and (4) CUMS+Ex. The differences in functional brain changes were determined by BOLD functional magnetic resonance imaging (fMRI).ResultsThe results showed that VWR exercise significantly reversed the CUMS-induced behavioral abnormalities. Base on the fMRI amplitude of low-frequency fluctuation (ALFF) analysis, we found that VWR exercise could restore the CUMS-induced excessive BOLD activation in parts of limbic system, such as cortex, hippocampus and corpus callosum. Furthermore, CUMS-induced BOLD suppressive regions were also partially attenuated by VWR exercise, such as amygdala, cerebellum anterior lobe, thalamus, midbrain, and pontine. Most of these regions are involved in mood-regulating circuit, suggesting dysfunction of the circuit in CUMS model of depression, and VWR exercise could adjust the mood-regulating circuit.ConclusionsThese results suggested that VWR exercise ameliorated depression-like behaviors and brain BOLD signals in CUMS induced depression mice.

Graphical abstract

http://ift.tt/2qUREhR

Acute low-level alcohol consumption reduces phase locking of event-related oscillations in rodents

Publication date: 14 July 2017
Source:Behavioural Brain Research, Volume 330
Author(s): Leslie R. Amodeo, Derek N. Wills, Cindy L. Ehlers
Event-related oscillations (EROs) are rhythmic changes that are evoked by a sensory and/or cognitive stimulus that can influence the dynamics of the EEG. EROs are defined by the decomposition of the EEG signal into magnitude (energy) and phase information and can be elicited in both humans and animals. EROs have been linked to several relevant genes associated with ethanol dependence phenotypes in humans and are altered in selectively bred alcohol-preferring rats. However, pharmacological studies are only beginning to emerge investigating the impact low intoxicating doses of ethanol can have on event-related neural oscillations. The main goal of this study was to investigate the effects of low levels of voluntary consumption of ethanol, in rats, on phase locking of EROs in order to give further insight into the acute intoxicating effects of ethanol on the brain. To this end, we allow rats to self-administer unsweetened 20% ethanol over 15 intermittent sessions. This method results in a stable low-dose consumption of ethanol. Using an auditory event-related potential "oddball" paradigm, we investigated the effects of alcohol on the phase variability of EROs from electrodes implanted into the frontal cortex, dorsal hippocampus, and amygdala. We found that intermittent ethanol self-administration was sufficient to produce a significant reduction in overall intraregional synchrony across all targeted regions. These data suggest that phase locking of EROs within brain regions known to be impacted by alcohol may represent a sensitive biomarker of low levels of alcohol intoxication.



http://ift.tt/2qUT8ZH

Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study

Publication date: Available online 25 May 2017
Source:Auris Nasus Larynx
Author(s): Sung-Dong Kim, Sung-Lyong Hong, Min-Jung Kim, Joo-Yeon Kim, Yong-Wan Kim, Soo-Kweon Koo, Kyu-Sup Cho
ObjectiveAlthough hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty.Subjects and methodsSeventy six adult patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with hemostatic gelatin sponge and the other one with polyvinyl acetate. Patients' subjective symptoms while the packing was in situ, hemostatic properties, patients' pain on removal, degree of bleeding on removal of the packing, time for hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated.ResultsBoth packs were equally effective in the control of postoperative bleeding following septoplasty. However, hemostatic gelatin sponge packing was significantly more comfortable while in situ and less painful on removal of the pack. The polyvinyl acetate packing was associated with significantly more bleeding on removal, therefore much time was needed to control hemorrhage. There was no significant difference in the cost of the pack used and outcome of wound healing.ConclusionThe use of hemostatic gelatin sponge after septoplasty results in significantly less discomfort and greater patient satisfaction with no adverse reactions when compared with polyvinyl acetate packing. Therefore, hemostatic gelatin sponge may be a useful packing material after septoplasty.



http://ift.tt/2qpKezK

Evaluation of Penicillin Allergy in the Hospitalized Patient: Opportunities for Antimicrobial Stewardship

Abstract

Purpose of Review

Penicillin allergy is often misdiagnosed and is associated with adverse consequences, but testing is infrequently done in the hospital setting. This article reviews historical and contemporary innovations in inpatient penicillin allergy testing and its impact on antimicrobial stewardship.

Recent Findings

Adoption of the electronic medical record allows rapid identification of admitted patients carrying a penicillin allergy diagnosis. Collaboration with clinical pharmacists and the development of computerized clinical guidelines facilitates increased testing and appropriate use of penicillin and related β-lactams. Education of patients and their outpatient providers is the key to retaining the benefits of penicillin allergy de-labeling.

Summary

Penicillin allergy testing is feasible in the hospital and offers tangible benefits towards antimicrobial stewardship. Allergists should take the lead in this endeavor and work towards overcoming personnel limitations by partnering with other health care providers and incorporating technology that improves the efficiency of allergy evaluation.

http://ift.tt/2rCLVi4

Evaluation of Penicillin Allergy in the Hospitalized Patient: Opportunities for Antimicrobial Stewardship

Abstract

Purpose of Review

Penicillin allergy is often misdiagnosed and is associated with adverse consequences, but testing is infrequently done in the hospital setting. This article reviews historical and contemporary innovations in inpatient penicillin allergy testing and its impact on antimicrobial stewardship.

Recent Findings

Adoption of the electronic medical record allows rapid identification of admitted patients carrying a penicillin allergy diagnosis. Collaboration with clinical pharmacists and the development of computerized clinical guidelines facilitates increased testing and appropriate use of penicillin and related β-lactams. Education of patients and their outpatient providers is the key to retaining the benefits of penicillin allergy de-labeling.

Summary

Penicillin allergy testing is feasible in the hospital and offers tangible benefits towards antimicrobial stewardship. Allergists should take the lead in this endeavor and work towards overcoming personnel limitations by partnering with other health care providers and incorporating technology that improves the efficiency of allergy evaluation.

http://ift.tt/2rCLVi4

Middle ear adenomatous neuroendocrine tumors: a 25-year experience at MD Anderson Cancer Center

Abstract

Neuroendocrine tumors are extremely rare in the middle ear. We reviewed our institutional experience with middle ear adenomatous neuroendocrine tumors (MEANTs). We searched our institution's pathology files to identify patients treated from 1990 to 2015 who had lesions classified as middle ear adenomas, adenomatous tumors, adenomatous tumors with neuroendocrine differentiation, carcinoid tumors of the middle ear, low-grade neuroendocrine tumors of the middle ear, and neuroendocrine carcinomas of the middle ear and identified 14 such patients for whom follow-up information was available. Herein, we review the pathology and differential diagnosis of these patients' tumors and discuss the management and follow-up of these patients. Our report adds to the series cases of MEANTs with recurrences, lymph node involvement, distant metastases, and tumor-related deaths. Our experience suggests that, although these tumors have long been considered to be low-aggression neoplasms, long-term follow-up studies to ascertain this supposed benignity are warranted.

http://ift.tt/2r1zJEL

Recommandation de la SFORL. Prise en charge des épistaxis de l’adulte en première intention

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): E. Bequignon, B. Vérillaud, L. Robard, J. Michel, V.P. Escabasse, L. Crampette, O. Malard
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge des épistaxis en première intention.MéthodesÀ partir d'une revue de la littérature scientifique par un groupe de travail multidisciplinaire, des recommandations ont été rédigées, fondées sur les articles et l'expérience individuelle des membres, puis relues par un groupe de lecture indépendant afin d'aboutir au texte de synthèse. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsEn première intention, le mouchage, le nettoyage des fosses nasales et une compression bidigitale sont recommandés. En cas de saignement persistant, l'anesthésie locale avec vasoconstriction précède les gestes nasaux à visée diagnostique et thérapeutique. Quand l'origine des saignements n'est pas antérieure, l'endoscopie est essentielle, et localise l'origine des saignements dans la plupart des cas. En cas de saignement actif, une cautérisation est réalisée si le site de saignement est identifié. S'il n'est pas visualisé ou si échec des premières mesures, un tamponnement antérieur pourra être réalisé par un médecin non spécialiste ORL. La survenue d'une épistaxis impose, au décours, la réalisation d'une endoscopie des fosses nasales par un médecin ORL. Les patients doivent être informés des gestes à réaliser en cas d'épistaxis à domicile et des risques des différents traitements.



http://ift.tt/2r1O3x7

Évaluation fonctionnelle du traitement de l’insuffisance glottique par injection d’acide hyaluronique : étude rétrospective à propos de 20 cas

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Dorbeau, F. Marmouset, E. Lescanne, D. Bakhos, S. Morinière
ObjectifsDécrire la technique d'injection de l'acide hyaluronique dans les plis vocaux pour traiter une insuffisance glottique, en évaluer les indications ainsi que les résultats vocaux à 1 mois, et au-delà de 6 mois postopératoires.Patients et méthodesÉtude monocentrique rétrospective de mars 2012 à août 2015. Les critères d'inclusion étaient : paralysie récurrentielle unilatérale ou défaut d'affrontement cordal à mobilité conservée. Les critères d'exclusion étaient : thyroplastie préalable, troubles de déglutition majeurs, troubles cognitifs gênant l'évaluation vocale subjective. L'injection de Restylane^® était réalisée sous anesthésie générale ou locale. On évaluait le Voice Handicap Index (VHI), le temps maximum phonatoire (TMP) et le score GRBAS en préopératoire, puis à 1, et plus de 6 mois postopératoires.RésultatsVingt patients ont été inclus, 14 avaient une paralysie récurrentielle unilatérale et 6 un défaut d'affrontement. L'injection de Restylane^® a été faite sous anesthésie générale pour 16 patients et sous anesthésie locale pour 4 (20 %). À 1 mois postopératoire, on retrouvait une diminution significative du VHI (–36 points, p=0,0001) et du GRBAS (–6,95 points, p=0,0001) et une augmentation significative du TMP (+4,95sec, p=0,0001). À 6 mois, le VHI, le TMP et le GRBAS étaient toujours significativement améliorés (respectivement p=0,0002, p=0,001 et p=0,0001) ; et il n'y avait pas de différence significative entre VHI, TMP et GRBAS à 1 et 6 mois. Trois patients ont présenté une complication mineure, et deux patients ont récupéré une mobilité cordale normale.ConclusionL'injection d'acide hyaluronique est une technique efficace pour la prise en charge des insuffisances glottiques. Elle permet une amélioration des paramètres vocaux objectifs et subjectifs qui reste satisfaisante même à 6 mois du geste.



http://ift.tt/2r1gOKk

Fonctionnement du système tubotympanique

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Martin, A. Karkas, J.-M. Prades
La trompe d'Eustache (tube auditif) et les cavités tympanomastoïdiennes forment un ensemble anatomique et fonctionnel difficilement dissociable, d'où l'appellation « système tubotympanique ». L'étude de ce système a fait l'objet de nombreux travaux dont les résultats complexes et parfois contradictoires rendent difficile une vue d'ensemble de son fonctionnement. L'objectif cet article est d'en synthétiser les connaissances actuelles, préalable indispensable à la compréhension de son dysfonctionnement et notamment de la genèse de l'otite chronique. L'ensemble du système est tapissé par une muqueuse qui en assure la continuité, bien qu'elle comporte certaines particularités selon la zone concernée, et y joue un rôle primordial. Ainsi, dans des conditions physiologiques, la diffusion gazeuse à travers la muqueuse tympanomastoïdienne assure l'essentiel de l'équilibre pressionnel régnant entre l'oreille moyenne (OM) et le monde extérieur, l'ouverture tubaire n'intervenant que très peu. Lors des changements rapides et importants de la pression atmosphérique, la fonction ventilatoire de la trompe est alors mise en jeu, sous l'effet d'un mécanisme réflexe. Le système possède en outre d'autres fonctions indispensables au bon fonctionnement de l'OM, une fonction de protection vis-à-vis des sécrétions et agents pathogènes en provenance du rhinopharynx, mais aussi de certains bruits physiologiques, une fonction de clairance des cavités de l'OM dépendant du transport mucociliaire des pathogènes, liée en partie à la sécrétion des glandes sous-muqueuses et une fonction de défense immunitaire.



http://ift.tt/2qhBq3x

Efficacité de la radiothérapie « volumetric modulated arc therapy » dans les cancers épidermoïdes ORL : données de la « vraie vie »

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): C. Moncharmont, A. Vallard, J.-B. Guy, J.-M. Prades, C. Rancoule, N. Magné
ObjectifsIl existe peu de données concernant l'efficacité de la radiothérapie en modulation d'intensité volumétrique par arc thérapie (VMAT), délivrée dans le cadre du traitement des cancers épidermoïdes (CE) ORL. L'objectif était d'étudier les résultats et les modes de récidive des patients traités par VMAT à l'encontre d'un CE ORL localement avancé.MéthodesLes données de tous les patients, traités en intention curative par VMAT à l'encontre d'un CE ORL stade III ou IV, ont été rétrospectivement étudiées.RésultatsEntre 2010 et 2013, 130 patients furent traités pour un CE localement avancé de l'oropharynx (n=55 ; 42 %), de l'hypopharynx (n=38 ; 29 %), du larynx (n=22 ; 17 %), ou de la cavité buccale (n=15 ; 12 %). L'âge médian était de 60 ans (39–85). La durée de suivi médiane était de 18,1 mois (0–43,7). À la fin du suivi, 60 patients étaient décédés (46 %). La survie sans progression (SSP) et la survie globale (SG) à 2 ans étaient de 63,6 % et 77,3 % pour les tumeurs laryngées, 60 % et 60 % pour les tumeurs de la cavité buccale, 52,6 % et 57,6 % pour les tumeurs oropharyngées, et 38,8 % et 54,7 % pour les tumeurs hypopharyngées. La plupart des récidives étaient situées dans les champs, ou en bordure de champs de la radiothérapie.ConclusionCette analyse rétrospective est, à notre connaissance, la plus large étude s'intéressant à l'efficacité du VMAT dans les CE ORL. Les résultats et les modes de récidive constatés semblent concorder avec ceux rapportés en radiothérapie conformationnelle par modulation d'intensité (IMRT).



http://ift.tt/2r1B4vc

Tumeurs desmoïdes cervico-faciales de l’enfant : mise au point sur la prise en charge

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Risoud, G. Mortuaire, X. Leroy, P. Leblond, P. Fayoux
ObjectifLes tumeurs desmoïdes cervico-faciales de l'enfant sont des tumeurs rares à agressivité locale potentiellement létales. L'objectif est de discuter la prise en charge de ces tumeurs à partir d'une série de cas et de l'analyse de la littérature.Matériel et méthodesL'étude rétrospective reprenait les données médicales des enfants traités pour tumeur desmoïde cervico-faciale entre 1976 et 2014.RésultatsSur les 6 enfants traités, 5 ont bénéficié d'une chirurgie d'exérèse large dont 2 avaient une invasion microscopie des berges (R1) avec récidive nécessitant une nouvelle exérèse. Un enfant présentant une lésion trop étendue a bénéficié d'une chimiothérapie par méthotrexate et vinorelbine hebdomadaire pendant 18 mois, permettant une régression du volume lésionnel de 93 % sans récidive.ConclusionsLes tumeurs desmoïdes cervico-faciales de l'enfant sont plus agressives que chez l'adulte, avec une morbi-mortalité élevée et un taux élevé de récidive. Un bilan d'imagerie par scanner et IRM est préférable avant biopsie. Bien qu'efficace chez l'adulte, la radiothérapie externe doit être évitée chez l'enfant compte tenu d'une moins bonne efficacité que chez l'adulte, et des séquelles esthétiques, fonctionnelles voire néoplasiques qu'elle comporte à long terme. Le traitement est chirurgical à chaque fois qu'une exérèse radicale large est possible. En cas de risque vital ou fonctionnel trop important, une chimiothérapie sans effet indésirable à long terme (type méthotrexate associé à un vinca-alcaloïde) pourra être proposée. Un suivi prolongé doit être réalisé compte tenu du risque de récidives.



http://ift.tt/2r1afHx

Comment libérer les évidements : rôle du triangle inter-spino-jugulaire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Périé, M. Lesnik, S. Samaha, J. Lacau St Guily
La technique des évidements ganglionnaires cervicaux est bien codifiée. Elle permet l'exérèse des groupes ganglionnaires, qui comporte au moins les groupes IIa, IIb, III et IV selon la classification de Robbins pour les cancers des voies aérodigestives supérieures. L'évidement est classiquement réalisé de bas en haut et d'arrière en avant, mais varie en fonction de la localisation des adénopathies. Pour permettre de faciliter l'évidement du groupe IIb, sans traction sur le nerf spinal accessoire, et le contrôle précoce de la veine jugulaire interne en haut, cette libération de la veine facilitant aussi la dissection ultérieure du tronc thyro-linguo-facial et le repérage du XII, le rôle pivot de la libération du triangle inter-spino-jugulaire au début de l'évidement cervical est décrit. La littérature ne distingue pas cette dissection spécifique et son importance. Ce triangle constitue la partie postérieure du groupe IIa, mais est intimement lié anatomiquement à la libération du groupe IIb.



http://ift.tt/2qhuiUY

Laryngectomie et pharyngo-laryngectomie totale première dans les cancers pharyngolaryngés de stade T4 : résultats carcinologiques et fonctionnels et facteurs pronostiques

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Roux, O. Dassonville, M. Ettaiche, E. Chamorey, G. Poissonnet, A. Bozec
ObjectifsLes objectifs de cette étude étaient d'évaluer les résultats carcinologiques et fonctionnels de la laryngectomie ou pharyngo-laryngectomie totale (PLT) première pour cancer du larynx ou de l'hypopharynx avec extension tumorale extra-laryngée (T4), ainsi que de déterminer les facteurs prédictifs de ces résultats.Matériel et méthodesAnalyse rétrospective des dossiers informatisés de tous les patients ayant bénéficié d'une (P)LT première pour un carcinome épidermoïde du larynx ou de l'hypopharynx de stade T4 dans notre institution entre 2000 et 2014. Les facteurs prédictifs des résultats carcinologiques et fonctionnels ont été recherchés en analyse univariée et multivariée.RésultatsAu total, 63 patients (58 hommes et 5 femmes) d'âge moyen égal à 68,8±9,7 ans ont été inclus dans cette étude. Les survies globale et spécifique étaient de 69 % et 80 % à 3 ans et de 56 % et 69 % à 5 ans respectivement. En analyse multivariée, le sexe féminin (p<0,001), le score ASA (ASA≥3 ; p=0,006) et la présence d'emboles vasculaires (p=0,006) avaient un impact significatif péjoratif sur la survie globale. Six mois après la fin du traitement, 90 % des patients avaient retrouvé une alimentation orale autonome et 83 % de ceux appareillés d'une prothèse phonatoire avaient récupéré une voix intelligible.ConclusionLa (P)LT première reste le traitement de référence des cancers de stade T4 du larynx et de l'hypopharynx. Elle permet d'obtenir des résultats carcinologiques et fonctionnels satisfaisants.



http://ift.tt/2qhApsq

L’effet de l’insuffisance rénale chronique non diabétique sur la fonction olfactive

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Koseoglu, S. Derin, B. Huddam, M. Sahan
ObjectifsDans l'insuffisance rénale chronique (IRC), la détérioration de la filtration glomérulaire résulte de l'accumulation de métabolites dans le corps, qui affecte tous les organes. Cette étude a été réalisée pour étudier les fonctions olfactives, et déterminer si l'hémodialyse ou la dialyse péritonéale améliore l'odorat chez les patients atteints d'IRC non diabétiques.Matériel et méthodesL'odorat a été analysé chez des patients atteints d'IRC ayant une créatininémie≥2mg/dL et non dialysés, chez des patients atteints d'IRC hémodialysés ou sous dialyse péritonéale, et chez des témoins sains. Les patients diabétiques ont été exclus puisque le diabète à lui seul est une cause de dysfonctionnement olfactif. L'échantillon étudié se composait d'un total de 107 personnes, dont 38 patients atteints d'IRC sous hémodialyse, 15 patients atteints d'IRC sous dialyse péritonéale, 30 patients avec une créatininémie≥2mg/dL sans nécessité de dialyse, et 24 témoins sains avec une fonction rénale normale. L'odorat a été analysé à l'aide du test Sniffin' Stick, et les groupes ont été comparés sur leurs résultats au test.RésultatsTous les paramètres du test Sniffin' Stick ont été altérés chez les patients atteints d'IRC. Les scores médians TDI des patients atteints d'IRC et des sujets sains étaient de 24,75 (13–36) et de 32,5 (27,7–37,75), respectivement, avec une différence statistiquement significative entre les deux (p<0,001). Les fonctions olfactives chez les patients en dialyse étaient meilleures que chez ceux atteints d'IRC non dialysés (p=0,020).ConclusionL'IRC non diabétique affecte négativement les fonctions olfactives. La dialyse améliore l'odorat chez ces patients.



http://ift.tt/2qhV53D

Editorial Board

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3





http://ift.tt/2qhrC9H

Troubles de l’équilibre post-traumatique

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): M. Elzière, A. Devèze, C. Bartoli, G. Levy
Les causes responsables de troubles de l'équilibre sont multiples et le syndrome subjectif des traumatisés crâniens reste un diagnostic d'élimination. Néanmoins, avec l'avancée des différentes explorations fonctionnelles oto-neurologiques et de l'imagerie cérébrale, il est maintenant possible d'objectiver le plus souvent cette plainte fonctionnelle. Ces dernières années, de nouveaux diagnostics ont été mis en évidence, ce qui a permis une meilleure reconnaissance de ces pathologies dans le domaine de la réparation du dommage corporel. Nous tenterons de préciser l'ensemble de ces étiologies et de déterminer, grâce à une synthèse de la littérature, les éléments pertinents pouvant modifier la prise en charge de ces patients, particulièrement dans le domaine expertal.



http://ift.tt/2r1zJ7v

Recommandation de la SFORL. Prise en charge des épistaxis de l’adulte en deuxième intention

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): B. Verillaud, L. Robard, J. Michel, V. Prulière Escabasse, E. Béquignon, L. Crampette, O. Malard
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie et de chirurgie de la face et du cou (SFORL) concernant la prise en charge des épistaxis en deuxième intention, c'est-à-dire après échec du tamponnement antérieur et/ou du tamponnement antéro-postérieur.MéthodesUn groupe de travail multidisciplinaire a été chargé d'effectuer une revue de la littérature scientifique sur la thématique étudiée. À partir de ces textes et de l'expérience de chacun, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail. Une réunion de synthèse a permis d'aboutir au texte final. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsIl est recommandé que l'embolisation artérielle soit effectuée par un neuroradiologue expérimenté disposant d'un plateau technique dédié et du matériel adapté afin de limiter le risque de complications. Il est recommandé d'effectuer une angio-TDM du crâne et des TSA avant embolisation dans le cas d'une épistaxis post-traumatique avec suspicion de lésion de l'artère carotide interne. En cas d'épistaxis persistante malgré l'hémostase endoscopique sphéno-palatine, il est recommandé d'effectuer l'hémostase de l'artère ethmoïdale antérieure par voie canthale interne, avec éventuellement une progression assistée par l'endoscope. Il est recommandé en cas d'épistaxis résistante aux procédures chirurgicales et neuroradiologiques habituelles d'effectuer une exploration chirurgicale des fosses nasales et de l'ethmoïde, avec une coagulation élective en cas de saignement en provenance d'une branche artérielle secondaire, voire une ethmoïdectomie en cas de saignement non systématisé. Un arbre décisionnel a été élaboré pour orienter la stratégie thérapeutique de prise en charge d'une épistaxis en deuxième intention.



http://ift.tt/2qhzQyA

Recommandation de la SFORL. Prise en charge des épistaxis dans le cadre des troubles de la coagulation liés aux antithrombotiques

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): V. Escabasse, E. Bequignon, B. Vérillaud, L. Robard, J. Michel, O. Malard, L. Crampette
ObjectifLes auteurs exposent les recommandations de la Société française d'oto-rhino-laryngologie concernant la prise en charge des épistaxis liés aux traitements antithrombotiques.MéthodesUne revue de la littérature scientifique a été effectuée par un groupe de travail multidisciplinaire. À partir de ces textes, des recommandations ont été rédigées, puis relues par un groupe de lecture indépendant du groupe de travail afin d'aboutir au texte final. Les recommandations proposées ont été classées en grade A, B, C ou accord professionnel selon un niveau de preuve scientifique décroissant.RésultatsAvant toute décision de modification du traitement antithrombotique, il est recommandé de rechercher un surdosage et d'évaluer le risque thrombotique. Chez un patient porteur d'un stent, la bi-antiagrégation doit être maintenue durant le mois suivant la pose du stent et si possible pendant 3 mois. En cas d'épistaxis contrôlée par tamponnement avec un surdosage en antivitamine K (AVK), les mesures correctives sont fonction de l'INR. En cas d'épistaxis non contrôlée, il est recommandé d'arrêter les AVK, d'administrer des antidotes et de suivre régulièrement l'évolution de l'INR. En cas d'embolisation par voie endovasculaire, il n'est pas recommandé de modifier le traitement par anticoagulant.



http://ift.tt/2r1mjIB

Kératoaméloblastome mandibulaire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): S. Anajar, A. Lakhbal, R. Allah Abada, M. Mahtar
IntroductionLe kératoaméloblastome est une tumeur odontogène extrêmement rare, 18 cas seulement ont été rapportés dans la littérature.ObservationNous rapportons un cas de kératoaméloblastome chez une patiente âgée de 32 ans, avec revue de la littérature sur les caractéristiques cliniques, l'aspect radiologique, les résultats histopathologiques et les options de traitement.DiscussionLe kératoaméloblastome est une tumeur rare observée plus fréquemment chez l'homme (sex-ratio de 3:1) et caractérisée par la production de kératine dans les îlots odontogéniques ainsi que dans le stroma fibreux.



http://ift.tt/2r1rfxi

Goitre ectopique parapharyngé gauche coexistant avec une thyroïde eutopique et syndrome de Claude Bernard-Horner postopératoire

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): W. Foma, E. Pegbessou, B. Amana, E. Kpemissi
IntroductionLe but de cette observation est de rapporter un cas de goitre ectopique parapharyngé gauche dont l'exérèse a été marquée par un syndrome de Claude Bernard-Horner postopératoire tout en relevant les difficultés de prise en charge.ObservationIl s'agissait d'une femme de 25 ans, qui a consulté pour dysphagie haute et qui présentait une masse parapharyngée gauche bien limitée refoulant les gros vaisseaux en dehors et en arrière. Une cervicotomie exploratrice a permis l'exérèse de cette masse. L'examen anatomopathologique de la pièce a noté un parenchyme thyroïdien hyperplasique. Le contrôle postopératoire a montré une glande thyroïde eutopique et euthyroïdienne. Les suites opératoires ont été marquées par un syndrome de Claude Bernard-Horner persistant avec un an de recul.DiscussionL'ectopie thyroïdienne parapharyngée coexistant avec une thyroïde fonctionnelle est extrêmement rare. Les masses parapharyngées sont le plus souvent d'origine parotidienne et nerveuse. La chirurgie de l'espace parapharyngé peut entraîner une lésion du sympathique cervical à l'origine du syndrome de Claude Bernard-Horner, comme chez notre patiente.ConclusionL'ectopie thyroïdienne devrait être évoquée dans le diagnostic des masses de l'espace parapharyngé. Bien que rare, le syndrome de Claude Bernard-Horner est à redouter dans la chirurgie de ces masses.



http://ift.tt/2qhBoZt

Plaques érythémateuses sur le pavillon de l’oreille

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): G. Serarslan, C. Arlı, E. Atik




http://ift.tt/2qhpf72

Leishmaniose laryngée, une manifestation rare d’une maladie émergente

Publication date: June 2017
Source:Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 134, Issue 3
Author(s): L. Silva, E. Damrose, A.-M.-F. Fernandes




http://ift.tt/2r1BEZR

Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients

To investigate outcomes of pediatric patients at a single institution with invasive fungal rhinosinusitis (IFRS) and to determine variables that impact overall survival.

http://ift.tt/2r1tvV9

Letter to the Editor, regarding the article: "Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-centre study" (2017; 94: 36-39)

With great interest we read the article by Lee et al. "Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-centre study" (2017; 94: 36-39). In this study the authors investigated children and adolescents aged under 18 who visited the otolaryngology departments of eleven hospitals (mostly university hospitals) with dizziness as their main complaint. They concluded that in these patients, vestibular migraine (VM) and benign paroxysmal vertigo of childhood (BPVC) were the most common diseases, and prevalence of disease by age showed different distributions.

http://ift.tt/2qhJaTo

Response to Letter to the Editor: Prevalence of vestibular and balance disorders in children and adolescents according to age category: A multi-center study in Korea

First, we thank you for your interesting comments on our study. This study was designed to identify the etiologies and prevalence of vestibular and balance disorders according to age categories, in children and adolescents, in a multi-center study.

http://ift.tt/2r1vZDa

Success rate and complications associated with dental implants in the incisive canal region: a systematic review

A systematic review was conducted to evaluate the success rate of dental implants placed in the incisive canal region and the complications related to this procedure. An electronic search was performed in the PubMed, Scopus, and Web of Science databases. Articles reporting the incisive canal deflation technique or neurovascular bundle lateralization technique, with or without concomitant dental implant installation and grafting procedures, were evaluated. Ten articles met the inclusion criteria; only one retrospective study and one longitudinal clinical trial were found.

http://ift.tt/2qhaBwJ

A new approach of splint-less orthognathic surgery using a personalized orthognathic surgical guide system: A preliminary study

The purpose of this study was to evaluate a personalized orthognathic surgical guide (POSG) system for bimaxillary surgery without the use of surgical splint. Ten patients with dentofacial deformities were enrolled. Surgeries were planned with the computer-aided surgical simulation method. The POSG system was designed for both maxillary and mandibular surgery. Each consisted of cutting guides and three-dimensionally (3D) printed custom titanium plates to guide the osteotomy and repositioning the bony segments without the use of the surgical splints.

http://ift.tt/2r1BpOr

Correction

Reich K, Leonardi C, Langley RG, et al. Inflammatory bowel disease among patients with psoriasis treated with ixekizumab: A presentation of adjudicated data from an integrated database of 7 randomized controlled and uncontrolled trials. J Am Acad Dermatol. 2017:76:441-448.e2.

http://ift.tt/2qhHsBp

ImmunoCAP Assays: pros and cons in allergology

Allergen-specific IgE measurements together with the clinical history are the cornerstones of allergy diagnosis. During the past decades not only characterization and standardization of allergen extracts have improved but also assay technology. Here we discuss the uses, advantages, misinterpretations and limitations of ImmunoCAP IgE assays (Thermo Fisher Scientific/Phadia, Uppsala, Sweden) in the field of allergology. They can be performed as singleplex (ImmunoCAP) and since a decade also as multiplex (ISAC).

http://ift.tt/2rW2Vgh

Hematopoietic Stem Cell Transplantation For RelB Deficiency

HSCT conditioning is tolerated well by patients with RelB deficiency and leads to immune reconstitution.

http://ift.tt/2rmBVJT

Prevention of food allergy development and suppression of established food allergy by neutralization of TSLP, IL-25 and IL-33

IL-25, IL-33 and TSLP are required to induce a mouse model of food allergy and all of these cytokines contribute to murine food allergy maintenance. This suggests an approach for suppressing human food allergy.

http://ift.tt/2rVXJJs

Vitamin D supplementation during pregnancy: Effect on the neonatal immune system in a randomized controlled trial

Programming of the immune system during fetal development can influence asthma-related risk factors and outcomes in later life. Vitamin D is a well-recognized immune modulator, and deficiency of this nutrient during pregnancy is hypothesized to influence disease development in offspring.

http://ift.tt/2rmw4UM

A new method for the localization of the innervation zone based on monopolar surface-detected potentials

Publication date: Available online 25 May 2017
Source:Journal of Electromyography and Kinesiology
Author(s): Javier Rodriguez-Falces
In monopolar electrode configuration, the shape of the motor unit potential (MUP) undergoes essential morphologic changes with increasing distance from the innervation zone. In particular, the rising phase of the MUP slows down and becomes longer as the electrode is moved further from the innervation zone. Based on this, it is hypothesized that the maximum slope of the rising phase of a monopolar MUP (SlopeMAX) would reach its highest value at the innervation zone. Herein, we sought to determine whether the location of the innervation zone coincides with the position in the muscle of the monopolar MUP with highest SlopeMAX and whether new criteria for the localization of the innervation region can be proposed based on the SlopeMAX of monopolar potentials. Multichannel surface (13×5 electrode array) and intramuscular (wire electrodes inserted with needles of lengths 15 and 25 mm) EMG signals were concurrently recorded in monopolar configuration from the biceps brachii muscle of 10 healthy subjects. The spatial distribution of monopolar and bipolar MUPs along the fibers' direction were obtained by spike-triggered averaging of the surface EMG. We found that the monopolar MUP with steepest rising phase (i.e., highest SlopeMAX) was located either just above or at half of the inter-electrode distance from the innervation zone. High levels of agreement (94-98%) were found between the position of the innervation zone assessed with the SlopeMAX criteria of monopolar potentials and the position identified using the phase reversal criteria of bipolar potentials. The present results legitimize the use of compound muscle action potentials (M waves) to localize the innervation zone: this location would correspond to the electrode position which yielded the monopolar M wave with highest SlopeMAX.



http://ift.tt/2qhO82n

WEBINAR – Learn From David Gergen How You Can Be Integrated Into Hospitals as the Dental Sleep Doctor

David Gergen, CEO of the American Sleep and Breathing Academy (ASBA), visited Dallas, TX on May 17, 2017 to meet with executives overseeing a hospital chain made up of 16 hospitals regarding a groundbreaking program in sleep dentistry. In addition, the meeting included NFL Hall of Fame running back and "Prince of Texas" Earl Campbell who will be involved in doing advertisements for the program. The hospitals are now going to, when medically indicated, send for oral appliance therapy (OAT) as the first line of defense in treating obstructive sleep apnea (OSA). The program, which will be operated by Pro Player Health Alliance (PPHA) and the ASBA, is going to integrate sleep dentists into hospitals.

After completing his trip to Texas, David Gergen and team were able to secure three clinics for Dr. Harry Sugg and three clinics for Dr. Rebecca Lauck. Learn how you can become involved in your area by attending a 30 minute webinar presented by David Gergen. Click here to register.

http://ift.tt/2qUFkhN

Malignant external otitis: The shifting treatment paradigm

Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat.

http://ift.tt/2r1u0i5

Lipopolysaccharide Detection across the Kingdoms of Life

Publication date: Available online 24 May 2017
Source:Trends in Immunology
Author(s): Jonathan C. Kagan
Studies in recent years have uncovered a diverse set of eukaryotic receptors that recognize lipopolysaccharide (LPS), the major outer-membrane component of Gram-negative bacteria. Indeed, Toll-like receptors, G-protein-coupled receptors, integrins, receptor-like kinases, and caspases have emerged as important LPS-interacting proteins. In this review, the mammalian receptors that detect LPS are described. I highlight how no host protein is involved in all LPS responses, but a single lipid (phosphatidylinositol-4,5-bisphosphate) regulates many LPS responses, including endocytosis, phagocytosis, inflammation, and pyroptosis. I further describe LPS response systems that operate specifically in plants, and discuss potentially new LPS response systems that await discovery. This diversity of receptors for a single microbial product underscores the importance of host–microbe interactions in multiple kingdoms of life.



http://ift.tt/2qhpvCY

Editorial Board and Contents

Publication date: June 2017
Source:Trends in Immunology, Volume 38, Issue 6





http://ift.tt/2r1Aopy

Malignant external otitis: The shifting treatment paradigm

Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat.

http://ift.tt/2r1u0i5

Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars

Abstract

Aim

The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline.

Materials and methods

A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias.

Results

The pain scores in both groups were analyzed using the Mann–Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted.

Conclusion

From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.

http://ift.tt/2qhNd1R

The burden of headache disorders in Ethiopia: national estimates from a population-based door-to-door survey

Headache disorders are the third-highest cause of disability worldwide, with migraine and medication-overuse headache (MOH) the major contributors. In Ethiopia we have shown these disorders to be highly preval...

http://ift.tt/2rmJRe1

Bilateral Optic Disc Pits With Posterior Pituitary Ectopia.

Posterior pituitary ectopia has been reported previously in association with optic nerve hypoplasia, as a variant of septo-optic dysplasia. We describe a 14-year-old boy with posterior pituitary ectopia and bilateral optic disc pits. He had hypopituitarism and a reduction in visual acuity to 20/40 in each eye, owing to loss of foveal ganglion cells. Optic pits and posterior pituitary ectopia may have occurred together in the same subject by chance, but the rarity of both conditions suggests a possible association. (C) 2017 by North American Neuro-Ophthalmology Society

http://ift.tt/2rVY8LU

Author’s Reply: A Systematic Review of Complications Associated with Direct Implants vs. Tissue Expanders Following Wise Pattern Skin-Sparing Mastectomy

We would like to thank the authors who read with and subsequently provided a reply to our original article entitled: "A Systematic Review of Complications Associated with Direct Implants vs. Tissue Expanders Following Wise Pattern Skin-Sparing Mastectomy."1,2 Firstly, regarding our methodology, the author's put forth the notion that numbers 20 and 21 of the PRISMA guidelines were not followed correctly, as we did not provide confidence intervals or I2 values for the included studies. According to an erratum published on the PRISMA website (http://ift.tt/2rVS4D4), "The published PRISMA checklists contain an error in the wording for Item 21.

http://ift.tt/2rmRlh4

Delayed type of allergic skin reaction to Candida albicans in eosinophilic rhinosinusitis cases

Eosinophilic chronic rhinosinusitis (ECRS) is frequently complicated by asthma, and recognized as refractory and persistent rhinosinusitis. However, the detailed pathophysiology of ECRS has not been elucidated yet. In this study, we investigated the association between recurrent ECRS and intradermal testing to multi-antigens including Candida albicans.

http://ift.tt/2rmS2as

Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study

Although hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty.

http://ift.tt/2rVY92f

Retention systems for extraoral maxillofacial prosthetic implants: a critical review

We describe the techniques available for retention of implant-supported prostheses: bar-clips, O-rings, and magnets. We present reported preferences and, although this is limited by the heterogeneity of methods used and patients studied, we hope we have identified the best retention systems for maxillofacial prosthetic implants. If practitioners know the advantages and disadvantages of each system, they can choose the most natural and comfortable prosthesis. We searched the PubMed and Scopus databases, and restricted our search to papers published 2001–13.

http://ift.tt/2qlkRj7

Virtual planning of a composite model of bone and teeth to facilitate the adjustment of a hybrid distractor for the transport of alveolar bone

In recent years 3-dimensional computer planning in maxillofacial surgery has been widely used.1 Hammoudeh et al described stereolithographic modelling for the orientation of vectors when using a bone-to-bone distractor,2 but the method is not accurate enough for use with a hybrid distractor.

http://ift.tt/2rEUQ2n

Care of long-term survivors of head and neck cancer after treatment with oral or facial prostheses, or both

The current evidence of good practice in the delivery of long-term supportive care to patients who have been treated for head and neck cancer is sparse. We recruited 10 survivors so that we could follow their experience after their acute treatment was over. There were six men (mean (range) age 72 (54-86) years) and four women (mean (range) age 69 (67-73) years). After ethics committee approval had been given, we used structured interviews and questionnaires to investigate the impact of the resection and reconstruction, the patients' perceived needs, and their use of supportive care services.

http://ift.tt/2qkLZPC

Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study

Although hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty.

http://ift.tt/2rVY92f

Delayed type of allergic skin reaction to Candida albicans in eosinophilic rhinosinusitis cases

Eosinophilic chronic rhinosinusitis (ECRS) is frequently complicated by asthma, and recognized as refractory and persistent rhinosinusitis. However, the detailed pathophysiology of ECRS has not been elucidated yet. In this study, we investigated the association between recurrent ECRS and intradermal testing to multi-antigens including Candida albicans.

http://ift.tt/2rmS2as

Linear polysialoside outperforms dendritic analogs for inhibition of influenza virus infection in vitro and in vivo

Publication date: September 2017
Source:Biomaterials, Volume 138
Author(s): Sumati Bhatia, Daniel Lauster, Markus Bardua, Kai Ludwig, Stefano Angioletti-Uberti, Nicole Popp, Ute Hoffmann, Florian Paulus, Matthias Budt, Marlena Stadtmüller, Thorsten Wolff, Alf Hamann, Christoph Böttcher, Andreas Herrmann, Rainer Haag
Inhibition of influenza A virus infection by multivalent sialic acid inhibitors preventing viral hemagglutinin binding to host cells of the respiratory tract is a promising strategy. However, optimal geometry and optimal ligand presentation on multivalent scaffolds for efficient inhibition both in vitro and in vivo application are still unclear. Here, by comparing linear and dendritic polyglycerol sialosides (LPGSA and dPGSA) we identified architectural requirements and optimal ligand densities for an efficient multivalent inhibitor of influenza virus A/X31/1 (H3N2). Due to its large volume, the LPGSA at optimal ligand density sterically shielded the virus significantly better than the dendritic analog. A statistical mechanics model rationalizes the relevance of ligand density, morphology, and the size of multivalent scaffolds for the potential to inhibit virus-cell binding. Optimized LPGSA inhibited virus infection at IC50 in the low nanomolar nanoparticle concentration range and also showed potent antiviral activity against two avian influenza strains A/Mallard/439/2004 (H3N2) and A/turkey/Italy/472/1999 (H7N1) post infection. In vivo application of inhibitors clearly confirmed the higher inhibition potential of linear multivalent scaffolds to prevent infection. The optimized LPGSA did not show any acute toxicity, and was much more potent than the neuraminidase inhibitor oseltamivir carboxylate in vivo. Combined application of the LPGSA and oseltamivir carboxylate revealed a synergistic inhibitory effect and successfully prevented influenza virus infection in mice.

Graphical abstract

http://ift.tt/2rlSvK3

Catalase-loaded cisplatin-prodrug-constructed liposomes to overcome tumor hypoxia for enhanced chemo-radiotherapy of cancer

Publication date: September 2017
Source:Biomaterials, Volume 138
Author(s): Rui Zhang, Xuejiao Song, Chao Liang, Xuan Yi, Guosheng Song, Yu Chao, Yu Yang, Kai Yang, Liangzhu Feng, Zhuang Liu
Aiming at improved therapeutic efficacies, the combination of chemotherapy and radiotherapy (chemo-radiotherapy) has been widely studied and applied in clinic. However, the hostile characteristics of tumor microenvironment such as hypoxia often limit the efficacies in both types of cancer therapies. Herein, catalase (CAT), an antioxidant enzyme, is encapsulated inside liposomes constituted by cisplatin (IV)-prodrug-conjugated phospholipid, forming CAT@Pt (IV)-liposome for enhanced chemo-radiotherapy of cancer. After being loaded inside liposomes, CAT within CAT@Pt (IV)-liposome shows retained and well-protected enzyme activity, and is able to trigger decomposition of H2O2 produced by tumor cells, so as to produce additional oxygen for hypoxia relief. As the result, treatment of CAT@Pt (IV)-liposome induces the highest level of DNA damage in cancer cells after X-ray radiation compared to the control groups. In vivo tumor treatment further demonstrates a remarkably improved therapeutic outcome in chemo-radiotherapy with such CAT@Pt (IV)-liposome nanoparticles. Hence, an exquisite type of liposome-based nanoparticles is developed in this work by integrating cisplatin-based chemotherapy and catalase-induced tumor hypoxia relief together for combined chemo-radiotherapy with great synergistic efficacy, promising for clinical translation in cancer treatment.



http://ift.tt/2rVpZMq