Head and Neck Diseases by Alexandros G.Sfakianakis: 09/26/17

Erosive adenoma of the nipple (EAN) is a benign condition that involves major ducts of the nipple. Its clinical presentation may resemble other disorders. Complete removal of the nipple is often suggested because of frequent relapse. However, adverse cosmetic and functional results have prompted clinicians to look for other more conservative options.

Aims

To present a case of EAN successfully treated using Mohs micrographic surgery (MMS) and summarize differential diagnosis and treatment.

Materials and Methods

A 40-year-old woman with EAN was diagnosed by immunohistochemical markers after clinical suspicion. We have reviewed other cases treated with MMS in the literature.

Results

In this patient, lesion size was 0.8 cm and the margin specimen was 1 × 0.9 × 0.2 cm, with EAN as histopathologic diagnosis. No atypia or malignancy was reported. Final esthetic outcome was reached with only one session, under local anesthesia and on an outpatient basis.

Discussion

Dermatologic lesions appearing on the nipple's surface should be closely followed. Paget's disease, carcinoma or proliferative lesions like EAN have to be considered, and such conditions require different surgical approaches. Traditional complete removal of the nipple is performed in many cases, but it may result in over-treatment and unfavorable cosmetic outcome. MMS is frequently used in dermatologic surgery to treat malignant lesions with a high cure rate, avoiding excess tissue excision and leading to better patient satisfaction.

Conclusion

EAN can be successfully treated by minimal resection, especially if early diagnosis is done. MMS offers a better aesthetic outcome than traditional total excision.

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Oral lesions of acute generalized exanthematous pustulosis

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Reply to “Significance of interferon gamma in the prediction of successful therapy of common warts by intralesional injection of Candida antigen”

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Tocotrienol-rich fraction attenuates UV-induced inflammaging: A bench to bedside study

Summary

Background

UV radiation from the sun is the most common environmental stressor to damage the skin. It is now well established that photodamaged skin manifests signs of mild but chronic inflammation, termed as "inflammaging." Thus, there is an urgent need for anti-inflammatory regimes that can limit the damage caused by inflammation.

Objectives

This study aimed to evaluate the possible palliative effects of a new topical nanoemulsion formulation containing tocotrienol-rich fraction (TRF) on UV-induced inflammation (erythema) of human skin.

Methods

An in vitro model was used to demonstrate the ability of TRF to alleviate photodamage via attenuation of UV-induced oxidative stress and inflammation. Two ex vivo models (skin antioxidative potential and radical sun protection factor) were used to determine the efficacy of different formulations of TRF on the skin. A UV-induced erythema protection test in 20 subjects was conducted.

Results

In vitro studies involving HaCaT keratinocytes revealed that TRF possesses marked anti-inflammatory properties, as indicated by the attenuation of UV-induced upregulation of pro-inflammatory cytokines. A 1% TRF formulation was found to be more effective in enhancing the endogenous antioxidative protection of skin compared to 1% TRF in medium chain triglycerides because of its higher penetration kinetic profile. The clinical study showed that formulated TRF was effective in reducing skin redness after UV irradiation as early as after 6 hours of application. A significant depigmentation was also observed in TRF treatment subjects.

Conclusion

TRF may serve as an anti-inflammatory compound that is safe to be applied daily to protect the skin from UV-induced inflammaging.

http://ift.tt/2wVmsyX

Tocotrienol-rich fraction attenuates UV-induced inflammaging: A bench to bedside study

Summary

Background

Objectives

This study aimed to evaluate the possible palliative effects of a new topical nanoemulsion formulation containing tocotrienol-rich fraction (TRF) on UV-induced inflammation (erythema) of human skin.

Methods

Results

Conclusion

TRF may serve as an anti-inflammatory compound that is safe to be applied daily to protect the skin from UV-induced inflammaging.

http://ift.tt/2wVmsyX

Risk prediction tools for keratinocyte carcinoma after solid organ transplantation: a review of the literature

Summary

Long-term iatrogenic immunosuppression increases the risk of cutaneous malignancies in organ transplant recipients (OTRs), particularly the keratinocyte cancers basal cell carcinoma and cutaneous squamous cell carcinoma (cSCC). cSCC is the most common malignancy in OTRs, with the risk increased to over 65-fold in transplanted patients relative to the general population. There have been very few risk prediction tools developed for accurate determination of the risk of developing keratinocyte cancers in the OTR population. This review summarizes the prediction tools developed to date, and outlines future directions for developing more accurate prediction models that are clinically useful for the transplant physician and dermatologist.

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Risk prediction tools for keratinocyte carcinoma after solid organ transplantation: a review of the literature

Summary

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Grounding a natural background level for fluoride in a potentially contaminated crystalline aquifer in south India

Abstract

Fluoride contamination is one of the most alarming issues for those countries that depend on groundwater drinking water supply. A careful examination of the hydrogeochemical conditions and routine monitoring of fluoride level are therefore quintessential. Estimation of natural background level (NBL) of fluoride becomes significant information for assessing the current and future contamination episodes. Vellore District in Tamil Nadu is a hard rock terrain known for its F-rich groundwater. In this study, we attempted to form a benchmark for fluoride using hydrochemical pre-selection (based on TDS and NO₃) and cumulative probability plots (CPP). Principle components analysis is (PCA) applied to evaluate the corresponding factor grouping of the total of 68 samples, which is later mapped using geostatistical tool in ArcGIS. From the CPP, we derived the NBL of F as 0.75 mg/L. This value is compared with the observed concentration in each sample and they were spatially plotted based on the NBL. Resultant plot suggests that W-NW part of the study area has exceeded and E-EW regions are below the NBL of F. Spatial variation of the factor scores also supported this observation. Grounding an NBL and extending it to other parts of the potential contaminated aquifers are highly recommended for better understanding and management of the water supply systems.

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Heavy metal pollution in Nanchang City and its health implication on traffic policemen

Abstract

The purpose of this study is to evaluate the health effect of heavy metal pollution in air pollutants on traffic policemen. This study will facilitate the scientific evaluation of health status of traffic policemen. PM₁₀ samples were collected from industrial area, congested traffic area and residential area respectively in Nanchang City, and the concentrations of heavy metals were analyzed. The traffic policemen were examined through chest X-rays. The total of 637 urine samples and 142 blood samples have been collected, and the concentrations of Pb in samples were detected. Vehicle flux data of Nanchang City were collected from the Department of Transport's Traffic Management. Statistic analyses were carried out by statistics software of Excel 2003 and SPSS20.0, and the health effect of heavy metal pollution of PM₁₀ on the traffic policemen was evaluated. The discharge of pollutants from enterprises is an important reason for the high content of heavy metals in urban air pollution. With the rapid growth of urban traffic flow, Bayi Bridge becomes an important transportation hinge in Nanchang City, and the bidirectional traffic flow rate through the bridge at peak hours reached 99 vehicles per minute. The latent hazard of occupational harm on the traffic policemen caused by automobile exhaust is increasing. The concentration of Pb in the urine and blood samples from traffic policemen working in Nanchang City was 268.310 ± 177.031 and 22.873 ± 21.137 μg/L, respectively. Both results (2.04% of Pb in urine and 18.31% of Pb in blood) exceeded the highest limit of observed occupationally outdoor workers. This study provides an initial contribution for the assessment of city air pollution, esp. the health effect of heavy metal (Pb) pollution on traffic policemen.

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In situ remediation of tetrachloroethylene and its intermediates in groundwater using an anaerobic/aerobic permeable reactive barrier

Abstract

Tetrachloroethylene (PCE) is among the most ubiquitous chlorinated compounds found in groundwater contamination. Its chlorinated degradation by-products remain highly toxic. In this study, an anaerobic/aerobic permeable reactive barrier system consisting of four different functional layers was designed to remediate PCE-contaminated groundwater. The first (oxygen capture) layer maintained the dissolved oxygen (DO) concentration at < 1.35 mg/L in influent supplied to the second (anaerobic) layer. The third (oxygen-releasing) layer maintained DO concentration at > 11.3 mg/L within influent supplied to the fourth (aerobic) layer. The results show that 99% of PCE was removed, mostly within the second layer (anaerobic). Furthermore, the toxic by-products trichloroethylene (TCE), dichloroethylene (DCE), and vinyl chloride (VC) were further degraded by 98, 90, and 92%, respectively, in layer 4 (aerobic). Thus, the designed anaerobic/aerobic permeable reactive barrier system could control both PCE and its degradation by-products, showing great potential as an efficient remediation alternative for the in situ treatment of PCE-contaminated groundwater.

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Effects of metal ions on the cultivation of an oleaginous microalga Chlorella sp.

Abstract

A coupling technique to purify wastewater for lipid production based on microalgae is attractive and promising for its potential to clean water and as biofuel feedstocks. Metal ions from wastewater might be involved in microalgal cultivation. In this study, the effects of metal ions on algal growth, lipid-producing potential, and water purifying capability of Chlorella sp. HQ were investigated. The effects of metal ions (Cr⁶⁺, Cu²⁺, Mn²⁺, Zn²⁺, Fe³⁺, Na⁺, and K⁺) on alga lipid production combined with water purification showed that Chlorella sp. HQ had strong resistance to metal ions and could efficiently remove them (Fe³⁺ 85.40~98.73%, Mn²⁺ 45.63~97.24%, Zn²⁺ 81.93~100.00%, Cu²⁺ 81.71~95.19%, Cr⁶⁺ 20.07~45.60%). Meanwhile, nutrient removal (total nitrogen (TN) 78.15~94.77%, total phosphorus (TP) 80.52~100%) was not inhibited by metal ions. Besides that, the highest algal biomass, lipid yield, and triacylglycerol (TAG) yield peaked at 350.00 ± 31.50, 87.50 ± 3.54, and 33.39 ± 19.42 mg L⁻¹, respectively, with the addition of Fe³⁺ (6.6 mg L⁻¹), Na⁺ (101.81 mg L⁻¹), and K⁺ (31.9 mg L⁻¹). The lipid/TAG content significantly increased up to 54.17 ± 11.91%/44.92 ± 0.42%, 100%/100%, 32.56 ± 12.40%/37.53 ± 4.58%, and 77.50 ± 1.77%/46.19 ± 1.06%, separately, with the addition of Cr⁶⁺(0.50 mg L⁻¹), Cu²⁺(5.02 mg L⁻¹), Zn²⁺(5.05 mg L⁻¹), and Mn²⁺(50.52 mg L⁻¹).

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Marine sedimentary lipidomics of the glacial-interglacial changes during the lower Pleistocene (SW Iberian Margin)

Abstract

Analyses of trimethylsilyl-derivatized neutral lipids by gas chromatography coupled to mass spectrometry afford a wealth of information contained in the marine sediments. This information is useful for unraveling the processes associated with past climate changes such as those from glacial and interglacial periods. Studies of samples from the Iberian Margin deposited about 1,300,000–1,400,000 years ago afforded the qualitative identification and quantification of n-alkanes, n-alkan-1-ols, isoprenoids, triterpenoids, sterols, hopanols, alkenones, alkenols, and polycyclic aromatic hydrocarbons. Using this information, the lipidomic approach has allowed to identifying differences in sea surface temperatures, marine productivity, microbial degradation processes, and inputs from continental plants between these periods. Differences in predominant higher plant species related to climate changes have also been observed.

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Peritoneum as the sole distant metastatic site of lung adenosquamous cell carcinoma: a case report

Peritoneum metastasis of lung cancer is a rare event which, in addition to the peritoneum, usually involves multiple metastatic tissues. Here we report a case of a patient with lung adenosquamous cell carcinom...

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Deep cerebral venous thrombosis mimicking influenza-associated acute necrotizing encephalopathy: a case report

Acute necrotizing encephalopathy is one of the most devastating neurological complications of influenza virus infection. Acute necrotizing encephalopathy preferentially affects the thalamus bilaterally, as doe...

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Clinical Snippets

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FRT – FONDATION RENE TOURAINE

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Issue Information

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Sphenoid Sinus Diseases: A Review of 1,442 Patients

Objective. To review and report diseases of the sphenoid sinus from the literature and from a university hospital. Methods. Inpatients' data were retrospectively gathered and reviewed from January 2006 to June 2016. Clinical data, imaging, organisms, and pathological reports were collected. Pathology was divided into infection/inflammation, tumor, and miscellaneous. A literature review was performed with the search term "isolated sphenoid disease" in PubMed. Original primary studies with 20 patients or more were reviewed. Results and Discussion. One hundred and twenty-two patients were enrolled. Seventy-two subjects were female (59%). The average age was 54.3 years (±18.0). Imaging abnormalities were found incidentally in 27 patients (22.1%). The most common symptom was headache (63.9%). Visual loss, the second most common symptom, was more frequent in the tumor group (30.6% versus 54.2%). From the literature review, 21 primary studies with 1,320 total patients were included. From all studies and the present study, infection/inflammation was the most common pathology (75%) [95% confidence interval (CI): 0.696, 0.804]. Overall, tumors were found in 18.9% and malignant tumors in 7.0% [95% CI: 0.045, 0.095]. Conclusion. A specific diagnosis of a sphenoid lesion is needed during active investigation. Infection/inflammation was the most common pathology and malignancy was found in 7%.

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Sphenoid Sinus Diseases: A Review of 1,442 Patients

Livin’ On The Edge: glia shape nervous system transition zones

Publication date: December 2017
Source:Current Opinion in Neurobiology, Volume 47
Author(s): Laura Fontenas, Sarah Kucenas
The vertebrate nervous system is divided into two functional halves; the central nervous system (CNS), which includes the brain and spinal cord, and the peripheral nervous system (PNS), which consists of nerves and ganglia. Incoming peripheral stimuli transmitted from the periphery to the CNS and subsequent motor responses created because of this information, require efficient communication between the two halves that make up this organ system. Neurons and glial cells of each half of the nervous system, which are the main actors in this communication, segregate across nervous system transition zones and never mix, allowing for efficient neurotransmission. Studies aimed at understanding the cellular and molecular mechanisms governing the development and maintenance of these transition zones have predominantly focused on mammalian models. However, zebrafish has emerged as a powerful model organism to study these structures and has allowed researchers to identify novel glial cells and mechanisms essential for nervous system assembly. This review will highlight recent advances into the important role that glial cells play in building and maintaining the nervous system and its boundaries.

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Predictors of Venous Thromboembolism and Early Mortality in Lung Cancer: Results from a Global Prospective Study (CANTARISK)

AbstractBackground.Patients with lung cancer are known to be at increased risk for venous thromboembolism (VTE). Venous thromboembolism is associated with increased risk for early mortality. However, there have been no studies performing a comprehensive assessment of risk factors for VTE or early mortality in lung cancer patients undergoing systemic chemotherapy in a global real‐world setting.Materials and Methods.CANTARISK is a prospective, global, noninterventional cohort study including patients with lung cancer initiating a new cancer therapy. Clinical data were collected until 6‐month follow‐up. The impact of patient‐, disease‐, and treatment‐related factors on the occurrence of VTE and early mortality was evaluated in univariable and multivariable Cox regression analyses. A previously validated VTE risk score (VTE‐RS) was also calculated (also known as Khorana score).Results.Of 1,980 patients with lung cancer who were enrolled from 2011 to 2012, 84% had non‐small cell lung cancer. During the first 6 months, 121 patients developed a VTE (6.1%), of which 47% had pulmonary embolism, 46% deep vein thrombosis, 3% catheter‐associated thrombosis, and 4% visceral thrombosis. Independent predictors for VTE included female sex, North America location, leg immobilization, and presence of a central venous catheter. The VTE‐RS was not significantly associated with VTE in either univariable or multivariable analysis in this population. During the study period, 472 patients died, representing 20%, 24%, 36%, and 25% with VTE‐RS 1, 2, ≥3, or unknown, respectively (p < .0001). Significant independent predictors of early mortality include older age, current/former smoking, chronic obstructive pulmonary disease, Eastern Cooperative Oncology Group performance status ≥2, no prior surgery, and metastatic disease, as well as the VTE‐RS.Conclusion.In this global, prospective, real‐world analysis, several demographic, geographic, and clinical factors are independent risk factors for VTE and early mortality in patients with lung cancer. The VTE‐RS represents a significant independent predictor of early mortality but not for VTE in lung cancer in the era of targeted therapy.Implications for Practice.Multiple risk factors for both venous thromboembolism (VTE) and early mortality in patients with lung cancer receiving systemic chemotherapy should guide best practice by better informing clinical evaluation and treatment decision‐making. The Khorana risk score is of value in assessing the risk of early all‐cause mortality along with other clinical parameters in patients with lung cancer receiving systemic therapy. Further study is needed to fully evaluate the validity of the risk score in predicting the risk of VTE in the modern era of lung cancer therapy.

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A Clinical and Biological Guide for Understanding Chemotherapy‐Induced Alopecia and Its Prevention

AbstractChemotherapy‐induced alopecia (CIA) is the most visibly distressing side effect of commonly administered chemotherapeutic agents. Because psychological health has huge relevance to lifestyle, diet, and self‐esteem, it is important for clinicians to fully appreciate the psychological burden that CIA can place on patients. Here, for the first time to our knowledge, we provide a comprehensive review encompassing the molecular characteristics of the human hair follicle (HF), how different anticancer agents damage the HF to cause CIA, and subsequent HF pathophysiology, and we assess known and emerging prevention modalities that have aimed to reduce or prevent CIA. We argue that, at present, scalp cooling is the only safe and U.S. Food and Drug Administration‐cleared modality available, and we highlight the extensive available clinical and experimental (biological) evidence for its efficacy. The likelihood of a patient that uses scalp cooling during chemotherapy maintaining enough hair to not require a wig is approximately 50%. This is despite different types of chemotherapy regimens, patient‐specific differences, and possible lack of staff experience in effectively delivering scalp cooling. The increased use of scalp cooling and an understanding of how to deliver it most effectively to patients has enormous potential to ease the psychological burden of CIA, until other, more efficacious, equally safe treatments become available.Implications for Practice.Chemotherapy‐induced alopecia (CIA) represents perhaps the most distressing side effect of chemotherapeutic agents and is of huge concern to the majority of patients. Scalp cooling is currently the only safe option to combat CIA. Clinical and biological evidence suggests improvements can be made, including efficacy in delivering adequately‐low temperature to the scalp and patient‐specific cap design. The increased use of scalp cooling, an understanding of how to deliver it most effectively and biological evidence‐based approaches to improve its efficacy have enormous potential to ease the psychological burden of CIA, as this could lead to improvements in treatment and patient quality‐of‐life.

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Anteroposterior polarity and elongation in the absence of extraembryonic tissues and spatially localised signalling in Gastruloids, mammalian embryonic organoids [RESEARCH ARTICLE]

D. A. Turner, M. Girgin, L. Alonso-Crisostomo, V. Trivedi, P. Baillie-Johnson, C. R. Glodowski, P. C. Hayward, J. Collignon, C. Gustavsen, P. Serup, B. Steventon, M. Lutolf, and Arias A. Martinez

The establishment of the anteroposterior (AP) axis is a critical step during animal embryo development. In mammals, genetic studies have shown that this process relies on signals spatiotemporally deployed in the extraembryonic tissues that locate the position of the head and the onset of gastrulation, marked by T/Brachyury (T/Bra) at the posterior of the embryo. Here, we use Gastruloids, mESC-based organoids, as a model system to study this process. We find that Gastruloids localise T/Bra expression to one end and undergo elongation similar to the posterior region of the embryo suggesting that they develop an AP axis. This process relies on precisely timed interactions between Wnt/β-Catenin and Nodal signalling, whereas BMP signalling is dispensable. Additionally, polarised T/Bra expression occurs in the absence of extraembryonic tissues or localised sources of signals. We suggest that the role of extraembryonic tissues in the mammalian embryo might not be to induce the axes but to bias an intrinsic ability of the embryo to initially break symmetry. Furthermore, we suggest that Wnt signalling has a separable activity involved in the elongation of the axis.

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The Influence of Occupation on Self-perceived Vocal Problems in Patients With Voice Complaints

This study aimed to examine the relationships among patient occupation, laryngeal diagnosis, perceptual dysphonia severity, and patient-perceived voice impairment.

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Correlation between Voice and Auditory Processing

To compare and to correlate the performance of women with behavioral dysphonia and without voice disorders in auditory processing tests and in the Voice Tone Reproduction Test (VTRT).

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Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia

Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown.

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Assessment of facial asymmetry before and after the surgical repair of cleft lip in unilateral cleft lip and palate cases

This study was performed to assess facial asymmetry in patients with unilateral cleft lip and palate (UCLP) before and after primary lip repair. Three-dimensional facial images of 30 UCLP cases (mean age 3.7±0.8months) captured 1–2days before surgery and 4 months after surgery using stereophotogrammetry were analysed. A generic mesh – a mathematical facial mask consisting of thousands of points (vertices) – was conformed on the three-dimensional images. Average preoperative and postoperative conformed facial meshes were obtained and mirrored by reflecting on the lateral plane.

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Outcomes of septorhinoplasty: a new approach comparing functional and aesthetic results

The aim of this study was to compare objective and subjective functional results of septorhinoplasty with subjective aesthetic results. A prospective study was performed including global and subgroup analyses (primary versus secondary septorhinoplasty). Three instruments were used to evaluate pre- and postoperative results: rhinomanometry for the objective functional analysis, the Nasal Symptom Obstruction Evaluation (NOSE) scale for the subjective functional analysis, and the Rhinoplasty Outcome Evaluation (ROE) scale for the subjective aesthetic analysis.

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Reply

We thank Ayubi and Safiri1 for their commentary on our recently published article "Clinical predictors of remission and persistence of adult-onset asthma."2 In this study, we found that moderate to severe bronchial hyperresponsiveness and nasal polyps were independent predictors of asthma persistence.2

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Comments on clinical predictors of remission and persistence of adult-onset asthma

We were interested to read the article by Westerhof et al1 published as an article in press in the Journal of Allergy and Clinical Immunology in April 2017. They tried to identify the significant predictors of asthma persistence and remission in adults with newly diagnosed, well-defined asthma. The results demonstrated that nasal polyps and airway hyperresponsiveness can be significant predictors of persistent asthma.1 Undoubtedly, an important study has been conducted but it seems that some methodological points should be noticed.

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Stratifying migraine patients based on dynamic pain provocation over the upper cervical spine

Migraine patients usually report a high prevalence of neck pain preceding or during the migraine attack. A recent investigation of musculoskeletal dysfunctions in migraine patients concluded that neck pain is ...

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Facing the Future: A Call for Higher Education in Sleep Technology

The American Association of Sleep Technologists (AAST) is the national membership organization representing sleep technologists. The Board of Directors of the AAST recognizes that changes in the workforce will result in an increased need for technologists with a higher level of education. In order to meet the needs of members, the AAST has: (1) convened a summit of stakeholders to discuss the changing landscape for sleep technologists; (2) hosted an educational task force to provide ongoing communication and support; and (3) commissioned a survey of members, educators and employers to better define educational gaps and opportunities for sleep technologists.

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Manifestations of Inhalant Allergies Beyond the Nose

The upper and lower airways are linked epidemiologically and pathophysiologically. The upper and lower airways are considered a single, functional unit characterized by shared immunologic mechanisms, often referred to as the unified airway. Upper and lower airway inflammatory disease frequently coexist in the same patient. Allergic rhinitis and rhinosinusitis are associated with asthma. Treatment of both diseases impacts asthma outcomes. The otolaryngologist may be the first physician to suspect and diagnose asthma in patients with upper airway complaints. A thorough understanding of the relationship between allergic rhinitis, rhinosinusitis, and asthma will facilitate early identification of asthma and improve patient outcomes.

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Manifestations of Inhalant Allergies Beyond the Nose

Transcutaneous aponeurotic repair with small detachment of the levator aponeurosis for aponeurotic blepharoptosis in Japanese patients

To examine the surgical outcomes of a modified transcutaneous aponeurotic repair for aponeurotic blepharoptosis in a Japanese population.

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Reduction mammoplasty in adolescents and elderly a ten year case series analyzing age related outcome with focus on safety and complications

Reduction mammoplasty alleviates symptoms of macromastia in various ways. Current study results mainly identify perioperative risk factors for middle aged patients. We investigated a large series of consecutive breast reductions procedures to study whether patients' age at the time of operation is related to the postoperative outcome.

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¿Cuándo es necesario realizar una ecografía del tiroides?

La ecografía o imagen por ultrasonido se ha consolidado como una forma eficiente y muy habitual de evaluar la enfermedad tiroidea y manejar diversas condiciones de la tiroides. Las ecografías de alta resolución han mejorado en los últimos años hasta convertirse en una herramienta de una enorme utilidad. Es el instrumento de elección para evaluar la presencia de alteraciones en la tiroides en niños y mujeres embarazadas.

Las indicaciones para llevar a cabo una ecografía de la tiroides, según la Asociación Americana de Endocrinólogos Clínicos (AACE) son las siguientes:

Confirmar la presencia de un nódulo tiroideo cuando el examen físico puede dar lugar a equívoco
Caracterizar el nódulo o los nódulos para medirlos con precisión e identificar su estructura interna y su grado de vascularización
Diferenciar tumores benignos y malignos, en función de la imagen de la ecografía
Diferenciar nódulos tiroideos y otras masas que pueden presentarse en la zona, como linfoadenopatías, quistes en el tirogloso o higromas.
Evaluar los cambios en el tejido de la tiroides (parénquima)
Detectar tumores post-quirúrgicos o residuales en la tiroides o metástasis en ganglios linfáticos del cuello
Hacer un cribado de pacientes de riesgo de cáncer de tiroides, como aquellas personas con antecedentes familiares de cáncer, neoplasia endocrina múltiple de tipo II o que estuvieron expuestos a radiación en la zona del cuello en la infancia
Guiar durante procedimientos de diagnóstico (citología/biopsia) o terapéuticos

La ecografía es una prueba indolora, que se basa en ondas sonoras para crear imágenes del interior del cuerpo. Puede llevarse a cabo en un departamento de radiología o en una consulta.

Cómo se hace una ecografía

La prueba no requiere preparación
El paciente se tumba con una almohada u otra forma de soporte suave que mantenga el cuello levemente estirado
El técnico o el médico aplica un gel con base acuosa en el cuello para ayudar a que se transmitan mejor las ondas sonoras
A continuación, el técnico o el médico mueve el transductor (un dispositivo alargado que emite las ondas) por la zona del cuello.
El transductor emite ondas que atraviesan el cuerpo y rebotan en el área que se va a analizar (en este caso la glándula tiroides)
Un ordenador registra los movimientos de las ondas sonoras al rebotar y crea una imagen a partir de éstas

En un resultado normal, la tiroides tiene el tamaño, forma y posición esperados.

Los resultados alterados pueden deberse a:

Quistes
Aumento del tamaño de la tiroides (bocio)
Nódulos tiroideos
Tiroiditis (inflamación de la tiroides) –junto con biopsia-
Cáncer de tiroides –junto con biopsia-

Cuando se observan nódulos mediante ecografía de la tiroides, se procede de la siguiente forma:

Si su apariencia es benigna (riesgo 0%) no se practica biopsia
Si su apariencia es muy poco sospechosa (riesgo <3% ) se practica la biopsia en nódulos que miden 2 cm o más)
Si su apariencia es poco sospechosa (riesgo 5-10%) se practica la biopsia en los nódulos de 1,5 cm o mayores
Si su apariencia es sospechosa en un grado medio (riesgo 10-20%) se realiza la biopsia cuando miden 1 cm o más
Si su apariencia es altamente sospechosa (riesgo 70% o más) se realiza la biopsia cuando miden 1 cm o más

La tiroides normal consiste en dos lóbulos unidos por una parte estrecha. Su tamaño, forma y volumen varían con la edad y dependen de si el paciente es hombre o mujer.

Las dimensiones normales son: 18-20 mm longitudinalmente y 8-9 mm de diámetro entre la parte anterior y la posterior (AP) en un recién nacido; 25 mm longitudinalmente y 12-15 mm de diámetro AP en la población adulta.

Los límites del volumen normal de la tiroides (excluyendo la unión entre los lóbulos, a menos que su espesor sea mayor de 3 mm) son: 10-15 ml en mujeres y 12-18 en varones.

Si crees que puedes padecer algún tipo de enfermedad relacionada con el tiroides, entra en nuestro cuestionario de síntomas de tiroides alterada y sal de dudas. ¿A qué esperas?

La entrada ¿Cuándo es necesario realizar una ecografía del tiroides? se publicó primero en Cuida tu tiroides.

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¿Qué implicaciones tiene la proteína tiroglobulina alta en las enfermedades tiroideas?

La tiroglobulina (Tg) es una proteína que segrega la glándula tiroides como respuesta a la estimulación de la TSH (que se produce en la hipófisis). Tiene una función determinante en la formación de tiroxina y triyodotironina. Por ese motivo también se puede llamar "prohormona", ya que sirve a la síntesis de hormonas. También interviene en el almacenamiento de las formas inactivas de hormonas tiroideas y de yodo en el organismo.

La tiroglobulina es producto de la acción de células tiroideas normales bien diferenciadas, y también de células cancerígenas. Aunque los niveles de tiroglobulina están típicamente elevados en personas con cáncer de tiroides, hay una considerable cantidad de enfermedades benignas que también pueden explicar ese aumento en los niveles de tiroglobulina.

Como normalmente la tiroglobulina sólo se fabrica a partir de células tiroideas, es un indicador útil de la presencia (o ausencia de células tiroideas).

En una tiroides sana se acumulan la cantidad de hormonas necesaria para el organismo durante varias semanas. Como tiene una relación estrecha con el consumo de yodo en la dieta, los niveles esperados de tiroglobulina en sangre son diferentes según la dieta propia de la zona geográfica en la que vive el paciente.

¿Para qué se realiza la prueba de tiroglobulina?

Sobre todo, como marcador tumoral para evaluar la eficacia del tratamiento del cáncer de tiroides y detectar recaídas
No todos los cánceres de tiroides incrementan la producción de tiroglobulina, pero sí los más frecuentes:
- Carcinoma papilar de tiroides
- Carcinoma folicular de tiroides
Junto con la prueba de TSH, antes del tratamiento del cáncer, se realiza un análisis para ver si los niveles de tiroglobulina son altos, de ser así, se repetirá la prueba más adelante para observar los cambios
En ocasiones se pide un test de tiroglobulina para ayudar a determinar la causa de hipertiroidismo y para comprobar la eficacia del tratamiento de dolencias como la enfermedad de Graves
Rara vez, se pide la prueba para diferenciar la tiroiditis subaguda de la tirotoxicosis y para determinar la causa de hipotiroidismo congénito en recién nacidos

¿Cuándo se pide?

Antes de una cirugía de cáncer tiroides
Después de haber completado el tratamiento del cáncer de tiroides
A intervalos regulares después de la cirugía para asegurarse de que no hay restos de células cancerígenas
Ante síntomas de hipertiroidismo
En casos de bocio, o ante indicios de enfermedad de Graves o tiroiditis
A intervalos regulares en personas que toman fármacos antitiroideos
En niños pequeños con síntomas de hipotiroidismo

¿Qué significa?

En individuos sanos, las concentraciones de tiroglobulina en el flujo sanguíneo son muy bajas
Los niveles deberían ser indetectables o extremadamente bajos
- tras la tiroidectomía
- después del tratamiento con yodo radiactivo
Si en el control después de la cirugía la concentración es alta podría haber células tiroideas residuales (que pueden ser normales o cancerosas) y se procederá a administrar un tratamiento adicional
Basándose en los resultados del test de tiroglobulina una opción es el tratamiento con yodo radiactivo para la destrucción de las células residuales
Posteriormente se realizará otra prueba de tiroglobulina para comprobar la eficacia del tratamiento y se llevarán a cabo controles periódicos
Si los niveles de tiroglobulina son bajos durante varias semanas tras la cirugía y luego vuelven a elevarse es probable que el paciente esté sufriendo una recaída
Los niveles decrecientes en pacientes tratados por enfermedad de Graves (hipertiroidismo) indican respuesta al tratamiento
Los pacientes con bocio, tiroiditis o hipertiroidismo pueden tener concentraciones elevadas de tiroglobulina, pero no es una prueba que se les practique habitualmente
Los niveles altos de tiroglobulina no indican que una persona padezca cáncer
En los controles de tiroglobulina en pacientes con cáncer, es más importante la variación en los resultados a lo largo del tiempo que un resultado concreto

Si crees que puedes padecer algún tipo de enfermedad relacionada con la glándula tiroides, entra en nuestro cuestionario de síntomas de tiroides alterada y sal de dudas.

La entrada ¿Qué implicaciones tiene la proteína tiroglobulina alta en las enfermedades tiroideas? se publicó primero en Cuida tu tiroides.

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Cansancio crónico: Síntomas relacionados con las enfermedades tiroideas

Aunque la fatiga es uno de los problemas que con mayor frecuencia suscitan una visita a la consulta del médico, es un tema en el que aún hay mucha investigación por llevar a cabo.

En principio, el hipotiroidismo (funcionamiento de la glándula tiroides por debajo de los umbrales normales) se asocia con sensación de cansancio, aumento de peso y depresión. Aunque no hay forma de prevenir la enfermedad, tratarla suele ser sencillo. Se recomienda acudir a la consulta cuando además del cansancio la persona muestra aumento de peso, depresión, sensibilidad al frío, sequedad en la piel o el cabello o dolores musculares. La única forma precisa de determinar si existe un problema en el funcionamiento de la tiroides es someterse a una prueba, un simple análisis de sangre, para detectar los niveles de hormonas tiroideas en el organismo. Curiosamente, el hipertiroidismo (actividad de la glándula tiroides por encima del umbral normal) también puede provocar fatiga y debilidad muscular.

Algunos expertos han resumido las condiciones médicas más comunes que pueden explicar la sensación de cansancio. Si bien los propios médicos matizan que cualquier enfermedad (sobre todo las que cursan con dolor) puede producir fatiga, el listado que proponen es el siguiente:

Celiaquía– La intolerancia al gluten, además de fatiga, suele presentarse con pérdida de peso, anemia y diarrea.
Anemia– Uno de los motivos más frecuentes del cansancio crónico es la falta de hierro.
Síndrome de fatiga crónica– Se trata de una enfermedad discapacitante, que se manifiesta con un cansancio severo que se prolonga al menos durante seis meses. Se ha asociado con irritación en la garganta, cefalea, dolor muscular o articular.
Apnea del sueño– El estrechamiento de los conductos respiratorios impide que las personas con esta condición descansen de forma apropiada, lo cual les hace sentirse exhaustos a lo largo del día.
Hipotiroidismo- Los niveles bajos de tiroxina, propios de las personas con hipotiroidismo, provocan cansancio.
Diabetes– Además del cansancio, los pacientes con diabetes suelen experimentar una sed intensa y pérdida de peso.
Fiebre glandular– Una infección por virus típica de los adolescentes y adultos jóvenes. Aunque suele resolverse en unas semanas, la fatiga puede prolongarse meses.
Depresión– La depresión en sí misma se asocia a falta de energía, pero además si dificulta el descanso hace que los pacientes se sientan fatigados durante el día.
Síndrome de piernas inquietas– También produce dificultades para conciliar el sueño.
Ansiedad– La ansiedad puntual es normal, pero si se manifiesta constantemente y no se puede controlar, se considera patológica. También es un síntoma de hipertiroidismo, y hace que los pacientes se sientan cansados y faltos de energía.

Estrategias para hacer frente a la fatiga:

Cuando un paciente con hipotiroidismo sufre falta de energía, un buen método para resolver la situación es asegurarse de que sus niveles de hormonas tiroideas son correctos para su edad y estado de salud. Según el Colegio Americano de Endocrinólogos Clínicos, los valores normales de TSH (tirotropina) oscilan entre 0,3 y 3,0 mIU/mL. No obstante, hay laboratorios o médicos que usan criterios más amplios, desde 0,2 hasta 8,0 mIU/mL. Consulte con su médico cuál es su nivel óptimo.
Realizar una prueba de T3 o T3 inversa. La triyodotironina (T3) es una hormona que se asocia a la producción de energía, mientras que la T3 inversa es una molécula similar, pero de efecto contrario.
En los pacientes con hipotiroidismo de Hashimoto pueden presentarse deficiencias de hierro, vitamina B12 o ácido fólico, que se asocian con fatiga. Resolverlas puede ser una forma de recuperar la energía.
La intolerancia a ciertos alimentos (no alergia) puede provocar fatiga. Los pacientes con enfermedad de Hashimoto padecen en ocasiones intolerancia al gluten, los productos lácteos, la soja, el huevo, el maíz y algunos frutos secos. Una dieta de eliminación puede ayudar.
Optimizar los niveles de glucosa, ya que los desequilibrios en la glucosa afectan a los niveles de energía.
Compruebe sus niveles de vitamina D, ya que la falta de ésta puede provocar fatiga.
Se ha sugerido que los suplementos con L-carnitina pueden aliviar los síntomas de fatiga en pacientes con hipotiroidismo, particularmente en menores de 50 años y en quienes se han sometido a una tiroidectomía.

En caso de padecer alguno de estos síntomas, puedes realizar nuestro cuestionario de síntomas de tiroides alterada, con el que podrás averiguar con facilidad si tienes algún problema relacionado con la glándula tiroides.

La entrada Cansancio crónico: Síntomas relacionados con las enfermedades tiroideas se publicó primero en Cuida tu tiroides.

http://ift.tt/2wURhnp

¿Por qué aparece un quiste tiroideo en la glándula?

Los quistes tiroideos son nódulos llenos de líquido presentes en la glándula tiroides. Pueden ser muy pequeños (de menos de 1 cm) o bastante grandes y pueden presentarse de forma súbita. Los nódulos pueden ser quistes (contenido líquido) y en ese caso no hay componentes sólidos detectables dentro del quiste. Por otro lado, el nódulo puede ser complejo, y contener tanto elementos líquidos como sólidos. Los quistes que únicamente contienen líquido tienen un riesgo muy bajo de evolucionar a cáncer de tiroides si se les compara con los quistes complejos.

Tipos

Quistes líquidos
Quistes complejos

Los nódulos se pueden formar por los siguientes motivos:

Falta de yodo
Crecimiento de tejido tiroideo normal (adenoma). No se conoce su causa exacta, pero el adenoma no es maligno ni se considera grave a menos que los síntomas sean molestos para el paciente.
Restos de un adenoma pueden dar lugar a quistes complejos
Inflamación de la tiroides

Los quistes tiroideos pueden aumentar de tamaño rápidamente, ocasionando hemorragia en nódulos pequeños que estaban presentes en la tiroides. Ese aumento de tamaño repentino puede también ser causa de síntomas en el cuello:

Dolor
Dificultad al tragar
Cambios en la voz por presión en las cuerdas vocales (poco frecuente)

El diagnóstico de un quiste tiroideo se efectúa con ecografía o tras una biopsia, al obtenerse fluido procedente de la lesión en la tiroides.

Los quistes tiroideos pueden resolverse espontáneamente, aunque no es algo que ocurra con frecuencia (menos del 15% de los casos)

La expresión "quiste tiroideo" no es un diagnóstico en sí, sino que describe el hallazgo de un nódulo con líquido. Por eso, después de detectarlo el médico puede realizar diversas pruebas para conocer ante qué clase de quiste se encuentra.

El especialista buscará en primer lugar diferenciar nódulos malignos de nódulos benignos para definir su tratamiento. Las pruebas indicadas en primer lugar incluyen:

Analítica de sangre general
Prueba de imagen (primero, ecografía)

La prueba más precisa para conocer el tipo de quiste con certeza es la punción aspiración con aguja fina, que se suele realizar con apoyo de la ecografía para obtener muestras del quiste del punto exacto que ofrecerá mayor información para el diagnóstico.

Se ha sugerido que la complicación más frecuente de este procedimiento es el sangrado de la lesión, si bien algunos especialistas han hecho hincapié en que en ocasiones permite el vaciado definitivo de algunas lesiones quísticas.

Se indica cirugía para extraerlos –entre otras- ante las siguientes situaciones:

Disnea (dificultad para respirar)
Disfonía (alteraciones en la voz)
Disfagia (dificultad al tragar)

La entrada ¿Por qué aparece un quiste tiroideo en la glándula? se publicó primero en Cuida tu tiroides.

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Allergy and immunology in Africa: Challenges and unmet needs

The tremendous increase in allergy in the African continent cannot simply be explained by the change in public hygiene. There are many "prehygiene" communities with sewage-contaminated water supplies, helminth infestations, bare footedness, and poor housing, and still there is a high prevalence of allergic disease. Africans can be exposed to many risk factors facilitating severe asthma and wheezing, including airborne viruses, smoke, indoor dampness, cockroaches, and poor access to health care. Although the reporting on food allergy is inadequate to perform systematic reviews or meta-analyses, the available data suggest that food allergy is underdiagnosed.

http://ift.tt/2wjQkVS

ATF6α regulates airway hyperreactivity, smooth muscle proliferation, and contractility

ORMDL3 on chromosome 17q21 is highly linked to asthma and regulates several downstream pathways including ATF6α. We demonstrated that ATF6α in airway smooth muscle (ASM) plays an important role in ASM contractility, proliferation, and AHR.

http://ift.tt/2fr3Z6Q

FLOTOR Pilot Study

Conditions: Chylothorax; Esophageal Cancer; Thoracic Duct Intra-Operative Injury
Intervention: Drug: Indocyanine Green
Sponsor: Oxford University Hospitals NHS Trust
Not yet recruiting

http://ift.tt/2xAGaC0

FLOTOR Pilot Study

Predictors of Normal Tissue Response From the Microenvironment in Radiotherapy for Prostate and Head-and-neck Cancer

Conditions: Prostate Cancer; Head and Neck Cancer
Interventions: Radiation: External beam radiotherapy for prostate cancer; Radiation: External beam radiotherapy for head and neck cancer
Sponsor: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
Recruiting

http://ift.tt/2yqZDnJ

Predictors of Normal Tissue Response From the Microenvironment in Radiotherapy for Prostate and Head-and-neck Cancer

Assessing toxicity of metal contaminated soil from glassworks sites with a battery of biotests

Publication date: 1 February 2018
Source:Science of The Total Environment, Volumes 613–614
Author(s): M. Hagner, M. Romantschuk, O.-P. Penttinen, A. Egfors, C. Marchand, A. Augustsson
The present study addresses toxicological properties of metal contaminated soils, using glassworks sites in south-eastern Sweden as study objects. Soil from five selected glassworks sites as well as from nearby reference areas were analysed for total and water-soluble metal concentrations and general geochemical parameters. A battery of biotests was then applied to assess the toxicity of the glassworks soil environments: a test of phytotoxicity with garden cress (Lepidium sativum); the BioTox™ test for toxicity to bacteria using Vibrio fischeri; and analyses of abundancies and biomass of nematodes and enchytraeids. The glassworks- and reference areas were comparable with respect to pH and the content of organic matter and nutrients (C, N, P), but total metal concentrations (Pb, As, Ba, Cd and Zn) were significantly higher at the former sites. Higher metal concentrations in the water-soluble fraction were also observed, even though these concentrations were low compared to the total ones. Nevertheless, toxicity of the glassworks soils was not detected by the two ex situ tests; inhibition of light emission by V. fischeri could not be seen, nor was an effect seen on the growth of L. sativum. A decrease in enchytraeid and nematode abundance and biomass was, however, observed for the landfill soils as compared to reference soils, implying in situ toxicity to soil-inhabiting organisms. The confirmation of in situ bioavailability and negative effects motivates additional studies of the risk posed to humans of the glassworks villages.

Graphical abstract

http://ift.tt/2hwKESh

Zinc oxide nanoparticles in predicted environmentally relevant concentrations leading to behavioral impairments in male swiss mice

Publication date: 1 February 2018
Source:Science of The Total Environment, Volumes 613–614
Author(s): Joyce Moreira de Souza, Bruna de Oliveira Mendes, Abraão Tiago Batista Guimarães, Aline Sueli de Lima Rodrigues, Thales Quintão Chagas, Thiago Lopes Rocha, Guilherme Malafaia
Although the potential neurotoxic effects from the exposure to zinc oxide nanoparticles (ZnO NPs) on humans and on experimental models have been reported in previous studies, the effects from the exposure to environmentally relevant concentrations of them remain unclear. Thus, the aim of the present study is to investigate the effects from the exposure to environmentally relevant concentrations of ZnO NPs on the behavior of male Swiss mice. The animals were daily exposed to environmentally relevant concentrations of ZnO NPs (5.625×10⁻⁵mgkg⁻¹) at toxic level (300mgkg⁻¹) through intraperitoneal injection for five days; a control group was set for comparison purposes. Positive control groups (clonazepam and fluoxetine) and a baseline group were included in the experimental design to help analyzing the behavioral tests (open field, elevated plus maze and forced swim tests). Although we did not observe any behavioral change in the animals subjected to the elevated plus maze and forced swim tests, our data evidence the anxiogenic behavior of animals exposed to the two herein tested ZnO NPs concentrations in the open field test. The animals stayed in the central part of the apparatus and presented lower locomotion ratio in the central quadrants/total of locomotion during this test. It indicates that the anxiogenic behavior was induced by ZnO NP exposure, because it leads to Zn accumulation in the brain. Thus, the current study is the first to demonstrate that the predicted environmentally relevant ZnO NPs concentration induces behavioral changes in mammalian experimental models. Our results corroborate previous studies that have indicated the biological risks related to the water surface contamination by metal-based nanomaterials.

Graphical abstract

http://ift.tt/2hwV9Fi

Screening of biologically important Zn2+ by a chemosensor with fluorescent turn on-off mechanism

Publication date: 15 January 2018
Source:Spectrochimica Acta Part A: Molecular and Biomolecular Spectroscopy, Volume 189
Author(s): Tanveer A. Khan, Monika Sheoran, Venkata Nikhil Raj M., Surbhi Jain, Diksha Gupta, Sunil G. Naik
Reported herein the synthesis, characterization and biologically important zinc ion binding propensity of a weakly fluorescent chemosensor, 4-methyl-2,6-bis((E)-(2-(4-phenylthiazol-2-yl)hydrazono)methyl)phenol (1). ¹H NMR spectroscopic titration experiment reveals the binding knack of 1 to the essential Zn²⁺. The photo-physical studies of 1 exhibit an enhancement in the fluorescence by several folds upon binding with the zinc ions attributed to PET-off process, with a binding constant value of 5.22×10³M⁻¹. 1 exhibits an excellent detection range for Zn²⁺ with lower detection limit value of 2.31×10⁻⁸M. The selectivity of 1 was studied with various mono and divalent metal cations and it was observed that most cations either quenches the fluorescence or remains unchanged except for Cd²⁺, which shows a slight enhancement in fluorescence intensity of 1. The ratiometric displacement of Cd²⁺ ions by Zn²⁺ ions shows an excellent selectivity towards in-situ detection of Zn²⁺ ions. Photo-physical studies also support the reversible binding of 1 to Zn²⁺ ions having on and off mechanism in presence of EDTA. Such recognition of the biologically important zinc ions finds potential application in live cell imaging.

Graphical abstract

http://ift.tt/2hxpkfp

Prognostic impact of pretreatment neutrophil-to-lymphocyte ratio (NLR) in nasopharyngeal carcinoma – a retrospective study of 180 Taiwanese patients

Abstract

Objectives

Nasopharyngeal cancer (NPC) is an endemic disease in Taiwan. Prognostic factors the anatomical TNM stage are important for its prognostic stratification. An elevated neutrophil-to-lymphocyte ratio (NLR) has been reported to be associated with poor prognosis in various solid tumors. In this study, we analyzed the prognostic impact of the NLR in NPC in Taiwan.

Design

Single institution retrospective study.

Setting

Medical Center.

Participants

One hundred and eighty patients with NPC treated at the Far Eastern Memorial Hospital, Taiwan, from January 2007 to December 2013.

Main outcome measures

The association between the clinical or hematological presentations and the prognosis.

Results

The majority of the 180 patients included in this study were men (80%) and were <65 years old (91.7%). A neck mass (55.6%) was the most common clinical presentation, followed by nasal (39.4%) and aural (30.6%) symptoms. In addition, the majority (75.4%) of patients had advanced stage (III and IV) disease. Patients with a high NLR (≧3.6) had significantly lower progression-free survival, overall survival, and disease-specific survival rates. The association between high NLR and poor prognosis was more pronounced in patients with advanced disease than in those with early stage NPC. The results of a multivariate analysis revealed that advanced age, clinical symptoms including headache, diplopia and facial numbness, advanced disease stage, and high NLR were independent prognostic factors.

Conclusion

A high NLR is an independent poor prognostic factor of NPC in Taiwan.

http://ift.tt/2xHY2g5

Age specific incidence and treatment patterns of head and neck cancer in the Netherlands – a cohort study

Abstract

Objectives

To explore the incidence and treatment pattern of head and neck cancer in different age groups.

Design

cohort study.

Setting

Netherlands Cancer Registry.

Participants

All new primary head and neck cancer cases diagnosed between 2010 and 2014 were included and categorized in different age groups.

Main outcome measures

Tumour site, stage, treatment modality, location of diagnosis and treatment.

Results

The study population was composed of 11,558 tumours. Oral cancer was the most common primary site (31%), followed by laryngeal (25%) and oropharyngeal cancer (22%). Ninety-six percent of the entire study population was diagnosed and/or treated in a certified head and neck oncology centre which was lower in the 80+ population (92%). Multimodality treatment was less frequently applied with increasing age (e.g. oral cavity: 17% in 80+ vs. 34% in 60-; p<0.001). The percentage of patients not receiving tumour directed treatment increased with age (e.g. oropharyngeal cancer: 25% in 80+ vs. 6% in 80-; p<0.001).

Conclusions

This study confirms that less multimodal and tumour directed treatment is applied with the increasing age of head and neck cancer patients.

http://ift.tt/2fwqzPc

On the Evaluation of a SuperPower Sound Processor for Bone-Anchored Hearing

Abstract

Objectives

Performance of a superpower bone-anchored hearing aid (Baha), the Baha Cordelle from Cochlear Bone-Anchored Solutions (BCD1), was compared to its successor, the Baha 5 SuperPower (BCD2)

Design

a comparative study in which each patient served as its own control.

Setting

tertiary clinic.

Participants

Ten experienced BCD1 users with profound mixed hearing loss. For comparison, data from another study with ten experienced users with a severe mixed hearing loss using a Cochlear Baha 5 power sound processor (BCD-P) were included.

Main outcome measures

speech reception thresholds in noise and APHAB and SSQ questionnaires.

Results

Speech reception thresholds for the digits-in-noise test were significantly lower (p<5%), i.e. more favourable, for BCD2 in the speech and noise frontal condition and in the speech frontal and noise contralateral condition than for BCD1. For the group with severe mixed loss fitted with BCD-P the SRTs were not significantly different (p>5%) from the BCD2 values.

With the APHAB questionnaire scores were significantly lower, i.e. more favourable, for the ease-of-communication (p<5%) and the background noise (p<1%) domains for BCD2 than for BCD1. APHAB scores for the aversiveness of loud sounds domain were not significantly different for both devices (p>5%). Scores for the speech and quality domains of the SSQ questionnaire were significantly higher, i.e. more favourable, for BCD2 than for BCD1. APHAB and SSQ scores for BCD-P were not significantly different from those for BCD2 (p>5%).

Conclusions

Data for BCD2 in profound mixed loss are similar to those for BCD-P and a severe mixed loss. Out of ten patients two expressed a strong preference for BCD2 over BCD1 and seven patients had a preference for BCD2 over BCD1. One patient preferred BCD1 because of its built-in telecoil facility.

http://ift.tt/2xKhQzL

Intravenous Opioid Drug Abuse as an Independent Risk Factor for Supraglottic Squamous Cell Carcinoma – A Case Control Study

Abstract

Objectives

Intravenous opioid drug abuse (IVDA) was previously correlated with laryngeal cancer. However, discrimination of this correlation by anatomical subsites has not yet been described. In this study we aim to further establish the association between IVDA and laryngeal squamous cell carcinoma (SCC) and to indicate the laryngeal subsites that are predisposed for this correlation.

Design

A retrospective matched case control study.

Setting and Participants

Patients diagnosed with supraglottic SCC (SG-SCC) between 1996 and 2016 treated in a tertiary academic referral center were enrolled to the case group. The control group comprised of matched patients diagnosed with glottis SCC (G-SCC). Matching was based on gender, age and socioeconomic rank.

Main outcome measures

Variables studies as risk factors included: smoking, alcohol consumption, history of IVDA and infectious diseases. The variables were tested for association with the two groups and with each other.

Results

Forty eight patients with SG-SCC were matched with 48 G-SCC patients. IVDA rates significantly increased among SG-SCC patients. Of the SG-SCC group, 18.8% had a positive history for IVDA compared with 2.1% of the G-SCC (p-value=0.008). A history of IVDA was found to be a risk factor for SG-SCC, independent of smoking, excessive alcohol, and socioeconomic status. The odds ratio for patients with an IVDA history to have SG-SCC relatively to G-SCC was 10.846 (95% CI:1.3-89.4).

Conclusions

IVDA represent an independent risk factor for SG-SCC. The pathogenesis should be investigated not just as a risk factor, since opioids are commonly used for pain management in oncologic patients.

http://ift.tt/2fxFgSd

Prognostic impact of pretreatment neutrophil-to-lymphocyte ratio (NLR) in nasopharyngeal carcinoma – a retrospective study of 180 Taiwanese patients

Abstract

Objectives

Design

Single institution retrospective study.

Setting

Medical Center.

Participants

One hundred and eighty patients with NPC treated at the Far Eastern Memorial Hospital, Taiwan, from January 2007 to December 2013.

Main outcome measures

The association between the clinical or hematological presentations and the prognosis.

Results

Conclusion

A high NLR is an independent poor prognostic factor of NPC in Taiwan.

http://ift.tt/2xHY2g5

Age specific incidence and treatment patterns of head and neck cancer in the Netherlands – a cohort study

Abstract

Objectives

To explore the incidence and treatment pattern of head and neck cancer in different age groups.

Design

cohort study.

Setting

Netherlands Cancer Registry.

Participants

All new primary head and neck cancer cases diagnosed between 2010 and 2014 were included and categorized in different age groups.

Main outcome measures

Tumour site, stage, treatment modality, location of diagnosis and treatment.

Results

Conclusions

This study confirms that less multimodal and tumour directed treatment is applied with the increasing age of head and neck cancer patients.

http://ift.tt/2fwqzPc

On the Evaluation of a SuperPower Sound Processor for Bone-Anchored Hearing

Abstract

Objectives

Performance of a superpower bone-anchored hearing aid (Baha), the Baha Cordelle from Cochlear Bone-Anchored Solutions (BCD1), was compared to its successor, the Baha 5 SuperPower (BCD2)

Design

a comparative study in which each patient served as its own control.

Setting

tertiary clinic.

Participants

Main outcome measures

speech reception thresholds in noise and APHAB and SSQ questionnaires.

Results

Conclusions

http://ift.tt/2xKhQzL

Intravenous Opioid Drug Abuse as an Independent Risk Factor for Supraglottic Squamous Cell Carcinoma – A Case Control Study

Abstract

Objectives

Design

A retrospective matched case control study.

Setting and Participants

Main outcome measures

Variables studies as risk factors included: smoking, alcohol consumption, history of IVDA and infectious diseases. The variables were tested for association with the two groups and with each other.

Results

Conclusions

IVDA represent an independent risk factor for SG-SCC. The pathogenesis should be investigated not just as a risk factor, since opioids are commonly used for pain management in oncologic patients.

http://ift.tt/2fxFgSd

NCI-funded TMIST study compares 2-D and 3-D mammography for finding breast cancers

radiology-technician-reviewing-mammograp

TMIST, the first randomized trial comparing two types of digital mammography for breast cancer screening, is enrolling participants. Developed by ECOG-ACRIN and NCI, the trial is comparing 2-D and 3-D mammography for finding breast cancers.

http://ift.tt/2xy0aVN

Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: a 20 year study of a community-based cohort

Summary

Objective

Prospective studies, mostly from Europe and North America, suggest that serum 25-hydroxyvitamin D (25(OH)D) is inversely associated with mortality and cardiovascular disease (CVD) risk. Data from other regions are limited, and threshold levels for adverse cardiovascular outcomes uncertain. We examined serum 25(OH)D as a predictor of total mortality and cardiovascular outcomes in an Australian cohort.

Design

A 20-year, community-based cohort study.

Patients

Participants in the 1994/1995 Busselton Health Survey (n=3946, baseline age 25-84 years).

Measurements

Baseline serum 25(OH)D and mortality and cardiovascular outcomes to 2014 obtained by record linkage.

Results

The mean serum 25(OH)D concentration was 60.6±18.0 nmol/L. During 20 years follow-up (excluding the first 2 years), 889 participants died (including 363 from CVD) and 944 experienced a CVD event (including 242 with heart failure). In the full cohort, controlling for Framingham risk score variables, higher baseline 25(OH)D was associated with significantly reduced all-cause mortality (adjusted HR 0.83 per SD increment of 25(OH)D, 95% CI 0.77-0.90), CVD death (HR 0.85, 95% CI 0.74-0.96) and heart failure (HR 0.81, 95% CI 0.69-0.94), but not CVD events (HR 0.99, 0.92-1.07). In restricted cubic spline regression models, serum 25(OH)D below 65 and 55 nmol/L was associated with higher total mortality and higher CVD mortality/heart failure, respectively. In participants without CVD at baseline (n=3220) results were similar, but hazard ratios were attenuated and associations with CVD mortality no longer significant.

Conclusions

In an Australian community-based cohort, baseline vitamin D levels below 55-65 nmol/L are predictive of all-cause mortality, CVD death and heart failure.

http://ift.tt/2xCRbUM

The use of crack and other illicit drugs impacts oral health-related quality of life in Brazilians

Abstract

Objective

The aim of the present study was to investigate the impact of the use of crack and other illicit drugs on oral health-related quality of life (OHRQoL) in young adults.

Methods

This cross-sectional study evaluated 106 crack users at a public treatment center for drug addiction and 106 controls matched for gender, age, and use of tobacco. Clinical examinations were performed for dental caries and periodontal disease. The outcome was OHRQoL, which was determined using the Oral Health Impact Profile (OHIP-14). The association between OHRQoL and illicit drugs was modeled using conditional Poisson regression.

Results

Users of crack and other illicit drugs had a poorer OHRQoL than the controls (P < 0.001). Among the crack users, the odds ratio to yield high OHIP-14 was 3.40 (95% confidence interval, 1.91-6.08). Adjustment for sex, age, schooling, income, smoking, dental caries and periodontal disease did not change such an estimate considerably. The functional limitation and psychological discomfort domains were associated with the use of illicit drugs.

Conclusion

Users of crack and other illicit drugs exerted a negative impact on OHRQoL independently of socio-demographic characteristics and tobacco use, suggesting the need for special attention regarding the specific oral health needs of this population as well as drug prevention and treatment strategies.

http://ift.tt/2wQL0hr

A pseudo-thermodynamic description of dispersion for nanocomposites

Publication date: 27 October 2017
Source:Polymer, Volume 129
Author(s): Yan Jin, Gregory Beaucage, Karsten Vogtt, Hanqiu Jiang, Vikram Kuppa, Jay Kim, Jan Ilavsky, Mindaugas Rackaitis, Andrew Mulderig, Kabir Rishi, Vishak Narayanan
Dispersion in polymer nanocomposites is determined by the kinetics of mixing and chemical affinity. Compounds like reinforcing filler/elastomer blends display some similarity to colloidal solutions in that the filler particles are close to randomly dispersed through processing. It is attractive to apply a pseudo-thermodynamic approach taking advantage of this analogy between the kinetics of mixing for polymer compounds and thermally driven dispersion for colloids. In order to demonstrate this pseudo-thermodynamic approach, two polybutadienes and one polyisoprene were milled with three carbon blacks and two silicas. These samples were examined using small-angle x-ray scattering as a function of filler concentration to determine a pseudo-second order virial coefficient, A2, which is used as an indicator for compatibility of the filler and polymer. It is found that A2 follows the expected behavior with lower values for smaller primary particles indicating that smaller particles are more difficult to mix. A2 is analogous to the excluded volume and long-range interaction potential for non-equilibrated nanocomposites. The measured values of A2 can be used to specify repulsive interaction potentials for coarse grain DPD simulations of filler/elastomer systems. In addition, new methods to quantify the filler percolation threshold and filler mesh size as a function of filler concentration are obtained. The results represent a new approach to understanding and predicting dispersion in polymer nanocomposites based on a thermodynamic analogy.

Graphical abstract

http://ift.tt/2jZwwFQ

Preadmission statin use improves the outcome of less severe sepsis patients - a population-based propensity score matched cohort study

Abstract

Background.

Randomized controlled trials on the post-admission use of statins in sepsis patients have not shown a survival benefit. Whether preadmission use of statins would confer any beneficial effects in sepsis patients has not been well studied.

Methods.

We conducted a population-based cohort study on a national health insurance claims database between 1999 and 2011. Sepsis patients were identified by ICD-9 codes compatible with the third International consensus definitions for sepsis. Use of statin was defined as the cumulative use of any statin for more than 30 days before the indexed sepsis admission. We determined the association between statin use and sepsis outcome by multivariate-adjusted Cox proportional hazard models and propensity score matched analysis. To minimize baseline imbalance between statin users and non-statin users, we matched/adjusted for social economic status, comorbidities, proxies for healthy lifestyle, health care facility utilization, and use of medications.

Results.

We identified 52 737 sepsis patients, of which 3599 received statin treatment. Statins use was associated with a reduced 30-day mortality after multivariable adjustment (HR 0.86, 95% CI, 0.78–0.94) and propensity score matching (HR, 0.88; 95% CI, 0.78–0.99). On subgroup analysis, the beneficial effects of statins were not significant in patients receiving ventilator support or requiring ICU admission.

Conclusions.

In this national cohort study, preadmission statin therapy before sepsis development was associated with a 12% reduction in mortality when compared with patients who never received a statin. There were no consistent beneficial effects of statins in all patient subgroups.

http://ift.tt/2fvIuFJ

Preadmission statin use improves the outcome of less severe sepsis patients - a population-based propensity score matched cohort study

Abstract

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Conclusions.

Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension

We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.

http://ift.tt/2k2ewe7

Copper deficiency caused by excessive alcohol consumption

Copper deficiency is a disease that causes cytopaenia and neuropathy and can be treated by copper supplementation. Long-term tube feeding, long-term total parenteral nutrition, intestinal resection and ingestion of zinc are known copper deficiency risk factors; however, alcohol abuse is not. In this case, a 71-year-old man had difficulty waking. He had a history of drinking more than five glasses of spirits daily. He was well until 3 months ago. A month before his visit to our hospital, he could not eat meals but continued drinking. He had macrocytic anaemia on admission. Copper and ceruloplasmin levels were markedly low, and we diagnosed copper deficiency. There were no other known risk factors for copper deficiency. After he began drinking cocoa as a copper supplement, the anaemia ameliorated and he was able to walk. This is the first report showing alcohol abuse as a risk factor for copper deficiency.

http://ift.tt/2ypfYcG

Chronic subdural haematoma presenting as freezing of gait

In this report, we describe a case of freezing of gait (FOG) in a patient with chronic subdural haematoma (CSDH). An 81-year-old patient presented with progressive FOG about 6 weeks after a minor head trauma. MRI revealed CSDH in the left hemisphere, resulting in a marked compression of the hemisphere. His FOG disappeared after neurosurgical evacuation of the haematoma. It is suggested that the subdural haematoma in his left frontal cortices caused FOG. CSDH should be considered as a differential diagnosis when FOG develops after a head trauma in elderly patients, and prompt evaluations including neuroimaging and timely neurosurgical intervention are required.

http://ift.tt/2xyyoZ2

An unexpected complication following uterine artery embolisation

A 35-year-old nulliparous woman underwent uterine artery embolisation (UAE) for heavy menstrual bleeding and anaemia due to fibroids, refractive to medical and surgical treatment.

Bilateral UAE was performed after cephazolin prophylaxis and analgesia. Postoperatively, pain and abdominal bloating were prominent. Symptoms were initially treated as postembolisation syndrome, and analgesia was escalated. By the third day, pain was worsening and the woman developed marked tachypnoea and tachycardia, with raised inflammatory markers and lactate. An abdominal X-ray and CT showed dilated colon. A colonoscopy demonstrated severe mucosal ulceration down to the muscular layer.

A subtotal colectomy and end ileostomy formation was performed with intraoperative findings of toxic megacolon with near perforation. The cause of the toxic megacolon, in the absence of previous bowel pathology, was attributed to pseudomembranous colitis as a consequence of single dose prophylactic antibiotic.

http://ift.tt/2yq7fa0

Pneumocephalus Following Self-Inflicted Penetrating Brain Injury

Objective. Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. Material and Method. We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. Result. Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. Conclusion. Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.

http://ift.tt/2y5TyBe

Pneumocephalus Following Self-Inflicted Penetrating Brain Injury

Efficacy and safety of the Janus Kinase 1 inhibitor PF-04965842 in patients with moderate to severe psoriasis: phase 2, randomized, double-blind, placebo-controlled study

Abstract

Background

PF-04965842 is an oral Janus Kinase 1 inhibitor being investigated for treatment of plaque psoriasis.

Objectives

To evaluate the efficacy, safety and tolerability of PF-04965842 in patients with moderate to severe plaque psoriasis.

Methods

Patients in this phase 2, placebo-controlled study (NCT02201524) were randomised to receive placebo, 200 mg once-daily (QD), 400 mg QD, or 200 mg twice-daily (BID) PF-04965842 for 4 weeks. The primary endpoint was change from baseline in Psoriasis Area Severity Index (PASI) at Week 4. Study enrolment was discontinued on 25 June 2015 due to changes in the sponsor's development priorities.

Results

Fifty-nine patients were randomised and received at least one dose of PF-04965842 or placebo. The estimated treatment effect (active-placebo PASI change from baseline) and 90% CI at Week 4 was –5·1 (–9·2, –1·0), –5·6 (–9·6, –1·6) and –10·0 (–14·2, –5·8) for the 200 mg QD, 400 mg QD and 200 mg BID groups, respectively. At Week 4, the proportion of patients achieving PASI75 was 17% for the placebo and 200 mg QD groups, 50% for the 400 mg QD group and 60% for the 200 mg BID group. There were more abnormal laboratory test results of clinical interest (low neutrophil, reticulocyte and platelet counts) in the 200 mg BID group vs the QD treatment groups. No serious infections or bleeding events related to neutropenia or thrombocytopenia, respectively, were reported.

Conclusions

These results suggest that treatment with PF-04965842 improves symptoms and is well tolerated in patients with moderate to severe psoriasis.

http://ift.tt/2jXbbg6

Efficacy and safety of the Janus Kinase 1 inhibitor PF-04965842 in patients with moderate to severe psoriasis: phase 2, randomized, double-blind, placebo-controlled study

Abstract

Background

PF-04965842 is an oral Janus Kinase 1 inhibitor being investigated for treatment of plaque psoriasis.

Objectives

To evaluate the efficacy, safety and tolerability of PF-04965842 in patients with moderate to severe plaque psoriasis.

Methods

Results

Conclusions

These results suggest that treatment with PF-04965842 improves symptoms and is well tolerated in patients with moderate to severe psoriasis.

http://ift.tt/2jXbbg6

A novel approach using metabolomics coupled with hematological and biochemical parameters to explain the enriching-blood effect and mechanism of unprocessed Angelica sinensis and its 4 kinds of processed products

Publication date: Available online 25 September 2017
Source:Journal of Ethnopharmacology
Author(s): Peng Ji, Yanming Wei, Yongli Hua, Xiaosong Zhang, Wanling Yao, Qi Ma, Ziwen Yuan, Yanqiao Wen, Chaoxue Yang
Ethnopharmacological relevanceAngelica sinensis (AS), root of Angelica sinensis (Oliv.) Diels, an important kind of Chinese traditional herbal medicine, has been used for women to enrich the blood for thousands of years. It is mainly distributed in Gansu province of China. According to Traditional Chinese medicine usage, unprocessed AS (UAS) and its 4 kinds of processed products (ASs) are all used to treat different diseases or syndromes. The difference among the enriching-blood effects of ASs is unclear. And their exact mechanisms of enriching the blood are not fully understood.Aim of the studyIn this study, our aim is to compare the enriching-blood effect and explain the related mechanism of ASs, to lay the foundation for the blood deficiency diagnosis and the rational use of ASs in the clinic.Materials and methodsASs were used to intervene the blood deficiency syndrome model mice induced by acetyl phenylhydrazine (APH) and cyclophosphamide (CTX). A novel approach using metabolomics coupled with hematological and biochemical parameters to explain the enriching-blood effect and mechanism of ASs was established. The blood routine examination, ATPase, glucose-6-phosphate dehydrogenase, methemoglobin, glutathion peroxidase, glutathione reductase, and erythropoietin were measured. Two biofluids (plasma and urine) obtained from mice were analyzed with GC-MS. Distinct changes in metabolite patterns of the two biofluids after mice were induced by APH and CTX, and mice were intervened with ASs were analyzed using partial least squares-discriminant analysis. Potential biomarkers were found using a novel method including variable importance in the projection (VIP) >1.0, volcano plot analysis, and significance analysis of microarray.ResultsThe results of hematological, biochemical parameters and the integrated metabolomics all showed the blood deficiency syndrome model was built successfully, ASs exhibited different degree of enriching-blood effect, and AS pached with alcohol (AAS) exhibited the best enriching-blood effect. 16 metabolites in the plasma and 8 metabolites in the urine were considered as the potential biomarkers. These metabolites were involved in 7 metabolic pathways which were concerned with the different enriching-blood effect mechanisms of ASs. The correlation analysis results confirmed L-Valine (plasma), Linoleic acid (urine), L-Aspartic acid (urine) and Cholesterol (urine) were strong positive or negative associated with biochemical indicators.ConclusionsThe enriching-blood effects of ASs are different. The pathological mechanisms of blood deficiency syndrome and the enriching-blood effect mechanism of ASs are involved in 7 metabolic pathways. L-Valine (plasma), Linoleic acid (urine), L-Aspartic acid (urine), Cholesterol (urine) are four important biomarkers being related to the enriching-blood effect of ASs. The combination of VIP, volcano plot analysis and significance analysis of microarray is suitable for screening biomarkers in metabolomics study. They can lay the foundation for clinical practice.

Graphical abstract

http://ift.tt/2fOascL

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 26 Σεπτεμβρίου 2017

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¿Para qué se realiza la prueba de tiroglobulina?

¿Cuándo se pide?

¿Qué significa?

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