Kim et al. from Korea [1] have done a remarkable job on retrospective review of their large number of patients with thyroid carcinoma first staging them according to the 7th edition of the AJCC/UICC staging system of thyroid cancer and re-staging them according to the most recent, 8th edition and changes implemented in the 8th edition. They have also done a comparative analysis of cause specific survival (CSS) and implications of the new and revised staging system [2]. The revised staging system was published in January of 2017, however, officially it will be implemented in January 2018 at which time the staging system of thyroid cancer will change worldwide.
http://ift.tt/2wCyOfy
Δευτέρα 7 Αυγούστου 2017
Paradigm shifts in staging of thyroid cancer
Prognostic factors and occult nodal disease in mucoepidermoid carcinoma of the oral cavity and oropharynx: An analysis of the National Cancer Database
Salivary gland malignancies are rare and account for only 3% of head and neck cancers [1]. Despite their rarity, these neoplasms are heterogeneous and are classified into 24 different histologic subtypes by the World Health Organization [2]. Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy and is most often located in the parotid gland followed by the minor salivary glands throughout the upper aero-digestive tract, most notably in the oral cavity (OC) and oropharynx (OP) [3,4].
http://ift.tt/2wCxtW5
Outcome following radiotherapy for head and neck basal cell carcinoma with ‘aggressive’ features
Basal cell carcinoma (BCC) is a malignant neoplasm derived from the basal layer of the epidermis [1]. It is the most common cancer type in western countries and the incidence is rising [2]. Most BCCs (80–90%) occur in elderly patients and frequently on sun-exposed body parts such as the head and neck, which is also the most common site [3,4]. Head and neck BCC (HN-BCC) are generally slow growing. However, a subset of HN-BCC may behave more aggressively and lead to greater morbidity and mortality [5].
http://ift.tt/2vJSVvS
Rebamipide gargle in preventive management of chemo-radiotherapy induced oral mucositis
Oral mucositis is inflammation of oral mucosa which is an inevitable and acute side effect in patients undergoing chemo-radiotherapy for head & neck cancer. The clinical appearance ranges from redness to severe ulceration causing pain that is aggravated even by normal oral functioning [1]. The extent of the injury is directly related to the mucosal volume irradiated, anatomic sub site exposed, treatment intensity, and individual patient predisposition [2]. Oral epithelial basal cells have high mitotic rate, thus they are commonly affected by cytotoxic drugs and ionizing radiation.
http://ift.tt/2wCDkL9
Post-operative therapy following transoral robotic surgery for unknown primary cancers of the head and neck
Management of head and neck squamous cell carcinoma (HNSCC) is typically based on the site, stage, and pathologic characteristics of the identified tumor. However, when a primary tumor is not identified several treatment dilemmas arise: How should potential primary sites be treated and to what extent? If treated with primary radiation, what sites should be targeted and to what dose? What is the role of diagnostic surgical resection?
http://ift.tt/2vJyWNP
Tube feeding during treatment for head and neck cancer – Adherence and patient reported barriers
Treatment fidelity is important to assess in intervention research trials as it refers to the extent to which interventions are delivered as intended according to the study protocol [1]. It is particularly important for intervention research trials which encompass behavioural change, so that the efficacy of the intervention can be considered in the correct context and inappropriate rejection of potentially effective interventions can be minimised [2]. Treatment fidelity has been described as having at least four core components including: study design and protocol to outline how the intervention should be organised and delivered; training and supervision of those delivering the intervention to ensure consistency; monitoring of intervention delivery to determine whether the intervention was delivered as intended; and monitoring of intervention receipt to determine whether the intervention was received and understood [1,3].
http://ift.tt/2wCYR6m
Dual peptide-mediated targeted delivery of bioactive siRNAs to oral cancer cells in vivo
Oral and pharyngeal cancer is the ninth most common cancer worldwide [1], and in the U.S.A. it is estimated that about 50,000 new cases and approximately 10,000 deaths occur annually due to cancer of the oral cavity and pharynx [2]. Although significant advances have been made in cancer treatment, the prognosis for oral cancer remains poor in comparison to other cancer types, including breast, skin, and prostate [2]. Moreover, the five-year survival rate for all stages of oral cancer is 64% and has only modestly improved over the past few decades [2,3].
http://ift.tt/2wCDB0r
Evaluation of the Xpert® HPV assay in the detection of Human Papillomavirus in formalin-fixed paraffin-embedded oropharyngeal carcinomas
Over the last few decades, it has become clear that Human Papillomavirus (HPV) does not only cause ano-genital cancers, but also represents the etiological agent of a subset of Head and Neck Squamous Cell Carcinomas (HNSCC) [1]. The majority of the HPV-driven HNSCC are oropharyngeal squamous cell carcinomas (OPSCC) which arise at the tonsils or base of the tongue. Recently, a significant increase in the incidence of HPV-related OPSCC was observed in the US [2] and several European countries [3,4].
http://ift.tt/2vJTQwg
Patterns of fractionation for patients with T2N0M0 glottic larynx cancer undergoing definitive radiotherapy in the United States
External beam radiotherapy (EBRT) offers an effective definitive intervention with the promise of anatomic and functional preservation to patients with early-stage larynx cancer [1–4]. While conventional fractionation (CFxn) at 1.8–2.0 Gray (Gy) per day has been the predominant schedule in most series, developments in radiobiology [5–7] have sparked interest in alternative fractionation schedules as a means of improving local control.
http://ift.tt/2vJzZ08
Characteristics and long-term outcomes of head and neck squamous cell carcinoma after solid organ transplantation
Head and neck cancer accounts for approximately 500,000 cases annually worldwide, with over 62,000 Americans diagnosed each year and almost 13,000 dying from the disease [1,2]. It is well-recognized that the immune system plays a major role in anti-tumor surveillance in healthy individuals, a finding that is confirmed by the increased incidence of cancer diagnosis in some acquired (such as after organ transplant) or hereditary (such as GATA2 deficiency) immunodeficiency states [3]. Our understanding of the interactions between immunity and tumorigenesis is growing at a fast rate such that modulating the immune system has been the largest breakthrough in cancer therapy in the last decade [4].
http://ift.tt/2wCx9GA
Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers
Mandibular osteoradionecrosis (MORN) is a cause of significant morbidity in patients with head and neck cancers treated with radiation therapy (RT). Osteoradionecrosis is defined as an area of exposed bone secondary to necrosis following RT with failure to heal after a period of 3–6months [1]. The mandible is the most commonly affected bone due to the distribution of head and neck primaries and the relative hypovascular nature of the mandible. The pathogenesis of MORN is thought to be secondary to bone tissue and vascular damage causing a hypoxic, hypocellular, and hypovascular environment [2] and a radiation-induced fibroatrophic process [3].
http://ift.tt/2vJOZLx
Outcomes of oral cavity cancer patients treated with surgery followed by postoperative intensity modulated radiation therapy
Locally advanced oral cavity squamous cell carcinoma (OCSCC) is standardly treated with surgery. Adjuvant postoperative radiation therapy is recommended for patients with adverse features including: stage IV disease, inadequate margins, and invasion of tumor into perineural spaces, lymphovascular spaces or bone. Over the last decade, the addition of chemotherapy to adjuvant radiation was recommended, particularly for patients who have 'high risk' pathologic features which include extracapsular nodal extension (ECE) and/or a positive surgical margin.
http://ift.tt/2vJNHQA
Validation and comparison of the 7th and 8th edition of AJCC staging systems for non-metastatic nasopharyngeal carcinoma, and proposed staging systems from Hong Kong, Guangzhou, and Guangxi
Proper classification and staging of cancer is essential for the physician to assign proper treatment, evaluate results of management and clinical trials, and to serve as the standard for local, regional and international reporting on cancer incidence and outcome.
http://ift.tt/2wCPp2T
Conditional relative survival of oral cavity cancer: Based on Korean Central Cancer Registry
There were an estimated 300,383 global cases of lip and oral cavity cancer in 2012, with more than half of the patients located in Asia [1]. In Korea, the incidence of oral cavity cancer has been dynamically changing, with an increasing incidence among women, as well as an increasing incidence of tongue cancer among young adults [2]. Although oral cavity cancer does not account for a large proportion of all Korean cancer cases, the cancer is associated with significant effects on physiological function, facial esthetics, and survival.
http://ift.tt/2vJE2cS
A comprehensive study of smoking-specific microRNA alterations in head and neck squamous cell carcinoma
Head and neck squamous cell carcinoma (HNSCC) affects more than 650,000 people annually, with 5-year mortality rates exceeding 50% [1,2]. Because HNSCCs are linked to several distinct risk factors, including tobacco use, alcohol consumption, and HPV infection [3], and arise in a number of different sites within the head and neck region, they collectively exhibit significant heterogeneity at the molecular and genetic level and disparate response to treatment and clinical outcome.
http://ift.tt/2wCVKeJ
The importance of log odds of positive lymph nodes for locoregional recurrence in oral squamous cell carcinoma
Oral squamous cell carcinoma is one of the most common malignancies worldwide (OSCC) [1]. The annual incidence is 263.000 and 128.000 deaths are registered per year [1]. Despite major advances in diagnostic and therapeutic techniques, the prognosis of patients with oral squamous cell carcinoma has not improved in the last three decades and still remains below 50% [2,3].
http://ift.tt/2vJSG3W
Endoscopic DCR using bipedicled interlacing mucosal flaps
Objective
Obstruction of the nasolacrimal duct is a relatively common condition that affects patients of all ages, races, and sexes. The surgical gold standard for complete nasolacrimal duct obstruction and dacryocystitis is dacryocystorhinostomy (DCR). The purpose of this study was to describe a novel, bipedicled interlacing mucosal sparing flap technique for endoscopic DCR (eDCR).
Methods
A posteriorly based mucosal flap over the fundus is combined with a novel, anteriorly based mucosal flap over the intraosseus portion of the nasolacrimal duct (NLD). This exposes a wide area of the maxillary bone, allowing for exposure and identification of the NLD/sac complex in a safer, more inferior position. The interlacing mucosal flaps may be replaced at the conclusion of the procedure, thereby minimizing bone exposure and maintaining excellent long-term patency.
Results
The authors have utilized this technique in 55 procedures with 100% positive identification of the NLD and lacrimal sac, 0% complication rate, 100% anatomical patency rate, and 96.4% success rate after a minimal follow-up of 6 months.
Discussion
The bipedicled interlacing flap technique for eDCR provides for safe and reproducible identification of the NLD and lacrimal sac while minimizing bone exposure and restenosis rate.
Conclusion
The bipedicled interlacing flap technique for eDCR provides for safe and reproducible identification of the NLD and lacrimal sac while minimizing bone exposure and restenosis rate.
Level of Evidence
N/A Laryngoscope, 2017
http://ift.tt/2vA0Pre
Adjuvant photodynamic therapy in head and neck cancer after tumor-positive resection margins
Objective
In case of close or positive resection margins after oncological resection in head and neck surgery, additional treatment is necessary. When conventional options are exhausted, photodynamic therapy (PDT) can play a role in achieving clear margins. The purpose of the current study was to evaluate the clinical benefit of PDT as adjuvant therapy next to surgery with positive resection margins. The role of the time interval between surgery and PDT on survival outcomes also was investigated.
Study Design
Retrospective cohort analysis.
Methods
Adjuvant PDT was performed in patients with a malignancy in the head and neck region with close or positive resection margins who were not eligible for conventional treatment options. The primary endpoint was progression-free survival. Secondary endpoints were disease-free survival, overall survival, and optimal time interval between surgery and PDT.
Results
Fifty-four patients were treated with surgery followed by meta-tetrahydroxyphenylchlorin-mediated PDT. There was a large diversity in tumor location and histopathology, as well as in time interval between surgery and PDT. The 2-year progression-free survival rate was 30%; 2-year disease-free survival rate was 28%; and 2-year overall survival was 51%. Disease-free survival was significantly better when the time interval between surgery and PDT was ≥ 6 weeks (P = 0.02).
Conclusion
PDT can be applied as adjuvant therapy after surgery in cases of a malignancy with close or positive tumor resection margins. However, the clinical benefits are yet to be determined. There is a significantly better disease-free survival with a time interval between surgery and PDT of minimal 6 weeks.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2vzljjV
Use of standardized letters of recommendation for otolaryngology head and neck surgery residency and the impact of gender
Objectives
To evaluate gender-based differences in narrative letters of recommendation (NLORs) and standardized letters of recommendation (SLORs) submitted for applicants to an otolaryngology head and neck surgery (OHNS) residency program.
Study Design
Retrospective review.
Methods
Nine hundred fifty-eight letters of recommendation (LORs) submitted to one OHNS program in 2013 to 2014 were analyzed.
Results
NLORs (n = 590) and SLORs (n = 368) were reviewed. Male writers composed over 85% of all LORs. Compared with male writers, female writers of LORs were more likely to compose a letter of minimal assurance (P < 0.025). Female writers of SLORs were more likely to rank applicants higher in communication skills (P < 0.035) and match potential (P < 0.045). Analysis of LORs by applicant gender revealed that female applicants were more likely than male applicants to be described as team players (P < 0.025) and less likely to receive a letter of minimal assurance (P < 0.001). Compared with SLORs, NLORs written for male applicants were more likely to reference their leadership potential (P < 0.001). Female applicants were less likely to be described as "bright" (P < 0.001) and more likely to have their appearance mentioned (P < 0.03) in NLORs when compared to SLORs.
Conclusion
Although we found that SLORs reduce gender biases compared to NLORs, there remain significant differences in how female and male applicants are described. Greater awareness of historical biases likely has contributed to more equitable letter writing, although impactful gender biases remain when reviewing applicants.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2vh5AmP
Endoscopic DCR using bipedicled interlacing mucosal flaps
Objective
Obstruction of the nasolacrimal duct is a relatively common condition that affects patients of all ages, races, and sexes. The surgical gold standard for complete nasolacrimal duct obstruction and dacryocystitis is dacryocystorhinostomy (DCR). The purpose of this study was to describe a novel, bipedicled interlacing mucosal sparing flap technique for endoscopic DCR (eDCR).
Methods
A posteriorly based mucosal flap over the fundus is combined with a novel, anteriorly based mucosal flap over the intraosseus portion of the nasolacrimal duct (NLD). This exposes a wide area of the maxillary bone, allowing for exposure and identification of the NLD/sac complex in a safer, more inferior position. The interlacing mucosal flaps may be replaced at the conclusion of the procedure, thereby minimizing bone exposure and maintaining excellent long-term patency.
Results
The authors have utilized this technique in 55 procedures with 100% positive identification of the NLD and lacrimal sac, 0% complication rate, 100% anatomical patency rate, and 96.4% success rate after a minimal follow-up of 6 months.
Discussion
The bipedicled interlacing flap technique for eDCR provides for safe and reproducible identification of the NLD and lacrimal sac while minimizing bone exposure and restenosis rate.
Conclusion
The bipedicled interlacing flap technique for eDCR provides for safe and reproducible identification of the NLD and lacrimal sac while minimizing bone exposure and restenosis rate.
Level of Evidence
N/A Laryngoscope, 2017
http://ift.tt/2vA0Pre
Adjuvant photodynamic therapy in head and neck cancer after tumor-positive resection margins
Objective
In case of close or positive resection margins after oncological resection in head and neck surgery, additional treatment is necessary. When conventional options are exhausted, photodynamic therapy (PDT) can play a role in achieving clear margins. The purpose of the current study was to evaluate the clinical benefit of PDT as adjuvant therapy next to surgery with positive resection margins. The role of the time interval between surgery and PDT on survival outcomes also was investigated.
Study Design
Retrospective cohort analysis.
Methods
Adjuvant PDT was performed in patients with a malignancy in the head and neck region with close or positive resection margins who were not eligible for conventional treatment options. The primary endpoint was progression-free survival. Secondary endpoints were disease-free survival, overall survival, and optimal time interval between surgery and PDT.
Results
Fifty-four patients were treated with surgery followed by meta-tetrahydroxyphenylchlorin-mediated PDT. There was a large diversity in tumor location and histopathology, as well as in time interval between surgery and PDT. The 2-year progression-free survival rate was 30%; 2-year disease-free survival rate was 28%; and 2-year overall survival was 51%. Disease-free survival was significantly better when the time interval between surgery and PDT was ≥ 6 weeks (P = 0.02).
Conclusion
PDT can be applied as adjuvant therapy after surgery in cases of a malignancy with close or positive tumor resection margins. However, the clinical benefits are yet to be determined. There is a significantly better disease-free survival with a time interval between surgery and PDT of minimal 6 weeks.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2vzljjV
For Embryos, Mother Can Only Take You So Far
Publication date: 7 August 2017
Source:Developmental Cell, Volume 42, Issue 3
Author(s): Patrick L. Ferree, Stefano Di Talia
Early embryonic development is characterized by rapid cleavage divisions, which impose significant constraints on metabolic pathways. In this issue, Song et al. (2017) show that Drosophila embryos synthesize a large fraction of nucleotides on the go and that negative feedback between dATP and ribonucleotide reductase ensures tight control of dNTP concentration.
Teaser
Early embryonic development is characterized by rapid cleavage divisions, which impose significant constraints on metabolic pathways. In this issue, Song et al. (2017) show that Drosophila embryos synthesize a large fraction of nucleotides on the go and that negative feedback between dATP and ribonucleotide reductase ensures tight control of dNTP concentration.http://ift.tt/2vzcs1w
Midkine and Melanoma Metastasis: A Malevolent Mix
Publication date: 7 August 2017
Source:Developmental Cell, Volume 42, Issue 3
Author(s): Sinem Karaman, Kari Alitalo
Using an in vivo reporter for lymphangiogenesis, a recent study in Nature from Olmeda et al. (2017) describes a new subset of melanomas that induce systemic pre-conditioning of distant organs for formation of tumor metastatic niches, and identifies the responsible factor as the pleiotropic cytokine midkine.
Teaser
Using an in vivo reporter for lymphangiogenesis, a recent study in Nature from Olmeda et al. (2017) describes a new subset of melanomas that induce systemic pre-conditioning of distant organs for formation of tumor metastatic niches and that show that the responsible factor is the pleiotropic cytokine midkine.http://ift.tt/2vgETPe
Anchoring Chromatin Loops to Cancer
Publication date: 7 August 2017
Source:Developmental Cell, Volume 42, Issue 3
Author(s): Faith Fowler, Jessica K. Tyler
Although some genomic rearrangements are caused by replication or transcription, the etiology of others is unclear. Reporting in Cell, Canela et al. (2017) reveal that type II topoisomerase-mediated release of torsional strain at chromosomal loop anchors generates DNA double-strand breaks that drive multiple oncogenic translocations in a transcription-independent manner.
Teaser
Although some genomic rearrangements are caused by replication or transcription, the etiology of others is unclear. Reporting in Cell, Canela et al. (2017) reveal that type II topoisomerase-mediated release of torsional strain at chromosomal loop anchors generates DNA double-strand breaks that drive multiple oncogenic translocations in a transcription-independent manner.http://ift.tt/2vgU8I3
GATA Factor-Regulated Samd14 Enhancer Confers Red Blood Cell Regeneration and Survival in Severe Anemia
Publication date: 7 August 2017
Source:Developmental Cell, Volume 42, Issue 3
Author(s): Kyle J. Hewitt, Koichi R. Katsumura, Daniel R. Matson, Prithvia Devadas, Nobuyuki Tanimura, Alexander S. Hebert, Joshua J. Coon, Jin-Soo Kim, Colin N. Dewey, Sunduz Keles, Siyang Hao, Robert F. Paulson, Emery H. Bresnick
An enhancer with amalgamated E-box and GATA motifs (+9.5) controls expression of the regulator of hematopoiesis GATA-2. While similar GATA-2-occupied elements are common in the genome, occupancy does not predict function, and GATA-2-dependent genetic networks are incompletely defined. A "+9.5-like" element resides in an intron of Samd14 (Samd14-Enh) encoding a sterile alpha motif (SAM) domain protein. Deletion of Samd14-Enh in mice strongly decreased Samd14 expression in bone marrow and spleen. Although steady-state hematopoiesis was normal, Samd14-Enh−/− mice died in response to severe anemia. Samd14-Enh stimulated stem cell factor/c-Kit signaling, which promotes erythrocyte regeneration. Anemia activated Samd14-Enh by inducing enhancer components and enhancer chromatin accessibility. Thus, a GATA-2/anemia-regulated enhancer controls expression of an SAM domain protein that confers survival in anemia. We propose that Samd14-Enh and an ensemble of anemia-responsive enhancers are essential for erythrocyte regeneration in stress erythropoiesis, a vital process in pathologies, including β-thalassemia, myelodysplastic syndrome, and viral infection.
Graphical abstract
Teaser
GATA-2 is a regulator of hematopoiesis. Hewitt et al. find that a GATA-2-regulated enhancer, controlling expression of an SAM domain protein, promotes red blood cell regeneration and hence survival of anemia in mice. This enhancer is part of a family of anemia-responsive elements, which may orchestrate the response to anemia.http://ift.tt/2vgP4TM
Human Centromeres Produce Chromosome-Specific and Array-Specific Alpha Satellite Transcripts that Are Complexed with CENP-A and CENP-C
Publication date: 7 August 2017
Source:Developmental Cell, Volume 42, Issue 3
Author(s): Shannon M. McNulty, Lori L. Sullivan, Beth A. Sullivan
Human centromeres are defined by alpha satellite DNA arrays that are distinct and chromosome specific. Most human chromosomes contain multiple alpha satellite arrays that are competent for centromere assembly. Here, we show that human centromeres are defined by chromosome-specific RNAs linked to underlying organization of distinct alpha satellite arrays. Active and inactive arrays on the same chromosome produce discrete sets of transcripts in cis. Non-coding RNAs produced from active arrays are complexed with CENP-A and CENP-C, while inactive-array transcripts associate with CENP-B and are generally less stable. Loss of CENP-A does not affect transcript abundance or stability. However, depletion of array-specific RNAs reduces CENP-A and CENP-C at the targeted centromere via faulty CENP-A loading, arresting cells before mitosis. This work shows that each human alpha satellite array produces a unique set of non-coding transcripts, and RNAs present at active centromeres are necessary for kinetochore assembly and cell-cycle progression.
Graphical abstract
Teaser
Non-coding RNAs are required for centromere function in model systems, but the identity and function of human centromeric transcripts are less clear. McNulty et al. show that human centromeres produce array-specific, non-coding alpha satellite RNAs that differentially complex with centromere proteins for centromere assembly and cell-cycle progression.http://ift.tt/2vzoTKF
The Helicase Aquarius/EMB-4 Is Required to Overcome Intronic Barriers to Allow Nuclear RNAi Pathways to Heritably Silence Transcription
Publication date: 7 August 2017
Source:Developmental Cell, Volume 42, Issue 3
Author(s): Alper Akay, Tomas Di Domenico, Kin M. Suen, Amena Nabih, Guillermo E. Parada, Mark Larance, Ragini Medhi, Ahmet C. Berkyurek, Xinlian Zhang, Christopher J. Wedeles, Konrad L.M. Rudolph, Jan Engelhardt, Martin Hemberg, Ping Ma, Angus I. Lamond, Julie M. Claycomb, Eric A. Miska
Small RNAs play a crucial role in genome defense against transposable elements and guide Argonaute proteins to nascent RNA transcripts to induce co-transcriptional gene silencing. However, the molecular basis of this process remains unknown. Here, we identify the conserved RNA helicase Aquarius/EMB-4 as a direct and essential link between small RNA pathways and the transcriptional machinery in Caenorhabditis elegans. Aquarius physically interacts with the germline Argonaute HRDE-1. Aquarius is required to initiate small-RNA-induced heritable gene silencing. HRDE-1 and Aquarius silence overlapping sets of genes and transposable elements. Surprisingly, removal of introns from a target gene abolishes the requirement for Aquarius, but not HRDE-1, for small RNA-dependent gene silencing. We conclude that Aquarius allows small RNA pathways to compete for access to nascent transcripts undergoing co-transcriptional splicing in order to detect and silence transposable elements. Thus, Aquarius and HRDE-1 act as gatekeepers coordinating gene expression and genome defense.
Graphical abstract
Teaser
Nuclear RNAi is essential for heritable silencing in many organisms. Akay et al. show that RNA helicase EMB-4/AQR physically interacts with nuclear Argonaute HRDE-1 and bridges the small RNA pathway to transcriptional silencing. They further show that introns can form a barrier to transcriptional silencing, which EMB-4/AQR can overcome.http://ift.tt/2vyWOmS
The Conserved Intron Binding Protein EMB-4 Plays Differential Roles in Germline Small RNA Pathways of C. elegans
Publication date: 7 August 2017
Source:Developmental Cell, Volume 42, Issue 3
Author(s): Katarzyna M. Tyc, Amena Nabih, Monica Z. Wu, Christopher J. Wedeles, Julia A. Sobotka, Julie M. Claycomb
Proper regulation of the germline transcriptome is essential for fertility. In C. elegans, germline homeostasis hinges on a complex repertoire of both silencing and activating small RNA pathways, along with RNA processing. However, our understanding of how fundamental RNA processing steps intersect with small RNA machineries in the germline remains limited. Here, we link the conserved intron binding protein, EMB-4/AQR/IBP160, to the CSR-1 and HRDE-1 nuclear 22G-RNA pathways in the C. elegans germline. Loss of emb-4 leads to distinct alterations in CSR-1- versus HRDE-1-associated small RNA and mRNA transcriptomes. Our transcriptome-wide analysis shows that EMB-4 is enriched along pre-mRNAs of nearly 8,000 transcripts. While EMB-4 complexes are enriched for both intronic and exonic sequences of HRDE-1 targets, CSR-1 pathway targets are enriched for intronic, but not exonic, sequences. These data suggest that EMB-4 could contribute to a molecular signature that distinguishes the targets of these two germline small RNA pathways.
Graphical abstract
Teaser
The CSR-1 and HRDE-1 nuclear small RNA pathways maintain germline transcriptome homeostasis and fertility in C. elegans. Tyc, Nabih, Wu et al. implicate conserved intron binding protein EMB-4/AQR/IBP160 in these pathways. EMB-4 differentially binds to CSR-1 versus HRDE-1 targets, possibly contributing to a molecular signature that distinguishes transcripts between pathways.http://ift.tt/2vzoJTz
Primary Cilia Signaling Shapes the Development of Interneuronal Connectivity
Publication date: 7 August 2017
Source:Developmental Cell, Volume 42, Issue 3
Author(s): Jiami Guo, James M. Otis, Holden Higginbotham, Chase Monckton, JrGang Cheng, Aravind Asokan, Kirk Mykytyn, Tamara Caspary, Garret D. Stuber, E.S. Anton
Appropriate growth and synaptic integration of GABAergic inhibitory interneurons are essential for functional neural circuits in the brain. Here, we demonstrate that disruption of primary cilia function following the selective loss of ciliary GTPase Arl13b in interneurons impairs interneuronal morphology and synaptic connectivity, leading to altered excitatory/inhibitory activity balance. The altered morphology and connectivity of cilia mutant interneurons and the functional deficits are rescued by either chemogenetic activation of ciliary G-protein-coupled receptor (GPCR) signaling or the selective induction of Sstr3, a ciliary GPCR, in Arl13b-deficient cilia. Our results thus define a specific requirement for primary cilia-mediated GPCR signaling in interneuronal connectivity and inhibitory circuit formation.
Graphical abstract
Teaser
Growth and connectivity of interneurons are fundamental to the formation of functional neural circuitry. Guo et al. show that primary cilia signaling, via Arl13b-GPCR pathway, promotes interneuronal connectivity and inhibitory circuit formation. Primary cilia signaling is a non-synaptic signaling mechanism through which environmental signals can shape and refine interneuronal networks.http://ift.tt/2vgYyyA
Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews
The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis (ARC). To inform the development of recommendations, we...
http://ift.tt/2vIwjuG
Laser and Light Treatments for Hair Reduction in Fitzpatrick Skin Types IV–VI: A Comprehensive Review of the Literature
Abstract
Unwanted facial and body hair presents as a common finding in many patients, such as females with hirsutism. With advances in laser and light technology, a clinically significant reduction in hair can be achieved in patients with light skin. However, in patients with darker skin, Fitzpatrick skin types (FST) IV–VI, the higher melanin content of the skin interferes with the proposed mechanism of laser-induced selective photothermolysis, which is to target the melanin in the hair follicle to cause permanent destruction of hair bulge stem cells. Many prospective and retrospective studies have been conducted with laser and light hair-removal devices, but most exclude patients with darkly pigmented skin, considering them a high-risk group for unwanted side effects, including pigmentation changes, blisters, and crust formation. We reviewed the published literature to obtain studies that focused on hair reduction for darker skin types. The existing literature for this patient population identifies longer wavelengths as a key element of the treatment protocol and indicates neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, alexandrite, and ruby lasers as well as certain intense pulsed light sources for safe hair reduction with minimal side effects in patients with FST IV–VI, so long as energy settings and wavelengths are appropriate. Based on the findings in this review, safe and effective hair reduction for patients with FST IV–VI is achievable under proper treatment protocols and energy settings.
http://ift.tt/2ukPFXG
Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews
The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis (ARC). To inform the development of recommendations, we...
http://ift.tt/2vIwjuG
Platelets Modulate Innate Immune Response Against Human Respiratory Syncytial Virus In Vitro
Viral Immunology , Vol. 0, No. 0.
http://ift.tt/2hEZ8TG
Role of Ultrasound in Predicting Tumor Invasiveness in Follicular Variant of Papillary Thyroid Carcinoma
http://ift.tt/2uB5Xa7
Role of Ultrasound in Predicting Tumor Invasiveness in Follicular Variant of Papillary Thyroid Carcinoma
http://ift.tt/2uB5Xa7
Photobiomodulation in the Prevention of Tooth Sensitivity Caused by In-Office Dental Bleaching. A Randomized Placebo Preliminary Study
Photomedicine and Laser Surgery Aug 2017, Vol. 35, No. 8: 415-420.
http://ift.tt/2vJTwgW
The History of Photobiomodulation: Endre Mester (1903–1984)
Photomedicine and Laser Surgery Aug 2017, Vol. 35, No. 8: 393-394.
http://ift.tt/2wCFOco
Efficacy of Multiwave Locked System Laser on Pain and Function in Patients with Chronic Neck Pain: A Randomized Placebo-Controlled Trial
Photomedicine and Laser Surgery Aug 2017, Vol. 35, No. 8: 450-455.
http://ift.tt/2vJntOt
Aggressive large-cell neuroendocrine carcinoma of the sigmoid colon in a patient with ulcerative colitis
Colonic inflammation seen in inflammatory bowel disease (IBD) predisposes to the development of colorectal adenocarcinoma. In contrast, colorectal neuroendocrine carcinomas (NECs) have rarely been reported in the setting of IBD, and no definitive relationship between these tumours and IBD has been established. Dysplasia from chronic inflammation leading to neuroendocrine cell differentiation may be responsible for NEC development, though this finding has not been seen consistently. We present a case of large-cell neuroendocrine carcinoma of the sigmoid colon in a 65-year-old woman with long-standing ulcerative colitis. Although she underwent regular endoscopic follow-ups and was receiving the tumour necrosis factor alpha inhibitor infliximab, her tumour was large and aggressive, with metastases to the liver discovered at time of diagnosis. This case highlights the aggressive nature and poor prognosis of NECs and stresses the need to identify patients at high risk of developing NECs and develop improved surveillance guidelines for detecting them.
http://ift.tt/2uBiRVk
Rare combination of left-sided congenital diaphragmatic hernia and omphalocele
We reported a rare case of left-sided posterolateral congenital diaphragmatic hernia (CDH) and omphalocele, which is not associated with chromosomal abnormalities or other syndromes. Omphalocele was detected antenatally (CDH was not detected in antenatal ultrasound). The patient suffered from respiratory failure secondary to severe pulmonary hypertension. As the combination of CDH and omphalocele is rare and with the abdominal content herniating into the omphalocele instead of the thorax, antenatal diagnosis of such condition can be difficult. Unlike other reported cases in the literature, our patient's respiratory condition has been improving with time and is surviving beyond the infancy period. We believe this to be the first such survival case reported in the literature.
http://ift.tt/2ukFpyk
Gallstone ileus of the duodenum: an unexpected presentation of Bouveret's syndrome
This report describes a patient who presented with a large gallstone obstructing the duodenal bulb, with the chief complaint of acute on chronic abdominal pain. Classically, this is known as Bouveret's syndrome or a gallstone ileus of the duodenum. Our patient's current health status presented a challenge, with the presence of several comorbidities, particularly a large abdominal aortic aneurism. We chose an open procedure for this reason. The stone was removed through a laparotomy, and the cholecystoduodenal fistula that the stone used to pass into the small bowel was repaired. With our patient's future medical needs in mind, only the necessary interventions were performed to regain functionality of the bowel. This came in the form of a diverting gastrojejunostomy, with a distal jejunostomy and feeding tube inserted. The patient tolerated the procedure well, only remaining intubated postoperative due to her chronic obstructive pulmonary disease (COPD). She achieved a complete recovery and transitioned home.
http://ift.tt/2uBkUJi
Splenic rupture following synchronised direct current cardioversion
Atraumatic rupture of the normal spleen is a rare entity. Often, a triggering factor or minor physical event can be ascribed as the aetiology for rupture, including coughing, vomiting or minor medical procedures not involving the spleen. A 65-year-old man who was hospitalised for eosinophilic pneumonia developed haemodynamically unstable atrial flutter that necessitated urgent synchronised direct current cardioversion (DCCV). Two hours after successful cardioversion, he developed signs of an acute abdomen with free intraperitoneal fluid identified on bedside ultrasonography. Exploratory laparotomy revealed gross haemoperitoneum and splenic rupture requiring splenectomy. With exception of capsular defects and haemorrhage suggestive of organ rupture, the gross and histological examination of the spleen was otherwise unremarkable. The patient denied recent trauma. The cause of his spleen rupture was attributed to cardioversion and subsequent abdominal muscle contraction. This represents the first known case of splenic rupture associated with DCCV.
http://ift.tt/2ukJnXR
Reduction en masse of inguinal hernia: a review of a rare and potential fatal complication following reduction of inguinal hernia
Reduction en masse is reduction of a hernial sac into the pre-peritoneal space with a loop of bowel remaining incarcerated at the neck of the sac, leading to early strangulation. This is a rare complication, usually encountered with inguinal hernias, with a false reassurance to the patient and the treating physician that complete reduction has been achieved. Unless early intervention is carried out, this condition will typically present with worsening pain and absence of an appreciable hernia bulge at the groin, and intestinal necrosis may be encountered on exploration. The outcome will depend on the severity of peritonitis/sepsis, and mortality remains high for late presentations. A case of early presentation of reduction en masse of an inguinal hernia is reported with a review of the existing literature.
http://ift.tt/2uAVStJ
Orbital multiple myeloma: a diagnostic challenge
Orbital involvement in multiple myeloma is unusual. We describe the case of an 85-year-old woman who presented with right eye proptosis, reduced visual acuity and diplopia. Computed tomography showed a lobulated, enhancing soft tissue mass arising from the right greater wing of the sphenoid with intraconal, lacrimal gland and ocular muscle involvement. Histopathology revealed predominantly atypical plasma cells in a background of reactive lymphocytes, with monoclonality towards kappa light chain protein, suggestive of multiple myeloma. This case illustrates the diagnostic imaging challenge of orbital multiple myeloma.
http://ift.tt/2ukCWnG
Paraneoplastic cerebellar degeneration secondary to ovarian carcinosarcoma: a cerebellar conundrum
We present a case of an elderly female patient who presented with a 6-month history of progressive slurred speech, vertigo, unsteadiness and falls. She underwent an extensive battery of neurological and cardiovascular investigations, none of which demonstrated a diagnostic cause for her symptoms. She was referred to the stroke and neurology teams and was started on treatment for presumed anxiety. As her symptoms continued to progress, she was referred to the falls service. Following a multidisciplinary team discussion, she was reviewed by the consultant geriatrician who felt this may be due to a malignancy so the consultant geriatrician arranged blood testsand CT scan of her chest, abdomen and pelvis. These demonstrated a large left adnexal mass and a raised Ca-125 level. The patient was diagnosed with an ovarian tumour, which was treated surgically. A provisional diagnosis of paraneoplastic cerebellar degeneration, secondary to ovarian carcinosarcoma, was made.
http://ift.tt/2uBBsk2
Missed diaphragmatic injury after blunt trauma presenting with colonic strangulation: a rare scenario
Diaphragmatic rupture occurs in 4%–5% cases of thoracoabdominal injuries. It may present acutely, in a delayed fashion or as a complicated hernia. We are describing the case of a young male presenting in respiratory distress with history of chest trauma 1.5 years back. On investigation, he was found to have left side diaphragmatic hernia containing gangrenous colon with lung collapse. The patient underwent successful operative intervention and discharged after 25 days of hospital stay. Record review suggested that the above mentioned diaphragm injury was missed in his evaluation 1.5 years back. Diaphragmatic injury must always be suspected in thoracoabdominal injuries, as missed injury may cause devastating complications like the one narrated above in due course.
http://ift.tt/2ukFJgH
An uncommon hip pain
Description
A 55-year-old man with a medical history of hypertension and dyslipidaemia, presented to our Hip clinic with non-traumatic left hip pain of five months duration. The pain was insidious in onset and gradually progressive. The pain aggravated on , prolonged sitting or squatting, and relieved with rest. There was no history of any constitutional symptoms. The gait of the patient was essentially normal. There was tenderness over the anterior joint line and mild pain on flexion and internal rotation of the hip. There was no limb length discrepancy or wasting of the adjacent muscles. Distal neurovascular examination was normal.
A plain X-ray of the pelvis showed an ill-defined expansile lytic lesion involving the left superior pubic ramus with sclerotic margins and few internal septations (figure 1). Further CT and MRI scans defined the extent of the lesion (figure 2A,B,C and 3A,B,C). Through a Pfannenstiel incision, the lesion in the...
http://ift.tt/2uBFbhB
Abdominal aortic aneurysm in the setting of Clostridium perfringens pancreatitis
We report a case of a 56-year-old woman who presented with worsening abdominal pain located in the left upper quadrant together with abdominal distention, nausea and anorexia. One month prior to this admission, she had presented and had been diagnosed with concurrent acute pancreatitis and rapidly expanding abdominal aortic aneurysm. The aneurysm was prioritised over the pancreatitis and she underwent uncomplicated endovascular repair. Cross-sectional imaging was consistent with infected pancreatic necrosis and also revealed a large collection located in the anterior pararenal space with extensive gas formation. An image-guided fluid aspiration revealed Clostridium perfringens as the causative organism. She was treated by placement of large bore drains along with irrigation and targeted intravenous antibiotic for 6 weeks. The collections resolved completely and at 6 months follow-up she was well and symptom free.
http://ift.tt/2ukJrqz
Toe-to-finger combined with free flap transfer for primary one-stage post-traumatic reconstruction of the complex fingerless hand
Toe-to-finger transplantation is intimately related to the development of microsurgical free tissue transplantation, which is one of the most important advances in the history of reconstructive surgery. It is also generally acknowledged that a mangled hand with massive tissue loss and amputation of multiple digits presents a challenge for plastic and reconstructive surgeons. In this retrospective study we reviewed 11 cases of primary one-stage post-traumatic reconstruction of complex fingerless hands using a combination of toe-to-finger and free tissue transplantation performed in Shanghai Jiao Tong University affiliated Sixth People's Hospital and Shanghai Jiao Tong University School of Medicine affiliated Ninth People's Hospital from January 2001 to November 2014.
http://ift.tt/2veB1Qx
The merits of decision modelling in the earliest stages of the IDEAL framework – an innovative case in DIEP flap breast reconstructions
IDEAL framework aims at improving the evidence base of available surgical innovations. However, the development of such innovations and collection of evidence is costly. Surgical innovation can provide more value for money if innovations are evaluated in an early stage, where evaluations can inform the decision whether to stop or further develop an innovation. We illustrate how decision modelling can be readily adopted at the earliest stages (0-1) of the IDEAL framework, using an innovation in bilateral DIEP flap breast reconstruction as an example.
http://ift.tt/2wp5Dx6
Frailty and Risk of Cardiovascular Diseases in Older Persons: The Age, Gene/Environment Susceptibility-Reykjavik Study
Rejuvenation Research , Vol. 0, No. 0.
http://ift.tt/2uATyTx
Medical Podcasting and Circulation on the Run: Why, How, and What Now.
Author: Lam, Carolyn S.P. MBBS, PhD; Barry, Karen MS; Khera, Amit MD, MSc
Page: 513-515
http://ift.tt/2vJIAQC
Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study.
Author: Oishi, Emi MD; Ohara, Tomoyuki MD, PhD; Sakata, Satoko MD; Fukuhara, Masayo MD, PhD; Hata, Jun MD, PhD; Yoshida, Daigo PhD; Shibata, Mao MD, PhD; Ohtsubo, Toshio MD, PhD; Kitazono, Takanari MD, PhD; Kiyohara, Yutaka MD, PhD; Ninomiya, Toshiharu MD, PhD
Page: 516-525
http://ift.tt/2wCiuew
Rollercoaster Blood Pressure: An Alzheimer Disease Risk Factor?.
Author: Merkler, Alexander E. MD; Iadecola, Costantino MD
Page: 526-528
http://ift.tt/2vJEyrf
When Lightning Strikes: Fulminant Myocarditis in the Realm of Inflammatory Cardiomyopathies.
Author: Cooper, Leslie T. Jr MD
Page: 546-548
http://ift.tt/2vJpRVc
Fibroblast-Specific Genetic Manipulation of p38 Mitogen-Activated Protein Kinase In Vivo Reveals Its Central Regulatory Role in Fibrosis.
Author: Molkentin, Jeffery D. PhD; Bugg, Darrian BS; Ghearing, Natasha BS; Dorn, Lisa E. BS; Kim, Peter BS; Sargent, Michelle A. BS; Gunaje, Jagadambika BS; Otsu, Kinya MD, PhD; Davis, Jennifer PhD
Page: 549-561
http://ift.tt/2wC3SMq
p38[alpha]: A Profibrotic Signaling Nexus.
Author: Stratton, Matthew S. PhD; Koch, Keith A. PhD; McKinsey, Timothy A. PhD
Page: 562-565
http://ift.tt/2vJkvt7
EphA2 Expression Regulates Inflammation and Fibroproliferative Remodeling in Atherosclerosis.
Author: Finney, Alexandra C. BS; Funk, Steven D. PhD; Green, Jonette M. BS; Yurdagul, Arif Jr PhD; Rana, Mohammad Atif MD; Pistorius, Rebecca MD; Henry, Miriam BS; Yurochko, Andrew PhD; Pattillo, Christopher B. PhD; Traylor, James G. MD; Chen, Jin MD, PhD; Woolard, Matthew D. PhD; Kevil, Christopher G. PhD; Orr, A. Wayne PhD
Page: 566-582
http://ift.tt/2wC3SvU
Modifiable Risk Factors and Atrial Fibrillation.
Author: Lau, Dennis H. MBBS, PhD; Nattel, Stanley MD, PhD; Kalman, Jonathan M MBBS, PhD; Sanders, Prashanthan MBBS, PhD
Page: 583-596
http://ift.tt/2vJJc8T
How Low Is Too Low With Salt in Heart Failure? Randomized Studies Needed to Resolve Concern.
Author: Kuehn, Bridget M.
Page: 597-598
http://ift.tt/2wCosMP
Worsening Conduction Delay in Hypertrophic Cardiomyopathy: What Drug Is Responsible?.
Author: Garcia-Granja, Pablo Elpidio MD; Sandin-Fuentes, Maria MD; Garcia-Moran, Emilio MD, PhD; Sevilla, Teresa MD, PhD; Rubio, Jeronimo MD, PhD
Page: 599-601
http://ift.tt/2vJNn4H
Prasugrel or Ticagrelor in ST-Segment-Elevation Myocardial Infarction Patients With Diabetes Mellitus.
Author: Sardella, Gennaro MD *; Mancone, Massimo MD, PhD; Stio, Rocco Edoardo MD, PhD; Cavallo, Erika MD; Di Roma, Angelo MD; Colantonio, Riccardo MD; Calcagno, Simone MD *
Page: 602-604
http://ift.tt/2wCerPp
Letter by Iellamo and Volterrani Regarding Article, "High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction".
Author: Iellamo, Ferdinando MD; Volterrani, Maurizio MD, PhD
Page: 605-606
http://ift.tt/2vJDYKm
Letter by Wisloff et al Regarding Article, "High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction".
Author: Wisloff, Ulrik PhD; Lavie, Carl J. PhD, MD; Rognmo, Oivind PhD
Page: 607-608
http://ift.tt/2wCBSrM
Letter by Bianchi Regarding Article, "High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction".
Author: Bianchi, Vittorio Emanuele MD
Page: 609-610
http://ift.tt/2vJFuvS
Response by Ellingsen et al to Letters Regarding Article, "High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction".
Author: Ellingsen, Oyvind MD, PhD; Halle, Martin MD; Prescott, Eva MD, DMSc; Linke, Axel MD
Page: 611-612
http://ift.tt/2wCmBaC
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.
Author: Yancy, Clyde W. MD, MSc, MACC, FAHA, FHFSA, Chair; Jessup, Mariell MD, FACC, FAHA, Vice Chair; Bozkurt, Biykem MD, PhD, FACC, FAHA *+; Butler, Javed MD, MBA, MPH, FACC, FAHA *++; Casey, Donald E. Jr MD, MPH, MBA, FACC [S]; Colvin, Monica M. MD, FAHA %7c%7c; Drazner, Mark H. MD, MSc, FACC, FAHA, FHFSA ++; Filippatos, Gerasimos S. MD *; Fonarow, Gregg C. MD, FACC, FAHA, FHFSA *++; Givertz, Michael M. MD, FACC, FHFSA *[P]; Hollenberg, Steven M. MD, FACC #; Lindenfeld, JoAnn MD, FACC, FAHA, FHFSA *[P]; Masoudi, Frederick A. MD, MSPH, FACC **; McBride, Patrick E. MD, MPH, FACC ++; Peterson, Pamela N. MD, FACC, FAHA ++; Stevenson, Lynne Warner MD, FACC *++; Westlake, Cheryl PhD, RN, ACNS-BC, FAHA, FHFSA [P]
Page: e137-e161
http://ift.tt/2vJjK3h
MicroRNA-150 controls differentiation of intraepithelial lymphocytes via TGF-β receptor II regulation
miR-150 deficiency reduces IEL population in the small intestine, resulting in increased susceptibility to anti-cancer drug-induced damage in the intestinal epithelial cells.
http://ift.tt/2ukIuyr
More Than a Decade Follow-up in Severe or Difficult-to-Treat Asthma: TENOR II
More than a decade after TENOR I, substantial disease burden, including high rates of comorbidities, allergic sensitization, poorly controlled asthma, and exacerbations were observed in patients with severe or difficult-to-treat asthma in TENOR II, despite standard-of-care therapy.
http://ift.tt/2uBnS0h
Propagation of respiratory viruses in human airway epithelia reveals persistent virus-specific signatures
Using reconstituted airway epithelia, we highlight marked differences in in vitro pathogenesis of respiratory viruses. In the absence of immune cells, we observe viral persistence linked to a contained tissue-response rather than to viral mutations.
http://ift.tt/2ukv4m8
Anaphylaxis associated with omalizumab administration: Risk factors and patient characteristics
Source:Journal of Allergy and Clinical Immunology
Author(s): Phillip L. Lieberman, Ilisten Jones, Richa Rajwanshi, Karin Rosén, Dale T. Umetsu
http://ift.tt/2fnArdu
MicroRNA-150 controls differentiation of intraepithelial lymphocytes via TGF-β receptor II regulation
Publication date: Available online 7 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sang-Hwan Seo, Min Seong Jang, Doo-Jin Kim, Seok-Min Kim, Se-Chan Oh, Cho-Rok Jung, Yunji Park, Sang-Jun Ha, Haiyoung Jung, Young-Jun Park, Suk Ran Yoon, Inpyo Choi, Tae-Don Kim
BackgroundIntraepithelial lymphocytes (IELs) in the intestines play pivotal roles in maintaining the integrity of the mucosa, regulating the immune cells, and protecting against pathogenic invasion. Although several extrinsic factors such as transforming growth factor-β (TGF-β) have been identified to contribute to IEL generation, intrinsic regulatory factors have not been fully determined.ObjectiveHere, we investigated the regulation of IEL differentiation and the underlying mechanisms in mice.MethodsWe analyzed IELs and the expression of molecules associated with IEL differentiation in wildtype control and microRNA-150-knockout mice. Methotrexate (MTX) was administered to mice lacking microRNA (miR)-150 and control mice.ResultsmiR-150 deficiency reduced the IEL population in the small intestine and increased susceptibility to MTX-induced mucositis. Evaluation of expression of IEL differentiation-associated molecules showed that miR-150-deficient IELs exhibited decreased expression of TGF-β receptor II (TGF-βRII), CD103, CD8αα, and RUNX3 in all the IEL subpopulations. The reduced expression of TGF-βRII in miR-150-deficient IELs was caused by the increased expression of c-Myb/miR-20a. Restoration of miR-150 or inhibition of miR-20a recovered the TGF-βRII expression.ConclusionmiR-150 is an intrinsic regulator of IEL differentiation through TGF-βRII regulation. miR-150-mediated IEL generation is crucial for maintaining intestinal integrity against anticancer drug-induced mucositis.
Graphical abstract
Teaser
miR-150 deficiency reduces IEL population in the small intestine, resulting in increased susceptibility to anti-cancer drug-induced damage in the intestinal epithelial cells.http://ift.tt/2hFlaFK
More Than a Decade Follow-up in Severe or Difficult-to-Treat Asthma: TENOR II
Publication date: Available online 7 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Bradley E. Chipps, Tmirah Haselkorn, Brandee Paknis, Benjamin Ortiz, Eugene R. Bleecker, Farid Kianifard, Aimee J. Foreman, Stanley J. Szefler, Robert S. Zeiger
BackgroundThe Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR I) study demonstrated high morbidity in patients with severe/difficult-to-treat asthma, despite standard-of-care treatment.ObjectiveTo determine the long-term natural history of disease and outcomes in patients in TENOR I, after more than a decade.MethodsTENOR I was a multicenter, observational study (2001–2004) of 4756 patients with severe/difficult-to-treat asthma. TENOR II was a follow-up study of TENOR I patients using a single, cross-sectional visit in 2013/2014. Overall, the sites participating in TENOR II originally enrolled 1230 patients in TENOR I. Clinical and patient-reported outcomes were assessed, including very poorly controlled (VPC) asthma based on National Heart, Lung, and Blood Institute (NHLBI) guidelines.ResultsA total of 341 (27.7%) patients were enrolled in TENOR II and were representative of the TENOR I cohort. Most frequent comorbidities were rhinitis (84.0%), sinusitis (47.8%) and gastroesophageal reflux disease (46.3%). Mean (SD) percent predicted pre- and post-bronchodilator FEV1 were 72.7% (21.4%) and 78.2% (20.7%), respectively. A total of 231/317 (72.9%) tested positive for ≥1 allergen-specific IgE. Mean (SD) blood eosinophil count was 200 μL (144). Eighty-eight (25.8%) patients experienced an asthma exacerbation in the prior 3 months requiring hospital attention and/or oral corticosteroids. Over half (197/339; 58.1%) had VPC asthma. Medication use suggested undertreatment.ConclusionTENOR II provides longitudinal data to characterize disease progression, heterogeneity and severity in severe/difficult-to-treat asthma. Findings show continued morbidity, including a high degree of comorbid conditions, allergic sensitization, exacerbations and VPC asthma, including reduced lung function.
Teaser
More than a decade after TENOR I, substantial disease burden, including high rates of comorbidities, allergic sensitization, poorly controlled asthma, and exacerbations were observed in patients with severe or difficult-to-treat asthma in TENOR II, despite standard-of-care therapy.http://ift.tt/2hE5nHd
FPIES: not so rare after all!
Source:Journal of Allergy and Clinical Immunology
Author(s): Anna Nowak-Wegrzyn, Jonathan M. Spergel
http://ift.tt/2fnYCsn
Comparison between autogenous iliac bone and freeze-dried bone allograft for repair of alveolar clefts in the presence of plasma rich in growth factors: A randomized clinical trial
This study aimed to compare the effectiveness of alveolar cleft repair using iliac bone and freeze-dried bone allograft (FDBA) in the presence of plasma rich in growth factors (PRGF).
http://ift.tt/2ujt3lY
Cementoblastoma: an updated analysis of 258 cases reported in the literature
To investigate the recurrence rate of cementoblastomas for different variables aside from the clinical/radiologic features.
http://ift.tt/2vHKOip
Clarifying a Hierarchical Model of Risk Factors for Social Anxiety and Depression
Source:Journal of Anxiety Disorders
Author(s): Nicholas P. Allan, Danielle Cooper, Mary E. Oglesby, Nicole Short, Kevin G. Saulnier, Norman B. Schmidt
Within a hierarchical framework for depressive and anxiety disorders, negative affect (NA) is posited to be indirectly related to social anxiety and depression through cognitive vulnerabilities, including intolerance of uncertainty (IU) and anxiety sensitivity (AS). However, few prior studies have considered whether the lower-order dimensions of IU (i.e., prospective and inhibitory IU) and AS (i.e., physical, cognitive, and social concerns) better explain the indirect relation between NA and social anxiety and depression. The indirect relations between NA and social anxiety and depression through these cognitive vulnerabilities were examined using structural equation modeling in a clinical sample (N=298). NA and social anxiety symptoms were indirectly related through AS social concerns and inhibitory IU, although a direct effect of NA was also found. Only AS social concerns explained the relation between NA and a social anxiety disorder diagnosis. AS cognitive concerns was the only cognitive vulnerability factor to indirectly explain the relation between NA and depressive symptoms, although a direct effect of NA was also found. These findings suggest that the lower-order dimensions of AS and IU demonstrate more specific and less transdiagnostic associations with social anxiety and depression.
http://ift.tt/2wowNUO
Voice-Specialized Speech-Language Pathologist's Criteria for Discharge from Voice Therapy
No standard protocol exists to determine when a patient is ready and able to be discharged from voice therapy. The aim of the present study was to determine what factors speech-language pathologists (SLPs) deem most important when discharging a patient from voice therapy. A second aim was to determine if responses differed based on years of voice experience.
http://ift.tt/2uAWf7A
Factors Affecting Voice Therapy Completion in Singers
The purpose of this study was to determine (a) which factors may affect singers' completing voice therapy, and (b) develop predictive profiles to capture those singers at risk for dropping out of voice therapy.
http://ift.tt/2ukmaFe
Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study
Background. Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view () could be assumed to decrease PTH compared to traditional tonsillectomy (). Methods. In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery or thereafter ). The findings at resection site and pain were measured. Results. 869 patients were included (183 ; 686 ). PTH requiring RTT was not seen in the group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (). Postoperative edema and local infection at resection site were proven to be predictive of PTH (). Conclusion. Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the group. Benefit for was observed in high-volume and long experienced surgeons.
http://ift.tt/2vfQT3u
Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study
Background. Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view () could be assumed to decrease PTH compared to traditional tonsillectomy (). Methods. In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery or thereafter ). The findings at resection site and pain were measured. Results. 869 patients were included (183 ; 686 ). PTH requiring RTT was not seen in the group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (). Postoperative edema and local infection at resection site were proven to be predictive of PTH (). Conclusion. Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the group. Benefit for was observed in high-volume and long experienced surgeons.
http://ift.tt/2vfQT3u
Oral administration of geranylgeranylacetone to protect vestibular hair cells
Publication date: Available online 7 August 2017
Source:Auris Nasus Larynx
Author(s): Shinpei Nagato, Kazuma Sugahara, Yoshinobu Hirose, Yousuke Takemoto, Makoto Hashimoto, Hironori Fujii, Hiroshi Yamashita
ObjectiveWe recently reported that the heat shock response played a major role in the protection of hair cells against stress. Oral administration of the heat shock inducer, geranylgeranylacetone (GGA) protected hair cells against intense noise. In our present study, we investigated the effect of GGA on vestibular hair cell death induced by an aminoglycoside.MethodsWe used CBA/N mice aged 4–6 weeks. The mice were divided into two groups, GGA and control. Mice in the GGA group were fed a diet containing GGA (0.5%) for 4 weeks, and those in the control group were fed a standard diet. Immunohistochemical analyses for Hsp70 were performed in four animals. The utricles of the remaining animals were cultured in medium for 24h with neomycin to induce hair cell death. After fixation, the vestibular hair cells were immunohistochemically stained against calmodulin, and hair cell survival was evaluated.ResultsThe vestibular hair cells of mice in the GGA group expressed Hsp70. In addition, after exposure to neomycin, vestibular hair cell survival was higher in the GGA group than in the control group.ConclusionOur results demonstrated the oral administration of GGA induced the heat shock response in the vestibule and could protect sensory cells.
http://ift.tt/2woAha7
Pathophysiology and immunological profile of myasthenia gravis and its subgroups
Fredrik Romi | Yu Hong | Nils Erik Gilhus
http://ift.tt/2woL9EM
Known unknowns: how might the persistent herpesvirome shape immunity and aging?
Janko Nikolich-Zugich | Felicia Goodrum | Kenneth Knox | Megan J Smithey
http://ift.tt/2vdNi7v
Salinity stress, enhancing basal and induced immune responses in striped catfish Pangasianodon hypophthalmus (Sauvage)
Publication date: Available online 7 August 2017
Source:Journal of Proteomics
Author(s): Mélodie Schmitz, Tamar Ziv, Arie Admon, Sébastien Baekelandt, Syaghalirwa N.M. Mandiki, Maëlenn L'Hoir, Patrick Kestemont
In the Mekong Delta, striped catfish are faced with chronic salinity stress related to saltwater intrusion induced by global climatic changes. In this study, striped catfish juveniles were submitted to a prolonged salinity stress (up to 10ppt) over three weeks followed by infection with a virulent bacterial strain, Edwardsiella ictaluri. Osmoregulatory parameters were investigated. In addition, a label free quantitative proteomics workflow was performed on kidneys. The workflow consisted of an initial global profiling of relative peptide abundances (by LC/MS, peak area quantification based on extracted ion currents), followed by identification (by MS/MS). The aim of the study was to highlight specific functional pathways modified during realistic salinity stress, particularly those involved in immunity. In kidney proteome, 2483 proteins were identified, of which 400 proteins were differentially expressed between the freshwater and the saline water conditions. Several pathways and functional categories were highlighted, mostly related to energy metabolism, protein metabolism, actin cytoskeleton, signaling, immunity, and detoxification. In particular, the responsiveness of proteins involved in small GTPases and Mitogen Activated Protein Kinase p38 signaling, phagolysosome maturation, and T-cells regulation is discussed.Statement of significanceIn the Mekong River Delta (Vietnam), striped catfish production is threatened by extensive sea water intrusion exacerbated by sea level rise. In fish, the effect of chronic exposure to salinity stress on immune capacities and response to disease has been poorly investigated. This study aims to highlight the main molecular changes occurring in the kidney during acclimation to salinity stress, particularly those involved in the immune defences of fish.
Graphical abstract
http://ift.tt/2hEtci0
Hyoscine butylbromide for colorectal polyp detection: prospective, randomized, placebo-controlled trial
OBJECTIVES: The removal of pre-malignant colorectal lesions prevents cancer. Hyoscine has been proposed as a means of improving diagnosis by reducing colonic movements. The aim of this study was to analyze whether this anti-spasmodic enhances the detection of pre-malignant colorectal lesions. METHODS: In a randomized, double-blinded fashion patients received hyoscine or a saline solution in all consecutive colonoscopies in which the cecum was reached. Lesions were analysed with respect to number, size, location, histology and capillary pattern. RESULTS: A total of 440 colonoscopies were randomized. The overall polyp detection rate (PDR) and the adenoma detection rate (ADR) were 65.2% and 49.3%, respectively. In the hyoscine group, non-polypoid lesions were detected significantly more often (p=0.01). In the placebo group 281 lesions were diagnosed (202 adenomas) and in the hyoscine group 282 lesions were detected (189 adenomas) (p=0.23). The PDR and ADR were similar between the placebo and hyoscine groups (64% vs 66% and 50% vs 47%, respectively). No differences were observed between the two groups in the advanced-ADR or advanced neoplasia detection rate, as well the mean numbers of polyps, adenomas, advanced adenomas and advanced neoplasias detected per patient. The administration of hyoscine also did not improve the diagnostic accuracy of digital chromoendoscopy. The presence of adenomatous polyps in the right colon was detected significantly more frequently in the hyoscine group (OR 5.41 95% CI 2.7 - 11; p<0.01 vs OR 2.3 95% CI 1.1 - 4.6; p=0.02). CONCLUSION: The use of hyoscine before beginning the withdrawal of the colonoscope does not seem to enhance the PDR and the ADR.
http://ift.tt/2vJpb1Z
Clinical Features of Refractory Ascites in Outpatients
OBJECTIVES: To present the clinical features and outcomes of outpatients who suffer from refractory ascites. METHODS: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month. RESULTS: The most common etiology of cirrhosis in both groups was alcoholism [49 refractory (R) and 11 non-refractory ascites (NR)]. The majority of patients in the refractory group had Child-Pugh class B cirrhosis (p=0.034). The nutritional assessment showed protein-energy malnutrition in 81.6% of the patients in the R group and 35.5% of the patients in the NR group, while hepatic encephalopathy, hernia, spontaneous bacterial peritonitis, upper digestive hemorrhage and type 2 hepatorenal syndrome were present in 51%, 44.9%, 38.8%, 38.8% and 26.5% of the patients in the R group and 9.1%, 18.2%, 0%, 0% and 0% of the patients in the NR group, respectively (p=0.016, p=0.173, p=0.012, p=0.012, and p=0.100, respectively). Mortality occurred in 28.6% of the patients in the R group and in 9.1% of the patients in the NR group (p=0.262). CONCLUSION: Patients with refractory ascites were malnourished, suffered from hernias, had a high prevalence of complications and had a high postoperative death frequency, which was mostly due to infectious processes.
http://ift.tt/2vJftgb
Laryngeal tube suction for airway management during in-hospital emergencies
OBJECTIVE: The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation laryngeal tube suction (LTS-II/LTS-D) in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation. METHODS: During a seven-year period, patients treated with a laryngeal tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4), who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2) over 5 minutes, subjective overall assessment and complications were recorded. RESULTS: In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80), followed by cardiopulmonary resuscitation (25%, n=26) or an overlap between both (18%, n=19). In 94% of patients (n=100), users placed the laryngeal tube during the first attempt. In 93% of patients (n=98), the tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100) to 99% (5-100) was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg) decreased significantly to an average of 38.4 mmHg (10-62 mmHg) after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference. CONCLUSIONS: LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic intubation become available.
http://ift.tt/2wBIozg
The relationship of the medial roof and the posterior wall of the maxillary sinus to the sphenoid sinus: a radiologic study
Resumo Introdução: O teto medial do seio maxilar é uma crista formada pela margem superior da antrostomia do seio maxilar. A parede posterior do seio maxilar é sempre incluída em campos cirúrgicos. Objetivo: Fazer estudo radiológico para avaliar a utilidade do teto medial do seio maxilar e da parede posterior do seio maxilar como referências anatômicas fixas para fornecer uma via segura de abordagem ao seio esfenoidal. Método: Foram analisados 115 exames de tomografia computadorizada consecutivos dos seios paranasais (230 lados) de pacientes adultos coreanos feitos de janeiro de 2014 a dezembro de 2014. Com o uso do assoalho nasal como ponto de referência, as distâncias verticais entre o teto medial do seio maxilar e o óstio esfenoidal e entre o teto e o assoalho esfenoidal anterior foram medidos. Em seguida, as distâncias verticais do ponto mais alto do teto medial do seio maxilar e o óstio esfenoidal e entre o teto e ao assoalho esfenoidal anterior foram medidas. A distância coronal da parede posterior do seio maxilar ao óstio esfenoidal foi determinada. Resultados: A altura média do ponto mais alto do teto medial do seio maxilar em relação ao assoalho nasal foi medida como 33,83 ± 3,40 mm. A distância vertical média do ponto mais alto do teto medial do seio maxilar até o óstio esfenoidal e do teto ao assoalho esfenoidal anterior foi de 1,79 ± 3,09 mm, de 12,02 ± 2,93 mm e 6,18 ± 2,88 mm, respectivamente. A distância coronal média da parede posterior do seio maxilar ao óstio esfenoidal foi de 0,78 mm. O óstio esfenoidal estava por trás do plano coronal da parede posterior do seio maxilar com mais frequência em 103 lados (44,4%). O mesmo se encontrava no plano coronal em 68 lados (29,3%) e na frente do plano em 61 lados (26,3%). Conclusões: O teto medial do seio maxilar e a parede posterior do seio maxilar podem ser usados como pontos de referência confiáveis para localizar e possibilitar uma abordagem segura ao seio esfenoidal.
http://ift.tt/2vJbU9G
The sphenoid sinus, foramen rotundum and vidian canal: a radiological study of anatomical relationships
Resumo Introdução: O seio esfenoidal (SE) é uma estrutura importante em cirurgias da base do crânio, que está cercada por várias estruturas anatômicas vitais, como as artérias carótidas internas, o nervo óptico e os nervos cranianos no interior do seio cavernoso. Além disso, o forame redondo (FR) é um pequeno canal profundamente situado na base do crânio, que representa a forma de saída do nervo maxilar. Compreender as relações anatômicas do osso esfenoidal é fundamental para as abordagens endonasais expandidas da base do crânio. Objetivo: Registrar e analisar os índices de medição do SE e FR no plano coronal de exames normais de tomografia computadorizada (TC). Método: Os pacientes que foram submetidos a TC dos seios paranasais (SPN) de junho de 2014 a novembro 2015 foram retrospectivamente incluídos neste estudo transversal. Obtivemos várias medidas morfométricas de ambos os lados, direito e esquerdo, com o uso do software de computador. Também classificamos os tipos de FR e canal pterigoideo (CP) e determinamos a posição do FR em relação à base da placa pterigoide lateral. Resultados: Cem pacientes com a média de 38,56 ± 18,51 anos foram incluídos neste estudo. As distâncias médias bilaterais de FR foram de 38,48 ± 3,87 mm. As distâncias médias direita e esquerda dos FR até a linha média foram de 19,00 ± 2,07 e 19,34 ± 2,17 mm, respectivamente (p = 0,03). Vinte e oito casos (28%) tinham canal pterigoideo do tipo I, 48% e 24% canais pterigoideos de tipo II e III, respectivamente. Quatro pacientes (4%) tinham forame redondo do tipo I, 28% e 44% do tipo II-a e II-b, respectivamente, e 24% forame redondo do tipo III. A posição dos FR em relação à base da placa pterigoide lateral era em linha em 50% dos casos, medialmente posicionados em 47% e lateralmente posicionados em 3% dos casos. Conclusão: Os resultados deste estudo podem ser usados para promover uma melhor compreensão anatômica da área, necessária para cirurgias endoscópicas da base do crânio.
http://ift.tt/2vJ5vLQ
Endoscopic repair of cerebrospinal fluid rhinorrhea
Resumo Introdução: A liquorreia nasal indica uma fístula liquórica (FL), uma comunicação aberta entre o líquido cerebrospinal intracraniano e a cavidade nasal. Pode ser traumática e espontânea. Objetivo: Avaliar o desfecho do reparo endoscópico da fístula liquórica nasal com o uso de fluoresceína. Método: Este estudo retrospectivo incluiu 30 pacientes de ambos os sexos, com idade média de 48,7 anos, tratados de 2007 a 2015. Todos os pacientes foram submetidos à administração lombar de solução de fluoresceína de sódio a 5% no pré-operatório. A fístula foi fechada com enxerto de três camadas e cola de fibrina. Resultados: As fístulas de líquido cerebrospinal foram comumente localizadas no seio etmoidal (37%) e esfenoidal (33%). A maioria dos pacientes apresentou fístulas liquóricas traumáticas (2/3). A taxa de sucesso relatada para a primeira tentativa de reparo foi de 97%. Complicações ocorreram em três pacientes: um apresentou hidrocefalia aguda; um, síndrome reversível de encefalopatia no quinto dia de pós-operatório com perda bilateral da visão; e um foi diagnosticado com hidrocefalia dois anos após o reparo de fístula liquórica. Conclusão: O diagnóstico endoscópico e o reparo de fístulas liquóricas nasais com uso de fluoresceína intratecal têm alta taxa de sucesso e baixo índice de complicações.
http://ift.tt/2vJi7CM
Evaluation of vestibular evoked myogenic potentials (VEMP) and electrocochleography for the diagnosis of Ménière's disease
Resumo Introdução: A doença de Ménière (DM) é uma doença da orelha interna caracterizada por vertigem episódica, zumbido, plenitude aural e audição flutuante. Seu diagnóstico pode ser especialmente difícil nos casos em que os sintomas vestibulares estão presentes isoladamente (DM vestibular). O diagnóstico de certeza é histológico e somente pode ser feito no post mortem, após análise do osso temporal. A hidropisia endolinfática é um achado histopatológico da doença e ocorre mais frequentemente na cóclea e sáculo, seguidos pelo utrículo e canais semicirculares. Os potenciais evocados miogênicos vestibulares (VEMP) surgiram como método de avaliação da função vestibular em 1994. Até então não havia uma maneira exclusiva de avaliação da função sacular e do nervo vestibular inferior e como o sáculo era responsável por grande parte dos casos de hidropisia severa, o VEMP apareceu como uma nova ferramenta para auxiliar no diagnóstico da DM. Objetivo: Avaliar a sensibilidade e especificidade do VEMP e da eletrococleografia (ECochG) no diagnóstico da DM em comparação com o diagnóstico clínico. Método: Foram selecionados 12 pacientes (24 orelhas) com diagnóstico de DM definida de acordo com os critérios clínicos propostos pela American Academy of Otolaryngology-Head and Neck Surgery 1995 (AAO-HNS) e 12 voluntários saudáveis alocados no grupo controle (24 orelhas). Considerou-se o diagnóstico clínico pela AAO-HNS como padrão ouro. Todos os pacientes foram submetidos a exame otoneurológico, incluindo audiometria tonal e vocal, VEMP e eletrococleografia extratimpânica. A sensibilidade e especificidade para detectar a presença ou ausência de doença foram calculadas e os respectivos intervalos de confiança de 95% obtidos. A confiabilidade dos testes de diagnóstico VEMP e eletrococleografia em ambas as orelhas foi avaliada pelo índice kappa. Resultados: Em ambos os testes e em ambas as orelhas, a capacidade para diagnosticar os casos saudáveis é alta, a especificidade varia de 84,6%-100%. Além disso, a capacidade dos testes para o diagnóstico da doença varia de baixa a moderada sensibilidade, com valores de 37,5%-63,6%. A concordância dos dois testes na orelha direita, medida pelo coeficiente de kappa, foi igual a 0,54; 95% IC (0,20-0,89) indicaram uma concordância moderada. Para a orelha esquerda essa concordância foi igual a 0,07 com 95% IC (-0,33-0,46), o que indicou uma concordância fraca entre os testes. A sensibilidade do VEMP para a orelha direita foi de 63,6% e para a orelha esquerda, de 62,5%. A sensibilidade da ECochG para a orelha direita foi de 63,6% e 37,5% para a orelha esquerda. Conclusão: A especificidade de ambos os testes foi alta e a sensibilidade do VEMP foi maior do que a da eletrococleografia.
http://ift.tt/2vJhRna
Rhinoseptoplasty in children
Abstract Introduction: Untreated septal and/or nasal pyramid deviation in children should be corrected as soon as possible, because they can result in esthetic or functional problems years later. Objective: To report the surgical experience in treating children with nasal septum and/or nasal pyramid deviation. Methods: Review of medical records of 202 children, 124 (61.4%) males and 78 (38.6%) females, between 4 and 16 years of age (M = 11 years) who underwent rhinoplasty and/or septoplasty in a Pediatric Otolaryngology Service of the Dept. of Otolaryngology and Head and Neck Surgery between January 1994 and January 2010. Results: Septoplasty performed in 157 cases (77.7%); rhinoseptoplasty in 23 cases (11.4%), and rhinoplasty in 22 cases (10.9%). Conclusion: Nasal changes should be corrected in children, in order to provide harmonious growth, and prevent severe sequelae found in mouth breathers.
Resumo Introdução: Desvio do septo e/ou da pirâmide nasal em crianças, se não tratado, pode apresentar problemas estéticos ou funcionais após anos, devendo ser corrigido o quanto antes. Objetivo: Relatar experiência cirúrgica no tratamento de crianças com desvio de septo nasal e/ou pirâmide nasal. Método: Revisão de prontuários de 202 crianças, 124 (61,4%) do gênero masculino e 78 (38,6%) do feminino, entre quatro e 16 anos (M = 11 anos), submetidas a rino e/ou septoplastia de janeiro de 1994 a janeiro de 2010, no Serviço de Otorrinopediatria do Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço. Resultados: Septoplastia feita em 157 casos (77,7%); rinosseptoplastia em 23 casos (11,4%) e rinoplastia em 22 casos (10,9%). Conclusão: Alterações nasais devem ser corrigidas em crianças, para proporcionar crescimento harmônico e evitar as graves sequelas encontradas no respirador bucal.
http://ift.tt/2wBZAob
Effect of cigarette smoke on counts of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa in young patients with perennial allergic rhinitis
Abstract Introduction: In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. Objective: To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. Methods: In a cross-sectional study, forty-four patients were evaluated (aged 7-19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. Results: Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. Conclusions: Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.
Resumo Introdução: Em adolescentes com rinite alérgica perene, a exposição à fumaça do cigarro de tabaco aumenta a contagem de eosinófilos na mucosa nasal. O recrutamento de eosinófilos surge da ação combinada de alguns sinais celulares e moleculares, inclusive a eotaxina. Objetivo: Avaliar o efeito da exposição à fumaça do cigarro de tabaco na contagem de células imunorreativas a eotaxina-1 e eosinófilos na mucosa nasal de crianças e adolescentes com rinite alérgica perene. Método: Em um estudo transversal, 44 pacientes foram avaliados (entre sete e 19 anos): 22 com e 22 sem exposição à fumaça do cigarro de tabaco. Depois de responder a dois questionários validados, sobre asma e alergias na infância e sobre a gravidade dos sintomas nasais, as amostras de mucosa nasal foram obtidas por meio de raspagem do terço médio das conchas inferiores. Em seguida, as contagens de células imunorreativas para eotaxina-1 e eosinófilos foram avaliadas por imuno-histoquímica. Resultados: Os pacientes com exposição à fumaça do cigarro de tabaco apresentaram contagens de células mais elevadas tanto para eotaxina-1 como para eosinófilos em comparação com os pacientes sem exposição à fumaça, sem correlação entre as duas variáveis. No entanto, ambas as contagens, de eotaxina-1 e eosinófilos foram relacionadas com a razão cotinina/creatinina. Conclusões: A exposição à fumaça do cigarro de tabaco pode aumentar a eotaxina-1 e a contagem de eosinófilos na mucosa nasal de pacientes jovens com rinite alérgica perene.
http://ift.tt/2vJhV6h
Sulfated glycosaminoglycans in human vocal fold lamina propria
Resumo Introdução: A distribuição, concentração e função dos glicosaminoglicanos nos diversos tecidos da prega vocal ainda não está esclarecida. Objetivo: Avaliar a distribuição e concentração dos glicosaminoglicanos sulfatados nas diferentes camadas da prega vocal humana de acordo com o sexo e a idade. Método: Foram usadas 11 pregas vocais obtidas de cadáveres (sete homens e quatro mulheres) sem lesão de laringe, com menos de 12 horas de óbito e entre 35 e 98 anos. As pregas foram submetidas à extração de glicosaminoglicanos da cobertura e ligamento e leitura pós-eletroforese. Os dados foram comparados segundo camada, idade e sexo. Resultados: A concentração de dermatan sulfato foi significativamente maior em todas as camadas. Não foram observadas diferenças nas concentrações totais de glicosaminoglicanos nas camadas estudadas quanto ao gênero. É significantemente menor em indivíduos abaixo de 60 anos na cobertura. Conclusão: Dermatam sulfato, condroitim sulfato e heparam sulfato foram observados na cobertura e no ligamento de pregas vocais humanas, de ambos os sexos, sendo a concentração de dermatam sulfato foi significativamente maior em todas as camadas. A concentração de glicosaminoglicanos na cobertura é significativamente menor em indivíduos abaixo de 60 anos em comparação com idosos.
http://ift.tt/2wCimfn
Rhinitis as an associated factor for anxiety and depression amongst adults
Abstract Introduction: Anxiety and depression are frequent disorders of chronic diseases, yet there is no conclusive information to their association with rhinitis. Objective: The objective is to determine the frequency of anxiety and depression and its possible association to allergic rhinitis (AR) and non-allergic rhinitis (NAR). Methods: This is a cross-sectional study in which procured subjects with AR (n = 111), NAR (n = 34) and a control group (n = 96) from the university hospital. The presence of anxiety and depression was considered when it reached a score > 13 based on The Beck Anxiety Inventory Test and The Beck Depression Inventory II Test, respectively. The association between AR and NAR with anxiety and depression was adjusted with the Mantel-Haenszel Method and logistic regression. Results: The frequency for anxiety in AR, NAR and the control group was 45.9%, 52.9%, 10.4%, respectively (p < 0.001); depression frequency was 38.7%, 47.1%, 16.6% (p = 0.0003), respectively. Both AR and NAR were associated to anxiety and depression in women, but not to men. After adjusting the sex: AR was associated to anxiety (OR = 5.7, p < 0.001) and depression (OR = 2.5, p = 0.015), while NAR was also associated to anxiety (OR = 7.8, p < 0.001) and depression (OR = 3.3, p < 0.014). In multivariate analysis it was identified that AR, NAR and the individual's sex (women) were factors associated to anxiety and depression. Results showed that age was only associated to anxiety. Conclusion: AR and NAR are diseases associated to anxiety and depression, at least in women.
Resumo Introdução: Ansiedade e depressão são distúrbios frequentes em doenças crônicas, embora não haja informação conclusiva sobre sua associação com a rinite alérgica. Objetivo: Determinar a frequência de ansiedade e depressão e sua possível associação a rinite alérgica (RA) e rinite não alérgica (NRA). Método: Estudo transversal, no qual indivíduos com RA (n = 111), NRA (n = 34) e um grupo controle (n = 96) foram recrutados a partir do hospital universitário. A presença de ansiedade e depressão foi considerada quando atingiu uma pontuação > 13 no Teste do Inventário de Ansiedade de Beck e no Teste II do Inventário de Depressão de Beck, respectivamente. A associação entre a RA e RNA com ansiedade e depressão foi ajustada com o Método de Mantel-Haenszel e regressão logística. Resultados: A frequência de ansiedade na RA, RNA e grupo controle foi de 45,9%, 52,9%, 10,4%, respectivamente (p < 0,001); a frequência de depressão foi de 38,7%, 47,1%, 16,6% (p = 0,0003), respectivamente. Tanto a RA como a RNA foram associadas a ansiedade e depressão em mulheres, mas não para os homens. Depois de ajustar o sexo: RA foi associada à ansiedade (OR = 5,7, p < 0,001) e depressão (OR = 2,5, p = 0,015), enquanto a RNA foi associada a ansiedade (OR = 7,8, p < 0,001) e depressão (OR = 3,3, p < 0,014). Na análise multivariada identificou-se que a RA, RNA e o sexo do indivíduo (mulheres) foram fatores associados a ansiedade e depressão. Os resultados mostraram que a idade só foi associada à ansiedade. Conclusão: RA e RNA são doenças associadas a ansiedade e depressão, pelo menos em mulheres.
http://ift.tt/2wBFyu6
Comparison of drug-induced sleep endoscopy and Müller's maneuver in diagnosing obstructive sleep apnea using the VOTE classification system
Resumo Introdução: O conhecimento do local da obstrução e do padrão de colapso das vias respiratórias é essencial para determinar o tratamento cirúrgico e clínico corretos de pacientes com Síndrome de Apneia Obstrutiva do Sono (SAOS). Para este fim, vários testes e procedimentos de diagnóstico foram desenvolvidos. Objetivo: Determinar se a Endoscopia de Sono Induzido por Fármacos (DISE) ou Manobra de Müller (MM) seria mais bem-sucedida na identificação do local de obstrução e do padrão de colapso das vias respiratórias superiores em pacientes com SAOS. Método: O estudo incluiu 63 pacientes (52 do sexo masculino e 11 do sexo feminino) que foram diagnosticados com SAOS em nossa clínica. As idades variaram de 30 a 66 anos e a idade média foi de 48,5 anos. Todos os pacientes foram submetidos a DISE e MM e os resultados destes exames foram caracterizados de acordo com a região/grau de obstrução, bem como a classificação VOTE. Os resultados de cada teste foram analisados de acordo com o nível das vias respiratórias superiores e comparados por análise estatística (teste estatístico kappa de Cohen). Resultados: Houve concordância estatisticamente significativa entre os resultados da DISE e MM para os procedimentos que envolvem configuração anteroposterior (73%), lateral (92,1%) e concêntrica (74,6%) do véu palatino. Os resultados da parte lateral da orofaringe também estavam em concordância entre os testes (58,7%). Os resultados da configuração lateral da epiglote estavam em concordância entre os testes (87,3%). Não houve concordância estatisticamente significativa entre os dois exames para os procedimentos que envolvem a parte anteroposterior da língua (23,8%) e epiglote (42,9%). Conclusão: Sugere-se que a DISE apresenta várias vantagens, como segurança, facilidade de uso e confiabilidade, que superam a MM em termos da capacidade de diagnosticar locais de obstrução e o padrão de colapso da via respiratória superior. O MM pode também fornecer algum conhecimento sobre o padrão de colapso da faringe. Além disso, recomendamos o uso da classificação VOTE em combinação com DISE.
http://ift.tt/2wBTN1O
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