A Quadrangular Flap Technique for Vermilion Repair in Unilateral Cleft Lip

Summary: In unilateral cleft lip repair, the vermilion triangular flap technique reported by Noordhoff1 and its modification are widely accepted for the augmentation of the vermilion height on the medial side of the cleft; however, these techniques do not focus on the deformity of the labial tubercle. In this article, we herein report a modified technique for vermilion repair that is focused on the labial tubercle. The muco-vermilion quadrangular flap was elevated from the lateral lip to augment the labial tubercle. As a result, the amount of labial tubercle is appropriate. Fifty-three consecutive unilateral cleft lip repairs were performed. In most cases, the amount of the labial tubercle was appropriate, and the curvature of free margin was preferable. The technique could reduce the number of scars on the vermilion by placing some of the suture lines on the oral surface and enabled the augmentation of the labial tubercle. In conclusion, the quadrangular flap can be considered an ideal flap for the construction of the vermilion.

http://ift.tt/2tqZa60

Incarcerated congenital transmesenteric hernia in an adult: a case report

Abstract

Transmesenteric hernia is a rare cause of bowel obstruction and strangulation. It can be due to iatrogenic injury, trauma, inflammatory and less likely congenital. We present a case of true congenital transmesenteric hernia in a 26-year-old male with no previous surgical history or trauma. The patient presented acutely with no prior symptoms. Investigations provided limited information towards the diagnosis of the hernia, but suggestive of mid-gut volvulus. Emergency laparotomy was performed to find >75% of small bowel herniating through a proximal jejunal mesenteric defect leading to incarceration and early strangulation. No resection was required and patient recovered well. This case presents yet another rare pathology and highlights the importance of keeping a low threshold for operative intervention in uncertain cases.

http://ift.tt/2uq894k

Traumatic diaphragmatic rupture with underlying lung laceration and tension pneumoperitoneum

Abstract

Tension pneumoperitoneum is commonly caused by gastrointestinal perforation and pulmonary causes are extremely rare. We present a case of a 47-year-old male post motor vehicle accident with a suspected left-sided haemopneumothorax on initial chest x-ray. CT of the chest post chest tube insertion showed a left-sided diaphragmatic rupture and an extensive diaphragmatic hernia. While en-route to the operating theatre, the intubated patient developed tension pneumoperitoneum with positive pressure ventilation and required immediate surgical intervention and repair. A review of the literature around tension pneumoperitoneum and diaphragmatic hernia in trauma is discussed.

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Hybrid approach to the management of infective endocarditis complicated by coronary artery embolism: a case report

Abstract

Septic coronary embolization in a patient with endocarditis is a rare and can be a devastating complication. The management of this clinical problem in the current era may be best served with a multi-modality approach. We present an interesting case of a patient with septic coronary embolization managed with the combined use of aspiration thrombectomy followed by surgical management of the infected valve.

http://ift.tt/2upVuyD

Acne keloidalis nuchae: risk factors and associated disorders – a retrospective study

Abstract

Background

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis which usually occurs in young adult males of African descent. Studies have suggested that AKN may be associated with other dermatologic conditions and even general medical disorders. The aim of this study was to identify cutaneous and extracutaneous associated disorders and to examine risk factors in our population for developing AKN.

Methods

The study was a retrospective, descriptive, and analytical study conducted at the Dermatology Outpatient department of the University Hospital of the West Indies. Data were obtained from the medical records of patients diagnosed over a 15-year period (2000–2014).

Results

There were 1031 new patients during the study period. Of these, 43 (4.2%) had AKN. The male to female ratio for AKN was approximately 7:1. Pseudofolliculitis barbae was associated with keloidal plaques on the scalp (OR = 6.22, P = 0.036). Also, when the duration of AKN was divided into two groups (0–5 years and greater than 5 years), there was an association between keloidal plaques and duration of greater than 5 years (OR = 7.5, P = 0.032). However, when the odds ratio was adjusted, only the duration of AKN remained significantly associated with keloidal plaques (OR = 7.08, P = 0.047). Chronic scalp folliculitis (P = 0.001) and the presence of any component disease of the metabolic syndrome (OR = 14, P = 0.008) and specifically hypertension (OR = 6.75, P = 0.036) were significantly associated with the extension of the lesions beyond the nape and occipital scalp.

Conclusions

Pseudofolliculitis barbae, chronic scalp folliculitis, and aspects of the metabolic syndrome may be associated with acne keloidalis nuchae.

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Severe colloid milium presenting as papillomatosis cutis associated with vitiligo

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Intrinsic and Extrinsic Causes of Malignancies in Primary Immunodeficiency Disorders

Malignancies occur with a higher incidence rate and manifest earlier in life in patients with primary immunodeficiency disorders (PID) than in the general population. However, no universal mechanism of malignancy predisposition in PID can been determined. Despite the strong support for the physiological role of tumor immunosurveillance and increasing success of strategies in immunological tumor therapy, which include checkpoint inhibition, monoclonal antibodies, and engineered T cell antigen receptors, the incidence and pattern of malignancies in PID do not reflect an increased tumor immune escape per se.

http://ift.tt/2uqeVY2

An elusive ciliopathy: Joubert syndrome

The police brought a 65-year-old female patient to the EADU after being found 'roaming the streets' in an apparent state of confusion. This was her third admission under the same circumstances during the last 3 years. Neurological examination revealed (1) cognitive impairment, (2) oculomotor apraxia, (3) abnormal cancellation of vestibular ocular reflex, (4) mild ataxia and (5) mild hypotonia. Renal function was abnormal and liver function was normal. No retinal disturbance was found. The head CT on admission was normal for stroke and the lumbar puncture was negative for encephalitis. Her brain MRI showed 'molar tooth sign', suggestive of Joubert syndrome, which was confirmed by genetic testing showing anomalous NPHP1 gene

http://ift.tt/2s8jeq9

Endogenous endophthalmitis and osteomyelitis associated with interleukin 17 inhibitor treatment for psoriasis in a patient with diabetes

A 64-year-old man with type 2 diabetes mellitus and plaque psoriasis presented to the emergency room with 3 days of progressive right eye pain and decreased vision. After extensive workup and multidisciplinary team effort, the patient was diagnosed with and treated for unilateral endogenous methicillin-sensitive Staphylococcus aureus endophthalmitis, bacteraemia and osteomyelitis of the foot. The patient had been started on the interleukin 17 (IL-17) inhibitor secukinumab for his treatment-resistant plaque psoriasis 4 weeks prior to presentation. After treatment, his final vision was light perception and the foot infection resolved without sequelae. To our knowledge, this is the first reported case of both endogenous endophthalmitis and osteomyelitis associated with an IL-17 inhibitor.

http://ift.tt/2triYGu

ILF2 Is a Regulator of RNA Splicing and DNA Damage Response in 1q21-Amplified Multiple Myeloma

Publication date: Available online 29 June 2017
Source:Cancer Cell
Author(s): Matteo Marchesini, Yamini Ogoti, Elena Fiorini, Anil Aktas Samur, Luigi Nezi, Marianna D'Anca, Paola Storti, Mehmet Kemal Samur, Irene Ganan-Gomez, Maria Teresa Fulciniti, Nipun Mistry, Shan Jiang, Naran Bao, Valentina Marchica, Antonino Neri, Carlos Bueso-Ramos, Chang-Jiun Wu, Li Zhang, Han Liang, Xinxin Peng, Nicola Giuliani, Giulio Draetta, Karen Clise-Dwyer, Hagop Kantarjian, Nikhil Munshi, Robert Orlowski, Guillermo Garcia-Manero, Ronald A. DePinho, Simona Colla
Amplification of 1q21 occurs in approximately 30% of de novo and 70% of relapsed multiple myeloma (MM) and is correlated with disease progression and drug resistance. Here, we provide evidence that the 1q21 amplification-driven overexpression of ILF2 in MM promotes tolerance of genomic instability and drives resistance to DNA-damaging agents. Mechanistically, elevated ILF2 expression exerts resistance to genotoxic agents by modulating YB-1 nuclear localization and interaction with the splicing factor U2AF65, which promotes mRNA processing and the stabilization of transcripts involved in homologous recombination in response to DNA damage. The intimate link between 1q21-amplified ILF2 and the regulation of RNA splicing of DNA repair genes may be exploited to optimize the use of DNA-damaging agents in patients with high-risk MM.

Graphical abstract

Teaser

Marchesini et al. show that in multiple myeloma the overexpression of ILF2, resulting from chromosome 1q21 amplification, drives resistance to DNA-damaging agents partly by modulating the interaction between YB-1 and the splicing factor U2AF65 to promote the processing and stabilization of transcripts involved in homologous recombination.


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Association between severity of untreated Sleep Apnoea and postoperative complications following major cardiac surgery: A prospective observational cohort study

To examine whether untreated Sleep Apnoea is associated with prolonged Intensive Care Unit (ICU) stay and increased frequency of postoperative ICU complications, in patients undergoing major cardiac surgery.

http://ift.tt/2tqGeo5

Actigraphy scoring for sleep outcome measures in chronic obstructive pulmonary disease

Actigraphy is commonly used to measure sleep outcomes so sleep can be measured conveniently at home over multiple nights. Validity of actigraphy has been demonstrated in people with sleep disturbances; however, validity of scoring settings in people with chronic medical illnesses such as chronic obstructive pulmonary disease remains unclear. The purpose of this secondary analysis was to compare actigraphy customized scoring settings with polysomnography for measurement of sleep outcomes in people with chronic obstructive pulmonary disease who have insomnia.

http://ift.tt/2s7J0uM

Reviewing the impact of lipid synthetic flux on Th17 function

Publication date: June 2017
Source:Current Opinion in Immunology, Volume 46
Author(s): Yoko Kidani, Steven J Bensinger
CD4+ T helper 17 cells (Th17) acquire specific effector functions in response to activation and instructional signals. Accumulating evidence indicates that specific cellular lipid metabolic pathways play essential roles in regulating the differentiation and function of Th17 cells. Mechanistic studies reveal that metabolic fluxes through both the cholesterol and long chain fatty acid biosynthetic pathways are important in controlling RORγ transcriptional activity through their ability to generate lipid ligands of RORγ. Genetic and pharmacologic studies demonstrate that altering the flux through these lipid biosynthetic pathways impacts the generation of IL-17 as well as the balance of Th17 and CD4+ regulatory T cells (Tregs). In this mini-review, we briefly introduce the mechanics of cholesterol and long chain fatty acid biosynthesis. We also discuss the evidence underlying the unique role that these lipid metabolic pathways play in intrinsically regulating the fate and function of Th17 cells under normal and pathogenic conditions.



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Successful management of primary atrophic rhinitis by turbinate reconstruction using autologous costal cartilage

Initial management of primary atrophic rhinitis is conservative, with nasal ointments, saline irrigation, and antibiotics prescribed to relieve symptoms. However, in cases that show no improvement, a surgical approach is considered. Recently, many studies have reported successful surgical outcomes using various nasal implants. However, no study has reported implantation of autologous costal cartilage in PAR patients. We report here the case of a 63-year-old woman diagnosed with PAR that was intractable to medical therapy.

http://ift.tt/2s7KDIM

Successful management of primary atrophic rhinitis by turbinate reconstruction using autologous costal cartilage

Initial management of primary atrophic rhinitis is conservative, with nasal ointments, saline irrigation, and antibiotics prescribed to relieve symptoms. However, in cases that show no improvement, a surgical approach is considered. Recently, many studies have reported successful surgical outcomes using various nasal implants. However, no study has reported implantation of autologous costal cartilage in PAR patients. We report here the case of a 63-year-old woman diagnosed with PAR that was intractable to medical therapy.

http://ift.tt/2s7KDIM

A prospective randomized cost billing comparison of local fasciocutaneous perforator vs free Gracilis flap for lower limb reconstruction

We read with extreme interest the article published by Dr Abdelrahman et al. [1]. The colleagues are to be commended for their aim of performing a prospective randomized cost billing charges comparison of local fasciocutaneous perforator vs free Gracilis flap reconstruction for lower limb reconstruction. We do agree with the authors that lower limb traumatic wounds are a complex surgical topic, which should be approached in a multidisciplinary way. Moreover, the financial impact of a surgical procedure is an essential element to take into consideration.

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Response to comments on: A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy

Thank you for your letter and for allowing us to respond. We acknowledge that dr. Mangano et al. agree with us on the importance and relevance of the study. Regarding the first comment we present here the method we used for sample size calculation based on the flap viability outcome for each flap using the following equation n = [ (Z α/2+ Zβ)/(P1-P2)] (P1q1 + P2q2) [1], where:

http://ift.tt/2t7p9wQ

Commentary on The New Opt-Out Dutch National Breast Implant Registry - Lessons learnt from the road to implementation

The Dutch can be considered fortunate in, unlike many other countries, an estimated 95% of implants are used by a single craft group and funding for a breast implant registry is forthcoming (1). The authors point out that the variance between the quality and uptake around the world of different registry projects has detracted from the ability to extract useful information from these data bases in the past, and believe that an opt out system will improve the situation. ICOBRA was established to increase the homogeneity of the data set, but without universality of uptake as in the Dutch system, assemblage of these various sources is questionable.

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Recent trends for the removal of colored particles in industrial wastewaters

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Letter to the editor

This is in reference to a very well-written article titled 'Surgical timing for facial paralysis after temporal bone trauma' by Xu P et al. [1]. The paper is well-written and the authors have conducted a good study. However, there are certain points of concern regarding the methodology which I would like to highlight through your esteemed journal.

http://ift.tt/2s7GFQx

Letter to the editor

This is in reference to a very well-written article titled 'Surgical timing for facial paralysis after temporal bone trauma' by Xu P et al. [1]. The paper is well-written and the authors have conducted a good study. However, there are certain points of concern regarding the methodology which I would like to highlight through your esteemed journal.

http://ift.tt/2s7GFQx

Would brief alcohol intervention be helpful in facial trauma patients?A Narrative Review

Abstract

Facial trauma is commonly associated with excessive consumption of alcohol and is often associated with interpersonal violence or motor vehicle accidents. Alcohol-related trauma presentation to hospitals causes a major service burden, and there have been efforts to reduce such trauma load with educational programs and social support. Brief alcohol intervention (BAI) in an acute setting (emergency department or trauma centre) has been shown as an effective means to reduce future alcohol intake and the incidence of future alcohol-related injuries, especially in the period immediately following injuries. Less is known about the potential benefit of BAI when provided by the surgical team in the same clinical context. This article explores the individual component of brief alcohol intervention and its provision by an acute surgical service by way of a narrative review. The progress of research into brief alcohol intervention for facial trauma patients is also reviewed. The methods and rationale behind screening patients for targeted BAI are discussed in a separate article.

http://ift.tt/2tqKnsl

I125 brachytherapy guided by individual three-dimensional printed plates for recurrent ameloblastoma of the skull base

Ameloblastoma is one of the most common benign odontogenic tumours of the mandible and the maxilla. Wide excision of the tumour is the first choice for treatment (except for unicystic ones). Patients with invaded margins or unresectable lesions may require radiotherapy. Today, permanent implantation of I125 seeds is widely used in the treatment of cancer of the head and neck. We report a case of recurrent ameloblastoma of the base of the skull that was treated with I125 brachytherapy. The outcome has been encouraging, with total disappearance of the tumour on positron emission tomography 18 months later.

http://ift.tt/2tvN2kF

Long-term influence of mandibular advancement on the volume of the posterior airway in skeletal Class II-patients: a retrospective analysis

In the past, maxillomandibular advancement has resulted in considerable improvement in the volume of the posterior airway space. The objective of the present study was to find out how mandibular advancement without maxillary involvement would affect the posterior airway space in patients with mandibular retrognathism. Cone-beam computed tomographic (CT) scans were done for 20 patients before, and six months after, mandibular advancement. Cephalometric analysis at both time points included 2-dimensional and 3-dimensional assessment of the upper airway.

http://ift.tt/2u4SfwQ

Body talk, weight status, and pathological eating behavior in romantic relationships

Publication date: 1 October 2017
Source:Appetite, Volume 117
Author(s): Ellen Hart, Chong Man Chow, Cin Cin Tan
This study examined whether engagement in body talk would interact with weight status (body mass index; BMI) to predict pathological eating behaviors among romantically involved adults. Adults (N = 137, females = 86.86%, average age = 23.50) involved in a romantic relationship were recruited to complete an online survey about their body image, dietary behaviors, and engagement in body talk. Results indicated that engagement in negative body talk was directly related to higher pathological eating (i.e., drive for thinness, dieting, and bulimia symptoms). Positive body talk, on the other hand, had a significant interaction effect with BMI to predict pathological eating. For individuals with a high BMI, high engagement in positive body talk was associated with increased drive for thinness, dieting, and bulimia symptoms. However, for those with a low BMI, high engagement in positive body talk was protective against pathological eating. These findings suggest that while negative body talk is harmful in general, positive body talk is uniquely problematic for individuals of a higher weight status.



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‘My lips are sealed’ - The impact of package resealability on the consumption of tempting foods

Publication date: 1 October 2017
Source:Appetite, Volume 117
Author(s): Caroline De Bondt, Anneleen Van Kerckhove, Maggie Geuens
Resealable packages are nowadays omnipresent on store shelves. While the main advantage of the resealability feature is its ability to reclose the package in order to extend the shelf life of the food product inside, the present research's aim is to assess whether this advantage also has implications for palatable, energy-dense food consumption. Two studies provide intentional as well as behavioral evidence for the claim that consumers are better able to self-regulate their consumption and thus eat less in one occasion when a palatable, energy-dense food product is offered in a resealable (vs. unresealable) package. A third study investigates the effect of package resealability across multiple consumption occasions and reveals that the resealability feature limits the volume consumed on each occasion (conditional on consumption incidence) while it does not accelerate consumption frequency, resulting in a lower total consumed volume of palatable, energy-dense snacks over a six-day period. This research offers actionable insights for consumer welfare and public health care and aids manufacturers in delineating optimal food packaging strategies.



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Randomised controlled trial of a text messaging intervention for reducing processed meat consumption: The mediating roles of anticipated regret and intention

Publication date: 1 October 2017
Source:Appetite, Volume 117
Author(s): V. Carfora, D. Caso, M. Conner
The present study aimed to extend the literature on text messaging interventions involved in promoting healthy eating behaviours. The theoretical framework was the Theory of Planned Behaviour (TPB). A randomized controlled trial was used to test the impact of daily text messages compared to no message (groups) for reducing processed meat consumption (PMC) over a 2 week period, testing the sequential mediation role of anticipated regret and intention on the relationship between groups and PMC reduction. PMC and TPB variables were assessed both at Time 1 and Time 2. Participants were Italian undergraduates (at Time 1 N = 124) randomly allocated to control and message condition groups. Undergraduates in the message condition group received a daily SMS, which focused on anticipated regret and urged them to self-monitor PMC. Participants in the control group did not receive any message. Those who completed all measures at both time points were included in the analyses (N = 112). Findings showed that a daily messaging intervention, controlling for participants' past behaviour, reduced self-reported consumption of PMC. Mediation analyses indicated partial serial mediation via anticipated regret and intentions. The current study provided support for the efficacy of a daily messaging intervention targeting anticipated regret and encouraging self-monitoring in decreasing PMC. Outcomes showed the important mediating role of anticipated regret and intentions for reducing PMC.



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Consumption of key food groups during the postpartum period in low-income, non-Hispanic black mothers

Publication date: 1 October 2017
Source:Appetite, Volume 117
Author(s): Melissa C. Kay, Heather Wasser, Linda S. Adair, Amanda L. Thompson, Anna Maria Siega-Riz, Chirayath M. Suchindran, Margaret E. Bentley
The postpartum period can impact diet quality and subsequently place women at greater risk for overweight or obesity. This study examined consumption of key food groups during the first 2 years postpartum among low income, non-Hispanic black, first-time mothers. Data were from the Infant Care, Feeding and Risk of Obesity Study, a cohort of 217 mother–infant dyads, followed from 3 to 18 months postpartum, collected from 2003 to 2007. At each study visit (3, 6, 9, 12, and 18 months) 24-h dietary recalls were collected. Consumption levels were compared to those recommended from the 2010 Dietary Guidelines for Americans (DGAs) for each of the following food groups: fruits, vegetables, grains, whole grains, protein foods and dairy, as well as an estimated upper limit for sugar-sweetened beverage (SSB) consumption. At each time point, mothers met recommended intake levels for grains and protein foods only. In random-intercept logistic regression models, no demographic or household characteristics were associated with a likelihood of consuming recommended levels for any of the food groups according to the DGAs. Given the low intake of fruits, vegetables, whole grains and lean protein foods and high intake of SSBs and refined grains, interventions targeting women's diet during the postpartum period are warranted.



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Modelling and Extraction of Pulsatile Radial Distension and Compression Motion for Automatic Vessel Segmentation from Video

Publication date: Available online 29 June 2017
Source:Medical Image Analysis
Author(s): Alborz Amir-Khalili, Ghassan Hamarneh, Rafeef Abugharbieh
Identification of vascular structures from medical images is integral to many clinical procedures. Most vessel segmentation techniques ignore the characteristic pulsatile motion of vessels in their formulation. In a recent effort to automatically segment vessels that are hidden under fat, we motivated the use of the magnitude of local pulsatile motion extracted from surgical endoscopic video. In this article we propose a new approach that leverages the local orientation, in addition to magnitude of motion, and demonstrate that the extended computation and utilization of motion vectors can improve the segmentation of vascular structures. We implement our approach using four alternatives to magnitude-only motion estimation by using traditional optical flow and by exploiting the monogenic signal for fast flow estimation. Our evaluations are conducted on both synthetic phantoms as well as two real ultrasound datasets showing improved segmentation results with negligible change in computational performance compared to the previous magnitude only approach.

Graphical abstract

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Estimation of individual axon bundle properties by a Multi-Resolution Discrete-Search method

Publication date: Available online 29 June 2017
Source:Medical Image Analysis
Author(s): Ricardo Coronado-Leija, Alonso Ramirez-Manzanares, Jose Luis Marroquin
A stable, accurate and robust-to-noise method for the estimation of the intra-voxel bundle-wise diffusion properties for diffusion-weighted magnetic resonance imaging is presented. The proposed method overcomes some of the limitations of most of the multi-fiber algorithms in the literature and extends them to estimate the diffusion profiles, improving the estimation of the intra-voxel geometry at challenging microstructure configurations, that is to say: relatively small crossing angles, different voxel-wise anisotropic diffusion profiles and low SNR. The proposed methodology is based on four key novel ideas: (i) A Multi-Resolution Discrete-Search determines the orientation of the fiber bundles accurately and naturally constrains the sparsity on the recovered solutions; (ii) the determination of the number of fiber bundles using the F-test combined with a Rician bias correction; (iii) a Simultaneous Denoising and Fitting procedure that exploits the spatial redundancy of the axon bundles to achieve robustness with respect to noise; and (iv) a general framework for the estimation of the axial and radial diffusivity parameters independently for each voxel. A new useful evaluation metric is also proposed, which combines the information of the success rate in the estimated number of bundles and the angular error, avoiding in this way, some of the limitations these metrics have individually. A novel methodology for the evaluation of the methods on in-vivo data is also proposed. This work presents an extensive evaluation: the proposed methodology has been tested on state-of-the-art biophysical synthetic data for a variety of conditions, on the challenging spatially coherent phantom used on the HARDI reconstruction Challenge 2012, and on the recently released in-vivo MASSIVE data-set. Our results present significant improvements on the estimation of the number and orientation of the fiber bundles over the Spherical Deconvolution algorithm for multi-shell data, which is one of the most widely used multi-fiber algorithm. The results also show that, by the voxel-wise estimation of the diffusion profiles, the axial and radial diffusivity parameters are robustly estimated, being this essential for a better understanding of the individual bundle diffusion properties at challenging structural configurations.

Graphical abstract

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Guest editors of MICCAI 2016 Special Issues of Medical Imaging Analysis: The 19th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI 2016)

Publication date: Available online 29 June 2017
Source:Medical Image Analysis
Author(s): Sebastien Ourselin, Mert R. Sabuncu, William Wells, Leo Joskowicz, Gozde Unal, Andreas Maier




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Cross-sectional association of coffee and caffeine consumption with sex hormone-binding globulin in healthy non-diabetic women

Abstract

Objective

Low sex hormone-binding globulin (SHBG) is a consistent risk factor for type 2 diabetes, particularly in women. Coffee consumption has been associated with a lower risk of type 2 diabetes but its effects on SHBG are less known.

Design and methods

This was a cross-sectional study of 2,377 non-diabetic pre- and post-menopausal women from the E3N cohort study whose baseline SHBG was measured. Information on diet (including coffee and caffeine consumption), lifestyle, and medical conditions was collected through questionnaires. The relationship between coffee and caffeine consumption and SHBG was modeled, with adjustment for covariates and stratification by body mass index (BMI) categories (< or ≥25 kg/m²) and menopausal status.

Results

The mean age was 57.3 ± 6.4 years and 61% of the 2,453 women were postmenopausal. High coffee (≥3 cups/day) and caffeine (≥265 mg/day) intakes were associated with a reduced risk of being in the 1^st quartile of the SHBG level distribution (<46.3 nmol∙L⁻¹) in a multivariate adjusted model (OR: 0.69 [95% CI 0.52-0.92] and OR: 0.68 [95% CI 0.50-0.94] respectively). No association was found between tea consumption and SHBG levels. In multivariate models stratified on BMI categories and menopausal status, associations were restricted to women with a BMI ≥25 kg/m² or being postmenopausal. The association with SHBG was consistently noted with both consumption of caffeinated coffee and caffeine, but not for decaffeinated coffee.

Conclusions

High coffee and caffeine consumptions are associated with a reduced risk of low SHBG, an established risk marker for T2DM, which might contribute to the protective effects of coffee for type 2 diabetes.

This article is protected by copyright. All rights reserved.

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The medial pterygoid muscle: a stabilizer of horizontal jaw movement

Abstract

There is limited information of the normal function of the human medial pterygoid muscle (MPt). The aims were to determine whether (a) the MPt is active throughout horizontal jaw movements with the teeth apart and (b) whether single motor units (SMUs) are active during horizontal and opening - closing jaw movements. Intramuscular electrodes were placed in the right MPt of 18 participants who performed 5 teeth-apart tasks: 1) postural position, 2) ipsilateral (i.e. right) jaw movement, 3) contralateral movement, 4) protrusive movement, 5) opening–closing movement. Movement tasks were guided by a target and were divided into BEFORE, OUT, HOLDING, RETURN and AFTER phases according to the movement trajectories recorded by a jaw tracking system. Increased EMG activity was consistently found in the OUT, HOLDING and RETURN phases of the contralateral and protrusive movement tasks. An increased RETURN phase activity in the ipsilateral task indicates an important role for the MPt in the contralateral force vector. Of the 14 SMUs active in the opening-closing task, 64% were also active in at least 1 horizontal task. There were tonically active SMUs at the postural jaw position in 44% of participants. These new data point to an important role for the MPt in the fine control of low forces as required for stabilization of vertical mandibular position not only to maintain postural position, but also throughout horizontal jaw movements with the teeth apart. These findings provide baseline information for future investigations of the possible role of this muscle in orofacial pain conditions.

This article is protected by copyright. All rights reserved.

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Long-term stability of limiting nasal alar base width changes with a cinch suture following Le Fort I osteotomy with submental intubation

The aim of this study was to assess the effectiveness of the nasal alar base cinch suture following Le Fort I osteotomy at long-term follow-up. One hundred and forty participants (89 female, 51 male) aged between 16 and 51 years underwent Le Fort I osteotomy with submental intubation. Anthropometric measurements of the nose were taken intraoperatively, immediately postoperative, and for up to 3 years postoperative: the maximum lateral convexity of the alae (Al–Al) and the lateral extremity of the alar base curvature at the alar groove (Ac–Ac).

http://ift.tt/2sn2jEq

Method of osteotomy fixation and need for removal following bimaxillary orthognathic, osseous genioplasty, and intranasal surgery: a retrospective cohort study

The purpose of this study was to determine the incidence and causes of fixation hardware removal after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. A retrospective study was performed, involving subjects with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. At a minimum, subjects underwent Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty.

http://ift.tt/2sn2hfM

Vertebral anomalies in craniofacial microsomia: a systematic review

Craniofacial microsomia (CFM) is characterized by a heterogeneous underdevelopment of the facial structures arising from the first and second branchial arches, but extracraniofacial malformations such as vertebral anomalies also occur. This systematic review provides an overview of the literature on the types and prevalence of vertebral anomalies found in patients with CFM. A systematic search was conducted. Data on the number of patients, patient characteristics, types and prevalence of vertebral anomalies, and other associations between CFM and vertebral anomalies were extracted from the articles identified.

http://ift.tt/2t7luPO

Relaxation induced by the nitric oxide donor and cyclooxygenase inhibitor NCX2121 in renal hypertensive rat aortas

Publication date: 30 September 2017
Source:European Journal of Pharmaceutical Sciences, Volume 107
Author(s): Tiago Dal-Cin de Paula, Bruno R. Silva, Marcella D. Grando, Laena Pernomian, Alejandro Ferraz do Prado, Lusiane Maria Bendhack

Graphical abstract

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Freeze dried solid dispersion of exemestane: A way to negate an aqueous solubility and oral bioavailability problems

Publication date: 30 September 2017
Source:European Journal of Pharmaceutical Sciences, Volume 107
Author(s): Shamandeep Kaur, Sunil K. Jena, Sanjaya K. Samal, Vaishali Saini, Abhay T. Sangamwar
This study was envisaged to demonstrate the potential of exemestane loaded phospholipid/sodium deoxycholate solid dispersions (EXE-PL/SDC-SDs) on the solubility and oral bioavailability of EXE. Initial studies were performed to screen the best suitable phospholipid among lysophosphatidylcholine, Phospholipon® P80H and Lipoid® E80S for solid dispersion preparation. Further studies were carried out to optimize the molar concentration of phospholipid and sodium deoxycholate (SDC) for EXE-PL/SDC-SDs preparation. Optimized EXE-PL/SDC-SDs was prepared using Lipoid® E80S and SDC in 1:4M concentration, respectively and lyophilized using 10% w/w 2-hydroxypropyl-β-cyclodextrin (2-HPCD). The physical state of EXE in lyophilized formulation was confirmed by DSC and PXRD. Lyophilized formulation exhibits a significant increase in solubility and dissolution rate as compared to free drug EXE. Apparent permeability study was performed on Caco-2 cell line for 2h. The lyophilized EXE-PL/SDC-SDs exhibits 4.6-fold increase in absorptive transport as compared to EXE. Pharmacokinetic study in fasted female Sprague-Dawley rats revealed a 2.3-fold increase in AUC0-72h. Thus, the results suggest that PL/SDC-SDs is a promising carrier for EXE delivery.

Graphical abstract

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Investigating therapeutic usage of combined Ticagrelor and Aspirin through solid-state and analytical studies

Publication date: 30 September 2017
Source:European Journal of Pharmaceutical Sciences, Volume 107
Author(s): Hassane Sadou Yayé, Ivo B. Rietveld, Maria Barrio, Philippe-Henri Secrétan, Antoine Faucheron, Maher Karoui, Patrick Tilleul, Najet Yagoubi, Bernard Do
The mainstay treatment for patients with acute coronary syndrome is an oral route dual antiplatelet therapy with a P2Y12-receptor antagonist and Aspirin (ASA). To improve patient adherence to such treatments, combination therapies (polypill) are envisioned. Physicochemical solid-state studies have been carried out to develop a preformulation strategy of ASA with the P2Y12-receptor antagonist Ticagrelor (TIC). The investigations were carried out using differential scanning calorimetry, liquid chromatography-high resolution-multistage mass spectrometry (LC-HR-MSⁿ) and as complementary techniques Fourier transform infrared measurements and thermogravimetric analysis. A simple eutectic transition at 98°C with a mole fraction for the eutectic liquid of 0.457 has been observed and the mixing of ASA and TIC molecules in each other's crystal structures appears to be limited. No cocrystals of TIC and ASA have been found. The appearance of the eutectic liquid was linked with a clear onset of chemical instability of the two pharmaceuticals. The decomposition mechanism in the liquid phase involves prior decomposition of ASA, whose residues react with well-identified TIC interaction sites. Seven interaction products were observed by LC-HR-MSⁿ linked to corresponding degradation products. The most important degradation pathway is N-dealkylation. In conclusion, polypills of ASA and TIC are a viable approach, but the decomposition of ASA should be avoided by eliminating high temperatures and high humidity.

Graphical abstract

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Transcriptional Consequences of XPA Disruption in Human Cell Lines

Publication date: Available online 29 June 2017
Source:DNA Repair
Author(s): Mandira Manandhar, Megan G. Lowery, Karen S. Boulware, Kevin H. Lin, Yue Lu, Richard D. Wood
Nucleotide excision repair (NER) in mammalian cells requires the xeroderma pigmentosum group A protein (XPA) as a core factor. Remarkably, XPA and other NER proteins have been detected by chromatin immunoprecipitation at some active promoters, and NER deficiency is reported to influence the activated transcription of selected genes. However, the global influence of XPA on transcription in human cells has not been determined. We analyzed the human transcriptome by RNA sequencing (RNA-Seq). We first confirmed that XPA is confined to the cell nucleus even in the absence of external DNA damage, in contrast to previous reports that XPA is normally resident in the cytoplasm and is imported following DNA damage. We then analyzed four genetically matched human cell line pairs deficient or proficient in XPA. Of the ∼14,000 genes transcribed in each cell line, 325 genes (2%) had a significant XPA-dependent directional change in gene expression that was common to all four pairs (with a false discovery rate of 0.05). These genes were enriched in pathways for the maintenance of mitochondria. Only 27 genes were different by more than 1.5-fold. The most significant hits were AKR1C1 and AKR1C2, involved in steroid hormone metabolism. AKR1C2 protein was lower in all of the immortalized XPA-deficient cells. Retinoic acid treatment led to modest XPA-dependent activation of some genes with transcription-related functions. We conclude that XPA status does not globally influence human gene transcription. However, XPA significantly influences expression of a small subset of genes important for mitochondrial functions and steroid hormone metabolism. The results may help explain defects in neurological function and sterility in individuals with xeroderma pigmentosum.



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Pressure and Flow Comparisons Across Vocal Pathologies

The aim of this study was to aid in the distinction among hyperadductive dysphonias by evaluating peak glottal pressure, release burst, and mid and final airflow values across repeated /pa/ syllable trains.

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Appendiceal Mucinous Neoplasms: Diagnosis and Management

AbstractObjective.Appendiceal mucinous neoplasms (AMNs) are a rare and heterogeneous disease for which clinical management is challenging. We aim to review the literature regarding modalities of treatment to guide the management of AMNs.Methods and Review Criteria.We conducted a PubMed search in February 2016 for English‐language publications, using the terms "appendiceal," "appendix," "carcinoma," "cancer," "mucinous," "treatment," "genes," "target," "genomic," and terms listed in the articles' subheadings. Published reports and abstracts from the American Society of Clinical Oncology meetings were also searched.Results.In this review, we summarize current data and controversies in AMN classification, clinical presentation, molecular alterations, treatment outcomes with regard to cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and the role of systemic chemotherapy.Conclusion.Appendiceal mucinous neoplasms are a heterogeneous group of tumors with a rising incidence. Treatment is based on stage and histology. Low‐grade tumors are treated surgically with resection of the primary site in early stage disease, or peritoneal debulking and HIPEC in patients with advanced stage disease. Treatment of high‐grade tumors requires further prospective trials, and options include debulking surgery and HIPEC with or without preoperative chemotherapy. Trials evaluating novel therapies based on the molecular profiling of AMN tumors are needed to evaluate therapeutic options in patients who are not surgical candidates.Implications for Practice.This review provides a reference to guide gastroenterologists, pathologists, surgeons, and oncologists in the management of appendiceal mucinous neoplasms (AMNs), a rare and heterogeneous disease with no consensus on histologic classification or guidelines for treatment algorithms. This review summarizes all AMN classifications and proposes a treatment algorithm based on stage and histology of disease.

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Reduction of severe oropharyngeal hemorrhage following transoral robotic surgery

The epidemic of human papillomavirus-associated-oropharyngeal carcinoma (HPV OPSCC) has significantly impacted the practice of head and neck surgical oncology. The rising rates of this disease, younger age and better prognosis have charged our community to explore de-intensification treatment modalities particularly as a growing population will suffer from the long term sequelae of treatment for a greater period of time. Concurrent chemoradiation therapy (CCRT) has become a standard of care but the improved survival conferred with this modality has a price of increasing rates of early and late toxicities [1,2].

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Label-free electrochemiluminescence assay for aqueous Hg2+ through oligonucleotide mediated assembly of gold nanoparticles

Publication date: 15 December 2017
Source:Biosensors and Bioelectronics, Volume 98
Author(s): Dong-Mei Wang, Qi-Qi Gai, Rong-Fu Huang, Xingwang Zheng
Development of ultrasensitive method for Hg²⁺ analysis is important for human health protection and environment monitoring. In this work, we present a highly sensitive and selective electrochemiluminescence (ECL) assay in a "turn-on" mode for the detection of Hg²⁺ through selective assembly of gold nanoparticles (AuNPs) on the surface of indium tin oxide (ITO) electrode. In the absence of Hg²⁺, the nonthiolated ssDNA could protected AuNPs against its assembly on ITO surface, producing rather low ECL emission for Ru(bpy)3²⁺/TPA system. Conversely, binding of Hg²⁺ with the Hg²⁺-specific oligonucleotide through thymine-Hg²⁺-thymine coordination formed the double-stranded structure, which could not effectively adsorb to AuNPs in solution. The assembly of free-state AuNPs is achieved, which well preserves electronical conductivity. The presence of AuNPs can catalyze the electro-oxidation of TPA, producing significantly enhanced ECL signal. Through detecting the ECL signal mediated by assembly of AuNPs, the proposed method was able to ensure substantial signal amplification and a low background. It was demonstrated that the ECL intensity was correlated with the ssDNA-based recognition reaction, enabling quantitative analysis of Hg²⁺ over the range of 8pM to 2nM, with a detection limit of 2pM. ECL intensity of the system were extremely specific for Hg²⁺ even in the presence of 1000-fold higher concentrations of other metal ions. Analytical results of Hg²⁺ spiked into water samples by the proposed ECL method were in good agreement with that obtained by atomic fluorescent spectrometry or mass spectrometry data.



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Field-effect transition sensor for KI detection based on self-assembled calixtube monolayers

Publication date: 15 December 2017
Source:Biosensors and Bioelectronics, Volume 98
Author(s): Kirill Puchnin, Mariia Andrianova, Alexander Kuznetsov, Vladimir Kovalev
A series of novel calixarene-based tubes comprising different numbers of silatrane anchoring groups was synthesized. For the first time, a self-assembled monolayer (SAM) derived from calixtubes was formed on a SiO2 surface. The formation of the SAM was confirmed by X-ray photoelectron spectroscopy, scanning electron microscopy-energy dispersive X-ray analysis, and contact angle measurements. Modification of the sensitive surface of a conventional ion-selective field effect transistor (ISFET) with the afforded SAM resulted in the production of a KI-sensitive sensor. This sensor selectively determined KI compare to different alkali metal iodides: NaI, RbI, CsI; also investigation of different potassium salts (acetate, iodide, nitrate, chloride, dihydrophosphate, perchlorate) showed the highest response to KI. This sensor was successfully employed to determine the presence of KI in artificial saliva with a limit of detection of ~3 × 10⁻⁸ М. In addition, it was found that the detection limit of the sensor could be increased by combining the sensor with a microfluidic system. Due to the obtained sensor sensitivity and its ability to detect KI in artificial saliva, we could conclude that this sensor shows great potential for application in the determination of KI in different media, such as the human body and in biological liquids, such as saliva or urine.



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Fluorescent carbon nanoparticle-based lateral flow biosensor for ultrasensitive detection of DNA

Publication date: 15 December 2017
Source:Biosensors and Bioelectronics, Volume 98
Author(s): Sunitha Takalkar, Kwaku Baryeh, Guodong Liu
We report a fluorescent carbon nanoparticle (FCN)-based lateral flow biosensor for ultrasensitive detection of DNA. Fluorescent carbon nanoparticle with a diameter of around 15nm was used as a tag to label a detection DNA probe, which was complementary with the part of target DNA. A capture DNA probe was immobilized on the test zone of the lateral flow biosensor. Sandwich-type hybridization reactions among the FCN-labeled DNA probe, target DNA and capture DNA probe were performed on the lateral flow biosensor. In the presence of target DNA, FCNs were captured on the test zone of the biosensor and the fluorescent intensity of the captured FCNs was measured with a portable fluorescent reader. After systematic optimizations of experimental parameters (the components of running buffers, the concentration of detection DNA probe used in the preparation of FCN-DNA conjugates, the amount of FCN-DNA dispensed on the conjugate pad and the dispensing cycles of the capture DNA probes on the test-zone), the biosensor could detect a minimum concentration of 0.4 fM DNA. This study provides a rapid and low-cost approach for DNA detection with high sensitivity, showing great promise for clinical application and biomedical diagnosis.



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Mice exposure to tannery effluents changes their olfactory capacity, and their response to predators and to the inhibitory avoidance test

Abstract

The current study has assessed whether the oral and/or dermal exposure of C57Bl/6 J mice to tannery effluent (a complex pollutant consisting of xenobiotic mixtures) could damage their olfactory functions, as well as whether it changes their aversive behavior in the inhibitory avoidance test. Accordingly, the animals were distributed in groups which were exposed or not to this xenobiotic through two different routes (oral and dermal), for 15 days. The effluent group subjected to oral exposure received drinking water containing 5% tannery effluent, whereas the animals in the dermal group were exposed to raw tannery effluent for 1 h/day. The animals dermally exposed to the tannery effluent (males and females) have shown the highest latency to find palatable food in the buried food test. The shortest time spent by the animals (orally or dermally) exposed to tannery effluent in the safety zone of the apparatus used in the predator exposure test, as well as the longest time spent by them in the aversive zone, have shown failures in their perception to the risk represented by the presence of the predator (cat). The passive avoidance test results have shown that the dermal exposure to tannery effluent led to partial memory deficit in male and female mice; therefore, the present study has confirmed the tannery effluent toxicity to mammals. Moreover, the present study was pioneer in demonstrating that the dermal exposure to this xenobiotic, even for a short period-of-time, can change the olfactory and cognitive functions of animals, as well as lead to harmful consequences to their health.

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Bacterial periphytic communities related to mercury methylation within aquatic plant roots from a temperate freshwater lake (South-Western France)

Abstract

Macrophyte floating roots are considered as hotspots for methylmercury (MeHg) production in aquatic ecosystems through microbial activity. Nevertheless, very little is known about periphyton bacterial communities and mercury (Hg) methylators in such ecological niches. The ability to methylate inorganic Hg is broadly distributed among prokaryotes; however, sulfate-reducers have been reported to be the most important MeHg producers in macrophyte floating roots. In the present work, the periphyton bacterial communities colonizing Ludwigia sp. floating roots were investigated through molecular methods. Among the 244 clones investigated, anaerobic microorganisms associated with the sulfur biogeochemical cycle were identified. Notably, members of the sulfur-oxidizing prokaryotes and the anoxygenic, purple non-sulfur bacteria (Rhodobacteraceae, Comamonadaceae, Rhodocyclaceae, Hyphomicrobiaceae) and the sulfate reducers (Desulfobacteraceae, Syntrophobacteraceae, and Desulfobulbaceae) were detected. In addition, 15 sulfate-reducing strains related to the Desulfovibrionaceae family were isolated and their Hg-methylation capacity was tested using a biosensor. The overall results confirmed that Hg methylation is a strain-specific process since the four strains identified as new Hg-methylators were closely related to non-methylating isolates. This study highlights the potential involvement of periphytic bacteria in Hg methylation when favorable environmental conditions are present in such ecological micro-niches.

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Successful management of primary atrophic rhinitis by turbinate reconstruction using autologous costal cartilage

Publication date: Available online 29 June 2017
Source:Auris Nasus Larynx
Author(s): Marn Joon Park, Yong Ju Jang
Initial management of primary atrophic rhinitis is conservative, with nasal ointments, saline irrigation, and antibiotics prescribed to relieve symptoms. However, in cases that show no improvement, a surgical approach is considered. Recently, many studies have reported successful surgical outcomes using various nasal implants. However, no study has reported implantation of autologous costal cartilage in PAR patients. We report here the case of a 63-year-old woman diagnosed with PAR that was intractable to medical therapy. Under general anesthesia, bilateral inferior turbinate reconstruction with autologous costal cartilage was successfully performed without any complications. One month after surgery, her symptoms improved dramatically. At the 2-year follow-up, her Sinonasal Outcome Test 25 (SNOT-25) score was 6, down from an initial score of 108. Her OMU CT showed improved sinonasal mucosal thickness and disappearance of thick mucosal secretion compared with preoperative CT image. Although this is a single case experience, it is suggested that turbinate reconstruction using autologous costal cartilage can serve as promising surgical modality for management of atrophic rhinitis.



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Cáncer de Tiroides: Síntomas de la enfermedad en Hombres

El cáncer de tiroides es más común en mujeres que en hombres. Por incidencia, es el más frecuente de los cánceres del sistema endocrino, y el séptimo cáncer más diagnosticado en mujeres, mientras que en los varones ni siquiera figura entre los 15 tipos de cáncer más comunes.  No obstante, también está aumentando su incidencia entre la población masculina.

En los varones, el cáncer de tiroides suele tener peor pronóstico que en las mujeres. Este fenómeno está tan consolidado que las escalas de riesgo tienen en cuenta el sexo de los pacientes. En la escala AMES (edad, metástasis, extensión y tamaño, por sus iniciales en inglés), que divide a los pacientes en casos de bajo o alto riesgo según esos cuatro criterios, los hombres se consideran pacientes de alto riesgo –sin que haya metástasis en puntos del organismo "lejanos" de la tiroides- diez años antes que las mujeres: al llegar a los 41.  El sistema de la Organización Europea para la Investigación del Cáncer también tiene en cuenta el sexo de los pacientes a la hora de evaluar si su pronóstico será favorable o no.

Evolución del cáncer según el sexo del paciente

Cuando se estudian tipos de cáncer que afectan a órganos diferentes en hombres y mujeres, es fácil ver el origen de las diferencias entre unos casos y otros. No obstante, cuando se trata de órganos que comparten ambos sexos, es más difícil explicar por qué unos y otros parecen evolucionar de forma diferente. Por ejemplo, se ha visto que también hay disparidad entre sexos en cáncer de pulmón y de hígado.

Se ha descartado que haya diferencias en el riesgo de cáncer de tiroides por exposición a la radiación para hombres y mujeres. Respecto a los factores nutricionales, como la ingesta de yodo en la dieta, hay muchos trabajos al respecto, pero ninguno ha establecido claramente que los hombres y las mujeres respondan de forma diferente a los patrones de alimentación que guardan relación con el cáncer de tiroides.

En otros tipos de cáncer, como el de mama (que también se da en hombres), se ha visto que las hormonas sexuales afectan al desarrollo de los tumores. En el caso del cáncer de tiroides, algunos experimentos realizados en laboratorio –no se trata de observaciones en pacientes- sugieren que el estrógeno podría ser un factor que influye en la evolución del carcinoma papilar de tiroides, y eso podría explicar en parte las diferencias entre la evolución de la enfermedad entre sexos. Además, se ha planteado como una posible línea de investigación para identificar nuevos tratamientos.

La importancia de la detección precoz

Algunos estudios han sugerido que los casos de cáncer de tiroides suelen detectarse en fases más avanzadas entre los hombres. En un estudio de pacientes diagnosticados y tratados en Nueva York, se vio que los tumores de gran tamaño son más frecuentes en pacientes varones: Menos del 60% de los hombres incluidos en el estudio tenían tumores por debajo de los 5 centímetros, mientras que en las mujeres el 80% de los tumores medían menos de 5 centímetros. Los autores de este estudio también sugerían que, como los pacientes varones tenían una edad media superior a la del grupo de mujeres, eso podría tener que ver con las tasas de supervivencia, que eran menores para ellos. También se ha visto que entre las pacientes es más frecuente que los tumores estén limitados a la glándula tiroides, mientras que en los varones había una proporción mayor de casos en los que el cáncer había llegado a los ganglios linfáticos.

Se ha razonado que al diagnosticarse y comenzar el tratamiento más tarde, el éxito de las terapias ha sido menor en los varones. Por ese motivo, se ha recomendado realizar pruebas de cribado para que la enfermedad pueda tratarse antes y así se obtengan mejores resultados terapéuticos.

En una revisión de las investigaciones en la materia se ha visto que la disparidad en cuanto a la incidencia, la agresividad y el pronóstico del cáncer entre hombres y mujeres existe, pero no se conocen bien los mecanismos que explican estas diferencias. La previsión de los expertos es que, puesto que el número de casos de cáncer de tiroides está aumentando, esas diferencias serán aún más patentes en el futuro.

La entrada Cáncer de Tiroides: Síntomas de la enfermedad en Hombres se publicó primero en Cuida tu tiroides.

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¿En qué casos se realiza la prueba de la hormona estimulante de la tiroides?

La prueba de hormona estimulante de la tiroides (TSH, por sus siglas en inglés) es un análisis que sirve para determinar la cantidad de hormona TSH presente en la sangre de un paciente. Esta hormona se produce en la glándula pituitaria y su función es hacer que la tiroides libere hormonas hacia el riego sanguíneo.

Para llevar a cabo la prueba, se obtiene una muestra de sangre. En el mismo análisis el médico puede recomendar que se midan también los niveles de T3 y T4 (hormonas tiroideas). No es necesario prepararse de forma especial antes del análisis, aunque siempre es conveniente que, si el paciente está tomando algún medicamento, consulte con su médico si es posible que los fármacos alteren de alguna forma los resultados de la prueba. En ocasiones, se suspenden de forma muy breve los tratamientos con amiodarona, dopamina, litio, yoduro de potasio, prednisona u otros glucocorticoides.

Motivos para realizar la prueba

El médico pide que se realice el test de TSH en personas con signos o síntomas de alteración en el normal funcionamiento de la glándula tiroides. Puede que sospeche de hipotiroidismo (funcionamiento por debajo del umbral considerado normal) o hipertiroidismo (exceso de actividad de la glándula). La prueba también se realiza después de prescribir un tratamiento, para ver cómo está funcionando y ajustar con precisión las dosis a las necesidades de cada paciente. Además, es un test habitual en mujeres que están planeando un embarazo, ya que la actividad de la tiroides es importante en el desarrollo del feto.

En general, los resultados normales oscilan entre 0,4 y 4,0 mIU/L (unidades milimétricas internacionales presentes por litro), aunque se debate si los valores por encima de 2,5 ya deberían considerarse anormales.

Cuando el resultado está por encima de ese margen, es frecuente que la causa sea hipotiroidismo. Los niveles inferiores a lo normal se asocian con hiperactividad en la tiroides, que puede deberse a enfermedad de Graves, bocio multinodular tóxico o bocio multinodular no tóxico, exceso de yodo en el organismo, una dosis excesivamente alta de medicación tiroidea o consumo excesivo de suplementos nutricionales que contienen hormona tiroidea, algunos medicamentos (glucocorticoides, esteroides, dopamina, algunos fármacos que se emplean en quimioterapia y analgésicos opiáceos como la morfina).

Hay quienes experimentan un cierto dolor durante la extracción de sangre, aunque para otras personas la sensación es más bien de pinchazo. Después de la extracción es posible que aparezca un ligero hematoma, que suele desaparecer al poco tiempo.

La entrada ¿En qué casos se realiza la prueba de la hormona estimulante de la tiroides? se publicó primero en Cuida tu tiroides.

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Hipertiroidismo y aumento de peso: ¿cómo podemos corregir la hiperfunción de la glándula?

La hormona tiroidea, que tiene forma de mariposa y se encuentra en la base del cuello por delante de la tráquea, es necesaria para el desarrollo del feto y el funcionamiento normal del metabolismo en adultos, entre otras muchas funciones. Puesto que el hipertiroidismo es una desviación respecto al funcionamiento normal de la tiroides, en este caso por exceso, se puede predecir que los cambios en el peso corporal –tanto pérdida como aumento de peso- asociados a la disfunción se corregirán al tratar el hipertiroidismo y restablecer el equilibrio hormonal.

La tasa metabólica basal (TMB)

La relación entre la enfermedad tiroidea, el peso corporal y el metabolismo es compleja. La hormona tiroidea regula el metabolismo, que se determina midiendo la cantidad de oxígeno que el cuerpo consume en un tiempo determinado. Si la medida se efectúa en reposo, el resultado obtenido se denomina tasa metabólica basal (TMB, o BMR por sus siglas en inglés). Esta fue una de las primeras pruebas empleadas para evaluar el estado de la tiroides, asociándose las tasas bajas a casos en los que la glándula estaba funcionando por debajo del umbral normal (hipotiroidismo) y los resultados más elevados a funcionamiento por encima de dicho umbral (hipertiroidismo).

Con posterioridad, diversos estudios asociaron estas observaciones con registros de los niveles de hormona tiroidea y mostraron que las concentraciones más bajas de hormona tiroidea en sangre eran propias de personas con TMB reducida y los niveles elevados, típicos de sujetos con TMB elevada. En la práctica, muy pocos facultativos realizan el cálculo de la tasa porque es una prueba compleja y el resultado está sujeto a otros factores diferentes al del funcionamiento de la tiroides.

Equilibrio energético

Se ha observado una correlación entre las diferencias en la TMB y el equilibrio energético. Este último refleja la diferencia entre las calorías que una persona ingiere y las que el cuerpo utiliza. Cuando se eleva la tasa por medio de medicamentos (ocurre, por ejemplo, con las anfetaminas) el equilibrio energético se altera y se tiende a perder peso. Este tipo de hallazgos han hecho que se extienda la idea de que los cambios en los niveles de hormona tiroidea, que se asocian a su vez a cambios en la TMB, deberían también afectar al equilibrio energético y al peso corporal.

Sin embargo, la tasa no es el único factor a la hora de considerar el peso corporal y la función tiroidea. Otras muchas hormonas, proteínas y sustancias influyen en el peso corporal y el gasto de energía. Por ese motivo, es posible que modificar uno solo de estos elementos (el nivel de hormona tiroidea, en este caso) no produzca exactamente el efecto esperado.

En general, la probabilidad de perder peso es proporcional a la severidad de la hiperactividad de la tiroides, de forma que, si hay un exceso acusado de actividad tiroidea, lo más frecuente es que se produzca una marcada pérdida de peso. Asimismo, el tratamiento contribuye a detener el proceso.

Por otro lado, los pacientes expresan en ocasiones su preocupación por un potencial aumento de peso (excesivo) cuando se corrige el hipertiroidismo. De producirse, y dado que otros factores pueden influir en ello, su médico evaluará situaciones como obesidad previa al diagnóstico de hipertiroidismo o hipotiroidismo, y las corregirá para restablecer el equilibrio metabólico. Se ha visto que son más propensos a desarrollar obesidad los pacientes en los que no se controla debidamente la función de la glándula tiroides.

Hay estudios que muestran que recibir orientación con un especialista en nutrición después del tratamiento del hipertiroidismo reduce el riesgo de un aumento de peso excesivo en estos pacientes.

Es posible perder peso por efecto de otras afecciones en las que se produce una elevación de hormonas, como en la fase tóxica de la tiroiditis, o si la dosis de hormona tiroidea es demasiado elevada. Los especialistas realizan controles a sus pacientes para definir la dosis precisa que cada individuo necesita. Además, es posible que el hipertiroidismo produzca un aumento del apetito, así que algunas personas no pierden peso, sino que lo ganan cuando desarrollan la enfermedad, en función de cuánto aumenten su ingesta calórica.

La entrada Hipertiroidismo y aumento de peso: ¿cómo podemos corregir la hiperfunción de la glándula? se publicó primero en Cuida tu tiroides.

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Conoce los diferentes tipos de operación de tiroides existentes a día de hoy

Se recomienda la cirugía de la tiroides por cuatro motivos fundamentales: la presencia de un nódulo que podría ser un tumor; la existencia de un tumor canceroso ya diagnosticado; para aliviar síntomas locales producidos por un nódulo o bocio, tales como presión en la tráquea, dificultad para tragar o abultamiento antiestético; y síntomas derivados de una producción o liberación excesiva de hormona tiroidea –ya sea por la presencia de un nódulo tóxico, bocio multinodular o enfermedad de Graves-.

Hay tres técnicas quirúrgicas básicas: la tiroidectomía convencional (en la cual se practica una incisión en el centro del cuello para acceder a la tiroides); la tiroidectomía endoscópica (se practican pequeñas incisiones en el cuello, a través de las cuales se realiza la operación guiada por una cámara de vídeo) y la tiroidectomía robótica (bien con pequeñas incisiones en el pecho y la axila o por incisión en la parte alta del cuello), que se utiliza para evitar hacer la incisión en el centro del cuello.

Biopsia tiroidea abierta

Consiste en la escisión de un nódulo para su análisis posterior por parte de un patólogo. Rara vez se practica.

Lobectomía de tiroides

Es una operación en la cual se extirpa la mitad de la glándula tiroides. Se trata de un procedimiento habitual para tratar el cáncer diferenciado de tiroides (papilar o folicular) con tumores de pequeño tamaño y en los que no hay ningún signo de propagación fuera de la tiroides. A veces los médicos se refieren a ella como "lobectomía diagnóstica", ya que las pruebas que se realizan antes de la intervención no siempre son suficientes para establecer definitivamente si hay o no cáncer de tiroides y en parte la operación se lleva a cabo para determinarlo.

En ocasiones, la lobectomía diagnóstica incluye un procedimiento denominado "sección congelada": se obtiene una muestra de tejido durante la intervención para que un patólogo la examine mientras el paciente aún está anestesiado. Si se detecta cáncer, el cirujano procederá a extirpar la glándula en su totalidad. El resultado de la sección congelada no es certero al cien por cien en el momento, y el resultado definitivo suele obtenerse días después.

Todos los pacientes que se someten a una extracción parcial de la tiroides tendrán que acudir a su médico para que realice controles y compruebe sus niveles de hormona tiroidea de forma rutinaria.

 Istmectomía 

La istmectomía consiste en la extirpación del istmo de la tiroides, la parte de la glándula que une los dos lóbulos. Tiene pocas indicaciones, sobre todo la del nódulo tiroideo benigno localizado en el istmo.

 Tiroidectomía total o casi total

Esta operación consiste en la extracción de la glándula tiroides en su totalidad o prácticamente en su totalidad. En ocasiones se practica para tratar afecciones benignas que están presentes en los dos lóbulos de la glándula, como bocio o enfermedad de Graves. También se lleva a cabo en casos de cáncer.

La tiroidectomía es "casi total" cuando el cirujano decide dejar una pequeña cantidad de tejido tiroideo sano sin extraer. Un motivo es que se trate de tejido que está próximo a zonas importantes del organismo, como los nervios que controlan la voz, la deglución o la respiración, así como las glándulas paratiroides (cuatro glándulas de pequeño tamaño que se encuentran sobre la tiroides y regulan el equilibrio entre el calcio y el fósforo en el organismo).

Los pacientes que se someten a este procedimiento necesitarán tomar levotiroxina a diario de por vida.

Tiroidectomía de complemento

Es la extracción (exéresis) del tejido tiroideo que ha quedado después de una resección parcial. Es posible que esta cirugía se lleve a cabo años después de la primera intervención o bien inmediatamente después de ésta (en la semana siguiente a la primera operación).

Las razones para recomendar una tiroidectomía de complemento son las mismas que indican la necesidad de realizar una tiroidectomía total. Después de la operación, todos los pacientes necesitarán tomar levotiroxina a diario de por vida.

Extirpación de los ganglios linfáticos

Si se detecta que el cáncer se ha extendido a los ganglios linfáticos del cuello, lo habitual es extirparlos en la misma intervención en la que se lleva a cabo la cirugía de la tiroides.

En casos de cáncer papilar o folicular, ante la sospecha de cáncer en solo uno o dos ganglios linfáticos, éstos se extirpan y se trata cualquier potencial resto de células cancerosas con yodo radiactivo.

La entrada Conoce los diferentes tipos de operación de tiroides existentes a día de hoy se publicó primero en Cuida tu tiroides.

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Enfermedad de Graves: Síntomas e información de interés

La enfermedad de Graves es una causa frecuente de hipertiroidismo (exceso de actividad de la glándula tiroides), y recibe su nombre del médico irlandés que la describió por primera vez. También se conoce como "bocio tóxico difuso".

Es particularmente frecuente en mujeres y suele presentarse antes de los 40 años. A fecha de hoy, no es posible predecir qué personas van a desarrollar la enfermedad. No obstante, se han identificado algunos factores que predisponen a ello: la edad, el sexo, los antecedentes familiares y la exposición a situaciones de estrés emocional o ambiental. El riesgo también es mayor para miembros de la familia de una persona a la cual se ha diagnosticado. Asimismo, los pacientes con otras alteraciones autoinmunes tienen más probabilidades que la población general de desarrollar enfermedad de Graves. Así, se ha observado una asociación entre ésta y la diabetes tipo 1, la artritis reumatoide y el vitíligo.

Se considera una condición "autoinmune" porque tiene su origen en un funcionamiento alterado del sistema de defensas del organismo. En una situación de normalidad, el sistema inmunológico fabrica anticuerpos que sirven para defendernos de virus, bacterias u otros elementos extraños. Sin que se conozca el motivo, cuando una persona desarrolla enfermedad de Graves los anticuerpos atacan a las células de la glándula tiroides y alteran su correcto funcionamiento.

Muchas funciones, síntomas diversos

Como la tiroides produce hormonas que participan en diversas funciones del organismo, los síntomas y signos de la enfermedad son muy diversos. Entre otros, incluyen ansiedad e irritabilidad, temblor en manos o dedos, sensibilidad al calor, aumento de la sudoración, sensación de calor o humedad en la piel, diarrea, pérdida de peso (sin cambios en la alimentación), aumento del tamaño de la glándula tiroides (bocio), alteraciones del ciclo menstrual, disfunción eréctil, reducción del deseo sexual, engrosamiento y enrojecimiento de la piel, alteraciones del ritmo cardiaco y problemas oculares.

Se calcula que el 30% de las personas que padecen enfermedad de Graves desarrollan problemas oculares (oftalmopatía). Esta complicación tiene su origen en la inflamación y otros procesos propios del sistema inmunológico que pueden afectar a los músculos y tejidos que rodean los ojos. Se manifiesta, entre otros síntomas, con exoftalmia (ojos prominentes o "saltones", vulgarmente), sensación arenosa, presión o dolor, inflamación o enrojecimiento, sensibilidad a la luz, pérdida de visión.

Una manifestación poco frecuente es la dermopatía de Graves, que consiste en enrojecimiento y aumento del espesor de la piel, sobre todo en las espinillas y la parte superior de los pies.

Tratamientos

 Para tratar la enfermedad de Graves se aplican terapias que controlan la hiperactividad de la tiroides. Una de las opciones son los medicamentos betabloqueantes para el control de la frecuencia cardiaca y la ansiedad, entre otros. Estos fármacos no controlan la actividad de la glándula, y su utilidad reside que pueden aliviar algunos síntomas.

Los medicamentos antitiroideos sí se emplean para moderar la actividad de la glándula. Es frecuente que se recurra a ellos antes de la cirugía o de la terapia con yodo radiactivo. Con menor frecuencia, puede plantearse su uso como tratamiento a largo plazo.

El tratamiento con yodo radiactivo se administra en forma oral.

La cirugía parcial o total es otra forma de abordar la enfermedad, aunque es la menos empleada de las terapias para la enfermedad de Graves. Se recomienda en mujeres embarazadas que no toleran la medicación anti-tiroidea, casos en los que se prefiere la intervención quirúrgica para descartar la presencia de cáncer o pacientes en los que las demás opciones han fracasado.

En caso de optar por una de estas dos últimas estrategias, el paciente tomará diariamente levotiroxina para restablecer el equilibrio de hormonas tiroideas.

El tratamiento adecuado de la enfermedad de Graves mejora la oftalmopatía en caso de que esta se haya desarrollado. Para aliviar los síntomas a veces se recomienda administrar terapia adicional o de apoyo (coadyuvante) con prednisona, un fármaco que inhibe el sistema inmunológico. La oftalmopatía suele ser más severa cuando el paciente fuma. Evitar el tabaco contribuirá al éxito de los tratamientos.

La entrada Enfermedad de Graves: Síntomas e información de interés se publicó primero en Cuida tu tiroides.

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Conoce los síntomas del Nódulo Tiroideo

Cuando se habla de nódulo tiroideo se hace referencia a un crecimiento anormal de células de la tiroides que forman un bulto en la glándula. Puede tratarse de un nódulo benigno o de un tumor canceroso, una acumulación de fluidos o de células tiroideas. Es más común en mujeres que en hombres, y la probabilidad de que aparezca incrementa con la edad.

Hay pocos nódulos tiroideos cancerosos, pero algunos factores de riesgo (como haber estado expuesto a radiación o antecedentes familiares de cáncer de tiroides) pueden aumentar las probabilidades de que una persona sufra la forma cancerosa de esta condición.

En la mayor parte de los casos se ignora cuál es el origen de los nódulos, aunque la falta de yodo en la dieta puede ser causa de su aparición. También se ha observado que la inflamación crónica de la tiroides por enfermedad de Hashimoto puede provocar la aparición de nódulos. En general, las condiciones que con mayor frecuencia se observan en pacientes con nódulos son, además de la falta de yodo y la enfermedad de Hashimoto; el desarrollo anormal de tejido normal de la glándula tiroides (también se conoce como "adenoma tiroideo"), que no es canceroso y no se considera una enfermedad grave a menos que cause molestias al paciente o se trate de un nódulo de gran tamaño; quiste tiroideo (una cavidad que contiene fluidos o partes sólidas, muchas veces restos de un adenoma), que suele ser benigno; bocio multinodular (en lugar de un único nódulo hay varios) y cáncer de tiroides.

Sin síntomas

En la mayoría de los casos, los nódulos no causan síntoma alguno. Sólo si uno es muy grande, puede ejercer presión sobre alguna parte del cuello. Entonces es posible que curse con dolor, dificultad al tragar o al respirar, ronquera y cambios en la voz, así como bocio (aumento del tamaño de la tiroides). Cuando las células del nódulo producen hormonas tiroideas, pueden asociarse con síntomas de hipertiroidismo: cambios súbitos del estado de ánimo, nerviosismo, debilidad muscular, aumento del apetito, alteraciones del sueño y del ritmo de los latidos del corazón. En ocasiones, el nódulo se presenta en un paciente con enfermedad de Hashimoto. En esos casos pueden presentarse síntomas como sequedad de la piel, pérdida de cabello, inflamación del rostro, intolerancia al frío, fatiga y aumento involuntario de peso.

No obstante, dado que la mayor parte de los pacientes no experimentan síntomas, lo más normal es que el nódulo sea detectado por un médico durante un reconocimiento rutinario del cuello o al realizar pruebas de imagen. Cuando se ha detectado, hay diversos tipos de pruebas médicas que pueden realizarse: biopsia de aguja, escáner, ecografía de la tiroides y prueba de hormona estimuladora de la tiroides (TSH, por sus siglas en inglés).

Tratamiento

El tratamiento depende del tipo de nódulo. Así, cuando se ha descartado que sea un tumor canceroso y no hay síntomas, el único tratamiento recomendado es una serie de consultas para observar su evolución, con la realización de nuevas biopsias o ecografías. Esta estrategia se conoce como "watchful waiting".

En ocasiones se prescriben levotiroxina o tratamiento con yodo radiactivo para reducir el tamaño y la actividad del nódulo (si es hiperactivo). Otras opciones terapéuticas en esta situación son el tratamiento con medicamentos anti-tiroideos y la cirugía.

En caso de que el nódulo sea canceroso, o se sospecha que pudiera serlo, o bien cuando éste produce molestias al tragar o al respirar, se recomienda recurrir a la cirugía para extirparlo. Después de la operación, el paciente necesitará terapia de sustitución con levotiroxina de por vida.

La entrada Conoce los síntomas del Nódulo Tiroideo se publicó primero en Cuida tu tiroides.

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¿Cuándo es recomendable una dieta baja en yodo?

La dieta baja en yodo durante un periodo breve de tiempo forma parte de la preparación de los pacientes que van a recibir terapia con yodo radiactivo para el tratamiento del cáncer papilar o folicular de tiroides. Su objetivo es mejorar la eficacia de esta terapia, y es una estrategia recomendada por diversas sociedades científicas.

La dieta debe cumplirse durante una o dos semanas antes de la terapia y uno o dos días después, aunque el médico puede variar estos periodos en función de las características individuales o las necesidades del paciente. El objetivo es reducir el consumo habitual de yodo para que cuando se administre el tratamiento, las células tiroideas lo absorban mejor y aumente su eficacia.

La dieta baja en yodo se define por una ingesta inferior a 50 microgramos diarios. No debe confundirse con la dieta baja en sodio. La recomendación en una dieta normal es consumir 150 microgramos de yodo al día.

El paciente deberá tener en cuenta que los alimentos y bebidas que se consumen deben tener pequeñas cantidades de yodo que permitan mantenerse por debajo del umbral de los 50 microgramos.

Alimentos que habría que descartar: sal yodada, sal marina y alimentos que contengan cualquiera de las dos; mariscos y productos del mar, así como conservas de pescado en general (está permitido el pescado de río, como la trucha); lácteos (leche, queso, cremas, yogur, mantequilla, helado, leches en polvo); yema de huevo y productos elaborados con ésta; pan o bollería que incluyan en su elaboración ingredientes ricos en yodo (productos de este tipo con la especificación "bajo en yodo" sí se pueden comer); colorante E127; la mayor parte de los chocolates (el polvo de cacao y algunas formas de chocolate negro sí se pueden incluir en la dieta); soja y derivados (a excepción del aceite de soja, la lecitina de soja también se puede consumir); vitaminas y suplementos nutricionales que contengan yodo. Es necesario consultar con el médico si alguno de los medicamentos que ha prescrito debería ser excluido o sustituido por otro para respetar el límite de consumo diario de yodo.

Por el contrario, pueden consumirse sin problema frutas y verduras frescas, a excepción de las siguientes, que son ricas en yodo: coles de Bruselas, judías verdes, acelgas, brécol, espinacas, hojas de nabo, espárragos, remolacha, berros y apio. Se permiten también los frutos secos sin sal añadida, clara de huevo, carnes (sin tratamiento con caldos), y cereales y derivados sin ingredientes ricos en yodo, así como pasta con la misma condición. Lo mismo puede decirse del azúcar, mermeladas, gelatinas, especias vegetales y aceites. Están permitidos los refrescos que no contengan E127, café y té, cerveza, vino, zumos de frutas y limonada.

Dado que no siempre se incluye en la lista de ingredientes el colorante empleado, algunas sociedades científicas recomiendan evitar, por precaución, todos los alimentos procesados y suplementos vitamínicos o nutricionales de color rojo, anaranjado o marrón, en los que es muy común el uso de E127.

Se recomienda consumir con moderación los siguientes alimentos que contienen yodo: verduras enlatadas tales como pepinillos o guisantes; fresas, manzanas tipo golden, mora y piña; carnes en conserva, embutidos y productos de charcutería; frutos secos; productos que incluyan conservantes (mayonesa, tomate frito); caramelos y dulces de color rojo; café o té instantáneo que contengan E127.

Los expertos recomiendan leer con mucha atención la lista de ingredientes de toda la comida envasada que vaya a consumirse. En general, es preferible evitar los alimentos procesados siempre que se pueda, porque los fabricantes no están obligados a informar en las etiquetas sobre el contenido en yodo. Por lo tanto, aunque aparezca el contenido en sal de un producto, no hay forma de saber si esa sal es yodada o no.

En realidad, hay muchos alimentos que están permitidos durante una dieta baja en yodo. El mejor modo de cumplirla es preferir las comidas elaboradas en casa, con ingredientes frescos y carnes sin procesar. A veces puede ser muy fácil adaptar los platos favoritos a los requerimientos de la dieta eliminando los ingredientes que tienen mucho yodo o sustituyéndolos por otros similares que son aceptables en la dieta.

Es preferible pensar que la sal que contienen los alimentos precocinados contiene yodo, evitar las comidas fuera de casa (ya que es difícil saber cuáles son los ingredientes empleados en su preparación) y consumir leche de arroz, avena, sésamo, quinoa, almendras, avellanas, girasol y coco como sustitutos de la leche de vaca.

La entrada ¿Cuándo es recomendable una dieta baja en yodo? se publicó primero en Cuida tu tiroides.

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¿Cuáles son los valores normales de TSH (Análisis de la hormona estimulante de la tiroides)?

El rango de valores normales en una prueba de TSH va de 0,4 a 4,0 unidades milimétricas internacionales por litro (mIU/L). No obstante, los expertos hacen notar que los valores de TSH pueden variar a lo largo del día, y recomiendan realizar la prueba a primera hora de la mañana.

No hay acuerdo en la comunidad científica sobre el umbral máximo que debe considerarse normal, para algunos expertos, los valores por encima de 2,5 mIU/L son anormales. También es posible que haya variaciones según el laboratorio que efectúa el análisis, ya que algunos técnicos emplean medidas diferentes. Consulte con su médico el significado de sus resultados.

Si está recibiendo tratamiento para una enfermedad tiroidea, es habitual que el objetivo sea mantener los niveles de TSH entre 0,5 y 4,0 mIU/L a menos que se dé una de las siguientes circunstancias: que haya una enfermedad en la pituitaria o hipófisis (una glándula situada en la base del cráneo) o que el paciente haya recibido tratamiento para el cáncer de tiroides. En ambos casos se esperan niveles bajos de TSH. Si el paciente es una mujer embarazada, es posible que aun estando dentro de los niveles normales se le recete tratamiento con la hormona por precaución.

 

La entrada ¿Cuáles son los valores normales de TSH (Análisis de la hormona estimulante de la tiroides)? se publicó primero en Cuida tu tiroides.

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Otoplasty for prominent ears – demographics and surgical timing in different populations

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Lauri Kajosaari, Juhani Pennanen, Tuomas Klockars
IntroductionProminent ears are seen in approximately 5% of the population. This benign condition can be treated surgically to reduce or prevent psychological and social problems, most commonly in children before the start of school. Our aim was to examine the demographic characteristics of patients undergoing prominent ear surgery in Finland, and compare findings with international data.MethodsA retrospective study of all the patients treated for prominent ears in our academic tertiary care referral center during 2007-2011 was performed to gather demographic details of operated patients.A systematic review of published series of prominent ear surgery after the year 2000 was performed to gather demographic details for international comparison.ResultsA total of 180 patients were operated in our institution for prominent ears, most of the cases (78.9%) were bilateral. Age at operation ranged between 3 and 36 years, with mean of 9.2 y and median of 7 y. The most common reason for seeking operative treatment was aesthetic complaint, followed by bullying.Review process gathered 20 publications, describing a total of 4433 patients who had been operated for prominent ears. There was wide variation the mean age at operation, ranging 7-38 y while the mean overall was 15.0y. Gender distribution of patient samples was also very variable, with percentage of females ranging from 38 to 71% (overall 52%). There was also considerable variation in the tendency to perform unilateral operations: from 0% up to 21% of the reported population. There were no statistically significant correlations linking these demographic variables, though there was a trend that females are more likely to have this operation performed at an older age.ConclusionsThe treatment culture of prominent ear surgery varies substantially in international comparison. The age at which this operation is performed showed most variation. Omitting some of the basic demographic variables while reporting the results of surgery was common in the reviewed publications.



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Sleep quality and communication aspects in children

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Camila de Castro Corrêa, Maria Renata José, Eduardo Carvalho Andrade, Mariza Ribeiro Feniman, Ana Paula Fukushiro, Giédre Berretin-Felix, Luciana Paula Maximino
ObjectivesTo correlate quality of life of children in terms of sleep, with their oral language skills, auditory processing and orofacial myofunctional aspects.MethodsNineteen children (12 males and seven females, in the mean age 9.26) undergoing otorhinolaryngological and speech evaluations participated in this study. The OSA-18 questionnaire was applied, followed by verbal and nonverbal sequential memory tests, dichotic digit test, nonverbal dichotic test and Sustained Auditory Attention Ability Test, related to auditory processing. The Phonological Awareness Profile test, Rapid Automatized Naming and Phonological Working Memory were used for assessment of the phonological processing. Language was assessed by the ABFW Child Language Test, analyzing the phonological and lexical levels. Orofacial myofunctional aspects were evaluated through the MBGR Protocol. Statistical tests used: the Mann-Whitney Test, Fisher's exact test and Spearman Correlation.ResultsRelating the performance of children in all evaluations to the results obtained in the OSA-18, there was a statistically significant correlation in the phonological working memory for backward digits (p = 0.04); as well as in the breathing item (p = 0.03), posture of the mandible (p = 0.03) and mobility of lips (p = 0.04).ConclusionA correlation was seen between the sleep quality of life and the skills related to the phonological processing, specifically in the phonological working memory in backward digits, and related to orofacial myofunctional aspects.



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Adenotonsillectomy outcomes in children with sleep apnea and narcolepsy

Publication date: September 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Sneh Biyani, Tina D. Cunningham, Cristina M. Baldassari
ObjectiveTo identify improvements in daytime sleepiness following adenotonsillectomy in children with non-severe obstructive sleep apnea and narcolepsy.Study designCase series with chart review over 15 years.SettingTertiary Children's Hospital.Subjects and methodsChildren between 6 and 17 years of age with narcolepsy that underwent adenotonsillectomy for non-severe obstructive sleep apnea (OSA) were included. Narcolepsy was diagnosed based on clinical assessment and the Multiple Sleep Latency Test (MSLT) results. A standardized instrument, the pediatric Epworth Sleepiness Scale (ESS), was used to assess daytime sleepiness before and after adenotonsillectomy.ResultsNine children with a mean age of 12.1 years were included. The majority of the subjects (78%, n = 7) were African American and six children (66.7%) were obese. Four children (44%) were treated with wake promoting agents during the study. The mean preoperative apnea hypopnea index on polysomnography was 4.89 (SD 1.86), while the mean sleep latency on MSLT was 6.32 min (SD 3.14). The mean preoperative ESS was 16.10 and the postoperative ESS was 10.80 (SD 3.96). There was significant improvement (p = 0.02) in the ESS following adenotonsillectomy with seven children (78%) reporting diminished daytime sleepiness.ConclusionsChildren with non-severe OSA and narcolepsy experience significant improvement in daytime sleepiness following adenotonsillectomy. Future studies are needed to determine the incidence and clinical significance of non-severe OSA in children with narcolepsy.



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Efficient model calibration method based on phase experiments for anaerobic–anoxic/nitrifying (A2N) two-sludge process

Abstract

A systematic calibration and validation procedure for the complex mechanistic modeling of anaerobic–anoxic/nitrifying (A2N) two-sludge system is needed. An efficient method based on phase experiments, sensitivity analysis, and genetic algorithm is proposed here for model calibration. Phase experiments (anaerobic phosphorus release, aerobic nitrification, and anoxic denitrifying phosphate accumulation) in an A2N sequencing batch reactor (SBR) were performed to reflect the process conditions accurately and improve the model calibration efficiency. The calibrated model was further validated using 30 batch experiments and 3-month dynamic continuous flow (CF) experiments for A2N-SBR and CF-A2N process, respectively. Several statistical criteria were conducted to evaluate the accuracy of model predications, including the average relative deviation (ARD), mean absolute error (MAE), root mean square error (RMSE), and Janus coefficient. Visual comparisons and statistical analyses indicated that the calibrated model could provide accurate predictions for the effluent chemical oxygen demand (COD), ammonia nitrogen (NH₄⁺-N), total nitrogen (TN), and total phosphorus (TP), with only one iteration.

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Biogeochemical and engineered barriers for preventing spread of contaminants

Abstract

The intensive industrial development and urbanization, as well as the negligible return of hazardous components to the deeper layers of the Earth, increases the contamination load on the noosphere (i.e., the new status of the biosphere, the development of which is mainly controlled by the conscious activity of a human being). The need for reducing the spread and mobility of contaminants is growing. The insights into the role of the tree in the reduction of contaminant mobility through its life cycle are presented to show an important function performed by the living matter and its products in reducing contamination. For maintaining the sustainable development, natural materials are often used as the media in the environmental protection technologies. However, due to increasing contamination intensity, the capacity of natural materials is not sufficiently high. Therefore, the popularity of engineered materials, such as biochar which is the thermochemically modified lignocellulosic product, is growing. The new approaches, based on using the contaminant footprint, as well as natural (biogeochemical) and engineered barriers for reducing contaminant migration and their application, are described in the paper.

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Overview of Cancer Stem Cells and Stemness for Community Oncologists

Abstract

Advances in cancer research in the past have led to an evolving understanding of cancer pathogenesis and the development of novel drugs that significantly improve patient outcomes. However, many patients still encounter treatment resistance, recurrence, or metastasis and eventually die from progressing disease. Experimental evidence indicates that a subpopulation of cancer cells, called cancer stem cells (CSCs), possess "stemness" properties similar to normal stem cells, including self-renewal, differentiation, and proliferative potential. These stemness properties are lost during differentiation and are governed by pathways such as STAT3, NANOG, NOTCH, WNT, and HEDGEHOG, which are highly dysregulated in CSCs due to genetic and epigenetic changes. Promising results have been observed in preclinical models targeting these CSCs through the disruption of stemness pathways in combination with current treatment modalities. This has led to anti-CSC–based clinical trials in multiple stages of development. In this review, we discuss the role of CSCs and stemness pathways in cancer treatment and how they relate to clinical observations. Because CSCs and the stemness pathways governing them may explain the negative clinical outcomes observed during treatment, it is important for oncologists to understand how they contribute to cancer progression and how they may be targeted to improve patient outcomes.

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Medical Examiners Say Sleep Apnea Contributed to Carrie Fisher’s Death

The Los Angeles County medical examiner's office has released a summary of its findings into the death of "Star Wars" actress Carrie Fisher.

The actress and writer died in December at the age of 60. Her mother, actress Debbie Reynolds, died one day later.
In a news release, the coroner listed the results of a body examination performed three days after Fisher's death.

The agency said Fisher's manner of death is undetermined. Medical examiners concluded that "sleep apnea and other undetermined factors" contributed to her death.

 

Read the full article here.

 

Source: cnn.com

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Viral Replication Complexes Are Targeted by LC3-Guided Interferon-Inducible GTPases

Publication date: Available online 29 June 2017
Source:Cell Host & Microbe
Author(s): Scott B. Biering, Jayoung Choi, Rachel A. Halstrom, Hailey M. Brown, Wandy L. Beatty, Sanghyun Lee, Broc T. McCune, Erin Dominici, Lelia E. Williams, Robert C. Orchard, Craig B. Wilen, Masahiro Yamamoto, Jörn Coers, Gregory A. Taylor, Seungmin Hwang
All viruses with positive-sense RNA genomes replicate on membranous structures in the cytoplasm called replication complexes (RCs). RCs provide an advantageous microenvironment for viral replication, but it is unknown how the host immune system counteracts these structures. Here we show that interferon-gamma (IFNG) disrupts the RC of murine norovirus (MNV) via evolutionarily conserved autophagy proteins and the induction of IFN-inducible GTPases, which are known to destroy the membrane of vacuoles containing bacteria, protists, or fungi. The MNV RC was marked by the microtubule-associated-protein-1-light-chain-3 (LC3) conjugation system of autophagy and then targeted by immunity-related GTPases (IRGs) and guanylate-binding proteins (GBPs) upon their induction by IFNG. Further, the LC3 conjugation system and the IFN-inducible GTPases were necessary to inhibit MNV replication in mice and human cells. These data suggest that viral RCs can be marked and antagonized by a universal immune defense mechanism targeting diverse pathogens replicating in cytosolic membrane structures.

Graphical abstract

Teaser

The replication complexes (RCs) of positive-sense RNA viruses have been considered impenetrable to antiviral responses. Biering et al. discovered that viral RCs can be marked by the LC3 conjugation system of autophagy and targeted by IFN-inducible GTPases, demonstrating a universal effector mechanism against cytosolic vacuoles containing viruses, bacteria, protists, or fungi.


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Cutaneous Leishmaniasis Induces a Transmissible Dysbiotic Skin Microbiota that Promotes Skin Inflammation

Publication date: Available online 29 June 2017
Source:Cell Host & Microbe
Author(s): Ciara Gimblet, Jacquelyn S. Meisel, Michael A. Loesche, Stephen D. Cole, Joseph Horwinski, Fernanda O. Novais, Ana M. Misic, Charles W. Bradley, Daniel P. Beiting, Shelley C. Rankin, Lucas P. Carvalho, Edgar M. Carvalho, Phillip Scott, Elizabeth A. Grice
Skin microbiota can impact allergic and autoimmune responses, wound healing, and anti-microbial defense. We investigated the role of skin microbiota in cutaneous leishmaniasis and found that human patients infected with Leishmania braziliensis develop dysbiotic skin microbiota, characterized by increases in the abundance of Staphylococcus and/or Streptococcus. Mice infected with L. major exhibit similar changes depending upon disease severity. Importantly, this dysbiosis is not limited to the lesion site, but is transmissible to normal skin distant from the infection site and to skin from co-housed naive mice. This observation allowed us to test whether a pre-existing dysbiotic skin microbiota influences disease, and we found that challenging dysbiotic naive mice with L. major or testing for contact hypersensitivity results in exacerbated skin inflammatory responses. These findings demonstrate that a dysbiotic skin microbiota is not only a consequence of tissue stress, but also enhances inflammation, which has implications for many inflammatory cutaneous diseases.

Graphical abstract

Teaser

The role of skin commensal microbes in dermal cellular responses is largely unknown. Gimblet et al. investigate the role of the skin microbiota during cutaneous leishmaniasis. Leishmania infection creates a dysbiotic skin microbiota that is transmissible to naive skin. Additionally, dysbiosis prior to infection or injury exacerbates skin inflammation.


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