Functional Endoscopic Sinus Surgery of Nasal Polyposis: The Vexing Question of Whether to Resect or Preserve Middle Turbinate

Abstract

Functional endoscopic sinus surgery is the mainstay of surgical management of nasal polyposis since 1975. The decision between the partial resection and preservation of the middle turbinate (MT) has stirred up considerable debate. Partial MTR permits easy access to the affected paranasal sinuses intraoperatively and postoperatively. However, there may be alteration of nasal function, frontal sinusitis and anosmia. Preservation of middle turbinate is precludes these complications, and allows the MT to serve as a vital anatomical landmark for revision surgery. Therefore, our study compared the outcomes of the two approaches to aid surgeons in deciding the best possible approach. Randomized control trial. 31 patients (60 sides of nasal cavity) with nasal polyposis were divided into two groups. Group I consisted of 30 sides of nasal cavity with middle turbinate resection, while group II consisted of 30 sides of nasal cavity without middle turbinate resection. Both the groups were compared postoperatively for 6 months. In group I and group II, 5 sides (16.6%) and 11 sides (36.6%) showed polypoidal changes respectively. 3 sides (10%) in group I and 8 sides (26.6%) in group II showed blockage of maxillary sinus ostia. All the sides in group I had patency of frontal sinus. In group II, 5 sides (16.6%) showed blockage of frontal sinus ostia. The maxillary antrostomy patency in group I and group II were 90% (27) and 73.33% (22) respectively. Assessment of symptomatic improvements for nasal obstruction, hyposmia, headache and rhinorrhoea was done using questionnaires. Symptomatic improvement was higher in group I compared to group II with statistical significance (p = 0.001). Our study demonstrated that partial resection of middle turbinate decreased the chances of recurrence of disease and post-operative complications and resulted in significantly better symptomatic improvements.

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Aquaporin-4 Serostatus and Visual Outcomes in Clinically Isolated Acute Optic Neuritis

Background: Aquaporin-4 antibodies (AQP4-Ab) are associated with neuromyelitis optica spectrum disorder (NMOSD) and typically this disorder has a poor visual prognosis as a result of optic neuritis (ON). Our aim was to report the clinical features at onset and final visual outcomes at 6 months of patients with ON who were positive for AQP4-Ab vs. those who were negative for AQP4-Ab. Methods: Retrospective cohort study. AQP4-Ab were tested by indirect immunofluorescence in 57 patients with a first episode of ON. All patients initially were referred for consideration of multiple sclerosis ON (MSON), NMOSD, or any other inflammatory central nervous system disorder during follow-up (41.31 ± 24.32 months). Our patients were diagnosed as having NMOSD, MSON, chronic relapsing inflammatory ON, and single isolated ON. Risk factors associated with visual outcomes of ON patients were assessed through an ordinal regression model. Results: Positive AQP4-Ab were associated with male sex (P = 0.02), earlier age of onset (P = 0.01), and myelitis relapses (P = 0.04). Seronegative group had fewer recurrences of ON than the seropositive group (35% vs 58%, P = 0.14). Patients that were positive for AQP4-Ab did not have worse visual acuity at baseline and after 6 months. However, poor visual acuity during first attack was associated with a worse visual acuity at 6 months (odds ratio = 2.28, 95% CI [1.58–3.28], P = 0.03). Conclusions: At 6 months, positive AQP4-Ab vs negative AQP4-Ab patients no evidence of poorer visual acuity. Lower visual acuity at baseline was associated with poor visual recovery at 6 months. Address correspondence to Edgar Carnero Contentti, Department of Neurology, Hospital Carlos G. Durand, Av Diaz Velez 5044, C1405DCS, Buenos Aires, Argentina. Email: junior.carnero@hotmail.com, ecarnerocontentti@hospitalaleman.com The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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Diesel oil removal by Serratia sp. W4-01 immobilized in chitosan-activated carbon beads

Abstract

Serratia sp. W4-01 was immobilized in chitosan-activated carbon beads and used for diesel oil removal. The type and concentration of chitosan, activated carbon content, and bead diameter were investigated as factors affecting diesel oil removal. The results showed that 2% (w/v) squid pen chitosan beads modified with 1% activated carbon (w/v) and with a 3-mm diameter had a good spherical shape and strength as well as diesel oil removal capability. The immobilized W4-01 cells removed more than 40% of diesel oil after 7 days when the initial diesel oil concentration was 100 to 400 mg L⁻¹, whereas 29–36% of diesel oil was removed after 14 days when the initial concentration was 800 to 1000 mg L⁻¹. Additionally, the immobilized cells maintained the ability to remove diesel oil over a pH range of 5–11. The addition of a biosurfactant increased the diesel oil removal from 62 to 75%. The reusability tests revealed that the ability of immobilized cells to remove diesel oil was enhanced after reuse, and 50–90% of diesel oil was removed during 2 to 12 reuse cycles. The stability and survival of W4-01 cells was confirmed by scanning electron microscopy and confocal laser scanning microscopy. The results of this study showed the potential use of W4-01 cells immobilized in chitosan-activated carbon beads for future applications in remediating diesel contamination.

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Effects of phosphorus on absorption and transport of selenium in rice seedlings

Abstract

The effects of different concentrations of phosphorus (P) on absorption and transfer of selenium (Se) in rice seedlings were studied by hydroponics experiment. The interaction between iron plaque and phosphorus on absorption and transport of selenium were studied by adding a large amount of iron-induced iron plaque, to provide a theoretical basis for rational application of phosphate fertilizer in the selenium bio-strengthening process of rice. The results showed that phosphorus deficiency may result in the formation of reddish brown iron oxide coating on the root surface of rice. The formation of root iron plaque of rice is related to concentration of phosphorus, and low concentration of phosphorus (0–1.5 mmol L⁻¹) can increase the amount of root iron plaque. Compared P deficiency culture and 2 mmol L⁻¹ P culture, Se content in the shoots and roots decreased by 76 and 47%, respectively. Addition of Fe²⁺ significantly reduced biomass of shoot and had no significant effect on the roots; when the P concentration increased from 0.1 to 0.3 mmol L⁻¹, transfer coefficient of Se decreased. Therefore, both root iron plaques induced by phosphorus deficiency and iron addition have a strong adsorption effect on selenium, which reduces the transport of selenium from the rice roots to the shoots. In the lower range of phosphorus concentration, low phosphorus can promote selenium content of rice shoot, while higher on the contrary. In the practice of rice production, proper management of phosphorus nutrient is of great significance to control selenium content in rice grain.

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Abstracts from the 11th International Symposium on Minimal Residual Disease, 3–5 May 2018, Montpellier, France

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August iotaderma (#294)

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JAAD Case Reports article List

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Reply to: “Re-evaluating pyoderma gangrenosum patients for Behçet disease before initiating any invasive procedures is essential”

To the Editor: We would like to thank Dr Aksoy1 for drawing attention to the unique challenges facing patients with Behçet syndrome in the perioperative setting. Her comments serve as an important reminder for physicians who are translating research into the clinical setting: we must consider the representativeness of the study sample when we generalize results to other settings or populations. Our patients' disease was diagnosed by using the Su criteria, and the overall demographics of our cohort are consistent with the known epidemiology of the disease in the United States.

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Answers to CME examination

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Fat reduction

Despite the favorable safety profile of liposuction, complications occur that need to be appropriately managed. In the second article in this continuing medical education series, the range of complications that may arise from liposuction are described, and the latest best practices to manage them are discussed. Specific technical strategies to prevent and minimize the risk of complications are also presented. Early recognition, accurate diagnosis, and proper clinical management can ensure an optimal outcome and patient satisfaction in individuals who are investing in fat reduction procedures.

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July iotaderma (#293)

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Answers to CME examination

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Fat reduction

The advances in understanding the pathophysiology and anatomy of adipose tissue together with the emergence of technological innovations in procedures and devices for fat reduction have led to a dramatic rise in patient demand for this procedure. The objective of this continuing medical education series, which is intended for the novice or experienced dermatologist, is to provide an update of the pathophysiology and anatomic considerations of adipose tissue, and detail the liposuction procedure, from patient selection/management to the latest developments in liposuction devices.

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CME examination

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Dermatology Calendar

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CME examination

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Journal Based CME Instructions and Information

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Information for Readers

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Editorial Board

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Adult supraglottitis: a life-threatening disease and potential airway emergency

Description 

An 87-year-old woman was brought by ambulance to the emergency department (ED) with fever and dyspnoea. There was audible stridor, and the patient was noted to have a large left-sided submandibular swelling. She was in respiratory distress with a respiratory rate of 30. She was administered 100% oxygen. The on-call anaesthetics and ear, nose and throat (ENT) team were called emergently on arrival of the patient due to concern regarding possible impending airway compromise. A portable anteroposterior chest X-ray was performed on the patient on arrival to the ED as the cause of her dyspnoea was initially unclear. This showed marked upper airway narrowing (detail from the chest X-ray is depicted in figure 1). Only a venous blood gas was taken from the patient prior to intubation which showed acidosis with a pH of 7.31 and hypercarbia of 7.62 kilopascals.

Figure 1

Anteriorposterior radiograph...

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Table of Contents

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Two cases of high-output heart failure as initial presentation of iliac arteriovenous fistula

We present two cases of females in their 40s presenting with biventricular heart failure being the consequence of a large arteriovenous fistula. Both patients had undergone abdominal surgery several years prior to the heart failure event with the initial finding of moderate pulmonary hypertension and high-output heart failure. CT revealed a large arteriovenous fistula between the common iliac artery and vein which subsequently was closed percutaneously.

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Re-evaluating pyoderma gangrenosum patients for Behçet disease before initiating any invasive procedures is essential

To the Editor: I would kindly like to remind your readers that pyoderma gangrenosum–like lesions also occur in Behçet disease, as is stated in a comment on the study "Risk of developing pyoderma gangrenosum after procedures in patients with a known history of pyoderma gangrenosum—A retrospective analysis."1 As the authors mentioned, the pathergy phenomenon is associated with pyoderma gangrenosum, but pathergy can also be seen in other conditions such as Behçet disease.2 Although very rare, pyoderma gangrenosum–like lesions are one of the clinical manifestations of Behçet disease.

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Port-wine stain as a clue for two rare coexisting entities

Phakomatosis pigmentovascularis (PPV) is an uncommon dermatosis characterised by the presence of both pigmentary and vascular abnormalities.¹ Its pathogenesis is not elucidated, and the prognosis is mainly determined by the presence of extracutaneous manifestations, such as Klippel-Trenaunay syndrome (KTS), that is defined by the triad of a port-wine stain (PWS), anomalous veins and progressive overgrowth of the affected extremity. Herein, we report a case of an adult patient, who presented with a large PWS, nevus of Ota, ocular melanosis, and limb hypertrophy and varicosities. These findings represented a rare association of PPV type IIb and KTS.

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Response to “Comment on: ‘When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council’”

To the Editor: We thank Drs Daunton and Goulding1 for their interest in our article2 and for their comments. Naturally, we agree that "a holistic assessment is needed" in patients with atopic dermatitis, including consideration of "existent comorbidities," as stated in our article. It was beyond the scope of our recommendation to discuss in detail the many comorbidities of AD, including the associated neuropsychiatric issues that the International Eczema Council recently reviewed.3

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Recurrent inflammatory myofibroblastic tumour of the lung: FDG PET/CT scan findings

Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm, occurring most often in children and young adults. IMTs have intermediate biological behaviour with the chance of local invasion, recurrence and even distant metastasis. Wide range of clinical presentations makes the precise diagnosis of IMT more challenging. The best method for definitive diagnosis is tissue biopsy and newer imaging modalities including fleurodeoxyglucose (FDG) positron emission tomography (PET)/CT are useful tools in detection of disease recurrence or distant metastasis. Complete surgical resection is the best-known treatment for this tumour. Here we are presenting an IMT case in a 12-year-old girl in which her recurrent pulmonary IMT was diagnosed based on FDG PET/CT findings and referred for further salvage treatment. Overall imaging modalities are not specific, but PET/CT scan can be useful tool for evaluation of IMT regarding initial staging and restaging to assess treatment response and recurrence.

https://ift.tt/2NMDLM1

Neonatal facial palsy, a case series: is CPAP the culprit?

We report a case series of three idiopathic unilateral facial nerve palsies in neonates with no identified risk factors. Neuroimaging done was normal. All the neonates had complete spontaneous recovery within a month, with no residual deficits. As per our knowledge, there are very few case reports of facial palsy in a neonate reported in literature and are often labelled as idiopathic.

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Bullous pemphigoid and diabetes mellitus: Are we missing the larger picture?

To the Editor: We read with interest the study by Benzaquen et al1 reporting an increased risk for development of bullous pemphigoid (BP) in patients who are receiving a dipeptidyl peptidase-4 inhibitor (DPP4i). Their findings are supported by previous studies showing a significant signal of increased risk for development of BP during exposure to a DPP4i in the European and French pharmacovigilance databases.1

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T-wave alternans: a harbinger for malignant ventricular arrhythmias

Description

A 50-year-old male chronic alcoholic presented to our emergency department with seizures and loss of consciousness after an alcoholic binge. He had no other significant medical history and was not on any regular medications. On examination, his pulse was 90 beats/min and his blood pressure was 80/60 mm Hg. His resting ECG showed sinus rhythm with QT prolongation. His serum sodium was 133 mmol/dL, potassium was 3.5 mmol/dL, magnesium was 1.4 mmol/dL and calcium was 6.6 mg/dL. The ECG demonstrated wide QRS tachycardia with a heart rate of approximately 200 beats/min and mild irregularity and morphology suggestive of polymorphic ventricular tachycardia initiated by a ventricular premature contraction falling on the terminal part of the T wave of the preceding sinus beat (figure 1A, black arrows). The postelectroversion tracing showed sinus rhythm at a rate of 55 beats/min, with alternating small, narrow (figure 1B, red arrows) and broad deep T-wave inversions (figure 1B, black...

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Reply to: “Bullous pemphigoid and diabetes mellitus: Are we missing the larger picture?”

To the Editor: We read with interest the letter titled "Bullous pemphigoid and diabetes mellitus—are we missing the larger picture?" by Geller et al1 and have several comments. The authors discuss the claimed association between diabetes mellitus (DM) and bullous pemphigoid (BP) and speculate about its underlying mechanisms.

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Acute presentation of a partially obstructing laryngeal tumour: adjuvant agents to gaseous induction of anaesthesia

We present the case of a 53-year-old man who attended our emergency department with stridor. He had recently undergone investigation for possible glottic cancer. We discuss the airway management of such a case. We believe this to be the first description of propofol target controlled infusion and clonidine to supplement a sevoflurane gas induction, in order to obtund response to intubation while maintaining spontaneous ventilation. We also consider how airway interventions may impact prognosis and need to be considered.

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Comment on: “When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council”

To the Editor: We read with interest the recent expert panel recommendations by Simpson et al on when systemic therapies may be indicated in the management of atopic dermatitis (AD).1 The authors rightly highlight the importance of identifying and addressing potential biologic exacerbating factors such as infection or contact allergy, as well as the role of patient education in improving adherence to topical therapy. However, we believe that the recommendations offered are narrow in scope. AD, like so many other chronic skin diseases, is a condition in which a holistic biopsychosocial approach must be used to allow the clinician to fully understand the patient, so as to optimize treatment outcomes and patient well-being.

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Oral findings in children and adolescents with Prader-Willi syndrome

Abstract

Objective

To assess the significance of changes in the saliva in the etiology of gingivitis and tooth wear in children and adolescents with Prader-Willi syndrome (PWS).

Materials and methods

The study included 80 (2.8–18 years old; 39 girls and 41 boys): 40 in PWS group (mean age 8.0 ± 4.24 years) and 40 in control group (mean age 7.9 ± 4.12 years). General condition, oral para-functional habits, tooth wear (modified TWI), oral hygiene and gingival status (Plaque Index (PLI) and Gingival Index (GI)), localization of gingivitis, and salivary characteristics were assessed. The chi-square test, the Mann-Whitney U test, Spearman's rank correlation, and odds ratio based on logistic regression in a statistical analysis were applied.

Results

Chances of gingivitis were increased by low PLI (odds ratio (OR) = 32.53), low resting salivary flow (OR = 3.96), increased viscosity of saliva (OR = 3.54), and mouth breathing (OR = 8.17). For gingivitis in anterior regions, low PLI (OR = 107.67), low resting (OR = 5.73) and stimulated (OR = 1.86) salivary flow, increased viscosity of saliva (OR = 5.87), mouth breathing (OR = 10.00), and low stimulated salivary flow (OR = 3.18) were observed. Tooth wear rates were increased by teeth grinding (OR = 16.20), mouth breathing (OR = 4.33), increased viscosity of saliva (OR = 11.67) and low resting (OR = 6.07), and stimulated (OR = 4.22) salivary flow.

Conclusions

In PWS, reduced salivary secretion, increased viscosity, of saliva and mouth breathing increase the risk of plaque-induced gingivitis and tooth wear.

Clinical relevance

The prevention and treatment of tooth wear and gingivitis in PWS patients is necessary not only to treat bruxism and mouth breathing but also to limit the influence of negative changes of saliva.

https://ift.tt/2LhpHJ1

FDA Approves Tecovirimat, First Drug for Smallpox Treatment

Tecovirimat (TPOXX) provides a treatment option should smallpox ever be used as a bioweapon and is the first product to be awarded a material threat medical countermeasure priority review voucher.
FDA Approvals

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Photodynamic and photobiological effects of light-emitting diode (LED) therapy in dermatological disease: an update

Abstract

Benefit deriving from the use of light is known since ancient time, but, only in the last decades of twentieth century, we witnessed the rapid expansion of knowledge and techniques. Light-emitted diode (LED)-based devices represent the emerging and safest tool for the treatment of many conditions such as skin inflammatory conditions, aging, and disorders linked to hair growth. The present work reviews the current knowledge about LED-based therapeutic approaches in different skin and hair disorders. LED therapy represents the emerging and safest tool for the treatment of many conditions such as skin inflammatory conditions, aging, and disorders linked to hair growth. The use of LED in the treatment of such conditions has now entered common practice among dermatologists. Additional controlled studies are still needed to corroborate the efficacy of such kind of treatment.

https://ift.tt/2Jmywzs

Snacking is Common in People with Diabetes Type 1 and Type 2 with Insulin Therapy and Is Not Associated With Metabolic Control or Quality of Life

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0631-8813

Objective The aim of this observational study was to analyse snacking pattern and satisfaction with snacking, and to associate snacking patterns with metabolic control and quality of life in people with diabetes type 1 and 2 on insulin therapy. Methods In 2017, 390 people with diabetes were interviewed in a university outpatient department: 132 diabetes type 1 (56.1y, diabetes duration 24.2y, HbA1c 7.0%), 89 diabetes type 2/biphasic insulin (72.8y, diabetes duration 22.0y, HbA1c 7.1%) and 169 diabetes type 2/prandial insulin (66.7y, diabetes duration 20.5y, HbA1c 7.0%). Standardised questionnaires were used to assess eating patterns, satisfaction with snacking, treatment satisfaction and quality of life. Results The far majority snacked regardless of diabetes type and type of insulin therapy (70.5% type 1, 80.9% type 2/biphasic insulin, 74.6% type 2/prandial insulin) and liked to do so or did not mind (type 1 diabetes 79.5%, type 2 diabetes/biphasic insulin 84.8%, type 2 diabetes/prandial insulin 83.5%). Snacking because of recommendations of healthcare professionals was rare (10.8% type 1 diabetes, 8.2% type 2 diabetes/biphasic insulin, 9.4% type 2 diabetes/prandial insulin). Snacking and not snacking participants did not differ in respect to HbA1c, quality of life or treatment satisfaction. Conclusions Snacking seems to be a common habit in individuals with diabetes and most of them like to snack. Snacking is not associated with better or worse metabolic control or quality of life. The decision to snack or not to snack can be left to the individual and integrated into the therapy without danger for the glycaemic control.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Merkelzellkarzinome der Kopf-Hals-Region

Laryngo-Rhino-Otol
DOI: 10.1055/a-0588-9400

Merkelzellkarzinome (MCC) sind hochmaligne neuroendokrine Tumore der Haut. Auch wenn sie sehr selten sind, hat sich ihre Inzidenz in den letzten 20 Jahren verdoppelt. Ihre Mortalität ist höher als die des malignen Melanoms. Risikofaktor ist neben UV-Exposition eine iatrogene oder anderweitige Immunsuppression. MCC betreffen vor allem Menschen jenseits des 70. Lebensjahrs und treten in der Hälfte der Fälle in der Kopf-Hals-Region auf.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Marked attenuation of the amplitude of transcranial motor-evoked potentials after intravenous bolus administration of ketamine: a case report

It is believed that ketamine does not affect motor-evoked potential amplitude, whereas various anesthetic drugs attenuate the amplitude of transcranial motor-evoked potential. However, we encountered a patient...

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Unraveling molecular targets of bisphenol A and S in the thyroid gland

Abstract

Bisphenol A (BPA) is a well-known endocrine disruptor with several effects on reproduction, development, and cancer incidence, and it is highly used in the plastic industry. Bisphenol S (BPS) was proposed as an alternative to BPA since it has a similar structure and can be used to manufacture the same products. Some reports show that BPA interferes with thyroid function, but little is known about the involvement of BPS in thyroid function or how these molecules could possibly modulate at the same time the principal genes involved in thyroid physiology. Thus, the aims of this work were to evaluate in silico the possible interactions of BPA and BPS with the thyroid transcription factors Pax 8 and TTF1 and to study the actions in vivo of these compounds in zebrafish thyroid gene expression. Adult zebrafish treated with BPA or BPS showed that sodium iodide symporter, thyroglobulin, and thyroperoxidase genes were negatively or positively regulated, depending on the dose of the exposure. Human Pax 8 alignment with zebrafish Pax 8 and Rattus norvegicus TTF1 alignment with zebrafish TTF1 displayed highly conserved regions in the DNA binding sites. Molecular docking revealed the in silico interactions between the protein targets Pax 8 and TTF1 with BPA and BPS. Importance of some amino acids residues is highlighted and ratified by literature. There were no differences between the mean energy values for BPA docking in Pax 8 or TTF1. However, BPS energy values were lower in TTF1 docking compared to Pax 8 values. The number of amino acids on the protein interface was important for Pax 8 but not for TTF1. The main BPA interactions with proteins occurred through Van der Waals forces and pi-alkyl and alkyl interactions, while BPS interactions mainly occurred through carbon hydrogen bonds and conventional hydrogen bonds in addition to Van der Waals forces and pi-alkyl interactions. These data point to a possible interaction of BPA and BPS with Pax 8 and TTF1.

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Gliotoxin penetrates and impairs the integrity of the human blood-brain barrier in vitro

Abstract

Cerebral fungal infections represent an important public health concern, where a key element of pathophysiology is the ability of the fungi to cross the blood-brain barrier (BBB). Yet the mechanism used by micro-organisms to cross such a barrier and invade the brain parenchyma remains unclear. This study investigated the effects of gliotoxin (GTX), a mycotoxin secreted by Aspergillus fumigatus, on the BBB using brain microvascular endothelial cells (BMECs) derived from induced pluripotent stem cells (iPSCs). We observed that both acute (2 h) and prolonged (24 h) exposure to GTX at the level of 1 μM or higher compromised BMECs monolayer integrity. Notably, acute exposure was sufficient to disrupt the barrier function in iPSC-derived BMECs, resulting in decreased transendothelial electrical resistance (TEER) and increased fluorescein permeability. Further, our data suggest that such disruption occurred without affecting tight junction complexes, via alteration of cell-matrix interactions, alterations in F-actin distribution, through a protein kinase C-independent signaling. In addition to its effect on the barrier function, we have observed a low permeability of GTX across the BBB. This fact can be partially explained by possible interactions of GTX with membrane proteins. Taken together, this study suggests that GTX may contribute in cerebral invasion processes of Aspergillus fumigatus by altering the blood-brain barrier integrity without disrupting tight junction complexes.

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Factors influencing the effective dose associated with CBCT: a systematic review

Abstract

Introduction

Due to potential impact of the effects of ionizing radiation used in medical and dental examinations on public health in recent years, many studies are being conducted to quantify the radiation dose values, evaluate scanners, and indicate factors that could influence or reduce radiation doses.

Objectives

This study aimed to evaluate, by a systematic review, the factors that influence the effective radiation dose associated with cone beam computed tomography and respective effects, and compared the effective dose of different cone beam computed tomography (CBCT) scanners with similar exposure parameters.

Materials and methods

A search was conducted on five databases from 2007 to 2015.

Results

The search identified 741 abstracts, among which 44 eligible articles were retrieved in full text. Twenty-three studies met the inclusion criteria and were included. Additional copper filter was evaluated in one study, patient size in 2 studies, region of interest in 1 study, use of a thyroid shield in 2 studies, scan angle in 3 studies, exposure time in 10 studies, FOV diameter in 17 studies, FOV height in 17 studies, kV in 16 studies, mA in 18 studies, mAs in 13 studies, voxel in 8 studies, and resolution in 3 studies. When similar exposure parameters were evaluated, it was observed that CBCT scanner with lower effective dose was Kodak® 9000C 3D (mean 21.2 μSv) in selected studies.

Conclusions

Thirteen factors were related to changes in the effective dose emitted by different scanners. More studies are needed to identify the image quality requirements in addition to measure the radiation.

Clinical relevance

Studies that give more information for professionals who request and interpret the exams and for technicians who perform 3D images about effective radiation dose associated with CBCT are necessary.

https://ift.tt/2JlTa2w

Epitope Mapping of Anti-Telomerase Reverse Transcriptase Monoclonal Antibodies

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


https://ift.tt/2L8ouqA

Effect of Prior Biologic Use on Cost-Effectiveness of Brodalumab vs. Ustekinumab for Treatment of Moderate-to-Severe Psoriasis in the United States

Abstract

Introduction

Clinical trials have shown brodalumab to have better efficacy than ustekinumab for the treatment of moderate-to-severe psoriasis. An estimation of the cost-effectiveness of brodalumab vs. ustekinumab is warranted and may be useful for treatment decision-making processes, especially in the context of the cost considerations of the current US healthcare system. Therefore, we compared the cost-effectiveness of brodalumab with ustekinumab for treatment of moderate-to-severe psoriasis in biologic-naïve and biologic-experienced patients in the USA.

Methods

An Excel-based economic model was developed to estimate and compare total annual costs to health plans associated with treatment with brodalumab vs. ustekinumab per achievement of Psorasis Area and Severity Index (PASI) 75, 90, and 100 for patients with moderate-to-severe psoriasis.

Results

For treatment with brodalumab vs. ustekinumab, total annual treatment costs per PASI 75, 90, and 100 were $31,106, $57,776, and $163,069, respectively, lower for a patient naïve to prior biologic treatment; they were $40,535, $65,472, and $223,610, respectively, lower for a patient experienced with prior biologic treatment. In an additional analysis among patients with and without prior biologic failure, they were $52,822, $93,309, and $365,606, respectively, lower for a patient with failure and they were $31,660, $57,128, and $164,996, respectively, lower for a patient without failure.

Conclusion

Compared to ustekinumab, treatment with brodalumab was associated with better cost-effectiveness ratios for biologic-naïve and experienced-patients and also patients with and without prior biologic treatment failure. The greater cost-effectiveness of brodalumab was most prominent for biologic-experienced and prior biologic treatment failure patients.

Funding

Ortho Dermatologics.

https://ift.tt/2JjZebX

Distribution of metabolic/obese phenotypes and association with diabetes: 5 years’ cohort based on 22,276 elderly

Abstract

Aims

To describe the distribution and changes of different metabolic/obese phenotypes among more than 22,000 male elderly in China, and also explore the association with diabetes incidence.

Methods

A cohort study based on 22,276 male elderly was conducted in Beijing, from 2009 to 2013. Multiple Cox model was used to calculate the relative risk.

Results

There were only 53.8% of total participants who kept the same phenotype for the 5 years. On the whole, participants with metabolically unhealthy phenotypes had higher relative risks (RRs) than those with metabolically healthy phenotypes. RRs for diabetes showed an increasing trend along with metabolic abnormalities (p < 0.001). However, no statistically significant difference was found across different obese status with the same number of metabolic abnormalities. Changes of metabolic/obese status also showed the same trend. Those who had kept metabolic unhealthy had the highest RRs for diabetes incidence, which was higher than those who kept obesity.

Conclusions

Both metabolically healthy obesity and metabolically unhealthy normal weight phenotypes had an increased risk for diabetes incidence, and metabolic abnormalities might have more influence on diabetes than obesity itself. Changes of metabolic/obese status also had an important impact on diabetes incidence.

https://ift.tt/2menLWA

Raltitrexed Concurrent With Radiotherapy for Elderly Chinese Patients With Squamous Cell Carcinoma of Esophagus

Condition:   Esophagus Squamous Cell Carcinoma
Intervention:   Drug: raltitrexed
Sponsor:   Huai'an First People's Hospital
Not yet recruiting

https://ift.tt/2zxvuZe

Raltitrexed Concurrent With Radiotherapy for Elderly Chinese Patients With Squamous Cell Carcinoma of Esophagus

Condition:   Esophagus Squamous Cell Carcinoma
Intervention:   Drug: raltitrexed
Sponsor:   Huai'an First People's Hospital
Not yet recruiting

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Distribution of metabolic/obese phenotypes and association with diabetes: 5 years’ cohort based on 22,276 elderly

Abstract

Aims

To describe the distribution and changes of different metabolic/obese phenotypes among more than 22,000 male elderly in China, and also explore the association with diabetes incidence.

Methods

A cohort study based on 22,276 male elderly was conducted in Beijing, from 2009 to 2013. Multiple Cox model was used to calculate the relative risk.

Results

There were only 53.8% of total participants who kept the same phenotype for the 5 years. On the whole, participants with metabolically unhealthy phenotypes had higher relative risks (RRs) than those with metabolically healthy phenotypes. RRs for diabetes showed an increasing trend along with metabolic abnormalities (p < 0.001). However, no statistically significant difference was found across different obese status with the same number of metabolic abnormalities. Changes of metabolic/obese status also showed the same trend. Those who had kept metabolic unhealthy had the highest RRs for diabetes incidence, which was higher than those who kept obesity.

Conclusions

Both metabolically healthy obesity and metabolically unhealthy normal weight phenotypes had an increased risk for diabetes incidence, and metabolic abnormalities might have more influence on diabetes than obesity itself. Changes of metabolic/obese status also had an important impact on diabetes incidence.

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Pseudomyxoma peritonei presenting as irreducible epigastric hernia

Abstract

Abdominal wall hernia is a common and usually straightforward pathology presenting in surgery clinics. On occasion, the surgeon is faced with unexpected findings requiring difficult intraoperative decision. We present a case of pseudomyxoma peritonei incidentally found during surgery for epigastric hernia. The patient complained of a long lasting epigastric hernia with recent onset pain and growth. Surgery was limited to laparoscopic incisional biopsy of mucinous peritoneal deposit, confirming the diagnosis and suggesting an appendiceal origin. The patient was subsequently referred to a specialized peritoneal cancer unit for definitive treatment which consisted of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy, which can be compromised by previous organ resection. This case highlights the importance of maintaining a high level of suspicion before unusual clinical courses of common pathology.

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Case series of two falciform ligament incisional hernias and their laparoscopic repair

Abstract

Incisional hernias involving the falciform ligament have only been reported in two case reports in the English literature. This is the first reported case series of two falciform ligament incisional hernias. Both patients had undergone a prior cholecystectomy. Laparoscopic transabdominal pre-peritoneal repair was performed with an uneventful recovery in both patients. In the previously published reports both patients underwent an open herniorrhaphy with an underlay mesh repair. These are the first two documented laparoscopic repairs of a falciform ligament incisional hernia. The laparoscopic repair also included intra-corporeal suturing of the hernia necks with a non-absorbable suture. We extrapolated this data from the component separation technique which reconstituted the abdominal musculature in their normal anatomical position resulting in a reduced hernia recurrence rate.

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Laparoscopic approach for a presacral myelolipoma resembling a liposarcoma

Abstract

Myelolipomas are rare benign tumors that are commonly found in the adrenal glands. Extra-adrenal locations are rare, and presacral myelolipomas represent the most common extra-adrenal location. The differential diagnosis of malignant presacral neoplasms is very challenging. We present a case of a presacral neoplasm that was completely removed with a laparoscopic approach and diagnosed as a myelolipoma only after pathological examination.

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Patients with urticaria are at a higher risk of anaphylaxis: A nationwide population‐based retrospective cohort study in Taiwan

The Journal of Dermatology, EarlyView.


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Coexistence of X‐linked ichthyosis and Nagashima‐type palmoplantar keratosis: A case report

The Journal of Dermatology, EarlyView.


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Serum interleukin‐34 levels in patients with systemic sclerosis: Clinical association with interstitial lung disease

The Journal of Dermatology, EarlyView.


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Effects of tumor necrosis factor‐α, interleukin‐23 and interleukin‐17A inhibitors on bodyweight and body mass index in patients with psoriasis

The Journal of Dermatology, EarlyView.


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Does patient age influence anti-cancer immunity?

Abstract

Geriatric oncology, important for the ever-increasing numbers of elderly cancer patients, has thus far focused primarily on tolerance to chemotherapy. With the advent of breakthrough immunomodulatory antibody treatments relying on the patient's own immune system to control the tumor, the issue of immunosenescence becomes extremely important. There is increasingly a valid concern that anti-cancer immunity may be compromised in the elderly due to (i) their low amounts of naïve T cells (potentially leading to holes in the repertoire for neoantigens), (ii) "exhaustion" of potentially tumor-specific memory T cells, and (iii) higher amounts of suppressive cells. Encouragingly, but only anecdotally, accumulated clinical experience suggests that advanced age does not result in poorer responses or greater toxicity in elderly patients treated with anti-CTLA-4 or anti-PD-1/PD-L1 antibodies. Here, I briefly contrast immune features of the elderly with the young, commonly referred to as "immunosenescence," and the influence of patient age on the outcome of checkpoint blockade. As newer agents are licensed, and new combinations tested, broader and more detailed studies focusing on the age question will be crucial and should be taken into consideration when designing clinical trials.

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Cancer immune therapy for lymphoid malignancies: recent advances

Abstract

Immunotherapy has played an important part in improving the life of patients with lymphoproliferative diseases especially since the addition of rituximab to chemotherapy in the CD20-positive neoplasms in the 1990s. While this field of passive immunotherapy is continuously evolving, several breakthroughs will expand the treatment modalities to include more active immunotherapy. With the approval of immune checkpoint-blocking antibodies for Hodgkin lymphoma and bispecific antibodies for acute lymphoblastic leukemia (ALL), activation of endogenous T cells already plays a role in several lymphoid malignancies. With the approval of cellular therapies with CAR-T cells for ALL and diffuse large B cell lymphoma, the impact of the manipulation of immune responses is taken even further. Vaccines are cellular therapies in the opposite end of the spectrum in terms of side effects, and while the big breakthrough is still to come, the prospect of a very low-toxic immunotherapy which could be applicable also in premalignant states or in frail patients drives a considerable research activity in the area. In this review, we summarize the mechanisms of action and clinical data on trials in the lymphoid neoplasms with chimeric antigen receptor T cells, bispecific antibodies, immune checkpoint-blocking antibodies, and antineoplastic vaccination therapy.

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Differential expression of E-cadherin and P-cadherin in pT3 prostate cancer: correlation with clinical and pathological features

Abstract

Cadherins seem to play and important role in prostate cancer (PCa) progression. E-cadherin loss of expression has been associated with poor prognosis; P-cadherin's role is still elusive. Although pT3 PCa is often considered "high-risk cancer," it does not exhibit an uniformly poor prognosis. Herein, we assessed the prognostic value and survival impact of E-cadherin and P-cadherin immunoexpression in pT3 PCa. Radical prostatectomy (RP) specimens from 102 pT3 PCa patients treated between 1991 and 2014 in a single institution were designated for E-cadherin and P-cadherin immunoexpression analysis. A representative block from each specimen was selected for tissue micro-array (TMA) construction, using 3 cores per case. E-cadherin immunoexpression was assessed via a digital image analysis system. For P-cadherin, scoring criteria for HER2 in gastric cancer were used. Clinical records of all patients were reviewed for baseline clinical/pathologic characteristics and follow-up data. E-cadherin-low PCa patients displayed worse disease-specific survival (DSS), although not reaching statistical significance (HR 2.65, 95%CI 0.81–7.88). However, considering the pT3b group only, those with low E-cadherin immunoexpression displayed significantly worse overall-survival (OS) and DSS (HR 3.69, 95%CI 1.18–11.50; HR 5.90, 95%CI 1.40–24.81). No significant differences in survival were found for P-cadherin differential immunoexpression. Furthermore, an association between E-cadherin and P-cadherin immunoexpression (p = 0.019) was found, as among E-cadherin-low PCa, 96.6% were P-cadherin negative. We demonstrated that low E-cadherin immunoexpression discriminates among pT3b PCa patients those with poorer survival and which might benefit from specific therapy. The role of P-cadherin in PCa seems context-dependent deserving further investigation.

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Industrial water use, income, trade, and employment: environmental Kuznets curve evidence from 17 Taiwanese manufacturing industries

Abstract

This paper investigated the relationships between industrial water use, income, trade, and employment for 17 Taiwanese industries from 1998 to 2015. We explored cross-sectional dependent unit root, panel cointegration, and causality tests to estimate their long-term relationships and causal nexus. There existed long-term equilibrium relationships among the variables. The long-term elasticity estimates of industrial water use with respect to income, squared income, trade, and employment are 4.27, − 0.15, 0.22, and 0.92, respectively. The results do not confirm an inverted U-shaped environmental Kuznets curve. A unidirectional causal relationship is found between water use and income, and a bidirectional causal relationship is identified between water use and employment. Exports cause industrial water use. As expected, both employment and exports lead to income. Hence, policy makers should promote investment into water efficiency and water recycling. Various governments reward firms for water efficiency and lower consumption without negative long-term effects on economic growth.

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Skin toxicity with anti-EGFR monoclonal antibody in cancer patients: a meta-analysis of 65 randomized controlled trials

Abstract

We performed a meta-analysis to fully investigate the skin toxicities of anti-EGFR monoclonal antibody (EGFR-MoAbs) in cancer patients. The relevant studies of the randomized controlled trials (RCTs) in cancer patients treated with EGFR-MoAbs were retrieved and the systematic evaluation was conducted. EMBASE, MEDLINE, and PubMed were searched for articles published till November 2017. The relevant RCTs in cancer patients treated with EGFR-MoAbs were retrieved and the systematic evaluation was conducted. 65 RCTs and 25994 patients were included. The current meta-analysis suggests that the use of EGFR-MoAbs significantly increases the risk of developing all-grade and high-grade skin toxicity, such as rash, hand–foot syndrome, dry skin and oral mucositis. Rash was the most common skin toxicity. Patients receiving nimotuzumab were associated with the least risk of skin toxicity. The risk of high-grade skin toxicity tended to be higher in the study in which the EGFR-MoAbs treatment duration was longer. The available data suggested that the use of EGFR-MoAbs significantly increases the risk of developing skin toxicity. Physicians should be aware of skin toxicity and should monitor cancer patients when receiving EGFR-MoAbs.

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Stellenwert der Phototherapie in der Behandlung des chronischen Pruritus

Zusammenfassung

Die Phototherapie und Photochemotherapie (PUVA) sind wichtige Säulen in der Behandlung von entzündlichen Hauterkrankungen wie Psoriasis und atopischer Dermatitis sowie des kutanen T‑Zell-Lymphoms (z. B Mycosis fungoides/Sezary-Syndrom). Viele dieser Hauterkrankungen gehen mit quälendem Pruritus einher. Auch bei systemischen Erkrankungen der Niere und Leber sowie des endokrinen und blutbildenden Systems kann Pruritus ein belastendes Symptom der betroffenen Patienten sein. Die Behandlung mit ultraviolettem Licht kann nicht nur spezifische Hautveränderungen bessern, sondern auch den Pruritus vieler Hautkrankheiten sowie vieler systemischer Erkrankungen reduzieren. Die meist sehr gute antipruritische Wirkung, die bekannten und bei richtiger Durchführung geringen Nebenwirkungen sowie die Möglichkeit des Einsatzes bei Erwachsenen jeden Alters, Schwangeren/Stillenden und unter bestimmten Bedingungen auch bei Kindern machen die Phototherapie zu einer wertvollen Behandlungsmöglichkeit bei chronischem Pruritus unterschiedlicher Ursache. Der Einsatz der Phototherapie sollte daher früh erwogen werden, wenn lokaltherapeutische Maßnahmen nicht ausreichen, um den Pruritus zu lindern.

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An Atypical HNF4A Mutation Which Does Not Conform to the Classic Presentation of HNF4A-MODY.

Related Articles

An Atypical HNF4A Mutation Which Does Not Conform to the Classic Presentation of HNF4A-MODY.

Case Rep Endocrinol. 2018;2018:1560472

Authors: Spiro AJ, Vu KN, Warnock AL

Abstract
Objective: To present the case of an atypical Hepatocyte Nuclear Factor 4 Alpha (HNF4A) mutation that is not consistent with the classically published presentation of HNF4A-Mature Onset Diabetes of the Young (MODY).
Methods: Clinical presentation and literature review.
Results: A 43-year-old nonobese man was referred to the endocrinology clinic for evaluation of elevated fasting blood glucose (FBG) measurements. Laboratory review revealed prediabetes and hypertriglyceridemia for the previous decade. Testing of autoantibodies for type 1 diabetes was negative. Genetic testing showed an autosomal dominant, heterozygous missense mutation (c.991C>T; p.Arg331Cys) in the HNF4A gene, which is correlated with HNF4A-MODY. Phenotypically, patients with an HNF4A-MODY tend to have early-onset diabetes, microvascular complications, low triglyceride levels, increased birth weight, fetal macrosomia, and less commonly neonatal hyperinsulinemic hypoglycemia. The patient did not demonstrate any of these features but instead presented with late-onset diabetes, an elevated triglyceride level, and a normal birth weight.
Conclusion: Our patient likely represents an atypical variant of HNF4A-MODY with a milder clinical presentation. Patients with atypical, less-severe presentations of HNF4A-MODY may be largely undiagnosed or misdiagnosed, but identification is important due to implications for treatment, pregnancy, and screening of family members.

PMID: 29998026 [PubMed]

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Obesogenic Endocrine Disrupting Chemicals: Identifying Knowledge Gaps

Publication date: Available online 13 July 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Almudena Veiga-Lopez, Yong Pu, Jeremy Gingrich, Vasantha Padmanabhan

Endocrine disrupting chemicals (EDCs) are compounds that are part of everyday consumer products and industrial manufacturing processes. EDCs can interfere with the endocrine system, including the adipose tissue. Accumulating evidence from epidemiological, animal, and in vitro studies demonstrates that EDCs can alter body weight, adipose tissue expansion, circulating lipid profile, and adipogenesis, with some resulting in transgenerational effects. These outcomes appear to be mediated through multiple mechanisms, from nuclear receptor binding to epigenetic modifications. A better understanding of the signaling pathways via which these EDCs contribute to an obesogenic phenotype, the interaction amongst complex mixtures of obesogenic EDCs, and the risks they pose relative to the obesity epidemic are still needed for risk assessment and development of prevention strategies.

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Akute neurale Schwerhörigkeit nach Injektionsbehandlung der Halswirbelsäule

Zusammenfassung

Beschrieben wird der Fall einer 39-jährigen Patientin, die bei Zervikalgien eine Injektionsbehandlung der Halswirbelsäule erhielt. Durch eine akzidenzielle Injektion in das Zervikalmark kam es zu einer Synkope mit sensomotorischem Defizit und beidseitiger neuraler Schwerhörigkeit. Injektionsbehandlungen der Wirbelsäule werden trotz geringer Evidenzlage und teils gravierendem Komplikationsspektrum regelhaft bei Wirbelsäulenbeschwerden durchgeführt. Bei neurootologischen Komplikationen sollte eine zeitnahe HNO-ärztliche Untersuchung und ggf. Rehabilitation angestrebt werden.

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Role of Electronystagmography in Diagnosis of Secondary BPPV in Elderly Patients with Vertigo: A Retrospective Study

Abstract

Elderly population is frequently affected by vertigo which affects their mobility and makes them vulnerable to fall and other morbidities. Often these patient visit neurologist and are often subjected to CT scan, MRI brain etc. to rule out a central cause of vertigo; whereas majority of these patients suffer from vestibular cause of vertigo. A schematic approach by detailed history, simple tests for vestibular functions like Dix Hallpike, supine roll and head impulse test give important clue to diagnosis. Often the diagnosis is benign paroxysmal positional vertigo (BPPV) which is treated by repositioning maneuver. There are often other vestibular causes which may be diagnosed by Electronystagmography (ENG), electrocochleography and other tests. This study was undertaken to study occurrence of secondary BPPV utilizing various parameters of ENG. The study group comprised of 131 patients from the neuro-otology proforma data base at ENT centre and vertigo clinic from January 2015 to December 2017. Inclusion criterion was male and female aged 51 years and above presenting with dizziness, imbalance, rotational vertigo, unsteadiness as the chief complaint. Exclusion criterion was BPPV relieved after Epley's maneuver, Otitis externa, acute Otitis media, Suppurative Otitis media, pre existing neurological condition and history of ear surgery. Neuro-otology Data obtained and the ENG findings were tabulated in the master chart and the observations interpreted and transferred to Claussen's butterfly chart. The study group comprised of 58 male (44.27%) and 73 female (55.73%) with a male female ratio of 1:1.25. ENG exhibited 36 patients (27.49) to have recurrent BPPV, 53 (40.45%) were found to have unilateral/bilateral canal paresis. Meniere's disease was diagnosed in 39 (29.77%) patients and brain stem pathology identified in 3 (2.29%) cases.

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Surgical Management of Parapharyngeal Space Tumours in a Single Tertiary Care Center

Abstract

Because of the inaccessibility and overcrowding of the vital neurovascular structures, management of the parapharyngeal space (PPS) tumour is always a challenge to the surgeons. Here we have discussed the clinical findings and management of the PPS tumours with special concern to the surgical approaches. It is a retrospective study containing 14 patients of PPS tumour from June 2015 to January 2018 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. 14 consecutive patients with PPS tumours were included in the study. The retrospective clinical data, diagnostic procedures, surgical approaches and the complications were analyzed after 12 months of surgery. Of 14 patients included in the study, 10 patients were males and 4 were females. Prestyloid and poststyloid spaces were involved in 28.57% and 71.42% cases respectively. Transcervical excision of the tumours were performed in 10 patients, 2 patients had undergone transcervical-transoral approach. Transcervical transmandibular and transcervical transparotid excision of tumours were performed in one patient each. Facial nerve injury was detected in 3(21.42%) patients. Injury to the internal carotid artery and wound infection were detected in one patient each. Radiological imaging, especially the MRI helps by narrowing the spectrum of the differential diagnosis distinguishing the benign from malignant lesions, especially in cases where FNAC is contraindicated. Although the transcervical approach is commonly practiced, the combined surgical approach can be effectively applied specially for extensive PPS tumours associated with satisfactory clinical outcomes.

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Orthokeratinized odontogenic cysts: a Spanish tertiary care centre study based on HPV DNA detection

Abstract

Background

The role of human papillomavirus (HPV) in orthokeratinized odontogenic cysts (OOCs) has rarely been studied. The objective is to describe the clinicopathological findings in a series of OOCs from a Spanish population that were investigated in relation to the possible presence of HPV.

Methods

A clinicopathological retrospective analysis followed by a molecular analysis of 28 high- and low-risk HPV genotypes was performed in OOC samples of patients seen during the last 15-years in a Spanish tertiary care center.

Results

Of 115 odontogenic cysts with keratinization, 16 cases of OOCs were confirmed and evaluated. OOCs occurred predominantly in the mandible of males (mean age 36.06 ± 13.16 years). Swelling of the jaw followed by pain were the most common clinical symptoms, and 56.5% of the OOC cases were associated with an unerupted tooth. After a mean post-cystectomy follow-up of 3.8 years, only one recurrent case was observed, resulting in a verrucous cystic lesion that was considered premalignant after immunohistological examination. DNA extraction was successful from 14 of the 16 OOC cases. None of the primary OCCs or the single recurrent OOC were positive for HPV in the molecular analysis.

Conclusions

OOCs show a very limited potential for recurrence. Our results suggest that neither high- or low-risk HPV subtypes are likely to play a role in the etiology or neoplastic transformation of OOC, at least in the Spanish population.

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