Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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! # Ola via Alexandros G.Sfakianakis on Inoreader

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Σάββατο 14 Ιουλίου 2018

Prevalence and Characterization of Staphylococcus aureus Cultured From Raw Milk Taken From Dairy Cows With Mastitis in Beijing, China.

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Prevalence and Characterization of Staphylococcus aureus Cultured From Raw Milk Taken From Dairy Cows With Mastitis in Beijing, China.

Front Microbiol. 2018;9:1123

Authors: Wang W, Lin X, Jiang T, Peng Z, Xu J, Yi L, Li F, Fanning S, Baloch Z

Abstract
The colonization of dairy herds and subsequent contamination of raw milk by Staphylococcus aureus (S. aureus), especially those expressing a multi-drug resistance (MDR), biofilm and toxins producing ability, remains an important issue for both the dairy producer and public health. In this study, we investigated the prevalence, antimicrobial resistance, virulence, and genetic diversity of S. aureus in raw milk taken from 2 dairy farms in Beijing, China. Ninety (46.2%, 90/195) samples were positive for S. aureus. Resistant to penicillin (PEN) (31.3%), ciprofloxacin (18.8%) and enrofloxacin (15.6%) were the most often observed. Isolates cultured from farm B showed significantly higher resistance to penicillin (73.9%), ciprofloxacin (34.8%), enrofloxacin (34.8%), tilmicosin (17.4%), and erythromycin (17.4%) than those from farm A (p < 0.05). Totally, 94.8% S. aureus harbored at least one virulence gene and the pvl (93.8%), sec (65.6%), and sea (60.4%) genes were the most frequently detected. The pvl and sec genes were more often detected in isolates from farm A (97.3% and 84.9% respectively) than those from farm B (p < 0.05). Of all 77 staphylococcus enterotoxin (SE)-positive isolates, more than 90% could produce enterotoxins and 70.1% could produce two types. Biofilm related genes (icaA/D, clf/B, can, and fnbA) were detected in all96 isolates. All 96 isolates could produce biofilm with 8.3, 70.8, and 18.8% of the isolates demonstrating weak, moderate and strong biofilm formation, respectively. A total of 5 STs, 7 spa types (1 novel spa type t17182), 3agr types (no agrII), and 14 SmaI-pulso-types were found in this study. PFGE cluster II-CC1-ST1-t127-agr III was the most prevalent clone (56.3%). Isolates of agr III (PFGE Cluster I/II-CC1-ST1-t127/2279) had higher detection of virulence genes than those of agr I and agr IV. TheMSSA-ST398-t1456-agr I clone expressed the greatest MDRbut with no virulence genes and weakly biofilm formation. Our finding indicated a relatively high prevalence of S. aureus with less antimicrobial resistance but often positive for enterotoxigenicity and biofilm formation. This study could help identify predominant clones and provide surveillance measures to eliminate and decrease the contamination of S. aureus in raw milk of dairy cows with mastitis.

PMID: 29988423 [PubMed]



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Staphylococcus aureus Evasion of Host Immunity in the Setting of Prosthetic Joint Infection: Biofilm and Beyond.

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Staphylococcus aureus Evasion of Host Immunity in the Setting of Prosthetic Joint Infection: Biofilm and Beyond.

Curr Rev Musculoskelet Med. 2018 Jul 09;:

Authors: Ricciardi BF, Muthukrishnan G, Masters E, Ninomiya M, Lee CC, Schwarz EM

Abstract
PURPOSE OF REVIEW: The incidence of complications from prosthetic joint infection (PJI) is increasing, and treatment failure remains high. We review the current literature with a focus on Staphylococcus aureus pathogenesis and biofilm, as well as treatment challenges, and novel therapeutic strategies.
RECENT FINDINGS: S. aureus biofilm creates a favorable environment that increases antibiotic resistance, impairs host immunity, and increases tolerance to nutritional deprivation. Secreted proteins from bacterial cells within the biofilm and the quorum-sensing agr system contribute to immune evasion. Additional immunoevasive properties of S. aureus include the formation of staphylococcal abscess communities (SACs) and canalicular invasion. Novel approaches to target biofilm and increase resistance to implant colonization include novel antibiotic therapy, immunotherapy, and local implant treatments. Challenges remain given the diverse mechanisms developed by S. aureus to alter the host immune responses. Further understanding of these processes should provide novel therapeutic mechanisms to enhance eradication after PJI.

PMID: 29987645 [PubMed - as supplied by publisher]



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A Dual-Replicon Shuttle Vector System for Heterologous Gene Expression in a Broad Range of Gram-Positive and Gram-Negative Bacteria.

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A Dual-Replicon Shuttle Vector System for Heterologous Gene Expression in a Broad Range of Gram-Positive and Gram-Negative Bacteria.

Curr Microbiol. 2018 Jul 09;:

Authors: Hua M, Guo J, Li M, Chen C, Zhang Y, Song C, Jiang D, Du P, Zeng H

Abstract
Origin of replication (ori in theta-replicating plasmids or dso in rolling circle replicating plasmids) initiates plasmid replication in a broad range of bacteria. These two kinds of plasmids were both identified in Streptococcus, a genus composed of both human commensal bacteria and pathogens with the ability to cause severe community-acquired infections, including meningitides, septicemia, and respiratory tract diseases. Given the important roles of Streptococcus in the exchange of genetic elements with other symbiotic microbes, the genotypes and phenotypes of both Streptococcus spp. and other symbiotic species could be changed during colonization of the host. Therefore, an improved plasmid system is required to study the functional, complicated, and changeable genomes of Streptococcus. In this study, a dual-replicon shuttle vector system named pDRE was constructed to achieve heterologous gene expression. The vector system contained theta replicon for Escherichia coli. The origin of rolling circle replicon was synthesized according to pMV158 in Gram-positive bacteria. By measuring the products of inserted genes at multiple cloning sites, the ability of this vector system in the replication and expression of heterologous genes was assessed in four Streptococcus and three other Gram-positive bacteria: Bacillus subtilis, Lactococcus lactis, and Staphylococcus aureus. The results showed that the newly constructed vector could simultaneously replicate and express heterologous genes in a broad range of Gram-positive and Gram-negative bacteria, thus providing a potentially powerful genetic tool for further functional analysis.

PMID: 29987521 [PubMed - as supplied by publisher]



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WGS analysis of ST9-MRSA-XII isolates from live pigs in China provides insights into transmission among porcine, human and bovine hosts.

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WGS analysis of ST9-MRSA-XII isolates from live pigs in China provides insights into transmission among porcine, human and bovine hosts.

J Antimicrob Chemother. 2018 Jul 06;:

Authors: Zhou W, Li X, Osmundson T, Shi L, Ren J, Yan H

Abstract
Objectives: To elucidate the phylogenetic relationships among ST9-MRSA-XII isolates from different sources and their genetic features in colonization of different hosts.
Methods: We obtained whole-genome sequences of two ST9-MRSA-XII isolates from nasal swabs associated with live pigs in China, and compared them with 135 previously sequenced genomes of 78 human-associated, 39 bovine and 18 porcine Staphylococcus aureus consisting of 11 MRSA of SCCmecXII, 62 MRSA of other SCCmec types and 62 MSSA. The distribution of diverse mobile genetic elements (MGEs), resistance genes and virulence determinants was investigated in relation to isolate phylogeny. Comparisons of SNPs and small insertion/deletions (indels) were conducted to examine genome-level variation between porcine and bovine ST9-MRSA-XII.
Results: Phylogenetic analysis revealed that both of our porcine ST9-MRSA-XII isolates clustered with porcine, bovine and human-associated ST9-MRSA-XII. All of these isolates possessed a novel type V pathogenicity island, νSaα, carrying the von Willebrand-binding protein gene vwb, the immune evasion complex gene scn, the aminoglycoside resistance gene aadE, staphylococcal superantigen-like genes (ssl1-ssl11) and lpl tandem genes. Compared with bovine ST9-MRSA-XII BA01611, our porcine isolates contain non-synonymous nucleotide substitutions in genes encoding adhesins and an indel located in a phosphonate ABC transporter pseudogene.
Conclusions: The data suggest transmission of ST9-MRSA-XII among swine, cattle and humans. The extraordinary success of the ST9-MRSA-XII group in colonization of various hosts is likely due to acquisition of many MGEs harbouring functional antimicrobial resistance and virulence genes. Transmission of ST9-MRSA-XII between porcine and bovine hosts was accompanied by changes in binding profile and function in genes involved in metabolism.

PMID: 29986036 [PubMed - as supplied by publisher]



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Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudintermedius (MRSP) among employees and in the environment of a small animal hospital.

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Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudintermedius (MRSP) among employees and in the environment of a small animal hospital.

Vet Microbiol. 2018 Jul;221:153-158

Authors: Feßler AT, Schuenemann R, Kadlec K, Hensel V, Brombach J, Murugaiyan J, Oechtering G, Burgener IA, Schwarz S

Abstract
The aim of the study was to investigate methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudintermedius (MRSP) among employees of a small animal hospital and the hospital environment. In total, 96 swabs from employees and 73 swabs from the clinic environment were investigated. Cation-adjusted-Mueller-Hinton broth (CAMHB) + 6.5% NaCl was used for enrichment before plating on Mueller-Hinton (MH) agar with 2% NaCl and 0.25 mg/L oxacillin. The staphylococcal species was determined using MALDI-TOF MS. The isolates were subjected to mecA-PCR, macrorestriction analysis, and antimicrobial susceptibility testing. MRSA were present in five nasal swabs of the 55 employees tested and in six environmental samples, MRSP in two employees (nasal and hand swabs, each) and in three environmental samples. All isolates harboured mecA. Susceptibility testing revealed that all but one of the isolates were multiresistant. All isolates were resistant to β-lactams and fluoroquinolones. All but one of the isolates were resistant to macrolides and lincosamides. A single MRSA was resistant to gentamicin. All MRSP were resistant to trimethoprim/sulfamethoxazole and non-susceptible to gentamicin. One isolate was also resistant to tetracycline. Macrorestriction analysis revealed three main SmaI patterns for MRSA and two main SmaI patterns for MRSP. All environmental isolates were found in areas of high people and animal traffic, such as dog ward areas, waiting and triage rooms. The finding of indistinguishable MRSA or MRSP among employees and in the environment of the small animal hospital suggests the possibility of transfer of these bacteria between humans, animals, and the hospital environment.

PMID: 29981702 [PubMed - in process]



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IgG4-Related Disease of the Thyroid Gland Requiring Emergent Total Thyroidectomy: A Case Report.

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IgG4-Related Disease of the Thyroid Gland Requiring Emergent Total Thyroidectomy: A Case Report.

Head Neck Pathol. 2018 May 31;:

Authors: Zhao Z, Lee YJ, Zheng S, Khor LY, Lim KH

Abstract
IgG4-related disease of the thyroid gland is a recently recognized subtype of thyroiditis, often with rapid progression requiring surgical treatment. It is considered as a spectrum of disease varying from early IgG4-related Hashimoto's thyroiditis (HT) pattern to late fibrosing HT or Riedel's thyroiditis patterns. Here, we report a 47-year-old Malay woman presenting with progressively painless neck swelling over 3 years and subclinical hypothyroidism. Computed tomography (CT) scan revealed diffuse thyroid enlargement (up to 13 cm) with retrosternal extension and without regional lymphadenopathy. Fine needle aspiration of the thyroid showed a limited number of follicular epithelial cell groups with widespread Hurthle cell change and scanty background colloid, but no evidence of lymphocytosis. The cytologic features fell into the category of 'atypia of undetermined significance'. Subsequently, the patient developed hypercapnic respiratory failure secondary to extrinsic upper airway compression by the thyroid mass and underwent emergent total thyroidectomy. Histology of the thyroid showed diffuse dense lymphoplasmacytic infiltrate and fibrosis. Follicular cells exhibited reactive nuclear features and some Hurthle cell change. IgG4+ plasma cells were over 40/high power field while overall IgG4/IgG ratio was above 50%. The overall features suggest the diagnosis of IgG4-related disease of the thyroid gland in the form of IgG4-related HT. Post-surgery, the patient was found to have markedly elevated serum IgG4 concentration but PET/CT did not show significant increased fludeoxyglucose uptake in other areas. Her recovery was complicated by a ventilator-associated pneumonia with empyema, limiting early use of corticosteroids for treatment of IgG4-related disease.

PMID: 29855801 [PubMed - as supplied by publisher]



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Immunohistochemical Biomarkers in Diagnosis of Hematolymphoid Neoplasms of Endocrine Organs.

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Immunohistochemical Biomarkers in Diagnosis of Hematolymphoid Neoplasms of Endocrine Organs.

Endocr Pathol. 2018 Jun;29(2):176-188

Authors: Kuzu I, Dogan A

Abstract
The hematolymphoid infiltrations are challenging lesions in endocrine organs and tissues. The fourth edition of WHO classification of tumors of endocrine organs and the fourth edition of WHO classification of tumors of hematopoietic and lymphoid tissues are recently published. The updates in both fields include some new disease descriptions and prognostic markers. Our aim in this review article is to give practical diagnostic information about the most frequently seen hematolymphoid involvements of the pituitary gland, thyroid, and adrenal tissue. We designed the text in the order of organs and the contents according to the disease frequency. The pituitary gland and cellar region are the most frequently involved with Langerhans cell histiocytosis. Although it is very rare, Erdheim-Chester disease has recently been included in the classification and still needs more clear diagnostic definitions. Lymphoproliferative thyroid lesions and presentations create diagnostic problems for the pathologists. IGG4-related disease and its relation with thyroiditis is a new concept. There are many unknowns on pathobiology of the disease spectrum and discussion on defined diagnostic criteria of the IGG4-related thyroid diseases. The overlapping features of thyroiditis and primary thyroid lymphomas also create diagnostic difficulties. The frequently recognized primary hematolymphoid lesions of the endocrine organs may not be difficult to diagnose since they are expected lesions. The secondary involvement of hematolymphoid neoplasia may be more difficult to diagnose for an endocrine pathologist. In this review article, we aim to give brief description of the diseases and practical diagnostic approach by using optimum markers guided by the latest WHO classifications.

PMID: 29855797 [PubMed - in process]



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Coronary Toxicities of Anti-PD-1 and Anti-PD-L1 Immunotherapies: a Case Report and Review of the Literature and International Registries

Abstract

Immunotherapy medications that target programmed death 1 protein (PD-1) and programmed death-ligand 1 (PD-L1), such as nivolumab, pembrolizumab, and atezolizumab, are currently used in the first- or second-line treatment of non-small cell lung cancers, among other indications. However, these agents are associated with immune-related side effects, the most common of which are endocrinopathies, colitis, hepatitis, and interstitial pneumonitis. In contrast, coronary toxicities are rarely reported and remain poorly understood. Here, we describe the case of a patient who developed an acute coronary syndrome when treated with nivolumab as second-line therapy for metastatic pulmonary adenocarcinoma. A review of the literature, the French pharmacovigilance registry, and the World Health Organization pharmacovigilance database led to the identification of four cases of patients with coronary manifestations attributable to anti-PD1 immunotherapy (with no reported cases of patients undergoing anti-PD-L1 immunotherapy), which we describe herein. The potential mechanisms causing adverse coronary reactions to this type of therapy, which is used to treat lung cancer as well as other solid and hematological neoplastic diseases, are also discussed.



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MicroRNAs as Mediators of Resistance Mechanisms to Small-Molecule Tyrosine Kinase Inhibitors in Solid Tumours

Abstract

Receptor tyrosine kinases (RTKs) are widely expressed transmembrane proteins that act as receptors for growth factors and other extracellular signalling molecules. Upon ligand binding, RTKs activate intracellular signalling cascades, and as such are involved in a broad variety of cellular functions including differentiation, proliferation, migration, invasion, angiogenesis, and survival under physiological as well as pathological conditions. Aberrant RTK activation can lead to benign proliferative conditions as well as to various forms of cancer. Indeed, more than 70% of the known oncogene and proto-oncogene transcripts involved in cancer code for RTKs. Consequently, these receptors are broadly studied as targets in the treatment of different tumours, and a large variety of small-molecule tyrosine kinase inhibitors (TKIs) are approved for therapy. In most cases, patients develop resistance to the TKIs within a short time. MicroRNAs are short (18–22 nucleotides) non-protein-coding RNAs that fine-tune cell homeostasis by controlling gene expression at the post-transcriptional level. Deregulation of microRNAs is common in many cancers, and increasing evidence exists for an important role of microRNAs in the development of resistance to therapies, including TKIs. In this review we focus on the role of microRNAs in mediating resistance to small-molecule TKIs in solid tumours.



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Preparation of Folic Acid-Targeted Temperature-Sensitive Magnetoliposomes and their Antitumor Effects In Vitro and In Vivo

Abstract

Background

Ovarian cancer is a common gynecologic malignancy with poor prognosis, requiring innovative new therapeutic strategies. Temperature-controlled drug delivery to cancer cells represents a novel, promising, targeted treatment approach.

Objective

We prepared folate receptor-targeted thermosensitive liposomes wrapped with the HSP90 inhibitor 17-AAG and superparamagnetic material (17-AAG/MTSLs-FA), and tested the efficacy of these targeted magnetoliposomes in vitro and in vivo.

Methods

Magnetic thermosensitive liposomes wrapped with 17-AAG were coprecipitated with Fe3O4 magnetic nanoparticles and prepared by a rotary evaporation method. Experiments were conducted with SKOV3 human ovarian cancer cells and MCF7 human breast carcinoma cells to evaluate the anti-tumor effects.

Results

17-AAG/MTSLs-FA prepared in this study met the basic requirements for therapeutic application. The preparation method is relatively simple and the raw materials are readily available. The product exhibited strong magnetism, high encapsulation efficiencies, and satisfactory performance. The liposomes combined with hyperthermia significantly inhibited the proliferation of SKOV3 cells and induced apoptosis. Experiments using a mouse subcutaneous model as well as an ascites tumor xenograft model indicated that 17-AAG/MTSLs-FA was stable in vivo and effectively targeted tumor tissues expressing the folate receptor.

Conclusions

Folic acid-conjugated 17-AAG magnetic thermosensitive liposomes in combination with an alternating magnetic field for heating can achieve a synergistic anti-tumor effect of chemotherapy and heat treatment, potentially offering a new method for ovarian cancer treatment.



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Targeted Next-Generation Sequencing in Men with Metastatic Prostate Cancer: a Pilot Study

Abstract

Introduction

Tumor profiling by targeted next-generation sequencing (tNGS) and personalized treatment based on these results is becoming increasingly common in patients with metastatic solid tumors, but it remains unclear whether this strategy results in benefit to patients with metastatic prostate cancer (mPCa).

Objective

To assess the clinical utility of tNGS in treatment decision-making for patients with mPCa.

Patients and Methods

Patients with available genomic profiling using tumor tissue (FoundationOne, F1) or cell-free DNA (FoundationACT, Guardant360) were included. Targetable genomic alterations (tGA) included a change in the copy number or mutations in DNA repair genes, mismatch repair genes, PTEN, cyclin-dependent kinases, ERBB2, BRAF, TSC, and the PIK3/mTOR pathway.

Results

The study included 66 patients, 86% of which had metastatic castration-resistant prostate cancer (mCRPC), and who had received a median of 3 (range 0–7) treatments prior to tNGS. The most frequent alterations were found in TP53 (42%), PTEN (35%), androgen receptor (AR) (30%), DNA repair (30%), PIK3CA signaling pathway (21%), cyclin-dependent kinases (15%), BRAF (9%), and MMR/MSI (6%) genes. Among the 45 (68%) tGA+ patients, tNGS influenced treatment in 13 (29%) [PARP inhibitor (n = 7), mTOR inhibitor (n = 4), anti-PD-1 (n = 2), anti-HER2 (n = 1)]. The median progression-free survival (PFS) was 4.1 months [95% confidence interval (CI), 2.8–5.4]. Among tGA+ patients who did not receive tNGS-based therapy, systemic treatment (n = 17) included chemotherapy (71%), new generation anti-androgen therapy (24%), and cabozantinib (6%); the median PFS was 4.3 months (95% CI, 2.6–6.0; p = 0.7 for tGA+ with personalized therapy vs. tGA+ without personalized therapy).

Conclusion

In this cohort, the use of tNGS was feasible, detected frequent genomic alterations, and was used late in the disease course. Further studies and larger portfolios of targeted therapy trials are needed to maximize the benefit of tNGS in this population.



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Growing Role of Regorafenib in the Treatment of Patients with Sarcoma

Abstract

Sarcomas encompass a group of rare solid tumors responsible for approximately 1% of all cancer-related deaths in the United States each year. Subtypes include, but are not limited to, soft tissue sarcomas (STS) such as leiomyosarcoma, liposarcoma, pleomorphic sarcoma, and gastrointestinal stromal tumor (GIST). Treatment options for patients with STS vary depending on, among other factors, histological subtype. Data from a mix of phase 2 and phase 3 trials have suggested that the orally available multikinase inhibitor regorafenib may have efficacy in patients with STS who have progressed on previous lines of systemic therapy. Some clinical benefit of regorafenib has been shown in patients with leiomyosarcoma, synovial sarcoma, GIST, Ewing's sarcoma, and other sarcoma subtypes, suggesting a broad spectrum of potential activity in this population. Studies have also shown that the safety profile of regorafenib is acceptable in these patients, with adverse events that can be managed through dose reductions and/or interruptions as well as other supportive measures.



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BIM Deletion Polymorphism Confers Resistance to Osimertinib in EGFR T790M Lung Cancer: a Case Report and Literature Review

Abstract

The third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) osimertinib (AZD9291) has shown significant clinical efficacy against the EGFR T790M mutation in non-small cell lung cancer (NSCLC) patients. However, resistance inevitably occurs, and the mechanisms leading to treatment failure need to be further investigated. The B-cell lymphoma 2 (BCL-2)-like 11 (BIM) deletion polymorphism, which occurs at a frequency of 21% in East Asians but is absent in African and European populations, has been associated with resistance to first-generation EGFR TKIs, such as gefitinib and erlotinib; and is a poor prognostic factor for NSCLC patients with EGFR mutations. Nevertheless, the significance of this BIM deletion polymorphism in the resistance to osimertinib has not been reported. Here, we show for the first time that a NSCLC patient harboring the EGFR L858R/T790M mutations, as well as the BIM deletion polymorphism, exhibited poor clinical outcomes with osimertinib treatment. This result suggests that the BIM deletion polymorphism might have prognostic value for determining NSCLC patient outcomes following osimertinib treatment.



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MiR-146b protect against sepsis induced mice myocardial injury through inhibition of Notch1

Abstract

Myocardial dysfunction is a major cause of death in sepsis. MicroRNA-146b (miR-146b) has been reported to be related to myocardial disease. However, the role of miR-146b in sepsis as well as myocardial injury is still unclear. Septic cardiac dysfunction in mice was induced by cecal ligation and puncture (CLP) and miR-146b was found increased significantly in the myocardium tissue of CLP mice. It was found that up-regulation of miR-146b by agomiR injection suppressed expression of IL-1β in mice as well as myocardium apoptosis in CLP mice. However, suppression of miR-146b by antagomiR injection had inverse effects. Notch1 was identified as a target gene of miR-146b by bioinformatics analysis. And it was verified that in cardiomyocytes, the decrease of miR146b led to increase of both the mRNA and protein level of Notch1 and vice versa. In septic mice serum stimulated cardiomyocytes, up-regulation of miR-146b decreased the level of Notch1 and Hes1. The knockout of Notch1 in transgenic mice showed that the deficiency of Notch1 improved myocardial injury induced by CLP operation. The apoptosis of cardiomyocytes was relieved and the expression of IL-1β was decreased. In conclusion, miR-146b targets to Notch1 and protected cardiomyocytes against inflammation and apoptosis.



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Cellular and subcellular localization of uncoupling protein 2 in the human kidney

Abstract

The uncoupling protein-2 (UCP2) is an anion transporter that plays a key role in the control of intracellular oxidative stress. In animal models UCP2 downregulation has several pathological sequelae, particularly affecting the vasculature and the kidney. Specifically, in these models kidney damage is highly favored in the absence of UCP2 in the context of experimental hypertension. Confirmations of these data in humans awaits further information, as no data are yet available concerning the cell-type and subcellular expression in the human kidney. In the present study, we aimed to characterize the UCP2 protein distribution in human kidney biopsies. In humans UCP2 is mainly localized in proximal convoluted tubule cells, with an intracytoplasmic punctate staining. UCP2 positive puncta are often localized at the interface between the endoplasmic reticulum and the mitochondria. Glomerular structures do not express UCP2 at detectable levels. The expression of UCP2 in proximal tubular cells may explain their relative propensity to damage in pathological conditions including the hypertensive disease.



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Human urine-derived stem cells play a novel role in the treatment of STZ-induced diabetic mice

Abstract

Human urine-derived stem cells (hUSCs) are a potential stem cell source for cell therapy. However, the effect of hUSCs on glucose metabolism regulation in type 1 diabetes was not clear. Therefore, the aim of the study was to evaluate whether hUSCs have protective effect on streptozotocin (STZ)-induced diabetes. hUSCs were extracted and cultivated with a special culture medium. Flow cytometry analysis was applied to detect cell surface markers. BALB/c male nude mice were either injected with high-dose STZ (HD-STZ) or multiple low-dose STZ (MLD-STZ). Serum and pancreatic insulin were measured, islet morphology and its vascularization were investigated. hUSCs highly expressed CD29, CD73, CD90 and CD146, and could differentiate into, at least, bone and fat in vitro. Transplantation of hUSCs into HD-STZ treated mice prolonged the median survival time and improved their blood glucose, and into those with MLD-STZ improved the glucose tolerance, islet morphology and increased the serum and pancreas insulin content. Furthermore, CD31 expression increased significantly in islets of BALB/c nude mice treated with hUSCs compared to those of un-transplanted MLD-STZ mice. hUSCs could improve the median survival time and glucose homeostasis in STZ-treated mice through promoting islet vascular regeneration and pancreatic beta-cell survival.



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Three-dimensional reconstructed eccrine sweat glands with vascularization and cholinergic and adrenergic innervation

Abstract

Functional integrity of the regenerated tissues requires not only structural integrity but also vascularization and innervation. We previously demonstrated that the three-dimensional (3D) reconstructed eccrine sweat glands had similar structures as those of the native ones did, but whether the 3D reconstructed glands possessing vascularization and innervation was still unknown. In the study, Matrigel-embedded eccrine sweat gland cells were implanted under the inguinal skin. Ten weeks post-implantation, the vascularization, and innervation in the 10-week reconstructed eccrine sweat glands and native human eccrine sweat glands were detected by immunofluorescence staining. The results showed that the fluorescent signals of general neuronal marker protein gene product 9.5, adrenergic nerve fiber marker tyrosine hydroxylase, and cholinergic nerve fiber markers acetylcholinesterase and vasoactive intestinal peptide embraced the 3D reconstructed glands in circular patterns, as the signals appeared in native eccrine sweat glands. There were many CD31- and von Willebrand factor-positive vessels growing into the plugs. We demonstrated that the 3D reconstructed eccrine sweat glands were nourished by blood vessels, and we for the first time demonstrated that the engineering sweat glands were innervated by both cholinergic and adrenergic fibers. In conclusion, the 3D reconstructed eccrine sweat glands may have functions as the native ones do.



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Correction to: BrdU/EdU dual labeling to determine the cell-cycle dynamics of defined cellular subpopulations

In the original publication of the article, two errors were made in describing the equations for Tc.



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Cell type specific expression of Follistatin-like 1 (Fstl1) in mouse embryonic lung development

Abstract

Follistatin like-1 (Fstl1) is a secreted glycoprotein and can be up-regulated by TGF-β1. To better study the function of Fstl1 in lung development, we examined Fstl1 expression in the developing lung, in a cell type specific manner, using a tamoxifen inducible Fstl1-reporter mouse strain. Our results show that Fstl1 is ubiquitously expressed at saccular stage in the developing lung. At E18.5, Fstl1 expression is robust in most type of mesenchymal cells, including airway smooth muscle cells surrounding airways, vascular smooth muscle cells, endothelial cells, and vascular pericytes from blood vessel, but not PDGFRα+ fibroblasts in the distal alveolar sacs. Meanwhile, relative weak and sporadic signals of Fstl1 expression are observed in epithelium, including a subgroup of club cells in proximal airways and a few type II alveolar epithelial cells in distal airways. Our data help to understand the critical role of Fstl1 in lung development and lung disease pathogenesis.



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Over-expression of IQGAP1 indicates poor prognosis in head and neck squamous cell carcinoma

Abstract

IQ-domain GTPase-activating protein 1 (IQGAP1) is associated with the development and progression of many human cancers. We aimed to investigate the expression and clinicopathological significances of IQGAP1 in head and neck squamous cell carcinoma (HNSCC). In this study, immunohistochemical staining of IQGAP1, co-inhibitory immune checkpoint molecules and macrophage markers were performed in human HNSCC samples to analyze the expression and correlation with clinicopathological characteristics. Immunoreactivity of IQGAP1 was also detected in immunocompetent mouse HNSCC tissue. We found that IQGAP1 expression level was significantly increased in human HNSCC compared with dysplasia and normal mucosa, and the expression of IQGAP1 in HNSCC was positively associated with advanced lymph node status. Besides, our data indicated that patients with higher IQGAP1 expression exhibited poor overall survival compared with patients with lower IQGAP1 expression. Furthermore, this study demonstrated that IQGAP1 expression was positively associated with TIM3, Galectin-9 (TIM3 ligand), B7H4, macrophage markers CD68 and CD163. In conclusion, these findings suggest that over-expression of IQGAP1 in human HNSCC may indicate poor prognosis.



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Semaphorin 3A promotes osteogenic differentiation of BMSC from type 2 diabetes mellitus rats

Abstract

Bone regeneration is impaired in patients with type 2 diabetes mellitus (T2DM), which leads to non-healing after bone loss. The decreased osteogenic capacity of bone mesenchymal stem cells (BMSCs) might be a main reason. Sema3A, as a powerful protein promoting osteocyte differentiation, shows potential for bone regeneration treatment. BMSCs may be a therapeutic solution. In this study, we divided BMSCs from T2DM rats (BMSCs-D) and normal rats (BMSCs-N), identified their ability to differentiate into different cell types. Then we found decreased expression of Sema3A in BMSCs-D compared with BMSCs-N. Stimulating with Sema3A showed no influence in the proliferation or migration of BMSCs. However, Sema3A stimulation significantly increased the expression of osteogenic‑related genes, including type I collagen, alkaline phosphatase, Runt-related transcription factor 2 (RUNX2), bone morphogenetic protein and osteocalcin. Besides, the osteogenic capacity of BMSCs was also increased by Sema3A stimulation. In conclusion, we proved that exogenous Sema3A stimulation might repair the osteogenic capacity of BMSCs-D, thus providing a new strategy for restoring the impaired bone regeneration ability for T2DM patients.



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VEGFA and VEGFR2 RNAscope determination in gastric cancer

Abstract

Gastric cancer is the fifth most common cancer and third leading cause of cancer-related death worldwide. Several studies on angiogenic blocking agents in gastric cancer revealing promising results by the use of monoclonal antibodies against VEGFA or its receptor VEGFR2 or against VEGFA activating pathway. The validation of biomarkers useful to better organize the clinical trials involving anti-angiogenic therapies is crucial. Molecular markers such as RNA are increasingly used for cancer diagnosis, prognosis, and therapy guidance as in the case of the targeted therapies concerning the inhibition of angiogenesis. The aim of this study is to set the conditions for evaluating the expression of VEGFA and VEGFR2 in gastric cancer specimens and in healthy gastric mucosa by the use of RNAscope, a novel RNA in situ hybridization (ISH) method that allows the visualization of a specific gene expression in individual cells. We found the increased expression of VEGFA in the tubular glands and VEGFR2 in the endothelium of gastric cancer samples mainly in the T2, T3 and T4 stages of tumor progression as compared to the healthy controls. These results obtained by the application of this highly sensitive method for oligonucleotide detection the role of angiogenesis in gastric cancer progression already highlighted by conventional immunohistochemical methods, and offer significant promise as a new platform for developing and implementing RNA-based molecular diagnostics also in the conditions in which immunohistochemistry is not applicable.



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Gamma-enolase predicts lung damage in severe acute pancreatitis-induced acute lung injury

Abstract

Severe acute pancreatitis (SAP) associated acute lung injury (ALI) accounts for about 70% mortality of SAP patients. However, there are no precise biomarkers for the disease currently. Herein, we evaluated the potential of gamma-enolase (ENO2), against its universal isoform alpha-enolase (ENO1), as a marker of SAP–ALI in a rat model. Firstly, 16 male Sprague–Dawley rats were randomly divided into two groups, Sham (n = 8) and SAP–ALI (n = 8), for pancreatitis induction. Ultra-structure examination by electron microscopy and HE staining were used for lung injury assessment. Lung tissue expressions of alpha-enolase and gamma-enolase were evaluated by qRT-PCR and immunohistochemistry. In a prospective validation experiment, 28 rats were used: sham (n = 8), SAP–ALI at 3 h (3 h, n = 10), and SAP–ALI at 24 h (24 h, n = 10). Lung tissue damage, tissue expression and circulating alpha-enolase and gamma-enolase levels were evaluated. Elevated serum levels of α-amylase and TNF-α were observed in SAP rats but not in sham-operated rats. Histological examination of pancreatic and lung tissues indicated marked damage in SAP rats. While alpha-enolase was universally expressed, gamma-enolase was expressed only in damaged lung tissues. Gamma-enolase was detected in lung tissues, BALF, and serum as early as 3 h post-surgery when physical pathological damage was not apparent. Unlike alpha-enolase, secreted and/or circulating gamma-enolase level progressively increased, especially in serum, as lung damage progressed. Thus, gamma-enolase may signal and correlate lung tissue damage well before obvious physical pathological tissue damage and might be a candidate diagnostic and/or prognostic marker.



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miR-155 inhibits the formation of hypertrophic scar fibroblasts by targeting HIF-1α via PI3K/AKT pathway

Abstract

Hypertrophic scar (HS) is a serious skin fibrotic disease characterized by the excessive proliferation of fibroblasts and often considered as a kind of benign skin tumor. microRNA-155 (miR-155) is usually served as a promising marker in antitumor therapy. In view of the similarities of hypertrophic scar and tumor, it is predicted that miR-155 may be a novel therapeutic target in clinical trials. Here we found the expression levels of miR-155 was gradually down regulated and HIF-1α was upregulated in HS tissue and HS derived fibroblasts (HFs). And cell proliferation was inhibited when miR-155 was overexpressed or HIF-1α was silenced. Moreover, overexpression of miR-155 in HFs could reduce the expression of collagens in vitro and inhibit the collagen fibers arrangement in vivo, whereas miR-155 knockdown gave opposite results. Furthermore, we found that miR-155 directly targeted the HIF-1α, which could also independently inhibit the expression of collagens in vitro and obviously improved the appearance and architecture of the rabbit ear scar in vivo when it was silencing. Finally, we found that PI3K/AKT pathway was enrolled in these processes. Together, our results indicated that miR-155 was a critical regulator in the formation and development of hypertrophic scar and might be a potential molecular target for hypertrophic scar therapy.



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CGRP gene-modified rBMSCs show better osteogenic differentiation capacity in vitro

Abstract

Calcitonin gene-related peptide (CGRP) is a marked and important neuropeptide expressed in nerve fibers during bone repair. This study investigated the role of CGRP overexpression on osteogenic differentiation of rat bone mesenchymal stem cells (rBMSCs). rBMSCs were infected with viral stocks of pLenO-DCE-CGRP (CGRP group) or pLenO-DCE (Vector group), while normal rBMSCs were used as a control. Transfection efficiency of rBMSCs was analyzed by flow cytometry. Cell proliferation was examined using a Cell Counting Kit-8 and flow cytometry. Expressions of alkaline phosphatase(ALP), bone sialoprotein (BSP) and Runt-related transcription factor 2(Runx2) in rBMSCs were detected at 1 and 2 weeks after mineral induction by real-time PCR and western blotting. Alizarin Red staining was applied at 28 days. The ratio of osteoprotegerin (OPG) to receptor activator of nuclear factor kappa B ligand (RANKL) was also detected to determine the underlying mechanism. pLenO-DCE-CGRP-induced rBMSCs stably overexpressing CGRP were successfully established. Overexpression of the CGRP gene significantly promoted rBMSC proliferation (p < 0.05). In addition, expressions of osteogenesis-related indexes were upregulated in the CGRP group (p < 0.05) compared with vector and control groups, and more mineralization nodules were observed in the CGRP group (p < 0.05). CGRP gene increased OPG and reduced RANKL in rBMSCs. Hence, the OPG/ RANKL ratio was increased in the CGRP group compared with the other two groups. CGRP gene-modified rBMSCs show better osteogenic differentiation capacity compared with rBMSCs in vitro.



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AhR activation protects intestinal epithelial barrier function through regulation of Par-6

Abstract

The Par complex (Par-6/Par-3/aPKC) plays a key role in the maintenance of the intestinal barrier function through the regulation of epithelial junction formation. The aryl hydrocarbon receptor (AhR) has been shown to be an important regulator for intestinal homeostasis. In this study, we investigated the role of the AhR activation on the regulation of Par complex. AhR activation by 6-formylindolo (3,2-b) carbazole (FICZ) represses the abnormal expression of the Par complex in a mouse model of dextran sulphate sodium (DSS)-induced colitis. In T84 cells, overexpression of Par-6 causes intestinal barrier dysfunction. Lipopolysaccharide (LPS)-induced intestinal epithelial barrier dysfunction and increase in Par-6 expression was prevented by AhR activation. However, FICZ did not alter the expression of Par-3 or aPKC. Furthermore, AhR activation alleviated LPS-induced increase of Par-6 through repressing the expression of activating protein-2γ (Ap-2γ). These results reveal the protective effects of AhR activation on LPS induced disruption of intestinal epithelial barrier function through suppressing the expression of Par-6 expression. Our findings provide novel insights into the protective role of AhR in intestinal barrier function.



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Monitoring of methane emission from a landfill site in daily and hourly time scales using an automated gas sampling system

Abstract

Landfill sites are significant sources of methane gas globally. Understanding the temporal variabilities of methane emissions from landfill sites is necessary for estimating such emissions. In this study, an automated monitoring system was used to monitor methane emission flux and concentration on daily and hourly time scales at a landfill site. Measured methane emission fluxes were almost negligible in the studied area. However, methane concentration at landfill surface at nighttime was significantly higher than those in the daytime, which demonstrates the importance of investigating methane emissions at an hourly time scale, including during nighttime. The daily and hourly variations in methane concentration were well correlated with either soil temperature or volumetric water content near the surface. The obtained relations indicate that the automated monitoring system measurements can facilitate a more comprehensive understanding of the methane emission mechanisms at different time scales.



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Graphical Abstracts



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Meet Our Regional Editor



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Editorial: Advances in Therapies of Cerebellar Disorders



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Current and Promising Therapies in Autosomal Recessive Ataxias



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Neurotransplantation Therapy and Cerebellar Reserve



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Physiological and Morphological Principles Underpinning Recruitment of the Cerebellar Reserve



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Non-invasive Cerebellar Stimulation in Cerebellar Disorders



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Cognitive Impact of Cerebellar Damage: Is There a Future for Cognitive Rehabilitation?



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The Underlying Role of Oxidative Stress in Neurodegeneration: A Mechanistic Review



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N-3 (Omega-3) Fatty Acids: Effects on Brain Dopamine Systems and Potential Role in the Etiology and Treatment of Neuropsychiatric Disorders



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Clinical Observation of Electroencephalographic Changes and Risk of Convulsion Occurrence in Children Receiving Neural Precursor Cell Transplantation



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Conference Report: 184th American Association for the Advancement of Science Annual Meeting, Austin TX, USA Feb. 15-19, 2018



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Assessment of chromium hyper-accumulative behaviour using biochemical analytical techniques of greenhouse cultivated Sonchus asper on tannery waste dump site soils

Abstract

Keeping the sources of pollution such as chromium (Cr) under a safe limit is a daunting challenge due to the negative impact of heavy metal bioaccumulation in vegetation and the concomitant human health exposure. We took a closer look at Sonchus asper by cultivating in the green house. It resulted in 80% germination when cultivated over nine different soils collected from the tannery dump site. The biochemical analytical techniques such as mass spectrometry indicated significant bioaccumulation of Cr in the plant tissue. As per the ICP-MS analysis, this annual herb resulted in the accumulation of 601 mg kg−1 of total Cr with 212 mg kg−1 in its shoot from soil samples containing up to 41 mg kg−1 of hexavalent Cr. The energy dispersive X-ray (EDX) spectroscopy of S. asper revealed a higher level of S element indicating a sulfate-Cr binding relation. Elevated content of Cr in soil (73,721 ± 65 mg kg−1) caused biochemical changes in the shoot of S. asper as indicated by the disappearance of Fourier transform infrared spectroscopy (FTIR) bands at 935 and 872 cm−1 and further revealing aliphatic –CH2 appearing as anti-symmetry νa(CH2) and symmetric vibration νs(CH2) at the band of 2920 and 2850 cm−1, respectively.



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Hydrogel applications for adsorption of contaminants in water and wastewater treatment

Abstract

During the last decade, hydrogels have been used as potential adsorbents for removal of contaminants from aqueous solution. To improve the adsorption efficiency, there are numerous different particles that can be chosen to encapsulate into hydrogels and each particle has their respective advantages. Depending on the type of pollutants and approaching method, the particles will be used to prepare hydrogels. The hydrogels commonly applied in water/wastewater treatment was mainly classified into three classes according to their shape included hydrogel beads, hydrogel films, and hydrogel nanocomposites. In review of many recently research papers, we take a closer look at hydrogels and their applications for removal of contaminants, such as heavy metal ion, dyes, and radionuclides from water/wastewater in order to elucidate the reactions between contaminants and particles and potential for recycling and regeneration of the post-treatment hydrogels.

Graphical abstract



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HNF4A-related Fanconi syndrome in a Chinese patient: a case report and review of the literature

The p.R63W mutation in hepatocyte nuclear factor-4 alpha (HNF4A) leads to a heterogeneous group of disorders with various clinical presentations. Recently, patients with congenital hyperinsulinism and Fanconi syn...

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Seed priming with Se mitigates As-induced phytotoxicity in rice seedlings by enhancing essential micronutrient uptake and translocation and reducing As translocation

Abstract

We laid down this investigation to explore the promotive and antagonistic aspect of selenium (Se) when supplemented through seed priming technology in rice before sowing into arsenic (As) free and As spiked soil. Findings suggest that As stress inhibits germination (35.38%), seedling growth (38.19%), chlorophyll content by 42.31%, and reduced translocation of iron, zinc, manganese by 19.40, 17.33, and 18.40% respectively, in the seedlings of unprimed seeds. Seedlings of unprimed seeds also had greater As translocation into the aerial part beside repressing micronutrient translocation, significantly. On the contrary, Se-primed seeds had higher germination (27.82%), longer root length (20.14%), greater chlorophyll content beside having greater translocation of iron, zinc, manganese in shoots along with restricting As translocation in rice seedlings by confining more As in the root, in a significant manner (p < 0.05 level) than the unprimed seedlings grown in identical stress. On the other hand, seedlings of Se-primed seeds grown alike the control also had higher germination % (7.08%), root and shoot length with significantly less proline, and hydrogen peroxide content in root and shoot. Findings indicate that seed priming with Se executes dual role, a growth promoting and antagonism in a more practical and farmer-friendly way to mitigate As-induced toxicity and enhance growth in rice seedlings.



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Biologics for pityriasis rubra pilaris treatment: A review of the literature

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Monica Napolitano, Damiano Abeni, Biagio Didona

Pityriasis rubra pilaris (PRP) is a rare inflammatory papulosquamous skin disease that is often refractory to conventional therapies. The off-label use of biologics, such as anti–tumor necrosis factor, anti–interleukin (IL) 12/IL-23, and anti–IL-17 agents, has been proven successful in the past 2 decades for PRP treatment. Our aim was to analyse the literature for the use of biologics in PRP treatment. We conducted a review by performing PubMed and ClinicalTrials.gov searches. Sixty-eight articles met our selection criteria and are herein discussed. Out of 86 PRP patients, the vast majority were treated with anti–tumor necrosis factor, anti–IL-12/IL-23, or anti–IL-17 biologics, either alone or in combination therapy. A marked-to-complete response was observed in 50%-78%, a partial response in 11%-25%, and no or poor response in 11%-25%. This review has several limitations, including small sample sizes and the lack of shared study design criteria. In some instances, PRP might have resolved spontaneously. Further, the presence of concomitant therapy or the lack of detailed data on previous treatments, makes it difficult to strictly define a therapeutic role per se of specific biologics in PRP. This review shows that biologics may be regarded as a tool for PRP treatment alone or in combination therapy although clinical trials are needed to better assess their efficacy and safety.



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Dermatology Calendar

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s):



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

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Arash Mostaghimi, Cara Joyce



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

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Luna Aksoy



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

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Michael Benzaquen, Luca Borradori, Simone Cazzaniga, Philippe Berbis, Laurence Feldmeyer



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

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Shamir Geller, Noa Kremer, Tal Zeeli, Eli Sprecher



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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’”

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Eric L. Simpson, Nick J. Reynolds, Carsten Flohr, Amy S. Paller, Jonathan I. Silverberg, Michel J. Cork, Emma Guttman-Yassky, Alan D. Irvine



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

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Adam Daunton, Jonathan M.R. Goulding



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A simple method to facilitate fat removal from full-thickness skin grafts

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Marina Zoéga Hayashida, Mauro Yoshiaki Enokihara, Sérgio Henrique Hirata, Ival Peres Rosa



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Dermoscopy for the detection and safe extraction of an intracutaneous foreign body

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Sidharth Sonthalia, Abhijeet Kumar Jha, Feroze Kaliyadan



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Dermoscopy is a useful bedside tool for the evaluation of cutaneous loxoscelism

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Cristián Navarrete-Dechent, Sergio Álvarez-Véliz



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Correction

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s):



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Modernizing regulation of cosmetic products: Reintroduction of the Personal Care Products Safety Act

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Harrison P. Nguyen, Wilma F. Bergfeld, Howard P. Forman, Donald V. Belsito, Jean L. Bolognia



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How data can deliver for dermatology

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Katrina Abuabara, Maryam M. Asgari, Suephy C. Chen, Robert P. Dellavalle, Sunil Kalia, Aaron M. Secrest, Jonathan I. Silverberg, James A. Solomon, Martin A. Weinstock, Jashin J. Wu, Mary-Margaret Chren, Epidemiology Expert Research Group



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Dermatology, climate change, and the perils of attacks on expertise

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Saami Khalifian, Misha Rosenbach



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The “dermatologist recommended” label: Is it meaningful?

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Mary E. Lohman, Peter A. Lio, Shuai Xu



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Shortage of lidocaine with epinephrine: Causes and solutions

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Brandon Bodie, Robert T. Brodell, Stephen E. Helms



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Real-world evidence–What is it and does it matter for approval of drugs?

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): William H. Eaglstein



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Is there a doctor onboard?: The ethical conundrum of a specialist asked to provide in-flight medical assistance

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Sunil H. Adwani, Preeti Jhorar, Jane M. Grant-Kels



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Consultative teledermatology in the emergency department and inpatient wards: A survey of potential referring providers

Publication date: August 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 2

Author(s): Justin Cheeley, Suephy Chen, Robert Swerlick



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Antibiotic resistance and relevance to general dental practice in Australia

Australian Dental Journal, Volume 0, Issue ja, -Not available-.


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Testing environmental Kuznets curve hypothesis in G7 countries: the role of renewable energy consumption and trade

Abstract

This study has been conducted to examine the impact of trade, economic growth, and renewable energy on environmental degradation in G7 countries. The data consist of the years 1991–2016. We employed the panel unit root test and co-integration test, along with cross-sectional dependence and cross-sectionally augmented IPS unit root test by Pesaran (J Appl Econ 22:265–312, 2007). We also employed dynamic ordinary least squares, fully modified ordinary least squares, and fixed effect ordinary least squares regression. The result concluded that all the variables are co-integrated in the long run and all the variables create a significant effect on CO2 emission. This study implies that economic growth and trade increases the CO2 emission in the long run whereas the renewable energy consumption reduces the CO2 emission in the long run. The result also provides support for the Environmental Kuznets curve hypothesis in G7 countries.



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Organic carbon content and humus composition after application aluminum sulfate and rice straw to soda saline-alkaline soil

Abstract

The soil organic carbon accumulation in soda saline-alkaline soil and the humus composition changes with application of aluminum sulfate and rice straw were investigated by the controlled simulative experiments in laboratory. For evaluating the amelioration effect, organic carbon content and humus composition in soda saline-alkaline soil were investigated with different application amounts of rice straw and aluminum sulfate. Potassium dichromate oxidation titration (exogenous heat) method and Kumada method were used to analyze the contents of organic carbon and humus composition, respectively. The transformation of soil organic matter in the saline-alkali soil during the amelioration has been clarified in this paper. The results demonstrated that the contents of soil organic carbon were significantly increased (13–92%) with different application amounts of rice straw and aluminum sulfate. The contents of free fraction and combined fraction of humus and their compositions (humic acid and fulvic acid) were increased with different application amounts of rice straw. The free fraction of humus was increased more dramatically. Due to aluminum sulfate application, free fraction of humus and humic acid (HA) was transformed to combined fraction partially. Free HA was changed to be P type with rice straw application. With aluminum sulfate application, free form of HA was changed from type P to type Rp. For rice straw application, combined HA only was transferred within the area of type A. Aluminum sulfate addition had no significant effect on the type of combined form of HA. With the same amount of rice straw application, the contents of soil organic carbon were increased by increasing the amount of aluminum sulfate application. Both rice straw and aluminum sulfate applications could reduce the humification degree of free and combined fraction of HA. According to the types of HA, it could be concluded that humus became younger and renewed due to the application of rice straw and aluminum sulfate.



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Application of Escherichia coli antibiotic resistance patterns for contamination source identification in watershed

Abstract

Spatial correlation of pollution of the water resource in Taipei, Taiwan, were examined by analyzing the antibiotic resistance patterns (ARPs) of 96 Escherichia coli colonies, which were isolated from 7 sampling sites in 3 river sections. The ARPs were the growth patterns of isolated E. coli colonies in the medium with seven kinds of antibiotics, including ampicillin, chlortetracycline, erythromycin, oxytetracycline, streptomycin, tetracycline, and salinomycin of different concentrations. The results showed that the survival rate of E. coli decreased with increasing concentration of antibiotics; however, various ARPs under different antibiotics of different concentrations significantly increased both the useful information and complexities. Hierarchical cluster analysis (HCA) and two-stage principal component analysis (PCA) were applied to analyze the spatial correlations and interrelations of distinct ARPs among sampling sites in this study. It was found that the seven sampling sites can be categorized into three groups which may represent three possible pollution characteristics.



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Hypermetabolism in the cerebellum and brainstem and cortical hypometabolism are independently associated with cognitive impairment in Parkinson’s disease

Abstract

Purpose

Cognitive impairment (CI) in Parkinson's disease (PD) is associated with a widespread reduction in cortical glucose metabolism and relative increases in the cerebellum and brainstem as measured using 18F-fluorodesoxyglucose (FDG) PET. We separately analysed CI-related hypermetabolism and hypometabolism in comparison with neuropsychological test performance and investigated whether increased FDG uptake is a true feature of the disease or a normalization effect.

Methods

The study included 29 subjects (12 patients with PD, 10 patients with PD dementia and 7 healthy controls") who underwent FDG PET and comprehensive neuropsychological testing. Test performance across various cognitive domains was summarized in a cognitive staging score. Metabolic indices reflecting associated changes in regional cerebral glucose metabolism (rCGM) were calculated: index(−) for CI-related hypometabolism, and index(+) for CI-related hypermetabolism. We tested whether index(+) offered additional value in predicting the severity of CI in multiple regression analysis.

Results

At higher stages of CI, increased rCGM was found in the posterior cerebellar vermis and pons, associated with impaired attention, executive function and memory. Reduced rCGM was found in various cortical regions in agreement with the literature. In multiple regression analysis, both indices independently predicted the severity of CI with a whole-model R2 of 0.68 (index(−), p = 0.0006; index(+), p = 0.013), confirmed by alternative analyses combining different reference tissues in the multiple regression.

Conclusion

We found CI-related hypermetabolism in cerebellar regions that are known to be involved in several cognitive functions and in the pons. These alterations may represent compensatory activation of cognitive networks including cerebropontocerebellar tracts.



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Effects on Eichhornia crassipes under Zn stress

Abstract

Eichhornia crassipes is a macrophyte widely used in phytoremediation, demonstrating a high ability to remove metals from water. The aim of this work was to evaluate its enzymatic detoxification strategies and metal accumulation when it is exposed to different Zn concentrations (0, 2, 4, 6, and 9 ppm) for periods of 24, 48, and 72 h. Zn concentration in roots was significantly higher than in aerial parts. Independently of the treatment, in the first 48 h, concentrations of photosynthetic pigments were not affected. However, a significant increase (between 19 and 34%) in Chl-b concentrations for all treatments was observed at 72 h. Carotenoid concentration was not affected during the first 48 h, while at 72 h, there was a significant increase regarding the control (between 11 and 24%) for all treatments. Malondialdehyde concentration in aerial parts and roots was not affected during the experiment. Nonetheless, a significant increase in the enzymatic activity of the antioxidant system was observed. Results suggest that Zn could have potential antioxidant properties, which may result in the activation of different antioxidant enzymes involved in the protection against metal stress.



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Retrospective definition of reaction risk in Italian children with peanut, hazelnut and walnut allergy through component-resolved diagnosis

Publication date: Available online 14 July 2018

Source: Allergologia et Immunopathologia

Author(s): M. Giovannini, P. Comberiati, M. Piazza, E. Chiesa, G.L. Piacentini, A. Boner, G. Zanoni, D.G. Peroni

Abstract
Background

Serum IgE evaluation of peanut, hazelnut and walnut allergens through the use of component-resolved diagnosis (CRD) can be more accurate than IgE against whole food to associate with severe or mild reactions.

Objectives

The aim of the study was to retrospectively define the level of reaction risk in children with peanut, hazelnut and walnut sensitization through the use of CRD.

Methods

34 patients [n = 22 males, 65%; median age eight years, interquartile range (IQR) 5.0–11.0 years] with a reported history of reactions to peanut and/or hazelnut and/or walnut had their serum analyzed for specific IgE (s-IgE) by ImmunoCAP® and ISAC® microarray technique.

Results

In children with previous reactions to peanut, the positivity of Arah1 and Arah2 s-IgE was associated with a history of anaphylaxis to such food, while the positivity of Arah8 s-IgE were associated with mild reactions. Regarding hazelnut, the presence of positive Cora9 and, particularly, Cora14 s-IgE was associated with a history of anaphylaxis, while positive Cora1.0401 s-IgE were associated with mild reactions. Concerning walnut, the presence of positive Jug r 1, Jug r 2, Jug r 3 s-IgE was associated with a history of anaphylaxis to such food. ImmmunoCAP® proved to be more useful in retrospectively defining the risk of hazelnut anaphylaxis, because of the possibility of measuring Cor a14 s-IgE.

Conclusions

Our data show that the use of CRD in patients with allergy to peanut, hazelnut and walnut could allow for greater accuracy in retrospectively defining the risk of anaphylactic reaction to such foods.



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Comparison of clinical outcomes between butterfly inlay cartilage tympanoplasty and conventional underlay cartilage tympanoplasty

Publication date: Available online 14 July 2018

Source: Auris Nasus Larynx

Author(s): Min Bum Kim, Jin-A. Park, Michelle J. Suh, Chan Il Song

Abstract
Objective

To assess the efficacy of butterfly inlay cartilage tympanoplasty and compare it with conventional underlay cartilage tympanoplasty in terms of success rate and hearing outcomes.

Materials and methods

The study included 35 patients (36 ears) who underwent butterfly inlay cartilage tympanoplasty (inlay group, 23 ears of 22 patients) or conventional underlay cartilage tympanoplasty (underlay group, 13 ears). The anatomical success rate and hearing outcomes were analysed.

Results

Re-perforation occurred in 2 cases (8.7%) in the inlay group and 3 (23.1%) in the underlay group. One patient in the inlay group developed a serious infection, and one in the underlay group developed massive granulation of the tympanic membrane. In the inlay group, the air-bone gap (ABG) decreased from 19.9 (±12.6) dB HL preoperatively to 13.8 (±11.3) dB HL postoperatively (p = 0.047), in the underlay group, it decreased from 23.5 (±15.8) dB HL to 18.3 (±20.6) dB HL. Regarding improvement in ABG, the difference between the group was not statistically significant (p = 0.968).

Conclusion

Butterfly inlay cartilage tympanoplasty is comparable with conventional underlay cartilage tympanoplasty in both anatomic and audiological success rates. Owing to its simplicity, shorter operation time, and rapid patient recovery, butterfly inlay cartilage tympanoplasty could be considered a favourable surgical option.



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Reply to the Letter to the Editor from Peters et al: On the use of the liver as a reference organ for Deauville scoring in lymphoma patients and how it may be affected by liver steatosis



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Association of Tinnitus and Other Cochlear Disorders With a History of Migraines.

Related Articles

Association of Tinnitus and Other Cochlear Disorders With a History of Migraines.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 12;:

Authors: Hwang JH, Tsai SJ, Liu TC, Chen YC, Lai JT

Abstract
Importance: A headache is a symptom of a migraine, but not all patients with migraine have headaches. It is still unclear whether a migraine might increase the risk of cochlear disorders, even though a migraine does not occur concurrently with cochlear disorders.
Objective: To investigate the risk of cochlear disorders for patients with a history of migraines.
Design, Setting, and Participants: This study used claims data from the Taiwan Longitudinal Health Insurance Database 2005 to identify 1056 patients with migraines diagnosed between January 1, 1996, and December 31, 2012. A total of 4224 controls were also identified from the same database based on propensity score matching. Statistical analysis was performed from January 23, 1996, to December 28, 2012.
Main Outcomes and Measures: The incidence rate of cochlear disorders (tinnitus, sensorineural hearing impairment, and/or sudden deafness) was compared between the cohorts by use of the Kaplan-Meier method. The Cox proportional hazards regression model was also used to examine the association of cochlear disorders with migraines.
Results: Of the 1056 patients with migraines, 672 were women and 384 were men, and the mean (SD) age was 36.7 (15.3) years. Compared with the nonmigraine cohort, the crude hazard ratio for cochlear disorders in the migraine cohort was 2.83 (95% CI, 2.01-3.99), and the adjusted hazard ratio was 2.71 (95% CI, 1.86-3.93). The incidence rates of cochlear disorders were 81.4 (95% CI, 81.1-81.8) per 1 million person-years for the migraine cohort and 29.4 (95% CI, 29.2-29.7) per 1 million person-years for the nonmigraine cohort. The cumulative incidence of cochlear disorders in the migraine cohort (12.2%) was significantly higher than that in the matched nonmigraine cohort (5.5%). Subgroup analysis showed that, compared with the nonmigraine cohort, the adjusted hazard ratios in the migraine cohort were 3.30 (95% CI, 2.17-5.00) for tinnitus, 1.03 (95% CI, 0.17-6.41) for sensorineural hearing impairment, and 1.22 (95% CI, 0.53-2.83) for sudden deafness.
Conclusions and Relevance: In this population-based study, the risk of cochlear disorders, especially for tinnitus, was found to be significantly higher among patients with a history of migraines. This finding may support the presence and/or concept of "cochlear migraine."

PMID: 30003226 [PubMed - as supplied by publisher]



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The Role of Migraine in Hearing and Balance Symptoms.

Related Articles

The Role of Migraine in Hearing and Balance Symptoms.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 12;:

Authors: Lin HW, Djalilian HR

PMID: 30003218 [PubMed - as supplied by publisher]



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Sociodemographic Characteristics and Treatment Response Among Aging Adults With Voice Disorders in the United States.

Related Articles

Sociodemographic Characteristics and Treatment Response Among Aging Adults With Voice Disorders in the United States.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 12;:

Authors: Bertelsen C, Zhou S, Hapner ER, Johns MM

Abstract
Importance: Aging adults face unique barriers to care and have unique health care needs with a high prevalence of chronic conditions. A high proportion of individuals in this group have voice disorders, in part due to age-related changes in laryngeal anatomy and physiologic features. These disorders contribute significantly to health care costs and remain poorly understood.
Objective: To describe sociodemographic characteristics and response to treatment among aging adults with voice disorders.
Design, Setting, and Participants: A cross-sectional study using the 2012 National Health Interview Survey was used to evaluate adults who reported voice disorders in the past 12 months. Self-reported demographics and data regarding health care visits for voice disorders were analyzed. Statistical analysis was conducted from March 1, 2017, to February 1, 2018.
Main Outcomes and Measures: Self-reported voice disorders, whether or not treatment was sought, which types of professionals were seen for treatment, and whether or not the voice disorder improved after treatment.
Results: Among 41.7 million adults in the United States 65 years or older, 4.20 million (10.1%; 2 683 199 women and 1 514 909 men; mean [SE] age, 74.5 [0.3] years) reported having voice disorders. Of those with voice disorders, 10.0% (95% CI, 8.3%-11.7%) sought treatment. Of individuals seeking treatment, 22.1% (95% CI, 7.9%-36.3%) saw an otolaryngologist and 24.3% (95% CI, 10.6%-38.0%) saw a speech language pathologist. By controlling for race/ethnicity, income, sex, and geography, it was found that men were less likely than women to report voice disorders (36.1% [95% CI, 31.7%-40.5%] vs 63.9% [95% CI, 59.5%-68.3%]; odds ratio, 0.70; 95% CI, 0.57-0.86). Race/ethnicity, income, and geography were not significantly associated with the likelihood that an individual 65 years or older reported voice disorders. A greater percentage of elderly adults seeking treatment than not seeking treatment reported improvement in symptoms (32.4%; 95% CI, 17.9%-47.0% vs 15.6%; 95% CI, 10.4%-20.8%). Among adults treated for a voice disorder, a lower proportion of adults 65 years or older reported improvement in symptoms with treatment compared with adults younger than 65 years (32.4%; 95% CI, 17.9%-47.0% vs 56.0%; 95% CI, 42.5%-69.6%).
Conclusions and Relevance: A small percentage of older adults with voice disorders seek treatment; even fewer are treated by an otolaryngologist or a speech language pathologist. A greater percentage of those who undergo treatment experienced symptomatic improvement compared with those who did not undergo treatment. These trends highlight the need for greater access to and awareness of services available to older adults with voice disorders.

PMID: 30003217 [PubMed - as supplied by publisher]



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Association of Symptoms and Clinical Findings With Anticipated Outcomes in Patients With Recurrent Head and Neck Cancer.

Related Articles

Association of Symptoms and Clinical Findings With Anticipated Outcomes in Patients With Recurrent Head and Neck Cancer.

JAMA Otolaryngol Head Neck Surg. 2018 Jul 12;:

Authors: Pipkorn P, Licata J, Kallogjeri D, Piccirillo JF

Abstract
Importance: Despite advances in treatment over the last decades, recurrent head and neck cancer continues to have a poor prognosis. Prognostic accuracy may help in patient counseling.
Objective: To explore whether symptoms and clinical variables can predict prognosis in the setting of recurrent head and neck cancer.
Design, Setting, and Participants: In this retrospective cohort study, patients treated for head and neck cancer with curative intent at Siteman Cancer Center in St Louis, Missouri (a tertiary cancer center) between January 1, 2007, and December 31, 2014, were reviewed. The dates of data analysis were October 2016 to June 2017. Patients who developed a recurrent cancer were included, with 196 patients meeting inclusion criteria.
Main Outcomes and Measures: Symptoms and clinical findings at presentation of recurrence were recorded. Sequential sequestration and conjunctive consolidation (2 multivariable techniques) were used to create a composite staging system to predict 1-year overall survival (OS).
Results: Among 196 patients (mean [SD] age, 61 [11] years; 166 [84.7%] of white race/ethnicity; 76.5% male), 1-year OS was 58.2% (114 of 196 patients). Time to recurrence, symptom severity stage, and rTNM stage were consolidated into a 3-category Clinical Severity Staging System, with 1-year OS rates of 90.2% (95% CI, 82.7%-97.6%) for the 61 patients classified as A, 58.1% (95% CI, 47.7%-68.6%) for the 86 patients classified as B, and 18.4% (95% CI, 7.5%-29.2%) for the 49 patients classified as C. The discriminative power of the new composite staging was better than that of the American Joint Committee on Cancer classification (C = 0.79 vs C = 0.66).
Conclusions and Relevance: These findings suggest that clinical variables are associated with anticipated outcomes in patients with recurrent head and neck cancer.

PMID: 30003215 [PubMed - as supplied by publisher]



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Correction to: Extranodal lymphoma arising within the maxillary alveolus: a systematic review

Owing to an unfortunate mistake at Springer's end, the original article was published with errors which are corrected with this erratum as suggested by the author. The authors are not responsible for this procedural lapse.



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Assessment of seafood contamination under the marine strategy framework directive: contributions of the German environmental specimen bank

Abstract

Descriptor 9 (D9) of the European Union Marine Strategy Framework Directive refers to the compliance of contaminant levels in fish and other seafood of a defined marine region or subregion with human health threshold values. This requires georeferenced samples that are often difficult to obtain when relying on commercial fisheries or programs designed for monitoring human exposure. The present study examines whether georeferenced samples of blue mussel (Mytilus edulis) and eelpout (Zoarces viviparus) fillet of the German environmental specimen bank (ESB) can be used in this context. The suitability of the ESB samples, procedures, and analytical methods is evaluated with respect to D9 requirements. Based on ESB data for the D9 relevant contaminants Pb, Cd, Hg, ∑4 PAHs, PCDD/Fs, dioxin-like (dl)-PCBs, and indicator non-dl-PCBs and the potentially relevant substances TBT, PFOS, PBDE, and HBCDD, the Good Environmental Status for D9 is assessed at the ESB sites in the North and Baltic Seas. The overall evaluation indicates that ESB samples are suitable for D9 assessment with the limitation that only coastal areas of the North and Baltic Seas are covered. Over a period of up to 30 years, concentrations of the D9 relevant contaminants were well below the maximum levels allowed for human consumption.



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Impact of balloon laryngoplasty on management of acute subglottic stenosis

Abstract

Purpose

To assess the impact of balloon laryngoplasty on clinical and surgical outcomes in pediatric patients with acute subglottic stenosis.

Methods

Two case series were included and compared. The first group included patients treated initially either with tracheostomy (if severe symptoms) or with close follow-up (if mild symptoms). Those children underwent re-evaluation and specific treatment of their stenosis with laser incisions or open surgeries some weeks later. The other group included children treated initially with balloon laryngoplasty, reflecting a shift in surgical practice after 2009. Data as success of the procedure, mean hospital stay, mean pediatric intensive care unit (PICU) stay, post-procedure fever, need of antibiotics, procedure-related complications, and deaths were assessed and compared between both cohorts.

Results

The sample comprised 38 pediatric patients aged 0–5 years. Fifteen children were treated before 2009, of who 10 (66.7%) required tracheostomy soon after the diagnosis. Ultimately, 13 (86.6%) underwent laryngotracheal reconstruction. Twenty-three children were treated after 2009 and the success rate in these patients treated primarily with balloon laryngoplasty was 82.6%. Of these, only 3 (13%) required tracheostomy and 1 (4.3%) required further open laryngotracheal reconstruction. Patients treated by balloon laryngoplasty underwent fewer procedures under general anesthesia and had a lower burden of treatment-related morbidity, as denoted by shorter PICU stay, less antibiotic use, earlier postoperative resumption of oral feeding, and a lower incidence of postoperative complications and fever.

Conclusion

When used for management of acute laryngeal stenosis, balloon laryngoplasty is associated with a high success rate, presenting lower morbidity than open surgery.



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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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Virtual Reality Analgesia in Labor: The VRAIL Pilot Study—A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women

This pilot study investigated the use of virtual reality (VR) in laboring women. Twenty-seven women were observed for equivalent time during unmedicated contractions in the first stage of labor both with and without VR (order balanced and randomized). Numeric rating scale scores were collected after both study conditions. Significant decreases in sensory pain −1.5 (95% CI, −0.8 to −2.2), affective pain −2.5 (95% CI, −1.6 to −3.3), cognitive pain −3.1 (95% CI, −2.4 to −3.8), and anxiety −1.5 (95% CI, −0.8 to −2.3) were observed during VR. Results suggest that VR is a potentially effective technique for improving pain and anxiety during labor. Accepted for publication June 6, 2018. D. P. Frey is currently affiliated with the Oregon Anesthesiology Group, Obstetric Anesthesiology, Providence Portland Medical Center, Portland, Funding: Funding for this study was provided by the Department of Anesthesiology, University of Michigan as well as in part by the National Institutes of Health (AR054115 and GM042725). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Clinical trial: NCT02926469 at https://ift.tt/2zCUsXv. Reprints will not be available from the authors. Address correspondence to David P. Frey, DO, Oregon Anesthesiology Group, Obstetric Anesthesiology, Providence Portland Medical Center, 707 SW Washington St, Suite 700, Portland, OR 97205. Address e-mail to VRAILQuestions@gmail.com. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Frequency of Operative Anesthesia Care After Traumatic Injury

BACKGROUND: Virtually all anesthesiologists care for patients who sustain traumatic injuries; however, the frequency with which operative anesthesia care is provided to this specific patient population is unclear. We sought to better understand the degree to which anesthesia providers participate in operative trauma care and how this differs by trauma center designation (levels I–V), using data from a comprehensive, regional database—the Washington State Trauma Registry (WSTR). We also sought to specifically assess operative anesthesia care frequency vis a vis the American College of Surgeons guidelines for continuous anesthesiology coverage for Level II trauma center accreditation. METHODS: We conducted a retrospective analysis measuring the frequency of operative anesthesia care among patients enrolled in the WSTR. Univariate comparisons were made between trauma patients who had surgery during their admission and those who did not (medical management only). In addition, clinical factors associated with surgical intervention were measured. We also measured the average times from hospital admission to surgery and compared these times across trauma centers, grouped level I, II, and III–V. RESULTS: From 2004 to 2014, there were approximately 176,000 encounters meeting WSTR inclusion criteria. Approximately 60% of these trauma encounters included exposure to operative anesthesia during the admission. Among all surgical procedures during the trauma admission, approximately 33% occurred within a level I trauma center, 23% occurred within a level II trauma center, and 44% occurred in a trauma center with a III, IV, or V designation. The predominant procedure category during a trauma admission was orthopedic. The presence of hypotension on admission (P

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A Systematic Review Evaluating Neuraxial Morphine and Diamorphine-Associated Respiratory Depression After Cesarean Delivery

The prevalence of neuraxial opioid–induced clinically significant respiratory depression (CSRD) after cesarean delivery is unknown. We sought to review reported cases of author-reported respiratory depression (ARD) to calculate CSRD prevalence. A 6-database literature search was performed to identify ARD secondary to neuraxial morphine or diamorphine, in parturients undergoing cesarean delivery. "Highest" (definite and probable/possible) and "lowest" (definite) prevalences of CSRD were calculated. Secondary outcomes included: (1) prevalence of CSRD associated with contemporary doses of neuraxial opioid, (2) prevalence of ARD as defined by each study's own criteria, (3) case reports of ARD, and (4) reports of ARD reported by the Anesthesia Closed Claims Project database between 1990 and 2016. We identified 78 articles with 18,455 parturients receiving neuraxial morphine or diamorphine for cesarean delivery. The highest and lowest prevalences of CSRD with all doses of neuraxial opioids were 8.67 per 10,000 (95% CI, 4.20–15.16) and 5.96 per 10,000 (95% CI, 2.23–11.28), respectively. The highest and lowest prevalences of CSRD with the use of clinically relevant doses of neuraxial morphine ranged between 1.63 per 10,000 (95% CI, 0.62–8.77) and 1.08 per 10,000 (95% CI, 0.24–7.22), respectively. The prevalence of ARD as defined by each individual paper was 61 per 10,000 (95% CI, 51–74). One published case report of ARD met our inclusion criteria, and there were no cases of ARD from the Closed Claims database analysis. These results indicate that the prevalence of CSRD due to neuraxial morphine or diamorphine in the obstetric population is low. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Accepted for publication May 31, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Nadir Sharawi, MBBS, FRCA, MSc, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 W Markham, Slot 515, Little Rock, AR 72205. Address e-mail to nelsharawi@uams.edu. © 2018 International Anesthesia Research Society

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Ability of a New Smartphone Pulse Pressure Variation and Cardiac Output Application to Predict Fluid Responsiveness in Patients Undergoing Cardiac Surgery

BACKGROUND: Pulse pressure variation (PPV) can be used to predict fluid responsiveness in anesthetized patients receiving controlled mechanical ventilation but usually requires dedicated advanced monitoring. Capstesia (Galenic App, Vitoria-Gasteiz, Spain) is a novel smartphone application that calculates PPV and cardiac output (CO) from a picture of the invasive arterial pressure waveform obtained from any monitor screen. The primary objective was to compare the ability of PPV obtained using the Capstesia (PPVCAP) and PPV obtained using a pulse contour analysis monitor (PPVPC) to predict fluid responsiveness. A secondary objective was to assess the agreement and the trending of CO values obtained with the Capstesia (COCAP) against those obtained with the transpulmonary bolus thermodilution method (COTD). METHODS: We studied 57 mechanically ventilated patients (tidal volume 8 mL/kg, positive end-expiratory pressure 5 mm Hg, respiratory rate adjusted to keep end tidal carbon dioxide [32–36] mm Hg) undergoing elective coronary artery bypass grafting. COTD, COCAP, PPVCAP, and PPVPC were measured before and after infusion of 5 mL/kg of a colloid solution. Fluid responsiveness was defined as an increase in COTD of >10% from baseline. The ability of PPVCAP and PPVPC to predict fluid responsiveness was analyzed using the area under the receiver-operating characteristic curve (AUROC), the agreement between COCAP and COTD using a Bland-Altman analysis and the trending ability of COCAP compared to COTD after volume expansion using a 4-quadrant plot analysis. RESULTS: Twenty-eight patients were studied before surgical incision and 29 after sternal closure. There was no significant difference in the ability of PPVCAP and PPVPC to predict fluid responsiveness (AUROC 0.74 [95% CI, 0.60–0.84] vs 0.68 [0.54–0.80]; P = .30). A PPVCAP >8.6% predicted fluid responsiveness with a sensitivity of 73% (95% CI, 0.54–0.92) and a specificity of 74% (95% CI, 0.55–0.90), whereas a PPVPC >9.5% predicted fluid responsiveness with a sensitivity of 62% (95% CI, 0.42–0.88) and a specificity of 74% (95% CI, 0.48–0.90). When measured before surgery, PPV predicted fluid responsiveness (AUROC PPVCAP= 0.818 [P = .0001]; PPVPC= 0.794 [P = .0007]) but not when measured after surgery (AUROC PPVCAP= 0.645 [P = .19]; PPVPC= 0.552 [P = .63]). A Bland-Altman analysis of COCAP and COTD showed a mean bias of 0.3 L/min (limits of agreement: −2.8 to 3.3 L/min) and a percentage error of 60%. The concordance rate, corresponding to the proportion of CO values that changed in the same direction with the 2 methods, was poor (71%, 95% CI, 66–77). CONCLUSIONS: In patients undergoing cardiac surgery, PPVCAP and PPVPC both weakly predict fluid responsiveness. However, COCAP is not a good substitute for COTD and cannot be used to assess fluid responsiveness. Accepted for publication June 7, 2018. A. Joosten and C. Boudart contributed equally and share first authorship. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Registration: Clinicaltrials.gov (NCT02692222). Reprints will not be available from the authors. Address correspondence to Alexandre Joosten, MD, Department of Anesthesiology, Hopital Erasme, 808 Rt de Lennik, 1070 Bruxelles, Brussels, Belgium. Address e-mail to Alexandre.Joosten@erasme.ulb.ac.be. © 2018 International Anesthesia Research Society

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Did ultrasound fulfill the promise of safety in regional anesthesia?

Purpose of review Ultrasound guidance has become the accepted standard of practice for peripheral regional anesthesia. Despite evidence supporting the efficacy of ultrasound-guided regional anesthesia, its impact on patient safety has been less clear. Recent findings Evidence has been consistent that ultrasound guidance reduces the incidence of vascular injury, local anesthetic systemic toxicity, pneumothorax and phrenic nerve block. Within the limited global scope of the epidemiology and etiologic complexity of perioperative (including block-related) peripheral nerve injury, there has not been consistent evidence that ultrasound guidance is associated with a reduced incidence of nerve injury. However, a recently published retrospective cohort study has demonstrated that the incidence of short-term nerve injury was decreased with ultrasound guidance compared with nerve stimulation. Ultrasound has led to development of novel blocks, approaches and refinement of existing ones, which may contribute to patient safety. Summary Ultrasound has revolutionized the way we approach regional anesthesia and contributed to patient safety. It is important to note that patient safety does not hinge on one single technology. Patient safety in regional anesthesia relies on a well trained practitioner to pay meticulous attention to indication, block and patient selection, anatomy, pharmacology, equipment and technique. Correspondence to Michael J. Barrington, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia. Tel: +61 3 9288 2211; e-mail: Michael.BARRINGTON@svha.org.au Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Traumatic brain injured patients: primum non nocere

Purpose of review Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one 'treatment fits all' approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI. Recent findings Prehospital care teams which include a physician may reduce mortality. The commonly held value of SBP more than 90 in TBI is now being challenged. There is increasing evidence that patients do better if managed in specialized neurocritical care or trauma ICU. Repeating computed tomography brain 12 h after initial scan may be of benefit. Elderly patients with TBI appear not to want an operation if it might leave them cognitively impaired. Summary Prehospital and neuro ICU management of TBI patients can significantly improve patient outcome. However, it is important to also consider whether these patients would actually want to be treated particularly in the elderly population. Correspondence to Dr Dhuleep S. Wijayatilake, Department of Anaesthesia and Intensive Care Medicine, Queens Hospital, Rom Valley Way, Romford RM7 0AG, UK. Tel: +44 1708503727; e-mail: sanjay.wijayatilake@nhs.net Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Stratification of neuropathic pain patients: the road to mechanism-based therapy?

Purpose of review It has been demonstrated that within one pain entity, patients may report highly heterogenic sensory signs and symptoms. Although mechanism might differ fundamentally between those patients, yet the treatment recommendations are uniform throughout all phenotypes. Therefore, the introduction of new stratification tools could pave the way to an individualized pain treatment. Recent findings In the past, retrospective stratifications of patients successfully identified responders to certain pharmacological treatments. This indicated predictive validity and reliability of this classification tool in those patient subgroups. Further on, these observations have been confirmed in prospective studies. Summary This review focusses on recent achievements in neuropathic pain and suggests a promising implementation of an individualized pharmacological therapy in the future. Correspondence to Dr Ralf Baron, MD, Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany. Tel: +49 431 500 23911; fax: +49 431 500 23914; e-mail: r.baron@neurologie.uni-kiel.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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New blocks for the same old joints

Purpose of review New block techniques are being constantly developed or old techniques modified to improve outcomes after surgery. This review discusses the reasons why new block techniques need to be developed to match the needs of contemporary anesthetic practice. Recent findings New block techniques have been developed for joint surgeries of both upper and lower extremities. New upper extremity blocks focus on decreasing the risk of complications like diaphragmatic paresis and improving the quality of blocks. Techniques for lower extremity surgeries are being performed distally, closer to the joints, to minimize weakness of the extremity. A review of the available evidence for these techniques is undertaken to get an understanding of the indications and limitations of these techniques. Summary Future studies need to be undertaken to further refine these techniques and produce evidence of support for analgesic efficacy, safety, and reliability. Correspondence to Sanjay K. Sinha, MBBS, Department of Anesthesiology, St. Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT 06105, USA. E-mail: sanjaysinha@comcast.net Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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