Παρασκευή 30 Νοεμβρίου 2018
Study on the influence of surface potential on the nitrate adsorption capacity of metal modified biochar
Abstract
Carbon materials, as effective adsorbents to numerous aqueous cationic contaminants, have been hardly applied to remove anions in wastewater. In this work, different modifying agents were used to modify corncob biochars (CC) and the surface potentials of these modified biochars were determined. Based on the findings, modification principle was determined to reveal the relationship between surface potentials of the biochars and their nitrate adsorption capacities. The surface potential was dominated by the metal cations and multivalent cations led to even positive zeta potential. The formation of metal oxide not only led to the augment in surface area but also increase the surface charge. FeCl3-modified biochar (Fe-CC) with the highest positive surface charge was utilized to remove anions (nitrate) from aqueous solutions. Characterization results confirm that Fe2O3 structure were successfully formed on biochar surface. This led to the formation of iron nitrate hydrate (Fe(NO3)3·9H2O), which enabled higher nitrate adsorption performance than that of pristine biochar. Batch experiments showed that nitrate adsorption on the Fe-CC was stable and almost independent of experimental pH and temperature. Based on the Langmuir model results, the maximum nitrate adsorption capacity of Fe-CC was 32.33 mg/g. Coexisting anions had negative influence on the adsorption performance. Findings of this work suggest that the modified biochar can be used in wastewater treatment to remove anions such as nitrate.
Graphic abstract
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Correction to: Analysis of swale factors implicated in pollutant removal efficiency using a swale database
The original publication of this paper contains an error. Correct presentation of Equation 1 is presented in this paper.
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Levothyroxine Replacement Therapy and Overuse: A Timely Diagnostic Approach
Thyroid, Ahead of Print.
https://ift.tt/2KKU3Ec
Correction to: Anti-Müllerian hormone serum levels in systemic lupus erythematosus patients: influence of the disease severity and therapy on the ovarian reserve
The original version of this article unfortunately contained a mistake in given and family names of all the authors.
https://ift.tt/2RrzO0G
Correction to: Anti-Müllerian hormone serum levels in systemic lupus erythematosus patients: influence of the disease severity and therapy on the ovarian reserve
The original version of this article unfortunately contained a mistake in given and family names of all the authors.
https://ift.tt/2RrzO0G
Split-mouth evaluation of connective tissue graft with or without enamel matrix derivative for the treatment of isolated gingival recession defects in dogs
Abstract
Objectives
The potential additive effect of an enamel matrix derivative (EMD) to a subepithelial connective tissue graft (CTG) for recession coverage is still controversially discussed. Therefore, the aim of this study was to histologically evaluate the healing of gingival recessions treated with coronally advanced flap (CAF) and CTG with or without EMD in dogs.
Materials and methods
Gingival recession defects (5 mm wide and 7 mm deep) were surgically created on the labial side of bilateral maxillary canines in 7 dogs. After 8 weeks of plaque accumulation and subsequent 2 weeks of chemical plaque control, the 14 chronic defects were randomized to receive either CAF with CTG (CAF/CTG) or CAF with CTG and EMD (CAF/CTG/EMD). The animals were sacrificed 10 weeks after reconstructive surgery for histologic evaluation.
Results
Treatment with CAF/CTG/EMD demonstrated statistically significantly better results in terms of probing pocket depth reduction (P < 0.05) and clinical attachment level gain (P < 0.001). The length of the epithelium was statistically significantly shorter in the CAF/CTG/EMD group than in the CAF/CTG group (1.00 ± 0.75 mm vs. 2.38 ± 1.48 mm, respectively, P < 0.01). Cementum formation was statistically significantly greater in the CAF/CTG/EMD group than following treatment with the CAF/CTG group (3.20 ± 0.89 mm vs. 1.88 ± 1.58 mm, respectively, P < 0.01). The CAF/CTG/EMD group showed statistically significantly greater complete periodontal regeneration (i.e., new cementum, new periodontal ligament, and new bone) than treatment with CAF/CTG (0.54 ± 0.73 mm vs. 0.07 ± 0.27 mm, respectively, P < 0.05).
Conclusion
Within their limits, the present findings indicate that the additional use of EMD in conjunction with CAF + CTG favors periodontal regeneration in gingival recession defects.
Clinical relevance
The present findings support the use of EMD combined with CTG and CAF for promoting periodontal regeneration in isolated gingival recession defects.
https://ift.tt/2E9eZV5
Distinct transcriptomic profiles of early-onset atopic dermatitis in blood and skin of pediatric patients
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. The pipeline of novel targeted treatments for AD is expanding, largely based on our growing knowledge of disease mechanisms, with new therapeutics particularly focused on immune modulation.1 Most of our understanding of AD is derived from profiling tissues and blood of longstanding AD in adults, due to the difficulty of obtaining samples from infants and young children. However, initiation of AD typically happens very early in life, and the disease is already chronically established in the majority of patients by 5yrs of age.
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Neutrophil to lymphocyte ratio is a novel independent predictor of severe exacerbation in asthma patients
Severe exacerbations are well-known complications of asthma, which increase the total and asthma-related health care costs1 and decrease the quality of life of patients2. Although some exacerbation predictors have been reported3,4, it is difficult to predict and prevent severe exacerbations in a large percentage of patients affected by asthma.
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Foreign bodies in the ear, nose, and throat in Japan: association with sociocultural and geographical conditions
Foreign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.
https://ift.tt/2QqiM5Y
LC3A, LC3B and Beclin-1 Expression in Gastric Cancer
Background: The current study examined the key proteins involved in autophagosome formation and their prognostic role in gastric cancer. Materials and Methods: Paraffin-embedded tissues from 121 consecutive patients treated with surgery for gastric cancer were analyzed immunohistochemically for the expression of autophagic proteins microtubule-associated proteins 1A/1B light chain 3A and 3B (LC3A, LC3B) and beclin-1 (encoded by BECN1 gene). Assessment of proliferative index using E3 ubiquitin-protein ligase (MIB1) and correlations with histopathological parameters and overall survival were performed. Results: Strong cytoplasmic expression was noted for all studied proteins, although to a varying proportion, the median percentage being 30% for LC3A, and 40% for LC3B and beclin-1. The median score of LC3A+ stone-like structures (SLS) was 0.2 (range 0-1) and the median proliferative index was 30% (range=0-95%). A significant association between LC3A, LC3B and beclin-1 expression was confirmed (p<0.01). SLS score was higher in tumors of the gastro-esophageal junction (p=0.009), and beclin-1 was overexpressed in intestinal-type tumors (p=0.001). High SLS score (p=0.008) was significantly related to poor prognosis, and this finding persisted in multivariate analysis (hazard ratio(HR)=2.01, p=0.003). Conclusion: Intense autophagic activity, as assessed by LC3A immunostaining and SLS quantification, is a strong prognostic marker in gastric cancer and can be useful for clinical application.
https://ift.tt/2FRD18G
Efficacy of Enteral Access in Patients with Esophageal Squamous Cell Carcinoma Under Neoadjuvant Therapy
Background: Enteral feeding tubes used to manage the nutritional status of esophageal cancer were evaluated regarding their effectiveness in patients receiving neoadjuvant therapy. Patients and Methods: A retrospective study evaluating patients with esophageal squamous cell carcinoma undergoing neoadjuvant therapy between 2001 and 2014 was conducted at a medical center. Hospital patients' records for enteral access (EA) insertion and treatment outcomes were statistically analyzed. Results: Patients with EA at initial diagnosis had lower body mass index than the group without EA (p=0.012). Chemotherapy-related adverse events with grade 3-4 mucositis were significantly less frequent in the EA group (p=0.008), and grade 3-4 anemia was significantly more frequent (p=0.012). The 4-year mortality rate was 63.0% in the EA group and 67.7% in the group without EA (pnon-inferiority=0.035), which met the non-inferiority criterion with a non-inferiority margin of 10%. Conclusion: Patients with esophageal squamous cell carcinoma with malnutrition status undergoing neoadjuvant therapy with EA showed an improved outcome at maintaining nutritional status, reduced severity of mucositis and improved survival rate.
https://ift.tt/2rd7LH3
Application of Artificial Intelligence-based Technology in Cancer Management: A Commentary on the Deployment of Artificial Neural Networks
Artificial intelligence was recognised many years ago as a potential and powerful tool to predict disease outcome in many clinical situations. The conventional approaches using statistical methods have provided much information, but are subject to limitations imposed by the complexity of medical data. The structures of the important variants of the machine learning system artificial neural networks (ANN) are discussed and emphasis is given to the powerful analytical support that could be provided by ANN for the prediction of cancer progression and prognosis. The predictive ability of the cellular markers, DNA ploidy and cell-cycle profiles, and molecular markers, such as tumour promoter and suppressor gene, and growth factor and steroid hormone receptors in breast cancer management were also analysed. ANN systems have been successfully deployed to evaluate microRNA profiles of tumours which saliently sway cancer progression and prognosis of the disease, thus counteracting the negative implications of their numerical abundance. Finally, in this setting, the prospective technical improvements in artificial neural networks, as hybrid systems in combination with fuzzy logic and artificial immune networks were also addressed.
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Prognostic Significance of Survivin Expression and Combined Analysis with Cancer Stem Cell and Epithelial-Mesenchymal Transition-related Markers in Patients with Rectal Cancer Undergoing Preoperative Chemoradiotherapy
Aim: To identify the candidate marker predicting treatment response and survival outcome in rectal cancer patients who received preoperative chemoradiotherapy (CRT). Patients and Methods: Between 2000 and 2015, 159 patients with histologically-confirmed rectal adenocarcinoma underwent preoperative CRT followed by surgery. Among them, 70 patients were enrolled and the expression of survivin, cancer stem cell markers (CD44 and CD133) and epithelial–mesenchymal transition markers (E-cadherin and TWIST1) in pretreatment biopsy specimens were evaluated by immunohistochemistry. Associations between the expression of markers and clinical outcomes were evaluated. Results: The median follow-up period of all patients was 71 (range=15-203) months. Five-year overall (OS), disease-free (DFS), locoregional recurrence-free (LRRFS) and distant metastasis-free (DMFS) survival were 80.5%, 60.2% 90.1% and 76.5%, respectively. A significant association between survivin overexpression and worse treatment outcome was shown on univariate analyses for OS, DFS and DMFS (p=0.022, 0.002, and 0.005, respectively). On multivariate analysis, survivin overexpression was an adverse prognosticator for DFS and DMFS (p=0.007 and 0.015, respectively), with a borderline significant trend towards a shorter OS (p=0.069). Four other single biomarkers were not associated with survival outcomes. However, overexpression of both survivin and CD44 was significantly associated with worse OS on multivariate analysis (p=0.003). Conclusion: Survivin combined with CD44 might be a candidate biomarker for the prediction of recurrence and survival in patients who received preoperative CRT for rectal cancer. Further research with a larger population is needed to validate these results.
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Does Transdermal Testosterone Increase the Risk of Developing Breast Cancer? A Systematic Review
Background/Aim: Hypoactive sexual desire disorder (HSDD) is hypothesised to manifest in postmenopausal women at onset of menopause due to decreased oestrogen levels. Transdermal testosterone is a potential treatment option. This systematic review explores the relationship between the incidence of breast cancer and transdermal testosterone use. Materials and Methods: Searches were conducted on the PubMed and Ovid databases. In Ovid, the advanced search function was used: 'transdermal testosterone not male'. In PubMed, the following search terms were used: 'transdermal, testosterone, menopausal, women, breast cancer, women'. Abstracts that fitted our initial criteria were further investigated. Results: A total of 25 publications from PubMed and 192 publications from Ovid were initially assessed. Three randomised control trials were judged to have sufficiently met our inclusion criteria. However, these trials were too heterogeneous for a meta-analysis. A systematic review was deemed the most appropriate analysis of the data available. Conclusion: The publications examined in this systematic review suggest that the use of transdermal testosterone to treat HSDD in postmenopausal women does not increase breast cancer incidence. However, further research in the form of adequately powered randomised controlled trials with breast cancer incidence being the primary end point is required in order to confirm this.
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Chemotherapy in Patients with Hereditary Angioedema
Background: Hereditary angioedema (HAE) is an autosomal dominant hereditary disorder characterized by episodic swelling of many body regions (especially throat and abdomen), potentially triggered by medication. No data are available for HAE in patients with cancer assigned to standard chemotherapy. The aim of our study was to identify circulating mediators potentially predictive of acute HAE attacks during chemotherapy. Patient and Methods: Repeated blood testing (approximately every week) for complement system members (C3, C4, CH50, C1 inhibitor, C1-inhibitor functional C1Q), D-dimers and for routine haematochemistry were performed in a 42-year-old male affected by type 2 HAE during standard adjuvant oxaliplatin/fluorouracil-based chemotherapy administered for stage III radically resected rectal cancer. Pre-medication with 1,000 U Berinert inhibitor C1 was administered every week throughout treatment. Mann–Whitney U-test was used to determine statistical differences in measures between the first 30 days of therapy and beyond day 30 of therapy. Results: Pre-chemotherapy values of tested variables (day 0) were: C3: 101 mg/dl, C4: 5.71 mg/dl, CH50: 74%, C1 inhibitor: 43.4 mg/dl, C1-inhibitor functional: 18%, C1Q: 150 mg/dl, and D-dimers: 113 g/ml. A significant change in circulating values was observed for C3, D-dimers and C1-inhibitor functional. Four HAE attacks were observed, they started from the forth cycle of treatment and all were manageable. Changes in C3, D-dimers and C1-inhibitor functional preceded the attacks. Conclusion: The stress induced by chemotherapy such a standard oxaliplatin/fluorouracil increases the risk of attacks in patients with HAE. However, circulating biomarkers such as D-dimers, C3 and C1-inhibitor functional may serve as early predictors of acute HAE crisis.
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Potent Antitumor T-Cell Memory Is Generated by Curative Viral Oncolytic Immunotherapy But Not Curative Chemotherapy
Background: Late developing breast cancer metastases are common and lethal despite treatment with adjuvant chemotherapy at the time of primary tumor excision. Stimulation of an antitumor immune response is an alternative strategy for preventing this devastating development. Materials and Methods: A mouse model of the human epidermal growth factor receptor 2 (HER2/neu)-positive mammary cancer was used to compare the antitumor memory T-cell response following tumor cure by viral oncolytic immunotherapy, chemotherapy, surgical excision, or surgical excision plus virus infection. Memory T-cell response was assessed by functional in vivo assays. Results: Antitumor T-cell memory was generated most powerfully by curative viral oncolytic immunotherapy and poorly by curative chemotherapy. Cure by surgical excision generated an immune antitumor response which was increased by neo-adjuvant virus infection. CD4 memory T-cells were most potent. Conclusion: Virus infection of tumor generates an antitumor memory immune response and chemotherapy suppresses this response. Clinical trials testing adjuvant immune stimulation instead of chemotherapy may be worth exploring because memory antitumor T-cells have the unique potential to find and eliminate small nests of metastatic cancer cells in sanctuary sites and prevent emergence of tumors from dormant cancer cells.
https://ift.tt/2FNSpCQ
Prognostic Significance of 14-3-3{varepsilon}, Aldo-keto Reductase Family 1 B10 and Metallothionein-1 in Hepatocellular Carcinoma
Background/Aim: Expression of 14-3-3 is associated with prognostic outcomes of hepatocellular carcinoma (HCC) patients. Metallothionein-1 (MT-1) proteins and aldo-keto-reductase family 1 B10 (AKR1B10) are considered potential tumor regulators of HCC. The aim of this study, was to examine the prognostic value of 14-3-3, MT-1 and AKR1B10 expression in HCC. Materials and Methods: The expression levels of 14-3-3, MT-1 and AKR1B10 in HCC cell lines and paraffin-embedded tissues were examined by western blotting and immunohistochemical analysis. Results: 14-3-3 positivity was significantly associated with decreased MT-1 expression in HCC. Patients with decreased MT-1 expression had worse survival rates and a higher risk of metastasis than 14-3-3-positive HCC patients with unchanged MT-1 expression. Distinct expression patterns of 14-3-3/MT-1/AKR1B10 were significantly associated with the metastatic incidence and survival rates of HCC patients. Patients with negative 14-3-3 staining in primary tumors had better prognostic outcomes. In contrast, patients with positive 14-3-3 staining, decreased MT-1 expression and no increase in AKR1B10 expression in primary tumors had the worst overall and disease-free survival rates and the highest metastatic risk. Conclusion: 14-3-3, AKR1B10, and MT-1 act as potential prognostic biomarkers of HCC.
https://ift.tt/2rmQ6wJ
Cytolytic Activity (CYT) Score Is a Prognostic Biomarker Reflecting Host Immune Status in Hepatocellular Carcinoma (HCC)
Background/Aim: The cytolytic activity (CYT) score is a new index of cancer immunity calculated from the mRNA expression levels of GZMA and PRF1. We assessed the clinical significance of the CYT score in HCC. Materials and Methods: The calculated CYT scores of peripheral blood cells (GSE24759), cell lines (CCLE) and HCC tissues (TCGA, GSE14520 and Kyushu cohorts) were assessed. Then, immunohistochemical analysis (IHC) of GZMA and PRF1 was performed. Results: The CYT scores of HCC tissues were lower than those of non-cancerous tissues. The 5-year recurrence-free survival of patients with low CYT scores was significantly shorter than that of patients with high CYT scores. Multivariate analysis indicated that the CYT score was an independent prognostic factor for RFS in TCGA and GSE14520 cohorts. Conclusion: CYT score could be a useful prognostic biomarker in HCC, possibly through reflecting the host immune status.
https://ift.tt/2FLXOu6
A Phase II Study of Tri-weekly Low-dose Nab-paclitaxel Chemotherapy for Patients with Advanced Gastric Cancer
Background/Aim: Nanoparticle albumin-bound (nab)-paclitaxel has demonstrated antitumor activity against advanced gastric cancer. However, gastric cancer patients can be difficult to treat with the recommended dose because of the high incidence of adverse toxicities. The aim of this study was to evaluate the safety and effectiveness of low-dose nab-paclitaxel in a multicenter, single-arm, phase II study. Patients and Methods: Treatment included low doses of 180 mg/m2 nab-paclitaxel administered on day 1 of each 21-day cycle. The primary endpoint was defined as the overall response rate (ORR). The secondary endpoints included progression-free survival (PFS), safety, and overall survival (OS). A total of 34 patients were enrolled in the full-analysis set. Results: The ORR was 5.9%. The median PFS and OS were 2.4 months and 9.2 months, respectively. The most common grade 3/4 toxicities were anemia (8.8%), neutropenia (5.9%), appetite loss (5.9%) and peripheral sensory neuropathy (5.9%). No treatment-related deaths occurred. Conclusion: The tri-weekly low dose of nab-paclitaxel therapy is effective towards advanced gastric cancer patients with good tolerability and an acceptable margin of safety.
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Evaluation of the Usefulness of FDG-PET/CT for Nodal Staging of Breast Cancer
Background/Aim: Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has recently been used to investigate lymph node (LN) metastases and several predictive features in patients with breast cancer (BC). The aim of this study was to assess the value of this non-invasive imaging procedure for axillary staging. Patients and Methods: Fifty patients with early primary unilateral, locally advanced, or recurrent invasive operable BC were enrolled. All patients underwent preoperative 18F-FDG PET/CT, and the results were compared with the histopathology of dissected axillary LNs and their biological and immunohistochemical characteristics. The diagnostic performance of 18F-FDG PET/CT in detecting LN metastases from primary or recurrent BC was analyzed. The mean values of the initial PET/CT parameters, including the primary tumour (SUV T) and ipsilateral axillary LNs (SUV LN), were compared with the clinicopathological features of patients to determine their usefulness for predicting clinical interactions. Results: The sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT for axillary LN staging were 87%, 90%, 88%, 93%, and 82%, respectively. Bivariate analyses showed strong interactions of nuclear grade (p=0.05), progesterone receptor expression (p=0.001), Ki-67 index (0.027), and local relapse with the SUV T. A high SUV LN value was significantly correlated with a higher nuclear grade score (p=0.05), oestrogen receptor negativity (p=0.001), progesterone receptor negativity (p=0.014), a high Ki-67 index (>20%; p=0.048), LN metastasis (p<0.001), a basal tumour (p=0.04), and locoregional recurrence (p<0.001). Conclusion: PET/CT is a reproducible, non-invasive imaging modality that is useful for evaluating a primary BC mass and its relationship with metastatic axillary LNs, thereby predicting tumour behaviour and guiding clinical practice.
https://ift.tt/2G31mZl
Targeted Therapies for Pancreatic Cancer and Hurdles Ahead
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and lethal cancers with a median survival of 6 months after diagnosis. Intrinsic resistance to chemotherapeutics and lack of effective targeted therapies are the major factors contributing to dismal prognosis. Several important genetic alterations (i.e., mutations, deletions) have been identified to be involved in the initiation and progression of pancreatic cancer, including KRAS and inactivation of tumor suppressors, such as TP53, SMAD4 and CDKN2A. Unique tumor microenvironment with excessive stroma due to desmoplastic reaction is one of the major characteristics of PDAC, promoting tumor growth and leading to treatment failures. In addition, tumor stroma represents an important biological barrier for drug delivery and successful treatment of PDAC. Small interfering RNA (siRNA) has recently emerged as a potential and targeted therapeutic approach which is now evaluated in clinical trials. However, siRNA-based therapeutics face important challenges, including rapid serum degradation, poor tumor cell uptake and cellular uptake, leading to off-target effects. Therefore, there is a great need for the development of safe and effective nanoparticles for better tumor-specific delivery of anti-cancer therapeutics. In this article, the main challenges in the treatment of pancreatic cancer and recent advancements on nano delivery systems of chemotherapeutics and gene-targeted agents, used both in preclinical and clinical trials are reviewed.
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Effect of Combined Epigenetic Treatments and Ectopic NIS Expression on Undifferentiated Thyroid Cancer Cells
Background: Poorly differentiated (PDTC) and anaplastic thyroid (ATC) cancer cells are characterized by the acquisition of epigenetic abnormalities, leading to the silencing of both the sodium iodide co-transporter and the Coxsackie adenovirus receptor. As aberrant histone acetylation and DNA methylation represent epigenetic mechanisms involved in neoplastic transformation, our study investigated the anticancer properties of epigenetic modifiers in thyroid carcinoma. Materials and Methods: The cytotoxicity and gene expression modulation of histone deacetylase and DNA methyltransferase inhibitors were evaluated in both PDTC and ATC. Results: Epigenetic treatments were cytotoxic to tumor thyrocytes and restored sodium iodide co-transporter and Coxsackie adenovirus receptor, expression as well as radioiodine uptake, in PDTC but not in ATC. However, ectopic expression sodium iodide co-transporter re-activated radioiodine incorporation in ATC. Conclusion: The ability of epigenetic treatments to interfere with tumor proliferation and induce Coxsackie adenovirus receptor expression, coupled with the ability of ectopic sodium iodide co-transporter to restore radioiodine uptake, raise the possibility that these therapeutic approaches may provide clinical benefit to patients with thyroid carcinoma refractory to radioiodine treatment.
https://ift.tt/2FQlkGu
Outcomes of Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Severe Cirrhosis and Ineligibility for Transplant
Background/Aim: Our study reviewed the results of patients with hepatocellular carcinoma and Child–Pugh score 8-11 cirrhosis treated with stereotactic body radiotherapy when liver transplant was not an option. Patients and Methods: A retrospective review was performed on 15 patients with Child–Pugh class B and C cirrhosis treated with stereotactic body radiotherapy. The median total dose was 35 Gy in 4-5 fractions. None were listed for a liver transplant due to either being outside of the Milan criteria or to medical contraindications. Results: The overall survival was 26.7% at 6 months, with a mean survival of 152 days. The mean survival with and without ascites was 3.3 months and 8.3 months, respectively. Conclusion: For hepatocellular carcinoma with cirrhosis of Child–Pugh score 8 or more, prognosis after liver stereotactic body radiotherapy was suboptimal. While irradiation achieved local tumor control, progressive cirrhosis was a common cause of death. Patients without ascites at the time of radiotherapy had the best prognosis.
https://ift.tt/2rcAk7n
Embryonal Origin of Metanephric Adenoma and its Differential Diagnosis
Background/Aim: The association of Wilms' tumor (WT), papillary renal cell tumor (PRCT) and mucinous tubular and spindle cell carcinoma (MTSCC) with embryonal rests has already been documented, but the cellular origin of metanephric adenoma (MA) is not yet known. The aim of this study was to understand their developmental evolution and find diagnostic markers. Materials and Methods: CD57, KRT7, AMACR, SCEL, WT1 and CDH17 expression was analysed by immunohistochemistry in the four types of tumors and the associated pre-neoplastic lesions. Results: Immunohistochemistry was able to differentiate WT, MA, MTSCC and PRCT. A phenotypic correlation between MA and perilobar nephrogenic rest associated with WT was identified. Conclusion: Perilobar nephrogenic rest and MA arise from differentiation arrested cells of the proximal domain of the S-shape body. We propose that WT1, MA, MTSCC and PRCT derive from different forms of maturation arrested embryonal rests.
https://ift.tt/2FRJ2C3
Prognostic Factors and a Survival Score in Patients Irradiated for Metastatic Epidural Spinal Cord Compression from Urothelial Carcinoma Cancer of the Bladder
Background/Aim: Prognoses of patients with metastatic epidural spinal cord compression (MESCC) from urothelial carcinoma of the bladder are generally poor. This study aimed to identify prognostic factors that can facilitate personalized care of these patients. Patients and Methods: In 46 patients, 10 factors were evaluated for overall response (OR), post-radiotherapy (RT) ambulatory status, local control of MESCC and overall survival (OS). Independent predictors of OS were incorporated in a scoring system. Results: Being ambulatory post-RT was associated with pre-RT ambulatory status (p<0.001) and better performance score (p<0.001). No factor was significantly associated with OR and local control. On multivariate analyses, lack of visceral metastases (p=0.002), being ambulatory pre-RT (p=0.001) and performance score 1-2 (p=0.004) were associated with improved OS. Based on these factors, there were three distinct prognostic groups with 0, 1-2 and 3 points and median OS times of 2, 4 and 11.5 months, respectively. Conclusion: Prognostic factors were identified and a new survival score was created that will help physicians aiming to personalize treatment for patients with MESCC from urothelial carcinoma of the bladder.
https://ift.tt/2rfjWmt
Cell Harvesting Methods Affect Cellular Integrity of Adherent Cells During Apoptosis Detection
Background/Aim: Annexin V and propidium iodide (PI) dual staining is commonly applied in bioscience as a method to detect apoptosis. However, excessive handling of adherent cells may interfere with the integrity of plasma membrane and hence impede the accuracy of this method. Here, we exploited PI uptake as an indicator of cell integrity and investigated how cell harvesting methods and solutions involved in common apoptosis detection techniques affected measurement results. Materials and Methods: Different cell harvesting techniques, staining with PI and flow cytometry were performed. Results: Non-fixed scrapped cells revealed significantly higher fractions of PI-positive staining compared to non-fixed trypsinized cells. In the case of harvesting cells by scrapping, samples stained in binding buffer (68.30±3.55%) showed consistently higher PI-positive staining than samples stained in PBS (36.37±5.90%) in a significant manner (p=0.015). Conclusion: Enzymatic harvesting using 0.25% trypsin instead of mechanical harvesting by rubber scraper caused less damage of cell integrity. Furthermore, the binding buffer used in the apoptosis detection protocol aggravated the existing plasma membrane damage caused by the rubber scraper.
https://ift.tt/2G0nMtQ
No Renal Toxicity After Repeated Treatment with Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in Patients with Unresectable Peritoneal Metastasis
Background/Aim: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a recent approach for intraperitoneal chemotherapy with promising results for patients with peritoneal metastasis (PM). The aim of this study was to report renal toxicity for patients who received at least 3 repeated PIPAC procedures. Patients and Methods: All patients who underwent at least 3 PIPAC cycles of cisplatin (7.5 mg/m2) and doxorubicin (1.5 mg/m2) for unresectable PM from December 2015 to September 2017, were analysed regarding postoperative renal toxicity. Results: Among 103 patients registered in a prospective single center database, 43 patients underwent at least 3 PIPAC cycles representing a total of 175 PIPAC. Median age was 59.8 years, 24 (55.8%) patients were female and median BMI was 22.2 kg/m2. Most common origins of PM were gastric 22 (51.1%) and ovarian 11 (25.6%) cancer. Median peritoneal cancer index (PCI) was 17 (range=5-39). For 39 (90.1%) patients, systemic chemotherapy was performed in addition to PIPAC. Forty-three (100%), 17 (39.5%), 14 (32.5%), 8 (18.6%), 3 (7%), 2 (4.7%) and 2 (4.7%) patients underwent three, four, five, six, seven, eight and nine PIPAC procedures, respectively. Repeated PIPAC did not induce significant acute nor cumulative renal toxicity in any patients. Conclusion: Repeated PIPAC did not induce clinically relevant renal toxicity. This study confirms the previous published results in a larger group of patients.
https://ift.tt/2reUXQw
Expression of CK7 and CDKN2 in Cervical Intraepithelial Neoplasia and Correlation with Clinical Outcome
Aim: To evaluate cyclin-dependent kinase inhibitor 2A (CDKN2A) and cytokeratin 7 (CK7) expression in cervical intraepithelial neoplasia (CIN) formalin-fixed samples. Materials and Methods: Staining with antibody clones G175-405 for CDKN2A and OV-TL 12/30 for CK7 were evaluated and the detection of protein expressions were compared in 147 patients with CIN. Results: Clinical follow-up of patients with CIN1 and CIN2 showed that most patients had a favorable outcome. Single CDKN2A or CK7 expression and their combined expression had a greater sensitivity and negative predictive value in CIN1, corresponding to the non-development of the disease. The positive predictive value of CDKN2A was greater than that of CK7. Combined expression of CDKN2A and CK7 showed that the sensitivity, specificity, positive predictive values, and negative predictive values had their maximum index in the CIN1 group. Analysis of combined expression of CDKN2A and CK7 showed that 85.7% of patients presented unfavorable clinical outcomes, with positive expression for both markers identified in CIN2. Conclusion: Combined expression of CK7 and CDKN2A was associated with a better diagnosis of CIN, and negative expression in CIN1/2 groups had a greater negative predictive value for patient clinical outcome.
https://ift.tt/2FPHWqt
Outcomes After Radiotherapy Alone for Metastatic Spinal Cord Compression in Patients with Oligo-metastatic Breast Cancer
Background/Aim: Patients with oligo-metastatic breast cancer are a unique patient subgroup with more favourable outlook than most patients with metastatic disease. Prognostic factors in these patients with metastatic spinal cord compression (MSCC) were evaluated. Patients and Methods: In 159 patients irradiated for MSCC from oligo-metastatic breast cancer, seven characteristics were retrospectively analyzed including age, interval between breast cancer diagnosis and irradiation of MSCC, time developing motor deficits, ambulatory status, involved vertebrae, performance score (ECOG-PS) and radiotherapy regimen. Results: Improvement of motor function was significantly associated with time developing motor deficits (p=0.017), post-radiotherapy ambulatory status with pre-radiotherapy ambulation (p=0.012) and ECOG-PS 1-2 (p=0.029). Radiation doses of 39-40 Gy (equivalent doses) resulted in 1- and 2-year local control of 100% and 95%. On multivariate analyses, higher doses were associated with local control (p=0.011). Pre-radiotherapy ambulatory status (p=0.001) and ECOG-PS 1-2 (p=0.002) were associated with survival. Conclusion: Significant prognostic factors were identified for patients with MSCC from oligo-metastatic breast cancer. Higher radiation doses improved local control.
https://ift.tt/2re1Otf
Changes in the clinical and histological characteristics of Chinese chronic rhinosinusitis with nasal polyps over 11 years
Background
Traditionally, it was believed that chronic rhinosinusitis with nasal polyps (CRSwNP) demonstrated less eosinophilic and more neutrophilic inflammation in China compared to North America and Europe. However, inflammatory patterns may change over time. The study aimed to analyze the changing trends in the clinical and histological characteristics of CRSwNP over time in China.
Methods
A total of 115 consecutive CRSwNP patients from 2003 to 2005 and 114 consecutive CRSwNP patients from 2014 to 2016 were enrolled in this retrospective study. The clinical and histological data were compared between patients from the 2 time periods.
Results
The percentage of eosinophils in nasal polyp tissue increased, and the percentage of neutrophils and total inflammatory cell count decreased, over 11 years. The proportion of eosinophilic CRSwNP significantly increased from 59.1% to 73.7% over 11 years. The proportion of neutrophils and the total inflammatory cell count in nasal polyps decreased, and the proportion of eosinophilic CRSwNP patients using intranasal corticosteroids 1 month before surgery increased remarkably over 11 years. Moreover, eosinophilic CRSwNP patients had better compliance with intranasal corticosteroid use than non‐eosinophilic CRSwNP patients, and patients with comorbid allergic rhinitis and asthma had better compliance with intranasal corticosteroid use than patients without those conditions.
Conclusion
Eosinophilic CRSwNP, which was previously a minor subtype in East Asians, has increased remarkably in incidence to become the predominant CRSwNP subtype in Beijing, China, indicating that rhinologists should place greater emphasis on its diagnosis and treatment.
https://ift.tt/2SkgySU
Optic neuritis following diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccination: a case report
Diphtheria, tetanus, pertussis, and inactivated poliovirus combined vaccine is widely used in young children as part of a series of immunizations before they start attending school. Case studies of demyelinati...
https://ift.tt/2FPpDSh
Efficacy and Safety of a Water-Based Head Lice Lotion: A Randomized, Controlled, Investigator-Blinded, Comparative, Bicentric Study
Abstract
Introduction
Silicones (e.g., dimethicone) are effective and safe alternatives to insecticides for the treatment of head lice. However, silicones are lipophilic substances and do not only leave the hair greasy but they are also difficult to wash out. We have evaluated the efficacy and safety of a potential solution to this problem: an aqueous dispersion of a novel silylated polyol that has the same mode of action as dimethicone (suffocation) without its negative impact on hair characteristics.
Methods
This was a randomized, controlled, investigator-blinded, bicentric study that was conducted at two locations in the state of Florida (USA) to compare the test product (medical device) to a pyrethrum-based pediculicide that is a first-line, prescription-free treatment against head lice in the USA. The subjects (n = 70) were randomly divided into two groups of 35 persons (test product group and reference product group), with each participant receiving two applications (day 0 and 7) of the product to be tested, according to the instructions for use. Efficacy and safety was evaluated at distinct time points. The primary objective was to establish a cure rate for the test product that was better than 70% at study end (day 10). Esthetic effects of the test product versus dimethicone were evaluated in a blinded, cross-over consumer study (n = 100).
Results
At study end, the cure rate (corrected for re-infestation) of 88.2% with the test product significantly surpassed the pre-defined target of 70%, and thus the superiority of the test product versus the reference product was confirmed. The number of subjects cured (free of head lice) after the first treatment was remarkably higher with the test product than with the reference product (57.1 vs. 2.9%, respectively). Both products were safe and well tolerated and both showed beneficial esthetical effects. The consumer test demonstrated that the test product had better washing-out properties than dimethicone, as reflected by a significantly lower average rinsing time and number of washings required to restore the visual aspect of the hair, especially in terms of greasiness.
Conclusion
Aqueous dispersions of silylated polyols are a promising new class of pediculicides that combine high cure rates with optimal user convenience (short treatment period, easy wash-out with positive effect on hair quality).
Trial Registration
ClinicalTrials.gov identifier, NCT03617926.
Funding
Oystershell Laboratories.
https://ift.tt/2E9WorM
A rare presentation of a paediatric sinonasal inverted papilloma
Abstract
Sinonasal inverted papilloma (IP) is a benign tumour with an extremely low incidence in children. We report the case of an 11-year-old Caucasian male presenting with recurrent right-sided epistaxis, nasal obstruction and a mass in the right nasal cavity. An initial diagnosis of a nasopharyngeal angiofibroma was considered; however, on detailed histological examination, the mass was found to be an inverted papilloma. This report aims to increase awareness of IP in the paediatric age group, as well as reinforcing the role of endoscopic surgery in the management of this condition.https://ift.tt/2DUXRS1
Brunner’s gland hyperplasia: an unusual duodenal submucosal lesion seen in four patients
Abstract
Brunner's gland hyperplasia is an extremely rare benign hamartomatous lesion seen in proximal duodenum. Difficulty in diagnosing the condition pre-operatively puts the surgeon in dilemma for deciding appropriate management. We retrieved details from prospectively maintained retrospective data from January 2014 to April 2018. Four patients were identified of which three were males and one was female. Symptoms ranged from 4 days to 4 years, with abdominal pain, vomiting and malena being predominant. No patients were identified with diagnosis pre-operatively. Diagnosis was made on histopathological examination of the resected specimen and none of them were having malignant features. At a median follow up of 11 months, no patient had recurrence and were symptom free. Brunner's gland hyperplasia is a rare elusive duodenal pathology, symptomatically mimicking alarming duodenal lesions and mostly diagnosed on histopathology of specimen. Patients may harbour the lesion for long periods with little symptoms and upon treatment have good outcomes.https://ift.tt/2Qv60TE
Minimally invasive drainage of a giant ovarian mucinous cystadenoma associated with a mature cystic teratoma
Abstract
A 26-year-old, otherwise healthy female presented to the Emergency Room for the evaluation of abdominal pain. It was immediately apparent that she had a massively distended abdomen. History revealed progressive abdominal distension over several years. Evaluation for pregnancy was negative and a computed tomography (CT) scan demonstrated a 38 × 32 × 23 cm septated cystic mass. Careful controlled partial needle decompression of the cyst, removing 18.5 l of fluid, was followed by a mini-laparotomy with complete removal of a multi-loculated cystic ovarian mass approximately 45 lb in weight. Pathology was consistent with mucinous cystadenoma of the ovary in association with a mature cystic teratoma. This surgical technique of percutaneous drainage of the cyst, followed by mini-laparotomy is a valuable example of a safe and effective minimally invasive treatment modality for giant ovarian mucinous cystadenomas.https://ift.tt/2DQ62yG
Challenges in diffusion MRI tractography – Lessons learned from international benchmark competitions
Publication date: Available online 29 November 2018
Source: Magnetic Resonance Imaging
Author(s): Kurt G. Schilling, Alessandro Daducci, Klaus Maier-Hein, Cyril Poupon, Jean-Christophe Houde, Vishwesh Nath, Adam W. Anderson, Bennett A. Landman, Maxime Descoteaux
Abstract
Diffusion MRI (dMRI) fiber tractography has become a pillar of the neuroimaging community due to its ability to noninvasively map the structural connectivity of the brain. Despite widespread use in clinical and research domains, these methods suffer from several potential drawbacks or limitations. Thus, validating the accuracy and reproducibility of techniques is critical for sound scientific conclusions and effective clinical outcomes. Towards this end, a number of international benchmark competitions, or "challenges", has been organized by the diffusion MRI community in order to investigate the reliability of the tractography process by providing a platform to compare algorithms and results in a fair manner, and evaluate common and emerging algorithms in an effort to advance the state of the field. In this paper, we summarize the lessons from a decade of challenges in tractography, and give perspective on the past, present, and future "challenges" that the field of diffusion tractography faces.
https://ift.tt/2SjNuuQ
Salvage laryngectomy following organ-preservation therapy – An evidence-based review
Publication date: January 2019
Source: Oral Oncology, Volume 88
Author(s): Dustin A. Silverman, Sidharth V. Puram, James W. Rocco, Matthew O. Old, Stephen Y. Kang
Abstract
Salvage total laryngectomy is often indicated in patients with recurrent or persistent laryngeal cancer after radiation or chemoradiation treatment. This article reviews and discusses key considerations regarding salvage laryngectomy. Within this article, a review of the salvage laryngectomy incidence in the major organ preservation trials, survival rates, predictors of outcomes, complication rates, and the roles of elective neck dissection and free tissue transfer for reconstruction in patients undergoing salvage laryngectomy is provided.
https://ift.tt/2AFEybN
Magnetic resonance-based volumetric measurement of the endolymphatic space in patients with Meniere’s disease and other endolymphatic hydrops-related diseases
Publication date: Available online 30 November 2018
Source: Auris Nasus Larynx
Author(s): Hiroshi Inui, Tsuyoshi Sakamoto, Taeko Ito, Tadashi Kitahara
Abstract
Objective
To employ magnetic resonance imaging (MRI) to measure the volume of the inner ear endolymphatic space (ELS) in patients with acute low-tone sensorineural hearing loss (ALHL), sudden deafness (SD), cochlear Meniere's disease (cMD), and unilateral MD (uMD) compared with control subjects (CS) with chronic rhinosinusitis.
Methods
Forty-one patients with ALHL, 82 with SD, 48 with cMD, 72 with uMD, and 47 CS participated in the study. With the exception of all uMD patients, none of the subjects had vertigo. Images of the inner ear fluid space, positive perilymph signal, and positive endolymph signal were acquired using a 3-T MRI scanner. Three-dimensional images were reconstructed semi-automatically by using anatomical and tissue information to fuse the inner ear fluid space images and the ELS images.
Results
The cochlear ELS/total fluid space (TFS) volume ratio was 10.2 ± 6.7% (mean ± standard deviation) in the CS group, 12.1 ± 5.7% in ALHL patients, 15.2 ± 8.7% in SD patients, 18.1 ± 8.2% in cMD patients, and 21.9 ± 16.4% in uMD patients. The vestibular ELS/TFS volume ratio was 17.7 ± 10.2% in the CS group, 18.9 ± 8.3% in ALHL patients, 19.9 ± 11.3% in SD patients, 22.5 ± 13.7% in cMD patients, and 35.7 ± 24.1% in uMD patients. The cochlear ELS/TFS volume ratio in patients with uMD was similar to that in the cMD group and significantly higher than that in the CS, ALHL, and SD groups (CS = ALHL < SD < cMD = uMD: p < 0.05 for CS vs. SD and p < 0.01 for CS vs. cMD). The vestibular ELS/TFS volume ratio in patients with uMD was significantly higher than that in the CS and all other patient groups (CS = ALHL = SD = cMD < uMD: p < 0.01 for uMD vs. all other groups).
Conclusion
The cochlear ELS volume of patients with MD and other endolymphatic hydrops-related diseases differed from that of CS. Our results suggest that ALHL may not be caused by endolymphatic hydrops. We confirmed the presence of extended ELS in patients with SD.
https://ift.tt/2Rl6fOp
Role of phosphorylcholine in Streptococcus pneumoniae and nontypeable Haemophilus influenzae adherence to epithelial cells
Publication date: Available online 29 November 2018
Source: Auris Nasus Larynx
Author(s): Hiroyuki Iuchi, Junichiro Ohori, Takayuki Kyutoku, Kotoko Ito, Yuichi Kurono
Abstract
Objective
Phosphorylcholine (PC) is a structural component of Streptococcus pneumoniae (Spn) and nontypeable Haemophilus influenzae (NTHi), and is known to be associated with adherence through the platelet activating factor receptor (PAF-R). Furthermore, high PC expression is considered to be involved in Spn and NTHi virulence. In this study, we examined the influence of PC expression on the adherence of Spn and NTHi to epithelial cells in order to clarify the potential effectiveness of a vaccine targeting PC.
Methods
Twenty-seven strains of Spn and twenty-two strains of NTHi were used, cultured overnight, and PC expression was evaluated by fluorescence activated cell sorting; the strains were divided into two groups: PC low expression (PC-low) and PC high expression (PC-high) groups. Bacterial adherence was then examined using Detroit 562 cells and BALB/c mice. Bacterial invasion was then examined in Detroit 562 cells.
Results
The adherence of Spn and NTHi and invasion of NTHi in the PC-high group was significantly reduced by pretreatment with a monoclonal anti-PC antibody (TEPC-15), PAF-R antagonist (ABT-491), and PC-keyhole limpet hemocyanin (PC-KLH). However, such findings were not observed in the PC-low group.
Conclusion
The present study suggests that PC is involved in the mucosal adhesion of Spn and NTHi, and the mucosal invasion of NTHi with PC-high strains, but not PC-low strains. These results suggest that a PC-targeting mucosal vaccine only affects PC-high Spn and NTHi strains and does not disturb commensal bacterial flora in the upper respiratory tract, which comprises nonpathogenic PC-low bacteria.
https://ift.tt/2Q0IH4G
Corrigendum to “Environmental factors associated with allergic rhinitis symptoms in Japanese university students: A cross-sectional study” [Auris Nasus Larynx 45 (2018) 1006–1013]
Publication date: Available online 29 November 2018
Source: Auris Nasus Larynx
Author(s): Hironobu Nishijima, Sayaka Suzuki, Kenji Kondo, Tatsuya Yamasoba, Shintaro Yanagimoto
https://ift.tt/2RuSehm
Klassifikation und Pathophysiologie von Angioödemen
Zusammenfassung
Hintergrund
Die differenzialdiagnostische Einordung von Angioödemen kann im klinischen Alltag eine Herausforderung darstellen.
Ziel der Arbeit
Ziel ist es, eine Übersicht über die aktuelle Klassifikation von Angioödemen zu geben und deren zugrunde liegende Pathophysiologie zu erläutern.
Material und Methoden
Es erfolgte die Auswertung aktueller Leitlinien und Forschungsarbeiten zur Pathophysiologie und Klassifikation von Angioödemen.
Ergebnisse
Angioödeme werden grundlegend in Mastzellmediator-induziert und Bradykinin-vermittelt unterschieden. Akute Angioödeme durch allergische Reaktionen oder im Rahmen einer akuten Urtikaria bzw. rezidivierende Angioödeme bei Patienten mit chronischer Urtikaria sind klassische Beispiele für Mastzellmediator-induzierte Angioödeme. Zu den Bradykinin-vermittelten Angioödemformen gehören das hereditäre Angioödem und das ACE(„angiotensin-converting enzyme")-Hemmer-induzierte Angioödem. Bradykinin-vermittelte Angioödeme kommen deutlich seltener vor als Mastzellmediator-induzierte Angioödeme und verlaufen of schwerer. Die Basis zur klinischen Unterscheidung beider Formen von Angioödemen ist die gezielte Anamneseerhebung und laborchemische Diagnostik.
Schlussfolgerungen
In den meisten Fällen lassen sich Angioödeme in Zusammenschau von Klinik und Diagnostik als Mastzellmediator-induziert oder Bradykinin-vermittelt unterscheiden. In sehr seltenen Fällen bleiben die Ursache und die verantwortlichen Mediatoren unklar.
https://ift.tt/2Q1GfLk
Large-Scale Otoscopic and Audiometric Population Assessment: A Pilot Study
Publication date: Available online 30 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Kenny H. Chan, Susan Dreith, Kristin M. Uhler, Veronica Tallo, Marilla Lucero, Joanne De Jesus, Eric AF. Simões
ABSTRACT
Objective
Large-scale otoscopic and audiometric assessment of populations is difficult due to logistic impracticalities, particularly in low- and middle-income countries (LMIC). We report a novel assessment methodology based on training local field workers, advances in audiometric testing equipment and cloud-based technology.
Methods
Prospective observational study in Bohol, Philippines. A U.S. otolaryngologist/audiologist team trained 5 local nurses on all procedures in a didactic and hands-on process. An operating otoscope (Welch-AllynR) was used to clear cerumen and view the tympanic membrane, images of which were recorded using a video otoscope (JedMedR). Subjects underwent tympanometry and distortion product otoacoustic emission (DPOAE) (Path SentieroR), and underwent screening audiometry using noise cancelling headphones and a handheld Android device (HearScreenR). Sound-booth audiometry was reserved for failed subjects. Data were uploaded to a REDCap database. Teenage children previously enrolled in a 2000-2004 Phase 3 pneumococcal conjugate vaccine trial, were the subjects of the trainees.
Results
During 4 days of training, 47 Filipino children (M/F = 28/19; mean/median age = 14.6/14.6 years) were the subjects of the trainee nurses. After the training, all nurses could perform all procedures independently. Otoscopic findings by ears included: normal (N=77), otitis media with effusion (N=2), myringosclerosis (N=5), healed perforation (N=6), perforation (N=2) and retraction pocket/cholesteatoma (N=2). Abnormal audiometric findings included: tympanogram (N=4), DPOAE (N=4) and screening audiometry (N=0).
Conclusion
Training of local nurses has been shown to be robust and this methodology overcomes challenges of distant large-scale population otologic/audiometric assessment.
https://ift.tt/2BHfVgO
Dog Bite Injuries to the Face: Is there Risk with Breed Ownership? A Systematic Review with Meta-Analysis
Publication date: Available online 29 November 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Garth Essig, Cameron Sheehan, Shefali Rikhi, Charles Elmaraghy, J. Jared Christophel
Abstract
Introduction
Dog bite injuries to the face are a serious, yet modifiable public health concern. This study explores the relationship between dog breed and the risk of biting and injury. The objective of this study is to determine the relative risk and severity of dog bite injuries to the face by breed.
Methods
Retrospective chart review of facial dog bite injuries presenting to the University of Virginia Health System and Nationwide Children's Hospital. Additionally, descriptive data was collected from 240 patients over the last 15 years. Bite risk by breed was assessed by a literature search from 1970 to current. A composite measure was used to determine the severity of injury, and characterize each patient into an ordinal scale of bite severity. An average of each breed bite rate within each study was calculated and combined to create an empiric bite risk by breed. Dog breeds were also further characterized morphologically.
Results
Bite risk by breed from the literature review and bite severity by breed from our case series were combined to create a total bite risk plot. Injuries from Pitbull's and mixed breed dogs were both more frequent and more severe. This data is well-suited for a bubble plot showing bite risk on the x-axis, bite severity on the y-axis, and size of the bubble by number of cases. This creates a "risk to own" graphic for potential dog owners.
Conclusions
Breeds vary in both rates of biting and severity. The highest risk breeds had both a high rate of biting and caused significant tissue injury. Physical characteristics can also help determine risk for unknown or mixed dog breeds. Potential dog owners can utilize this data when assessing which breed to own.
https://ift.tt/2KHFKjy
Surgical ablation of lingual tonsils in the treatment of obstructive sleep apnea
Publication date: Available online 30 November 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Mure, M. Blumen, A. Alali, L. Page, F. Chabolle
Abstract
Objectives/Hypothesis
The retrolingual space is one of the potential sites of obstruction identified in patients with obstructive sleep apnea syndrome (OSAS). Hypertrophied lingual tonsils (LT) can obstruct the airway at this level. The goal of this study was to measure the tolerance and efficacy of lingual tonsillectomy in patients with OSAS.
Study design
A retrospective chart review was conducted recruiting all patients with OSAS confirmed on sleep recording, who either had failed or refused medical treatment and who underwent lingual tonsillectomy.
Materials and methods
Diagnosis of LT hypertrophy was made by full ENT clinical examination using a flexible endoscopy, completed by MRI and followed by drug-induced sleep endoscopy. The surgical intervention was carried out endoscopically by diode laser or coblation. The primary endpoint to measure efficacy was drop in apnea-hypopnea index (AHI) on sleep recording at 6 months. Secondary endpoints comprised reduced snoring and Epworth Sleepiness Scale (ESS) and postoperative symptom tolerance.
Results
Eleven patients aged 44.3 ± 12.6 years were included. AHI dropped from 29.5 ± 21.7/h to 11.6 ± 9.6/h: i.e., by 60% (P = 0.005). Five patients had AHI < 10/h: i.e., cure rate of 45%. ESS dropped from 13 ± 3.4 to 8.1 ± 4.9 (P = 0.012). No complications were observed.
Conclusions
LT ablation seemed effective in OSAS with retrolingual obstruction in failure of medical treatment.
Level of evidence
4.
https://ift.tt/2BHd0EK
Risk factors for severity of juvenile-onset recurrent respiratory papillomatosis at first endoscopy
Publication date: Available online 29 November 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Moreddu, E. Lambert, D. Kacmarynski, R. Nicollas, J.-M. Triglia, R.J. Smith
Abstract
Objective
The study objective was to determine risk factors for severity of juvenile-onset recurrent respiratory papillomatosis (RRP) at first endoscopic evaluation.
Methods
Based on a review of all cases undergoing surgery for juvenile-onset RRP in two pediatric otolaryngology departments in the USA and France, the following severity risk factors were analyzed: number of laryngeal levels involved, extension to the subglottis, and bilateral involvement.
Results
Thirty-two patients were included, with 571 endoscopic procedures. Number of endoscopies per patient varied according to initial extension: 30.67 procedures when all three levels were involved, 15.57 procedures when two and 14.08 procedures when only one (P = 0.03). The odds ratio for risk of > 14 procedures in 3-level involvement was 20.43 (P = 0.047). Initial subglottic extension tended to be associated with more endoscopic procedures (23.67 vs 15.56, P = 0.16).
Conclusions
RRP severity correlated with initial laryngeal extension of papillomatous lesions at first endoscopy. This finding allowed a short 3-item assessment scale to be created for routine use, complementary to Derkay's assessment scale.
https://ift.tt/2KJ9wVf
Erratum
Publication date: December 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6
Author(s):
https://ift.tt/2KLOQvC
Anti-microbial Resistance In Atopic Dermatitis: Need for an Urgent Rethink
Publication date: Available online 29 November 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): C.P. Harkins, M.T.G. Holden, A.D. Irvine
https://ift.tt/2BJbyBW
Challenges in allergy immunology practice: Solutions needed for persistent patient problems
Publication date: December 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6
Author(s): Gailen D. Marshall
https://ift.tt/2So2d89
Author Index
Publication date: December 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6
Author(s):
https://ift.tt/2E5OVdl
A new acronym for PPI-REE?
Publication date: December 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6
Author(s): Russell Hopp
https://ift.tt/2SmBYil
Editorial Board
Publication date: December 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6
Author(s):
https://ift.tt/2E6hdUR
Information for Authors
Publication date: December 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6
Author(s):
https://ift.tt/2SmBRTX
Table of Contents
Publication date: December 2018
Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 6
Author(s):
https://ift.tt/2E44KkB
Increased IRF4 expression in isolated B cells from common variable immunodeficiency (CVID) patients
Publication date: Available online 30 November 2018
Source: Allergologia et Immunopathologia
Author(s): S. Afshar-Ghasemlou, N. Esmaeil, R. Sherkat, R. Yazdani, F. Abbasi-Rad, M. Ganjalikhani-Hakemi, A. Rezaei
Abstract
Background
Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by low serum levels of immunoglobulins (Igs) and recurrent infection. In most CVID patients, a defect in the differentiation of B cells into plasma cells has been observed. Several factors play an important role in the proliferation and differentiation of B cells, including IRF4 and XBP1 transcription factors.
Methods
In the present study we investigated the expression of IRF4 and XBP1 in the B-cells of CVID and healthy controls (HCs). For this purpose, we assessed the expression of IRF4 and XBP1 at both mRNA and protein levels by real time-PCR and flow cytometry, respectively.
Results
We found that IRF4 expression was significantly increased in CVID patients compared with controls. Although the XBP1 protein level was lower in patients in comparison to controls, this difference was not significant.
Conclusion
Taken together, increased IRF4 expression could be involved in defective functions of B cells in CVID patients.
https://ift.tt/2SfHIKK
Development of a tool for screening adverse food reactions and food allergy in Portuguese children
Publication date: Available online 30 November 2018
Source: Allergologia et Immunopathologia
Author(s): A. Jorge, M. Santos Silva, C. Lozoya-Ibánez, F. Lorente, E. Sarinho, R.M. Afonso, H. Pereira, L. Taborda-Barata
Abstract
Introduction and objectives
A standardised questionnaire may be an excellent tool for epidemiological studies aiming at screening children with suspected food allergies. Thus, the aim of the present study was to develop a screening questionnaire for assessing children with suspected food allergy and to analyse its reproducibility.
Materials and methods
A questionnaire of adverse food reactions was developed by literary review of similar questionnaires validated in other countries as well as less well defined, non-validated Portuguese questionnaires. Peer review of the questionnaire by a panel of specialists and subsequent exploratory analysis was carried out by applying the questionnaire in children with confirmed food allergy. Test–retest analysis was performed by giving a face-to-face questionnaire to 159 children with suspected adverse food reactions, aged between three and 11 years. Temporal stability using Spearman Rho correlation test and reproducibility was studied using Cohen's Kappa index.
Results
115 children confirmed adverse food reactions that occurred with one or more foods. Retest was given about three weeks after the test, to 50 of these children who were randomly selected. The questionnaire showed good temporal stability (Spearman correlation coefficient of 0.834), and good reproducibility (only two of the 27 items had a Kappa index <0.60).
Conclusions
This questionnaire showed good temporal stability and reproducibility. Its validation for screening children with suspected food allergy will allow a standardised approach to diagnosis and comparison of results obtained in different centres.
https://ift.tt/2E3Si4z
Changes in the prevalence of asthma and related risk factors in adolescents: Three surveys between 1994 and 2015
Publication date: Available online 30 November 2018
Source: Allergologia et Immunopathologia
Author(s): J. Mallol, V. Aguirre, M. Mallol-Simmonds, A. Matamala- Bezmalinovic, L. Calderón-Rodriguez, F. Osses-Vergara
Abstract
Methods
This study assesses the temporal trend of current asthma symptoms prevalence and associated factors in Chilean adolescents from South-Santiago, considering surveys performed in 1994, 2002 and 2015.
Results
The prevalence of current asthma symptoms showed a trend to increase from 11.1% in 1994 to 13.4% in 2015 (p < 0.001); physician-diagnosed asthma increased from 11.5% to 13.8%, (p < 0.001) whereas severe asthma and asthma with exercise decreased (p < 0.001). Female adolescents had a higher prevalence of current asthma in the three surveys (p < 0.001), and was a risk factor for asthma in the three surveys. In 2002, frequent consumption of meat and potatoes were associated with current asthma while frequent vigorous exercise was protective. Frequent exercise and parental tobacco smoking were risk for asthma in 2015 (p < 0.001). Current active tobacco smoking showed a trend to increase reaching a prevalence of 28.9% in 2015 (p < 0.001). There was a consistently low proportion of adolescents with current wheezing and asthma diagnosis (32.1% in 2015) and 37.6% of them had no asthma treatment.
Conclusion
The prevalence of current asthma in adolescents from the studied area would be still increasing. As in other studies, female adolescents had a higher prevalence of current asthma. Current active tobacco smoking has strikingly increased in the studied children while indoor passive tobacco exposure remains inadmissibly high. Our findings suggest that asthma in children is underdiagnosed and undertreated. More attention should be given to female gender, tobacco exposure, air pollution and local diagnostic preferences when studying and interpreting trends of asthma prevalence in adolescents from developing localities.
https://ift.tt/2SfHGCC
Self-reported hypersensitivity and allergy to foods amongst Mexican adolescents: Prevalence and associated factors
Publication date: Available online 30 November 2018
Source: Allergologia et Immunopathologia
Author(s): T.R. Bedolla-Pulido, M. Bedolla-Barajas, J. Morales-Romero, T.I. Bedolla-Pulido, M.V. Domínguez-García, D.D. Hernández-Colín, M.V. Flores-Merino
Abstract
Background
The prevalence of food allergy is on the rise on a global scale.
Objective
To determine the prevalence of food hypersensitivity (FHS) and probable food allergy (PFA), as well as the foods and factors associated with these occurrences.
Methods
A cross-sectional study was carried out among 1992 adolescents (aged 15–18 years). Each adolescent answered a structured questionnaire. A multivariate analysis was used to identify the association between the variables.
Results
The prevalence of FHS was 10.6% (the most commonly associated foods were shrimp, cow's milk and avocado) and the PFA was 7.8% (shrimp, cow's milk and pecan). The prevalences of oral allergy syndrome, food-associated urticaria and systemic reaction were 4.9%, 3.6% and 1.5%, respectively. The following factors were associated with FHS: personal history of asthma (OR 1.63; 95% CI: 1.11–2.41), allergic rhinitis (OR 2.60; 95% CI: 1.75–3.87), atopic dermatitis (OR 2.07; 95% CI: 1.25–3.43), maternal history of asthma (OR 1.80; 95% CI: 1.02–3.16), atopic dermatitis (OR 6.11; 95% CI: 2.45–15.29), and female sex (OR 1.89; 95% CI: 1.38–2.59). PFA was associated with a personal history of asthma (OR 1.65; 95% CI: 1.06–2.56), allergic rhinitis (OR 2.46; 95% CI: 1.56–3.88), atopic dermatitis (OR 2.02; 95% CI: 1.15–3.54), paternal allergic rhinitis (OR 2.52; 95% CI: 1.15–5.51), maternal atopic dermatitis (OR 7.46; 95% CI: 2.93–19.00), and female sex (OR 1.89; 95% CI: 1.31–2.72).
Conclusion
The adverse reactions associated with foods among late adolescents are a frequent occurrence, and the most commonly associated factor is atopy.
https://ift.tt/2E5MJCn
Sex, Microbes, and Polycystic Ovary Syndrome
Publication date: Available online 29 November 2018
Source: Trends in Endocrinology & Metabolism
Author(s): Varykina G. Thackray
Recent studies have shown that sex and sex steroids influence the composition of the gut microbiome. These studies also indicate that steroid regulation of the gut microbiome may play a role in pathological situations of hormonal excess, such as PCOS. Indeed, studies demonstrated that PCOS is associated with decreased alpha diversity and changes in specific Bacteroidetes and Firmicutes, previously associated with metabolic dysregulation. These studies suggest that androgens may regulate the gut microbiome in females and that hyperandrogenism may be linked with a gut 'dysbiosis' in PCOS. Future mechanistic studies will be required to elucidate how sex steroids regulate the composition and function of the gut microbial community and what the consequences of this regulation are for the host.
https://ift.tt/2P7zC4Z
Plasma CXCL13 is a predictive factor for HBsAg loss and clinical relapse after discontinuation of nucleos(t)ide analogue treatment
Publication date: Available online 30 November 2018
Source: Clinical Immunology
Author(s): Muye Xia, Guichan Liao, Hongjie Chen, Yin Wu, Rong Fan, Xiaoyong Zhang, Jie Peng
Abstract
In this study, we investigated whether plasma cytokine/chemokine levels could predict HBsAg loss or clinical relapse (CR) after stopping nucleos(t)ides analogue (NA) treatment. Theplasma cytokines/chemokines levels were measured at 0, 4, 8, 12, 24 and 48 weeks after NA discontinuation by using the enzyme-linked immunoassay (ELISA) kit. Cox regression analysis revealed that CXCL13 level at the end of treatment (EOT) was an independent predictor for CR (HR 0.26, p < 0.001) and HBsAg loss (HR 3.01, p = 0.008) after treatment cessation. Among the patients with EOT CXCL13 level < 80 pg/ml, the cumulative incidences of CR and HBsAg loss were 65% and 0% at 4 years, respectively. As for the patients with EOT CXCL13 level ≥ 1000 pg/ml, 47.5% cases had HBsAg loss. Our study showed that EOT CXCL13 level was associated with off-treatment response, which may be used to guide cessation of NA treatment in clinical practice.
https://ift.tt/2PaZooG
Πέμπτη 29 Νοεμβρίου 2018
Erratum zu: Primärversorgung von akutem Schwindel
Erratum zu:
HNO 2018 66:472–479
https://ift.tt/2E8VWdk
Die Autoren möchten auf einen Tippfehler im Manuskript hinweisen. Dabei wurde die Arbeit von Maxwell et al. [40] zitiert, welche die Bedeutung der Kopf-Anteflexion für die Durchführung des vKIT untersucht hat. Diese Arbeit kam zu dem …
https://ift.tt/2SnJBoN
A case of multinucleate cell angiohistiocytoma in a 14‐year old boy showing two different clinical and histopathological findings
Multinucleate cell angiohistiocytoma (MCAH) is a rare cutaneous disease entity characterized by multiple red‐to‐brown or violaceous papules usually located on the acral regions such as the face and the distal arms and legs. It affects elderly women more than men and hardly occurs at a young age. The exact pathogenic mechanism of MCAH is not yet clearly understood.
We report an exceptionally rare case of a 14‐year old boy who presented with multiple asymptomatic erythematous papules and a single flat brownish plaque on the left chest. The brownish plaque lesion histologically showed proliferation of dilated small vessels in the upper‐mid dermis and numerous oddly shaped multinucleate cells intermingled with lymphocytes and macrophages. The erythematous papules also showed dilated small vessels in the upper‐mid dermis and multiple interstitial histiocytic infiltrations, but no multinucleate cells were detected. In immunohistochemistry studies, CD68 and vimentin staining were positive for both specimens. Based on the clinicopathological findings and immunohistochemistry studies, MCAH was diagnosed.
To the best of our knowledge, this is the first case report of MCAH occurring in young age and showing two different clinical and histological phases at the same time.
This article is protected by copyright. All rights reserved.
https://ift.tt/2AyEXgq
Patient Navigation to Enhance Access to Care for Underserved Patients with a Suspicion or Diagnosis of Cancer
AbstractBackground.Interventions aimed at improving access to timely cancer care for patients in low‐ and middle‐income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City.Materials and Methods.From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment.Results.Seventy patients (median age 54, range 19–85) participated in this study. Ninety‐six percent (n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden (n = 50) and fear (n = 37). Median time to referral was 7 days (range 0–49), and time to specialist appointment was 27 days (range 1–97). Ninety‐one percent of patients successfully obtained appointments at cancer centers in <3 months.Conclusion.Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients.Implications for Practice.A patient navigation program for patients with suspicion or diagnosis of cancer in a second‐level hospital was feasible and acceptable. It reduced patient‐reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.
https://ift.tt/2DSOkKV
Use of Metformin and Platelet Reactivity in Diabetic Patients Treated with Dual Antiplatelet Therapy
Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0787-1382
Background Enhanced platelet reactivity represents one of the major determinants of cardiovascular risk among diabetic patients. The aim of the present study was to evaluate the impact of metformin use on platelet reactivity in diabetic patients receiving dual antiplatelet therapy (DAPT). Methods We included diabetic patients treated with DAPT after an acute coronary syndrome or percutaneous coronary intervention. Platelet reactivity was assessed at 30–90 days by Multiple-electrode aggregometry. In an additional cohort of diabetic patients naïve to antiplatelet therapy, we assessed platelet reactivity by light transmission aggregometry, surface expression of P-selectin and plasma concentration of Thromboxane B2 (TxB2). Results We included 219 diabetic patients, 117 (53.4%) treated with metformin. Metformin was associated with younger age (p=0.03), male gender (p=0.02), lower rate of hypertension (p=0.04), active smoker (p=0.002), previous MI (p<0.001) renal failure (p<0.001), fibrinogen (p<0.001) and C-reactive protein (p=0.04), larger use of diuretics (p=0.04) calcium antagonists (p=0.05), better glycemic control (p<0.001) and higher haemoglobin (p=0.003). The prevalence of HAPR did not significantly differ according to hypoglycemic treatment (p=0.73; adjusted OR[95%CI]=5.63[0.42-76], p=0.19). Moreover, no impact of metformin was observed for HRPR (p=0.77; adjusted OR[95%CI]=1.15[0.55-2.4], p=0.71). Among an additional cohort of 42 diabetic patients naïve to antiplatelet therapy, we confirmed no impact of metformin or insulin on aggregation. Conclusions Our study found no apparent association in diabetic patients treated with DAPT, between the use of metformin and platelet reactivity or the rate of HPR.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2Rjd5nG
Case 37-2018: A 23-Year-Old Woman with Vision Loss
Presentation of Case. Dr. Seth N. Levin (Neurology): A 23-year-old right-handed woman with a history of migraines was evaluated at this hospital for vertigo and vision loss affecting the right eye. Six days before admission, a right frontal headache and right retro-orbital pain developed; these…
https://ift.tt/2DS7Ebe
Case 35-2018: A 68-Year-Old Woman with Back Pain and a Remote History of Breast Cancer
Presentation of Case. Ms. Diane P. Doyle, M.S.N. (Medicine): A 68-year-old woman with a history of bilateral breast cancer was evaluated at the oncology clinic of this hospital for back and pelvic pain. Twenty-five years before the current evaluation, the patient was noted to have a small lump in…
https://ift.tt/2QqlnwB
Role of phosphorylcholine in Streptococcus pneumoniae and nontypeable Haemophilus influenzae adherence to epithelial cells
Phosphorylcholine (PC) is a structural component of Streptococcus pneumoniae (Spn) and nontypeable Haemophilus influenzae (NTHi), and is known to be associated with adherence through the platelet activating factor receptor (PAF-R). Furthermore, high PC expression is considered to be involved in Spn and NTHi virulence. In this study, we examined the influence of PC expression on the adherence of Spn and NTHi to epithelial cells in order to clarify the potential effectiveness of a vaccine targeting PC.
https://ift.tt/2Q3I8XN
Magnetic resonance-based volumetric measurement of the endolymphatic space in patients with Meniere’s disease and other endolymphatic hydrops-related diseases
To employ magnetic resonance imaging (MRI) to measure the volume of the inner ear endolymphatic space (ELS) in patients with acute low-tone sensorineural hearing loss (ALHL), sudden deafness (SD), cochlear Meniere's disease (cMD), and unilateral MD (uMD) compared with control subjects (CS) with chronic rhinosinusitis.
https://ift.tt/2RnDgcV
Corrigendum to “Environmental factors associated with allergic rhinitis symptoms in Japanese university students: A cross-sectional study” [Auris Nasus Larynx 45 (2018) 1006–1013]
In the ethical considerations section of the article, the ethical committee should read as follows: "The University of Tokyo, Graduate School of Medicine".
https://ift.tt/2Q4G6H8
The Quality of Systematic Reviews Addressing Peripheral Nerve Repair and Reconstruction
While systematic reviews are regarded as the strongest level of medical evidence, inconsistency in the quality and rigor of systematic reviews raises concerns about their use as a tool in guiding quality delivery in evidence-based clinical practice. The objective of this present study was to assess methodological soundness of systematic reviews with a particular focus on peripheral nerve repair and reconstruction.We performed a comprehensive search using PubMed and Scopus to identify all systematic reviews published on peripheral nerve reconstruction in 9 high-impact surgical journals.
https://ift.tt/2Q86rUQ
Anti-microbial Resistance In Atopic Dermatitis: Need for an Urgent Rethink
Atopic dermatitis (AD) results from a complex interplay of host genetic and environmental factors. There is a long established association between AD and Staphylococcus aureus. In healthy individuals this organism has a dichotomous relationship with the host, being a frequent component of the human microbiome, carried asymptomatically, and on occasion, an opportunistic pathogen capable of causing or influencing a broad ranging disease. In AD, high carriage rates of S. aureus on affected skin is commonly observed, with recent meta-analysis evidence demonstrating colonisation in approximately 70% of affected individuals 1.
https://ift.tt/2BHCLVB
Incidence of Thyroid Cancer Among Residents Within 5 Years of the 2011 Fukushima Nuclear Accident
This cohort study of 324 301 children and young adults in Fukushima, Japan, evaluates the number of detected thyroid cancers by age group within 5 years of the 2011 Fukushima Daiichi nuclear power station accident and compares basic clinical characteristics and demographic patterns in first-round and second-round examinations.
https://ift.tt/2BHFyxY
https://ift.tt/2BHFyxY
Effect of TIVA vs VIMA on Emergence Agitation After Nasal Surgery
This randomized clinical trial investigates the effect of total intravenous anesthesia (TIVA) vs volatile induction with maintenance anesthesia (VIMA) on the occurrence of emergence agitation among patients undergoing nasal surgery.
https://ift.tt/2KLmAcU
https://ift.tt/2KLmAcU
Care of Patients With Endocrine Conditions
In this issue, we present the study by Ohtsuru and colleagues who analyzed clinical characteristics of thyroid cancers screened by ultrasonography in children and young adults during the first 5 years after the 2011 Fukushima Daiichi Nuclear Power Station accident. Along with the publication of this landmark study, I am excited to announce a new section editor in JAMA Otolaryngology–Head & Neck Surgery who will be dedicated to the care of patients with endocrine conditions. I invited Louise Davies, MD, MS, to serve as the first Endocrinology Section Editor. Dr Davies is an internationally recognized expert on thyroid cancer with a focus on appropriate treatment of adults diagnosed with small thyroid nodules and has methodologic expertise in epidemiology and mixed-methods research approaches. I am also excited to announce the appointment of Luc G. T. Morris, MD, MSc, to the editorial board. Dr Morris' research program straddles head and neck cancer genomics and the epidemiology of overdiagnosis, and he has methodologic expertise in biostatistics and bioinformatics. Together, they will provide breadth and depth to this renewed area of clinical focus.
https://ift.tt/2BHhE5N
https://ift.tt/2BHhE5N
Why the Data From the Fukushima Daiichi Nuclear Power Station Accident Are Important
On March 11, 2011, the Great East Japan Earthquake and subsequent giant tsunami led to catastrophic damage at the TEPCO (Tokyo Electric Power Company Holdings) Fukushima Daiichi nuclear power station. Radioactive materials spread into the Fukushima Prefecture. Although the estimated release of radioactive material was quite small, the accident caused great alarm within the population. In response, 4 months later, in July 2011, the Fukushima Health Management Survey was launched to monitor for potential radiation-induced health effects, including a large-scale thyroid surveillance program. In this issue of JAMA Otolaryngology–Head & Neck Surgery, Ohtsuru and colleagues provide data from the initial 2 rounds of ultrasound screening during the first 5 years after the accident, the first round between 2011 and 2013 and the second round between 2014 and 2015. Ultimately, 324 301 individuals who had been younger than 18 years at the time of the accident (the age group at higher risk of thyroid cancer after radiation exposure) were included in the analysis. During the 4 years after the accident that the screening rounds took place, 187 children and adolescents were diagnosed with thyroid cancer; the most common pathologic diagnosis was papillary thyroid cancer (98.0%).
https://ift.tt/2KG4tot
https://ift.tt/2KG4tot
Thyroid Cancer Screening After Nuclear Accidents
This guideline recommendation by an expert group convened by the International Agency for Research on Cancer outlines recommendations for thyroid screening after nuclear events.
https://ift.tt/2BF8FSs
https://ift.tt/2BF8FSs
An Indolent Middle Ear Mass
A woman in her 30s with a 1-year history of left ear fullness presented with left-sided hearing that improved temporarily with autoinsufflation. What is your diagnosis?
https://ift.tt/2KHySD0
https://ift.tt/2KHySD0
Anemia and 30-Day Morbidity and Mortality After Thyroidectomy in Thyroid Cancer Treatment
This cross-sectional cohort study uses the American College of Surgeons National Surgical Quality Improvement Program database to evaluate whether an association exists between preoperative anemia and postoperative 30-day morbidity and mortality outcomes following thyroidectomy in adult patients with thyroid cancer.
https://ift.tt/2BHhDyL
https://ift.tt/2BHhDyL
Elevated expression of IL-17RB and ST2 on myeloid dendritic cells is associated with a Th2-skewed eosinophilic inflammation in nasal polyps
Interleukin(IL)-25, IL-33, and thymic stromal lymphopoietin (TSLP) underlie the crosstalk between epithelial cells and dendritic cells (DCs) during the development of Th2 responses. This study aimed to measure...
https://ift.tt/2PbLFhs
Xerostomia Risk After Radiation Therapy and Association With Parotid Dose
This cohort study investigates the association between radiation doses in the parotid glands and self-reported xerostomia among adults treated with whole-brain radiation therapy.
https://ift.tt/2KJvDee
https://ift.tt/2KJvDee
Regional Hyperthermia With Neoadjuvant Chemotherapy for Treatment of Soft Tissue Sarcoma
To the Editor Issels et al analyzed long-term local progression-free survival (LPFS), disease-free survival (DFS), and overall survival (OS) data from an important clinical trial evaluating the efficacy of regional hyperthermia (RHT) added to neoadjuvant chemotherapy (NACT) for localized high–risk soft tissue sarcoma. In the article, added value from RHT was summarized mainly with hazard ratios (HRs). For instance, for DFS, an HR of 0.71 was reported (95% CI, 0.55-0.93; P = .01) in favor of RHT. Median DFS times were 2.8 (95% CI, 2.0-4.9) and 1.5 years (95% CI, 1.1-2.1) for NACT with RHT and NACT alone, respectively. These median CIs overlap, indicating that the difference in median DFS time might not be statistically significant. For OS, the HR was 0.73 (95% CI, 0.54-0.98; P = .04), but median OS time for NACT with RHT was not available. In panels A to C of Figure 2 from the study by Issels et al, the Kaplan-Meier curves of the 2 arms appeared to be parallel after 3 years. Moreover, as noted in the article, NACT with RHT showed delayed OS benefit. These factors suggest that HRs are not constant over time and are difficult to interpret clinically as summary measures for treatment effect.
https://ift.tt/2BF99rI
https://ift.tt/2BF99rI
Regional Hyperthermia With Neoadjuvant Chemotherapy for Treatment of Soft Tissue Sarcoma—Reply
In Reply We thank Dr Sun et al and Dr Roussakow for their thoughtful comments on our recent article in JAMA Oncology.
https://ift.tt/2KGg4Eb
https://ift.tt/2KGg4Eb
Regional Hyperthermia With Neoadjuvant Chemotherapy for Treatment of Soft Tissue Sarcoma
To the Editor The report by Issels et al on long-term survival in the randomized clinical trial of regional hyperthermia (RHT) plus neoadjuvant chemotherapy vs neoadjuvant chemotherapy alone for treatment of soft tissue sarcoma is misleading. This report is a post hoc analysis of the initial study results, which showed no benefit in overall survival (OS) associated with RHT (hazard ratio [HR], 0.88; 95% CI, 0.64-1.21; P = .43). Issels et al reported the result of a competing-risks analysis that indicated that the specific risk of death from sarcoma was significantly lower after RHT (HR, 0.73; 95% CI, 0.54-0.98; P = .04), though the reported number of non–sarcoma-related deaths suggests that this risk was significantly higher after RHT (15 vs 6 deaths; odds ratio, 2.76; 95% CI, 1.04-7.29; P = .04 by 2-tailed χ2 test). In general, there is no gain in OS associated with neoadjuvant therapy with RHT. Instead of reporting the result as a secondary analysis, the authors presented it as the primary result of the study. They did not mention that there was no actual benefit in OS, presented the competing risks-based sarcoma-specific survival (SSS) as the initial study end point, and omitted the significant increase in the non–sarcoma-related mortality. Moreover, in the recent study there is a risk for selection bias because the authors excluded 12 patients apparently owing to withdrawal of consent or metastatic disease, though this exclusion was not included in the previous report after 3 years of follow-up. Interestingly, the authors stated the additional reason for the exclusion in the supplement: these patients did not start their allocated treatment after randomization. This additional reason for exclusion is confusing because it appears that 7 patients were excluded from the RHT arm in the most recent article, whereas the earlier study stated that only 4 did not start treatment. The recent study result is presented as a robust intention-to-treat analysis, though after the exclusions, this is a less reliable per-protocol analysis. Furthermore, the SSS is confounded by fewer cycles of chemotherapy in the control arm (median, 5 cycles) than in the RHT arm (median, 8 cycles), and apparently no adjustment for the confounding was applied. Other possible confounders, including the end point substitution, the competing risks-based nature of the end point, and selection bias resulting from the excluded patients, were not properly addressed. Thus, the conclusion that the advantage in SSS is owing to the longer follow-up may not be justified. In my opinion, this report does not show an advantage of RHT plus neoadjuvant chemotherapy vs neoadjuvant chemotherapy alone. I highlight these issues to prevent possible misinterpretation of this trial's results as positive and to avoid unproven treatments being used in clinical practice.
https://ift.tt/2BFQbBj
https://ift.tt/2BFQbBj
Abiraterone Acetate for Nonmetastatic Castration-Resistant Prostate Cancer
This Viewpoint uses results of randomized clinical trials to explore whether the use of abiraterone acetate plus prednisone is a cost-effective and appropriate treatment option for patients with nonmetastatic castration-resistant prostate cancer.
https://ift.tt/2KIk1rQ
https://ift.tt/2KIk1rQ
Burden of Multiple Myeloma in Taiwan
To the Editor Cowan et al explored the global burden of multiple myeloma (MM) from 1990 to 2016 and reported on the incidence, treatment choices, and frequency of stem cell transplant (SCT) worldwide. As a part of East Asia, Taiwan was reported to have an increase in MM incidence, and lenalidomide and bortezomib were approved for treatment of the disease. However, the frequency of SCT in Taiwan was not shown in Figure 2 of the study by Cowan et al. In Taiwan, at least 15 hospitals are performing SCT. Based on a survey from 2005, 7% of patients undergoing SCT were diagnosed with MM. By analyzing data from the longitudinal Taiwan Health Insurance Database from 2007 to 2015, Chang et al found that about 15.5% of patients with MM underwent SCT. Moreover, according to the Taiwan Bone Marrow Transplant Registry, the overall survival rate of patients with MM who underwent SCT was 76.9% at 3-year follow-up. We hope that this information is helpful to better understand the SCT status in Taiwan.
https://ift.tt/2BGyzWg
https://ift.tt/2BGyzWg
Burden of Multiple Myeloma in Taiwan—Reply
In Reply To determine the use of stem cell transplant worldwide, we cited prior data published by the World Bone Marrow Transplant network, which did not include transplant rates for Taiwan. We thank the authors for providing this information, which will be helpful to include in future iterations of the Global Burden of Disease study to improve estimates of diseases requiring stem cell transplant.
https://ift.tt/2KLggCc
https://ift.tt/2KLggCc
Anlotinib for Refractory Advanced Non–small Cell Lung Cancer in China
To the Editor Aguiar and colleagues reported the negative cost-effectiveness of first-line osimertinib for EGFR-mutated advanced non–small cell lung cancer (NSCLC). Anlotinib hydrochloride (AL3818), a novel oral multitarget tyrosine kinase inhibitor, was approved as a third-line treatment for refractory advanced NSCLC by the China Food and Drug Administration (CFDA) on May 9, 2018. Anlotinib targets vascular endothelial growth factor receptors, fibroblast growth factor receptors, platelet-derived growth factor receptors, and c-kit, which are involved in broad-spectrum inhibition of tumor angiogenesis and growth. In the phase 1 trial, anlotinib appeared to have broad antitumor capacity for refractory advanced solid tumors, with acceptable and manageable toxic effects, including hypertension, dermal toxic effects, and hypertriglyceridemia. In the phase 2 trial (NCT01924195) on refractory metastatic or recurrent NSCLC, third-line anlotinib treatment had a significant progression-free survival benefit compared with placebo (4.8 vs 1.2 months; P < .001). Subsequently, in the phase 3 trial (NCT02388919) in a similar setting, anlotinib improved the overall survival compared with placebo (9.6 vs 6.3 months; P = .002), with manageable toxic effects. Based on these serial phase 1 to 3 trials, the CFDA gave anlotinib rapid approval to market according to the updated governmental strategy for accelerated new drug approval. The drug met the requirements of controlling the heavy burden associated with lung cancer and decreasing the cost of new drug development in China.
https://ift.tt/2BGyrGg
https://ift.tt/2BGyrGg
Association Between Polycystic Ovary Syndrome and Cancer Risk
This cohort study of Swedish register data examines the association between polycystic ovary syndrome and cancer risk in females aged 15 to 50 years between 1985 and 2009.
https://ift.tt/2KLg7yE
https://ift.tt/2KLg7yE
Cost-effectiveness of Maintenance Capecitabine and Bevacizumab for Metastatic Colorectal Cancer
This Markov model study assesses the cost-effectiveness of capecitabine and bevacizumab maintenance therapy after induction chemotherapy for treatment of metastatic colorectal cancer.
https://ift.tt/2BFPNTn
https://ift.tt/2BFPNTn
Incidence of Y chromosome microdeletions in patients with Klinefelter syndrome
Abstract
Purpose
The aim of this study was to study the incidence of Y chromosome microdeletions in a Caucasian population of Klinefelter syndrome (KS) patients and to investigate the possible association between Y chromosome microdeletions and KS.
Materials and methods
We conducted a retrospective study on 118 KS patients, 429 patients with non-obstructive azoospermia (NOA), and 155 normozoospermic men. Eight of the 118 KS patients had undergone testicular sperm extraction (TESE). All patients underwent semen examination and Y chromosome microdeletions evaluated by PCR, using specific sequence tagged site (STS) primer sets, which spanned the azoospermia factor AZFa, AZFb, and AZFc regions of the Y chromosome.
Results
Semen analysis of the KS group revealed: 1 patient with oligozoospermia, 1 with severe oligoasthenoteratozoospermia, 2 with cryptozoospermia, and 114 with azoospermia. Eight of the 114 azoospermic KS patients underwent TESE, and spermatozoa were recovered from three of these, all of whom had non-mosaic karyotype 47, XXY. 10.7% of the NOA patients presented AZF microdeletions. In 429 cases with NOA, 8 cases had AZFa + b + c deletion, 6 cases had AZF b + c deletion, 4 cases had AZFa microdeletion, 8 cases had AZFb microdeletion, and 20 cases had AZFc microdeletion. Just one KS patient (0.8%) presented microdeletion in the AZFc region.
Conclusion
The percentage of microdeletions in KS patients was lower than in NOA patients, suggesting that AZF microdeletions and KS do not have a causal relationship and that Y chromosome microdeletions are not a genetic factor linked to KS.
https://ift.tt/2KHDady
Factors associated with successful switching between biologic therapies for the treatment of psoriasis in daily dermatological real‐life practice: The Resoswitch study
The main aim of this study was to describe switching practices in daily practice. Patients included were those seen in daily routine practice. Efficacy was defined as the achievement of at least 75% improvement in the PASI score (PASI75). A total of 1,157 patients were included. The frequency of switching was 29.9% and switching was efficient in 71.9% of the cases. The study's results allows a better understanding of the profile of patients who require switch and he appears a change of therapeutic class appears to be more effective in psoriasis patients who require a switch in their therapy.
This article is protected by copyright. All rights reserved.
https://ift.tt/2Rmw4gZ
Factors associated with successful switching between biologic therapies for the treatment of psoriasis in daily dermatological real‐life practice: The Resoswitch study
The main aim of this study was to describe switching practices in daily practice. Patients included were those seen in daily routine practice. Efficacy was defined as the achievement of at least 75% improvement in the PASI score (PASI75). A total of 1,157 patients were included. The frequency of switching was 29.9% and switching was efficient in 71.9% of the cases. The study's results allows a better understanding of the profile of patients who require switch and he appears a change of therapeutic class appears to be more effective in psoriasis patients who require a switch in their therapy.
This article is protected by copyright. All rights reserved.
https://ift.tt/2Rmw4gZ
Sexual dimorphism in hepatitis B and C and hepatocellular carcinoma
Abstract
The incidence of viral hepatitis B or C (HBV/HCV) infection and hepatocellular carcinoma is higher in male compared to female populations, showing a faster disease progression and results in a worse overall survival. Indeed, women are in general better protected from viral infections and show a lower risk of death from malignant cancer in comparison to men. Females mount stronger innate and adaptive immune responses than males, and therefore, most of the autoimmune diseases occur predominantly in females. Next to occupational and/or behavioral factors, cellular and molecular differences between the two sexes contribute to this observation. In this review, we will discuss underlying mechanisms that are important for the observed sex-related differences in liver diseases. A better appreciation of these differences between the two sexes might be of value for better and gender-specific treatment options.
https://ift.tt/2rdq6DO
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