Effects of Cutaneous Negative Pressure Application on Perforator Artery Flow in Healthy Volunteers: A Preliminary Study

J reconstr Microsurg
DOI: 10.1055/s-0038-1668157

Introduction The creation of skin flaps based on small perforator vessels is an increasingly popular procedure nowadays; the optimization of their blood supply enhances surgical success. This study evaluates the effects on the flowmetries of 7 days' negative pressure application on the skin surface overlying the muscle fascia emergence of periumbilical perforators of the deep inferior epigastric artery (DIEA). Methods Ten volunteer participants were enrolled. In each subject, one periumbilical perforator of the DIEA was identified on each side of the abdomen using an eco-color-Doppler. One of them was used as the control group, while the other (the study group) underwent 80 mm Hg negative pressure for 7 days. The flowmetries of both perforators were measured before and after the application of negative pressure wound therapy. Results After the application of negative pressure, randomly applied on the skin surface over one of the two selected periumbilical perforators, an increase in the flowmetries was observed in both groups of perforators (2.74 cm/s; p < 0.0001). The relative flowmetry increase in the control group was 9.55% (2.735 cm/s), while in the study group it was 44.03% (8.748 cm/s). Conclusion The application of negative pressure system on the skin surface over the muscle fascia emergence of the selected periumbilical perforators showed an increase in flowmetry. Although this is a preliminary study, this simple and economical procedure before surgery could be usefully employed to increase the rate of success in microsurgical procedures.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

https://ift.tt/2Pd0S36

Unilateral Autologous Breast Reconstruction with Bi-pedicled, Conjoined Deep Inferior Epigastric Perforator Flaps

J reconstr Microsurg
DOI: 10.1055/s-0038-1668161

Background The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and "footprint." This study summarizes our experience with using bipedicled DIEP flaps to improve the aesthetic results of unilateral breast reconstruction in such patients. Methods Consecutive patients undergoing unilateral breast reconstruction with bi-pedicled, conjoined DIEP flaps over a 4-year period were retrospectively reviewed. Primary and secondary flap microvascular anastomoses were performed to the antegrade internal mammary (IM) vessels and to either the retrograde IM vessels or a primary DIEP pedicle side branch, respectively. Clinical characteristics and outcomes were recorded. Results Sixty-three patients underwent immediate (n = 29) or delayed (n = 34) reconstruction, with age and body mass index of 54.1 ± 8.4 years and 26.6 ± 4.7, respectively. Mean follow-up was 14.1 months. Twenty-eight (44.4%) patients received prereconstruction radiation therapy. All patients had preoperative abdominal imaging, including 57 (90.5%) using magnetic resonance angiography. There were no flap losses with three operative interventions for flap salvage. Conclusions Unilateral breast reconstruction with bipedicled, conjoined DIEP flaps is safe and reliable. These procedures can be performed with a complication profile similar to single-pedicle DIEP flaps. The additional skin and soft tissue available with bi-pedicled flaps allows for greater flexibility in matching the shape and projection of a woman's contralateral breast, and in some cases is necessary to achieve an aesthetically acceptable reconstruction. With growing expectations among breast reconstruction patients, conjoined bi-pedicled flaps represent a tool for meeting their reconstructive needs and exceeding the status quo for aesthetic outcomes.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

https://ift.tt/2OGZPY9

Chemokine CXCL10 and Coronavirus-Induced Neurologic Disease

Viral Immunology, Ahead of Print.


https://ift.tt/2MuI8gZ

Photodegradation using TiO 2 -activated borosilicate tubes

Abstract

This study examines the photocatalytic activity of titanium dioxide (TiO₂) semiconductor supported on borosilicate tubes (cut-off 290 nm) towards removal of a mix of persistent organic pollutants (POPs) from water. For this purpose, two widely used analgesic and anti-inflammatory drugs (NSAIDs), ibuprofen (IBU) and mefenamic acid, along with MCPA sodium monohydrate, which is a common herbicide frequently used in the agricultural activities, were selected as a case study. Borosilicate tubes were coated with titanium oxide through two different approaches: sol-gel dip-coating and a hybrid nanoparticle dip-coating and plasma-enhanced chemical vapour deposition (PECVD) process. The photochemical reactor that hosts the titania-coated tubes was designed to permit continuous throughput of liquid feed stream. The photodegradation experiments were performed in laboratory conditions under artificial irradiation simulating solar light. The efficiency of direct photolysis and heterogeneous photocatalysis (TiO₂) was investigated, and the performance of each coating method was evaluated. Kinetic studies for each experiment were accomplished, the overall results showed poor efficiency and insufficient removal for NSAIDs through direct photolysis, whereas applying heterogeneous photacatalysis with TiO₂ coated on borosilicate tubes was found to accelerate their degradation rate with complete decomposition. Concomitantly, kinetic experimental results showed a critical difference of performance for the two coating methods used; in particular, the degradation rates of pollutants by the sol-gel-coated tubes were much faster than the degradation by the nanoparticle/PECVD-coated tubes. Using TiO₂ supported on borosilicate tubes appears to be a promising alternative to conventional TiO₂ suspension and avoid post-separation stages. The results achieved in this study can be used to optimise large-scale applications, and expanding the study to cover a wide range of pollutants will lead to achieve more representative results.

https://ift.tt/2BfJUhB

Enthesitis and Dactylitis in Psoriatic Disease: A Guide for Dermatologists

Abstract

Psoriatic arthritis (PsA) is an inflammatory arthritis that is estimated to affect approximately 30% of patients with psoriasis. Enthesitis and dactylitis, two hallmarks of PsA, are associated with radiographic peripheral/axial joint damage and severe disease. Clinical symptoms of enthesitis include tenderness, soreness, and pain at entheses on palpation, whereas dactylitis is recognized by swelling of an entire digit that is different from adjacent digits. Both ultrasound and magnetic resonance imaging can be used to diagnose enthesitis and dactylitis, especially in patients in whom symptoms may be difficult to discern. Delayed treatment of PsA can result in irreversible joint damage and reduced quality of life. Thus, it is recommended that dermatologists monitor patients with psoriasis for these two early and important manifestations of PsA.

https://ift.tt/2MlKfof

Plasma Kallistatin Levels in Children with Community-Acquired Pneumonia

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.


https://ift.tt/2MToxUV

Plasma Kallistatin Levels in Children with Community-Acquired Pneumonia

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.


https://ift.tt/2nHH2k5

Coexistence of medullary thyroid carcinoma and recurrent non-functional pituitary adenoma: a case report

Medullary thyroid carcinoma and pituitary adenoma are neuroendocrine tumors and their coexistence has not been reported in the literature, previously. Medullary thyroid carcinoma is a neoplasm of the thyroid g...

https://ift.tt/2w9DcUH

Ecological risk assessment of potentially toxic elements (PTEs) in the soil-plant system after reclamation of dredged sediment

Abstract

The Shayinghe River is an important tributary of the Huaihe River in China. The concentrations of potential toxic elements (PTEs), such as As, Hg, Pb, Cu, Zn, Cr, and Cd in soils and dominant vegetation from mud-dumping areas reclaimed with dredged sediments, and areas without mud-dumping (non-mud-dumping areas) adjacent to the Shayinghe River were investigated. The potential ecological risk index (ERI) and transfer coefficient (TC) were calculated and evaluated. The results showed that the potential toxic element concentrations in all sampling areas decreased in the order of (Zn, Cr) > (Cu, Pb) > As>Cd > Hg. Additionally, the total concentrations of the PTEs significantly increased from mud-dumping to the non-mud-dumping areas. Ecological risk assessment of soils showed that all the elements did not exhibit apparent ecological risks (except for As). This element exhibited a moderate ecological risk, implying that the dredging of sediments could increase the potential ecological risk of individual PTEs. Additionally, the PTEs in some of dominant plants in mud-dumping areas did not increase, indicating no apparent accumulation. The principal component analysis (PCA) showed that the principal components of the PTEs in plants from dredged sediments were different from those in the agricultural soil, indicating the influence of dredging on PTEs. Finally, Cd, Zn, and Hg had higher transfer coefficients (up to 6), even if their concentrations were relatively low, suggesting potential ecological risks to the plants.

https://ift.tt/2vOnBKF

Research on the ecological efficiency of the Yangtze River Delta region in China from the perspective of sustainable development of the economy-energy-environment (3E) system

Abstract

Balancing the relationship between economic development, energy utilization, and environmental protection has become an important task in China's Strip Planning and Construction. This article takes the annual panel data from 2005 to 2015 as the research object firmly grasps the research basis of the Economy-Energy-Environment (3E) System, and focuses on building a new research framework from both internal and external perspectives of the eco-efficiency index to achieve the exploratory research on regional ecological efficiency changes and influencing factors. First of all, it uses super-efficient slacks-based measure (SBM) model which introduces undesired outputs to measure eco-efficiency at different levels. Then, it applies Malmquist index to calculate total factor productivity and structural efficiencies. Finally, it selects six indicators and uses the STIRPAT regression model to analyze external factors. The results indicate that (1) the overall ecological efficiency is effective and maintaining a good momentum of development. Among all the cities and provinces, Shanghai and Zhejiang provinces play the role of "stabilizers," while Jiangsu and Anhui provinces act as "accelerators." (2) All 41 prefecture-level cities can be divided into four different types, i.e., "high-high", "low-high", "low-low," and "high-low" cities, and there is an obvious phenomenon of spatial clustering; (3) pure technical efficiency and scale efficiency is the core driving force for the improvement of ecological efficiency. (4) Anhui and Jiangsu provinces show a U-shaped relationship, while Zhejiang province shows an inverted U-shaped relationship.

Graphical abstract

The structure of introduction-body paragraphs-conclusion carbon

https://ift.tt/2Blo5Nw

Mesenchymal Stem Cells and Stromal Vascular Fraction for Hair Loss

The current state of the applicability of cell therapy for the treatment of various conditions of hair loss reveals a promising and potentially effective role. Further research, based on published work to date, is indicated to further explore the potential roles of autologous fat grafting, mesenchymal stem cells, and stromal vascular fraction therapy. The authors' evolving experience matches these promising scientific findings.

https://ift.tt/2nDNF6K

Microneedling with Biologicals

Microneedling is a popular and cost-effective treatment with little down time. The application of topical agents to enhance outcomes is common practice. Microchannels created with nonthermal needling close at 4 hours to 6 hours due to fibrin plugs. Channels created with thermal needling or fractional laser stay open longer and enhance drug or biological uptake more due to the dermal sponge injury pattern that is created. Nonthermal microneedling devices may need Food and Drug Administration clearance, which also notes that dermaceuticals should be considered drugs in many cases.

https://ift.tt/2MSx7mv

Mesothelial Stem Cells and Stromal Vascular Fraction

Autologous human fat-derived mesenchymal stem cells are present in stromal vascular fraction. Stromal vascular fraction can be easily and safely extracted from lipoaspirate. The regenerative, antiinflammatory and immunomodulatory effects of stromal vascular fraction are being documented in ongoing therapeutic response studies.

https://ift.tt/2PditIf

Introduction

The use of biologicals for clinical use is rapidly increasing. One of the logical questions is what constitutes a biological? The official definition of biological products by the Food and Drug Administration is "Biological products can be composed of sugars, proteins, or nucleic acids, or a combination of these substances. They may also be living entities, such as cells and tissues. Biologics are made from a variety of natural resources—human, animal, and microorganism—and may be produced by biotechnology methods."

https://ift.tt/2MMwhaX

Platelet-Rich Plasma for Hair Loss

Given substantial advances in hair regrowth research and platelet-rich plasma (PRP) science, a review of currently used systems and results is informative for physicians using a biologics approach to hair restoration. Overall positive clinical response to the use of PRP in androgenetic and alopecia areata patients is observed. The effects on hair density, count, and thickness were demonstrated through multiple clinical trials. Use as an adjunct to hair transplantation and with other technologies is also described. When compared with traditional oral/topical treatments, the lack of identifiable complications and convenience of treatment provide a positive outlook for future use and investigation.

https://ift.tt/2PdKrUi

Platelet-Rich Plasma for Skin Rejuvenation and Tissue Fill

Platelet preparations, including platelet-rich plasma and platelet-rich fibrin matrix, have been used to improve wound healing, recovery time, and cosmetic outcomes for facial rejuvenation. Bioactive growth factors released from platelets are the putative agents in producing a reparative tissue reaction in the treated area. Different methods of processing the patients' blood will yield different types of platelet preparations with different components and properties, and it is important to understand these differences and their potential implications. More robust studies are necessary to better understand the nuances of these preparations and their optimal use.

https://ift.tt/2MSN64l

Lasers, Microneedling, and Platelet-Rich Plasma for Skin Rejuvenation and Repair

Skin resurfacing for the purpose of rejuvenation and repair continues to evolve with the development of noninvasive or minimally invasive surgical substitutes. Advances in laser therapy, microneedling, and platelet-rich plasma have reinvigorated research in wound repair and regenerative science. An overall positive clinical response toward the use of platelet-rich plasma as an adjuvant to fractional photothermolysis and percutaneous collagen induction is observed. Its effect on post-treatment adverse symptoms, erythema, edema, crusting, and clinical outcomes in rejuvenation are summarized in this article. The lack of identifiable complications and convenience of treatment provides a positive outlook for future use and investigations.

https://ift.tt/2nFfMCB

Hair Biology

Healthy hair is vital to identity. Understanding the intricate anatomy and physiology of hair provides insight into the aging process and the eventual loss of either hair pigmentation or hair shafts. There are several biologics available that have enabled altering or slowing the aging process of hair, but, unfortunately, no agent exists that can reverse the natural course. The commonly used biologics are discussed.

https://ift.tt/2MSwYiX

Biologic Treatments Are Our Future, but a More Regulated One

There is very little question that development of biological products is a large part of facial plastic surgery's future. Our colleagues in plastic surgery have embraced these technologies and are moving forward with them.

https://ift.tt/2PdZGMK

A General Approach to Facial Palsy

Management of facial palsy can be daunting. This article presents a conceptual framework for classification and therapeutic management of facial palsy.

https://ift.tt/2nFLoZ1

Multipurpose efficacy of the lyophilized cell-free supernatant of Salmonella bongori isolated from the freshwater fish, Devario aequipinnatus: toxicity against microbial pathogens and mosquito vectors

Abstract

Presently, the discovery of effective drugs and pesticides from eco-friendly biological sources is an important challenge in the field of life sciences. The present research was aimed for standardizing an innovative approach in the evaluation of the biological potentiality of the metabolites of fish-associated bacteria. We have identified 17 skin-associated bacteria from the freshwater fish, giant danio, Devario aquipinnatus. They were screened through biofilm forming and extracellular enzyme producing ability. The results of preliminary antibacterial evaluation of the bacterial supernatants underlined the importance of three potential strains (BH8, BH10 and BH11) for further applied research. Hence, such strains were subsequently subjected to a novel extraction procedure to overcome the difficulties found in polar solvents mixed with the supernatant. The lyophilized cell-free supernatant (LCFS) of 3 isolates were individually extracted by using methanol. During the testing of LCFS's methanolic extract (LCFS-ME) of 3 isolates, only the extract of BH11-strain exhibited potent inhibitory activity against the pathogenic bacteria and fungi. Furthermore, the larvicidal and mosquitocidal assays on the filariasis vector, Culex quinquefasciatus also showed its potent toxicity on both the adults and developmental instars of mosquito. Through molecular and phylogenetic analyses, the BH11 strain was identified as Salmonella bongori (KR350635). The present finding emphasized that the S. bongori could be an important novel source of effective antimicrobials and mosquitocidal agents.

https://ift.tt/2PdO1gW

14 ways to lose weight without diet or exercise

Strict diets can be challenging to follow, and people may not always have the time or ability to exercise. However, a variety of simple lifestyle changes can help people lose weight and improve their health. These include taking probiotics, getting enough sleep, and thoroughly chewing food. Learn more here.

https://ift.tt/2nF09v1

14 ways to lose weight without diet or exercise

Strict diets can be challenging to follow, and people may not always have the time or ability to exercise. However, a variety of simple lifestyle changes can help people lose weight and improve their health. These include taking probiotics, getting enough sleep, and thoroughly chewing food. Learn more here.

https://ift.tt/2nF09v1

A lower energetic, protein and uncooked cornstarch intake is associated with a more severe outcome in glycogen storage disease type III: an observational study of 50 patients

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2PcNvzZ

Resolution of Atypical Lichen Myxedematosus After Sofosbuvir-Velpatasvir Treatment for Hepatitis C

This case report describes a patient with lichen myxedematosus that resolved after sofosbuvir-velpatasvir treatment for hepatitis C infection.

https://ift.tt/2MNFvE2

A Case of Pigmented Longitudinal Melanonychia

A man in his 40s presented to the dermatology clinic for evaluation of a dark brown longitudinal pigment band covering his left second toenail; the lesion appeared 12 months prior, had been growing, and was asymptomatic. What is your diagnosis?

https://ift.tt/2Pc0a68

Safety Risk of Dermatoscope Magnets in Patients With Cardiovascular Implanted Electronic Devices

This observational cross-sectional study assesses the magnets in 3 different dermatoscopes to determine their ability to disrupt the functionality of pacemakers, defibrillators, and other implanted devices in patients.

https://ift.tt/2MR39iO

Aprepitant for the Treatment of Pruritus in Sézary Syndrome

This randomized clinical trial assesses whether treatment with the neurokinin 1 receptor antagonist aprepitant decreases pruritus vs placebo in patients with Sézary syndrome.

https://ift.tt/2nEDleN

Self-reported Patient Motivations for Seeking Cosmetic Procedures

This multicenter observational study assesses the importance of self-reported factors that motivate patients to undergo minimally invasive cosmetic surgical procedures.

https://ift.tt/2MORUYf

Interpretation of Melanocytic Lesions in the Digital Era vs Traditional Microscopy

This study of 87 pathologists compares the use of digital whole-slide imaging vs traditional microscopy in pathologists' ability to accurately interpret melanocytic lesions and reproduce correct diagnoses.

https://ift.tt/2PbZVIg

The impact of allergen exposure and specific immunotherapy on circulating blood cells in allergic rhinitis

Allergic rhinitis (AR) is an IgE-mediated inflammatory disease of the nasal mucosa with well described local immune responses during allergen exposure. The frequent association of AR with general extra-nasal s...

https://ift.tt/2MpLuSw

Evolution of adjuvant treatment in endometrial cancer—no evidence and new questions?

Abstract

Purpose

For endometrial cancer (EC), clinical and pathological risk factors are taken to triage patients and estimate their prognosis. Lymph node involvement (pN+), lymphovascular space involvement (LSVI), grading, age of the patients, and T classification are internationally accepted parameters for treatment decisions.

Materials and methods

Studies on adjuvant radiation, chemotherapy, and chemoradiation are discussed against the background of risk stratification and clinical decision-making in early-to-advanced stage endometrial cancer. Recent publications on adjuvant treatment in high-risk disease and its implications for the patients with regard to expected oncologic benefit and treatment-related toxicity are discussed.

Results

Surgery is the mainstay of treatment of EC patients. Well-differentiated tumors and early disease (FIGO IA) should be followed up without further treatment. In FIGO I stage without risk factors, VBT remains the standard treatment after surgery. FIGO I, II patients with one or more risk factors (MI ≥ 50%, Grading[G]3, age >60 years, LVSI) benefit from external beam radiotherapy (EBRT) in terms of survival. There are no data of acceptable quality demonstrating that chemotherapy is superior to radiation in locally advanced carcinomas. Therefore, even in locally advanced disease (FIGO III, IV), EBRT remains the standard of care after surgery. EBRT contributes to the very low rate of local relapses and better DFS in these patients and should not be replaced by chemotherapy only. Whether and which subgroups of patients benefit from an additional (concomitant and/or adjuvant) chemotherapy in terms of disease-free survival remains a controversial issue. The recently published PORTEC-3 trial could not create clear evidence. With a high rate of isolated tumors cells and micrometastases in the specimens, the increasing use of unvalidated sentinel concepts in endometrial cancer raises more questions with regard to indications for adjuvant treatment.

Summary and perspectives

In the future, integrated genomic characterization of tumors might be helpful for treatment individualization in the adjuvant setting.

https://ift.tt/2nGWRY6

Characterization and Outcomes of Disease Progression in 52 Patients Treated with BRAF-V600 + MEK Inhibitors for Advanced Melanoma

Background: Combined treatment with BRAF-V600 and MEK inhibitors has significantly improved progression-free and overall survival of patients with BRAF-mutated melanoma. Pattern of disease progression and outcomes in patients have not been fully characterized. Methods: We conducted a single-center, retrospective, descriptive analysis of a cohort of 52 patients treated with BRAF-V600 + MEK inhibitors for advanced melanoma over a 12-month period. The aim of this study was to characterize disease progression, defined as metastatic pattern, disease kinetics, and response to subsequent therapies, in melanoma patients treated with BRAF-V600 + MEK inhibitors. Results: Disease progression was observed in 31/52 (59.6%) patients treated with BRAF-V600 + MEK inhibitors. Relapse of melanoma involved the CNS for 22/31 (70.9%) patients with disease progression, including 18/31 (58%) patients who had exclusive intracranial metastases. Sixteen patients died from disease progression. Among the 31 patients who had disease progression, the median time until a relapse was 8 months, and the median survival time after disease progression was 2 months. Conclusion: Our study shows that, for patients treated with BRAF-V600 + MEK inhibitors who lose response, disease progression was aggressive and had poor outcomes. Most patients had CNS metastases and low rates of therapeutic response to any subsequent therapy.
Dermatology

https://ift.tt/2Be1keC

Association between Atopic Dermatitis and the Metabolic Syndrome: A Systematic Review

Atopic dermatitis (AD) may be associated with the metabolic syndrome and by that carry an increased risk of cardio­vascular disease. Our objective was to provide an update on current knowledge of the association between AD and metabolic syndrome, including each component of the metabolic syndrome. A systematic literature review was performed to identify studies investigating the association between metabolic syndrome and AD from PubMed, Embase, and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A total of 14 studies, investigating the association between AD and the metabolic syndrome or AD and components of metabolic syndrome fulfilled the inclusion criteria and were included. It seems unlikely that the association between AD and metabolic syndrome is causal. However, women with AD tended to have components of metabolic syndrome more often than women without AD. There was a positive association between AD and central obesity measured as waist circumference, and this association was stronger for women than men. Despite conflicting results regarding hypertension, the association between hypertension and AD also appeared stronger for women. On the other hand, the association between AD and hyperglycemia appears unlikely, and the association between AD and cholesterol levels was inconsistent. In conclusion, it remains unclear whether AD is a risk factor for metabolic syndrome and its components. However, data indicate that central obesity is associated with AD and that the association is stronger for women than men.
Dermatology

https://ift.tt/2PbZZIc

Odontogenic necrotizing fasciitis: a systematic review of the literature

Abstract

Background

While odontogenic soft tissue infections of the head and neck are common, progression to necrotizing fasciitis is relatively rare. Necrotizing fasciitis is a potentially life-threatening and rapidly progressive soft tissue infection that can lead to significant skin and soft tissue loss, mediastinitis, vascular thrombosis or rupture, limb loss, organ failure, and death.

Methods

A PubMed literature search was conducted for case reports and case series on odontogenic necrotizing fasciitis. Individual patient data was analyzed and compiled and demographic, treatment, microbiology, and mortality data were extracted. Fisher's exact test was used to examine the relationship between death from odontogenic necrotizing fasciitis and diabetes mellitus (DM) and human immunodeficiency virus (HIV) positivity.

Results

A total of 58 studies totaling 164 patients were identified. Thirty-three patients had DM and 3 were HIV +. All patients underwent aggressive surgical debridement and treatment with IV antibiotics. Twenty patients were also treated with hyperbaric oxygen. There were 16 deaths reported, for a mortality rate of 9.8%. The mortality rate among patients with DM was 30.3 and 0% among HIV positive patients. There was a statistically significant increase in the mortality rate in DM patients with odontogenic necrotizing fasciitis (p = 0.0001, odds ratio for death 9.1).

Conclusions

Necrotizing fasciitis arising from odontogenic infection is a rapidly progressive and life-threatening illness. Prompt recognition of the infection, aggressive and often serial surgical debridement, and aggressive broad-spectrum antibiotics are necessary to prevent serious morbidity and mortality. Patients with diabetes mellitus are at a significantly increased risk of death from odontogenic necrotizing fasciitis.

https://ift.tt/2MNYpur

Announcement: A New Section Entitled Technology Pearls

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s):

https://ift.tt/2vKSwYz

Dermatology Calendar

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s):

https://ift.tt/2MN8iIS

Daily oxymetazoline cream demonstrates high and sustained efficacy in patients with persistent erythema of rosacea through 52 weeks of treatment

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Michael H. Gold, Mark Lebwohl, Brian S. Biesman, Deanne Mraz Robinson, Lei Luo, David R. Berk, Gurpreet Ahluwalia, Nancy Alvandi

https://ift.tt/2vKSr7d

Reply to: “Comment on ‘Prognostic value of sentinel lymph node biopsy according to Breslow thickness for cutaneous melanoma’”

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Evan Stiegel, Alok Vij

https://ift.tt/2MO6gbq

Comment on “Prognostic value of sentinel lymph node biopsy according to Breslow thickness for cutaneous melanoma”

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Elizabeth Greenwald, Tracey N. Liebman, David Polsky, Jennifer A. Stein

https://ift.tt/2vOkmTy

Reply to: “Serum vitamin D level and disease severity of alopecia areata: A meta-regression analysis”

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Tsung-Yu Tsai, Yu-Chen Huang

https://ift.tt/2KTPbuZ

Serum vitamin D level and disease severity of alopecia areata: A meta-regression analysis

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Chun-An Yao

https://ift.tt/2vOkhPK

Thromboprophylaxis and thalidomide in the noncancer setting: Toward an algorithm that is based on patient risk factors and underlying disease?

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): François Chasset, Laurent Arnaud, Camille Francès

https://ift.tt/2KUnX7j

Thalidomide and thromboprophylaxis for dermatologic indications: An unmet need for more evidence

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Anuradha Bishnoi, Vaneet Singh, Sanjeev Handa, Keshavamurthy Vinay

https://ift.tt/2vOk9zK

Response to “Vitamin D deficiency in patients with alopecia areata: A systematic review and meta-analysis” and an investigation of vitamin D in pediatric patients

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Elana Putterman, Leslie Castelo-Soccio

https://ift.tt/2KUMsBk

Tacking sutures to shrink surgical defects near free margins

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Stephanie Bayers, Kishwer S. Nehal, Rajiv I. Nijhawan

https://ift.tt/2vOk3bm

Dose escalation of doxepin for intractable pruritus

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Kristen M. Beck, Eric J. Yang, John Koo

https://ift.tt/2MQCcf8

Ethical challenges with treating nonadherent patients in a group practice setting

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Benjamin Freemyer, Benjamin Stoff

https://ift.tt/2nGHMFY

Effect of psoriatic arthritis on ixekizumab clinical outcomes in moderate-to-severe psoriasis patients: A post hoc analysis

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Alice B. Gottlieb, Kim A. Papp, Charles A. Birbara, Catherine L. Shuler, Russel Burge, Janelle Erickson, Lisa Kerr, Philip J. Mease

https://ift.tt/2KUnCS5

Bioimpedance measurement as an assessment of margin positivity in Mohs surgical specimens of nonmelanoma skin cancer: Management implications

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Ryan M. Svoboda, Manish J. Gharia, John Shell, William D. Gregory

https://ift.tt/2vOjNZW

Clinical, dermoscopic, and trichoscopic analysis of frontal fibrosing alopecia associated with acquired dermal macular hyperpigmentation: A cross sectional observational case-control study

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Muthu Sendhil Kumaran, Muhammed Razmi T, Keshavamurthy Vinay, Davinder Parsad

https://ift.tt/2KUM7P4

An effective game-based learning intervention for improving melanoma recognition

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Amit Sharma, Muneeb Ilyas, Nishita Maganty, Nan Zhang, Mark R. Pittelkow

https://ift.tt/2nHcRJO

Type I pityriasis rubra pilaris treated with tumor necrosis factor inhibitors, ustekinumab, or secukinumab: A review

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Nolan J. Maloney, Lisa D. Hisaw, Scott Worswick

https://ift.tt/2MLQq12

Skin cancer prevention messages on Facebook: Likes, shares, and comments

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): Adi Nosrati, Matthew A. Pimentel, Ashley Falzone, Roshini Hegde, Shilpa Goel, Mary-Margaret Chren, Rachel Eye, Eleni Linos, Sherry Pagoto, Barbara J. Walkosz

https://ift.tt/2nEtQwf

Inflammatory response and cytokine levels induced by intralesional photodynamic therapy and 630-nm laser in a case series of basal cell carcinoma

Publication date: September 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 3

Author(s): María Jesús Suárez-Valladares, Sara María Calleja-Antolín, Jose María García Ruíz de Morales, Manuel Angel Rodríguez Prieto, Jesús Vega-Gutierrez

https://ift.tt/2MRENpr

Rosenberg, NCI-supported researchers to receive 2018 Albany Prize

NCI's Steven A. Rosenberg, M.D., Ph.D., and two NCI-supported researchers have been named recipients of the 2018 Albany Medical Center Prize in Medicine and Biomedical Research for their pioneering immunotherapy research.

https://ift.tt/2PcOTTl

The Positive Effect of Sialendoscopy with Irrigation Lavage for Sialadenitis without Sialolithiasis or Stenosis

Aims: The aim of the study was to evaluate different irrigation solutions during sialendoscopy to reduce complaints caused by sialodochitis. Methods: The investigators designed and implemented a retrospective study composed of 94 patients with sialodochitis but no sialolithiasis or relevant stenosis of the salivary duct system. Three different irrigations (normal saline, cortisone single-shot, and cortisone) were used. After the sialendoscopy, the patients were asked about the current status of the affected salivary gland, and the quantity and quality of the gland swelling/inflammation over a follow-up period of 11.6 months (6–24 months). Results: At the time of follow-up, 41 patients (43.6%) no longer had any complaints with the salivary gland in question. In 75.5% of the patients, a satisfying result was achieved. In total, only 3 patients needed submandibulectomy in the course of the study due to persistent complaints. The outcome showed no statistical differences between the mean of the 3 groups (p = 0.149). Conclusion: Sialendoscopy with flushing/lavage seems to be a good treatment option for patients with sialodochitis lacking sialolithiasis. The results of this study suggest that the type of irrigation used during sialendoscopy seems to be secondary.
ORL

https://ift.tt/2MkwLJ8

Predictability of Preoperative Carotid Artery Corrected Flow Time for Hypotension After Spinal Anesthesia in Patients Undergoing Cesarean Section

Condition:   Cesarean Section
Intervention:   Diagnostic Test: Doppler sonographic measurement
Sponsor:   Yonsei University
Not yet recruiting

https://ift.tt/2PcAkPp

Imaging With a PET Agent for Detection of Cancers of the Head and Neck

Condition:   Head and Neck Cancer
Interventions:   Drug: [18F]- PARPi;   Diagnostic Test: PET/CT Scans
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting

https://ift.tt/2MLsfji

Predictability of Preoperative Carotid Artery Corrected Flow Time for Hypotension After Spinal Anesthesia in Patients Undergoing Cesarean Section

Condition:   Cesarean Section
Intervention:   Diagnostic Test: Doppler sonographic measurement
Sponsor:   Yonsei University
Not yet recruiting

https://ift.tt/2PcAkPp

Nutritional Course of Care After Surgical Treatment at the Patients Affected by a Cancer of the Head and by the Neck

Conditions:   Nutrition Disorders;   Head and Neck Cancer
Intervention:   Other: Experimental group
Sponsor:   Centre Hospitalier Universitaire, Amiens
Recruiting

https://ift.tt/2PczIcz

Imaging With a PET Agent for Detection of Cancers of the Head and Neck

Condition:   Head and Neck Cancer
Interventions:   Drug: [18F]- PARPi;   Diagnostic Test: PET/CT Scans
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting

https://ift.tt/2MLsfji

Nutritional Course of Care After Surgical Treatment at the Patients Affected by a Cancer of the Head and by the Neck

Conditions:   Nutrition Disorders;   Head and Neck Cancer
Intervention:   Other: Experimental group
Sponsor:   Centre Hospitalier Universitaire, Amiens
Recruiting

https://ift.tt/2PczIcz

A Pilot Study to Evaluate the Effects of Topically Applied Cosmetic Creams on Epidermal Responses

Application of exogenous products, such as creams, to the skin can result in subclinical changes in selected epidermal functions such as transepidermal water loss (TEWL), hydration, redness, and pH; these changes may lead to or contribute to irritation. Changes in skin surface inflammatory factors may provide further insight into this potential for irritation. The objective of this study was to evaluate the changes in epidermal properties and inflammatory mediators after 4 days of topical application of 2 different polymers formulated in cosmetic creams. Ten healthy volunteers (mean age ± SD: 20.0 ± 2.4 years) completed the study. TEWL, color, and pH were not significantly different after repeated application of these polymers. Hydration was significantly lower at sites treated with polymer A after 5 days. Significant increases in IL-1α, IL-1RA, and IL-1β were observed after cream application at sites treated with polymer A. This is the first study to apply noninvasive measurements to quantify subclinical changes in epidermal properties and inflammatory mediator expression before and after the application of a cosmetic product, which will allow for a more enhanced safety profile to be achieved.
Skin Pharmacol Physiol 2018;31:269–282

https://ift.tt/2BaALqL

Epidermal Lamellar Granules

In the mid-1950s and 1960s, transmission electron microscopes became widely available, leading to many studies of the ultrastructure of various tissues including the epidermis. Most of these studies involved tissue fixation with formaldehyde and postfixation with osmium tetroxide. A few studies employed freeze-fracture electron microscopy. One set of these studies identified a small organelle variously called lamellar granules (LGs), lamellar bodies, membrane-coating granules, cementsomes, and Odland bodies. LGs are round to ovoid in shape, with a diameter of about 200 nm. They have a bounding membrane surrounding a stack of internal lipid lamellae. These small organelles are first seen in the spinous layer and accumulate with differentiation in the granular layer. In the uppermost granular cells, the bounding membrane of the LG fuses into the cell plasma membrane, and the internal contents are extruded into the intercellular space. The initially extruded contents of the LG then rearrange to form the intercellular lamellae of the stratum corneum. In this context, LGs serve as the precursor to the permeability barrier of the skin. Various studies have provided evidence that they are derived from the Golgi apparatus, specifically the trans-Golgi. Isolated LGs contain phosphoglycerides, sphingomyelin, and glucosylceramides. The most unusual lipid component is a linoleate-containing glucosylceramide comprising 30- to 34-carbon ω-hydroxy­acids. Isolated granules also contain acid hydrolases including glucocerebrosidase, sphingomyelinase, and phospholipase A. They also contain proteases and antimicrobial peptides. Defective LGs have been associated with a number of skin diseases including ichthyotic conditions and defective barrier function. Recently, studies employing cryo-transmission electron microscopy have called into question the validity of observations on LGs with more conventional electron microscopic techniques. These studies suggest a continuity of the membrane structure from the Golgi through the intercellular lamellae of the stratum corneum.
Skin Pharmacol Physiol 2018;31:262–268

https://ift.tt/2MqdQMq

Nanoparticle-Mediated Upconversion of Near-Infrared Light: A Step Closer to Optogenetic Neuromodulation in Humans

Stereotact Funct Neurosurg

https://ift.tt/2OAe4hy

Scapular Bronchogenic Cyst in a Girl Presenting as Recurrent Cellulitis: A Case Report and Review of the Literature

Bronchogenic cysts are rare, congenital cysts originating from respiratory epithelium and typically found within the chest. Cutaneous bronchogenic cysts are exceedingly uncommon, with only 19 reported cases in the scapular region and almost exclusively occurring in male patients. Herein, we present the case of a female patient with recurrent cellulitis secondary to a bronchogenic cyst, which was diagnosed after surgical excision. We also provide a review of the literature to consolidate the current understanding of cutaneous scapular bronchogenic cysts. To our knowledge, this is the first such case reported from Canada.

https://ift.tt/2nE5S4f

Encapsulation of cinnamon essential oil in whey protein enhances the protective effect against single or combined sub-chronic toxicity of fumonisin B 1 and/or aflatoxin B 1 in rats

Abstract

Fumonisin B₁ (FB₁) and aflatoxin B₁ (AFB₁) are fungal metabolites that frequently co-occur in foodstuffs and are responsible for mycotoxicosis and several primary cancers. Cinnamon essential oil (CEO) has a spacious range of benefit effects but also has some limitations owing to its strong taste or its interaction with some drugs. This study aimed to use the cinnamon oil emulsion droplets (COED) for the protection against oxidative stress, cytotoxicity, and reproductive toxicity in male Sprague-Dawley rats sub-chronically exposed to FB₁ and/or AFB₁. The composition of CEO was identified using GC-MS then was encapsulated using whey protein as wall material. Male rats were divided into eight groups and treated orally for 8 weeks as follows: control group, AFB₁-trreated group (80 μg/kg b.w), FB₁-treated group (100 mg/kg b.w), FB₁ plus AFB₁-treated group, and the groups treated with COED plus FB₁ and/or AFB₁. Blood and samples of the kidney, liver, and testis were collected for different analysis and histopathological examination. The GC-MS analysis revealed that cinnamaldehyde, α-copaene, trans-cinnamaldehyde, caryophyllene, and delta-cadinene were the main compounds in COE. The average size of COED was 235 ± 1.4 nm and the zeta potential was − 6.24 ± 0.56. Treatment with FB₁ and/or AFB₁ induced significant disturbances in the serum biochemical analysis, oxidative stress parameters, DNA fragmentation, gene expression, and testosterone and severe pathological changes in the tested organs. Moreover, treatment with both mycotoxins induced synergistic toxic effects. COED did not induce toxic effects and could normalize the majority of the tested parameters and improve the histological picture in rats treated with FB₁ and/or AFB₁. It could be concluded that COED induce potential protective effects against the single or combined exposure to FB₁ and AFB₁.

https://ift.tt/2OyYySX

Methicillin-resistant Staphylococcus aureus Colonization and Pre- and Post-hospital Discharge Infection Risk.

Methicillin-resistant Staphylococcus aureus Colonization and Pre- and Post-hospital Discharge Infection Risk.

Clin Infect Dis. 2018 Aug 11;:

Authors: Nelson RE, Evans ME, Simbartl L, Jones M, Samore MH, Kralovic SM, Roselle GA, Rubin MA

Abstract
Background: The Department of Veterans Affairs implemented an active surveillance program for methicillin-resistant Staphylococcus aureus (MRSA) in 2007 in which acute care inpatients are tested for MRSA carriage on admission, unit-to-unit transfer, and discharge. Using these data, we followed patients longitudinally to estimate the difference in infection rates for those who were not colonized, those who were colonized on admission (importers), and those who acquired MRSA during their stay. We examined MRSA infections that occurred prior to discharge and at 30, 90, 180, and 365 days after discharge.
Methods: We constructed a dataset of 985626 first admissions from January 2008 through December 2015 who had surveillance tests performed for MRSA carriage. We performed multivariable Cox proportional hazards and logistic regression models to examine the relationship between MRSA colonization status and infection.
Results: The MRSA infection rate across the predischarge and 180-day postdischarge time period was 5.5% in importers and 7.0% in acquirers without a direct admission to the intensive care unit (ICU) and 11.4% in importers and 11.7% in acquirers who were admitted directly to the ICU. The predischarge hazard ratio for MRSA infection was 29.6 (95% confidence interval [CI], 26.5-32.9) for importers and 28.8 (95% CI, 23.5-35.3) for acquirers compared to those not colonized. Fully 63.9% of all MRSA pre- and postdischarge infections among importers and 61.2% among acquirers occurred within 180 days after discharge.
Conclusions: MRSA colonization significantly increases the risk of subsequent MRSA infection. In addition, a substantial proportion of MRSA infections occur after discharge from the hospital.

PMID: 30107401 [PubMed - as supplied by publisher]

https://ift.tt/2BezQpg

Clinical and prognostic role of detection timing of distant metastases in patients with differentiated thyroid cancer

Abstract

Purpose

Distant metastases (DM) from DTC occur in 5–25% of cases and are correlated to lower survival; the prognostic significance of the temporal onset of DM is unclear. Our aim was to retrospectively analyze the prevalence of DM and to assess the prognostic role of the timing of manifestation of DM regarding the outcome.

Materials and methods

We included 174 patients (mean age 64 years). According to the time of manifestation, DM were divided in two groups: synchronous DM (SDM, n = 108) defined as metastases present at initial diagnosis and metachronous DM (MDM, n = 66) as diagnosed during follow-up. SDM were further sub grouped in pre-RAIT when diagnosed during pre-surgery work-up (n = 35) and baseline-RAIT when detected by first whole body scan after RAIT (n = 73). Disease-specific survival (DSS) was analyzed using the Kaplan–Meier method.

Results

Total RAI activities and number of treatments were significantly higher in MDM, also loss of RAI avidity was more frequent in MDM. Forty-four patients died during follow-up, of which 41 were DTC-related deaths, 5-year and 10-year DSS were 80% and 56%. On univariate analysis MDM had significantly shorter DSS; also histotype and RAI avidity were significant risk factors of impaired survival. On multivariate analysis, only loss of RAI avidity remained as independent negative predictor (p = 0.043). Considering SDM, DSS was significantly shorter in pre-RAIT group than baseline-RAIT (p = 0.004). Instead there was no significant difference between pre-RAIT-SDM and MDM in survival outcome (p = 0.875).

Conclusions

In DTC with DM, loss of RAI uptake has an important role in survival. No significant difference in survival outcome was discovered between SDM and MDM; but, among SDM, pre-RAIT had significant shorter DSS than baseline-RAIT.

https://ift.tt/2nGsXTK

Qualität von Patienteninformationsbroschüren zum atopischen Ekzem

Zusammenfassung

Hintergrund

Wie bei anderen chronischen Erkrankungen spielt die Informationsvermittlung zu Erkrankungen und ihrer Therapie beim atopischen Ekzem (AE) eine große Rolle. Aus der Literatur ist bekannt, dass Informationsbroschüren häufig nicht den Anforderungen der evidenzbasierten Patienteninformation entsprechen.

Ziel der Arbeit

Ziel dieser Arbeit war es daher, die Qualität von Informationsbroschüren zum AE zu untersuchen.

Material und Methoden

Insgesamt wurden 35 Broschüren in die Studie eingeschlossen. Diese stammen von Selbsthilfegruppen, aus dem Internet und aus Arztpraxen der Fachrichtungen Allgemeinmedizin, Pädiatrie und Dermatologie sowie Apotheken in der Stadt Regensburg. Die Qualitätsanalyse wurde mittels DISCERN-Instrument durchgeführt.

Ergebnisse

Die untersuchten 35 Patienteninformationsbroschüren zum Thema AE wiesen nahezu alle relevante Mängel auf und waren qualitativ im Mittel- und Unterfeld anzusiedeln. Keine der Broschüren verfügte über eine sehr gute Qualität. Lediglich 3 Broschüren wurden als „gut" bewertet.

Diskussion

Die Standards der evidenzbasierten Patienteninformation werden von einem Großteil der Informationsbroschüren zum Thema AE nicht erfüllt. Es ist von einem Versorgungsmangel an qualitativ hochwertiger Information auszugehen. Eine Verbesserung der vorhandenen Informationsmaterialen sowie ein Abgleich von EBPI(evidenzbasierte Patienteninformation)-Standards und dem Informationsbedarf von AE-Patienten sollten Gegenstand künftiger Forschung sein.

https://ift.tt/2MLoASh

Thyroseq V3 Molecular Profiling for Tailoring the Surgical Management of Hürthle Cell Neoplasms.

Related Articles

Thyroseq V3 Molecular Profiling for Tailoring the Surgical Management of Hürthle Cell Neoplasms.

Case Rep Endocrinol. 2018;2018:9329035

Authors: Pearlstein S, Lahouti AH, Opher E, Nikiforov YE, Kuriloff DB

Abstract
Hürthle cell predominant thyroid nodules often confound the diagnostic utility of fine needle aspiration biopsy (FNAB) with cytology often interpreted as a Hürthle cell lesion with an indeterminate risk of malignancy, Bethesda category (BC) III or IV. Molecular diagnostics for Hürthle cell predominant nodules has also been disappointing in further defining the risk of malignancy. We present a case of a slowly enlarging nodule within a goiter initially reported as benign on FNAB, BC II but on subsequent FNAB suspicious for a Hürthle cell neoplasm, BC IV. The patient had initially requested a diagnostic lobectomy for a definitive diagnosis despite a higher risk of malignancy based on the size of the nodule > 4 cm alone. To better tailor this patient's treatment plan, a newer expanded gene mutation panel, ThyroSeq® v3 that includes copy number alterations (CNAs) and was recently found to have greater positive predictive value (PPV) for identifying Hürthle cell carcinoma (HCC), was performed on the FNAB material. Molecular profiling with ThyroSeq® v3 was able to predict a greater risk of carcinoma, making a more convincing argument in favor of total thyroidectomy. Surgical pathology confirmed a Hürthle cell carcinoma with 5 foci of angioinvasion and foci of capsular invasion.

PMID: 30105107 [PubMed]

https://ift.tt/2KUGn8a

Successful Management of Pheochromocytoma Detected in Pregnancy by Interval Adrenalectomy in a VHL Patient.

Related Articles

Successful Management of Pheochromocytoma Detected in Pregnancy by Interval Adrenalectomy in a VHL Patient.

Case Rep Endocrinol. 2018;2018:9014585

Authors: Kaluarachchi VTS, Bulugahapitiya U, Arambewela M, Gunathilake S

Abstract
A 34-year-old mother with diabetes mellitus for 6 years presented in the late second trimester of her third pregnancy with new onset hypertension and characteristic hyperadrenergic spells. Clinical examination was unremarkable except a blood pressure of 170/110 mmhg. She had an elevated 24 hour urinary normetanephrine level with ultrasonic evidence of a hyperechoic hypervascular well-defined right supra renal mass of 6 x 5 cm in size which was very suggestive of a pheochromocytoma. Her management decisions were made by a multidisciplinary team which decided to deliver the baby by lower segment cesarean section (LSCS) as the pregnancy was advanced and to proceed with interval adrenalectomy after contrast enhanced computer tomography (CECT) of the abdomen with adrenal protocol. As a result a healthy baby was delivered by an uncomplicated elective LSCS at 36 weeks of POA. CECT abdomen with adrenal protocol confirmed a right-sided pheochromocytoma without any evidence of metastasis. Uncomplicated laparoscopic right adrenalectomy led to a clinical and biochemical recovery of the patient while histology confirmed the pheochromocytoma without any evidence of invasion. Subsequent follow up revealed cerebellar hemangioblastomas and retinal angioma in the right eye which led to a clinical diagnosis of Von Hippel Lindau disease (VHL). Even though clinical criteria for Von Hippel Lindau disease were fulfilled, her VHL genetic test was negative. At present she and her family are under surveillance of the endocrine team.

PMID: 30105106 [PubMed]

https://ift.tt/2ML8lEZ

Bilateral Pheochromocytomas in a Patient with Y175C Von Hippel-Lindau Mutation.

Related Articles

Bilateral Pheochromocytomas in a Patient with Y175C Von Hippel-Lindau Mutation.

Case Rep Endocrinol. 2018;2018:8967159

Authors: Astapova O, Biswas A, DiMauro A, Moalem J, Hammes SR

Abstract
Von Hippel-Lindau (VHL) disease, caused by germline mutations in the VHL gene, is characterized by metachronously occurring tumors including pheochromocytoma, renal cell carcinoma (RCC), and hemangioblastoma. Although VHL disease leads to reduced life expectancy, its diagnosis is often missed and tumor screening guidelines are sparse. VHL protein acts as a tumor suppressor by targeting hypoxia-inducible factors (HIFs) for degradation through an oxygen-dependent mechanism. VHL mutants with more severely reduced HIF degrading function carry a high risk of RCC, while mutants with preserved HIF degrading capacity do not cause RCC but still lead to other tumors. VHL disease is classified into clinical types (1 and 2A-2C) based on this genotype-phenotype relationship. We report a case of bilateral pheochromocytomas and no other VHL-related tumors in a patient with Y175C VHL and show that this mutant preserves the ability to degrade HIF in normal oxygen conditions but, similar to the wild-type VHL protein, loses its ability to degrade HIF under hypoxic conditions. This study adds to the current understanding of the structure-function relationship of VHL mutations, which is important for risk stratification of future tumor development in the patients.

PMID: 30105105 [PubMed]

https://ift.tt/2nEBVRu

Ectopic Papillary Thyroid Cancer with Distant Metastasis.

Related Articles

Ectopic Papillary Thyroid Cancer with Distant Metastasis.

Case Rep Endocrinol. 2018;2018:8956712

Authors: Vázquez OR, Silva F, Acosta-Pumarejo E, Marín ML

Abstract
Ectopic thyroid tissue is a rare clinical entity wherein malignant lesions may arise, the most common one being papillary carcinoma. We present a case of a 68-year-old female who presented with a growing mass in the right clavicle. An MR of the shoulder showed a soft tissue mass arising from the anterior margin of the right distal clavicle. A fine needle aspiration of the mass showed papillary thyroid carcinoma. PET/CT confirmed the clavicular and mediastinal mass. Excision of the clavicular mass and total thyroidectomy with modified right neck dissection were performed. Pathology revealed no evidence of malignancy in the thyroid; lymph nodes were positive for metastatic thyroid carcinoma. Postsurgery CT showed the superior mediastinal mass with surrounding adenopathy; radioiodine (RAI) treatment with dose of 142.1 mCi [5257.7 MBq] was recommended. Posttherapy whole-body scan (WBS) showed RAI avid tissue in the neck and superior mediastinum. Follow-up chest CT revealed pulmonary nodules that increased in number and size; a second RAI therapeutic dose was given. The posttherapy RAI WBS was negative. Repeat PET/CT showed multiple hypermetabolic lesions in the mediastinum, neck, lymph nodes, pulmonary nodes, and right shoulder. The FDG avid lesions with no RAI uptake suggested tumor dedifferentiation.

PMID: 30105104 [PubMed]

https://ift.tt/2vMCcGD

A prospective diagnostic study on povidone–iodine retention in lesions suspected to be squamous cell carcinoma or keratoacanthoma

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2MMrnuu

Complete resolution and periodic recurrence of multiple postradiation atypical vascular lesions

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2PbjRuL

Subungual Bowen disease. Complete remission 14 years post‐photodynamic therapy (PDT)

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2ML548F

A prospective diagnostic study on povidone–iodine retention in lesions suspected to be squamous cell carcinoma or keratoacanthoma

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2MMrnuu

Complete resolution and periodic recurrence of multiple postradiation atypical vascular lesions

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2PbjRuL

Subungual Bowen disease. Complete remission 14 years post‐photodynamic therapy (PDT)

Australasian Journal of Dermatology, EarlyView.


https://ift.tt/2ML548F

Clinical and prognostic role of detection timing of distant metastases in patients with differentiated thyroid cancer

Abstract

Purpose

Distant metastases (DM) from DTC occur in 5–25% of cases and are correlated to lower survival; the prognostic significance of the temporal onset of DM is unclear. Our aim was to retrospectively analyze the prevalence of DM and to assess the prognostic role of the timing of manifestation of DM regarding the outcome.

Materials and methods

We included 174 patients (mean age 64 years). According to the time of manifestation, DM were divided in two groups: synchronous DM (SDM, n = 108) defined as metastases present at initial diagnosis and metachronous DM (MDM, n = 66) as diagnosed during follow-up. SDM were further sub grouped in pre-RAIT when diagnosed during pre-surgery work-up (n = 35) and baseline-RAIT when detected by first whole body scan after RAIT (n = 73). Disease-specific survival (DSS) was analyzed using the Kaplan–Meier method.

Results

Total RAI activities and number of treatments were significantly higher in MDM, also loss of RAI avidity was more frequent in MDM. Forty-four patients died during follow-up, of which 41 were DTC-related deaths, 5-year and 10-year DSS were 80% and 56%. On univariate analysis MDM had significantly shorter DSS; also histotype and RAI avidity were significant risk factors of impaired survival. On multivariate analysis, only loss of RAI avidity remained as independent negative predictor (p = 0.043). Considering SDM, DSS was significantly shorter in pre-RAIT group than baseline-RAIT (p = 0.004). Instead there was no significant difference between pre-RAIT-SDM and MDM in survival outcome (p = 0.875).

Conclusions

In DTC with DM, loss of RAI uptake has an important role in survival. No significant difference in survival outcome was discovered between SDM and MDM; but, among SDM, pre-RAIT had significant shorter DSS than baseline-RAIT.

https://ift.tt/2nGsXTK

Clinical Manifestation of Hyper IgE Syndrome Including Otitis Media

Abstract

Purpose of Review

The hyper IgE syndromes (HIES) comprise a group of rare primary immunodeficiency disorders (PIDDs), which are characterized by extremely high serum IgE levels, eczema, recurrent skin and pulmonary infections. Both autosomal dominant (AD) HIES due to STAT3 mutations and autosomal recessive (AR) HIES due to PGM3, SPINK5, DOCK8 and TKY2 mutations have been reported. Here, we aim to summarize and compare the major clinical manifestations of different subtypes of HIES. We will also discuss otitis media, which usually do not get enough attention in HIES. Update and familiarity with these clinical features will help to make a better diagnose, assessment and treatment of HIES.

Recent Findings

Although hyper serum IgE levels have been identified in PGM3 deficiency and Comel–Netherton syndrome, PGM3 and SPINK5 genes were not included in the list of genetic etiologies of AR-HIES by the Expert Committee of the International Union of Immunological Societies until 2015. The identification of these HIES-causing genes greatly promoted the pathogenic mechanism studies of HIES. Also, in recent years, more clinical manifestations, which were often not of concern in HIES patients, have been shown to be highly related to HIES. For example, a significantly high frequency of vascular and gastrointestinal abnormities has been reported in STAT3-deficient AD-HIES patients. These new findings might help to provide new clues to the functional study of these HIES-related genes.

Summary

This review summarizes and compares the major clinical manifestations of different subtypes of HIES, and we suggest that the incidence and severity of otitis media should not be underestimated in HIES patients.

https://ift.tt/2OCCM0u

Tips for Seeing Patients via Telemedicine

Abstract

Purpose of Review

Telemedicine is a technology that permits patients to be seen at a distance. This review describes different types of telemedicine, why they might be useful for a practice, what equipment is needed, and how to select and schedule patients.

Recent Findings

The use of synchronous telemedicine is increasing rapidly and has surpassed 50% of ambulatory encounters in some instances. Management of patients is particularly germane for an allergy practice since it is an outpatient specialty with patients who live in widely distributed locations with limited access to allergists. With utilization of digital exam equipment, in vitro tests for diagnosis, and spirometry at the patient location, there are few clear advantages of seeing patients in-person over virtual visits.

Summary

Telemedicine is here today. As its use increases, it is critical that allergy specialists embrace this new technology.

https://ift.tt/2P91zdR

Effects of quercetin on human oral keratinocytes during re-epithelialization: an in vitro study

Publication date: Available online 15 August 2018

Source: Archives of Oral Biology

Author(s): Miyashaer Hujiahemaiti, Xiaolin Sun, Jing Zhou, Huixin Lv, Xue Li, Manlin Qi, Minghan Chi, Chunyan Li, Yanmin Zhou

Abstract

Background

The width of keratinized mucosa plays an important role in esthetic and functional outcomes of dental implants. Lack of keratinized mucosa may lead to poor oral hygiene and greater soft-tissue recession. This study aimed at assessing the potential of quercetin in promoting human oral keratinocyte (HOK) proliferation and re-epithelializationin vitro.

Materials and Methods

HOK were detected in the absence or presence of test substances. The Cell Counting Kit-8 was used to assess cell viability and proliferation capacity. Re-epithelization was assessed using a keratinocyte monolayer scratch assay. Cell migration was monitored via Transwell chambers. Porphyromonas gingivalis lipopolysaccharide was used to stimulate keratinocytes for mimicking the inflammatory situation. mRNA expression of inflammatory cytokines (interleukin-1beta, IL-1β and tumor necrosis factor alpha, TNF-α), cell adhesion molecules (Integrin-α6, Integrin-β4), and growth factors (transforming growth factor beta 1,TGF-β1 and transforming growth factor beta 3, TGF-β3) were estimated using RT-qPCR. Protein contents of TGF-β1 and TGF-β3 were investigated by enzyme-linked immunosorbent assay.

Results

Multiplex analysis revealed that quercetin enhances HOK proliferation via an upregulation of adhesion molecules (Integrin-α6β4). Additionally, re-epithelialization rate was significantly greater in the presence of quercetin than in the control (P < 0.01). Furthermore, 20 µM of quercetin increases both mRNA and protein levels of TGF-β3 under basal and wound conditions without affecting TGF-β1 production. Expressions of pro-inflammatory cytokines were downregulated by quercetin treatment.

Conclusion

Quercetin promotes HOKs proliferation and oral re-epithelialization in vitro.

https://ift.tt/2MeYWt4

Expression of biological mediators during orthodontic tooth movement: A systematic review

Publication date: Available online 15 August 2018

Source: Archives of Oral Biology

Author(s): L. Vansant, M. Cadenas De Llano-Pérula, A. Verdonck, G. Willems

Abstract

Objectives

The aim of the present systematic review was to offer a timeline of the events taking place during orthodontic tooth movement(OTM).

Materials and methods

Electronic databases PubMed, Web of Science and EMBASE were searched up to November 2017. All studies describing the expression of signaling proteins in the periodontal ligament(PDL) of teeth subjected to OTM or describing the expression of signaling proteins in human cells of the periodontal structures subjected to static mechanical loading were considered eligible for inclusion for respectively the in-vivo or the in-vitro part. Risk of bias assessment was conducted according to the validated SYRCLE's RoB tool for animal studies and guideline for assessing quality of in-vitro studies for in-vitro studies.

Results

We retrieved 7583 articles in the initial electronic search, from which 79 and 51 were finally analyzed. From the 139 protein investigated, only the inflammatory proteins interleukin(IL)-1β, cyclooxygenase(COX)-2 and prostaglandin(PG)-E2, osteoblast markers osteocalcin and runt-related transcription factor(RUNX)2, receptor activator of nuclear factor kappa-B ligand(RANKL) and osteoprotegerin(OPG) and extracellular signal–regulated kinases(ERK)1/2 are investigated in 10 or more studies.

Conclusion

The investigated proteins were presented in a theoretical model of OTM. We can conclude that the cell activation and differentiation and recruitment of osteoclasts is mediated by osteocytes, osteoblasts and PDL cells, but that the osteogenic differentiation is only seen in stem cell present in the PDL. In addition, the recently discovered Ephrin/Ephs seem to play an role parallel with the thoroughly investigated RANKL/OPG system in mediating bone resorption during OTM.

https://ift.tt/2Bek1ik

Left ventricular MRI wall motion assessment by monogenic signal amplitude image computation

Publication date: Available online 15 August 2018

Source: Magnetic Resonance Imaging

Author(s): Narjes Benameur, Enrico Gianluca Caiani, Martino Alessandrini, Younes Arous, Nejmeddine Ben Abdallah, Foued Saadaoui, Tarek Kraiem

Abstract

Background

Cardiac Magnetic Resonance Imaging (MRI) is the commonly used technique for the assessment of left ventricular (LV) function. Apart manually or semi-automatically contouring LV boundaries for quantification of By visual interpretation of cine images, assessment of regional wall motion is performed by visual interpretation of cine images, thus relying on an experience-dependent and subjective modality.

Objective

The aim of this work is to describe a novel algorithm based on the computation of the monogenic amplitude image to be utilized in conjunction with conventional cine-MRI visualization to assess LV motion abnormalities and to validate it against gold standard expert visual interpretation.

Methods

The proposed method uses a recent image processing tool called "monogenic signal" to decompose the MR images into features, which are relevant for motion estimation. Wall motion abnormalities are quantified locally by measuring the temporal variations of the monogenic signal amplitude. The new method was validated by two non-expert radiologists using a wall motion scoring without and with the computed image, and compared against the expert interpretation. The proposed approach was tested on a population of 40 patients, including 8 subjects with normal ventricular function and 32 pathological cases (20 with myocardial infarction, 9 with myocarditis, and 3 with dilated cardiomyopathy).

Results

The results show that, for both radiologists, sensitivity, specificity and accuracy of cine-MRI alone were similar and around 59%, 77%, and 71%, respectively. Adding the proposed amplitude image while visualizing the cine MRI images significantly increased both sensitivity, specificity and accuracy up to 75%, 89%, and 84%, respectively.

Conclusion

Accuracy of wall motion interpretation adding amplitude image to conventional visualization was proven feasible and superior to standard image interpretation on the considered population, in inexperienced observers. Adding the amplitude images as a diagnostic tool in clinical routine is likely to improve the detection of myocardial segments presenting a cardiac dysfunction.

https://ift.tt/2KQcfL2

7.0 tesla high resolution MRI study on intracerebral migration of magnet-labeled neural stem cells in a mouse model of Alzheimer's disease

Publication date: Available online 15 August 2018

Source: Magnetic Resonance Imaging

Author(s): Fan Zhang, Shuang-Qing Chen, Ming-Min Tong, Pei-Jun Wang, Gao-Jun Teng

Abstract

Objective

To observe the migration characteristics of neural stem cells (NSCs) labeled with the MRI contrast agent superparamagnetic iron oxide (SPIO) in the brain of APP/PS1 transgenic mice with Alzheimer's disease (AD) by 7.0 T high resolution MRI.

Methods

C57BL/6 mouse NSCs were cultured, amplified, labeled with Feridex and Poly-l-lysine (FE-PLL) and evaluated by transmission electron microscopy (TEM). Using the random number table method, 24 APP/PS1 transgenic AD mice aged 12 months were equally assigned to two groups: animals in group A were transplanted with FE-PLL labeled NSCs and those in group B were transplanted with non-labeled NSCs in the right hippocampus. Twelve wild-type mice of the same age and born from the same litter were used as the control group (group C) and transplanted with FE-PLL labeled NSCs. Using the 7.0 T high resolution MR scanner, the transplanted NSCs were traced in vivo at 1 day, 1 and 2 weeks after cell transplantation. The MRI findings were compared with the histopathological findings.

Results

C57BL/6 mouse NSCs were cultured and amplified successfully. TEM showed large amounts of iron-containing particles in the cytoplasm of transplanted cells. MRI in group A showed the presence of spheroid low signals at the injection point of the hippocampus on T₂*WI one day after transplantation; one weeks later, the low signals were seen diffusing to the surroundings along the injection point, and covering almost the whole hippocampal area but the intensity of the low signals became weaker gradually; two weeks after transplantation, almost all low signals disappeared. In group B, no significant change in low signals was observed in the transplantation area at all designated time points. Although low signals were also observed in the hippocampus after transplantation of FE-PLL labeled NSCs in group C, their size and location remained almost unchanged. Prussian blue staining showed that migration of the FE-PLL labeled NSCs in the hippocampus of the AD mice was consistent with the MRI findings at all designated time points.

Conclusion

NSCs underwent diffuse and non-directional migration to the surroundings after they were transplanted to the hippocampus of APP/PS1 transgenic AD mice, and this migration pattern could be traced in vivo by MRI when they were labeled with magnet.

https://ift.tt/2vKeafr

Antiphospholipid syndrome: An update on risk factors for pregnancy outcome

Publication date: Available online 15 August 2018

Source: Autoimmunity Reviews

Author(s): De Carolis Sara, Tabacco Sara, Rizzo Francesca, Giannini Andrea, Botta Angela, Salvi Silvia, Garufi Cristina, Benedetti Panici Pierluigi, Lanzone Antonio

Abstract

Background

The optimal treatment of women with primary antiphospholipid syndrome (APS) is still debated. About 20–30% of women with APS remain unable to give birth to healthy neonates despite conventional treatment, consisting of prophylactic-dose heparin and low-dose aspirin. These cases are defined "refractory obstetric APS". The early identification of risk factors associated with poor pregnancy outcome could be the optimal strategy to establish criteria for additional therapies, such as hydroxychloroquine, steroids, intravenous immunoglobulin, and plasma exchange.

Purpose

The aim of the present study was to review current literature about risk factors for poor pregnancy outcome.

Search methods.

The PubMed database was used to search for peer-reviewed original and review articles concerning risk factors for pregnancy outcome in APS from 1st January 1990 to 15th January 2018.

Outcomes.

History of pregnancy morbidity and/or thrombosis, the association with SLE and/or other autoimmune diseases are well known history-based predictive factors for obstetrical complications, such as miscarriage, maternal venous thromboembolism, intrauterine foetal demise, preeclampsia, and neonatal death. Moreover, laboratory findings associated with poor pregnancy outcome are: triple antiphospholipid antibodies aPL positivity, double aPL positivity, single aPL positivity, false-positive IgM for CMV, and hypocomplementemia. Triple positivity is confirmed as the most significant risk factor by a large body of evidence.

Furthermore, the abnormal uterine arteries Doppler velocimetry results are confirmed to be strongly associated with poor pregnancy outcomes in APS. The good performance of the uterine arteries velocimetry, as a negative predictive factor, was reported by different studies. On the contrary, in case of abnormal uterine arteries results, the relevance of a careful surveillance is highlighted for the high risk of maternal-foetal complications. Nevertheless, this tool is a late indicator to suggest any additional treatments.

Conclusions

In order to prevent obstetrical complications and establish the optimal combination therapy, the knowledge at preconception or at the beginning of pregnancy of risk factors associated with poor pregnancy outcome could be a crucial step for management and treatment of APS. In addition, in the preconception assessment a regimen with low-dose aspirin, folic acid, and vitamin D supplementation should be offered, and a treatment strategy has to be established (conventional vs additional therapy). In fact, additional treatment has to be tailored for each patient.

https://ift.tt/2vL3LA2

The role of stress in the mosaic of autoimmunity. An overlooked association

Publication date: Available online 14 August 2018

Source: Autoimmunity Reviews

Author(s): Kassem Sharif, Abdulla Watad, Louis Coplan, Benjamin Lichtbroun, Alec Krosser, Michael Lichtbroun, Nicola Luigi Bragazzi, Howard Amital, Arnon Afek, Yehuda Shoenfeld

Abstract

Stress is defined as the pscyophysiological reaction in which the steady state is disturbed or threatened. Stress is not always perceived as a negative response. Stress results when environmental demands exceed an individuals' adaptive capacities. Autoimmune diseases are heterogeneous group of chronic diseases which occur secondary to loss of self antigen tolerance. The etiopathogenesis of autoimmune disease is uncertain. Genetic factors as well as environmental factors appear to interplay, leading to a cascade of events resulting in disease onset. Stress has been postulated to play a role in disease onset in the genetically susceptible patients. During the stress response, catecholamines and glucocorticoids are released from locus coeruleus and adrenal gland. These biomolecules exert control over various immune cells in the innate and adaptive arms of the immune system, thereby altering the cytokine profile released. The increase of IL-4 promotes T-helper 2 (T_h2) cell differentiation, while the decrease in IL-12 and the increased IL-10 production reduce the number of T-helper 1 (T_h1) cells.. The relationship between stress and autoimmune diseases is intricate. Stress has been shown to be associated with disease onset, and disease exacerbations in rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis, Graves' disease as well as other autoimmune conditions. In certain conditions such as psoriasis, stress has been implicated in delaying lesion clearance upon the application of standard treatment regimes. Finally, psychological therapy and cognitive behavioral therapy aimed to reduce stress levels was shown to be effective in influencing better outcomes in many autoimmune diseases. The purpose of this paper is to closer inspect the clinical evidence regarding the role of stress on influencing the various aspects of disease entities.

https://ift.tt/2OBODfj

Antiphospholipid syndrome: An update on risk factors for pregnancy outcome

Publication date: Available online 15 August 2018

Source: Autoimmunity Reviews

Author(s): De Carolis Sara, Tabacco Sara, Rizzo Francesca, Giannini Andrea, Botta Angela, Salvi Silvia, Garufi Cristina, Benedetti Panici Pierluigi, Lanzone Antonio

Abstract

Background

The optimal treatment of women with primary antiphospholipid syndrome (APS) is still debated. About 20–30% of women with APS remain unable to give birth to healthy neonates despite conventional treatment, consisting of prophylactic-dose heparin and low-dose aspirin. These cases are defined "refractory obstetric APS". The early identification of risk factors associated with poor pregnancy outcome could be the optimal strategy to establish criteria for additional therapies, such as hydroxychloroquine, steroids, intravenous immunoglobulin, and plasma exchange.

Purpose

The aim of the present study was to review current literature about risk factors for poor pregnancy outcome.

Search methods.

The PubMed database was used to search for peer-reviewed original and review articles concerning risk factors for pregnancy outcome in APS from 1st January 1990 to 15th January 2018.

Outcomes.

History of pregnancy morbidity and/or thrombosis, the association with SLE and/or other autoimmune diseases are well known history-based predictive factors for obstetrical complications, such as miscarriage, maternal venous thromboembolism, intrauterine foetal demise, preeclampsia, and neonatal death. Moreover, laboratory findings associated with poor pregnancy outcome are: triple antiphospholipid antibodies aPL positivity, double aPL positivity, single aPL positivity, false-positive IgM for CMV, and hypocomplementemia. Triple positivity is confirmed as the most significant risk factor by a large body of evidence.

Furthermore, the abnormal uterine arteries Doppler velocimetry results are confirmed to be strongly associated with poor pregnancy outcomes in APS. The good performance of the uterine arteries velocimetry, as a negative predictive factor, was reported by different studies. On the contrary, in case of abnormal uterine arteries results, the relevance of a careful surveillance is highlighted for the high risk of maternal-foetal complications. Nevertheless, this tool is a late indicator to suggest any additional treatments.

Conclusions

In order to prevent obstetrical complications and establish the optimal combination therapy, the knowledge at preconception or at the beginning of pregnancy of risk factors associated with poor pregnancy outcome could be a crucial step for management and treatment of APS. In addition, in the preconception assessment a regimen with low-dose aspirin, folic acid, and vitamin D supplementation should be offered, and a treatment strategy has to be established (conventional vs additional therapy). In fact, additional treatment has to be tailored for each patient.

https://ift.tt/2vL3LA2

The role of stress in the mosaic of autoimmunity. An overlooked association

Publication date: Available online 14 August 2018

Source: Autoimmunity Reviews

Author(s): Kassem Sharif, Abdulla Watad, Louis Coplan, Benjamin Lichtbroun, Alec Krosser, Michael Lichtbroun, Nicola Luigi Bragazzi, Howard Amital, Arnon Afek, Yehuda Shoenfeld

Abstract

Stress is defined as the pscyophysiological reaction in which the steady state is disturbed or threatened. Stress is not always perceived as a negative response. Stress results when environmental demands exceed an individuals' adaptive capacities. Autoimmune diseases are heterogeneous group of chronic diseases which occur secondary to loss of self antigen tolerance. The etiopathogenesis of autoimmune disease is uncertain. Genetic factors as well as environmental factors appear to interplay, leading to a cascade of events resulting in disease onset. Stress has been postulated to play a role in disease onset in the genetically susceptible patients. During the stress response, catecholamines and glucocorticoids are released from locus coeruleus and adrenal gland. These biomolecules exert control over various immune cells in the innate and adaptive arms of the immune system, thereby altering the cytokine profile released. The increase of IL-4 promotes T-helper 2 (T_h2) cell differentiation, while the decrease in IL-12 and the increased IL-10 production reduce the number of T-helper 1 (T_h1) cells.. The relationship between stress and autoimmune diseases is intricate. Stress has been shown to be associated with disease onset, and disease exacerbations in rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, multiple sclerosis, Graves' disease as well as other autoimmune conditions. In certain conditions such as psoriasis, stress has been implicated in delaying lesion clearance upon the application of standard treatment regimes. Finally, psychological therapy and cognitive behavioral therapy aimed to reduce stress levels was shown to be effective in influencing better outcomes in many autoimmune diseases. The purpose of this paper is to closer inspect the clinical evidence regarding the role of stress on influencing the various aspects of disease entities.

https://ift.tt/2OBODfj

Rapamycin for refractory discoid lupus erythematosus

Dermatologic Therapy, EarlyView.


https://ift.tt/2MjV0Hu

Clinical Manifestation of Hyper IgE Syndrome Including Otitis Media

Abstract

Purpose of Review

The hyper IgE syndromes (HIES) comprise a group of rare primary immunodeficiency disorders (PIDDs), which are characterized by extremely high serum IgE levels, eczema, recurrent skin and pulmonary infections. Both autosomal dominant (AD) HIES due to STAT3 mutations and autosomal recessive (AR) HIES due to PGM3, SPINK5, DOCK8 and TKY2 mutations have been reported. Here, we aim to summarize and compare the major clinical manifestations of different subtypes of HIES. We will also discuss otitis media, which usually do not get enough attention in HIES. Update and familiarity with these clinical features will help to make a better diagnose, assessment and treatment of HIES.

Recent Findings

Although hyper serum IgE levels have been identified in PGM3 deficiency and Comel–Netherton syndrome, PGM3 and SPINK5 genes were not included in the list of genetic etiologies of AR-HIES by the Expert Committee of the International Union of Immunological Societies until 2015. The identification of these HIES-causing genes greatly promoted the pathogenic mechanism studies of HIES. Also, in recent years, more clinical manifestations, which were often not of concern in HIES patients, have been shown to be highly related to HIES. For example, a significantly high frequency of vascular and gastrointestinal abnormities has been reported in STAT3-deficient AD-HIES patients. These new findings might help to provide new clues to the functional study of these HIES-related genes.

Summary

This review summarizes and compares the major clinical manifestations of different subtypes of HIES, and we suggest that the incidence and severity of otitis media should not be underestimated in HIES patients.

https://ift.tt/2OCCM0u

Tips for Seeing Patients via Telemedicine

Abstract

Purpose of Review

Telemedicine is a technology that permits patients to be seen at a distance. This review describes different types of telemedicine, why they might be useful for a practice, what equipment is needed, and how to select and schedule patients.

Recent Findings

The use of synchronous telemedicine is increasing rapidly and has surpassed 50% of ambulatory encounters in some instances. Management of patients is particularly germane for an allergy practice since it is an outpatient specialty with patients who live in widely distributed locations with limited access to allergists. With utilization of digital exam equipment, in vitro tests for diagnosis, and spirometry at the patient location, there are few clear advantages of seeing patients in-person over virtual visits.

Summary

Telemedicine is here today. As its use increases, it is critical that allergy specialists embrace this new technology.

https://ift.tt/2P91zdR

Rapamycin for refractory discoid lupus erythematosus

Dermatologic Therapy, EarlyView.


https://ift.tt/2MjV0Hu

An Autism-Related, Nonsense Foxp1 Mutant Induces Autophagy and Delays Radial Migration of the Cortical Neurons

Abstract

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that has a strong genetic component. Disruptions of FOXP1, a transcription factor expressed in the developing cerebral cortex, were associated with ASD. FOXP1(R525X) is a de novo heterozygous mutation found in patients with autism and severe mental retardation. To explore the neuronal basis of FOXP1(R525X) in ASD, we created Foxp1(R521X), a mouse homolog of the human variant. Ectopic expression of Foxp1(R521X) led to cytoplasmic aggregates and activated macroautophagy in neuroblastoma N2a cells and the developing neuronal cells. Cortical neurons expressing Foxp1(R521X) exhibited delayed migration and altered dendritic morphology. As a control, mutant Y435X that was expressed diffusively in the cytoplasm did not induce autophagy and migration delay in the cortex. The embryonic cortical cells had a minimal activity of nonsense-mediated mRNA decay (NMD) as assayed by a splicing-dependent NMD reporter. We hypothesize that the developing neuronal cells use autophagy but not NMD as a safeguard mechanism against nonsense mutant aggregates, resulting in impairment of the cortical development. This study suggests a novel mechanism other than heterozygous loss of FOXP1 for the development of ASD and may advance our understanding of the complex relationships between gene mutation and the related psychiatric disorders.

https://ift.tt/2Mrc0uN

Temporal-Order-Based Attentional Priority Modulates Mnemonic Representations in Parietal and Frontal Cortices

Abstract

The respective roles of occipital, parietal, and frontal cortices in visual working memory maintenance have long been under debate. Previous work on whether parietal and frontal regions convey mnemonic information has yielded mixed findings. One possibility for this variability is that the mnemonic representations in high-level frontoparietal regions are modulated by attentional priority, such as temporal order. To test this hypothesis, we examined whether the most recent item, which has a higher attentional priority in terms of temporal order, is preferentially encoded in frontoparietal regions. On each trial, participants viewed 2 gratings with different orientations in succession, and were cued to remember one of them. Using fMRI and an inverted encoding model, we reconstructed population-level, orientation representations in occipital (V1–V3), parietal (IPS), and frontal (FEF) areas during memory maintenance. Unlike early visual cortex where robust orientation representations were observed regardless of serial order, parietal, and frontal cortices showed stronger representations when participants remembered the second grating. A subsequent experiment using a change detection task on color rings excluded the possibilities of residual stimulus-driven signals or motor preparative signals for responses. These results suggest that mnemonic representations in parietal and frontal cortices are modulated by temporal-order-based attentional priority signals.

https://ift.tt/2KSRFtB

Low-Intensity Pulsed Ultrasound Stimulation Induces Coupling Between Ripple Neural Activity and Hemodynamics in the Mouse Visual Cortex

Abstract

Several studies have separately investigated neural activities and hemodynamic responses induced by low-intensity pulsed ultrasound stimulation (LIPUS), less is known about their coupling under LIPUS. This study aims to investigate the neurovascular coupling with LIPUS by measuring neural activity and hemodynamics. We found that the relative power and sample entropy of local field potential at the ripple band have a significant correlation to relative cerebral blood flow over time (correlation coefficients: 0.66 ± 0.13 [P < 0.01] and −0.58 ± 0.11 [P < 0.05]). These results demonstrate that LIPUS can induce neurovascular coupling in the mouse visual cortex.

https://ift.tt/2vN6uZI

The Functional Role of Large-scale Brain Network Coordination in Placebo-induced Anxiolysis

Abstract

Anxiety reduction through mere expectation of anxiolytic treatment effects (placebo anxiolysis) has enormous clinical importance. Recent behavioral and electrophysiological data suggest that placebo anxiolysis involves reduced vigilance and enhanced internalization of attention; however, the underlying neurobiological mechanisms are not yet clear. Given the fundamental function of intrinsic connectivity networks (ICNs) in basic cognitive processes, we investigated ICN activity patterns associated with externally and internally directed mental states under the influence of an anxiolytic placebo medication. Based on recent findings, we specifically analyzed the functional role of the rostral anterior cingulate cortex (rACC) in coordinating placebo-dependent cue-related (phasic) and cue-unrelated (sustained) network activity. Under placebo, we observed a down-regulation of the entire salience network (SN), particularly in response to threatening cues. The rACC exhibited enhanced cue-unrelated functional connectivity (FC) with the SN, which correlated with reductions in tonic arousal and anxiety. Hence, apart from the frequently reported modulation of aversive cue responses, the rACC appears to be crucially involved in exerting a tonically dampening control over salience-responsive structures. In line with a more internally directed mental state, we also found enhanced FC within the default mode network (DMN), again predicting reductions in anxiety under placebo.

https://ift.tt/2KSRtun

A Common CACNA1C Gene Risk Variant has Sex-Dependent Effects on Behavioral Traits and Brain Functional Activity

Abstract

Genome-wide association studies have suggested that allelic variations in the CACNA1C gene confer susceptibility to schizophrenia and bipolar disorder only in women. Here we investigated the sex-specific effects of the CACNA1C variant rs1024582 on psychiatry-related traits, brain activity during tasks and rest, and brain volume in 1207 normal male and female subjects. After correcting for multiple comparisons, there were significant interaction effects between sex and the minor allele of this polymorphism on the hostile behavior subscale scores of the Coronary-Prone Type Scale mediated by higher scores in female carriers of the minor allele. Imaging analyses revealed significant interaction effects between sex and the minor allele on fractional amplitude of low-frequency fluctuations in the right dorsolateral prefrontal cortex and on brain activity during the 2-back task in areas of the right posterior cingulate cortex, right thalamus, and right hippocampus, which were all mediated by reduced activity in female carriers of the minor allele. Our results demonstrated that the rs1024582 risk variant of CACNA1C is associated with reduced activity in the frontolimbic regions at rest and during a working memory task as well as with greater hostility in females in the healthy population.

https://ift.tt/2Mxh9BH

Dominant men are faster in decision-making situations and exhibit a distinct neural signal for promptness

Abstract

Social dominance, the main organizing principle of social hierarchies, facilitates priority access to resources by dominant individuals. Throughout taxa, individuals are more likely to become dominant if they act first in social situations and acting fast may provide evolutionary advantage; yet whether fast decision-making is a behavioral predisposition of dominant persons outside of social contexts is not known. Following characterization of participants for social dominance motivation, we found that, indeed, men high in social dominance respond faster–without loss of accuracy–than those low in dominance across a variety of decision-making tasks. Both groups did not differ in a simple reaction task. Then, we selected a decision-making task and applied high-density electroencephalography (EEG) to assess temporal dynamics of brain activation through event related potentials. We found that promptness to respond in the choice task in dominant individuals is related to a strikingly amplified brain signal at approximately 240 ms post-stimulus presentation. Source imaging analyses identified higher activity in the left insula and in the cingulate, right inferior temporal and right angular gyri in high than in low dominance participants. Our findings suggest that promptness to respond in choice situations, regardless of social context, is a biomarker for social disposition.

https://ift.tt/2OA9MXi

Adolescent Nicotine Exposure Induces Dysregulation of Mesocorticolimbic Activity States and Depressive and Anxiety-like Prefrontal Cortical Molecular Phenotypes Persisting into Adulthood

Abstract

Considerable evidence demonstrates strong comorbidity between nicotine dependence and mood and anxiety disorders. Nevertheless, the neurobiological mechanisms linking adolescent nicotine exposure to mood and anxiety disorders are not known. Disturbances in the mesocorticolimbic dopamine (DA) system, comprising the prefrontal cortex (PFC), ventral tegmental area (VTA), and nucleus accumbens (NAc), are correlates of mood and anxiety-related symptoms and this circuitry is strongly influenced by acute or chronic nicotine exposure. Using a combination of behavioral pharmacology, in vivo neuronal electrophysiology and molecular analyses, we examined and compared the effects of chronic nicotine exposure in rats during adolescence versus adulthood to characterize the mechanisms by which adolescent nicotine may selectively confer increased risk of developing mood and anxiety-related symptoms in later life. We report that exposure to nicotine, selectively during adolescence, induces profound and long-lasting neuronal, molecular and behavioral disturbances involving PFC DA D1R and downstream extracellular-signal-related kinase 1-2 (ERK 1-2) signaling. Remarkably, adolescent nicotine induced a persistent state of hyperactive DA activity in the ventral tegmental area (VTA) concomitant with hyperactive neuronal activity states in the PFC. Our findings identify several unique neuronal and molecular biomarkers that may serve as functional risk mechanisms for the long-lasting neuropsychiatric effects of adolescent smoking behaviors.

https://ift.tt/2Mp1mEN

Reappraisal of Interpersonal Criticism in Social Anxiety Disorder: A Brain Network Hierarchy Perspective

Abstract

Emotion regulation is thought to involve communication between and within large-scale brain networks that underlie emotion reactivity and cognitive control. Aberrant network interaction might therefore be a key neural feature of mental disorders that involve emotion dysregulation. Here we tested whether connectivity hierarchies within and between emotion reactivity and cognitive reappraisal networks distinguishes social anxiety disorder (SAD) patients (n = 70) from healthy controls (HC) (n = 25). To investigate network organization, we implemented a graph-theory method called Dependency Network Analysis. Participants underwent fMRI while watching or reappraising video clips involving interpersonal verbal criticism. During reappraisal, the reappraisal network exerted less influence on the reactivity network in SAD participants. Specifically, the influence of the right inferior frontal gyrus on both reappraisal and reactivity networks was significantly reduced in SAD compared with HC, and correlated negatively with negative emotion ratings among SAD participants. Surprisingly, the amygdala exhibited reduced influence on the reappraisal network in SAD relative to HC. Yet, during the watch condition, the left amygdala's influence on the reactivity network increased with greater social anxiety symptoms among SAD participants. These findings refine our understanding of network organization that contributes to efficient reappraisal or to disturbances in applying this strategy in SAD.

https://ift.tt/2KTI85t

Manganese tolerance in Verbascum olympicum Boiss. affecting elemental uptake and distribution: changes in nicotinic acid levels under stress conditions

Abstract

A multielemental determination methodology in conjunction with an organic acid analysis that were supplemented with other stress parameters and an ultrastructural analysis used herein to study Verbascum olympicum Boiss. (Scrophulariaceae) under Mn stress. Uptake and accumulation characteristics of B, Cu, Fe, Mn, Mo, and Zn were evaluated in 8-week-old seedlings grown in Hoagland's nutrient solution and exposed to 5 (CK), 50, and 200 μM MnSO₄ for 7 days. Hydrogen peroxide levels were determined to evaluate oxidative stress, and changes in compatible substance levels (total phenolic contents, glutathione and glutathione disulfide levels) were determined to assess antioxidant defense mechanisms. The distribution of manganese on the root surface was characterized by scanning electron microscopy images and energy-dispersive X-ray spectroscopy analysis. The levels of nicotinic acid, which is involved in nicotinamide adenine dinucleotide biosynthesis, were determined in roots and leaves to assess tolerance mechanisms. V. olympicum exhibited the ability to cope with oxidative stress originating from excessive Mn, while increased Mn concentrations were observed in both roots and leaves. The translocation factor of B was the most affected among other studied elements under the experimental conditions. Total nicotinic acid levels exhibited a trend of reduction in the roots and leaves, which could be attributed to the appropriate metabolic progress associated with oxidative stress based on the nicotinamide adenine dinucleotide cycle that may reach glutathione in response to manganese stress during plant growth.

https://ift.tt/2PbDK5d