Publication date: September 2018
Source: Anesthesiology Clinics, Volume 36, Issue 3
Author(s): Christopher A.J. Webb, T. Edward Kim
https://ift.tt/2Mq02yn
Δευτέρα 6 Αυγούστου 2018
Enhanced Recovery After Shoulder Arthroplasty
Publication date: September 2018
Source: Anesthesiology Clinics, Volume 36, Issue 3
Author(s): Taras Grosh, Nabil M. Elkassabany
https://ift.tt/2OQ6u3i
Forthcoming Issues
Publication date: September 2018
Source: Anesthesiology Clinics, Volume 36, Issue 3
Author(s):
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Contents
Publication date: September 2018
Source: Anesthesiology Clinics, Volume 36, Issue 3
Author(s):
https://ift.tt/2OR4t71
Contributors
Publication date: September 2018
Source: Anesthesiology Clinics, Volume 36, Issue 3
Author(s):
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Copyright
Publication date: September 2018
Source: Anesthesiology Clinics, Volume 36, Issue 3
Author(s):
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Regional Anesthesia
Publication date: September 2018
Source: Anesthesiology Clinics, Volume 36, Issue 3
Author(s): Nabil M. Elkassabany, Edward R. Mariano
https://ift.tt/2MoOZp2
Conservative management of pelvic sepsis with severe shock and multiple organ dysfunction syndrome after rubber-band ligation of internal haemorrhoids: surgery is not the only option
Abstract
Rubber-band ligation (RBL) is a safe and cost-effective approach to internal haemorrhoids. Potential side effects include pain, bleeding, urinary retention and occasionally pelvic sepsis and systemic inflammatory response syndrome (SIRS). At-risk patients are mainly those with immunocompromising conditions. Although aggressive surgical debridement or diverting colostomy appear to be obvious options when patients' life is threatened, their superiority to conservative measures has not been proven. We present the case of a 58-year-old female patient who presented 48 h after a RBL with pelvic pain, dysuria and leukocytosis. Her condition deteriorated rapidly that ventilator and inotropic support were required for a severe SIRS for almost 10 days. Laparoscopic exploration and imaging showed a rectosigmoiditis, ascites and superficial rectal necrosis with no transmural damage requiring an emergent surgery. Conservative management could possibly be a valid option in post-RBL pelvic sepsis even when severe associated multiple organ failure is present.https://ift.tt/2nnH9RP
Primary greater omental torsion as a cause of acute abdomen—a rare case report
Abstract
Greater omental torsion is a rare entity that can cause acute abdominal pain, may mimick other abdominal pathologies, and is difficult to be diagnosed preoperatively. We present a case of a male patient with greater omental torsion mimicking the symptoms of acute appendicitis. A 31-year-old male patient presented with right scrotal pain, initially treated by the urologists, however, 24 h later, he presented right lower quadrant pain, with characteristics of acute appendicitis. After finding in ischemic inflammatory mass on McBurney incision, an exploratory laparotomy was performed, revealing torsion of the greater omentum. Torsion of the greater omentum can be a cause of acute abdomen and could be misdiagnosed with acute appendicitis. Preoperative diagnosis is not easy and resection of the affected tissue is the preferred treatment of choice.https://ift.tt/2Kv3vtC
Adenomyomatous hyperplasia of distal common bile duct: a case report and review of the literature
Abstract
Adenomyomatous hyperplasia (AH) is commonly found in the gallbladder and is considered a tumor-like inflammatory lesion arising from Rokitansky-Aschoff sinus. It is extremely rare in the extrahepatic bile duct and only 15 cases have been reported to date. We describe a 63-year-old male patient who presented with cholangitis, underwent an extensive diagnostic workup, and ultimately had a Whipple procedure. Final pathology showed a 2.0 × 1.5 × 0.5 cm3 granular lesion in the distal common bile duct. There was prominent biliary epithelial proliferation with tubular–papillary architecture and minimal nuclear atypia in association with chronic inflammation, stroma reaction and smooth muscle proliferation. AH of the extrahepatic bile duct is a benign process but often requires a major operation to definitively diagnose.https://ift.tt/2nnH8NL
Fulminant descending mediastinitis secondary to infectious mononucleosis
Abstract
Descending mediastinitis is a rare, life-threatening condition caused by contiguous spread of oropharyngeal or cervical infection into the mediastinum. Infectious mononucleosis generally results in a self-limited illness characterized by fever, pharyngitis and lymphadenopathy. We present an exceptional case of an 18-year-old with infectious mononucleosis complicated by progressive bacterial superinfection and fulminant descending mediastinitis. After resuscitation, broad spectrum antibiotics, critical care support and definitive surgical management, they made a full recovery.https://ift.tt/2KABv7T
Tracheal segmental resection for tracheal cancer: comparison of cervical collar incision with median sternotomy and posterolateral incision
Abstract
We compare two surgical approaches for segmental tracheal resection for tracheal cancer: cervical collar incision with median sternotomy and right posterolateral incision. In case one, a 46-year-old woman presented with adenoid cystic carcinoma, measuring 4.5 cm longitudinally, located at the junction of the cervical and mediastinal trachea. Cervical collar incision with median sternotomy provided a good exposure of the entire trachea. Although a relatively long tracheal resection (5.0 cm) was required, sufficient mobilization of the entire trachea facilitated low-tension anastomosis. In case 2, a 39-year-old man presented with squamous cell carcinoma, measuring 1.8 cm longitudinally, located at the lower trachea 1.8 cm from the carina to the proximal side. Right posterolateral incision provided a good exposure of the lower trachea. Although the required tracheal resection was relatively short (3.0 cm), the anastomotic tension was high. The high anastomotic tension was likely attributed to the limited mobilization of the proximal trachea.https://ift.tt/2M0n6Yf
Acute appendicitis as the first presentation of appendiceal metastasis of gastric cancer—report of a rare case
Abstract
Metastatic tumors of the appendix is a rare entity, whereas only limited data involving metastasis arising from gastric cancer has been reported. Herein, the case of gastric adenocarcinoma metastasis presenting as acute appendicitis is reported. A 53-year-old male, with a history of subtotal gastrectomy due to gastric adenocarcinoma 3 years before, was referred to the Emergency Department with symptoms of acute appendicitis. While this condition was confirmed intraoperatively, histology examination and comparison with the previously excised gastric specimen indicated that metastasis of gastric adenocarcinoma to the appendix was present. Metastatic appendiceal carcinoma arising from the stomach is an extremely rare condition, associated with poor prognosis. Aggressive treatment of the solitary lesion may present favorable results.https://ift.tt/2Ky6rpe
Subacute carbon monoxide poisoning presenting as vertigo and fluctuating low frequency hearing loss
Abstract
It is estimated that up to 25 000 UK residents are exposed to small amounts of carbon monoxide (CO) annually. Symptoms of chronic exposure to CO are vague and non-specific and include dizziness and hearing loss. We describe a case of 38-year-old lady presenting with a 4-month history of vertigo and hearing loss. Initially diagnosed as Meniere's disease, the patient was investigated and followed up in the clinic. She reported leakage of carbon monoxide from her gas fire identified during a routine safety check. Her symptoms fully resolved after disconnecting the faulty gas fire. A rare cause of fluctuating hearing loss and vertigo is described, and the diagnostic challenges are discussed.https://ift.tt/2ndYzQy
Necrotizing fasciitis of the lower extremity caused by perforated sigmoid diverticulitis—a case report
Abstract
Diverticulosis of the sigmoid colon is a common condition and occurs more often in elderly patients. A well-known complication is infection or even perforation which often requires surgery. Necrotizing fasciitis as a complication of perforated diverticulitis is very rare. Here, we present a case of a covered perforated diverticulitis in an immunosuppressed patient leading to life-threatening necrotizing fasciitis requiring extracorporeal membrane oxygenation. Either hematogenous or local dissemination via the inguinal canal seemed the most probable mechanism of leg infection leading to hip articulation.https://ift.tt/2KEdhtC
A paradox of apparent brainless behavior: The time-course of compound word recognition
Publication date: Available online 7 August 2018
Source: Cortex
Author(s): Daniel Schmidtke
Abstract
A review of the behavioral and neurophysiological estimates of the time-course of compound word recognition brings to light a paradox whereby temporal activity associated with lexical variables in behavioral studies predates temporal activity of seemingly comparable lexical processing in neuroimaging studies. However, under the assumption that brain activity is a cause of behavior, the earliest reliable behavioral effect of a lexical variable must represent an upper temporal bound for the origin of that effect in the neural record. The present research provides these behavioral bounds for lexical variables involved in compound word processing. We report data from five naturalistic reading studies in which participants read sentences containing English compound words, and apply a distributional technique of survival analysis to resulting eye-movement fixation durations (Reingold & Sheridan, 2014). The results of the survival analysis of the eye-movement record place a majority of the earliest discernible onsets of orthographic, morphological, and semantic effects at less than 200 ms (with a range of 138-269 ms). Our results place constraints on the absolute time-course of effects reported in the neurolinguistic literature, and support theories of complex word recognition which posit early simultaneous access of form and meaning.
https://ift.tt/2vLgNgh
Olfactory ensheathing cells in facial nerve regeneration
Publication date: Available online 7 August 2018
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Manyi Li, Qiubei Zhu, Jisheng Liu
Abstract
Introduction
Olfactory ensheathing cell is a unique kind of glia cells, which can promote axon growth. Little is known about the differences between olfactory mucosa-olfactory ensheathing cells and olfactory bulb-olfactory ensheathing cells in the capability to promote nerve regeneration.
Objective
To study the recovery of the rat facial nerve after olfactory ensheathing cell transplantation, and to compare the differences between the facial nerve regeneration of olfactory mucosa-olfactory ensheathing cells and olfactory bulb olfactory bulb-olfactory ensheathing cells transplantation.
Methods
Institutional ethical guideline was followed (201510129A). Olfactory mucosa-olfactory ensheathing cells and olfactory bulb-olfactory ensheathing cells were cultured and harvested after 7 days in vitro. 36 Sprague Dawley male rats were randomly divided into three different groups depending on the transplanting cells: Group A, olfactory mucosa-olfactory ensheathing cells; Group B, olfactory bulb-olfactory ensheathing cells; Group C, DF-12 medium/fetal bovine serum. The main trunk of the facial nerve was transected and both stumps were inserted into a polylactic acid/chitosan conduit, then the transplanted cells were injected into the collagen in the conduits. After 4 and 8 weeks after the transplant, the rats of the three groups were scarified and the facial function score, facial nerve evoked potentials, histology analysis, and fluorescent retrograde tracing were tested and recorded, respectively, to evaluate the facial nerve regeneration and to analysis the differences among the three groups.
Results
Olfactory ensheathing cells can promote the facial nerve regeneration. Compared with olfactory bulb-olfactory ensheathing cells, olfactory mucosa-olfactory ensheathing cells were more effective in promoting facial nerve regeneration, and this difference was more significant 8 weeks after the transplantation than 4 weeks.
Conclusion
We discovered that olfactory ensheathing cells with nerve conduit could improve the facial nerve recovery, and the olfactory mucosa-olfactory ensheathing cells are more effective for facial nerve regeneration compared with olfactory bulb-olfactory ensheathing cells 8 weeks after the transplantation. These results could cast new light in the therapy of facial nerve defect, and furnish the foundation of auto-transplantation of olfactory mucosa-olfactory ensheathing cells in periphery nerve injury.
Resumo
Introdução
A célula embainhante olfatória é um tipo especial de célula glial que pode promover o crescimento do axônio. Pouco se sabe sobre as diferenças entre as células embainhantes olfatórias da mucosa olfatória e as células embainhantes olfatórias do bulbo olfatório em relação à sua capacidade de promover a regeneração nervosa.
Objetivo
Estudar a regeneração do nervo facial de ratos após o transplante de células embainhantes olfatórias e comparar as diferenças entre a regeneração do nervo facial com o transplante de células embainhantes olfatórias da mucosa olfatória e de células embainhantes olfatórias do bulbo olfatório.
Método
As recomendações éticas da instituição (201510129A) foram seguidas. Células embainhantes olfatórias da mucosa olfatória e células embainhantes olfatórias do bulbo olfatório foram cultivadas in vitro e coletadas após 7 dias. Trinta e seis ratos Sprague Dawley machos foram divididos aleatoriamente em três grupos diferentes, dependendo das células transplantadas: Grupo A, células embainhantes olfatórias da mucosa olfatória; Grupo B, células embainhantes olfatórias do bulbo olfatório; Grupo C, meio de DF-12/soro fetal bovino. O tronco principal do nervo facial foi seccionado e ambos os cotos foram inseridos em um conduto de ácido polilático/quitosana; em seguida, as células transplantadas foram injetadas em colágeno nos condutos. Após 4 e 8 semanas do transplante, os ratos dos três grupos foram agitados para a obtenção do escore da função facial, potenciais evocados do nervo facial, análise histológica e marcador fluorescente retrógrado, que foram testados e registrados, respectivamente, para avaliar a regeneração do nervo facial e analisar as diferenças entre os três grupos.
Resultados
Células embainhantes olfatórias podem promover a regeneração do nervo facial. Em comparação com as células embainhantes olfatórias do bulbo olfatório, as células embainhantes olfatórias da mucosa olfatória foram mais eficazes na promoção da regeneração do nervo facial, e essa diferença foi mais significativa 8 semanas após o transplante comparando-se com 4 semanas.
Conclusão
Verificamos que células embainhantes olfatórias com conduto nervoso podem melhorar a recuperação do nervo facial, e as células embainhantes olfatórias da mucosa olfatória são mais eficazes para a regeneração do nervo facial em comparação com as células embainhantes olfatórias do bulbo olfatório 8 semanas após o transplante. Esses resultados podem lançar uma nova luz ao tratamento de defeitos do nervo facial e fornecer a base do autotransplante de células embainhantes olfatórias da mucosa olfatória em lesões do nervo periférico.
https://ift.tt/2KAfCp9
Increased expression of pendrin in eosinophilic chronic rhinosinusitis with nasal polyps
Publication date: Available online 7 August 2018
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Taku Ito, Satoshi Ikeda, Tomoaki Asamori, Keiji Honda, Yoshiyuki Kawashima, Ken Kitamura, Keiko Suzuki, Takeshi Tsutsumi
Abstract
Introduction
Chronic rhinosinusitis with nasal polyps is heterogeneous disease and appropriate diagnostic algorithms in individual cases are necessary for effective medical treatment.
Objective
The purpose of this study was to clarify the relationship between the pendrin expression of nasal polyps and clinical and pathological characteristic features of eosinophilic chronic rhinosinusitis.
Methods
A total of 68 patients were classified into eosinophilic chronic rhinosinusitis or non-eosinophilic chronic rhinosinusitis groups according to the degree of eosinophilic infiltration into the nasal polyps. Clinical, hematological, and immunohistochemical analyses were performed and statistically compared between both groups.
Results
Thirty-eight were classified into eosinophilic chronic rhinosinusitis and 30 into non-eosinophilic chronic rhinosinusitis groups. There were no significant differences in age distribution, sex ratio, prevalence of asthma, or any other complications between the groups. The mean Lund–Mackay score and the number of serum eosinophils was significantly higher in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. The pendrin expression was more frequently detected in the epithelial surface layer of nasal polyps in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis groups. In addition, MUC5AC was more widely expressed in the eosinophilic chronic rhinosinusitis than in the non-eosinophilic chronic rhinosinusitis.
Conclusion
Increased expression of pendrin and MUC5AC in the nasal polyps would be associated with development of eosinophilic chronic rhinosinusitis. This finding could allow the development of a novel therapeutic agent targeted specifically to patients with eosinophilic chronic rhinosinusitis.
Resumo
Introdução
A rinossinusite crônica com pólipos nasais é uma doença heterogênea e algoritmos diagnósticos apropriados em casos individuais são necessários para um tratamento médico eficaz.
Objetivo
O objetivo deste estudo foi esclarecer a relação entre a expressão da pendrina de pólipos nasais e propriedades clínicas e patológicas características da rinossinusite crônica eosinofílica.
Método
Um total de 68 pacientes foram classificados como tendo rinossinusite crônica eosinofílica ou rinossinusite crônica não eosinofílica de acordo com o grau de infiltração eosinofílica nos pólipos nasais. Análises clínicas, hematológicas e imunohistoquímicas foram realizadas e comparadas estatisticamente entre os dois grupos.
Resultados
Entre os pacientes, 38 pacientes apresentavam rinossinusite crônica eosinofílica e constituíram o grupo 1 e 30 tinham rinossinusite crônica não eosinofílica, constituindo o grupo 2. Não houve diferenças significantes na distribuição etária, razão entre os sexos, prevalência de asma ou qualquer outra complicação entre os grupos. O escore médio de Lund-Mackay e o número de eosinófilos séricos foram significantemente maiores no grupo com rinossinusite crônica eosinofílica do que no grupo com rinossinusite crônica não eosinofílica. A expressão da pendrina foi mais frequentemente detectada na camada epitelial superficial dos pólipos nasais na rinossinusite crônica eosinofílica do que no grupo com rinossinusite crônica não eosinofílica. Além disso, MUC5AC foi mais amplamente expresso na rinossinusite crônica eosinofílica do que na rinossinusite crônica não eosinofílica.
Conclusão
O aumento da expressão da pendrina e MUC5AC nos pólipos nasais estaria associado ao desenvolvimento de rinossinusite crônica eosinofílica. Esse achado pode permitir o desenvolvimento de um novo agente terapêutico voltado especificamente para pacientes com rinossinusite crônica eosinofílica.
https://ift.tt/2ONlyP5
The effect of adenotonsillar hypertrophy and other obstructive diseases on sleep disorders in children
Publication date: Available online 7 August 2018
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Fatma Caylakli
https://ift.tt/2MlBXsi
The sap flow-based assessment of atmospheric trace gas uptake by three forest types in subtropical China on different timescales
Abstract
Assessing the uptake of trace gases by forests contributes to understanding the mechanisms of gas exchange between vegetation and the atmosphere and to evaluating the potential risk of these pollutant gases to forests. In this study, the multi-timescale characteristics of the stomatal uptake of NO, NO2, SO2 and O3 by Schima superba, Eucalyptus citriodora and Acacia auriculiformis were investigated by continuous sap flow measurements for a 3-year period. The peak canopy stomatal conductance (GC) for these three species appeared between 9:00 and 12:00, which was jointly regulated by the vapour pressure deficit (VPD) and photosynthetically active radiation (PAR). Additionally, annual and seasonal variations in the stomatal uptake of trace gases for these three tree species suggested that there was a combination effect between canopy stomatal conductance and ambient concentration on the uptake of trace gases. Furthermore, the result demonstrated that the trace gas absorption capacities among these three forest types followed the order of S. superba > E. citriodora > A. auriculiformis. The findings of this study have theoretical significance and application value in assessing air purification and the risk of harm to forests in Southern China.
https://ift.tt/2OknYnj
Assessment of treatment‐seeking behaviour in patients with psoriasis
British Journal of Dermatology, EarlyView.
https://ift.tt/2vKP3In
Assessment of treatment‐seeking behaviour in patients with psoriasis
British Journal of Dermatology, EarlyView.
https://ift.tt/2vKP3In
Harvested vs estimated follicular units in hair transplantation
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2vKQKWx
Efficacy of a moisturizer containing a pseudo‐ceramide and a eucalyptus extract for Japanese patients with mild atopic dermatitis in the summer
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2nggohV
Introducing a novel model: The special theory of relativity for attractiveness to define a natural and pleasing outcome following cosmetic treatments
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2vKpW8P
Harvested vs estimated follicular units in hair transplantation
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2vKQKWx
Efficacy of a moisturizer containing a pseudo‐ceramide and a eucalyptus extract for Japanese patients with mild atopic dermatitis in the summer
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2nggohV
Introducing a novel model: The special theory of relativity for attractiveness to define a natural and pleasing outcome following cosmetic treatments
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2vKpW8P
Ultrasound to improve the safety of hyaluronic acid filler treatments
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2AYtwCf
Sensitive scalp is associated with excessive sebum and perturbed microbiome
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2voJGQ3
Antera 3D camera: A novel method for evaluating the therapeutic efficacy of fractional CO2 laser for surgical incision scars
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2AYtdHB
Ultrasound to improve the safety of hyaluronic acid filler treatments
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2AYtwCf
Sensitive scalp is associated with excessive sebum and perturbed microbiome
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2voJGQ3
Antera 3D camera: A novel method for evaluating the therapeutic efficacy of fractional CO2 laser for surgical incision scars
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2AYtdHB
Preliminary evaluation of BioFire FilmArray ® Gastrointestinal Panel for the detection of noroviruses and other enteric viruses from wastewater and shellfish
Abstract
The BioFire FilmArray® Gastrointestinal Panel was evaluated for the rapid detection of adenovirus, astrovirus, norovirus, rotavirus and sapovirus from influent and effluent wastewater and shellfish. The multiplex BioFire FilmArray® Gastrointestinal Panel compared well to singleplex qPCR/RT-qPCR methods for the detection of adenovirus, astrovirus, rotavirus and sapovirus from influent and effluent wastewater samples. However, the BioFire FilmArray® Gastrointestinal Panel showed poor performance for the detection of norovirus, significantly underestimating its presence in wastewater and shellfish samples when compared with the singleplex norovirus GI and GII RT-qPCR assays. Therefore, improvement on detection efficiency for norovirus from environmental and food samples is necessary before using results from the FilmArray® Gastrointestinal Panel to assess associated public health risks.
https://ift.tt/2MpbB8P
Integrative 3′ Untranslated Region‐Based Model to Identify Patients with Low Risk of Axillary Lymph Node Metastasis in Operable Triple‐Negative Breast Cancer
AbstractBackground.Sentinel lymph node biopsy is the standard surgical staging approach for operable triple‐negative breast cancer (TNBC) with clinically negative axillae. In this study, we sought to develop a model to predict TNBC patients with negative nodal involvement, who would benefit from the exemption of the axillary staging surgery.Materials and Methods.We evaluated 3′ untranslated region (3′UTR) profiles using microarray data of TNBC from two Gene Expression Omnibus datasets. Samples from GSE31519 were divided into training set (n = 164) and validation set (n = 163), and GSE76275 was used to construct testing set (n = 164). We built a six‐member 3′UTR panel (ADD2, COL1A1, APOL2, IL21R, PKP2, and EIF4G3) using an elastic net model to estimate the risk of lymph node metastasis (LNM). Receiver operating characteristic and logistic analyses were used to assess the association between the panel and LNM status.Results.The six‐member 3′UTR‐panel showed a high distinguishing power with an area under the curve of 0.712, 0.729, and 0.708 in the training, validation, and testing sets, respectively. After adjustment by tumor size, the 3′UTR panel retained significant predictive power in the training, validation, and testing sets (odds ratio = 4.93, 4.58, and 3.59, respectively; p < .05 for all). A combinatorial analysis of the 3′UTR panel and tumor size yielded an accuracy of 97.2%, 100%, and 100% in training, validation, and testing set, respectively.Conclusion.This study established an integrative 3′UTR‐based model as a promising predictor for nodal negativity in operable TNBC. Although a prospective study is needed to validate the model, our results may permit a no axillary surgery option for selected patients.Implications for Practice.Currently, sentinel lymph node biopsy is the standard approach for surgical staging in breast cancer patients with negative axillae. Prediction estimation for lymph node metastasis of breast cancer relies on clinicopathological characteristics, which is unreliable, especially in triple‐negative breast cancer (TNBC)—a highly heterogeneous disease. The authors developed and validated an effective prediction model for the lymph node status of patients with TNBC, which integrates 3′UTR markers and tumor size. This is the first 3′UTR‐based model that will help identify TNBC patients with low risk of nodal involvement who are most likely to benefit from exemption axillary surgery.
https://ift.tt/2OhdPYt
Outcome of First‐Line Systemic Treatment for Unresectable Conventional, Dedifferentiated, Mesenchymal, and Clear Cell Chondrosarcoma
AbstractBackground.Chondrosarcoma is a heterogeneous group of primary bone sarcoma with an excellent overall survival after local therapy. However, the small percentage of patients who have no surgical treatment options have a very poor prognosis. We retrospectively collected data from these patients in four sarcoma centers and compared the progression‐free survival (PFS) for the different treatment regimens used for the four chondrosarcoma subtypes.Materials and Methods.Patients diagnosed with unresectable chondrosarcoma in all four major sarcoma centers were included, and data on first‐line systemic therapy were retrospectively collected for analysis.Results.A total of 112 patients were enrolled in this retrospective analysis: 50 conventional, 25 mesenchymal, 34 dedifferentiated, and 3 clear cell chondrosarcoma patients. In conventional chondrosarcoma patients, the longest mean PFS (6.7 months) was found in the group treated with antihormonal therapy. Patients diagnosed with mesenchymal chondrosarcoma were all treated with multidrug chemotherapy, and the mean PFS was 6.7 months. Doxorubicin monotherapy seems to have an unexplained better PFS than doxorubicin‐based combination therapy in patients with dedifferentiated chondrosarcoma (5.5 vs. 2.8 months, respectively; p = .275).Conclusion.Prospective studies need to be conducted based on preclinical work to develop a uniform regimen to treat advanced chondrosarcoma patients according to the diagnosed subtype and improve survival.Implications for Practice.Currently, there are no uniform treatment lines for advanced chondrosarcoma patients, which results in a very diverse group of treatment regimens being used. In this study, the data of 112 patients was collected. It was concluded that some treatment regimens seem to have a better progression‐free survival compared with others, and that these results also differ between the chondrosarcoma subtypes. Prospective studies need to be conducted based on preclinical work to develop a uniform regimen to treat advanced chondrosarcoma patients according to the diagnosed histological subtype to improve their survival.
https://ift.tt/2vp7S4O
Strategies for Recognizing and Managing Immune‐Mediated Adverse Events in the Treatment of Hodgkin Lymphoma with Checkpoint Inhibitors
AbstractThe programmed death‐1 (PD‐1) receptor checkpoint inhibitors nivolumab and pembrolizumab represent an important therapeutic advance in the treatment of relapsed or refractory classical Hodgkin lymphoma (cHL). Clinical trials have shown substantial therapeutic activity and an acceptable safety profile in heavily pretreated patients, resulting in U.S. Food and Drug Administration approval of nivolumab for the treatment of cHL that has relapsed or progressed after either autologous hematopoietic cell transplantation (auto‐HCT) and brentuximab vedotin treatment or three or more lines of systemic therapy (including auto‐HCT), and of pembrolizumab for adult or pediatric patients with refractory cHL or cHL that has relapsed after three or more prior therapies. Mechanistically, anti‐PD‐1 therapy prevents inhibitory signaling through PD‐1 receptors on T cells, thereby releasing a 'block' to antitumor T‐cell responses. However, this disinhibition can also lead to inappropriate T‐cell activation and responses against healthy tissues, resulting in immune‐mediated adverse events (IMAEs) that affect a number of organ systems. The skin, gastrointestinal, hepatic, and endocrine systems are most commonly involved, typically resulting in rash, colitis, abnormal liver enzyme levels, and thyroiditis, respectively. Notably, pneumonitis is a potentially fatal complication of checkpoint inhibitor immunotherapy. Hematologic oncologists who treat cHL with PD‐1 immune checkpoint inhibitors should monitor patients for IMAEs, as early recognition and treatment can rapidly reduce morbidity and mortality. This review focuses on IMAEs during the treatment of relapsed or refractory cHL with nivolumab and pembrolizumab.Implications for Practice.This article highlights the importance of monitoring for immune‐mediated adverse events (IMAEs) in patients with Hodgkin lymphoma (HL) who receive anti‐programmed death‐1 (anti‐PD‐1) therapy, with particular attention given to the recognition and management of such events. The risk of individual IMAEs differs between patients with HL and those with solid tumors, as prior treatments may predispose certain organ systems to specific IMAEs. Accurate and prompt diagnosis of IMAEs is essential for optimal management, allowing PD‐1 inhibitor therapy to be restarted in order to maintain disease control. Potential difficulties, such as distinguishing disease progression from pneumonitis, or colitis from diarrhea, are highlighted to raise clinical awareness.
https://ift.tt/2MonCLQ
Pretreatment 18F‐FDG Uptake Heterogeneity Predicts Treatment Outcome of First‐Line Chemotherapy in Patients with Metastatic Triple‐Negative Breast Cancer
AbstractBackground.Intratumoral heterogeneity of 18F‐fluorodeoxyglucose (18F‐FDG) uptake in primary tumor has proven to be a surrogate marker for predicting treatment outcome in various tumors. However, the value of intraindividual heterogeneity in metastatic diseases remains unknown. The aim of this study was to evaluate pretreatment positron emission tomography/computed tomography (PET/CT) 18F‐FDG‐based heterogeneity for the prediction of first‐line treatment outcome in metastatic triple‐negative breast cancer (mTNBC).Materials and Methods.mTNBC patients from three clinical trials (NCT00601159, NCT01287624, and NCT02341911) with whole‐body 18F‐FDG PET/CT scan before first‐line gemcitabine/platinum were included. Heterogeneity index (HI) and the maximum of FDG uptake (MAX) across total metastatic lesions (‐T) on baseline PET/CT scans were assessed. HI was measured by MAX divided by the minimum FDG uptake across metastatic lesions. Optimal cutoffs were determined by time‐dependent receiver operator characteristics (ROC) analysis. Progression‐free survival (PFS) and overall survival (OS) were estimated by Kaplan‐Meier method and compared by log‐rank test.Results.A total of 42 mTNBC patients were included in this study. The median PFS of patients with high HI‐T (>1.9) and high MAX‐T (>10.5) was significantly shorter than patients with low HI‐T (<1.9; p = .049) and low MAX‐T (<10.5; p = .001). In terms of OS, only high MAX‐T was significant for poorer outcome (p = .013). ROC curve analysis confirmed the predictive value of MAX and HI in mTNBC patients. Area under the ROC curve for MAX‐T and HI‐T was 0.75 and 0.65, indicating a higher predictive accuracy than conventional clinical risk factors.Conclusion.HI and MAX measured among metastatic lesions on pretreatment 18F‐FDG PET/CT scans could be potential predicators for first‐line treatment outcome in patients with mTNBC.Implications for Practice.Intratumoral heterogeneity of 18F‐fluorodeoxyglucose (FDG) uptake in primary tumor has proven to be a robust surrogate predictive marker. A novel positron emission tomography/computed tomography (PET/CT) parameter‐heterogeneity index (HI) to quantify the heterogeneous characteristics of metastatic disease is proposed. Triple‐negative breast cancer (TNBC) is a highly heterogeneous disease and remains a clinical challenge. The predictive performance of HI, along with the maximum FDG uptake (MAX), measured on pretreatment PET/CT scans in patients with metastatic TNBC was evaluated. Results indicate that HI and MAX may serve as applicable imaging predicators for treatment outcome of metastatic TNBC in clinical practice.
https://ift.tt/2McOG3A
Multilevel Factors Affecting Time to Cancer Diagnosis and Care Quality in Botswana
AbstractBackground.Cancer incidence is increasing in Africa, and the majority of patients are diagnosed with advanced disease, limiting treatment options and survival. We sought to understand care patterns and factors contributing to delayed diagnosis and treatment initiation among patients with cancer in Botswana.Patients and Methods.We recruited 20 patients who were enrolled in a prospective cancer cohort in Botswana to a qualitative substudy that explored cancer care pathways and factors affecting cancer care access and quality. We conducted an in‐depth interview with each participant between October 2014 and January 2015, using a a structured interview guide with questions about initial cancer symptoms, previous consultations, diagnosis, and care pathways. Medical records were used to confirm dates or treatment details when needed.Results.Individual and interpersonal factors such as cancer awareness and social support facilitated care‐seeking behaviors. However, patients experienced multiple delays in diagnosis and treatment because of provider and health system barriers. Health system factors, such as misdiagnosis, understaffed facilities, poor referral communication and scheduling, and inadequate laboratory reporting systems, affected access to and quality of cancer care.Conclusion.These findings highlight the need for interventions at the patient, provider, and health system levels to improve cancer care quality and outcomes in Botswana. Results also suggest that widespread cancer education has potential to promote early diagnosis through family and community networks. Identified barriers and facilitators suggest that interventions to improve community education and access to diagnostic technologies could help improve cancer outcomes in this setting.Implications for Practice.The majority (54%) of patients with cancer in Botswana present with advanced‐stage cancer despite universal access to free health care, limiting the options for treatment and decreasing the likelihood of positive treatment outcomes. To reduce time from symptom onset to cancer treatment initiation, causes of delay in cancer care trajectories must be identified. The narratives of the patients interviewed for this study give insight into psychosocial factors, outlooks on disease, lower‐level provider delays, and health system barriers that contribute to substantial delays for patients with cancer in Botswana. Identification of problems and barriers is essential for development of effective interventions to mitigate these factors, in order to improve cancer outcomes in this population.
https://ift.tt/2MlPeRO
10‐Year Results of Therapeutic Ratio by Intensity‐Modulated Radiotherapy Versus Two‐Dimensional Radiotherapy in Patients with Nasopharyngeal Carcinoma
AbstractBackground.The purpose of this study was to verify 10‐year results of survival and late toxicities and assess the ultimate therapeutic ratio of intensity‐modulated radiotherapy (IMRT) versus two‐dimensional radiotherapy (2DRT) in patients with nasopharyngeal carcinoma (NPC).Materials and Methods.We retrospectively reviewed the data from 1,276 patients with nonmetastatic NPC who received IMRT or 2DRT from January 2003 to December 2006.Results.Of the 1,276 patients, 512 were treated with IMRT and 764 with 2DRT. Median follow‐up was 115 months. At 10 years, the IMRT group demonstrated significantly better results than the 2DRT group in local failure‐free survival (L‐FFS; 90% vs. 84%; hazard ratio [HR], 0.57, 95% confidence interval [CI], 0.40–0.81; p = .001), failure‐free survival (FFS; 69% vs. 58%; HR, 0.69, 95% CI, 0.57–0.83; p < .001), and overall survival (OS; 75% vs. 63%; HR, 0.62, 95% CI, 0.51–0.77; p < .001). Subgroup multivariate analyses showed that radiotherapeutic technique (IMRT vs. 2DRT) remained an independent prognostic factor for L‐FFS in the T1 subgroup (HR, 0.30; 95% CI, 0.11–0.80; p = .02); for FFS in the stage II subgroup (HR, 0.42; 95% CI, 0.24–0.73; p = .002); and for OS in the stage I (HR, 0.20; 95% CI, 0.04–0.96; p = .04), stage II (HR, 0.39; 95% CI, 0.21–0.75; p = .004), and stage IVA–B (HR, 0.74, 95% CI, 0.56–0.98; p = .04) subgroups. The incidence of grade 3–4 temporal lobe necrosis, cranial neuropathy, eye damage, ear damage, neck soft tissue damage, trismus, and dry mouth was significantly lower in the IMRT group than in the 2DRT group.Conclusion.IMRT demonstrated an improved ultimate therapeutic ratio compared with 2DRT in patients with NPC after a 10‐year follow‐up, with significant improvement of L‐FFS, FFS, and OS and decrease in most late toxicities.Implications for Practice.The ultimate therapeutic ratio of intensity‐modulated radiotherapy versus two‐dimensional radiotherapy in patients with nasopharyngeal carcinoma is unclear. In this retrospective study of 1,276 patients with nonmetastatic nasopharyngeal carcinoma with a follow‐up of 115 months, intensity‐modulated radiotherapy demonstrated an improved ultimate therapeutic ratio compared with two‐dimensional radiotherapy, with significant improvement of local failure‐free survival, failure‐free survival, and overall survival and decrease in most late toxicities and noncancer deaths. However, distant control remains insufficient with this treatment modality.
https://ift.tt/2McNY6q
Use of Antidepressant Medications Moderates the Relationship Between Depressive Symptoms and Hospital Length of Stay in Patients with Advanced Cancer
AbstractBackground.Among patients with cancer, depressive symptoms are associated with worse clinical outcomes, including greater health care utilization. As use of antidepressant medications can improve depressive symptoms, we sought to examine relationships among depressive symptoms, antidepressant medications, and hospital length of stay (LOS) in patients with advanced cancer.Materials and Methods.From September 2014 to May 2016, we prospectively enrolled patients with advanced cancer who had an unplanned hospitalization. We performed chart review to obtain information regarding documented depressive symptoms in the 3 months prior to admission and use of antidepressant medications at the time of admission. We compared differences in hospital LOS by presence or absence of depressive symptoms and used adjusted linear regression to examine if antidepressant medications moderated these outcomes.Results.Of 1,036 patients, 126 (12.2%) had depressive symptoms documented prior to admission, and 288 (27.8%) were taking antidepressant medications at the time of admission. Patients with depressive symptoms experienced longer hospital LOS (7.25 vs. 6.13 days; p = .036). Use of antidepressant medications moderated this relationship; among patients not on antidepressant medications, depressive symptoms were associated with longer hospital LOS (7.88 vs. 6.11 days; p = .025), but among those on antidepressant medications, depressive symptoms were not associated with hospital LOS (6.57 vs. 6.17 days; p = .578).Conclusion.Documented depressive symptoms prior to hospital admission were associated with longer hospital LOS. This effect was restricted to patients not on antidepressant medications. Future studies are needed to investigate if use of antidepressant medications decreases LOS for patients hospitalized with advanced cancer and the mechanisms by which this may occur.Implications for Practice.This study investigated the prevalence of documented depressive symptoms in patients with advanced cancer in the 3 months prior to an unplanned hospitalization and the prevalence of use of antidepressant medications at time of hospital admission. The relationship of these variables with hospital length of stay was also examined, and it was found that documented depressive symptoms were associated with prolonged hospital length of stay. Interestingly, antidepressant medications moderated the relationship between depressive symptoms and hospital length of stay. These findings support the need to recognize and address depressive symptoms among patients with advanced cancer, with potential implications for optimizing health care utilization.
https://ift.tt/2MlP2SA
Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature
The duodenum and the left renal vein occupy the vascular angle made by the superior mesenteric artery and the aorta. When the angle becomes too acute, compression of either structure can occur. Each type of co...
https://ift.tt/2M5a1fs
Real-world outcomes in hereditary angioedema: first experience from the Icatibant Outcome Survey in the United Kingdom
Hereditary angioedema (HAE) is a potentially life-threatening, bradykinin-mediated disease, often misdiagnosed and under-treated, with long diagnostic delays. There are limited real-world data on best-practice...
https://ift.tt/2Mp7WYD
Enhancement of the biogas and biofertilizer production from Opuntia heliabravoana Scheinvar
Abstract
Waste Opuntia is an abundant source of biomass to produce biogas and biofertilizer in a small and commercial scale. This crop has a high biomass yield, wide adaptation to diverse climatic zones, rapid growth, and low input requirements. This study aimed to evaluate the combined effect of adjusting C/N ratio and an alkaline pretreatment (AP) of waste Opuntia heliabravoana Scheinvar in the production of biogas and biofertilizer in anaerobic reactors. AP bioreactors produced more biogas than the control (C, without the combined effect of AP); besides, in this process, it was not necessary to use additional water due to the high content of water that is present in the tissue of this crop. On the other hand, both biofertilizers (C and AP) had enssential microbial groups that help to enhance plant nutrition as S-reducers, S-oxidizers, amylolytic, cellulolytic bacteria, anaerobic S-mineralizers, cellulolytic fungi, and P-solubilizers. Also, the AP treatment to help to increase 1.5:1 total nitrogen (TN) concentration decreased the pathogenic microorganisms in the biofertilizer compared to the C treatment. For this reason, Opuntia spp. is a good substrate for production of biogas and biofertilizer with essential nutrients for many crops in area with water scarcity.
https://ift.tt/2ng3DE3
Assessing the impact of climate variability on maize using simulation modeling under semi-arid environment of Punjab, Pakistan
Abstract
Climate change and variability are major threats to crop productivity. Crop models are being used worldwide for decision support system for crop management under changing climatic scenarios. Two-year field experiments were conducted at the Water Management Research Center (WMRC), University of Agriculture Faisalabad, Pakistan, to evaluate the application of CERES-Maize model for climate variability assessment under semi-arid environment. Experimental treatments included four sowing dates (27 January, 16 February, 8 March, and 28 March) with three maize hybrids (Pioneer-1543, Mosanto-DK6103, Syngenta-NK8711), adopted at farmer fields in the region. Model was calibrated with each hybrid independently using data of best sowing date (27 January) during the year 2015 and then evaluated with the data of 2016 and remaining sowing dates. Performance of model was evaluated by statistical indices. Model showed reliable information with phenological stages. Model predicted days to anthesis and maturity with lower RMSE (< 2 days) during both years. Model prediction for biological yield and grain yield were reasonably good with RMSE values of 963 and 451 kg ha−1, respectively. Model was further used to assess climate variability. Historical climate data (1980–2016) were used as input to simulate the yield for each year. Results showed that days to anthesis and maturity were negatively correlated with increase in temperature and coefficient of regression ranged from 0.63 to 0.85, while its values were 0.76 to 0.89 kg ha−1 for grain yield and biological yield, respectively. Sowing of maize hybrids (Pioneer-1543 and Mosanto-DK6103) can be recommended for the sowing on 17 January to 6 February at the farmer field for general cultivation in the region. Early sowing before 17 January should be avoided due to severe reduction in grain yield of all hybrids. A good calibrated CERES-Maize model can be used in decision-making for different management practices and assessment of climate variability in the region.
https://ift.tt/2vHuUmF
Content and construct validity, predictors and distribution of self-reported atopic dermatitis severity in US adults
Publication date: Available online 6 August 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): JI Silverberg, ZC Chiesa Fuxench, JM Gelfand, DJ Margolis, M Boguniewicz, L Fonacier, MH Grayson, EL Simpson, PY Ong
https://ift.tt/2OPqKSD
Association of atopic dermatitis with allergic, autoimmune and cardiovascular comorbidities in US adults
Publication date: Available online 6 August 2018
Source: Annals of Allergy, Asthma & Immunology
Author(s): JI Silverberg, JM Gelfand, D Margolis, M Boguniewicz, L Fonacier, MH Grayson, EL Simpson, P Ong, ZC Chiesa Fuxench
https://ift.tt/2AJ4cA0
Inflammation cutanée de contiguïté secondaire à une sinusite aspergillaire
Publication date: Available online 6 August 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): H. Lefranc, C. Brugière, L. Plisson, F. Comoz, L. Verneuil, A. Dompmartin
Résumé
Introduction
L'inflammation cutanée de contiguïté est une entité peu décrite. Elle correspond à la manifestation cutanée d'un processus évolutif qui lui est sous-jacent (infectieux, inflammatoire, néoplasique). Les sinusites en sont une cause connue.
Observation
Nous rapportons le cas d'un homme de 70 ans, qui consultait pour une plaque inflammatoire centro-faciale évolutive. La biopsie cutanée montrait un infiltrat inflammatoire polymorphe et les prélèvements microbiologiques cutanés étaient négatifs. La tomodensitométrie (TDM) du massif facial montrait une sinusite maxillaire gauche. Les prélèvements chirurgicaux intra-sinusiens mettaient en évidence de l'aspergillus. Un traitement par voriconazole, associé à une chirurgie du sinus maxillaire, permettait une guérison de la plaque inflammatoire faciale.
Discussion
Seuls deux cas d'inflammation cutanée de contiguïté liée à une sinusite ont été rapportés dans la littérature, aucun en lien avec une sinusite aspergillaire. Nous rapportons donc le troisième cas d'inflammation cutanée de contiguïté liée à une sinusite, et le premier en rapport avec une sinusite aspergillaire.
Summary
Background
Contiguous skin inflammation is a poorly described entity. It constitutes a cutaneous manifestation of an underlying ongoing process (infectious, inflammatory or neoplastic). Sinusitis is a known cause.
Patients and methods
We report the case of a 70-year-old patient consulting for an ongoing centrofacial inflammatory plaque. Cutaneous biopsy revealed a polymorphic inflammatory infiltrate, and cutaneous microbiological specimens were negative. A facial CT-scan showed left maxillary sinusitis. Intra-sinus samples obtained at surgery showed aspergillus. Voriconazole combined with maxillary sinus surgery resulted in healing of the facial plaque.
Discussion
There have been only two published cases of contiguous skin inflammation related to sinusitis but no reported cases caused by aspergillus sinusitis. Herein we report the third case of contiguous skin inflammation associated with sinusitis, which is also the first related to aspergillus sinusitis.
https://ift.tt/2vnRX6v
Adulte collodion : une forme clinique originale de dermite caustique
Publication date: Available online 6 August 2018
Source: Annales de Dermatologie et de Vénéréologie
Author(s): H. Barailler, V. Cales, C. Salzes, T. Jouary
https://ift.tt/2ANzBRJ
Janus kinase 2 activation mechanisms revealed by analysis of suppressing mutations
Publication date: Available online 6 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Henrik M. Hammarén, Anniina T. Virtanen, Bobin George Abraham, Heidi Peussa, Stevan R. Hubbard, Olli Silvennoinen
Abstract
Background
Janus kinases (JAK1–3, TYK2) mediate cytokine signals in the regulation of hematopoiesis and immunity. JAK2 clinical mutations cause myeloproliferative neoplasms and leukemia and the mutations strongly concentrate in the regulatory pseudokinase domain, JAK homology 2, JH2. Current clinical JAK inhibitors target the tyrosine kinase domain and lack mutation- and pathway-selectivity.
Objective
To characterize mechanisms and differences for pathogenic and cytokine-induced JAK2 activation to enable design of novel selective JAK inhibitors.
Methods
Systematic analysis of JAK2 activation requirements using structure-guided mutagenesis, cell signaling assays, microscopy, and biochemical analysis.
Results
Distinct structural requirements identified for activation of different pathogenic mutations. Specifically, the predominant JAK2 mutation V617F is the most sensitive to structural perturbations in multiple JH2 elements (C helix (αC), SH2-JH2 linker and ATP-binding site). In contrast, activation of K539L is resistant to most perturbations. Normal cytokine signaling shows distinct differences in activation requirements: JH2 ATP-binding site mutations have only a minor effect on signaling, while JH2 αC mutations reduce homomeric (JAK2-JAK2) EPO signaling, and almost completely abrogate heteromeric (JAK2-JAK1) IFNγ signaling, potentially by disrupting a dimerization interface on JH2.
Conclusions
These results suggest that therapeutic approaches targeting the JH2 ATP-binding site and αC could be effective in inhibiting most pathogenic mutations. JH2 ATP-site targeting have potential for reduced side-effects by retaining EPO and IFNγ functions. Simultaneously, however, we identify the JH2 αC interface as a potential target for pathway-selective JAK inhibitors in diseases with unmutated JAK2, thus providing new insights for the development of novel pharmacological interventions.
https://ift.tt/2nn6xXT
Glucocorticoids promote intrinsic human Th17 differentiation
Publication date: Available online 6 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Juliana de Castro Kroner, Kristin Knoke, David M. Kofler, Julia Steiger, Mario Fabri
https://ift.tt/2Oi95ls
Jakinibs for the Treatment of Immunodysregulation in Patients with Gain of Function STAT1 or STAT3 Mutations
Publication date: Available online 6 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Lisa R. Forbes, Tiphanie P. Vogel, Megan A. Cooper, Johana Castro-Wagner, Edith Schussler, Katja G. Weinacht, Ashley S. Plant, Helen C. Su, Eric J. Allenspach, Mary Slatter, Mario Abinun, Desa Lilic, Charlotte Cunningham-Rundles, Olive Eckstein, Peter Olbrich, R. Paul Guillerman, Niraj C. Patel, Yesim Y. Demirdag, Christa Zerbe, Alexandra F. Freeman
Brief Summary
Treatment of the autoimmune and immune-dysregulatory features of patients with STAT1 GOF or STAT3 GOF disease remains challenging. Jakinibs have been used to treat the severe immune-dysregulation in patients with either STAT1 GOF or STAT3 GOF mutations.
https://ift.tt/2M0lPjW
Allergic Airway Sensitization Impairs Anti-Bacterial IgG Antibody Responses During Bacterial Respiratory Infections
Publication date: Available online 6 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Arthur H. Totten, Li Xiao, Danlin Luo, David Briles, Joanetha Y. Hale, Donna M. Crabb, Trenton R. Schoeb, Ammar Saadoon Alishlash, Ken B. Waites, T. Prescott Atkinson
Abstract
Background
Mycoplasma pneumoniae (Mpn), an atypical human pathogen, has been associated with asthma initiation and exacerbation. Asthmatics have been reported to have higher carriage rates of Mpn compared to non-asthmatics, and are at greater risk for invasive respiratory infections.
Objective
To study whether prior allergen sensitization affects the host response to chronic bacterial infection.
Methods
BALB/cJ and IL-4Rα-/- mice were sensitized with ovalbumin (OVA), and then infected with Mpn or Streptococcus pneumoniae (Spn). Immune parameters were analyzed at 30 days post-infection and included cellular profiles in bronchoalveolar lavage (BAL), and serum IgG and IgE antibody levels to whole bacterial lysate, recombinant P1 (rP1) adhesin, and OVA. Total lung RNA was examined for transcript levels and BAL fluid for cytokine protein profiles.
Results
Anti-Mpn antibody responses were decreased in allergen-sensitized, Mpn-infected animals compared to controls, but OVA-specific IgG responses were unaffected. Similar decreases in anti-Spn antibody levels were found in OVA-sensitized animals. However, Mpn, but not Spn, infection augmented anti-OVA IgE antibody responses. Loss of IL-4 receptor signaling partially restored anti-Mpn antibody responses in IgG2a and IgG2b subclasses. Inflammatory cytokine levels in BAL fluid from OVA-sensitized, Mpn- or Spn-infected animals were reduced compared to uninfected OVA-sensitized controls. Unexpectedly, airway hyperreactivity to methacholine was essentially ablated in Mpn-infected, OVA-sensitized animals.
Conclusions
An established Type 2-biased host immune response impairs the host immune response to respiratory bacterial infection in a largely pathogen independent manner. Some pathogens, e.g. Mpn, can augment ongoing allergic responses and inhibit pulmonary T2 cytokine responses and allergic airway hyperreactivity.
https://ift.tt/2Kup916
Kommentar der Schriftleitung
Laryngo-Rhino-Otol 2018; 97: 520-521
DOI: 10.1055/a-0589-3559
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Tonsillotomie verursacht weniger indirekte Kosten als Tonsillektomie
Laryngo-Rhino-Otol 2018; 97: 523-524
DOI: 10.1055/a-0465-0081
Gudnadottir G et al. Indirect costs related to caregivers' absence from work after paediatric tonsil surgery. Eur Arch Otorhinolaryngol 2017; 275: 2629–2636. doi:10.1007/s00405–0174526–7 Bei Kindern mit schlafbezogenen Atemwegsobstruktionen durch vergrößerte Rachenmandeln hat die Tonsillotomie die Tonsillektomie heute weitgehend ersetzt. Vorteil könnte neben geringerer Schmerzen und kürzerer Rekonvaleszenzzeit auch eine Reduktion indirekter Kosten durch kürzere Arbeitsausfallzeiten der Eltern oder Betreuer sein. Dies wurde im Rahmen einer schwedischen Kohortenstudie untersucht.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Prävention von Infekten der oberen Atemwege
Laryngo-Rhino-Otol 2018; 97: 529-536
DOI: 10.1055/a-0589-3591
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Weniger akute Atemwegsinfekte durch Vitamin-D-Supplementation?
Laryngo-Rhino-Otol 2018; 97: 524-525
DOI: 10.1055/a-0648-6964
Martineau AR. et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017; 356: i6583 Vitamin D spielt Studien zufolge auch eine Rolle bei der Abwehr pathogener Keime: 25-Hydroxy-Vitamin D (25[OH] Vitamin D) unterstützt z. B. die Synthese antimikrobieller Peptide. Es gibt also eine mögliche Erklärung für die Beobachtung, dass Personen mit niedrigen Vitamin-D-Spiegeln besonders empfindlich gegenüber respiratorischen Infekten sind. Untersuchungen zu einer präventiven Wirkung des Vitamin D verliefen jedoch zum Teil widersprüchlich.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Rhinoplastik
Laryngo-Rhino-Otol 2018; 97: 581-590
DOI: 10.1055/a-0589-3679
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Unter welchen Bedingungen ist eine ambulante Tonsillektomie sicher?
Laryngo-Rhino-Otol 2018; 97: 525-526
DOI: 10.1055/a-0621-2042
Morris S et al. Overnight in-hospital observation following tonsillectomy: retrospective study of post-operative intervention. J Laryngol Otol 2018; 132: 46–52 Die Sicherheit der ambulanten oder tagesklinischen Tonsillektomie ist gut dokumentiert. Allerdings existieren keine evidenzbasierten Leitlinien, die empfehlen, bei bestimmten Patienten keine ambulante Tonsillektomie auszuführen. Daher wollten australische Ärzte herausfinden, unter welchen Umständen eine ambulante Tonsillektomie als unsicher angesehen werden kann.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Umgang mit suizidalen Patienten
Laryngo-Rhino-Otol 2018; 97: 560-562
DOI: 10.1055/a-0589-3624
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Stimmlippenknötchen
Laryngo-Rhino-Otol 2018; 97: 527-528
DOI: 10.1055/a-0589-3602
Eine zu hohe Stimmbelastung kann zu Stimmlippenknötchen führen, einer subepithelialen Schwellung des Stimmlippenrandes. Die Therapie erfolgt aufeinander aufbauend durch Stimmruhe, Stimmübungen und Phonochirurgie mit anschließenden Stimm- oder Gesangsübungen.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
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Fragen für die Facharztprüfung
Laryngo-Rhino-Otol 2018; 97: 579-580
DOI: 10.1055/a-0589-3635
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Diagnostik und operative Therapie der Otosklerose
Laryngo-Rhino-Otol 2018; 97: 563-578
DOI: 10.1055/a-0589-3613
Die Otosklerose ist eine für den HNO-Arzt/Ärztin wichtige, oft in (Differenzial-)Diagnostik und Therapie anspruchsvolle Erkrankung. Wenngleich bis heute eine kausale Therapieoption nicht besteht, kann bei richtiger Diagnosestellung eine operative oder apparative Hörrehabilitation mit sehr hohen Erfolgschancen in Aussicht gestellt werden.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
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Intertriginous mastocytosis: a rare presentation of an uncommon disease
International Journal of Dermatology, EarlyView.
https://ift.tt/2vpwUAB
A case of Carvajal syndrome associated with cervical neuroblastoma in an 8‐year‐old girl
International Journal of Dermatology, EarlyView.
https://ift.tt/2MnYWTs
Issue Information
International Journal of Dermatology, Volume 57, Issue 9, Page i-iii,1019-1020, September 2018.
https://ift.tt/2vn5z29
Teaching & Learning Tips 11: Teaching a procedure
International Journal of Dermatology, Volume 57, Issue 9, Page 1114-1117, September 2018.
https://ift.tt/2MnYK6G
Gastric neuroendocrine neoplasm with late liver metastasis
Summary
Gastric neuroendocrine neoplasms (GNENs) are classified into three types according to their aetiology. We present a clinical case of a female patient of 66 years and a well-differentiated (grade 2), type 3 GNEN with late liver metastasis (LM). The patient underwent surgical excision of a gastric lesion at 50 years of age, without any type of follow-up. Sixteen years later, she was found to have a neuroendocrine tumour (NET) metastatic to the liver. The histological review of the gastric lesion previously removed confirmed that it was a NET measuring 8 mm, pT1NxMx (Ki67 = 4%). 68Ga-DOTANOC PET/CT reported two LM and a possible pancreatic tumour/gastric adenopathy. Biopsies of the lesion were repeatedly inconclusive. She had a high chromogranin A, normal gastrin levels and negative anti-parietal cell and intrinsic factor antibodies, which is suggestive of type 3 GNEN. She underwent total gastrectomy and liver segmentectomies (segment IV and VII) with proven metastasis in two perigastric lymph nodes and both with hepatic lesions (Ki67 = 5%), yet no evidence of local recurrence. A 68Ga-DOTANOC PET/CT was performed 3 months after surgery, showing no tumour lesions and normalisation of CgA. Two years after surgery, the patient had no evidence of disease. This case illustrates a rare situation, being a type 3, well-differentiated (grade 2) GNEN, with late LM. Despite this, it was possible to perform surgery with curative intent, which is crucial in these cases, as systemic therapies have limited efficacy. We emphasise the need for extended follow-up in these patients.
Learning points:GNENs have a very heterogeneous biological behaviour.
Clinical distinction between the three types of GNEN is essential to plan the correct management strategy.
LMs are rare and more common in type 3 and grade 3 GNEN.
Adequate follow-up is crucial for detection of disease recurrence.
Curative intent surgery is the optimal therapy for patients with limited and resectable LM, especially in well-differentiated tumours (grade 1 and 2).
https://ift.tt/2OMGlCn
Sterol profiles are valuable biomarkers for phenotype expression of Conradi–Hünermann–Happle syndrome with EBP mutations
British Journal of Dermatology, EarlyView.
https://ift.tt/2M1hlsD
Sterol profiles are valuable biomarkers for phenotype expression of Conradi–Hünermann–Happle syndrome with EBP mutations
British Journal of Dermatology, EarlyView.
https://ift.tt/2M1hlsD
Are patients with chronic pruritus more susceptible to social stress than healthy controls? An experimental case–control study
British Journal of Dermatology, EarlyView.
https://ift.tt/2KwZJQv
Inter-operator variability in the sensitivity of sentinel lymph node biopsy for melanoma
Plastic surgery trainees, in some circumstances, can progress to consultant level having performed only 15 generic lymph node surgeries, with no mention specifically of sentinel lymph node biopsy (SLNB) on the training log. The majority of SLNBs carried out for melanoma at our centre since 1999 have been performed by eight surgeons, six of whom had been formally trained and mentored in our unit or previously completed skin cancer fellowships. Two surgeons started performing the procedure without formal training or specialist fellowships.
https://ift.tt/2Mo9xy1
Mycophenolate mofetil extravasation resulting in extensive local tissue necrosis
Chemotherapy extravasation is an important complication of intravenous (IV) medication administration and can cause severe, irreversible local tissue damage, potential disfigurement, and functional impairment. Mycophenolate mofetil (MM) is an antiproliferative immunosuppressant used for prevention of organ rejection in solid organ transplant. We report a case of a 58-year-old man with a recent history of cardiac transplantation, with postsurgical course complicated by allograft failure, who was being treated with IV MM for prevention of transplant rejection.
https://ift.tt/2ANsMzL
Randomized side-by-side comparison of 755-nm diode laser alone and combined with topical photoenhancer gel for hair removal in patients with Fitzpatrick skin type I-V: Efficacy and safety study
Background: Improving laser hair removal (LHR) procedure with novel protocols techniques and photoenhancer ingredients are constantly evolving primarily in an attempt to enhance hair follicle photothermolytic damage and at the same time improve treatment safety and efficacy. Since laser technology advancement feeds market demand-cost relations improving laser hair removal paradigm that will boost clinical outcome and reduce operation costs is deemed necessary in today's LHR competitive market.
https://ift.tt/2OMA9KD
Shaving Is an Epiphenomenon of Type I and II Anti-CD20-Mediated Phagocytosis, whereas Antigenic Modulation Limits Type I Monoclonal Antibody Efficacy [IMMUNOTHERAPY AND VACCINES]
Rituximab is an anti-CD20 mAb used in the treatment of B cell malignancies. Loss of surface CD20 Ag from the surface of target cells is thought to be one mechanism governing resistance to rituximab, but how this occurs is not completely understood. Two explanations for this have been proposed: antigenic modulation whereby mAb:CD20 complexes are internalized in a B cell intrinsic process and shaving, in which mAb:CD20 complexes undergo trogocytic removal by effector cells, such as macrophages. However, there is conflicting evidence as to which predominates in clinical scenarios and hence the best strategies to overcome resistance. In this study, we investigated the relative importance of modulation and shaving in the downregulation of surface mAb:CD20. We used both murine and human systems and treated ex vivo macrophages with varying concentrations of non–FcR-interacting beads to achieve differential macrophage saturation states, hence controllably suppressing further phagocytosis of target cells. We then monitored the level and localization of mAb:CD20 using a quenching assay. Suppression of phagocytosis with bead treatment decreased shaving and increased modulation, suggesting that the two compete for surface rituximab:CD20. Under all conditions tested, modulation predominated in rituximab loss, whereas shaving represented an epiphenomenon to phagocytosis. We also demonstrate that the nonmodulating, glycoengineered, type II mAb obinutuzumab caused a modest but significant increase in shaving compared with type II BHH2 human IgG1 wild-type mAb. Therefore, shaving may represent an important mechanism of resistance when modulation is curtailed, and glycoengineering mAb to increase affinity for FcR may enhance resistance because of shaving.
https://ift.tt/2njPg1n
Clinical findings, histology, and management of nonmelanoma skin cancer in cancer survivors previously treated with radiotherapy
Purpose: Radiotherapy is a well known risk factor for nonmelanoma skin cancer (MNSC). This study aims to describe the clinical findings, histology and management of NMSC in cancer survivors previously treated with radiotherapy.
https://ift.tt/2vlnjuE
Clinical manifestations, management, and diagnostic techniques used in hematopoietic stem cell transplant patients with skin infections: A five-year review
The clinical management of infections depends on many factors including location of the patient presentation, specialty of the health care provider, and utilization of diagnostic tests. Appropriate management is especially critical when managing hematopoietic stem cell transplantation (HSCT) patients due to their susceptibility to infection. This retrospective chart review aimed to identify (1) clinical manifestations of skin infections, (2) clinical management methods, and (3) diagnostic testing patterns.
https://ift.tt/2ANsitr
Clinical response after guselkumab treatment among adalimumab PASI 90 nonresponders: Results from the VOYAGE 1 and 2 trials
Objective: To evaluate the levels of response to guselkumab (GUS) among adalimumab (ADA) PASI 90 nonresponders in the VOYAGE 1 and VOYAGE 2 trials.
https://ift.tt/2vreaRe
Cocaine-induced pyoderma gangrenosum–like lesions: Levamisole may be not the only culprit. Report of three cases and review of the literature
Background: Cocaine-induced pyoderma gangrenosum-like (CIPG), cocaine-induced midline destructive lesions (CIMDL), and retiform purpura (RP) are some of the mucocutaneous manifestations associated with cocaine consumption, the latter initially described in patients consuming cocaine adulterated with levamisole. It is estimated that up to 80% of cocaine is contaminated with levamisole.
https://ift.tt/2AIuLoR
Coexistence of cutaneous Langerhans cell histiocytosis and reticulohistiocytosis with initial presentation of skull lesions
Coexistence of Langerhans cell histiocytosis (LCH) and reticulohistiocytosis (RH) in different organ and the same skin area is never reported in the literature. We present a 20-year-old female adult with coexistence of bone LCH and diffuse cutaneous RH initially, and then progressed to multisystem LCH with synchronous development of LCH and RH in the skin after chemotherapy for one year. In our patient, multifocal bone LCH and diffuse cutaneous RH coexisted before chemotherapy. After she completed cytarabine (Ara-C) for 12 times, bone LCH much improved but cutaneous LCH developed on previous RH lesions.
https://ift.tt/2OPofj1
Collision tumor of basal cell carcinoma and nevus: Dermoscopic and confocal features
Introduction: A collision tumor is two or more independent neoplasms superimposed on one another. As a result of their overlapping clinical and dermoscopic features they may be diagnostically challenging. Reflectance confocal microscopy (RCM) allows for evaluation of the skin lesions in vivo and better planning concerning their management.
https://ift.tt/2AIuG4x
Combination therapies for vitiligo: 5-Fluorouracil laser–assisted drug delivery
Case report: A 35-year-old man with stable vitiligo on the hands with no response to previous treatments was submitted to three monthly sessions of fractional CO2 10,600 nm laser with drug delivery parameters (Sculptor CO2, Vydence; first 3 passes: tip 800, random mode, energy 30 mJ, density 150 mtz/cm2; fourth pass: tip 800, brush mode, energy 30 mJ, density 60 mtz/cm2). Immediately after, the drug delivery lotion with 5-FU 5% and alfa bisabolol 2% was applied. This lotion was applied at night for six days.
https://ift.tt/2OIFanv
Combination use of systemic therapies in psoriasis: Baseline characteristics from the Corrona Psoriasis Registry
Background: For patients with moderate to severe psoriasis or psoriatic arthritis, systemic monotherapy can be insufficient in attaining the desired level of control. As such, combination therapies are frequently used in difficult cases. The aim of this study was to analyze the baseline characteristics of patients who require combination therapy using preliminary data from the Corrona Psoriasis Registry.
https://ift.tt/2AIuxy1
Severe bullous pemphigoid with flares triggered by pychosocial stressors
Introduction: Bullous pemphigoid is a rare life-long skin condition that is typically characterized by areas of large fluid-filled blisters and scattered urticarial papules and plaques on the trunk, arms, and legs. It can be induced by medications including furosemide, captopril, or penicillin. Often misdiagnosed as urticaria, the classic manifestations of tense vesicels and bullae which develop on an urticarial base do not develop until later in the course of the disease. It is an immunobullous disorder caused by autoantibodies against basement membrane protein.
https://ift.tt/2OMzGrR
The use of asynchronous remote teledermatology to support frontline health workers: A case example
Introduction: Persistent dermatologic disorders are prevalent in underserved settings with little access to specialized care. We are presenting the case of a pediatric patient with a three month history of unidentified rash. A local nurse collaborated with a volunteer dermatologist through asynchronous remote teledermatology (ARTD) to determine an appropriate treatment plan, avoiding a referral outside of the community.
https://ift.tt/2ANrLrr
Utility of TLE1 immunohistochemistry in melanoma
Background: TLE1 immunohistochemistry (IHC) is widely used as a biomarker of synovial sarcoma. Recently, we described moderate to strong TLE1 expression in 57% of dermal spindle cell melanomas with an additional 33% with weak expression. The utility of TLE1 IHC in melanoma has not been well described. The aim of this study was to investigate TLE1 expression in melanoma.
https://ift.tt/2vo7t2j
Sweet syndrome in a patient with granulomatosis with polyangiitis
Sweet syndrome (acute febrile neutrophilic dermatosis) is rarely known to be associated with Granulomatosis with polyangiitis (GPA), a necrotizing vasculitis of small- and medium-sized blood vessels predominantly affecting respiratory tract, and kidneys. A 66-year-old woman with history of rhinosinusitis, adult onset asthma was seen in medicine clinic for recurrent epistaxis, paranasal sinus congestion, wheezing, dyspnea for 2 years despite maximal medical therapy and sinus surgery. Labs were significant for acute kidney injury (AKI); positive C-anti-neutrophil cytoplasmic antibody (1:5,120); high ESR, CRP, and anti-PR3 (anti–proteinase 3); and microscopic hematuria.
https://ift.tt/2ANrWD7
Reflectance confocal microscopy and image analysis to evaluate the efficacy of a topical facial serum with 20% vitamin C in improving signs of aging
Vitamin C is known for its antioxidant potential and activity in prevents and reverts signs of aging, also by the collagen biosynthetic pathway. Photoprotective properties of topically applied vitamin C have also been demonstrated, placing this molecule as a potential candidate for use in the prevention and treatment of skin aging. A topically applied serum containing 20% vitamin C in different forms (ascorbic acid, ascorbyl methylsilanol pectinate and ascorbyl glucoside) associated with ferulic acid and Ginkgo biloba extract was tested on healthy female volunteers presenting photoaged skin on face to evaluate clinical efficacy of such treatment.
https://ift.tt/2vo7pzB
The effects of postoperative intralesional corticosteroids in the prevention of recurrent earlobe keloids: A multispecialty retrospective review
Background: Effective treatment of keloids is challenging as the recurrence rate after surgical excision is high. Earlobe keloids are unique due to the low tension in this area, their tendency to respond better to therapy, and their lower recurrence rates after excision. Combination therapy with intralesional corticosteroids is commonly utilized to maximize treatment success. Data on the best treatment practices are lacking.
https://ift.tt/2OQanFt
Who needs penicillin allergy testing?
All individuals with an unconfirmed penicillin allergy should have their penicillin allergy evaluated, and if appropriate, tested to confirm current hypersensitivity or tolerance.
https://ift.tt/2vlwiMe
Content and construct validity, predictors and distribution of self-reported atopic dermatitis severity in US adults
Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with variable lesional severity and extent, a broad symptom-burden, including itch, skin pain1, sleep2, 3 and mental health disturbance4, and negative impact on quality of life (QOL)5. Each of these domains differentially and cumulatively affects AD patients and contributes to overall AD severity. Many different scales exist that measure various aspects of AD severity6-13. However, there is no single patient-reported outcome (PRO) that fully captures all aspects of disease severity.
https://ift.tt/2ANe7Ex
Association of atopic dermatitis with allergic, autoimmune and cardiovascular comorbidities in US adults
Atopic Dermatitis (AD) is a chronic inflammatory disorder that affects 7% of US adults (Silverberg et al., 2018; Hua & Silverberg, 2018), and causes significant quality of life impairment and disease burden (Silverberg et al., 2018), and has been found to be associated with a wide range of allergic and non-allergic comorbid disorders (Silverberg & Silverberg, 2014; Silverberg & Hanifin, 2013; Silverberg & Simpson, 2013; Narla & Silverberg, 2017). However, the relationship between AD and comorbid health disorders is complex.
https://ift.tt/2ONporr
Eficacia del corticoide intratimpánico como tratamiento de rescate en sordera súbita neurosensorial idiopática
Publication date: Available online 6 August 2018
Source: Acta Otorrinolaringológica Española
Author(s): Elizabeth Amarillo, Mónica Hernando, Gustavo Eisenberg, Mónica Granda, Guillermo Plaza
Resumen
Introducción
La hipoacusia súbita neurosensorial idiopática (SSI) es la pérdida de al menos 30 dB de causa desconocida. Dado que la recuperación auditiva en SSI es variable, el rescate con corticoides intratimpánicos (CIT) podría contribuir a la recuperación auditiva. Nuestro objetivo es analizar la respuesta auditiva tras CIT como rescate, en ausencia de recuperación completa tras tratamiento sistémico.
Material y método
Realizamos un estudio observacional de cohortes históricas de los 125 casos detectados de SSI entre 2006 y 2014. De ellos, 16 obtuvieron a la semana recuperación completa según los criterios de Siegel. Los 109 casos restantes se analizaron en dos grupos: el que recibió CIT (grupo de tratamiento) y otro que no lo recibió (grupo control). Evaluamos la recuperación auditiva a los 6 meses y a 2 años.
Resultados
La media de audición en la audiometría al diagnóstico no tenía diferencias significativas entre los grupos. Al séptimo día del tratamiento sistémico, el PTA obtenido fue de 53,13 dB en el grupo control y de 66,11 dB en el grupo de estudio (p < 0,01). Tras 6 meses, la ganancia en decibelios obtenida tras el tratamiento con CIT de rescate fue de 10,84 dB, y en el grupo control, de 1,13 dB (p < 0,0001). Tras CIT, solo se consiguió la recuperación completa en 10 pacientes. Ningún paciente del grupo control obtuvo recuperación completa.
Conclusión
Encontramos que el tratamiento de rescate con CIT en la SSI favorece la mejoría auditiva tras la ausencia de recuperación después de un tratamiento sistémico. Sin embargo, en la mayoría de los pacientes no consigue obtener una recuperación completa según criterios de Siegel.
Abstract
Introduction
Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30 dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed.
Material and method
An observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegel's criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up.
Results
The difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13 dB and 66.11 dB in the treatment group (P < .01). After 6 months, the mean PTA improvement was 10.84 dB in the treatment group, and 1.13 dB in the control group, a significant difference (P < .0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group.
Conclusion
Intratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegel's criteria in most cases.
https://ift.tt/2vpMqMN
Actualización del consenso sobre el diagnóstico y tratamiento de la sordera súbita idiopática
Publication date: Available online 6 August 2018
Source: Acta Otorrinolaringológica Española
Author(s): Mayte Herrera, José Ramón García Berrocal, Ana García Arumí, María José Lavilla, Guillermo Plaza, Grupo de Trabajo de la Comisión de Audiología de la SEORL
Resumen
Introducción
La sordera súbita idiopática (SSI) es aquella hipoacusia neurosensorial de inicio súbito de causa desconocida.
Objetivos
Actualización del consenso sobre el diagnóstico, tratamiento y seguimiento de la SSI.
Material y métodos
Presentamos una tercera actualización del consenso de SSI, mediante revisión sistemática de la literatura sobre la SSI desde 1966 hasta marzo de 2018, sobre los términos MESH «(acute or sudden) hearing loss or deafness», con 1.508 artículos relevantes.
Resultados
En cuanto al diagnóstico, ante una sospecha clínica de SSI, las pruebas diagnósticas que se consideran necesarias son las siguientes: otoscopia, acumetría, audiometría tonal, audiometría verbal y timpanograma para descartar causas transmisivas de sordera. Una vez hecho el diagnóstico clínico de SSI, antes de comenzar el tratamiento, se solicitará una batería analítica. Deberá completarse más tarde el estudio con RM de oído interno, idealmente en los primeros 15 días, para descartar causas específicas de sordera súbita neurosensorial y para contribuir a elucidar posibles mecanismos fisiopatológicos. A pesar de la controversia en cuanto al tratamiento de SSI, se recomienda, por los efectos en la calidad de vida de la SSI y los raros eventos indeseables con esteroides a corto plazo, que el tratamiento de la SSI esté basado fundamentalmente en los corticoides, que pueden utilizarse por vía oral o intratimpánica, en función del paciente. En caso de fracaso de la vía sistémica, se recomienda usar corticoides intratimpánicos como rescate. Respecto al seguimiento, se realizará un control a la semana del inicio, a los 7 días y hasta los 12 meses.
Conclusiones
Como consenso, el resultado de los tratamientos aplicados debería presentarse tanto en cantidad de decibelios recuperados en el umbral auditivo tonal como con parámetros de audiometría verbal.
Abstract
Introduction
Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss.
Objectives
To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL.
Material and methods
After a systematic review of the literature from 1966 to March 2018, on MESH terms «(acute or sudden) hearing loss or deafness», a third update was performed, including 1508 relevant papers.
Results
Regarding diagnosis, 11 ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months.
Conclusion
By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry.
https://ift.tt/2Mo6l5v
Tratamiento quirúrgico del angiofibroma nasofaríngeo juvenil en pacientes pediátricos
Publication date: Available online 6 August 2018
Source: Acta Otorrinolaringológica Española
Author(s): Juan Francisco Oré Acevedo, Luis Martín La Torre Caballero, Rosmery Janet Urteaga Quiroga
Resumen
Introducción y objetivos
El nasoangiofibroma juvenil es una neoplasia benigna sumamente vascularizada de tratamiento complejo, tanto en su preparación quirúrgica como en la cirugía a realizar, los riesgos y las recurrencias.
El objetivo es analizar el manejo y tratamiento quirúrgico para el nasoangiofibroma juvenil.
Materiales y métodos
Se revisaron las historias clínicas e imágenes de los pacientes intervenidos por la especialidad de cirugía de cabeza, cuello y maxilofacial con resultado de proceso patológico compatible con nasoangiofibroma juvenil, en el periodo comprendido entre enero de 2008 a diciembre de 2016.
Resultados
Se intervinieron 61 casos, todos ellos tratados con el mismo acceso quirúrgico por medio de una osteotomía Le Fort I. La totalidad de los pacientes fue de sexo masculino, con un promedio de edad de 13,3 años. Se utilizó la clasificación de Andrew-Fish para la estadificación de los casos, obteniendo los grados ii y i la mayor cantidad de casos.
Conclusiones
El abordaje descrito provee un acceso quirúrgico extenso, el cual es adecuado para los diferentes estadios de la tumoración. Requiere de experiencia para poder llevar a cabo la resección de la tumoración con el menor sangrado posible.
Abstract
Introduction and objectives
The juvenile nasopharyngeal angiofibroma is a highly vascularised benign neoplasm of complex treatment in its surgical preparation, surgery to be performed, risks and recurrences.
The aim of the study was to analyze the management and surgical treatment for the pathology of juvenile nasoangiofibroma.
Materials and methods
We reviewed the clinical histories and images of the patients who underwent surgery with a pathology result of juvenile nasoangiofibroma in the period from January 2008 to December 2016.
Results
Sixty-one cases were treated; all of them treated using the same surgical access by means of a Le Fort I osteotomy. All of the patients were male, with an average age of 13.3 years. The Andrew-Fish classification was used for staging the cases, most were staged as grade II and I.
Conclusions
The described approach provided extensive surgical access, which was adequate for the different stages of the tumour. It requires experience to be able to resect the tumour with the least possible bleeding.
https://ift.tt/2M1blQD
In vitro effect of a resin infiltrant on different artificial caries-like enamel lesions
Publication date: Available online 6 August 2018
Source: Archives of Oral Biology
Author(s): Maria Cristina Carvalho de Almendra Freitas, Larissa Vasconcellos Nunes, Lívia Picchi Comar, Rios Daniela, Ana Carolina Magalhães, Heitor Marques Honório, Wang Linda
Abstract
Objectives
A resin infiltrant was employed for the treatment of active white spot lesions due to its ability to penetrate into the enamel pores and prevent the progression of the lesion. However, limited information is available about its mechanical effect on different artificial enamel lesions as well as on its resistance to further demineralization. Therefore, this study aimed to evaluate the effects of the Icon® infiltrant on different artificial caries-like enamel lesions and its resistance to new acid challenges.
Design
Artificial lesions were produced in bovine enamel using three different protocols (demineralization/remineralization cycling, DE-RE; 8% methylcellulose gel, MC; and methyl ethyl diphosphonate solution, MHDP; n = 13). The specimens were treated with Icon® and subjected to a new acid challenge using DE-RE cycling. The surface and cross-sectional hardness were evaluated in sound, demineralized, treated and further demineralized enamel areas. Data were statistically analyzed using ANOVA and Tukey's test (p < 0.05).
Results
All of the demineralizing protocols produced subsurface artificial caries lesions. The infiltrant was able to partially recover the surface hardness and prevent further surface hardness loss in enamel previously demineralized using the DE-RE and MHDP protocols. In regard to cross-sectional hardness, no positive effect was found.
Conclusions
The effect of the infiltrant depends on the type of lesion created in vitro, and its action is limited to the lesion surface.
https://ift.tt/2ASwOGK
Clinical and Genetic Signatures of Local Recurrence in Oral Squamous Cell Carcinoma
Publication date: Available online 6 August 2018
Source: Archives of Oral Biology
Author(s): Yasmine Ghantous, Zaher Bahouth, Imad Abu El-naaj
Abstract
Purpose
Recurrent and metastatic Oral Squamous Cell Carcinoma (OSCC) is often incurable. There are large gaps in the understanding of the clinical course, biology and genetic biomarkers of OSCC which could help us identify patients with high-risk of recurrence who may benefit from intensified therapy or novel targeted therapy trials.
The purpose of this study was to identify significant clinical, pathological and genomic risk factors for local recurrence in OSCC.
Patients and methods
Molecular data sets and clinicopathological characteristics of 159 head and neck carcinoma patients were obtained from The Cancer Genome Atlas (TCGA) data portal and analyzed using the Genome Data Analysis Center and cBioPortal to find significant risk factors for tumor recurrence.
Results
The local recurrence rate was 24%. OSCC originating from the buccal mucosa composed 13% of all the tumors in the recurrent group, making it a statistically significant risk of recurrence (P value = .03). Likewise, positive surgical margins, pathological T staging, and alcohol consumption were found to be significantly associated with recurrence (P value < .05).
Genetic profiling revealed the top 5 mutated genes (using the MutSigCV analysis). Only one of these genes, CASP8 was the only gene that was significantly altered only in the recurrent group (Q value = 8.7 × 10-11). The fingerprint of 5 mutated genes was found in 97% of the patients in the recurrence group. Moreover, copy number alterations in cytoband 5p15.33, which involved amplification in telomerase reverse-transcriptase (TERT) gene, was found to be significant only in the recurrent group.
Conclusions
In the current study, we found several clinical and genetic characteristics that could define patients with high-risk of OSCC recurrence. This provides a means of identifying patients that may benefit from intensified therapy or novel targeted therapy trials.
https://ift.tt/2vpeFeK
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