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Τρίτη 24 Ιουλίου 2018
UTHealth/Memorial Hermann Conduct First Sinus Surgery in U.S. Using Augmented Reality Technology
Sinus surgeons with The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann-Texas Medical Center were the...https://ift.tt/2LMia58
Treating Esophageal Diverticula: Life-changing Surgeries for Two Patients
In most cases, Zenker's diverticula are spontaneous and occur in people over the age of 60. More complicated cases of...https://ift.tt/2uOyImy
Dr. William Yao Serves as Guest Editor of Otolaryngology Journal
William C. Yao, MD, was guest editor of "Surgical Techniques of Emergencies in Otolaryngology," in recent issue of Operative Techniques...https://ift.tt/2LMQmNT
Idiopathic cervical tracheal stenosis in an 11-year-old male
Publication date: October 2018
Source: International Journal of Pediatric Otorhinolaryngology, Volume 113
Author(s): Matthew R. Hoffman, Katrina M. Thompson, Jessica Van Beek-King
Abstract
Idiopathic laryngotracheal stenosis is a fibroinflammatory stenosis in persons without alternative explanation such as trauma, intubation, or autoimmune disease. Patients are usually females of child-bearing age. We report on an 11-year-old male who developed progressive dyspnea and stridor. Bronchoscopy revealed 90% stenosis of the cervical trachea. He underwent serial balloon dilation with steroid injection; stenosis decreased to 20%. He had no history of intubation or trauma. Histologic and laboratory workup for autoimmune disease was negative. This report highlights occurrence of a well-known disease in an uncommon population, and alerts providers to consider this when seeing new pediatric patients with symptoms of progressive airway restriction.
https://ift.tt/2LDQNx6
Protein tyrosine phosphatase PTPN22 regulates LFA-1 dependent Th1 responses
Publication date: Available online 24 July 2018
Source: Journal of Autoimmunity
Author(s): Cristina Sanchez-Blanco, Fiona Clarke, Georgina H. Cornish, David Depoil, Stephen J. Thompson, Xuezhi Dai, David J. Rawlings, Michael L. Dustin, Rose Zamoyska, Andrew P. Cope, Harriet A. Purvis
Abstract
A missense C1858T single nucleotide polymorphism within PTPN22 is a strong genetic risk factor for the development of multiple autoimmune diseases. PTPN22 encodes a protein tyrosine phosphatase that negatively regulates immuno-receptor proximal Src and Syk family kinases. Notably, PTPN22 negatively regulates kinases downstream of T-cell receptor (TCR) and LFA-1, thereby setting thresholds for T-cell activation. Alterations to the quality of TCR and LFA-1 engagement at the immune synapse and the regulation of downstream signals can have profound effects on the type of effector T-cell response induced. Here we describe how IFNγ+ Th1 responses are potentiated in Ptpn22−/− T-cells and in T-cells from mice expressing Ptpn22R619W (the mouse orthologue of the human genetic variant) as they age, or following repeated immune challenge, and explore the mechanisms contributing to the expansion of Th1 cells. Specifically, we uncover two LFA-1-ICAM dependent mechanisms; one T-cell intrinsic, and one T-cell extrinsic. Firstly, we found that in vitro anti-CD3/LFA-1 induced Th1 responses were enhanced in Ptpn22−/− T-cells compared to WT, whereas anti-CD3/anti-CD28 induced IFNy responses were similar. These data were associated with an enhanced ability of Ptpn22−/− T-cells to engage ICAM-1 at the immune synapse when incubated on planar lipid bilayers, and to form conjugates with dendritic cells. Secondly, we observed a T-cell extrinsic mechanism whereby repeated stimulation of WT OT-II T-cells with LPS and OVA323-339 pulsed Ptpn22−/− bone marrow derived dendritic cells (BMDCs) was sufficient to enhance Th1 cell development compared to WT BMDCs. Furthermore, this response could be reversed by LFA-1 blockade. Our data point to two related but distinct mechanisms by which PTPN22 regulates LFA-1 dependent signals to enhance Th1 development, highlighting how perturbations to PTPN22 function over time to regulate the balance of the immune response.
https://ift.tt/2LjV61f
Optimal strategies for bioremediation of nitrate-contaminated groundwater and microalgae biomass production
Abstract
Optimizing the mono-cultivation and mixed cultivation of Chlamydomonas reinhardtii, Chlorella vulgaris, and an Ettlia sp. was evaluated for treating nitrate-contaminated groundwater and biomass production. Ettlia sp. showed the highest nutrient assimilation and growth rate among the three microalgae during bioremediation. Light-dark cycle was the effective condition for nutrient removal and COD mitigation by microalgae. Mixed microalgae with a larger presence of the Ettlia sp. exhibited the highest biomass productivity, nitrate-nitrogen, and phosphate-phosphorus removal rates of 0.21 g/L/d, 16.6, and 3.06 mg/L/d, respectively. An N:P mass ratio of 5 was necessary to increase the mixed-microalgal performance. The settling efficiency of the mixed microalgae increased up to 0.55 when using pH modulation during 30 min. Therefore, applying an Ettlia sp.-dominant consortium was the optimum strategy for the bioremediation of nitrate-contaminated groundwater in 3 days.
https://ift.tt/2LCFqWj
Genome-wide analyses and functional profiling of human NK cell lines
Publication date: Available online 24 July 2018
Source: Molecular Immunology
Author(s): Justin T. Gunesch, Laura S. Angelo, Sanjana Mahapatra, Raquel P. Deering, Johanna E. Kowalko, Patrick Sleiman, John W. Tobias, Linda Monaco-Shawver, Jordan S. Orange, Emily M. Mace
Abstract
Natural killer (NK) cell lines, including YTS, NK92, NK3.3, and NKL, represent excellent models for the study of human natural killer cells. While phenotypic and functional differences between these cell lines have been reported, a multi-parametric study, encompassing genomic, phenotypic, and functional assays, has not been performed. Here, using a combination of techniques including microarray and copy number analyses, flow cytometry, and functional assays, we provide in-depth genetic, functional, and phenotypic comparison of YTS, NK92, NK3.3, and NKL cell lines. Specifically, we found that while the cell lines shared similarities in enrichment of growth and survival pathways, they had differential expression of 557 genes, including genes related to NK cell development, survival, and function. In addition, we provide genetic and phenotypic analyses that demonstrate distinct developmental origins of NK92, YTS, and NKL cell lines. Specifically, NK92 has a phenotype associated with the CD56bright NK cell subset, while both YTS and NKL appear more CD56dim-like. Finally, by classifying cell lines based on their lytic potential, we identified genes differentially expressed between NK cell lines with high and low lytic function. Taken together, these data provide the first comprehensive genetic, phenotypic, and functional analyses of these commonly used NK cell lines and provides deeper understanding into their origins and function. This will ultimately improve their use as models for human NK cell biology.
https://ift.tt/2OfYYOM
Response to YAJOT_2018_288 “Letter to the Editor: T2-weighted MRI screening algorithm for patients with asymmetric sensorineural hearing loss”
Publication date: Available online 24 July 2018
Source: American Journal of Otolaryngology
Author(s): Matthew L. Carlson, Alex D. Sweeney, John I. Lane
https://ift.tt/2LjQb0q
Antagonistic effects of Spirulina platensis on diazinon-induced hemato-biochemical alterations and oxidative stress in rats
Abstract
Spirulina platensis (SP) is a traditionally used microalga for a wide range of pharmacological activities, including amelioration of heavy metals and pesticides toxicity. This study evaluated the antioxidant and organoprotective effects of SP against diazinon (DZN)-induced subacute toxicity on the blood, heart, liver, and kidneys of male Wistar albino rats. Diazinon (20 mg/kg, subcutaneous) was administered to animals either alone or along with an oral pure SP powder at doses of 500 and 1000 mg/kg. Alterations in hematological and serum biochemical parameters, as well as oxidative stress markers in the hepatic, renal, and cardiac tissues were evaluated, using colorimetric spectrophotometric techniques. The obtained results revealed that in comparison to the control group, DZN-treated rats exhibited significantly lower (p < 0.05) red blood cells and platelets counts, hemoglobin and hematocrit values, and activities of serum acetylcholinesterase and tissue antioxidant enzymes (glutathione peroxidase, superoxide dismutase, and catalase). Meanwhile, biochemical analysis showed significantly higher (p < 0.05) white blood cells count, serum concentrations of tumor necrosis factor-α and cardiac [creatine kinase (CK) and CK-muscle/brain fraction], hepatic [transaminases and alkaline phosphatase], and renal [uric acid, urea and creatinine] injury markers, and tissue levels of malondialdehyde (a marker of lipid peroxidation) in the DZN-intoxicated group, compared to normal controls. Interestingly, the administration of SP significantly ameliorated the previous hemato-biochemical alterations and mitigated DZN-induced organ injuries and oxidative stress. In conclusion, the natural antioxidant microalga (SP) effectively alleviated the DZN-induced hematologic alterations and organ injuries, probably through its antioxidant and anti-inflammatory activities.
https://ift.tt/2LCxIeP
Correction to: Correction to: The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer
Regrettably, the author metadata used for the previous correction (doi: https://ift.tt/2LyZA3v) contained an error in the tagging of W. Glenn McCluggage's name; this has been corrected. No further adjustments have been made to the Correction, or the original Guideline paper (doi: https://ift.tt/2LM3IKq).
https://ift.tt/2uMU0kg
The Nasal Width and Boxiness Index: Introduction and Pilot Study on Reliability and Validity of Sonographic Morphometry
Facial plast Surg 2018; 34: 373-380
DOI: 10.1055/s-0038-1667025
Both intended and unintended surgical modifications of nasal width and shape of the nasal tip continue to be of interest to the rhinoplasty surgeon. As validated instruments for quantifying width and boxiness are lacking, the objective of this study was to introduce a width index and a boxiness index for the nasal dorsum and the nasal tip. A width index and a boxiness index were defined within the methodological limits of noncontact sonography. The reliability of both indices was studied by comparing the measurements of two examiners on the noses of five volunteers. The validity of the indices was studied by correlating the sonographic width and boxiness with the 5-point Likert scale ratings of photographs of 5 noses by 21 lay persons. Nasal width was defined as the diameter at a distance of 5 mm from the skin surface on a sonographic cross-section perpendicular to the skin surface. Boxiness was defined as the quotient of width at a depth of 1 and 5 mm. Bland–Altmann analysis revealed negligible bias between both examiners and 95% of limits of agreement of 13, 7, and 13% for width at 1 mm, width at 5 mm, and boxiness, respectively. Corresponding Pearson's correlation coefficients were r = 0.93, r = 0.93, and r = 0.71. The correlation between the cumulative lay persons' scores and sonographic width and boxiness were r = 0.97, r = 0.66, and r = 0.81 for nasal tip width, dorsal width, and boxiness, respectively. Both the width at a depth of 5 mm as measured with sonography and the boxiness index that is defined as width at a depth of 1 mm divided by the width at a depth of 5 mm may prove to be acceptable surrogate parameters for width and boxiness of the nose in comparative morphometric studies.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Rhinoplasty—Do Patients and Surgeons See the Same? A Double-Blind Study with 100 Randomized Patients
Facial plast Surg 2018; 34: 356-362
DOI: 10.1055/s-0038-1660823
One of the key points of a successful rhinoplasty is communication between the patient and surgeon. The surgeon needs to get a clear understanding of the patient's motivation for surgery and expectations of the procedure. This information is mandatory in formulating an optimal surgical plan and managing realistic expectations of the procedures. Ideally, surgeons and patients see, discuss, and quantify the same nasal defects. In reality, the subjective nature of perceiving aesthetics can cause variability of inter-rating nasal appearance. Therefore, one might question how well surgeons understand their patients. Do they see what patients see? The aim of this study is to assess the level of agreement on the evaluation of nasal appearance between patients, surgeons, and nonphysicians observers, and try to find predictive factors that cause high interobserver variability. This prospective, observational, and cross-sectional study was performed on a total of 100 randomized patients undergoing rhinoplasty. All patients were photographed before surgery and asked to rate the appearance of their nose on a 10 cm visual analogue scale (VAS) with 0 indicating very ugly and 10 indicating very nice. Subsequently, the photographs of each patient were, independently, rated by two panels: one constituted by two rhinoplasty surgeons and the other by four nonmedical raters. Both panels included European raters from the north (The Netherlands) and south (Portugal). Data regarding age, gender, skin type, and major nasal deformity were also collected. The authors found that there is no statistical agreement between the aesthetical evaluation of the nose between patients and surgeons or patients and nonmedical raters. Based exclusively on the VAS for subjective evaluation of nasal appearance, the authors' findings show that surgeons and patients do not "see the same" and generally, the score attributed by the surgeon is more favorable (almost 1 point higher) than the auto-assessment's score. This is important to realize when communicating about nasal appearance before rhinoplasty.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Teaching Facial Plastic Surgery
Facial plast Surg 2018; 34: 341-342
DOI: 10.1055/s-0038-1667136
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Introducing Hair Transplantation into a Facial Plastic Surgery Practice
Facial plast Surg 2018; 34: 384-388
DOI: 10.1055/s-0038-1666785
Hair restoration can be an integral addition to the facial plastic surgery practice. As surgeons dedicated to reconstructive and aesthetic surgery of the head and neck, hair restoration is a natural complement to a facial plastic surgeon's practice. This article presents the keys to adding and starting hair restoration to one's facial plastic surgery practice.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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A Plea for Ethics: Suggestions for Implementation in the Medical Curriculum
Facial plast Surg 2018; 34: 343-349
DOI: 10.1055/s-0038-1667026
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Refinements in Saddle Nose Reconstruction
Facial plast Surg 2018; 34: 363-372
DOI: 10.1055/s-0038-1660824
Saddle nose correction remains a challenging procedure for rhinoplasty surgeons due to both aesthetic and functional issues. The most common causes of saddle nose are nasal trauma and prior septal surgery, and a defective relationship between the caudal septum and the anterior septal spine is the principal postoperative pathology. The authors propose their own classification system for saddle nose with one new category and several approaches to deal with this condition in accordance with the level of severity. They strongly advocate major septal reconstruction for most cases of saddle nose, either by placing extended spreader grafts, caudal extension grafts, or a new extracorporeally made L strut. For extreme cases, integrated dorsal implant with columellar strut can successfully bypass the saddled nasal dorsum without dissecting the septal mucoperichondrial pocket and achieve adequate dorsal height. Further dorsal augmentation can be achieved by applying side/gap grafts or dorsal onlay grafts in different forms. In cases with retracted columella, a premaxillary plumping graft is another useful technique. Finally, in autoimmune-related saddling patients, the evidence indicates that their aesthetic problems can be managed safely with surgery as long as the disease is well under control.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Development and Validation of a Brief Four-Component Questionnaire to Identify Patient's Motivation to Undergo Functional Rhinoplasty
Facial plast Surg 2018; 34: 350-355
DOI: 10.1055/s-0038-1660835
Outcome of functional rhinoplasty depends on different domains such as functional and aesthetic improvement. The aim of this study was to develop a brief and comprehensible questionnaire to identify patient motivation to undergo rhinoplasty and to measure the outcome of an intervention within a short time during outpatient consultation. Patients undergoing rhinoplasty were asked to complete the Rhinoplasty Outcome Evaluation (ROE) questionnaire, the Nasal Obstruction Symptom Evaluation (NOSE) scale, and the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty (OAR) preoperatively, as well as one, three, and twelve months postoperatively. Patient satisfaction after surgery was assessed at postoperative consultations using a five-point Likert scale. Principle component analysis was performed to reveal the main domains, which were detected by the different questionnaires. Items with the strongest loading on a factor were identified by correlation matrix. Influence of the nasal appearance on the quality of life, troubles with nasal breathing, subjective perception of nasal appearance, and the wish for modification or alteration were found to be the four important domains of the questionnaires. The questions with the strongest loading on these domains were compiled and the four-component questionnaire (4CQ) was developed. The 4CQ is a very effective instrument to obtain a comprehensive impression of the varied determinants representing the major motifs to undergo functional rhinoplasty within a short time. The preoperative assessment of the 4CQ allows an estimation concerning the expected outcome.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Facial Asymmetry Index: Validation and Applications in Various Smile Restoration Techniques
Facial plast Surg 2018; 34: 381-383
DOI: 10.1055/s-0038-1660836
Consistent and objective evaluation of the paralyzed face is imperative for documenting preoperative findings and assessing postoperative outcomes of reanimation techniques. Static and dynamic facial asymmetry are the key features of the paralyzed face. To date, there is no consensus among surgeons on how best to document facial asymmetry. The authors propose a Facial Asymmetry Index (FAI) as an objective measure of facial asymmetry and validate its use and reliability across numerous reanimation techniques. Frontal photographs of patients with unilateral facial nerve paralysis were analyzed. The length from the medial canthus to the ipsilateral oral commissure was compared between affected and nonaffected sides. The FAI is the difference between the two values, with a higher value reflecting poorer facial symmetry. Validation and reliability testing was then performed. There was a consistent decrease in the FAI with procedural intervention (FAI pre = 10.1, FAI post = 3.17; p < 0.0001). Furthermore, there was excellent inter- and intrarater reliability among independent judges. The FAI is a powerful and accessible tool to quantify operative outcomes for many lower facial nerve reanimation techniques.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Tip-on-Tip Scapular (TOTS) Flap for Reconstruction of Combined Palatectomy and Rhinectomy Defects
Facial plast Surg 2018; 34: 389-393
DOI: 10.1055/s-0038-1666784
Combination anterior palatectomy and rhinectomy defects result in complete loss of midface and nasal support and present a significant reconstructive challenge. A novel use of the scapular tip free flap—the tip-on-tip scapula flap—was developed to provide both palatal repair and restoration of intrinsic nasal support. The scapular tip bone is split into a large proximal segment for the anterior palate and a smaller distal bone segment for nasal framework reconstruction. Two patients undergoing reconstruction of both total palatectomy and partial rhinectomy defects at a single academic tertiary care center were reviewed. In both cases, the larger proximal segment of the scapular tip flap, used for the palatal defect, was based on the angular artery. The distal bone segment, used for nasal framework repair, was vascularized in one of two ways. In the osteomyogenous serratus-scapular tip variant, the serratus arterial branch provided periosteal blood supply to the bone through a cuff of attached serratus muscle. In the split-scapular tip variant, the periosteum of the scapular tip was kept in continuity with the distal bone segment and fed through the periosteal vascular arcade from the angular branch. In both patients, the distal bone segment demonstrated robust intraoperative vascularity and both flaps healed without complication. Both patients were able to resume oral diets and had good nasal breathing.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Erratum: Failure of Synthetic Implants: Strategies and Management
Facial plast Surg 2018; 34: 429-430
DOI: 10.1055/s-0038-1667174
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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President Introductory Letter WSRM 2017
J reconstr Microsurg
DOI: 10.1055/s-0038-1667116
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The Boomerang Thigh Flap: Optimizing the Donor Site for an Extended Skin Island Flap
J reconstr Microsurg
DOI: 10.1055/s-0038-1667130
Background The anterolateral region of the thigh is one of the most used donor areas for flaps. However, there are cases in which large defects require more than the conventional skin island provided by the anterolateral thigh flap (ALT). For an extended skin island flap, we developed a new boomerang thigh flap (BTF), in which a boomerang design includes perforators from multiple branches of the lateral circumflex femoral artery (LCFA), providing a single-pedicle, large, reproducible, and reliable flap. We report the anatomical study and the use of the new BTF in a clinical series. Methods We dissected 20 flaps in fresh cadavers to determine the anatomical landmarks, vascular pedicle pattern, perforator distribution, and BTF flap dissection technique. After achieving a reproducible and reliable technique, with primary closure of the donor site based on the pinch test, the BTF was applied for microsurgical reconstructions in the head and neck, lower limb, and upper limb regions. Results The BTF corresponds to a 45° confluence of the ALT and the tensor fascia lata (TFL) elliptical skin islands. It includes the perforators from the transverse/ascending and the descending branches of the LCFA , which conjoined into a single arterial LCFA pedicle in 85% (17) of the cadaver dissections. All the venous branches drained into a single lateral circumflex femoral vein. ALT perforator distribution followed literature descriptions, while TFL perforators were mainly septocutaneous and projected into a virtual rectangle of 6 × 4 cm at the lateral margin of the TFL. Average BTF dimensions were 40 × 8.6 cm. For the clinical cases, flap dimensions and pedicle characteristics were equivalent to the anatomical findings. The BTF was separated into two skin islands in four cases and no major complications were reported. Conclusion The BTF is a reliable, reproducible, and divisible flap that provides extended skin island for reconstruction of large defects.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Recent Molecular Profiling Studies in Papillary and Follicular Thyroid Carcinoma Provide Clinical and Basic Insights
Clinical Thyroidology, Volume 30, Issue 7, Page 319-323, July 2018.
https://ift.tt/2v33bwB
A High Proportion of Serum rT3 Tests Are Ordered by a Relatively Small Number of Providers in a U.S.-Wide Sample
Clinical Thyroidology, Volume 30, Issue 7, Page 337-339, July 2018.
https://ift.tt/2LlQqIs
New Genomic Sequencing Classifier in Cytologically Indeterminate Thyroid Nodules Shows Improved Results
Clinical Thyroidology, Volume 30, Issue 7, Page 328-331, July 2018.
https://ift.tt/2LnJtqp
Higher Preconception Maternal Iodine Intakes Are Associated with Higher Child IQ
Clinical Thyroidology, Volume 30, Issue 7, Page 302-304, July 2018.
https://ift.tt/2v33asx
Some Advanced Thyroid Cancer Patients Have a Prolonged Response to Lenvatinib
Clinical Thyroidology, Volume 30, Issue 7, Page 305-308, July 2018.
https://ift.tt/2v337Nn
Editorial: Will the EUGOGO Predictive Score for Graves’ Orbitopathy Be Useful for Management?
Clinical Thyroidology, Volume 30, Issue 7, Page 300-301, July 2018.
https://ift.tt/2LnJkTT
Analysis of Clinical Factors 1 Year After Surgery for Thyroid Cancer Enables Prediction of Treatment-free Survival
Clinical Thyroidology, Volume 30, Issue 7, Page 309-311, July 2018.
https://ift.tt/2v33305
Residual Lymph Node Metastases after Initial Surgery—What Are the Implications for the Approach to Initial Surgery and Postoperative Therapy?
Clinical Thyroidology, Volume 30, Issue 7, Page 324-327, July 2018.
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Thyroglobulin Levels Do Not Predict Recurrence After Lobectomy for Low-Risk Papillary Thyroid Cancer
Clinical Thyroidology, Volume 30, Issue 7, Page 312-314, July 2018.
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Automated Analysis of Gray-Scale Ultrasound Images of Thyroid Nodules (“Radiomics”) May Outperform Image Interpretation by Less Experienced Thyroid Radiologists
Clinical Thyroidology, Volume 30, Issue 7, Page 332-336, July 2018.
https://ift.tt/2LnJ6Mx
What Factors Contribute to the Development of Central Hypothyroidism When Adult Patients with GH Deficiency Are Treated with rhGH?
Clinical Thyroidology, Volume 30, Issue 7, Page 315-318, July 2018.
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Letter to the Editor: Molecular Analysis Should Be Incorporated Into the Definition of NIFTP
Clinical Thyroidology, Volume 30, Issue 7, Page 340-341, July 2018.
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Effect of Runx2 silencing on autophagy and RANKL expression in osteoblasts
Publication date: Available online 24 July 2018
Source: Archives of Oral Biology
Author(s): Han Qin, Jun Cai
Abstract
Objective
This study aimed to investigate the effect of Runx2 silencing on autophagy and RANKL expression in mouse osteoblasts, and provide an experimental basis to assess obstacles in dental eruption.
Methods
In accordance with previously reported methods, LVpFU-GW-016PSC60109-1 virus was used to transfect mouse osteoblasts (MOI = 40). Target gene expression was assessed via cytometer, and the effect of silencing Runx2 was assessed via a two-step quantitative real-time polymerase chain reaction (qRT-PCR)-based method. Western blotting was performed to assess LC3, Beclin-1 and RANKL expression.
Results
As confirmed via qRT-PCR analysis, Runx2 was efficiently silenced in the experimental group (>90% efficiency). Western blotting revealed that LC3 and RANKL proteins were significantly down -regulated in the experimental group (group KD), their expression levels being particularly lower than those in the control group (group NC). However, Beclin-1 protein expression was not significantly different from that of the control.
Conclusion
Upon Runx2 silencing, autophagy-related proteins and RANKL were repressed in osteoblasts, thereby potentially causing the tooth eruption disorder.
https://ift.tt/2LkKUWu
Asthma Clinical Practice Guidelines: time for an update
Publication date: Available online 24 July 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Zuhair K. Ballas
https://ift.tt/2Og8RMy
Light-sheet microscopy reveals site-specific 3-dimensional patterns of the cutaneous vasculature and pronounced rarefication in aged skin
Publication date: Available online 24 July 2018
Source: Journal of Dermatological Science
Author(s): Kentaro Kajiya, Ryoma Bise, Catharina Commerford, Imari Sato, Toyonobu Yamashita, Michael Detmar
https://ift.tt/2A4cty1
Allergic Contact Dermatitis To Personal Care Products And Topical Medications In Adults With Atopic Dermatitis
Atopic dermatitis (AD) is associated with skin-barrier disruption, immune dysregulation, and application of emollients and topical medications, which may predispose towards developing allergic contact dermatitis (ACD).
https://ift.tt/2A8rvCM
Pore Architecture Effects on Chondrogenic Potential of Patient-Specific 3-Dimensionally Printed Porous Tissue Bioscaffolds for Auricular Tissue Engineering
Publication date: Available online 24 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): David A. Zopf, Colleen L. Flanagan, Anna G. Mitsak, Julia R. Brennan, Scott J. Hollister
Abstract
Objective
This study aims to determine the effect of auricular scaffold microarchitecture on chondrogenic potential in an in vivo animal model.
Methods
DICOM computed tomography (CT) images of a human auricle were segmented to create an external anatomic envelope. Image-based design was used to generate 1) orthogonally interconnected spherical pores and 2) randomly interspersed pores, and each were repeated in three dimensions to fill the external auricular envelope. These auricular scaffolds were then 3D printed by laser sintering poly-L-caprolactone, seeded with primary porcine auricular chondrocytes in a hyaluronic acid/collagen hydrogel and cultured in a pro-chondrogenic medium. The auricular scaffolds were then implanted subcutaneously in rats and explanted after 4 weeks for analysis with Safranin O and Hematoxylin and Eosin staining.
Results
Auricular constructs with two micropore architectures were rapidly manufactured with high fidelity anatomic appearance. Subcutaneous implantation of the scaffolds resulted in excellent external appearance of both anterior and posterior auricular surfaces. Analysis on explantation showed that the defined, spherical micropore architecture yielded histologic evidence of more robust chondrogenic tissue formation as demonstrated by Safranin O and Hematoxylin and Eosin staining.
Conclusions
Image-based computer-aided design and 3D printing offers an exciting new avenue for the tissue-engineered auricle. In early pilot work, creation of spherical micropores within the scaffold architecture appears to impart greater chondrogenicity of the bioscaffold. This advantage could be related to differences in permeability allowing greater cell migration and nutrient flow, differences in surface area allowing different cell aggregation, or a combination of both factors. The ability to design an anatomically correct scaffold that maintains its structural integrity while also promoting auricular cartilage growth represents an important step towards clinical applicability of this new technology.
https://ift.tt/2A70i3l
Nodular fasciitis of the tongue: A case report in an infant
Publication date: Available online 24 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Raymond P. Shupak, Bruce B. Horswell, Marcus D. Shaffer, Milton J. Plata
Abstract
Nodular fasciitis is a benign lesion uncommonly found in the head and neck region. Although described previously in adults, there have been no reports of nodular fasciitis in a child's tongue. A 4 month old male infant was referred for evaluation of a rapidly growing tongue lesion. He underwent excisional biopsy of the lesion. Initial pathology suggested a spindle cell tumor. Subsequent outside facility molecular testing was obtained and Nodular Fasciitis was confirmed. Nodular fasciitis is a rare benign tumor that can be often mistaken for malignancy. Special histochemical and molecular testing is required to obtain final diagnosis.
https://ift.tt/2mHprIE
Spoken word recognition in noise in Mandarin-speaking pediatric cochlear implant users
Publication date: Available online 24 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Cuncun Ren, Jing Yang, Dingjun Zha, Ying Lin, Haihong Liu, Ying Kong, Sha Liu, Li Xu
Abstract
Objective
The purpose of the present study was to compare spoken word recognition performance in the presence of speech spectrum-shaped noise and four-talker babbles in Mandarin-speaking children with cochlear implants (CIs).
Methods
Participants included 33 children with unilateral CIs (with a mean age of 10.4 ± 2.9 years old and a mean length of CI use of 7.5 ± 3.0 years). The Standard Chinese version of Lexical Neighborhood Test was implemented in quiet, speech-spectrum-shaped noise (SSN), and four-talker babble (FTB). The signal-to-noise ratios (SNRs) were set at +5 and +10 dB for both types of maskers. Participants responded by verbally repeating each word they heard and the response was scored as the percentage accuracy of recognition performance. A Generalized Linear Model (GLM) fitting, correlational tests, and a two-way repeated-measures ANOVA were conducted on the percent-correct data.
Results
Word recognition in quiet was on average 74.5% correct but dropped to 57.3% and 48.8% correct for SSN and FTB at 10 dB SNR, respectively, and 44.4% and 32.6% correct for SSN and FTB at 5 dB SNR, respectively. In both quiet and noise conditions, the participants showed lower recognition accuracy for the hard words than for the easy words. Disyllabic words were recognized with higher accuracy rates than were the monosyllabic words. The GLM analysis revealed that all four tested factors (masker type, SNR, lexical neighborhood feature, and lexical type) showed significant impacts on word recognition in children with CIs. Word recognition scores in the two types of maskers were significantly correlated for the disyllabic words at both SNRs and monosyllabic words at 10 dB SNR.
Conclusions
The present study demonstrated that the lexical features such as the lexical neighborhood characteristics and lexical type had significant effects on speech recognition performance in both quiet and noise conditions in pediatric CI users. Children with years of experience of CI use still encountered remarkable difficulties in everyday listening environment although their speech recognition in quiet reached relatively desired level. Fluctuating noise, such as speech babbles, caused greater challenge than steady-state noise for speech recognition in children with CIs.
https://ift.tt/2A73nkd
PREDICTORS OF NATURE OF INGESTED FOREIGN BODIES IN CHILDREN & ASSESSMENT OF OPERATIVE OUTCOMES
Publication date: Available online 24 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Rubeena Arora, Sunil Kumar, Gautam Bir Singh
Abstract
OBJECTIVE
To examine sensitivity/specificity of history & radiology to identify ingested foreign body (FB) and develop a protocol for management of ingested FBs in paediatric patients; to assess outcomes of removal of lithium button battery foreign body (LBBFB).
METHODS
Retrospective review. Children presenting to ENT emergency with suspected FB ingestion underwent rigid esophagoscopy and FB removal. Average age, number of attempts, duration of ingestion, success rate, and complications were analysed.
RESULTS
Cases of coin/LBBFB ingestion: 916/70. Mean age: 5.8/2.03 years (p<0.001). Average duration of ingestion: 37/9.5 h (p<0.001). Patients below 3: 31.3/62.8% (p<0.001). Suggestive history/radiological signs: 100%/100%, 75.7%/98.6% (p<0.0001). Site of impaction cricopharynx: 60.3%/74.3% (p=0.02). LBBFB group: Successful removal in 1st attempt: 66 (94.3%). Cases requiring multiple attempts due to impaction: 4 (5.7%). Parenteral steroids were administered before successful reattempt. No relation was found between duration of ingestion/impaction. Five (7.1%) cases developed complications. Average follow-up duration: 13.59 months.
CONCLUSIONS
Children <3 years with vague history of FB ingestion and suggestive chest x-ray should be sent urgently for FB removal. Parenteral pre-and postoperative short course steroid use may be considered to improve outcomes.
https://ift.tt/2OcRR9C
Changes in microbial communities during the removal of natural and synthetic glucocorticoids in three types of river-based aquifer media
Abstract
Glucocorticoids in sewage treatment plant effluent discharged into rivers could influence microbial community structure in river-based aquifer media and affect groundwater quality. The effect of representative natural and synthetic glucocorticoids, namely, hydrocortisone (CRL) and dexamethasone (DEX), on the microbial communities in three types of river-based aquifer media was evaluated. The aquifer media was taken from the Beijing Chaobai River (BJ), Hebei Hutuo River (HB), and Tianjin Duliujian River (TJ) and they exhibited different physicochemical and biological properties. The attenuation rates of CRL were 0.175, 0.119, and 0.096 day−1 and for DEX were 0.222, 0.151, and 0.113 day−1 in the media from BJ, HB, and TJ, respectively. All the attenuation rates followed first-order kinetics. The biodiversity decreased significantly with CRL and DEX amendment. The microbial community composition differed in relation to the type of aquifer media and glucocorticoids, especially for BJ at the phylum level. In BJ, the major bacterial genus was Bacillus and in HB it was Rhodobacter. However, in TJ, three bacterial genera (Methylophilus, Methylobacillus, and Methylotenera) and Candidatus_Nitrososphaera were predominant in the microflora. All these genera were able to degrade both CRL and DEX. Distance-based redundancy analysis revealed that total organic carbon (TOC), the type of glucocorticoid, and the pH were the main factors explaining the variations in microbial community composition.
https://ift.tt/2LJjG7T
Evaluating the Efficacy and Tolerability of Application of Metaderm Product for the Treatment of Psoriasis
Condition: Psoriasis
Intervention: Drug: Metaderm
Sponsor: University of Alabama at Birmingham
Not yet recruiting
https://ift.tt/2uXDUna
Intervention: Drug: Metaderm
Sponsor: University of Alabama at Birmingham
Not yet recruiting
https://ift.tt/2uXDUna
Efficacy of Osteopathic Manual Therapy Combined With Myofunctional Exercise for Temporomandibular Chronic Disorders
Condition: Temporomandibular Joint Dysfunction Syndrome
Interventions: Procedure: Osteopathic Treatment; Procedure: Myofunctional Motor control exercises
Sponsor: Maxilofacial Institute Bara Gaseni
Not yet recruiting
https://ift.tt/2LnjUpi
Interventions: Procedure: Osteopathic Treatment; Procedure: Myofunctional Motor control exercises
Sponsor: Maxilofacial Institute Bara Gaseni
Not yet recruiting
https://ift.tt/2LnjUpi
Study Investigating a Single Oral Dose of Fenebrutinib in Healthy Volunteers
Condition: Healthy Participants
Intervention: Drug: Fenebrutinib
Sponsor: Hoffmann-La Roche
Recruiting
https://ift.tt/2uXDNYM
Intervention: Drug: Fenebrutinib
Sponsor: Hoffmann-La Roche
Recruiting
https://ift.tt/2uXDNYM
Evaluating the Efficacy and Tolerability of Application of Metaderm Product for the Treatment of Psoriasis
Condition: Psoriasis
Intervention: Drug: Metaderm
Sponsor: University of Alabama at Birmingham
Not yet recruiting
https://ift.tt/2uXDUna
Intervention: Drug: Metaderm
Sponsor: University of Alabama at Birmingham
Not yet recruiting
https://ift.tt/2uXDUna
Efficacy of Osteopathic Manual Therapy Combined With Myofunctional Exercise for Temporomandibular Chronic Disorders
Condition: Temporomandibular Joint Dysfunction Syndrome
Interventions: Procedure: Osteopathic Treatment; Procedure: Myofunctional Motor control exercises
Sponsor: Maxilofacial Institute Bara Gaseni
Not yet recruiting
https://ift.tt/2LnjUpi
Interventions: Procedure: Osteopathic Treatment; Procedure: Myofunctional Motor control exercises
Sponsor: Maxilofacial Institute Bara Gaseni
Not yet recruiting
https://ift.tt/2LnjUpi
Study Investigating a Single Oral Dose of Fenebrutinib in Healthy Volunteers
Condition: Healthy Participants
Intervention: Drug: Fenebrutinib
Sponsor: Hoffmann-La Roche
Recruiting
https://ift.tt/2uXDNYM
Intervention: Drug: Fenebrutinib
Sponsor: Hoffmann-La Roche
Recruiting
https://ift.tt/2uXDNYM
Conformation of the N-Terminal Ectodomain Elicits Different Effects on DUOX Function: A Potential Impact on Congenital Hypothyroidism Caused by a H2O2 Production Defect
Thyroid, Ahead of Print.
https://ift.tt/2A8Xwea
Changes in Serum Thyroglobulin Levels After Lobectomy in Patients with Low-Risk Papillary Thyroid Cancer
Thyroid, Ahead of Print.
https://ift.tt/2mEBOVJ
Can China fulfill its commitment to reducing carbon dioxide emissions in the Paris Agreement? Analysis based on a back-propagation neural network
Abstract
Due to the increasingly severe situation regarding adaptation to climate change, global attention has focused on whether China can fulfill its commitment to the Paris Agreement as the largest producer of carbon dioxide (CO2) emissions. In this study, the CO2 emissions and CO2 intensities in China during 2030 were forecast using three scenarios, seven indicators, and a back-propagation neural network. Under the business as usual (BAU), strategic planning (SP), and low carbon (LC) scenarios, the predicted CO2 emissions in China during 2030 are 13,908.00, 11,837.60, and 9102.50 million tonnes, respectively, and the predicted CO2 intensities are 1.8652, 1.7405, and 1.5382 when considering carbon capture, utilization, and storage (CCUS). Furthermore, China cannot fulfill its commitment under the BAU scenario, whereas China will fulfill its commitment on schedule under the SP scenario. Under the LC scenario, China will fulfill its commitment ahead of schedule to reduce the CO2 intensity by 60% in 2025, and it will even reduce the CO2 intensity by 65% in 2030. In addition, if the amounts of CCUS are not considered for measuring the CO2 intensity, China can still fulfill its commitment under the LC scenario, whereas it cannot fulfill its commitment by 2030 under the SP scenario. This study evaluated the fulfillment of China's commitment in the Paris Agreement, demonstrated that CCUS plays an important role in reducing the CO2 intensity, and provided policy suggestions for the Chinese government regarding the reductions of the CO2 intensity.
https://ift.tt/2v0SoD2
Congenital Cholesteatoma: The Silent Pathology
ORL 2018;80:108–116
https://ift.tt/2JRi1vl
Reprogramming of Th1 cells into regulatory T cells through rewiring of the metabolic status
Abstract
T helper type 1 (Th1) cells form one of the most stable CD4 T-cell subsets, and direct conversion of fully differentiated Th1 to regulatory T (Treg) cells has been poorly investigated. Here, we established a culture method for inducing Foxp3 from Th1 cells of mice and humans. This is achieved simply by resting Th1 cells without T-cell receptor ligation before stimulation in the presence of transforming growth factor-beta (TGF-β). We named the resulting Th1-derived Foxp3+ cells Th1reg cells. Mouse Th1reg cells showed an inducible Treg-like phenotype and suppressive ability both in vitro and in vivo. Th1reg cells could also be induced from in vivo-developed mouse Th1 cells. Unexpectedly, the resting process enabled Foxp3 expression not through epigenetic changes at the locus, but through metabolic change resulting from reduced mammalian target of rapamycin complex 1 (mTORC1) activity. mTORC1 suppressed TGF-β-induced phosphorylation of Smad2/3 in Th1 cells, which was restored in rested cells. Our study warrants future research aiming at development of immunotherapy with Th1reg cells.https://ift.tt/2OhMWVc
STAT4 is required for the generation of Th1 and Th2, but not Th17 immune responses during monophosphoryl lipid A adjuvant activity
International Immunology, Volume 28, Issue 11, 1 November 2016, Pages 565–570, https://doi.org/10.1093/intimm/dxw038
https://ift.tt/2ND3ANN
https://ift.tt/2ND3ANN
Exposure to insulin degludec during pregnancy: report of a small series and review of the literature
Abstract
Background
Good glycaemic control during pregnancy is key to reduce maternal and foetal complications. Insulin degludec, an ultralong acting analogue with a "peakless" and stable pharmacokinetic profile, has the potential advantage of reducing hypoglycaemia and glucose variability compared to other basal insulins. Therefore, degludec could be a reasonable therapeutic option for pregnant women with type 1 diabetes (T1D). However, degludec is not licensed for use during pregnancy owing to the lack of safety data.
Methods and results
We herein report details on pregnancy and foetal outcomes in three women with uncontrolled T1D treated with insulin degludec during the first trimester or the whole pregnancy. In addition, we report an updated review of similar cases reported in literature. Overall, no congenital neonatal malformation was observed in the six cases described. Three babies required neonatal intensive care unit admission for respiratory distress, apnoeas, bilirubin increase or hypoglycaemia. However, the observed neonatal complications were deemed unlikely to be related to degludec treatment.
Conclusions
In summary, while awaiting for the results of an ongoing randomized controlled trial, data on six cases of degludec exposure during pregnancy reassuringly suggest no embryo–foetal toxicity. More information is needed before degludec can be safely recommended during pregnancy.
https://ift.tt/2OepDvt
In situ detection of PR3-ANCA+ B cells and alterations in the variable region of immunoglobulin genes support a role of inflamed tissue in the emergence of auto-reactivity in granulomatosis with polyangiitis
Publication date: Available online 24 July 2018
Source: Journal of Autoimmunity
Author(s): Gesche Weppner, Olena Ohlei, Christoph M. Hammers, Konstanze Holl-Ulrich, Jan Voswinkel, Julia Bischof, Katrin Hasselbacher, Gabriela Riemekasten, Peter Lamprecht, Saleh Ibrahim, Christof Iking-Konert, Andreas Recke, Antje Müller
Abstract
Circulating anti-neutrophilic cytoplasmic autoantibodies targeting proteinase 3 (PR3-ANCA) are a diagnostic and pathogenic hallmark of granulomatosis with polyangiitis (GPA). It is, however, incompletely understood if inflamed tissue supports presence or emergence of PR3-ANCA+ B cells. In search of such cells in inflamed tissue of GPA, immunofluorescence staining for IgG and a common PR3-ANCA idiotype (5/7 Id) was undertaken. Few 5/7 Id+/IgG+ B cells were detected in respiratory and kidney tissue of GPA. To gain more insight into surrogate markers possibly indicative of an anti-PR3-response, a meta-analysis comprising IGVH and IGVL genes derived from respiratory tract tissue of GPA (231 clones) was performed. Next generation sequencing-based IGHV genes derived from peripheral blood of healthy donors (244.353 clones) and previously published IGLV genes (148 clones) served as controls. Additionally, Ig genes of three murine and five known human monoclonal anti-PR3 antibodies were analyzed. Primary and probably secondary rearrangements led to altered VDJ usage and an extended complementarity determining region 3 (CDR3) of IGHV clones from GPA tissue. Selection against amino acid exchanges was prominent in the framework region of IGHV clones from GPA tissue. The comparison of V(D)J rearrangements and deduced amino acid sequences of the CDR3 yielded no identities and few similarities between clones derived from respiratory tissue of GPA and anti-PR3 antibodies, arguing against a presence of B cells that carry PR3-ANCA-prone Ig genes among the clones. In line with the scarcity of 5/7 Id+ B lymphocytes in GPA tissue, the results suggest that with respect to a local anti-PR3 response, methods detecting rare clones are required.
https://ift.tt/2mHKpXK
Molekulare Netzwerke von Hypoxie und neuronaler Apoptose in der Cochlea
Zusammenfassung
Hintergrund
In organotypischen Kulturen zeigt die Region des Modiolus (MOD) von neugeborenen Ratten eine 4‑fach höhere Rate des Zelltods als die Region des Corti-Organs (OC). Die unterschiedliche Vulnerabilität geht mit einer differenziellen Expression zahlreicher Gene einher.
Methodik
Organotypische Kulturen von OC und MOD von 3–5 Tage alten Ratten wurden einer norm- bzw. hypoxischen (pO2: 10–20 mmHg; 5 h) Atmosphäre ausgesetzt. 24 h nach Anlegen der Kultur wurde die Zelltodrate bestimmt und die Expression mittels c‑DNA-Microarray untersucht. Mithilfe der DAVID-Datenbank wurden aus einer Liste von 60 Genen mit veränderter Expression biologische Prozesse entsprechend der Gene-Ontology-Datenbank (GO) zugeordnet. Molekulare Netzwerke wurden mithilfe der Datenbanken STRING und ConsensusPathDB erstellt.
Ergebnisse
Das Netzwerk der GO-Annotationen „Hypoxie", „Entzündung" und „mechanischer Stimulus" deutet auf das Vorliegen von 2 Gen-Clustern, einem Cluster mit proinflammatorischen Genen (Ccl3, Cxcl2, Cxcr4, Ccl20) und einem Cluster mit hypoxieassoziierten Genen (c-Jun, Hif1a und Vegfa). Das Netzwerk der GO-Annotationen „positive und negative neuronale Apoptose" lässt vermuten, dass die unterschiedliche Expression der Gene c-Jun, Ngfr und Casp3 von entscheidender Bedeutung für die Regulation des programmierten Zelltods von neuronalen Zellen des OC und MOD ist.
Schlussfolgerung
Während c‑JUN als ein wichtiger Modulator des Gleichgewichts zwischen Zelltod und Überleben wirkt, scheinen die Assoziationen von NGFR und CASP3 bedeutsam für die Einleitung des Zelltods zu sein. Die Auswertung und Anwendung von Erkenntnissen aus biostatistischen Datenbanken sind ein wichtiges Mittel für das Verständnis der Funktion von einzelnen Genen und Gen-Clustern in medizinisch relevanten biologischen Prozessen.
https://ift.tt/2uO48cx
Small intestine polypoid arteriovenous malformation: a stepwise approach to diagnosis in a paediatric case
We report a case of acute gastrointestinal haemorrhage due to a small intestine polypoid arteriovenous malformation (AVM) in a patient with a remote history of obscure gastrointestinal bleeding (OGIB) 8 years earlier. The diagnosis of a small intestine AVM was made using video capsule endoscopy (VCE) and confirmed using single-balloon push enteroscopy. The lesion was marked with submucosal tattoo to aid in subsequent surgical resection of the lesion with primary duodenoduodenostomy. Since our patient's initial bleeding episode, a variety of advanced tools have become widely available to aid in the localisation of OGIB. This case illustrates the use of a stepwise approach using new medical technology to identify and manage OGIB in children. VCE and push enteroscopy proved to be important diagnostic modalities in this paediatric case.
https://ift.tt/2mDGxH7
Acute peritonsillar swelling: a unique presentation for Kawasaki disease in adolescence
We report the case of a 14-year-old man with unilateral peritonsillar swelling, airway compromise and fever. On physical examination, the patient was pyrexic with trismus, dysphonia, uvula deviation, exudative unilateral peritonsillar swelling and unilateral cervical lymphadenopathy. Attempts at aspirating the prominent peritonsillar region were unsuccessful. CT head and neck identified a large inflammatory mass arising from the left palatine tonsil. The patient was treated for presumptive peritonsillar abscess. After failing to respond to intravenous antimicrobials, he progressively developed the classical sequale of Kawasaki's Disease. Echocardiogram identified coronary arteritis. Intravenous immunoglobulin and high-dose aspirin were initiated and his clinical picture improved. Kawasaki's disease mimicking an acute infective process can pose a diagnostic dilemma. It is an uncommon differential in the adolescent population. Prompt recognition and initiation of appropriate therapy are imperative to minimise morbidity.
https://ift.tt/2A6dlCi
Multiple cranial nerve injuries and neck abscesses caused by a transorally penetrating organic stick
Foreign bodies cause a remarkable number of otolaryngological emergency visits and occasionally result in life-threatening conditions and later-emerging complications. Patient recovery depends on the detection and proper extraction of all foreign materials. Despite various obtainable diagnostic tools, adequate anamnesis forms the basis of clinical reasoning and should direct later examinations and radiological imaging. This case report describes a challenging patient with a unique trauma mechanism: many pieces of a fragmented organic foreign body emerged within 1 year of the initial injury, leading to repeated operations, a long period in an intensive care unit and a long-term swallowing and speech dysfunction.
https://ift.tt/2OgGGwC
Sporadic Burkitts lymphoma masquerading as an intussuscepted Meckels diverticulum in a 9-year-old child
We report the case of a 9-year-old boy who presented with abdominal pain and was found to have an intussusception with a sporadic Burkitt's lymphoma (BL) lead point. Our case was unusual in that the patient did not present with the typical clinical features of BL, nor was he in a high-risk demographic for this uncommon disease.
https://ift.tt/2A6d7uW
Acinic cell carcinoma of the parotid gland in pregnancy: an approach to cancer in pregnancy
A 27-year-old woman presented with an enlarging painless right preauricular mass at 28 weeks' pregnant. The mass had been stable for more than 10 years, but showed rapid growth during pregnancy. Imaging and biopsy were consistent with parotid gland malignancy, with surgical resection undertaken at 33+4 weeks' gestation. Histopathology confirmed acinic cell carcinoma. Labour was induced without complication at 36+6 weeks' gestation and adjuvant radiotherapy commenced 2 weeks postpartum. At 9 months follow-up, both mother and baby were well, with no signs of disease recurrence. Rapid progression in pregnancy, of a previously stable salivary gland mass, is a common feature among reported cases and was also observed in the current case. This suggests an aetiological link between pregnancy and salivary gland tumour progression. We demonstrate successful management of a parotid gland malignancy in pregnancy and review guiding principles for cancer management in pregnancy.
https://ift.tt/2Oea9aP
Double-positive with positive anti-glomerular basement membrane antibody and ANCA-positive disease in a patient with dermatomyositis
Approximately one in four patients (23.3%) with inflammatory myositis including dermatomyositis can require evaluation for acute kidney injury. The main cause of kidney injury is acute tubular necrosis from medications or myoglobinuria, though clinicians should be aware of a wide variety of possible aetiologies. We present the case of a 44-year-old woman with stable anti-Jo1 dermatomyositis, who presented with acute kidney injury. During her hospital course, she was diagnosed with double-positive disease characterised by circulating anti-glomerular basement membrane antibody and myeloperoxidase antineutrophil cytoplasmic antibody and renal biopsy revealing crescentic glomerulonephritis with linear staining of capillary wall for IgG.
https://ift.tt/2A7MPs7
Transabdominal ultrasound-guided Gartners abscess drainage, a rare cause of acute urinary retention in second trimester of pregnancy
Acute retention of urine in pregnancy is an emergency, since it can lead to loss of pregnancy besides other dire complications. Gartner's abscess is an extremely rare cause for this condition. We present a case of a 23-year-old primigravida woman who presented to us at 24 weeks of pregnancy with acute retention of urine. After clinical and radiological evaluation, a large Gartner's abscess was found to be the cause. Per vaginal drainage of the abscess was not attempted because insertion of transvaginal probe was extremely painful for the patient, and the abscess was located high up in the anterior fornix. Transabdominal approach under sonographic guidance was used for the drainage of the abscess. Careful aspiration of the abscess, avoiding injury to the placenta, fetus and maternal bladder, revealed 60 cc of frank pus. The patient was given injection hydroxyprogesterone caproate and antibiotics in the preprocedure period. Antibiotics were continued in the postprocedure period, and she was discharged at 26 weeks of pregnancy in satisfactory condition.
https://ift.tt/2mDCZVh
Allopurinol-induced DRESS syndrome presented as a cholecystitis-like acute abdomen and aggravated by antibiotics
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening adverse drug reaction characterised by generalised skin rash, fever, lymph node enlargement and haematological abnormalities, in addition to multiorgan involvement. However, diagnosis can be challenging, with rare cases presenting as an acute abdomen.
Its aetiopathogenesis is not fully understood but inefficient drug detoxification, deregulated immune responses, reactivation of host viruses and genetic predisposition appear to be important. Furthermore, it has been recently recognised that antibiotics may act as promoters of DRESS syndrome caused by another drug. We report the case of a 48-year-old man, receiving allopurinol, who developed DRESS syndrome, initially presenting with a cholecystitis-like acute abdomen that was triggered by antibiotics. This report also emphasises the utility of performing patch skin tests to establish drug imputability.
https://ift.tt/2A5NnyJ
Unsuspected Von Hippel-Lindau syndrome in acute-onset resistant hypertension
The discovery of adrenal lesions during routine testing for hypertension requires focused consideration for adrenal overproduction of cortisol, aldosterone or metanephrines. An otherwise healthy 25-year-old woman presented with headaches, diaphoresis and hot flushes with grossly elevated urine catecholamines, normetanephrines and norepinephrine levels, yet normal metanephrines, epinephrine/epinephrine, cortisol and aldosterone levels. Subsequent functional uptake studies and scans identified bilateral adrenal adenomas consistent with phaeochromocytomas. There was no family history of phaeochromocytomas or familial syndromes; however, a targeted genetic analysis for causes of familial phaeochromocytomas identified a heterozygous germline mutation in the VHL gene consistent with Von Hippel-Lindau syndrome. In this case, the identification of the VHL mutation led to careful screening and detection of clinically occult central nervous system hemangioblastomas and pancreatic neuroendocrine tumours. Verified genetic mutations facilitated best practices for long-term surveillance protocols, preconception counselling and screening of blood relatives. The patient responded well to surgical treatment and has ongoing multidisciplinary long-term surveillance.
https://ift.tt/2mDCN8v
Corneal perforation in undiagnosed Sjögrens syndrome following topical NSAID and steroid drops post routine cataract extraction
A 74-year-old man presented with a progressive decrease in visual acuity and foreign body sensation in his right eye 8 days post uncomplicated phacoemulsification cataract surgery and intraocular lens insertion. The patient had been placed on a perioperative cataract regimen which consisted of G. Maxitrol (dexamethasone, polymyxin B sulfate, neomycin sulfate) four times a day and G. Yellox twice daily (bromfenac, a non-steroidal anti-inflammatory) for 2 weeks. On examination, he had a corneal ulcer and stromal thinning in his right eye which progressed to a full thickness perforation 12 hours later. The patient required a full thickness tectonic corneal transplant. Direct questioning revealed that this patient had both dry mouth and eyes. Serology revealed that the patient was positive for rheumatoid factor and for anti-Ro and anti-La antibodies. A parotid gland biopsy revealed significant lymphocytic infiltrate consistent with Sjögren's syndrome.
https://ift.tt/2A6l3fL
Multiple distal coronary artery thrombosis in acute myocardial infarction: a rare presentation
Description
A 47-year-old man was referred to us with severe retrosternal chest pain and diaphoresis 6 hours back. Except for smoking, he had no other risk factors for coronary artery disease. The patient was haemodynamically stable and physical examination was unremarkable. The ECG done at the referral hospital revealed changes suggestive of inferolateral wall ST elevation myocardial infarction (STEMI) (figure 1), and left circumflex coronary artery was the most likely culprit vessel. Echocardiogram revealed hypokinesia of the inferolateral wall with mild mitral regurgitation. The patient was immediately shifted to the catheterisation lab and coronary angiogram was done. However, to our surprise, both the terminal branches of the major obtuse marginal artery and the distal segment of the left anterior descending coronary artery were occluded by thrombi in their distal segments (figure 2, videos 1 and 2). Because of the distal location of the thrombi, we...
https://ift.tt/2mEhT9m
3D printing for corrective osteotomy of malunited distal radius fractures: a low-cost workflow
After a severe trauma, a 16-year-old female patient sustained multiple injuries, including a distal radius fracture of the left arm. This distal radius fracture eventually developed into a malunion. In this case, we demonstrate our preoperative low-cost workup for three-dimensional (3D) planned and assisted corrective osteotomy of a malunited distal radius fracture using an in-hospital 3D printer.
https://ift.tt/2AdeLL4
Is orbital floor a reliable and useful surgical landmark in endoscopic endonasal surgery?: a systematic review
Abstract
Background
The orbital floor is considered as an important intraoperative reference point in endoscopic sinonasal surgery. The aim of this review is to evaluate its reliability and usefulness as a surgical landmark in endoscopic endonasal surgery.
Methods
A literature search was performed on electronic databases, namely PUBMED. The following keywords were used either individually or in combination: orbital floor; maxillary sinus roof; endoscopic skull base surgery; endoscopic sinus surgery. Studies that used orbital floor as a landmark for endoscopic endonasal surgery were included in the analysis. In addition, relevant articles were identified from the references of articles that had been retrieved. The search was conducted over a period of 6 months between 1st June 2017 and 16th December 2017.
Results
One thousand seven hundred forty-three articles were retrieved from the electronic databases. Only 5 articles that met the review criteria were selected. Five studies of the orbital floor (or the maxillary sinus roof) were reviewed, one was a cadaveric study while another 4 were computed tomographic study of the paranasal sinuses. All studies were of level III evidence and consists of a total number of 948 nostrils. All studies showed the orbital floor was below the anterior skull base irrespective of the populations. The orbital floor serves as a guide for safe entry into posterior ethmoids and sphenoid sinus.
Conclusions
The orbital floor is a reliable and useful surgical landmark in endoscopic endonasal surgery. In revision cases or advanced disease, the normal landmarks can be distorted or absent and the orbital floor serves as a reference point for surgeons to avoid any unintentional injury to the skull base, the internal carotid artery and other critical structures.
https://ift.tt/2uO2WWC
Combined Brain Mapping and Compact Intraoperative MRI for Brain Tumor Resection
Background: Surgery on patients with lesions in the dominant hemisphere for language is best done with awake language mapping. Intraoperative MRI (iMRI) has also been proposed as an ideal method for tumor resection control in patients with primary brain tumors. Objectives: This study examines the feasibility of low-field iMRI during awake craniotomy and tumor resection. Methods: 36 patients underwent awake resection with a compact iMRI for guidance. Outcomes were grouped using an A–D classification. Outcome A was defined as gross total resection (GTR) without iMRI, B as GTR achieved secondary to iMRI findings, C as resection stopped due to mapping but prior to iMRI, and, finally, D as resection stopped after iMRI had showed residual tumor but subsequent mapping limited further resection. Results: Diagnoses included primary brain tumors in all but 2 patients: 1 had mesial temporal sclerosis and 1 cysticercosis. Overall, outcomes A and D were the most common with 12 patients each, outcome C was the least common occurring in only 3 patients, and outcome B occurred in 9 patients. Hence, in 12 patients, iMRI led to increased tumor resection while in another 12 brain mapping limited the extent of resection. Conclusions: Combined awake language and motor mapping and iMRI guidance is feasible for resection of brain lesions. A compact iMRI has unique advantages for this approach.
Stereotact Funct Neurosurg
https://ift.tt/2v2i6XN
Stereotact Funct Neurosurg
https://ift.tt/2v2i6XN
Impact of prematurity for pancreatic islet and beta-cell development
As increasing numbers of babies born preterm survive into adulthood, it is becoming clear that, in addition to the well-described risks of neurodevelopmental sequelae, there also are increased risks for non-communicable diseases, including diabetes. Epidemiological studies indicate that risks are increased even for birth at late preterm and early term gestations and for both type 1 and type 2 diabetes. Thus, factors related to preterm birth likely affect development of the fetal and neonatal beta-cell in addition to effects on peripheral insulin sensitivity. These factors could operate prior to preterm birth and be related to the underlying cause of preterm birth, to the event of being born preterm itself, to the postnatal care of the preterm neonate or to a combination of these exposures. Experimental evidence indicates that factors may be operating during all these critical periods to contribute to altered development of beta-cell mass in those born preterm. Greater understanding of how these factors impact upon development of the pancreas may lead to interventions or management approaches that mitigate the increased risk of later diabetes.
https://ift.tt/2LH13le
cGMP-dependent protein kinase-2 regulates bone mass and prevents diabetic bone loss
NO/cGMP signaling is important for bone remodeling in response to mechanical and hormonal stimuli, but the downstream mediator(s) regulating skeletal homeostasis are incompletely defined. We generated transgenic mice expressing a partly-activated, mutant cGMP-dependent protein kinase type 2 (PKG2R242Q) under control of the osteoblast-specific Col1a1 promoter to characterize the role of PKG2 in post-natal bone formation. Primary osteoblasts from these mice showed a two- to three-fold increase in basal and total PKG2 activity; they proliferated faster and were resistant to apoptosis compared to cells from WT mice. Male Col1a1-Prkg2 R242Q transgenic mice had increased osteoblast numbers, bone formation rates and Wnt/β-catenin-related gene expression in bone and a higher trabecular bone mass compared to their WT littermates. Streptozotocin-induced type 1 diabetes suppressed bone formation and caused rapid bone loss in WT mice, but male transgenic mice were protected from these effects. Surprisingly, we found no significant difference in bone micro-architecture or Wnt/β-catenin-related gene expression between female WT and transgenic mice; female mice of both genotypes showed higher systemic and osteoblastic NO/cGMP generation compared to their male counterparts, and a higher level of endogenous PKG2 activity may be responsible for masking effects of the PKG2R242Q transgene in females. Our data support sexual dimorphism in Wnt/β-catenin signaling and PKG2 regulation of this crucial pathway in bone homeostasis. This work establishes PKG2 as a key regulator of osteoblast proliferation and post-natal bone formation.
https://ift.tt/2uL8P7a
The role of kisspeptin neurons in reproduction and metabolism
Kisspeptin is a neuropeptide with a critical role in the function of the hypothalamic–pituitary–gonadal (HPG) axis. Kisspeptin is produced by two major populations of neurons located in the hypothalamus, the rostral periventricular region of the third ventricle (RP3V) and arcuate nucleus (ARC). These neurons project to and activate gonadotrophin-releasing hormone (GnRH) neurons (acting via the kisspeptin receptor, Kiss1r) in the hypothalamus and stimulate the secretion of GnRH. Gonadal sex steroids stimulate kisspeptin neurons in the RP3V, but inhibit kisspeptin neurons in the ARC, which is the underlying mechanism for positive- and negative feedback respectively, and it is now commonly accepted that the ARC kisspeptin neurons act as the GnRH pulse generator. Due to kisspeptin's profound effect on the HPG axis, a focus of recent research has been on afferent inputs to kisspeptin neurons and one specific area of interest has been energy balance, which is thought to facilitate effects such as suppressing fertility in those with under- or severe over-nutrition. Alternatively, evidence is building for a direct role for kisspeptin in regulating energy balance and metabolism. Kiss1r-knockout (KO) mice exhibit increased adiposity and reduced energy expenditure. Although the mechanisms underlying these observations are currently unknown, Kiss1r is expressed in adipose tissue and potentially brown adipose tissue (BAT) and Kiss1rKO mice exhibit reduced energy expenditure. Recent studies are now looking at the effects of kisspeptin signalling on behaviour, with clinical evidence emerging of kisspeptin affecting sexual behaviour, further investigation of potential neuronal pathways are warranted.
https://ift.tt/2NFn2cE
STK25 regulates oxidative capacity and metabolic efficiency in adipose tissue
Whole-body energy homeostasis at over-nutrition critically depends on how well adipose tissue remodels in response to excess calories. We recently identified serine/threonine protein kinase (STK)25 as a critical regulator of ectopic lipid storage in non-adipose tissue and systemic insulin resistance in the context of nutritional stress. Here, we investigated the role of STK25 in regulation of adipose tissue dysfunction in mice challenged with a high-fat diet. We found that overexpression of STK25 in high-fat-fed mice resulted in impaired mitochondrial function and aggravated hypertrophy, inflammatory infiltration and fibrosis in adipose depots. Reciprocally, Stk25-knockout mice displayed improved mitochondrial function and were protected against diet-induced excessive fat storage, meta-inflammation and fibrosis in brown and white adipose tissues. Furthermore, in rodent HIB-1B cell line, STK25 depletion resulted in enhanced mitochondrial activity and consequently, reduced lipid droplet size, demonstrating an autonomous action for STK25 within adipocytes. In summary, we provide the first evidence for a key function of STK25 in controlling the metabolic balance of lipid utilization vs lipid storage in brown and white adipose depots, suggesting that repression of STK25 activity offers a potential strategy for establishing healthier adipose tissue in the context of chronic exposure to dietary lipids.
https://ift.tt/2uL8JMQ
Diet-induced thermogenesis: fake friend or foe?
Diet-induced thermogenesis (DIT) is energy dissipated as heat after a meal, contributing 5–15% to total daily energy expenditure (EE). There has been a long interest in the intriguing possibility that a defect in DIT predisposes to obesity. However, the evidence is conflicting; DIT is usually quantified by indirect calorimetry, which does not measure heat. Using gas exchange, indirect calorimetry measures total post-prandial EE, which comprises heat energy produced from brown adipose tissue (BAT) and energy required for processing and storing nutrients. We questioned whether DIT is reliably quantified by indirect calorimetry by employing infrared thermography to independently assess thermogenesis. Thermogenic activity of BAT was stimulated by cold and by a meal that induced a parallel increase in energy production. These stimulatory effects on BAT thermogenesis were inhibited by glucocorticoids. However, glucocorticoids enhanced postprandial EE in the face of reduced BAT thermogenesis and stimulated lipid synthesis. The increase in EE correlated significantly with the increase in lipogenesis. As energy cannot be destroyed (first law of thermodynamics), the energy that would have been dissipated as heat after a meal is channeled into storage. Post-prandial EE is the sum of heat energy that is lost (true DIT) and chemical energy that is stored. Indirect calorimetry does not reliably quantify DIT. When estimated by indirect calorimetry, assumed DIT can be a friend or foe of energy balance. That gas exchange-derived DIT reflects solely energy dissipation as heat is a false assumption likely to explain the conflicting results on the role of DIT in obesity.
https://ift.tt/2LJkfP0
Methicillin-resistant Staphylococcus aureus Swab Results Did Not Change Treatment or Outcome in Pediatric Spinal Fusion Patients.
Methicillin-resistant Staphylococcus aureus Swab Results Did Not Change Treatment or Outcome in Pediatric Spinal Fusion Patients.
J Am Acad Orthop Surg. 2018 Jul 20;:
Authors: Nielsen E, Andras LM, Harris LR, Skaggs DL
Abstract
INTRODUCTION: The aim of this study was to investigate whether preoperative methicillin-resistant Staphylococcus aureus (MRSA) swab results were predictive of surgical site infections (SSIs) in pediatric patients who have undergone spinal fusion.
METHODS: We conducted a retrospective chart review of patients who underwent posterior spinal fusion between 2004 and 2014 to determine preoperative MRSA colonization status and SSI rates and organisms. Before October 1, 2012, we administered vancomycin to the patients for infection prophylaxis; beginning October 1, 2012, patients received ceftazidime and Ancef (cefazolin for injection; GlaxoSmithKline). We added powdered vancomycin to all bone grafts.
RESULTS: A total of 1,200 patients met inclusion criteria. Of the patients, 2.3% (n = 28 of 1,200) were positive for MRSA, and an SSI developed in 3.1% (n = 37 of 1,200). No significant difference in infection rates was found between patients whose MRSA swab was positive and negative (positive swab = 1 SSI, negative swab = 36 SSIs; P = 0.88). Three SSIs were caused by MRSA.
CONCLUSION: The results of a preoperative MRSA nasal swab had no correlation with SSI rates.
LEVEL OF EVIDENCE: Level III.
PMID: 30036217 [PubMed - as supplied by publisher]
https://ift.tt/2mEecQT
The nasopharyngeal microbiota in patients with viral respiratory tract infections is enriched in bacterial pathogens.
| Related Articles |
The nasopharyngeal microbiota in patients with viral respiratory tract infections is enriched in bacterial pathogens.
Eur J Clin Microbiol Infect Dis. 2018 Jul 22;:
Authors: Edouard S, Million M, Bachar D, Dubourg G, Michelle C, Ninove L, Charrel R, Raoult D
Abstract
The nasopharynx is the primary site of colonization by respiratory pathogen that constitutes the port of entrance in the respiratory tract. The role of mucosal respiratory microbiota in infection has been recently emphasized; therefore, we aimed to assess if a specific respiratory microbiota profile was associated with symptomatic infection and/or with presence of respiratory viruses. We performed a case-control study to characterize the healthy respiratory microbiota and its alteration during acute viral infections. Next-generation sequencing of the 16S rRNA gene was applied to 225 nasopharyngeal samples from 177 patients with viral respiratory infection and 48 matched healthy controls. We evidenced an important decrease of bacterial alpha-diversity in patients with symptomatic respiratory infection and a loss of the healthy core microbiota, specifically anaerobes and Prevotella spp. Moreover, eight respiratory pathogens were enriched in these patients, including Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, Dol osigranulum pigrum and Corynebacterium propinquum/pseudodiphtheriticum, whose role in respiratory infection is unclear. The asymptomatic carrier of influenza harbors a microbiota similar to healthy subjects, suggesting a critical role of microbiota in the clinical expression of viruses. These data suggest that the commensal microbiota plays a significant role in susceptibility to viral infection. The frequent co-detection of virus and bacteria raises the question of a strategy to prevent bacterial disease, focusing on the prevention of nasopharyngeal colonization through effective antibiotic treatment. In addition to antibiotics, further studies should test preventive or therapeutic interventions for maintaining or restoring a healthy nasopharyngeal microbiota.
PMID: 30033505 [PubMed - as supplied by publisher]
https://ift.tt/2A55hSd
Platelet deficiency in Tpo −/− mice can both promote and suppress the metastasis of experimental breast tumors in an organ-specific manner
Abstract
Platelets are thought to play an important role in metastasis formation, although the mechanisms involved remain incompletely understood. Here we studied the influence of platelet numbers on organ-specific metastasis to the lungs and lymph nodes using Tpo deficient mice that have low platelet counts. After tail vein injection of 4T1 breast cancer cells, the number of lung metastases was significantly lower in Tpo−/− mice compared to Tpo+/+ mice. The same was true for the bone-tropic 4T1.2 derivative. In spontaneous orthotopic metastasis assays, 4T1 and 4T1.2 primary tumor growth was not affected by the genotype of the mice. However, the number of 4T1.2 lung metastases was significantly lower in Tpo−/− mice compared to Tpo+/+ mice, whereas the number of 4T1 lung metastases was unaffected. Moreover, in mice bearing 4T1 tumors, lymph node metastases were larger in the Tpo−/− background, and lymph node metastasis frequency was higher in Tpo−/− mice bearing 4T1.2 tumors compared to that in wild-type mice. Enhanced lymph node metastasis in Tpo−/− mice was not associated with changes in peritumoral lymphatic vessel density in the primary tumors. Together, our data indicate that platelets do not affect primary tumor growth in this breast cancer model, but can differentially influence site-specific metastasis to lymph nodes and lungs.
https://ift.tt/2LFQoqL
The Use of Cone Beam Computed Tomography to Assess Periodontal Biotype
Abstract
Purpose of Review
Periodontal biotype is a concept with great relevance to clinical practice. Although numerous factors contribute to determining biotype, including soft/hard tissue thickness, soft/hard tissue contours, amount of keratinized tissue, and tooth shape, gingival thickness has been mostly utilized. The use of cone beam computed tomography (CBCT) has been recently proposed as a state-of-the-art approach for assessing periodontal biotypes because it provides information relative to both soft and hard tissue dimensions.
Recent Findings
When used in conjunction with lip retraction or a dual-scan technique, reliable and reproducible measurements of gingival and alveolar thickness can be made on CBCT scans, with the potential to aid in periodontal biotype assessment.
Summary
While current data support the potential use of CBCT for periodontal biotype assessment, the technology in its current state should be used primarily for investigational purposes. The cost and radiation dose need to be considered and additional research is required before implementation into clinical practice.
https://ift.tt/2OdWMaH
Lactate Gap: A Diagnostic Support in Severe Metabolic Acidosis of Unknown Origin
Ethylene glycol poisoning is a medical emergency. The metabolites glycolate and glyoxylate give metabolic acidosis. Because of similar structure, these metabolites are misinterpreted as lactate by many point-of-care blood gas analyzers. The falsely high lactate values can lead to misdiagnosis, inappropriate laparotomies, and delayed antidotal therapy. As laboratory analyzers measure plasma lactate only, the difference or the "lactate gap" aids in early diagnosis. We present a patient with severe metabolic acidosis and elevated lactate levels on the point-of-care analyzer. A lactate gap supported the diagnosis of ethylene glycol poisoning. Hemodialysis and fomepizole treatment could be started immediately.
https://ift.tt/2NFbxSx
Brachial Plexus Chemical Neurolysis with Ethanol for Cancer Pain
Chemical neurolytic nerve blocks have been successfully used to treat a variety of cancer-related pain. However, the literature has been sparse regarding neurolysis of the brachial plexus for cancer pain. We present a unique case report of a successful chemical neurolysis of the brachial plexus with dehydrated ethanol for a patient suffering from metastatic mammary carcinoma with tumor invasion of the right brachial plexus.
https://ift.tt/2OcjRuf
Production of Infant Scale Evaluation (PRISE) in Persian normal hearing children: A validation study
Publication date: Available online 24 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Mohammad Majid Oryadi-Zanjani
Abstract
Introduction
Production of Infant Scale Evaluation (PRISE) is a popular parent-report scale used to assess the pre-first word vocalization of children. There is not any tool to assess pre-verbal vocalizations in Persian speaking children. Therefore, considering the two important roles of pre-verbal vocalizations both in the early diagnosis of hearing impairment and in measuring the effectiveness of CIs and habilitation programs, we aimed to adapt and validate the PRISE questionnaire on Persian normal hearing children aged 3-18 months and estimate the PRISE's normative distribution for them.
Methods
The research was administered as a cross-sectional study. Back translation method was used to develop the Persian version of the PRISE (PRISE-P). Six hundred and forty 3-18 month old Persian speaking children were recruited through consecutive sampling method. All of the children had passed the universal newborn hearing screening. According to the standard developmental test, all of the children had normal development. The internal consistency of the scale was measured through the Cronbach's alpha. The convergent validity was analyzed through comparing the PRISE scores with the Persian version of the Auditory Behavior in Everyday Life (ABEL-P).
Results
The Cronbach's alpha value of the PRISE was 0.88. The PRISE corrected item-total correlations were significantly high ranging from 0.86 to 0.89. A significant correlation was found between the PRISE-P and the ABEL-P total scores (r = 0.628). There was a high positive correlation between the PRISE total scores and the children's age (r = 0.791).
Conclusion
The PRISE-P is a valid and reliable tool to assess the pre-verbal vocalizations development in Persian speaking children aged 3 months and more.
https://ift.tt/2mG01Ls
Treatment outcome of childhood nasopharyngeal carcinoma: a single institution experience
Publication date: Available online 24 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Marina Nikitovic, Marija Popovic-Vukovic, Dragana Stanic, Jelena Bokun, Lejla Paripovic, Vesna Ilic, Ivana Miskovic, Milan Saric
Abstract
Objectives
Nasopharyngeal carcinoma is a rare malignancy in children. The aim of this study was to provide analysis of children with nasopharyngeal carcinoma treated in a single institution.
Methods and materials
Between 1999 and 2016, fourteen pediatric patients with a diagnosis of undifferentiated nasopharyngeal carcinoma were treated in our institution, and the patients' clinical characteristics, treatment modality, outcome, and toxicity were analyzed.
Results
The median age at diagnosis was 15,5 years. The gender ratio was 1:1. The majority of patients had regionally and/or locally advanced tumors and one had bone metastases at the time of diagnosis. All patients received chemotherapy before radiotherapy, with partial response in thirteen patients and complete response in one. Radiation dose to the primary tumor and involved cervical lymph nodes was 55-60 Gy, uninvolved cervical and supraclavicular regions received prophylactic radiation with dose of 45-50 Gy. Ten patients received adjuvant chemotherapy. Three-year time to progression (TTP) and three-year overall survival (OS) rates were 75% and 73% respectively. Five-year TTP was 65% and OS 63% respectively, and after ten years TTP and OS remained the same. At the end of follow-up period, ten patients were alive, and four died. All of the patients that had distant metastases died. Most common late complications were skin fibrosis and xerostomia.
Conclusions
Multimodal therapy of children with nasopharyngeal carcinoma is associated with long-term survival. It is expected that further advances in the management of these patients, with improved radiotherapy and chemotherapy, will reduce acute and late toxicity and improve quality of life of treated children.
https://ift.tt/2A2hjMd
Cochlear implantation in children with meningitis related deafness: The influence of electrode impedance and implant charge on auditory performance – a case control study
Publication date: Available online 24 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Victor Helmstaedter, Andreas Buechner, Stefan Stolle, Friedrich Goetz, Thomas Lenarz, Martin Durisin
Abstract
Objectives
Bacterial meningitis can cause a labyrinthitis. Consequences often are intracochlear soft tissue neoformation (cochlear obliteration) or intracochlear osteoneogenesis (cochlear ossification) and deafness. Cochlear implantation becomes challenging and hearing rehabilitation is complicated. This retrospective case-control-study aimed to find correlations between morphologic, electric and functional parameters.
Methods
The study group included children, who lost hearing due to a bacterial meningitis (n = 35 cases). Using preoperative computed tomography and intraoperative findings we grouped into 'unaltered cochleae', 'obliterated cochleae' and 'ossified cochleae'. Control group children suffered from deafness (n=16) of other etiology and presented with radiologically unchanged cochleae. Postoperative routine controls documented impedances, stimulation charge and hearing tests a various time points, which all were analysed.
Results
Control group patients showed a mean impedance of 6.3 kΩ and the mean charge applied was 19 nC. The study group averaged at 7.9 kΩ and 24.6 nC respectively. Patients with ossified cochleae had increased values of 8.6 kΩ and 29.7 nC. The control group reached a monosyllabic word understanding of 74% and the study group of 58%. Patients with ossified cochleae reached 36%.
Conclusions
Impedances and stimulation charge influence each other. Increased charge is necessary for higher cochlear implant output. Despite higher charges, patients with obliterated and patients with ossified cochleae significantly perform worse in hearing rehabilitation. Reduced audiological outcome in study group patients without morphologic cochlear changes furthermore hints at additional factors besides cochlear tissue neogenesis like postinflammational changes at the neural pathway.
https://ift.tt/2OdP8Nx
Early experience and health related quality of life outcomes following auditory brainstem implantation in children
Publication date: Available online 24 July 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Leena Asfour, David Friedmann, William H. Shapiro, J. Thomas Roland, Susan Waltzman
Abstract
Objective
To assess auditory brainstem implantation (ABI) outcomes in children with a prospective study.
Methods
Twelve patients with cochlear nerve deficiency received an auditory brainstem implant. Patients were evaluated with age appropriate speech perception and production assessments, and health related quality of life (HRQoL) surveys for parents of subjects and for subjects if age appropriate.
Results
Twelve patients received an ABI without major complications. Eleven out of twelve received some auditory benefit from their ABI. Parental HRQoL ratings were positive for all domains with the exception of communication. Self reported overall HRQoL metrics from two subjects were also positive.
Conclusions
ABI is a good option for patients who are not eligible for or fail CI. Our findings show that despite varying degrees of postoperative performance, HRQoL ratings were positive. The presence of additional disabilities and health problems resulted in less positive HRQoL outcomes. Our results emphasize the need to assess outcomes in these patients beyond speech perception and communication.
https://ift.tt/2A1TYds
The Energy Density and Treatment Times Are the Main Factors That Affect the Efficacy of Long-Pulsed 1,064-nm Nd:YAG Laser Treatment for Onychomycosis Caused by Trichophyton rubrum
Background: No optimal regimen exists for the LPNYL (long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet laser) for treating onychomycosis. Objective: To establish an optimal LPNYL treatment regimen for onychomycosis caused by Trichophyton rubrum (OCTr). Patients and Methods: First, 511 infected nails of 177 patients were treated using LPNYL with orthogonally designed regimens according to various energy densities, spot sizes, pulse widths, and treatment times. The optimal treatment regimen was established by multivariate analysis. Next, 69 patients with 221 infected nails were randomized to receive oral itraconazole (drug group) and the optimal regimen of LPNYL treatment (laser group). The clinical efficacy (CE) and mycological efficacy (ME) were evaluated at 6 and 12 months following the start of treatment, and adverse reactions were recorded in both groups. Results: Both CE and ME were significantly correlated with the energy density (p #x3c; 0.05) and treatment times (p #x3c; 0.05), but not with the spot size (0.071 #x3c; p #x3c; 0.083) or pulse width (0.051 #x3c; p #x3c; 0.060), at 6 or 12 months. There were no significant differences at 6 or 12 months (p #x3e; 0.05), and no significant difference was observed in CE at 12 months between the two groups (p #x3e; 0.05). At 6 months, the CE in the laser group was significantly higher than that in the drug group (p #x3c; 0.001). Conclusions: LPNYL is effective and safe for treating OCTr. The energy density and treatment times are the main factors that affect the efficacy. The optimal regimen for LPNYL is an energy density of 45 J/cm2, pulse width of 35 ms, spot size of 4 mm, frequency of 1 Hz, and 6 treatments with 1-week intervals. Laser treatment has rapid clinical recovery.
Dermatology
https://ift.tt/2mD13aR
Dermatology
https://ift.tt/2mD13aR
Radiofrequency Thalamotomy for Drug-Refractory Essential Tremor
Stereotact Funct Neurosurg
https://ift.tt/2LGuu6O
Serum Zinc Levels in Hidradenitis Suppurativa: A Case–Control Study
Abstract
Background
Serum zinc levels in patients with hidradenitis suppurativa (HS) have not been previously studied.
Objective
The aim was to investigate the association between HS and serum zinc levels.
Methods
A multicenter, prospective clinical and analytical case–control study was designed to assess the possible association between HS and serum zinc levels. Consecutive patients with moderate or severe HS (Hurley II or III exclusively) were enrolled. A control population was recruited from primary care clinics. Fasting blood samples were extracted from each patient and serum zinc levels determined. Candidate predictors for low serum zinc levels were determined using logistic regression models.
Results
In total, 122 patients with HS and 122 control subjects were studied. Of the 122 HS patients, 79 (64.8%) were Hurley II and 43 (35.2%) were Hurley III. Low serum zinc levels (≤ 83.3 µg/dL) were more prevalent in HS (adjusted odds ratio [ORa] 6.7, P < 0.001). After logistic regression analysis, low serum zinc levels were associated with Hurley III (ORa 4.4, P < 0.001), Dermatology Life Quality Index ≥ 9 (ORa 3.1, P = 0.005), number of affected sites ≥ 3 (ORa 2.4, P = 0.042), genital location (ORa 2.9, P = 0.009), and perineal location (ORa 2.5, P = 0.025).
Conclusion
Low serum zinc levels are more prevalent in HS than in a healthy population, an indicator that may also be associated with disease severity.
https://ift.tt/2v01tfo
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