Head and Neck Diseases by Alexandros G.Sfakianakis: 08/08/18

Τετάρτη 8 Αυγούστου 2018

Visual Snow: Visual Misperception

Background: Visual snow (VS) is a constant visual disturbance described as flickering dots occupying the entire visual field. Recently, it was characterized as the defining feature of a VS syndrome (VSS), which includes palinopsia, photophobia, photopsias, entoptic phenomena, nyctalopia, and tinnitus. Sixty percent of patients with VSS also experience migraine, with or without aura. This entity often is considered psychogenic in nature, to the detriment of the patient's best interests, but the high frequency of similar visual symptoms argues for an organic deficit. The purpose of this review is to clarify VSS as a true entity and elaborate the nature of individual symptoms and their relationship to each other. Evidence Acquisition: The literature was reviewed with specific regard to the clinical presentation and psychophysical, neurophysiological, and functional imaging studies in patients with defined visual disturbances that comprise VSS. Results: Consideration of the individual symptoms suggests that multiple factors are potentially involved in the development of VSS, including subcortical network malfunction and cortical hyperexcitation. Although there is substantial overlap between VSS and migraine syndromes in terms of co-occurring symptoms, both neurophysiological and neuroimaging studies provide substantial evidence of separate abnormalities of processing, supporting these as separate syndromes. Conclusions: VSS is likely associated with either hyperactive visual cortices or, alternatively, impaired processing of simultaneous afferent information projecting to cortex. VSS likely results from widespread disturbance of sensory processing resulting in sensory misperception. There may be a number of syndromes associated with impaired sensory processing resulting in sensory misperception, including migraine, persistent perceptual postural dizziness, and tinnitus, which overlap with VSS. Elucidation of abnormality in one defined syndrome may provide a path forward for investigating all. Address correspondence to Owen B. White, MD, PhD, FRACP, Department of Neurosciences, Central Clinical School, Alfred Hospital, Monash University, Prahran, Victoria 3181, Australia; E-mail: owen.white@monash.edu The authors report no conflicts of interest. © 2018 by North American Neuro-Ophthalmology Society

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Neuro-Ophthalmology: Diagnosis and Management

No abstract available

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Initial Impairment and Recovery of Vision-Related Functioning in Participants With Acute Optic Neuritis From the RENEW Trial of Opicinumab

Background: Leucine-rich repeat and immunoglobulin domain-containing Nogo receptor-interacting protein 1(LINGO-1 is a key suppressor of oligodendrocyte differentiation and axonal remyelination and regeneration. This analysis evaluated the potential benefit of opicinumab, a human monoclonal antibody against LINGO-1, vs placebo on exploratory clinical endpoints of patient-reported vision-related functioning and high-contrast visual acuity (HCVA) in RENEW participants with acute optic neuritis (AON). Methods: Participants were randomized to 100 mg/kg opicinumab intravenous or placebo every 4 weeks (6 infusions). Assessments were conducted in the per-protocol (PP) population and included: 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), 10-item Neuro-Ophthalmic Supplement (NOS-10), and HCVA. Results: The opicinumab group (n = 33) had worse mean (SD) baseline patient-reported vision-related functioning scores vs placebo (n = 36): NEI-VFQ-25 composite, 75.5 (17.6) vs 79.0 (16.6); NOS-10 composite, 63.6 (19.8) vs 69.8 (21.2), respectively. By Week 24, the placebo and opicinumab groups experienced substantial mean improvements from baseline (NEI-VFQ-25 composite, 15.17 vs 13.51 [difference (95% CI): −1.66 (−5.11 to 1.78)]; NOS-10 composite, 17.40 vs 16.04 [difference (95% CI): −1.35 (−7.38 to 4.67)]). Between-treatment differences in mean change from baseline were not significantly different at any time point. Analysis of covariance–adjusted mean recovery from baseline in HCVA at Week 24 for the affected eyes was 11.8 and 8.7 letters for placebo and opicinumab, respectively (P = 0.202). Conclusions: Most participants in the RENEW PP population demonstrated substantial recovery from baseline in patient-reported vision-related functioning and HCVA, regardless of treatment and structural damage. Average scores after recovery remained lower than those of published disease-free control groups. These results provide important information on visual function recovery in patients with AON, as measured by NEI-VFQ-25 and NOS-10. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Address correspondence to Jennifer Petrillo, PhD, Global Health Economics and Outcomes Research, Biogen, 225 Binney Street, Cambridge, MA 02142; E-mail: jennifer.petrillo@biogen.com The RENEW study and these analyses were funded by Biogen (Cambridge, MA). J. Petrillo is an employee of and holds stock/stock options in Biogen. D. Cadavid was an employee of Biogen at the time of these analyses and drafting of the manuscript, and is currently a full-time employee of Fulcrum Therapeutics. Y. Chai and L. Xu were full-time employees of Biogen, Cambridge, MA, at the time of these analyses and drafting of the manuscript, and may hold stock/stock options in Biogen. L. Balcer has received consulting/advisor fees from Biogen and Genzyme. S. Galetta has received consulting fees from Biogen. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2BFTkP1). ClinicalTrials.gov identifier: NCT01721161 (BIIB033 In Acute Optic Neuritis (AON); https://ift.tt/2vRpd5N). © 2018 by North American Neuro-Ophthalmology Society

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SAMHD1 deficient human monocytes autonomously trigger type I interferon

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Alicia Martinez-Lopez, Marta Martin-Fernandez, Sofija Buta, Baek Kim, Dusan Bogunovic, Felipe Diaz-Griffero

Abstract

Germline mutations in the human SAMHD1 gene cause the development of Aicardi-Goutières Syndrome (AGS), with a dominant feature being increased systemic type I interferon(IFN) production. Here we tested the state of type I IFN induction and response to, in SAMHD1 knockout (KO) human monocytic cells. SAMHD1 KO cells exhibited spontaneous transcription and translation of IFN-β and subsequent interferon-stimulated genes (ISGs) as compared to parental wild-type cells. This elevation of IFN-β and ISGs was abrogated via inhibition of the TBK1-IRF3 pathway in the SAMHD1 KO cells. In agreement, we found that SAMHD1 KO cells present high levels of phosphorylated TBK1 when compared to control cells. Moreover, addition of blocking antibody against type I IFN also reversed elevation of ISGs. These experiments suggested that SAMHD1 KO cells are persistently auto-stimulating the TBK1-IRF3 pathway, leading to an enhanced production of type I IFN and subsequent self-induction of ISGs.

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Inotuzumab Ozogamicin: A Review in Relapsed/Refractory B-Cell Acute Lymphoblastic Leukaemia

Abstract

The intravenous CD22-directed antibody drug conjugate inotuzumab ozogamicin (Besponsa^®) is approved in several countries including in the USA, EU and Japan, as monotherapy for the treatment of adults with relapsed/refractory B-cell acute lymphoblastic leukaemia (ALL). In adults with relapsed/refractory B-cell ALL who had received one or two prior treatment regimens, inotuzumab ozogamicin was associated with significantly higher rates of complete remission (including complete remission with incomplete haematological recovery) [CR/CRi] than standard therapy in the pivotal INO-VATE ALL trial. Inotuzumab ozogamicin was associated with significantly longer progression-free survival (PFS), duration of remission and higher haematopoietic stem cell transplantation (HSCT) rates than standard therapy. Although there was no significant between-group difference in overall survival duration as per the study design, the 2-year survival probability in the inotuzumab ozogamicin arm was twice that in the control arm. Inotuzumab ozogamicin had an acceptable tolerability profile. Thus, inotuzumab ozogamicin is an important new treatment option for patients with relapsed/refractory CD22-positive B-cell ALL.

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Vitamin D Deficiency has a Negative Impact on Cetuximab-Mediated Cellular Cytotoxicity against Human Colon Carcinoma Cells

Abstract

Background

Hypovitaminosis D is associated with an adverse prognosis in colon cancer patients, possibly due to the effects of the vitamin on the immune system. Antibody-dependent cell-mediated cytotoxicity (ADCC) significantly contributes to the anti-tumor effects of monoclonal antibodies, including cetuximab, an epidermal growth factor receptor (EGFR)-targeted monoclonal antibody that is frequently added to chemotherapy in the treatment of colon cancer.

Objective

The present study evaluates the association between vitamin D serum levels and the ability of ex vivo NK cells to support cetuximab-mediated ADCC in colon cancer cell lines.

Methods

Blood samples were obtained from 124 healthy volunteers and serum vitamin D was determined by RIA. NK cells were isolated from each sample and added to human colorectal carcinoma cells with or without cetuximab, and ADCC was assessed using a colorimetric lactate dehydrogenase assay.

Results

Correlation analysis indicates a significant, gender- and age-independent association between vitamin D levels and cetuximab-induced ADCC on HT29 cells, where NK cells from samples with vitamin D < 20 ng/mL are significantly less efficient in inducing ADCC. A confirmatory study on two additional colon cancer cell lines yielded similar results.

Conclusions

These data suggest that vitamin D supplementation in vitamin-deficient/insufficient colorectal cancer patients could improve cetuximab-induced ADCC.

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Effects of cold atmospheric plasma (CAP) on bacteria and mucosa of the upper aerodigestive tract

Publication date: Available online 8 August 2018

Source: Auris Nasus Larynx

Author(s): Sven Becker, Julia L. Zimmermann, Philipp Baumeister, Theresa F. Brunner, Tetsuji Shimizu, Yang-Fang Li, Gregor E. Morfill, Ulrich Harréus, Christian Welz

Abstract

Objective

Ear, nose and throat infections are among the most common reasons for absence from work. They are usually caused by various bacteria like Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes. Cold atmospheric plasma (CAP) can effectively eliminate even multi-resistant bacteria and has no cytotoxic or mutagenic effects on the mucosa when applied for less than 60 s. Aim of the study was to evaluate the effects of CAP on common ENT bacteria and on the mucosa of the upper aerodigestive tract.

Methods

The bactericidal effects of CAP against the bacteria most commonly causing ENT infections were investigated using the colony-forming units assay (CFU) on a Müller-Hinton agar plate after applying CAP for 30, 60, 90 and 120 s. To evaluate the interaction of CAP with mucosal cells, 3D mini organ cultures were treated for up to 180 s, after which cell viability and necrosis induction were evaluated.

Results

Treatment with CAP for 60 s or longer induced at least a 3-log₁₀ reduction in the bacterial load (> 99.9%). Treatment times shorter than 60 s had only slight cytotoxic effects on cell viability and necrosis whereas treatment times above 60 s showed a fast increase of cytotoxic side effects.

Conclusion

CAP exhibited strong bactericidal effects on the most common ENT pathogens. Treatment times of up to 60 s showed only minimal adverse reactions in healthy mucosa. CAP could be a promising new therapeutic modality for ENT infections.

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Lessons learnt from managing a case of dengue hemorrhagic fever complicated with acute liver failure and acute kidney injury: a case report

Dengue is a common arboviral infection with a diverse spectrum of clinical manifestations. Dengue hemorrhagic fever is a more severe form of infection characterized by plasma leak and hemoconcentration. Althou...

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Stability of mercury on a novel mineral sulfide sorbent used for efficient mercury removal from coal combustion flue gas

Abstract

Nano-structured zinc sulfide (Nano-ZnS) has been demonstrated to be a promising alternative to activated carbon (AC) for controlling mercury emission from coal combustion flue gas. The ultimate fate of the mercury-laden Nano-ZnS after mercury capture is mostly disposed in landfill with fly ashes. Thus, the stability of mercury adsorbed on the Nano-ZnS is of considerable significance in the secured disposal of fly ash after mercury removal and in the commercial application of the Nano-ZnS sorbent for removal of mercury from coal combustion flue gas. In this work, a modified toxicity characteristic leaching procedure (TCLP) was conducted to evaluate the leachability of mercury on the Nano-ZnS. The effects of leachate pH value, leaching time, liquid-to-solid ratio, and acid rain types on mercury leaching from the mercury-laden Nano-ZnS were systematically investigated. The TCLP results show that the concentration of mercury in leachate was far below the safe limit (200 μg/L) as imposed by the US Environmental Protection Agency (EPA) for classifying a material as a hazardous waste. All the key parameters that generally affected metal leaching rate exhibited slight effect on mercury leaching from the mercury-laden Nano-ZnS. Leaching tests at various highly severe conditions resulted in less than 0.01% mercury leaching from the mercury-laden Nano-ZnS. Sequential selective extraction tests demonstrated that mercury sulfide (HgS) was the dominant adsorption product on the Nano-ZnS, which guaranteed the excellent stability of mercury adsorbed on the Nano-ZnS.

Graphic abstract

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Waste-cleaning waste: synthesis of ZnO porous nano-sheets from batteries for dye degradation

Abstract

This paper describes a clean approach of waste-cleaning waste. Two-dimensional (2D) ZnO porous nano-sheets were synthesized from end-of-life zinc-carbon batteries via a simple homogeneous precipitation-calcination route, and the as-synthesized product was applied as photocatalyst for the purpose of photodegradation of methylene blue/MB aqueous solution under UV-Vis irradiation. Precipitation at ambient temperature resulted in the formation of the crystalline phase of zinc hydroxide nitrate hydrate [Zn₅(OH)₈(NO₃)₂(H₂O)₂], which was then transformed to ZnO through calcination. FE-SEM studies revealed the resulting ZnO had the morphology of porous nano-sheets with thickness of up to 100 nm. The photocatalytic activity tests proved that the batteries-derived ZnO porous nano-sheets can be a promising candidate for photodegradation of organic pollutant in industrial waste water. The results presented here confirm a possibility of utilization waste batteries as a resource of photodegrading MB in wastewater treatment, hereby an opportunity to deliver environmental benefits.

Graphical abstract

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HIF-1α-induced xenobiotic transporters promote Th17 responses in Crohn's disease

Publication date: Available online 8 August 2018

Source: Journal of Autoimmunity

Author(s): Anyan Xie, René J. Robles, Samiran Mukherjee, Haohai Zhang, Linda Feldbrügge, Eva Csizmadia, Yan Wu, Keiichi Enjyoji, Alan C. Moss, Leo E. Otterbein, Francisco J. Quintana, Simon C. Robson, Maria Serena Longhi

Abstract

In Crohn's disease, pathogenic Th17-cells express low levels of CD39 ectonucleotidase and are refractory to the immunosuppressive effects of unconjugated bilirubin (UCB), an endogenous ligand for aryl-hydrocarbon-receptor (AhR). This resistance to AhR ligation might be associated with alterations in responses to hypoxia. Limited exposure to hypoxia appears beneficial in acute tissue injury. However, in protracted inflammation, hypoxemia may paradoxically result in Th17-cell activation. We report here that in vitro exposure of Th17-cells from Crohn's disease patients to hypoxia limits responsiveness to AhR stimulation by UCB, as reflected by lower CD39 levels. Blockade of hypoxia-inducible-factor-1alpha (HIF-1α) upregulates CD39 and favors Th17-cell regulatory responses. Resistance of Th17-cells to AhR signaling results, in part, from HIF-1α-dependent induction of ATP-binding cassette (ABC) transporters: multidrug-resistance-protein-1 (MDR1) and multidrug-resistance-associated-protein-4 (MRP4). Increased ABC transporters promote efflux of suppressive AhR ligands, such as UCB, from Th17-cells. Inhibition of MDR1, MRP4 and/or HIF-1α with ritonavir (RTV) reconstitutes AhR function in Th17-cells, enhancing therapeutic effects of UCB in dextran-sulfate-sodium-induced experimental colitis.

Deleterious effects of hypoxia on Th17-cells in Crohn's disease can be ameliorated either by inhibiting HIF-1α or by suppressing ABC transporters to increase UCB availability as an AhR substrate. Targeting HIF-1α-ABC transporters could provide innovative therapeutic pathways for IBD.

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Transfer of Topical Testosterone to Subcutaneous Microdialysate, Blood and Saliva in Healthy Young Men

11-2017-0451-endo_10-1055-a-0650-4115-1.

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0650-4115

Objective We evaluated percutaneous penetration of topical testosterone and subsequent transfer to subcutaneous tissue, blood and saliva. Methods This microdialysis trial involved eight healthy male volunteers. Five participants received a single dose of 50 mg testosterone gel on the abdominal skin and three untreated participants served as controls. Two microdialysis probes were inserted percutaneously into the abdominal subcutaneous adipose tissue. On the skin above one probe, testosterone gel was applied (ipsilateral side). A second control probe was inserted on the contralateral side. For the determination of total and free testosterone, samples of subcutaneous microdialysate, serum, and saliva were collected over six hours, frozen, and analysed using ELISA procedures. Results Testosterone values in the ipsilateral microdialysate of treated subjects increased significantly within 6 h after gel application compared to controls. Salivary testosterone levels showed a rapid increase within 20 min after transdermal application followed by a plateau phase with tenfold increased testosterone levels. Microdialysate testosterone of the contralateral site started to rise moderately within the normal range 1 h after administration of testosterone gel whereas total and free testosterone serum concentrations increased within 2 h in each case followed by a plateau phase. Summary and Conclusion Single topical administration of testosterone gel leads to a continuous increase of testosterone in the subcutaneous ipsilateral microdialysate. Rapid salivary testosterone increase happens after gel administration followed by tenfold increased testosterone plateau values. Despite continuous influx, testosterone concentrations in serum, saliva, and contralateral microdialysate show a plateau formation thus avoiding testosterone excess.
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Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Review of Scientific Self-Experimentation: Ethics History, Regulation, Scenarios, and Views Among Ethics Committees and Prominent Scientists

Rejuvenation Research, Ahead of Print.

https://ift.tt/2M7IASY

Filling Procedures for Lip and Perioral Rejuvenation: A Systematic Review

Rejuvenation Research, Ahead of Print.

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Amylose cutanée dychromique autosomique récessive et mutations de GPNMB

Publication date: Available online 8 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): O. Dereure

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Efficacy and safety data for checkpoint inhibitors in advanced melanoma under real-life conditions: A monocentric study conducted in Nice from 2010 to 2016

Publication date: Available online 8 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): H. Taquin, E. Fontas, O. Massol, P. Chevallier, R. Balloti, G. Beranger, J.-P. Lacour, T. Passeron, H. Montaudié

Summary

Background

Immunotherapies using anti-CTLA4 and anti-PD1 antibodies have revolutionised the management of patients with advanced melanoma. The aim of our study was to analyse the efficacy and safety of immunotherapies in patients with advanced melanoma under real-life conditions.

Methods

We conducted a monocentric, retrospective, observational study that included all patients treated with immunotherapies (ipilimumab, i.e. ipi; nivolumab, i.e. niv and pembrolizumab, i.e. pbr) for advanced melanoma with exclusion of primary mucosal or ocular melanoma. The primary endpoint was progression-free survival (PFS).

Results

A total of 110 patients were included. Median PFS was better in the anti-PD1 group than in the anti-CTLA4 group (3.9 months vs. 2.9 months, P = 0.025). The frequency of adverse events of any grade was 53.4% with ipi, 66.7% with niv and 75% with pbr.

Discussion

Our study shows slightly inferior efficacy data vs. clinical trials of ipi and niv because patients were presenting more severe illness at inclusion. Nevertheless, the study argues in favour of the superiority of anti-PD1 antibodies vs. anti-CTLA4 antibodies in terms of PFS and best overall response. Moreover, our study exhibits safety data comparable to those from clinical trials except for a lower frequency with ipi.

Conclusion

Our efficacy and safety data obtained under real-life conditions are reassuring since they are consistent with data already published.

Résumé

Introduction

Les immunothérapies par anti-CTLA4 et anti-PD1 ont révolutionné la prise en charge du mélanome avancé. Le but de ce travail était d'étudier l'efficacité et la tolérance des immunothérapies utilisées en conditions de vie réelle chez des patients traités pour un mélanome avancé.

Méthodes

Étude observationnelle, rétrospective, monocentrique, incluant les patients en immunothérapie par ipilimumab (ipi), nivolumab (ni) ou pembrolizumab (pbr) pour un mélanome avancé hors mélanome muqueux ou choroïdien. Le critère principal de jugement était la survie sans progression (SSP).

Résultats

Au total, 110 patients ont été inclus. La médiane de SSP des patients sous anti-PD1 était supérieure à celle des patients traités par anti-CTLA4 (3,9 mois vs. 2,9 mois ; p = 0,025). La fréquence de survenue d'évènements indésirables quel que soit leur grade était de 53,4 % pour l'ipi, 66,7 % pour le niv et 75 % pour le pbr.

Discussion

Notre étude montre des données d'efficacité légèrement inférieures à celles des essais cliniques pour l'ipi et le niv, en lien avec des patients plus sévères à l'inclusion. Néanmoins, notre travail est en faveur de la supériorité des anti-PD1 par rapport à l'anti-CTLA4 en termes de SSP et de meilleure réponse globale. Il objective enfin des données de tolérance comparables à celles des essais cliniques, mis à part une fréquence moindre d'évènements indésirables dans the ipi group.

Conclusion

Nos données d'efficacité et de tolérance des immunothérapies dans le mélanome avancé en vie réelle sont rassurantes car cohérentes avec les données de la littérature.

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Skin Perforator Mapping Method for Anterolateral Thigh Flap using Indocyanine Green Angiography

Anterolateral thigh flap is one of the most popular flaps among microsurgeons. This flap was born in 19841), however it is still being refined to date 2, 3). In developing the flap, skin perforator mapping plays an important role in improving the reliability of operations. Nowadays, several methods of detecting perforators are reported. Among these, CT angiography, Sound Doppler and Color Doppler are the standard used to locate perforators.

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Autologous Fat Grafting after Sarcoma surgery: evaluation of oncological safety

The regenerative effectiveness of lipoaspirate procedures relies on the presence of mesenchymal stem cells, but the stromal microenvironment and hormonal secretions of adipose tissue can be involved in cancer growth. Only few oncological outcome studies of fat grafting at the surgical site of malignant neoplasms of mesenchymal origin are available; none of these examined a series of sarcoma cases.

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Potential of performing a microvascular free flap reconstruction using solely a 3D Exoscope instead of a conventional microscope

Since the introduction of the operating microscope in the mid of the 20th century reconstructive microsurgery has emerged and pushed its boundaries continuously 1, 2.

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“Hand rejuvenation by Stromal Enriched Lipograft”

The rejuvenation of the hand has received increased attention recently. Autologous transplantation of fat tissue enables subcutaneous regeneration by refilling the subcutaneous space 1,2 and hence reducing some of the age-related degenerative processes of the hand dorsum such as epidermal changes, dermal and subdermal atrophy, with deep intermetacarpal spaces, prominent bones and tendons, and bulging reticular veins.

https://ift.tt/2MemE7O

Extended Chest Wall Based Flap and Lipofilling for Immediate Breast Reconstruction for Obese Patients

Increasing rates of obesity in the general population have coincided with increased rates of obese patients with breast cancer1. Breast reconstruction in the overweight population represents a challenge for the plastic surgeon. Multiple studies have shown very high complication rates for both prosthetic and autologous reconstruction in these patients. Obesity confers independent risk of perioperative medical and surgical morbidity in breast reconstruction population2.

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The impact of surgical alar (lower lateral) cartilage manipulation on lateral crural stiffness

Cephalic trimming of the alar (or lower lateral) cartilage may cause weakening leading to external nasal valve collapse. Numerous methods have been proposed to combat this weakening in order to maintain lateral crural stiffness. The purpose of this study was to quantify the effect of mucosal stripping, cephalic trimming, cephalic turn-in flap, and lateral crural strut grafting on lateral crural stiffness.

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New technical method to correct secondary vermilion deformities with cleft lip

Various techniques for correcting whistling deformities that occurred after primary surgery for cleft lip have been reported. These techniques are mainly intended to correct the lack of volume of the red lip. However, irregularity of the dry-wet lip junction (mucocutaneous junction) in the red lip has rarely been mentioned. If the wet lip is located in an exposed area, not only is the aesthetic appearance poor but also uncomfortable complications such as a crusted or bleeding lip repeatedly occur under a dry condition.

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Half-transection Method Combined with Intravascular Stent for Supermicrosurgical Lymphaticovenular Anastomosis

Since the revolution of supermicrosurgical technique was first published in 2000 as the least invasive treatment for lymphedema, lymphaticovenular anastomosis (LVA) has become popular for the treatment of lymphedema and has been proved effective in reducing lymphedema severity.1-3 However, the lymphaticovenular anastomosis is a demanding technique because the functioning drainage lymphatic vessel is translucent, soft and has a thin wall. To overcome these challenges, the Intravascular Stent (IVaS) has been applied for safe and precise LVA.

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Effects of cold atmospheric plasma (CAP) on bacteria and mucosa of the upper aerodigestive tract

Ear, nose and throat infections are among the most common reasons for absence from work. They are usually caused by various bacteria like Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes. Cold atmospheric plasma (CAP) can effectively eliminate even multi-resistant bacteria and has no cytotoxic or mutagenic effects on the mucosa when applied for less than 60s. Aim of the study was to evaluate the effects of CAP on common ENT bacteria and on the mucosa of the upper aerodigestive tract.

https://ift.tt/2M0TlXf

Interpreting competitive adsorption of arsenate and phosphate on nanosized iron (hydr)oxides: effects of pH and surface loading

Abstract

Arsenate and phosphate have similar properties due to their electrochemical structures, but their environmental impacts are unique. The abundance and competition of arsenate and phosphate determine their bioavailability and leachability; thus, it is essential to understand their fate in the soil environment. In this study, the effects of pH and surface loading on the competitive adsorption of arsenate and phosphate on four iron (hydr)oxides were evaluated by employing the Langmuir isotherm, competitive sorption ratio (CSR), and competition effect (CE). The stability and transformation of the iron (hydr)oxides were also assessed. Various adsorption patterns were observed in the single and mixed treatments by controlling the addition of oxyanions, pH, surface loading, and type of iron (hydr)oxides. Arsenate was preferentially adsorbed at a low pH, whereas phosphate showed the opposite trend. The CE_As(V),P(V) was close to zero at low surface density (no competition) and sequentially changed to negative or positive values with increasing surface density, indirectly indicating the sequential development of promotive and competitive effects. Transformation in goethite was identified at a high pH with the presence of oxyanions, except that no transformation was observed upon the addition of oxyanions and with pH change. However, the stability of the iron (hydr)oxides decreased at a low pH and with the presence of phosphate, arsenate, or both. The hematite showed a significant promotive effect regardless of the pH. Our study revealed that the pH, surface loading, and type of iron (hydr)oxides are intercorrelated and simultaneously affect the adsorption characteristics of oxyanions and the stability of iron (hydr)oxides.

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Root and Root Canal Variations of the Human Maxillary and Mandibular Third Molars in a Chinese Population: a Micro–Computed Tomographic Study

Publication date: Available online 8 August 2018

Source: Archives of Oral Biology

Author(s): Wuyue Zhang, Ying Tang, Chao Liu, Yifen Shen, Xingmei Feng, Yongchun Gu

ABSTRACT

Objectives

To investigate the anatomical variations of the root and root canal configuration of the human third molars.

Designs

A total of 130 maxillary and 130 mandibular third molars were collected from a native Chinese population. All teeth were scanned by micro–computed tomography. After 3D reconstruction, the root and canal morphology of each tooth was examined both qualitatively and quantitatively.

Results

For maxillary molars, a single fused root (67 cases, 51.5%) and a single root canal system (64 cases, 49.2%) was most common root/canal form; the typical three-rooted molars were detected only in 33 cases (25.4%), and the secondary MB canals were detected only in 9 molars (6.9%). For mandibular molars, 62 teeth were single-rooted (47.7%) and 42 had a single root canal system (32.3%); 20 singled-rooted and 60 double-rooted molars exhibited independent mesial and distal root canal systems (61.5%), and the type 1-1 canal was the most common configuration for mesial (57 cases) and distal (81 cases) root canal systems. C-shaped canals were detected in 11 maxillary and 36 mandibular single-rooted molars. The mean root surface area, root and crown volume of mandibular third molars were significantly higher than the maxillary third molars (P < 0.01).

Conclusion

The root canal system of the third molars may exhibit several anatomic variations. Whereas in most of cases, the degree of the canal differentiation was at a low level, and the canal form was not complicate.

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Are Risk Factors for Coronary Artery Disease Different in Persons With and Without Obesity?

Metabolic Syndrome and Related Disorders, Ahead of Print.

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Low level laser therapy reduces oral leukoplakia lesion size: Results from a preliminary study

Publication date: Available online 8 August 2018

Source: Oral Oncology

Author(s): Bhagyashree Jagtap, D.Y. Patil Vidyapeeth, Kalyani Bhate, S.N. Santhoshkumar

https://ift.tt/2Me0mTR

New Ringer's lactate gel formulation on nasal comfort and humidification

Publication date: Available online 8 August 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Maura Catafesta das Neves, Fabricio Ricci Romano, Samuel Guerra Filho

Abstract

Introduction

The use of saline irrigation for nasal washes is a well established procedure in the treatment of sinonasal inflammation and infection. In addition to saline solutions, Ringer's lactate is also an efficient option for nasal washes and humidification.

Objective

To assess the comfort, humidification and tolerance regarding stinging sensation, provided by sodium chloride nasal gel at the concentrations of 4.5 mg/g and 6.0 mg/g through questionnaires answered by the patients.

Methods

A total of 60 patients, 56 females, aged between 22 and 66 years old (mean age of 47) and 4 males, aged between 36 and 66 years (mean age of 49), were included in the study for a period of 17 days (±2 days) treatment. The patients were monitored by a general practitioner throughout the study period. They were instructed to apply each product in both nostrils twice a day during a 7-day period (±2 days). The patients were evaluated prior to the use of the first product at visit 0 (V0), after 7 days of treatment (±2 days) at visit 1 (V1), after 3 days of product discontinuation at visit 2 (V2) and after 7 days (±2 days) of treatment with the second product, in visit 3 (V3).

Results

A significant difference (5% significance) was observed regarding comfort and stinging sensation between the two different concentrations; comfort was higher and stinging was lower with the 6.0 mg/g concentration gel. No difference in humidification was observed between the two treatments.

Conclusion

Ringer's lactate at the concentration of 6.0 mg/g was superior to that at 4.5 mg/g for parameters comfort and stinging sensation. No statistical difference was observed between the two products regarding nasal humidification.

Resumo

Introdução

O uso de soluções salinas para lavagem nasal está consagrado no tratamento de quadros inflamatórios e infecciosos nasossinusais. Além das soluções salinas, o ringer lactato é uma importante opção tanto para lavagem quanto para a hidratação nasal.

Objetivo

Avaliar a tolerabilidade (ardência e conforto) e umidificação do produto gel nasal cloreto de sódio 4,5 mg/g em relação ao ringer lactato 6,0 mg/g, por meio de questionários respondidos pelos pacientes.

Método

No total, 60 pacientes, 56 mulheres (22-66 anos; média: 47 anos) e 4 homens (36-66 anos; média: 49 anos) foram incluídos no estudo de 17 dias (± 2 dias) de tratamento. Os pacientes foram supervisionados por um clínico geral durante todo o período do estudo. Os pacientes utilizaram os produtos com uma borrifada em cada narina duas vezes ao dia, durante 7 dias (± 2 dias). As formulações foram avaliadas antes do uso do primeiro produto na visita 0 (V0), após 7 dias (± 2 dias) de tratamento na visita 1 (V1), após 3 dias de interrupção do primeiro tratamento na visita 2 (V2) e após 7 dias (± 2 dias) de uso do segundo produto na visita 3 (V3).

Resultados

Foi observada diferença significativa para o conforto das vias nasais, (significância de 5%), na comparação entre os tratamentos nos atributos de conforto e ardência. O conforto das vias nasais foi superior e a ardência inferior para o gel nasal ringer lactato 6,0 mg/g em comparação ao gel cloreto de sódio 4,5 mg/g. Não foi observada diferença significativa para a umidificação entre os tratamentos.

Conclusão

O gel ringer lactato 6,0 mg/g foi superior ao produto gel cloreto de sódio 4,5 mg/g nos quesitos conforto e ardência. Não foi observada diferença estatisticamente significante entre os tratamentos em relação à umidificação das vias nasais.

https://ift.tt/2OT5yuQ

Interleukin 8 (CXCL8)-CXC chemokine receptor 2 (CXCR2) axis contributes to MiR-4437-associated recruitment of granulocytes and natural killer cells in ischemic stroke

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Qianyi He, Xiaojuan Shi, Bin Zhou, Junfang Teng, Chaoqi Zhang, Shasha Liu, Jingyao Lian, Benyan Luo, Guoqiang Zhao, Hong Lu, Yuming Xu, Yajun Lian, Yanjie Jia, Yi Zhang

Abstract

Granulocytes and natural killer (NK) cells have been linked to brain injury in ischemic stroke. However, their recruitment from peripheral leucocytes in stroke patients is not well understood. Here, the expression of the interleukin 8 (CXCL8) in plasma, and CXC chemokine receptor 2 (CXCR2) in peripheral leucocytes of patients with ischemic stroke were evaluated. Based on the results, CXCR2 expression positively correlated with granulocytes and NK cells, which were in turn attracted by CXCL8. The results also indicated that CXCR2 was a direct target of microRNA (miR)-4437, a negative regulator of CXCR2, which was downregulated in peripheral leucocytes from patients with ischemic stroke. Furthermore, serum CXCL8 levels were associated with the infarct volume and functional outcomes in patients with ischemic stroke. The results of the receiver operating characteristic curve analysis with an optimal cut-off value of 34 pg/mL indicated serum CXCL8 levels could be a prognostic indicator for ischemic stroke. In conclusion, these data highlighted the involvement of the CXCL8-CXCR2 chemotactic axis in the recruitment of granulocytes and NK cells in ischemic stroke. Furthermore, miR-4437 was suggested as a novel target for treating ischemic stroke, while the serum CXCL8 level could be a prognostic factor for ischemic stroke.

https://ift.tt/2KDOrtv

Tumour origin and R1 rates in pancreatic resections: towards consilience in pathology reporting

Abstract

To evaluate differences in the R1 rates of ampullary (AC), pancreatic (PC), and distal bile duct (DBD) cancers in pancreatoduodenectomies (PD) using standardised pathology assessment. Data of PD (2010–2011) analysed in accordance with the Royal College of Pathologists (UK) protocol, were retrieved. Clinicopathologic features, including frequency, topography, and mode of margin involvement in AC (n = 87), PC (n = 18), and DBD (n = 5) cancers were evaluated. The R1 rate was 7%, 67%, and 20% in the AC, PC, and DBD cancers (p < 0.001). Within the PC cohort, R1 rate was heterogeneous (chemo-naïve, 77%; post-neoadjuvant, 40%). Commonest involved margins were as follows: posterior in overall PD (35%), AC (43%), overall PC (33%), and post-neoadjuvant PC (100%); superior mesenteric artery margin in chemo-naïve PC (38%) and common bile duct margin in DBD (100%) cancers. In AC, majority (66%) of R1 were signet ring cell type. Indirect margin involvement due to tumour within lymph node, perineural sheath or lymphovascular space was observed in 26% cases, and altered R1 rate in AC, PC, and DBD cohorts by 1%, 12%, and 0%, respectively. Although not statistically significant, patients with R1 had lower disease-free survival than those with R0 (mean, 25.4 months versus 44.4 months). Tumour origin impacts R1 data in PD necessitating its accurate classification by pathologists. Indirect involvement, histology, and neoadjuvant therapy influence the R1 rate, albeit in a minority of cases. Generating cogent R1 data based on standardised pathology reporting is the foremost need of the hour.

https://ift.tt/2OiSw8T

Effects of Expiratory Muscle Strength Training on Airway Protection and Swallowing in Chronic Dysphagia After Radiation Therapy

Condition: Cancer of the Head and Neck
Intervention: Device: Expiratory Muscle Strength Training (EMST)
Sponsor: Singapore General Hospital
Not yet recruiting

https://ift.tt/2Msm9nH

Surgery Followed by Risk-Directed Post-Operative Adjuvant Therapy for HPV-Related Oropharynx Squamous Cell Carcinoma: "The Minimalist Trial (MINT)"

Condition: HPV Related Oropharyngeal Squamous Cell Carcinoma
Interventions: Drug: Cisplatin; Radiation: Intensity modulated radiation therapy; Radiation: Intensity modulated proton therapy; Procedure: Surgery; Other: FACT-H&N; Other: MD Anderson Dysphagia Inventory; Other: University of Michigan Xerostomia Index; Other: Scale of Subjective Total Taste Acuity; Other: Neck Dissection Impairment Index
Sponsor: Washington University School of Medicine
Not yet recruiting

https://ift.tt/2MhV8qo

A Randomized Phase II Study on the Optimization of Immunotherapy in Squamous Carcinoma of the Head and Neck

Conditions: Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck; Carcinoma, Squamous Cell of Head and Neck
Interventions: Drug: Nivolumab and Ipilimumab; Drug: Docetaxel
Sponsors: AIO-Studien-gGmbH; Bristol-Myers Squibb
Recruiting

https://ift.tt/2Mvu6sd

Reversing Synchronized Brain Circuits With Targeted Auditory-Somatosensory Stimulation to Treat Phantom Percepts

Condition: Tinnitus
Interventions: Device: Sham then Active; Device: Active then Sham
Sponsors: University of Michigan; National Institute of Mental Health (NIMH)
Recruiting

https://ift.tt/2MaG7q3

Sintilimab Combined With Definitive Chemoradiation in Locoregionally-advanced Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Neoplasms
Interventions: Drug: Sintilimab; Drug: Gemcitabine; Drug: Cisplatin; Radiation: intensity-modulated radiotherapy
Sponsors: Sun Yat-sen University; Innovent Biologics (Suzhou) Co. Ltd.
Not yet recruiting

https://ift.tt/2MuLKwj

Effects of Expiratory Muscle Strength Training on Airway Protection and Swallowing in Chronic Dysphagia After Radiation Therapy

Condition: Cancer of the Head and Neck
Intervention: Device: Expiratory Muscle Strength Training (EMST)
Sponsor: Singapore General Hospital
Not yet recruiting

https://ift.tt/2Msm9nH

Surgery Followed by Risk-Directed Post-Operative Adjuvant Therapy for HPV-Related Oropharynx Squamous Cell Carcinoma: "The Minimalist Trial (MINT)"

A Randomized Phase II Study on the Optimization of Immunotherapy in Squamous Carcinoma of the Head and Neck

Reversing Synchronized Brain Circuits With Targeted Auditory-Somatosensory Stimulation to Treat Phantom Percepts

Sintilimab Combined With Definitive Chemoradiation in Locoregionally-advanced Nasopharyngeal Carcinoma

The effect of levamisole in the treatment of recalcitrant recurrent erythema multiforme major: An observational study

Publication date: Available online 8 August 2018

Source: Journal of Dermatological Science

Author(s): Ren-Feng Liu, Chun-Bing Chen, Rosaline C.Y. Hui, Yue-Zon Kuan, Wen-Hung Chung

Abstract

Background

Erythema multiforme major (EMM) is an immune-mediated mucocutaneous eruption mostly triggered by herpes simplex virus (HSV) infection. A vicious circle of recurrence may be developed due to HSV reactivation and prolonged use of systemic corticosteroids to control EMM. Levamisole is an immunomodulator and has been applied to prevent relapses of recurrent HSV infection.

Objective

To evaluate the clinical efficacy and safety of levamisole in patients with recalcitrant recurrent EMM.

Methods

We enrolled 23 patients with recurrent EMM treated with levamisole and 24 controls, and analyzed the demographics, treatments and outcomes.

Results

Patients with recurrent EMM for years (mean 3.99 ± 2.71) showed significantly reduced recurrences after various durations of levamisole treatment (recurrences after and before treatment: 3.98 ± 1.04 vs 6.75 ± 1.45 times per year, p = 1.33x10^-8). The recurrences of EMM also significantly reduced after levamisole treatment comparing to that of patients without levamisole treatment (p = 3.77x10^-9). No patient was reported to have severe side effects during or after levamisole treatment.

Conclusions

Levamisole was effective in reducing recurrences of recalcitrant recurrent EMM and can thus be considered an alternative or add-on therapy for this disorder.

https://ift.tt/2vKggeg

Councilor's Meeting/General Assembly of Members at the International Investigative Dermatology 2018 (IID2018)

Publication date: Available online 8 August 2018

Source: Journal of Dermatological Science

Author(s):

https://ift.tt/2nlch45

Early diagnosis of radio-insensitive human nasopharyngeal carcinoma xenograft models by diffusion kurtosis imaging

Publication date: Available online 8 August 2018

Source: Magnetic Resonance Imaging

Author(s): Xiang Zheng, Yunbin Chen, Youping Xiao, Dechun Zheng, Weibo Chen

Abstract

Objective

To investigate the feasibility of DKI in early detection of radio-insensitive nasopharyngeal carcinoma (NPC) xenografts in nude mice.

Materials and methods

Seventy-two nude mice were implanted with CNE-1 (low radio-sensitive) and CNE-2 (high radio-sensitive) NPC cell lines, and their respective xenografts were obtained. Then, the NPC-bearing nude mice were exposed to different doses of fraction irradiation, which are divided into non-irradiated group (G0), 10Gy group (G1), 20Gy group (G2), 30Gy group (G3), 3rd (G4) and 5th (G5) days after the entire dose (30y) of irradiation. Subsequently, DKI was performed on each group. Tumor volumes, shrink rates, D and K parameters were measured by two experienced radiologists. Student's t-test and receiver operating characteristic (ROC) curve analysis were conducted in this study.

Results

The differences of volume shrinkage rate between CNE-1 and -2 were observed in G2 (P = 0.032), with the shrink rates of 5.954% and 27.716%, respectively. The D values were reduced at G1 (D_G1, P = 0.001) and then increased gradually after irradiation. The K values were increased at G1 (K_G1, P = 0.001) and then declined sharply in CNE-2 (P < 0.01), but not in CNE-1 xenografts (P > 0.05). The respective AUC values for D_G1 and K_G1 were 0.875 and 0.917, with 66.7% and 83.3% sensitivity and 100% specificity, at the cutoff values of 1.27 × 10⁻³ mm²/s for parameter D and 0.88 for parameter K.

Conclusion

DKI can be used for early detection of radio-insensitive NPC xenografts prior to morphological change, where D_G1 and K_G1 may be the most valuable indicators.

https://ift.tt/2vuHNBo

Elucidation of Critical Epitope of Anti-Rat Podoplanin Monoclonal Antibody PMab-2

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.

https://ift.tt/2AUZQWk

Elevated endotracheal tube cuff pressure in the pediatric emergency department

Publication date: Available online 8 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Edward D. Ferenczy, Michael J. Stoner, Sandra P. Spencer, Samantha W. Gee, Daniel J. Scherzer, Joseph D. Tobias

https://ift.tt/2vO8U9H

Equilibrium study of binary mixture biosorption of Cr(III) and Zn(II) by dealginated seaweed waste: investigation of adsorption mechanisms using X-ray photoelectron spectroscopy analysis

Abstract

The alginate extraction residue (RES) from the Brazilian Sargassum filipendula was successfully employed as biosorbent in this binary equilibrium study, revealing a greater affinity and selectivity for Cr(III) than for Zn(II). Experimental results also revealed that the process is of endothermic nature and well adjusted by Langmuir–Freundlich binary model. The X-ray photoelectron spectroscopy (XPS) analysis revealed that coordination with hydroxyl groups of RES prevailed in Cr removal, followed by carboxyl-metal complexation. As far as Zn(II) is concerned, ion exchange with carboxylate groups of RES was the largest contributor. Nevertheless, scanning electron microscopy coupled with Fourier transform infrared spectroscopy indicated the participation of sulfate functions in a minor degree.

https://ift.tt/2AQfUZF

Facile preparation of microscale hydrogel particles for high efficiency adsorption of bisphenol A from aqueous solution

Abstract

Hydrogel microparticles (HMPs) were synthesized via reverse emulsion/UV light polymerization and employed as adsorbents for removing bisphenol A (BPA) from aqueous solution. Results demonstrated the smooth surface of HMPs, with particle size ranging from 137 to 535 μm. Functional groups, including –OH, C–O, C=O, and C–H, are all involved in BPA adsorption confirmed by FTIR. Effect of solution pH, contact time, and initial BPA concentration on adsorption process was examined. The adsorption capacity was found pH independent below pH 8.0 and decreased when pH values greater than 8.0. The maximum adsorption capacity of the HMPs for BPA was 174.77 mg/g. The adsorption process achieved an equilibrium state within 30 min by the pseudo-second-order kinetic rather than the other kinetic models and was fitted well with the Freundlich linear isotherm model. Also, the obtained isotherms reflected the formation of S-type isotherm curve according to Giles's classification. The BPA loaded on the HMPs could be totally regenerated by methanol/dimethylsulfoxide and can be used for five cycles maintaining 100% of adsorption capacity. When the HMPs were applied for the treatment of spiked real surface water, excellent results were also achieved indicating the high efficiency and potential of the adsorbent.

https://ift.tt/2OR7y6S

Association of Bullous Pemphigoid With Dipeptidyl-Peptidase 4 Inhibitors in Patients With Diabetes

This case-control study evaluates the association between use of dipeptidyl-peptidase 4 (DPP-4) inhibitors and development of bullous pemphigoid (BP) in patients with diabetes and characterizes those patients who develop DPP-4 inhibitor–associated BP.

https://ift.tt/2OUniGb

Topical Crisaborole—A Potential Treatment for Recalcitrant Palmoplantar Psoriasis

This case report describes the use of topical crisaborole to treat previously treatment-refractory palmoplantar psoriasis

https://ift.tt/2AZ8q6m

Evaluation of a Brief Dermatologist-Delivered Intervention vs Usual Care on Sun Protection Behavior

This longitudinal controlled cohort study examines the association of a brief dermatologist-delivered intervention with patient satisfaction and sun protection behavior among adults receiving dermatology care.

https://ift.tt/2OUmQHZ

Avoiding and Managing Medicare Fraud and Abuse Investigations of Mohs Surgery

This Viewpoint discusses ways dermatologists can manage and avoid investigations by the US Department of Justice and the Centers for Medicare & Medicaid Services for alleged Medicare fraud and abuse related to Mohs surgery.

https://ift.tt/2AS7EYS

A White Patch on the Tongue

An 80-year-old woman presented with an asymptomatic white patch affecting the tongue of 1 month's duration; she had a 15-year history of oral lichen planus managed with treatment. What is your diagnosis?

https://ift.tt/2vuMA5M

A Twitter Analysis of the #DontFryDay Campaign

This study assessed the reach of the "Don't Fry Day" campaign on Twitter, using the hashtag #DontFryDay, and identified what types of individuals and/or tweeters are engaging in the campaign.

https://ift.tt/2lp0YHg

Assessing the Competence of Aging Physicians Who Are Young at Heart

This Viewpoint discusses the issues involved in assessing the professional competence of aging physicians as increasing numbers of physicians continue to work past the age of 65 years.

https://ift.tt/2tyenkD

Distinguishing Mild, Moderate, and Severe Hidradenitis Suppurativa—Reply

In Reply We are grateful for the very constructive and positive feedback from Kokolakis and Sabat regarding our newly proposed Severity Assessment of Hidradenitis Suppurativa (SAHS) score.

https://ift.tt/2tnqqQY

Dynamic Trichoscopy

This Viewpoint discusses how the dermoscope is a practical instrument for use in routine practice and describes how its shortcomings can be overcome with increasing familiarity with the use of dynamic vs static trichoscopy.

https://ift.tt/2Hp6sKN

Dupilumab Treatment of Very Severe Refractory Atopic Hand Eczema

This case report describes the use of dupilumab to treat a patient with very severe refractory atopic hand eczema.

https://ift.tt/2z7EZ15

Lentigo Maligna—Challenges, Observations, Imiquimod, Confocal Microscopy, and Personalized Treatment

The word melanoma imparts considerable fear and concern in patients. Fortunately, for patients with the lentigo maligna (LM) subtype of melanoma in situ, there is overall good prognosis. The challenge of LM, however, is that it has the highest rate of local recurrence (approximately 20%) of all melanoma subtypes when treated by standard surgical excision alone, owing to frequent, unpredictable, subclinical extension. To reduce this risk, the use of Mohs surgery or staged excision has consistently demonstrated lower recurrence rates of 0.3% to 2.2% yet requires larger surgical margins for histological clearance than other in situ melanoma subtypes. Moyer et al also demonstrated that with increasing lesion size, both the surgical margin required to clear the lesion and the risk of local recurrence increased, suggesting increased subclinical spread with increasing lesion size. In addition, LM is typically located in the head and neck area, a complex zone with potential cosmetic and functional impairment owing to extensive surgery. Finally, differentiating LM from background atypical melanocytic hyperplasia can be challenging. Thus, treatments directed toward reducing the extent of surgery, minimizing morbidity, and providing a cure would enhance patient outcomes.

https://ift.tt/2H50D4K

Friedrich Daniel von Recklinghausen

Friedrich Daniel von Recklinghausen, MD, was one of the most prominent German pathologists of his time. His contributions resulted in the identification of several eponymous conditions, most notably von Recklinghausen disease, or neurofibromatosis type 1.

https://ift.tt/2OV0CWa

Lentigo Maligna Treated With Off-label Neoadjuvant Imiquimod

This medical record review examines the rate of recurrence of lentigo maligna in patients treated with neoadjuvant topical imiquimod, 5%, cream prior to conservatively staged excisions.

https://ift.tt/2H3ShKP

Cutavirus Infection in Primary Cutaneous B- and T-Cell Lymphoma

This virological study examines the association of cutavirus DNA with different types of cutaneous B-cell lymphoma and cutaneous T-cell lymphoma in lesional skin samples.

https://ift.tt/2N2NbTj

Assessment of a Predictive Scoring Model for Dermoscopy of Subungual Melanoma In Situ

This cohort study identifies the dermoscopic features of subungual melanoma in situ in a Korean population and assesses a predictive scoring model that distinguishes the diagnosis of subungual melanoma in situ from longitudinal melanonychia in patients with pigmented nails.

https://ift.tt/2ypUXDF

Strengthening the Case for the Role of Thrombophilia in Calciphylaxis

In Reply We thank Hickson and colleagues for their interest in our Original Investigation titled "Association Between Hypercoagulable Conditions and Calciphylaxis in Patients With Renal Disease: A Case-Control Study" on the role of hypercoagulable conditions in the development of calciphylaxis in patients with renal disease.

https://ift.tt/2KrBYtZ

Decision Tree Model vs Traditional Measures for Associations of Sun-Protective Behaviors

This cross-sectional national survey assesses whether decision-based modeling can identify patterns of sun-protective behaviors and sun sensitivity associated with the likelihood of sunburn among US adults.

https://ift.tt/2KueqnW

Underuse of the Sentinel Lymph Node Biopsy for High-Risk SCC of the Skin—Reply

In Reply We read with interest the response by Glazer et al regarding our study on the underuse of sentinel lymph node biopsy (SLNB) for high-risk cutaneous squamous cell carcinoma (cSCC) and noted several important inquiries and comments.

https://ift.tt/2Nib0qt

Association of Inadequately Controlled Disease With Patient-Reported Disease Burden in Atopic Dermatitis

This cross-sectional study examines the association of atopic dermatitis severity and disease control with the patient-reported disease burden in clinical practice.

https://ift.tt/2zaaLL0

August 2018 Issue Highlights

https://ift.tt/2OQUyOC

Targeting Tropomyosin Receptor Kinase in Cutaneous CYLD Defective Tumors With Pegcantratinib

This phase 2 randomized clinical trial investigates if topical targeting of topical tropomyosin receptor kinase (TRK) with an inhibitor, pegcantratinib, is safe and efficacious in treating tumors in patients with CYLD cutaneous syndrome.

https://ift.tt/2KpGysm

Skin Cancer Detection In Vivo With Reflectance Confocal Microscopy Performed by a Novice Reader

This study evaluates the learning curve, diagnostic accuracy, and challenges for a novice reader of reflectance confocal microscopy for determining a diagnosis of skin cancer.

https://ift.tt/2KRf6rS

Clinical and Laboratory Markers of Relapse in Cutaneous Polyarteritis Nodosa

This case series identifies clinical and laboratory markers that may be associated with relapse among patients with cutaneous polyarteritis nodosa.

https://ift.tt/2txYNFB

Trichophyton erinacei Transmitted to a Pregnant Woman From Her Pet Hedgehogs

This case report describes a pregnant woman who developed tinea manus from Trichophyton erinacei infection transmitted to her from her pet hedgehogs.

https://ift.tt/2IWzDdx

Human Papillomavirus Vaccine to Treat Cutaneous Basaloid Squamous Cell Carcinomas

This case report describes a woman with multiple, inoperable cutaneous basaloid squamous cell carcinomas who was treated with 9-valent human papillomavirus vaccine.

https://ift.tt/2tQgfVZ

Allergic rhinitis and periodontitis among Korean adults: results from a nationwide population-based study (2013–2015)

Abstract

Background

The purpose of this study was to examine whether allergic rhinitis is associated with periodontal disease in a representative sample of elderly Korean people that was adjusted for socio-demographic factors, oral and general health behaviors, and systemic health status.

Methods

A total of 10,643 subjects who were between 20 and 59 years of age participated in the Korean National Health and Nutrition Examination Survey and underwent cross-sectional examination. Medical history of allergic rhinitis was collected from participants by questionnaire; additionally, periodontal status was assessed using a Community Periodontal Index score of 3 or 4. Multivariate logistic regression analysis was conducted to adjust for socio-demographic variables, oral health status and behaviors, and general health status and behaviors. All analyses were performed using a complex sampling design.

Results

Allergic rhinitis and periodontitis showed a significant inverse association. After adjusting for all confounders, a trend of decreasing periodontitis risk was observed as allergic rhinitis increased. The adjusted odds ratio of periodontitis was 0.79 (0.66–0.95) for patients with allergic rhinitis.

Conclusion

A significant inverse association between allergic rhinitis and periodontal status was demonstrated in this patient population.

https://ift.tt/2M1LI2O

Incidental focal thyroid uptake on 18 F-Choline PET-CT: need to rule out thyroid cancer

https://ift.tt/2vvbWjL

Clinical Thyroidology, a Journal of the American Thyroid Association, announces Dr. Angela M. Leung as New Editor-in-Chief

The American Thyroid Association (ATA^®) is pleased to announce that Dr. Angela M. Leung has been selected as the new Editor-in-Chief of the ATA monthly journal Clinical Thyroidology^®, as of 2019.

Clinical Thyroidology is one of the ATA official journals distributed electronically. This highly valued abstract and commentary publication provides a broad-ranging look at the clinical thyroid literature. Experts in the field summarize the most cutting-edge, relevant articles of which clinicians should be aware and provide insight into the relevance and impact of each article on patient care.

Dr. Leung was selected based on her abilities to promote the growth, quality, reputation, and scholarship of this important ATA publication. She will continue the strong leadership of Dr. Jerome Hershman who, as EIC for 8 years, has led the diverse editorial board dedicated to making Clinical Thyroidology indispensable to clinicians and scientists interested in thyroid diseases.

Dr. Leung is a Health Sciences Clinical Assistant Professor of Medicine at the David Geffen School of Medicine, University of California Los Angeles (UCLA) and at the Greater Los Angeles VA Healthcare System. She is also an Associate Program Director of the UCLA/VA endocrinology fellowship training program. Since 2012, she has written regular commentaries for Clinical Thyroidology for the Public and, since 2014, reviews of papers in the current literature for Clinical Thyroidology as an Associate Editor. She also serves on the editorial board of Thyroid, the official peer-reviewed ATA journal.

Dr. Leung has been a member of the ATA since 2006 and has chaired committees focused on the scientific meeting program and on public health. For ATA annual meetings since 2006, she has served as a poster judge, been a moderator or speaker, served on the 2016 Program Committee, and co-chaired the program of the 87^th Annual Meeting of the ATA.

She is also a current member of the Endocrine Society and the American Association of Clinical Endocrinologists (AACE). Dr. Leung has served on the Endocrine Training Support Committee and Abstract Review Subcommittee for the AACE. She has been a reviewer of trainees' abstracts and a poster judge for Endocrine Society annual meetings, and most recently has worked with the Endocrine Society to consult on a multidisciplinary, international toxicologic review of thyroid disruptors. She serves on the editorial boards of the AACE's Endocrine Practice and of the Journal of Clinical and Translational Endocrinology and since 2013 has co-edited the annual thyroid issue of Current Opinion in Endocrinology, Diabetes, and Obesity.

Dr. Leung received her BA in biochemistry from Occidental College in Los Angeles, her MD from Boston University School of Medicine, and her MSc in epidemiology from Boston University School of Public Health. Between obtaining her MD and beginning studies for her MSc, she spent six years in postdoctoral training at the BU School of Medicine, first as an Intern and Resident, then as a Clinical and Research Fellow in the Section of Endocrinology, Diabetes, and Nutrition, and finally as a Fellow in the BU Clinical Research Training NIH K30 Program.

Following her training and fellowships, she was appointed Instructor of Medicine, then Assistant Professor of Medicine at BU School of Medicine. For the past five years, she has held an Assistant Professor appointment at the UCLA David Geffen School of Medicine. Along with her academic appointments have come Dr. Leung's clinical appointments in the Section of Endocrinology, Diabetes, and Nutrition at Boston Medical Center; the Division of Endocrinology at Harvard Vanguard Medical Associates (Quincy, MA); the Division of Endocrinology, Diabetes, and Metabolism in the VA Greater Los Angeles Healthcare System and to the same-named division in the UCLA Health System.

Dr. Leung has received numerous honors and awards that have recognized her academic, clinical, and research activities. She has lectured nationally and internationally on both clinical topics and on her research in the various fields of thyroid disease, published over 80 papers, reviews, and book chapters, provided online media interviews, and has participated in multiple national oral and poster abstract presentations. Dr. Leung has completed research projects focusing on thyroid disease, iodine nutrition, thyroid disruptors, thyroid cancer, and other topics that have been supported by the NIH.

Dr. Leung will begin her 3-year term as Editor-in-Chief on January 1, 2019.

###

The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international, individual membership organization for over 1,700 clinicians and researchers from 43 countries around the world, representing a broad diversity of medical disciplines. It also serves the public, patients, and their families through education and awareness efforts.

Celebrating its 95^th anniversary, ATA delivers its mission through several key endeavors: the publication of highly regarded monthly journals, Thyroid^®, Clinical Thyroidology^®, VideoEndocrinology, and Clinical Thyroidology for the Public; annual scientific meetings; biennial clinical and research symposia; research grant programs for young investigators; support of online professional, public, and patient educational programs; and the development of guidelines for clinical management of thyroid disease. Find out more about ATA at www.thyroid.org.

The post <i>Clinical Thyroidology</i>, a Journal of the American Thyroid Association, announces Dr. Angela M. Leung as New Editor-in-Chief appeared first on American Thyroid Association.

https://ift.tt/2M5p9dm

Clinical Thyroidology, a Journal of the American Thyroid Association, announces Dr. Angela M. Leung as New Editor-in-Chief

Dr. Leung will begin her 3-year term as Editor-in-Chief on January 1, 2019.

###

The post <i>Clinical Thyroidology</i>, a Journal of the American Thyroid Association, announces Dr. Angela M. Leung as New Editor-in-Chief appeared first on American Thyroid Association.

https://ift.tt/2M5p9dm

Incidental focal thyroid uptake on 18 F-Choline PET-CT: need to rule out thyroid cancer

https://ift.tt/2vvbWjL

Association of type 2 diabetes susceptible genes GCKR , SLC30A8 , and FTO polymorphisms with gestational diabetes mellitus risk: a meta-analysis

Abstract

Purpose

Current studies have detected the correlation of polymorphisms in type 2 diabetes susceptible genes GCKR, SLC30A8 and FTO with gestational diabetes mellitus (GDM) risk. However, findings of these studies were incongruous. Hence, we performed an integrated review and meta-analysis for the researches regarding the association of single nucleotide polymorphisms (SNPs) in GCKR, SLC30A8 and FTO genes and GDM risk.

Methods

Eligible publications were selected on the basis of several inclusion and exclusion criteria. Correlation between each SNP and GDM risk was estimated by computing odds ratios (ORs) with 95% confidence intervals (95%CIs).

Results

Consequently, 19 case-control studies (from 16 citations) including 3636 GDM cases and 7229 GDM-free controls were participated in a meta-analysis of seven prevalent SNPs (GCKR rs1260326 and rs780094; SLC30A8 rs13266634 and rs11558471; FTO rs8050136, rs1421085 and rs9939609). Our results demonstrated that the rs780094, rs13266634 and rs9939609 SNPs were significantly associated with GDM risk. In stratified analysis, correlations of rs780094 and rs13266634 SNPs could be observed in Asian and Caucasian subgroups. Moreover, association between rs9939609 SNP and GDM risk was detected in Caucasian subgroup.

Conclusions

The GCKR rs780094, SLC30A8 rs13266634 and FTO rs9939609 SNPs were demonstrated to be the potential biomarkers for GDM risk prediction.

https://ift.tt/2nkOp0v

Controversy on the Use of Povidone-Iodine in Chronic Wounds

Skin Pharmacol Physiol 2018;31:261

https://ift.tt/2vPVhGX

Association of type 2 diabetes susceptible genes GCKR , SLC30A8 , and FTO polymorphisms with gestational diabetes mellitus risk: a meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

The GCKR rs780094, SLC30A8 rs13266634 and FTO rs9939609 SNPs were demonstrated to be the potential biomarkers for GDM risk prediction.

https://ift.tt/2nkOp0v

First evaluation of floating microplastics in the Northwestern Adriatic Sea

Abstract

Plastic pollution in the marine environment is becoming a problem of global concern, and the Mediterranean is believed to be one of the worst affected regional seas. The present study presents data on floating microplastics in the Northwestern Adriatic Sea in order to evaluate the possible contribution of two significant potential sources: the lagoon of Venice and the Po River. Samples were collected in March and April 2014 along two transects located off Pellestrina Island (Venice) and the Po Delta, each consisting of four sampling stations at 0.5, 3, 10, and 20 km from the shoreline. Microplastics were quantified and classified according to their colors and shapes and analyzed by micro-attenuated total reflection-FT-IR. Microplastics were found in all samples, albeit with high spatial and temporal variability. The highest concentrations were observed in March at the offshore station of the Pellestrina transect (10.4 particles m⁻²) and the two landward stations off the Po Delta (2.1 and 4.3 particles m⁻²), highlighting the influence of various factors, such as surface circulation and river discharges, in determining specific accumulation patterns. The most common polymers were polyethylene and polypropylene, and most of the particles were secondary microplastics (83.5%). The patchy distribution of microplastics observed in the study area is driven by hydrodynamic and meteorological factors acting on short time scales.

https://ift.tt/2OTJ2SL

Characterization and adsorption capacity of potassium permanganate used to modify activated carbon filter media for indoor formaldehyde removal

Abstract

This study examined the effect of potassium permanganate (KMnO₄)-modified activated carbon for formaldehyde removal under different face velocities and different initial formaldehyde concentrations in building environment. We chose the coconut shell activated carbon due to their high density and purity. Moreover, they have a clear environmental advantage over coal-based carbons, particularly in terms of acidification potential. The chemical properties were characterized by FTIR to show the functional groups, EDS to calculate each component of their energy bands to know how the ratio is. Also, the morphology of the surface was examined with scanning electron microscopy (SEM). The BET determines specific surface area, pore size, and pore volume. It was found that where the initial formaldehyde concentration and the face velocity are low, adsorption capacity is high. The adsorption isotherms of formaldehyde on modified activated carbon are well fitted by both Langmuir and Freundlich equations. The rate parameter for the pseudo-first-order model, pseudo-second-order model, and intraparticle diffusion model was compared. The correlation coefficient of pseudo-second-order kinetic model (0.999 > R² > 0.9548) is higher than the coefficient of pseudo-first-order kinetic model (0.5785 < R² < 0.8755) and intraparticle diffusion model (0.9752 < R² < 0.9898). Thus, pseudo-second-order kinetic model is more apposite to discuss the adsorption kinetic in this test, and the overall rate of the modified activated carbon adsorption process appears to be influenced by more than one step that is both the intraparticle diffusion model and membrane diffusion.

https://ift.tt/2ASlxXd

Relationship between working memory and comprehension and expression of grammar in Farsi-speaking children with cochlear implants

Publication date: Available online 8 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Soodeh Khoramian, Zahra Soleymani

Abstract

Objectives

Grammar is one of the most fundamental components of language and working memory (WM) is one of the most important cognitive features. These two skills play a vital role in learning, literacy and communication. Children with cochlear implants (CIs) experience delays in both of these skills. The aim of this study was to investigate the relationship between these two skills in children with CIs.

Subjects and methods

The sample consisted of 20 Farsi-speaking children with CIs. WM was estimated by forward and backward auditory digit spans (FBS and BDS) from the Persian (Farsi) version of the Wechsler Intelligence Scale for Children, 4th edition. The comprehension of grammar by participants was evaluated using the Persian Syntax Comprehension Test. Grammar expression was assessed using the Photographic Expressive Persian Grammar Test. Pearson's correlation and simple linear regression were used for data analysis.

Results

The results of linear regression and correlation showed a strong correlation between comprehension of grammar and FDS (r = 0.61; p = 0.004) was obtained, between BDS and comprehension of grammar (r = 0.161; p = 0.080). FDS and expression of grammar (r = 0.163; p = 0.222) showed a positive but insignificant correlation.

Conclusion

The results indicate that WM decisively effects grammar. Enhancement of the phonological loop can improve grammar, especially comprehension of grammar. The effect of the central executive in grammar requires further research.

https://ift.tt/2MbzFPx

Basic choking education to improve parental knowledge

Publication date: Available online 8 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kathryn C. Bentivegna, Kevin T. Borrup, Meghan E. Clough, Scott R. Schoem

Abstract

Objective

To evaluate the effect of an educational intervention on parental knowledge of choking hazards and prevention.

Methods

A quasi experimental study was performed utilizing an internet based educational video intervention for parents with a child 6 months to 4 years old presenting to a Pediatric Otolaryngology clinic at a Level 1 pediatric hospital. Following the clinic visit, participants were sent a choking video (intervention) or general safety video (control) with a pretest and posttest knowledge survey (via email). An additional posttest knowledge survey was sent 30 days later as a surrogate measure for knowledge retained over time. Frequencies, chi square test, Independent t test and McNemar's test were used for statistical analyses.

Results

202 participants viewed the video and completed both the pretest and immediate posttest knowledge survey. Average change in total knowledge scores from the pretest to immediate posttest was statistically significant between the intervention (μ = 1.88, σ = 1.20) and control group (μ = 0.14, σ = 1.05); t (200) = −10.99, P < .001. This finding was consistent when assessing change from the pretest to 30 day posttest between the intervention (μ = 1.41, σ = 1.32) and control group (μ = 0.17, σ = 1.41); t (118) = −4.95, P < .001. A majority of the knowledge questions (5 of 7) showed a significant change in score from the pretest to immediate posttest (P = .001-.027). Additional analyses revealed accuracy on 4 of 7 knowledge questions significantly changed from the pretest to 30 day later posttest (P < .001- .002).

Conclusion

The brief educational video overall improved parental knowledge of choking hazards and prevention immediately after the video and 30 days later. Importantly, improved parental knowledge may decrease rates of choking among children.

https://ift.tt/2Om0Cxt

Atypical Histiocytic Lesion Preceding a Peripheral T-Cell Lymphoma Involving the Skin Exhibiting the Same Molecular Alterations

Abstract: Peripheral T-cell lymphoma (PTCL), not otherwise specified (NOS) is a diagnosis of exclusion, showing extreme cytological and phenotypic heterogeneity. Skin involvement of PTCL may be primary or secondary. Diagnosis of histiocytosis may be difficult, requiring clinical–pathological correlation. We describe a laryngeal atypical histiocytic lesion (AHL) and a nasal PTCL, NOS with cutaneous involvement in the same patient presenting with peculiar histopathologic and immunophenotypic features. The laryngeal neoplasm showed morphological and immunophenotypic evidence of histiocytic differentiation and does not fit any other category of the WHO classification nor the revised classification of histiocytosis. The nasal and cutaneous lesions presented features close to natural killer/T-cell lymphoma and gamma–delta T-cell lymphoma but did not meet accurately the WHO criteria. A somatic activating Q61K mutation was found on exon 3 of the NRAS gene in both AHL and PTCL, NOS. The mutation on NRAS gene in both AHL and PTCL, NOS may suggest a common origin from a precursor cell. Correspondence: Salma Machan, MD, Fundación Jiménez Díaz, Servicio de Dermatología, Av. De los Reyes Católicos, 2, Madrid 28040, Spain (e-mail: smachan@fjd.es). Supported by grants from the Instituto de Salud Carlos III, from Ministerio de Economía, Industria y Competitividad [RTICC RD06/0020/0107, RD12/0036/0060, PI12/1682, PT13/0010/0007, PI16/01294, SAF2013-47416-R, CIBERONC-ISCIII PIE15/0081, ISCIII-MINECO AES-FEDER (Plan Estatal I+D+I 2013-2016): PI14/00221 and PIE14/0064], and the Asociación Española Contra el Cáncer, Spain. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2hxkbZ3). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2vtNxLv

Re-evaluation of “Polymorphous Sweat Gland Carcinoma”

No abstract available

https://ift.tt/2OTixg3

Comparative Study of the Clinical Pathology, Immunophenotype, Epstein–Barr Virus Infection Status, and Gene Rearrangements in Adult and Children Patients With Hydroa Vacciniforme–Like Lymphoproliferative Disorder

Background: Hydroa vacciniforme–like lymphoproliferative disorder (HVLPD) is a rare Epstein–Barr virus (EBV)-associated lymphoma that mainly affects children. Objectives: To examine the similarities and differences in the clinical pathological features, EBV infection status, and gene rearrangements in adults and children patients with HVLPD. Methods: We compared the clinical manifestations, histopathology, immunophenotypical features, EBV infection status, and T-cell receptor gene rearrangements in the adult and children HVLPD groups. Results: Clinical manifestations differed between children and adults groups. The children were characterized by blisters and severe facial swelling, whereas the adults were characterized by mild facial swelling and papules. Mosquito bite was significantly related to morbidity in the children group. Histologically, the number of mast cells in the adult group was greater than in the children group (P

https://ift.tt/2ASrKSV

Undifferentiated Sarcoma as Intermediate Step in the Progression of Malignant Melanoma to Rhabdomyosarcoma: Histologic, Immunohistochemical, and Molecular Studies of a New Case of Malignant Melanoma With Rhabdomyosarcomatous Differentiation

Abstract: Malignant melanoma (MM) may display highly variable phenotypic diversity, sometimes associated with loss of immunohistochemical melanocytic markers and acquisition of nonmelanocytic lineage of differentiation. Primary cutaneous MM with rhabdomyosarcomatous differentiation is extremely rare with only 5 reported cases in the literature. To date, a chronological progression of a MM to rhabdomyosarcoma has not been conclusively documented. A 96-year-old man underwent a re-excision of an "atypical fibroxanthoma" of the forearm, which revealed a small lentigo maligna melanoma associated with a dominant dermal high-grade spindle cell nodule admixed with a population of malignant polygonal epithelioid cells. On immunohistochemical studies, the spindle cells were completely negative for all melanocytic markers, whereas a small population of polygonal neoplastic cells at the periphery was positive for Desmin and Myo-D1, supporting early rhabdomyosarcomatous transformation. Several subsequent re-excisions demonstrated merely nodules of malignant pleomorphic epithelioid cells with rhabdomyosarcomatous differentiation and devoid of melanocytic markers. In addition, both rhabdomyosarcomatous component and original MM displayed identical mutations. Therefore, the histologic, immunohistochemical, and molecular findings documented for the first time a chronological progression from an invasive MM to a pleomorphic rhabdomyosarcoma through an intermediate stage of undifferentiated sarcoma/atypical fibroxanthoma. Interestingly, subsequent recurrences of pure rhabdomyosarcomatous component displayed skip lesions/microsatellitosis, marked tumor-infiltrative lymphocytes, and rare junctional nests of rhabdomyosarcomatous cells in the epidermis, histologic features that were not described in primary cutaneous rhabdomyosarcoma and therefore could serve as morphologic clues to the diagnosis of rhabdomyosarcomatous transformation in an MM. Correspondence: Tien Anh N. Tran, MD, Department of Pathology, Florida Orlando Hospital, 601 East Rollins Street, Orlando, FL 32803 (e-mail: tien.tran.md@flhosp.org). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ORxKyc

A New Histologic Pattern in 6 Biopsies From Early Frontal Fibrosing Alopecia

Abstract: Frontal fibrosing alopecia (FFA) is an irreversible scarring alopecia with unknown etiology and no cure. The goal is to establish the diagnosis in the early stage, before developing a hairless band of atrophy involving the frontal, temporal scalp and sideburns. Pathology is rarely needed once the disease is clinically apparent. The classic histologic features include follicular dropout with the absence or atrophy of the sebaceous glands and lichenoid lymphohistiocytic infiltrate with concentric layered fibrosis at the upper follicular level. We describe a common pattern that was repeatedly seen in 6 horizontally sectioned scalp biopsies from patients with early presentation of FFA suspected on trichoscopy by the focal presence of peripilar casts around terminal hairs. All biopsies revealed overall preserved follicular architecture with average number of 11 vellus follicles, atrophy of the sebaceous glands, and perifollicular lymphohistiocytic infiltrate involving the outer root sheath of the vellus follicles (n = 5). There was no perifollicular fibrosis of the vellus follicles and no lichenoid inflammation and perifollicular fibrosis of the terminal follicles. This new pattern of "inflammatory vellus involvement" most likely corresponds to an early onset of the disease. The absence of the classic features in such biopsies from early FFA can lead to misdiagnosis. Correspondence: Mariya Miteva, MD, Miller School of Medicine, University of Miami, 1600 NW 10th Avenue, Miami, FL 33136 (e-mail: mmiteva@med.miami.edu). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2ASrvat

In response

No abstract available

https://ift.tt/2OUuhz9

Granulomatous Rosacea Versus Lupus Miliaris Disseminatus Faciei—2 Faces of Facial Granulomatous Disorder: A Clinicohistological and Molecular Study

Abstract: Granulomatous rosacea (GR) and lupus miliaris disseminatus faciei (LMDF) are 2 forms of facial granulomatous diseases. Although they show some morphological overlap, they have distinct clinical presentation. This study was performed to demonstrate the clinical and histological features of GR and LMDF and to establish their relationship to tuberculous etiology by molecular technique. All the cases of GR (n = 20) and LMDF (n = 10) diagnosed on skin biopsy over the past 6 years were reviewed along with their clinical detail. Polymerase chain reaction (PCR) was performed using primers specific for Mycobacterium tuberculosis. The mean age of patients with GR was 45 years 10 months (range 18–75 years) as compared to 33 years 5 months (range 18–57 years) in patients with LMDF. The GR cases comprised 13 men and 7 women patients, whereas all 10 LMDF cases were seen in men. GR cases had papular lesion over an erythematous base on face, whereas LMDF cases had papular/nodular/nodulocystic lesions on the face and neck. Histologically, GR cases showed small granulomas without necrosis in a background of variable lymphoid infiltrate and dilated capillaries, whereas LMDF showed large granulomas with caseous necrosis and minimal inflammation. Five cases (25%) of GR showed degenerating Demodex folliculorum mites. No case of GR or LMDF showed positivity for mycobacterial polymerase chain reaction. Despite some similarities, GR and LMDF show distinct clinical and histological features. Thus, LMDF is a distinct clinicopathological entity separate from the GR, with different etiopathogenesis. However, none of the conditions are related to a tuberculous etiology. Correspondence: Uma Nahar Saikia, MD, NAMS, Department of Histopathology, Room No 512, 5th floor, Research Block A, PGIMER, Chandigarh 160012, India (e-mail: umasaikia@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2AN6ii6

Effects of the percentage of air/water in spray on the efficiency of tooth ablation with erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation

Abstract

We aimed at examining the effects of a percentage of air/water in spray on the cutting efficiency of Er,Cr:YSGG laser for enamel and dentin. The intensity and frequency of irradiation were 3.0 W and 20 Hz for the enamel surface and 2.0 W and 20 Hz for the dentin surface, respectively. Flattened surfaces of enamel and dentin were irradiated at nine points for approximately 1 s under various percentages of air/water in spray using Er,Cr:YSGG laser. A high-speed video microscope was used to record each laser irradiation on the tooth surface. A slow video image was used to count the number of water micro-explosions yielded on the tooth surface during laser irradiation. A surface roughness tester was used to measure the depth of the dimple prepared with laser irradiation on each specimen. Each individual depth of dimple was divided by the number of water micro-explosions (pulse). This allowed for the calculation of the cutting depth per pulse. Following laser irradiation, several representative specimens were observed using an SEM. Two-way ANOVA was used as the statistical analysis. This revealed that there was no significant effect of the percentage of air/water in spray on the cutting depth for enamel surface (p > 0.05). On the contrary, a significant effect was observed in air-ratio for dentin cutting (p < 0.05). Both enamel and dentin were characterized by the presence of rough surfaces, as shown by the SEM images of the dimples. The percentage of air/water in spray was not significantly effective in laser cutting for enamel. Air-percentage was significantly effective in laser cutting for dentin.

https://ift.tt/2ATuj7i

Optimizing Value in Otolaryngology Through Patient Safety and Quality Improvements

Abstract

Purpose of Review

The goals of this paper are to explore the relationship between patient safety/quality improvement (PS/QI) activities and value generation in the field of otolaryngology and to suggest future opportunities for improvement or research. Value is defined as the ratio between health outcomes or improvements achieved and resources and dollars spent. It can therefore be increased by improving outcomes, reducing costs, or both. We present information suggesting that PS/QI activities may impact both the numerator and denominator in the value ratio, with the potential for powerful effects on value in health care.

Recent Findings

We describe clinical and administrative strategies demonstrated to increase value across multiple subspecialties in otolaryngology.

Summary

PS/QI can improve both components of value in health care. Relatively simple interventions may have significant impact and serve as good starting points. Larger-scale changes may have even broader impact but may require more infrastructure investment.

https://ift.tt/2ARoZRN

Thoughts on how to do the right thing

In the editorial entitled "Just Do the Right Thing," Theodore Freeman1 discussed the article by Clark et al2 entitled "Changes in Emergency Department Concordance With Guidelines for the Management of Stinging Insect–Induced Anaphylaxis: 1999–2001 vs 2013–2015" in the April issue of the Annals. He comments correctly on the lack of anaphylaxis guidelines in the emergency medicine literature. However, the Joint Task Force on Practice Parameters published in conjunction with emergency department (ED) physicians at the Mayo Clinic a specific parameter on ED diagnosis and treatment of anaphylaxis.

https://ift.tt/2MszFYw

Information for Readers

https://ift.tt/2M8DC7L

Information for Authors

https://ift.tt/2MszufO

Eosinophilic esophagitis 25 years after its recognition

It has been truly amazing to witness the progress made in understanding and managing eosinophilic esophagitis (EoE) since its recognition 25 years ago. If we examine EoE through history, we notice sporadic reports starting in 1978 of patients with presentations consistent with EoE. Not until 1993 did Attwood et al describe their adult case series, raising awareness about this disease.1 Two years later, Kelly et al discovered that EoE was triggered by food antigens rather than caused by acid-induced gastroesophageal reflux disease, through demonstration of disease remission with exclusive feeding with an amino acid-based formula.

https://ift.tt/2vsdOtR

https://ift.tt/2MpgezF

Editorial Board

https://ift.tt/2M8LcPM

Histiocytofibrome avec induction sébacée

Publication date: Available online 7 August 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): E. Lorier Roy, M.-H. Jégou, A. Osio

Résumé

Introduction

L'histiocytofibrome, ou dermatofibrome (DF), est une lésion bénigne commune revêtant de multiples aspects cliniques et histologiques. Le phénomène d'induction sébacée en regard d'un dermatofibrome est rare et peu décrit. L'observation détaillée d'un cas de DF avec induction sébacée permet de préciser et d'illustrer ici la sémiologie clinique et dermatoscopique de cette lésion, ainsi que celle de ses diagnostics différentiels.

Observation

Un homme de 52 ans consultait pour un examen de surveillance, qui révélait une lésion papuleuse ferme du milieu du dos. La surface de la lésion apparaissait comme une zone un peu pigmentée dans sa partie supérieure, faite de plusieurs petits lobules blanchâtres. L'examen histologique concluait à un histiocytofibrome avec induction sébacée.

Discussion

Le phénomène d'induction sébacée en regard d'un dermatofibrome est peu fréquent ; dans la très grande majorité des cas, il est observé sur la région des épaules. L'aspect dermatoscopique de surface, avec de multiples globules ou structures compactes arrondies blanchâtres (clods) regroupés en amas, est caractéristique. L'origine du phénomène d'induction sébacée est inconnue ; on peut évoquer un micro-environnement favorable de la peau des épaules, associé à des facteurs de croissance sécrétés par le DF.

Summary

Background

Histiocytoma or dermatofibroma (DF) is a common benign skin tumour with several clinical and histopathological variants. Sebaceous induction overlying a dermatofibroma is rare and infrequently reported. Using a detailed clinical case, herein the semiological and dermoscopic features of this lesion are described and illustrated, and the differential diagnoses presented.

Patients and methods

A 52-year-old man consulted for a physical examination, which revealed a firm papular lesion of the upper middle back. The upper part of the nodule was covered by a slightly hyperpigmented surface, with numerous small whitish lobules. Microscopic examination revealed a dermatofibroma with sebaceous induction.

Discussion

Sebaceous induction overlying a dermatofibroma is not frequent, and it occurs in most cases on or near the shoulder. The typical dermoscopic pattern involves many whitish globules or clumps grouped into clusters. The aetiology is unknown but could stem from a conducive microenvironment in shoulder skin, associated with growth factors secreted by the DF.

https://ift.tt/2ORmsdi

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τετάρτη 8 Αυγούστου 2018

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