Head and Neck Diseases by Alexandros G.Sfakianakis: 09/12/18

Τετάρτη 12 Σεπτεμβρίου 2018

Case Report of Transmissible Gastroenteritis Coronavirus Infection Associated with Small Intestine and Brain Lesions in Piglets

Viral Immunology, Ahead of Print.

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Contributors

SUJANA S. CHANDRASEKHAR, MD, FACS, FAAOHNS

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Nasal Airway Obstruction

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

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Erratumxv

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Forthcoming Issues

Facial Palsy: Diagnostic and Therapeutic Management

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An error was made in the June 2018 issue of Otolaryngologic Clinics (Volume 51, Issue 3) in the article, "Regional Overview of Specific Populations, Workforce Considerations, Training and Diseases in Latin America" by Drs. J. Pablo Stolovitzky and Jacqueline Alvarado.

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Transient severe distributive shock due to early dumping syndrome: a case report

Early dumping syndrome characterized by palpitation, dizziness, cold sweat, feebleness, and abdominal symptoms, occurs within 30 minutes after meals in patients who have undergone gastrectomy. This case report...

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Acute Retinal Necrosis Presenting With Optic Disc Edema

No abstract available

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Erratum

In the Review article, "Challenges in the treatment of asthma in children and adolescents" (Ann Allergy Asthma Immunol. 2018;120:382-388), on page 386, the legend for Figure 2 should have read as follows.

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Life in the FAST lane

Oral immunotherapy (OIT) for the treatment of food allergy represents a potential groundbreaking breakthrough in the management of food allergy.1 The standard dogma of food allergy has been that this is a disease without treatment, other than having a variable likelihood of outgrowing the allergy to the selected foods.2 Since 2006, there has been a steady increase in federally funded and other academic investigations of OIT to various foods that have been dominated mainly by studies of peanut, milk, and egg.

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Hidden allergens in food allergy

A 5-year-old girl with a history of tree nut allergy presented to our office with a chief concern of a recent episode of anaphylaxis without suspected ingestion of a known allergen. The history was obtained from the patient's mother and chart review.

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Allergen immunotherapy

Many allergy specialists would suggest that we have come a long way over the past 107 years since the initial publications from the Laboratory of the Department for Therapeutic Inoculations of Saint Mary's Hospital1,2 described the efficacy of subcutaneous allergen immunotherapy (AIT) in pollen allergy. Currently, there is a robust literature showing that AIT has efficacy in the treatment of asthma, prevents the development of further sensitization in mono-sensitized patients, decreases the progression to asthma in those undergoing subcutaneous AIT for allergic rhinitis, and provides persistent therapeutic effect even years after a 3- to 5-year course.

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Diane E. Schuller, MD (1943–2018)

The American College of Allergy, Asthma and Immunology (ACAAI) family lost a dedicated member and former past president with the passing of Diane E. Schuller, MD, one of the great leaders of our organization. Diane was born on November 27, 1943 in Brooklyn, New York, and died unexpectedly on January 25, 2018 in Hershey, Pennsylvania. A daughter of the late Charles W. Sr., and Dorothy (McWilliams) Schuller, Diane resided in Danville, Virginia since 1974.

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Editorial Board

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Information for Authors

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Information for Readers

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New diagnostic criteria for eosinophilic esophagitis

It has been quite a journey for the entity known as proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE). The new international consensus diagnostic criteria for eosinophilic esophagitis (EoE), recently published by Dellon et al1 and summarized by Spergel et al2 in this issue, currently state that the diagnosis of EoE can be made if esophageal symptoms and esophageal eosinophilia are present after ruling out other causes of esophageal eosinophilia. An 8- to 12-week trial with a high dose of PPI to rule out PPI-REE, as stated in the 2011 consensus recommendations,3 is no longer considered a requirement to confirm the diagnosis of EoE but rather a therapeutic option for EoE.

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Short and long-term impact of remifentanil on thermal detection and pain thresholds after cardiac surgery: A randomised controlled trial

BACKGROUND The clinical relevance of the suggested hyperalgesic effects of remifentanil is still unclear, especially in the long term. OBJECTIVE The current study evaluated the impact of remifentanil on thermal thresholds 3 days and 12 months after surgery, measured with Quantitative Sensory Testing. DESIGN A prospective, single-blind, randomised controlled trial. SETTING A tertiary care teaching hospital in The Netherlands, from 2014 to 2016. PATIENTS A total of 126 patients aged between 18 and 85 years, undergoing cardiothoracic surgery via sternotomy (coronary artery bypass grafts and/or valve replacement) were included. Exclusion criteria were BMI above 35 kg m−2, history of cardiac surgery, chronic pain conditions, neurological conditions, allergy to opioids or paracetamol, language barrier and pregnancy. INTERVENTIONS Patients were allocated randomly to receive intra-operatively either a continuous remifentanil infusion or intermittent intra-operative fentanyl as needed in addition to standardised anaesthesia with propofol and intermittent intravenous fentanyl at predetermined time points. MAIN OUTCOME MEASURES Warm and cold detection and pain thresholds 3 days and 12 months after surgery. In addition the use of remifentanil, presence of postoperative chronic pain, age, opioid consumption and pre-operative quality of life were tested as a predictor for altered pain sensitivity 12 months after surgery. RESULTS Both warm and cold detection, and pain thresholds, were not significantly different between the remifentanil and fentanyl groups 3 days and 12 months after surgery (P > 0.05). No significant predictors for altered pain sensitivity were identified. CONCLUSION Earlier reports of increased pain sensitivity 1 year after the use of remifentanil could not be confirmed in this randomised study using Quantitative Sensory Testing. This indicates that remifentanil plays a minor role in the development of chronic thoracic pain. Still, the relatively high incidence of chronic thoracic pain and its accompanying impact on quality of life remain challenging problems. TRIAL REGISTRY REGISTRATION ClinicalTrials.gov identifier NCT02031016. TRIAL REGISTRATION The study was registered at EudraCT (ref: 2013-000201-23) and ClinicalTrials.gov (https://ift.tt/2Mq69Sn). This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/OBJ4xP Correspondence to Catherijne A.J. Knibbe, Department of Clinical Pharmacy, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands Tel: +31 30 609 26 12; e-mail: c.knibbe@antoniusziekenhuis.nl Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Utility of TERT Promoter Mutations for Cutaneous Primary Melanoma Diagnosis

Abstract: Telomerase reverse transcriptase (TERT) promoter mutations are commonly found in malignant melanomas but rare in melanocytic nevi. To assess its potential diagnostic utility for the distinction of melanoma from nevus, we determined the TERT promoter mutation status of 86 primary melanomas, 72 melanocytic nevi, and 40 diagnostically problematic melanocytic proliferations. Of the 86 melanomas, 67 (77.9%) were TERT-positive, defined as harboring a hotspot TERT promoter mutation at positions -124C>T, -124_125CC>TT, -138_139CC>TT, or -146C>T. Of the 72 nevi, only 1 (1.4%) was TERT-positive. Of the 40 diagnostically uncertain melanocytic proliferations, 2 (5.0%) were TERT-positive. TERT positivity as a test for melanoma versus nevus had an accuracy of 87.3% [95% confidence interval (CI), 81.1–92.1], a sensitivity of 77.9% (95% CI, 68.9–85.4), a specificity of 98.6% (95% CI, 95.8–100), a positive predictive value of 98.5% (95% CI, 95.6–100), and a negative predictive value of 78.9% (95% CI, 72.6–85.4). Our results indicate that hotspot TERT promoter mutation status may be a useful ancillary parameter for the diagnosis of melanoma. In particular, the high specificity of these mutations for melanoma indicates the presence of a TERT promoter mutation in a melanocytic neoplasm associated with diagnostic controversy, or uncertainty should increase concern for a melanoma. Correspondence: Nancy E. Thomas, MD, PhD, Department of Dermatology, University of North Carolina, 2159 Genomic Science Building, CB#7287, Chapel Hill, NC 27599 (e-mail: nthomas@med.unc.edu). This work was funded by the National Cancer Institute grants R21CA134368, R33CA160138, R03CA199487 to K. Conway and N.E. Thomas, P01CA206980 to M. Berwick and N.E. Thomas, and P30CA016086 to H.S. Earp. This work was also supported by the Lineberger Comprehensive Cancer Center Bioinformatics Core. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Facial Phaeohyphomycosis in an Immunocompetent Individual: A Rare Presentation of a Rare Fungus

Abstract: Phaeohyphomycosis is a rare mycotic infection caused by heterogenous groups of dematiaceous fungi involving the skin and subcutaneous tissue. Here, we report a case of cutaneous phaeohyphomycosis presenting as cauliflower-like verrucous lesion over the face in an immunocompetent individual. Histopathology showed suppurative granulomatous inflammation replete with pigmented broad fungal hyphae which is stained with periodic acid–Schiff stain, Grocott's methanamine silver stain, Schmorl's stain, and Masson-Fontana stain. Culture showed black-colored colonies identified as Exophiala spinifera. Correspondence: Nandita Kakkar, MD, Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India-160012 (e-mail: nandita_kakkar@yahoo.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Pigmented Facial Contact Dermatitis to Benzyl Salicylate: A Comparative Histopathological and Immunohistochemical Study of the Involved Skin and the Positive Patch Test Site

Abstract: Pigmented contact dermatitis (PCD) is a noneczematous variant of allergic contact dermatitis, and benzyl salicylate is one of its causes. This type of PCD shows nonlichenoid interface dermatitis with pigment incontinence. We aimed to characterize the earliest histopathological changes of this reaction. A 51-year-old man presented with persistent facial eruption composed of hyperpigmented and hypopigmented macules due to exposure to benzyl salicylate present in his aftershave. The biopsies obtained from hyperpigmented and hypopigmented macules, and from the positive patch test site to benzyl salicylate, showed a nonlichenoid focal vacuolar interface dermatitis with mononuclear cells in the papillary dermis and around the pilosebaceous units, along with melanophages. A MART-1 immunostain showed intact melanocytes in all 3 biopsies. A Fontana–Masson stain demonstrated intact melanin in the basal cell layer of a facial hyperpigmented macule and the patch test site, but melanin was reduced in the biopsy taken from a hypopigmented facial macule. There were more epidermal and dermal CD1a+ Langerhans cells in the patch test biopsy than in the other 2 biopsies. Most of the mononuclear cells were CD3+. The CD4+ to CD8+ ratio was approximately 1:1 in the facial macules; yet, CD4+ cells outnumbered CD8+ cells in the patch test biopsy. There were a few TIA-1+ cells in all 3 biopsies. In conclusion, the earliest histopathological and immunophenotypical events in PCD due to benzyl salicylate are similar to those of longer-standing lesions, i.e., a nonlichenoid focal interface dermatitis involving the epidermis and pilosebaceous unit, along with dermal melanophages. Correspondence: Hiba Zaaroura, MD, Department of Dermatology, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel 3109601 (e-mail: hiba_zaroura@yahoo.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Borderline Lepromatous Leprosy: Uncommon Clinical Presentation

No abstract available

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Histopathology of Hand–Foot–Mouth Disease in Adults and Criteria for Differentiation From Erythema Multiforme

Background: Hand–foot–mouth disease (HFMD) is a common contagious viral infection usually affecting infants and children. Recently, literature on HFMD in adults is increasing. It has been reported that adults often present with unusual exanthems with similarities to erythema multiforme (EM). No study has so far compared the histologic features of HFMD with those of EM. Methods: Histopathologic features in 7 biopsies of 6 adult patients with HFMD are compared with biopsies from 9 patients with EM to identify the best criteria for differentiation. Results: HFMD and EM both have a perivascular lymphocytic infiltrate together with epidermal necrosis, spongiosis, ballooning, and reticular alteration. However, large numbers of neutrophils in parakeratosis (P

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Atypical Varicella-Zoster Kaposi Varicelliform Eruption in Sézary Syndrome

Abstract: Patients with mycosis fungoides experience considerable morbidity and mortality from secondary bacterial and viral infections. Staphylococcus aureus, β-hemolytic streptococci, herpes simplex virus, and herpes zoster virus remain the most common infectious pathogens in this group of patients. With depressed cellular immunity and diminished skin barrier as the main precipitating risk factors, immunocompromised patients can often present with an atypical presentation of a common dermatologic condition. The case herein discusses a clinically atypical nonvesicular Kaposi varicelliform eruption secondary to a varicella-zoster virus in a patient with Sézary syndrome. Concurrent polypharmacy in these patients is also a risk factor for development of drug hypersensitivity reactions. However, given their immunocompromised status, first and foremost, a careful inspection should be made of every atypical skin eruption in search of an infectious etiology, and afterward, an appropriate treatment should be promptly initiated. Correspondence: Silvija P. Gottesman, MD, 1991 Marcus Avenue, Ste 300, Lake Success, NY 11042 (e-mail: silvija.gottesman@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Education in Anesthesia: How to Deliver the Best Learning Experience

No abstract available

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Provider Education and Vaporizer Labeling Lead to Reduced Anesthetic Agent Purchasing With Cost Savings and Reduced Greenhouse Gas Emissions

Anesthetic agents are known greenhouse gases with hundreds to thousands of times the global warming impact compared with carbon dioxide. We sought to mitigate the negative environmental and financial impacts of our practice in the perioperative setting through multidisciplinary staff engagement and provider education on flow rate reduction and volatile agent choice. These efforts led to a 64% per case reduction in carbon dioxide equivalent emissions (163 kg in Fiscal Year 2012, compared with 58 kg in Fiscal Year 2015), as well as a cost savings estimate of $25,000 per month. Accepted for publication August 1, 2018. Funding: K.L.Z. receives nonclinical time for her role as Medical Director of Sustainability for UW Health. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Karin L. Zuegge, MD, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792. Address e-mail to zuegge@wisc.edu. © 2018 International Anesthesia Research Society

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The Perioperative Management of Ascending Aortic Dissection

Acute aortic syndromes are a distinct group of pathologies involving the wall of the aorta that present acutely and can be potentially fatal unless treated in a timely fashion. The syndrome is dominated by aortic dissections, which comprise ≥95% of all such presentations. Those involving the ascending aorta are particularly lethal and require specific and early surgical treatment compared to dissections involving other parts of the aorta. The surgical repair of an ascending aortic dissection presents multiple challenges to the anesthesiologist. Thoughtful management throughout the perioperative period is critical for minimizing the significant morbidity and mortality associated with this condition. In this narrative review, we provide an overview of the perioperative management of patients presenting for the surgical repair of an ascending aortic dissection. Preoperative discussion focuses on assessment, hemodynamic management, and risk stratification. The intraoperative section includes an overview of anesthetic management, transesophageal echocardiographic assessment, and coagulopathy, as well as surgical considerations that may influence anesthetic management. Accepted for publication July 17, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Madhav Swaminathan, MD, MMCi, FASE, FAHA, Department of Anesthesiology, Duke University Medical Center, Box 3094 DUMC/5691F HAFS, Durham, NC 27710. Address e-mail to madhav.swaminathan@duke.edu. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Trainability of Application of the Correct Cricoid Force: Time to Rely on Devices?

No abstract available

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Short and long-term impact of remifentanil on thermal detection and pain thresholds after cardiac surgery: A randomised controlled trial

Polymorphic Erythematous Macules and Plaques With Dysesthesia

A woman in her 50s presented with a 2-year history of disseminated dermatosis involving the trunk and limbs; the dermatosis was characterized by polymorphic erythematous macules and plaques with elevated and indurated borders without evanescence to pressure. What is your diagnosis?

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RCM and En Face Histopathologic Correlation of the Dermoscopic “Circle Within a Circle” in LM

This case report describes a process by which the dermoscopic "circle within a circle" feature can be correlated with findings of reflectance confocal microscopic (RCM) and en face histopathologic findings from a lentigo maligna lesion.

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Prescription to OTC Switch of Metronidazole and Azelaic Acid for Rosacea

This Viewpoint considers the advantages and disadvantages of topical treatments for rosacea, specifically metronidazole and azelaic acid, undergoing review to switch from prescription to over-the-counter availability.

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Association of Low SES With Hidradenitis Suppurativa

This cohort analysis evaluates the association of low socioeconomic status with hidradenitis suppurativa among patients in the United States.

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Scabies—An Ancient Disease With Unanswered Questions in Modern Times

This Viewpoint discusses the global disease burden of scabies, as well as its diagnosis and treatment.

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September 2018 Issue Highlights

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Sunscreen Use and Melanoma Risk Among Young Australian Adults

This population-based, case-control family study of data collected for the Australian Melanoma Family Study assesses the association of sunscreen use in childhood and early adulthood with the risk of cutaneous melanoma before age 40 years.

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Necrotizing Anogenital Ulcer in a Healthy 8-Month-Old Male

A healthy 8-month-old male infant was admitted for management of a rapidly progressive, painful anogenital ulcer; the lesion had developed acutely over 48 hours and had an associated symptom, but no fevers, chills, or other systemic symptoms. What is your diagnosis?

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

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

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A Comparison of Tanning Habits Among Gym Tanners and Other Tanners

This survey study evaluates the incidence of tanning in adults who use indoor gyms.

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Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis

This cohort study uses a self-completed questionnaire by respondents in the French NutriNet-Santé study to evaluate the association between a Mediterranean anti-inflammatory dietary profile and the severity of psoriasis.

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Topical Crisaborole—A Potential Treatment for Recalcitrant Palmoplantar Psoriasis

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

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Economic Analysis of a Noninvasive Molecular Pathologic Assay for Pigmented Skin Lesions

This economic analysis assesses the costs of use of the pigmented lesion assay vs visual and histopathologic assessment in model inputs of patients with primary pigmented lesions suggestive of melanoma.

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Characteristics and Skin Cancer Risk Behaviors of US Adult Sunless Tanners

This secondary analysis of a cross-sectional study using data from the 2015 National Health Interview Survey assesses the demographic characteristics and skin cancer risk behaviors of US adults who are sunless tanners.

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Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

This observational study reviews cases of endemic human leishmaniasis occurring in the United States, mostly in Texas, over a 10-year period.

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Linear Keratotic Lesions in a Young Woman

A woman in her 20s presented with linear hyperkeratotic papules on her right arm in a Blaschkoid pattern. What is your diagnosis?

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Dermatology Procedures Billed by Advanced Practice Professionals, 2012-2015

This longitudinal study uses Medicare data from 2012 through 2015 to review the trends in scope and volume of dermatology procedures performed by advanced practice professionals such as nurse practitioners and physician assistants.

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Facial-Aging App Availability in Waiting Rooms as a Potential Opportunity for Skin Cancer Prevention

This survey study explores whether a single exposure of adult patients in a waiting room to an app that approximates facial UV damage may lead to altered UV protection behavior.

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Effect of Stress Ball Use or Hand-holding on Anxiety During Skin Cancer Excision

This randomized clinical trial examines the effects of hand-holding vs stress ball use compared with usual care on anxiety in patients undergoing excisional removal of nonmelanoma skin cancer of the head or neck with local anesthesia.

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A critical evaluation of health risk assessment of modified mycotoxins with a special focus on zearalenone

Abstract

A comprehensive definition introducing the term "modified mycotoxins" to encompass all possible forms in which mycotoxins and their modifications can occur was recently proposed and has rapidly gained wide acceptance within the scientific community. It is becoming increasingly evident that exposure to such modified mycotoxins due to their presence in food and feed has the potential to pose a substantial additional risk to human and animal health. Zearalenone (ZEN) is a well-characterized Fusarium toxin. Considering the diversity of modified forms of ZEN occurring in food and feed, the toxicologically relevant endocrine activity of many of these metabolites, and the fact that modified forms add to a dietary exposure which approaches the tolerable daily intake by free ZEN alone, modified forms of ZEN present an ideal case study for critical evaluation of modified mycotoxins in food safety. Following a summary of recent scientific opinions of EFSA dealing with health risk assessment of ZEN alone or in combination with its modified forms, uncertainties and data gaps are highlighted. Issues essential for evaluation and prioritization of modified mycotoxins in health risk assessment are identified and discussed, including opportunities to improve exposure assessment using biomonitoring data. Further issues such as future consideration of combinatory effects of the parent toxin with its modified forms and also other compounds co-occurring in food and feed are addressed. With a particular focus on ZEN, the most pressing challenges associated with health risk assessment of modified mycotoxins are identified and recommendations for further research to fill data gaps and reduce uncertainties are made.

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Association of Lichen Planopilaris With Dyslipidemia

This cohort study evaluates the association between lichen planopilaris, hyperlipidemia, and metabolic syndrome.

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RUSSCO-RSP comparative study of immunohistochemistry diagnostic assays for PD-L1 expression in urothelial bladder cancer

Abstract

In this collaborative study by the Russian Society of Clinical Oncology and the Russian Society of Pathology, we assessed the concordance among three validated, commercially available PD-L1 immunohistochemistry assays for patients with urothelial cancer. Tumors from 100 urothelial cancer patients were stained with the antibody clones 22C3 (Agilent), SP142 (Ventana Medical Systems), and SP263 (Ventana Medical Systems), which are used in clinical trials of second-line therapy with checkpoint inhibitors. Four trained pathologists independently evaluated the percentages of tumor cells (TC) and tumor-infiltrating immune cells (IC) that were stained at any intensity by each of the antibodies. The test-specific cutoffs for the proportions of stained cells in a positive sample were pre-specified as TC + IC ≥ 10% or TC ≥ 10% for 22C3, IC ≥ 5% for SP142, and TC ≥ 25% or IC ≥ 25% for SP263. Three hundred immunohistochemistry slides were scored. The percentages of PD-L1 staining in the three assays without using any cutoff were higher in the IC than in the TC (55% versus 24% for 22C3, 45% versus 8% for SP142, and 72% versus 27% for SP263, respectively). The Pearson correlation coefficients for anti-PD-L1 staining in the IC were 0.5, 0.69, and 0.85 with 22C3/SP142, 22C3/SP263, and SP142/SP263, respectively. The Pearson correlation coefficients for PD-L1 staining in the TC were 0.93, 0.99, and 0.91 for the same pairs. Among the patients who were negative for PD-L1 staining by one test, 91–100% were also negative by the other tests. Among the patients who were positive by one test, 43–100% were also positive by the other tests. Our data indicate that repeated testing can be avoided as a patient with urothelial cancer who is classified as negative for PD-L1 expression by one of the three single tests using the corresponding cutoff rule is highly likely (91–100%) to be classified as negative by either of the other tests.

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Assessment and Retrieval of Aspirated Tracheoesophageal Prosthesis in the Ambulatory Setting

Tracheoesophageal prosthesis (TEP) is the most common voice restoration method following total laryngectomy. Prosthesis extrusion and aspiration occurs in 3.9% to 6.7% and causes dyspnea. Emergency centers are unfamiliar with management of the aspirated TEP. Prior studies report removal of aspirated TEP prostheses under general anesthesia. Laryngectomees commonly have poor pulmonary function, posing increased risks for complications of general anesthesia. We present a straightforward approach to three cases of aspirated TEP prosthesis removed in the ambulatory setting. In each case, aspirated TEP was diagnosed with flexible bronchoscopy under local anesthesia at the time of consultation, and all prostheses were retrieved atraumatically using a biopsy grasper forceps inserted via the side channel of the bronchoscope. The aspirated TEP prosthesis can be safely and efficiently removed via bedside bronchoscopy.

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Just Beneath the Surface

In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors' commentary follows. A 55-year-old man was evaluated in…

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The Use of Donation After Cardiac Death Organs for Simultaneous Liver-Kidney Transplant: To DCD or Not to DCD?

Background Due to challenges with organ scarcity, many centers performing simultaneous liver-kidney transplant are opting to accept donation after cardiac death (DCD) organs as a means of facilitating earlier transplant and reducing death rates on the waitlist. It has been suggested however, that DCD organs may have inferior graft and patient survival posttransplant compared with donation after neurologic death (DND) organs. Methods We created a Markov model to compare the overall outcomes of accepting a DCD SLKT now versus waiting for a DND SLKT in patients waitlisted for SLKT, stratified by base MELD score (≤ 20, 21-30, >30). Results Waiting for DND SLKT was the preferred treatment strategy for patients with a MELD score of ≤ 30 (incremental value of 0.54 and 0.36 QALYs for MELD ≤ 20 and MELD 21-30 with DND versus DCD SLKT, respectively). The option to accept a DCD SLKT became the preferred choice for those with a MELD score > 30 (incremental value of 0.31 QALYs for DCD versus DND SLKT). This finding was confirmed in a probabilistic sensitivity analysis and persisted when analyzing total life years obtained for accept DCD versus do not accept DCD. Conclusions There is a benefit to accepting DCD SLKT for patients with MELD > 30. Although not accepting DCD SLKT and waiting for DND SLKT is the preferred option for patients with MELD ≤ 30, the incremental value is small. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Corresponding Author: Amanda J Vinson, MD, 5082 Dickson Building, QEII Health Sciences Centre-VG site, 5820 University Avenue, Halifax, Nova Scotia, B3H 1V9, 902-473-2675, 902-473-2749. Email: Amanda.vinson@nshealth.ca Authorship Page Authorship: All authors participated in research design. AV and BK did the initial data analysis and KT and BK provided feedback and suggestions to make the analysis more robust. AV wrote the initial manuscript and BK, BGL and KT provided feedback and helped with constructing the figures. Disclosures: The authors declare no conflicts of interest. Funding: There was no funding for this study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Blood Pressure in De novo Heart Transplant Recipients Treated with Everolimus Compared with a Cyclosporine-Based Regimen: Results from the Randomized SCHEDULE Trial

Background Systemic hypertension is prevalent in heart transplant recipients, and has been partially attributed to treatment with calcineurin inhibitors (CNIs). The SCHEDULE trial was the first randomized trial to study early withdrawal of CNIs in de novo heart transplant recipients, comparing an everolimus-based immunosuppressive regimen with conventional CNI-based treatment. As a prespecified secondary endpoint, blood pressure was repeatedly compared across treatment arms. Methods SCHEDULE was a prospective, multicenter, randomized, controlled, parallel-group, open-label trial in de novo adult heart transplant recipients, undertaken at transplant centers in Scandinavia. Blood pressure was assessed with 24-hour ambulatory blood pressure monitoring up to 3 years after HTx in 83 patients. Results Overall, systolic blood pressure fell with time, from 138 ± 15 mmHg 2 weeks after HTx to 134 ± 11 mmHg after 12 months and 132 ± 14 mmHg after 36 months (p = 0.003). Diastolic blood pressure did not change over time. After 12 months, there was a numerically larger fall in systolic blood pressure in the everolimus arm (between-group difference 8 mmHg; p = 0.053), and after 36 months, there was a significant between group difference of 13 mmHg (p = 0.02) in favor of everolimus. Conclusions In this first, randomized trial with early CNI avoidance in de novo HTx recipients, we observed a modest fall in systolic blood pressure over the first 1 – 3 years after transplantation. The fall in systolic blood pressure was more pronounced in patients allocated to everolimus. Clinical trial registration: ClinicalTrials.gov (NCT01266148) at https://ift.tt/KkipBP Address for correspondence: Arne K. Andreassen, Department of Cardiology, Oslo University Hospital Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway. Phone +47230700. aandreas@ous-hf.no Authorship statement AK Andreassen participated in research design, performance of the research, writing of the manuscript, and critical revision of the manuscript for important intellectual content K Broch participated in writing of the manuscript, performance of the research, data analysis, and critical revision of the manuscript for important intellectual content H Eiskjær participated in research design, performance of the research, and critical revision of the manuscript for important intellectual content K Karason participated in research design, performance of the research, and critical revision of the manuscript for important intellectual content E Gude participated in research design, performance of the research, and critical revision of the manuscript for important intellectual content D Mølbak participated in performance of the research, and critical revision of the manuscript for important intellectual content W Stueflotten participated in performance of the research, and critical revision of the manuscript for important intellectual content L Gullestad participated in research design, performance of the research, and critical revision of the manuscript for important intellectual content Disclosure: The authors declare no conflicts of interest. Funding: The SCHEDULE trial was funded by Novartis Scandinavia. The funding source had no role in the design of the study, in the analyses of the results, or in the decision to publish. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2x9LCMp

IL-17A is critical for CD8+ T effector response in airway epithelial injury after transplantation

Background Airway epithelium is the primary target of trachea and lung transplant rejection, the degree of epithelial injury is closely correlated with obliterative bronchiolitis development. In this study, we investigated the cellular and molecular mechanisms of IL-17A-mediated airway epithelial injury after transplantation. Methods Murine orthotopic allogeneic trachea or lung transplants were implemented in wild type or RORγt-/- mice. Recipients received anti-IL-17A or anti-IFNγ for cytokine neutralization, anti-CD8 for CD8+ T cell depletion, or STAT3-inhibitor to suppress Th17/Tc17 development. Airway injury and graft inflammatory cell infiltration were examined by histopathology and immunohistochemistry. Gene expression of IL-17A, IFNγ, perforin, granzyme B and chemokines in grafts was quantitated by real-time RT-PCR. Results IL-17A and IFNγ were rapidly expressed and associated with epithelial injury and CD8+ T cell accumulation after allotransplantation. Depletion of CD8+ T cells prevented airway epithelial injury. Neutralization of IL-17A or devoid of IL-17A production by RORγt deficiency improved airway epithelial integrity of the trachea allografts. Anti-IL-17A reduced the expression of CXCL9, CXCL10, CXCL11 and CCL20, and abolished CD8+ T cell accumulation in the trachea allografts. Inhibition of STAT3 activation significantly reduced IL-17A expression in both trachea and lung allografts; however it increased IFNγ expression and cytotoxic activities, which resulted in the failure of airway protection. Conclusions Our data reveal the critical role of IL-17A in mediating CD8+ T effector response that causes airway epithelial injury and lung allograft rejection, and indicate that inhibition of STAT3 signals could drive CD8+ T cells from Tc17 toward Tc1 development. Correspondence: Jiangnan Xu, MD, Department of Immunology, Capital Medical University, No.10 Xi Tou Tiao, You An Men Wai, Beijing 100069, China. Phone: +8610-83911826; Fax: +8610-83911439; E-mail addresses: xujn@ccmu.edu.cn. Authorship Y.D. and J.X. participated in the research design. R.Z. performed the experiments, analyzed the data and prepared the figures. H.F. and R.C. helped with some experiments and data analysis. R.Z. and Y.D. wrote the manuscript. J.C.O. and J.X. provided critical revision of the article. All authors approved the final version of article. Disclosures The authors declare no conflicts of interest. Funding This work was supported by the National Natural Science Foundation of China (grants 81370188 and 81770092). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2xbmRzk

NKG2C natural killer cells in bronchoalveolar lavage are associated with cytomegalovirus viremia and poor outcomes in lung allograft recipients

Background Cytomegalovirus (CMV) infection is a risk factor for chronic lung allograft dysfunction (CLAD), which limits survival in lung allograft recipients. Natural killer (NK) cells that express the NKG2C receptor mediate CMV-specific immune responses. We hypothesized that NKG2C+ NK cells responding to CMV in the lung allograft would reduce CMV-related inflammation and would improve CLAD-free survival. Methods We prospectively followed 130 subjects who underwent lung transplantation from 2012 to 2016. Bronchoalveolar lavage (BAL) NK cells were immunophenotyped for NKG2C, maturation, and proliferation markers. CMV viral load, serologies, serial spirometry, and mortality were recorded from medical records. NK cell subset association with CMV endpoints were made using generalized estimating equation-adjusted linear models. BAL NKG2C+ NK cell association with CLAD-free survival was assessed by Cox proportional hazards modeling. Results NKG2C+ NK cells were more mature and proliferative than NKG2C- NK cells and represented a median of 7.8% of BAL NK cells. The NKG2C+ NK cell proportion increased prior to the first detection of viremia and was nearly tripled in subjects with high level viremia (>1000 copies/ml) compared with no detected viremia. Subjects with increased BAL NKG2C+ NK cells, relative to the median, had a significantly increased risk for CLAD or death (HR 4.2, 95% CI 1.2 – 13.3). Conclusions The BAL NKG2C+ NK cell proportion may be a relevant biomarker for assessing risk of CMV viremia and quantifying potential CMV-related graft injury that can lead to CLAD or death. Correspondence and reprint requests to Dr. John R. Greenland, San Francisco VA Medical Center, 4150 Clement St, San Francisco, CA 94121, USA; 415-221-4810x22962, john.greenland@ucsf.edu ORCIDS: DRC 0000-0002-0596-3434, JPS 0000-0003-0224-7472, JRG 0000-0003-1422-8367 FUNDING Project funding came from award number IK2CX001034 from the Clinical Sciences Research & Development Service of the VA Office of Research and Development, the UCSF Nina Ireland Program for Lung Health (NIPLH), and a NHLBI award number R01 HL134851 DISCLOSURES The authors of this manuscript have no conflicts of interest to disclose. AUTHORSHIP CONTRIBUTIONS DRC and JRG participated in research design, manuscript writing, performance of research, and data analysis. JAG, JK, SRH, LLL, QT, and JPS participated in research design, interpretation of the results, and manuscript editing. TC, AW, and MG participated in performance of research. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2NIwzTU

Patient Navigators in Transplantation – where do we go from here?

No abstract available

https://ift.tt/2x74sDK

Kidney Transplant in the Era of Modern Therapy for Multiple Myeloma

Chronic kidney disease is common in patients with multiple myeloma. Historically individuals with end stage renal disease and multiple myeloma did poorly with renal transplantation due to higher mortality rates from the malignancy itself or associated comorbidities. However, over the past 2 decades there have been significant advances in the treatment of multiple myeloma with the advent of new therapeutic agents resulting in an improvement of long term survival. As a result, more individuals with multiple myeloma are being referred for kidney transplantation, especially those with good functional capacity and minimal comorbidities. Recent literature has suggested that certain patients with multiple myeloma can successfully undergo renal transplantation after stem transplantation with consideration for maintenance therapy, although caution should be used with immunomodulating drugs due to the anecdotally reported risk of acute rejection. Therefore, having a multi-disciplinary approach with the transplant team and hematology both before and after transplant is crucial in maximizing the chance of success for these individuals. This review summarizes the literature on renal transplantation in patients with multiple myeloma as well as the therapeutic advancements that have occurred which may allow certain patients to undergo successful transplantation. Corresponding Author: Raymond L. Heilman, MD, 5777 East Mayo Boulevard, Phoenix, Arizona 85054, Heilman.Raymond@mayo.edu Authorship Page Janna L. Huskey – Participated in the writing of this paper Raymond L. Heilman - Participated in the writing of this paper Hasan Khamash - Participated in the writing of this paper Rafael Fonseca - Participated in the writing of this paper Rafael Fonseca Consulting: Amgen, BMS, Celgene, Takeda, Bayer, Janssen, Novartis, Pharmacyclics, Sanofi, Merck, Juno, Kite, Aduro, AbbVie. Scientific Advisory Board Adaptive Biotechnologies. Mayo Clinic and Rafael Fonseca hold a patent for the prognostication of myeloma using FISH. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2NIwsrs

Open Randomized Multicenter Study to Evaluate Safety and Efficacy of Low Molecular Weight Sulfated Dextran in Islet Transplantation

Background When transplanted human pancreatic islets are exposed to blood during intraportal infusion, an innate immune response is triggered. This instant blood-mediated inflammatory reaction (IBMIR) activates the coagulation and complement cascades and leads to the destruction of 25% of all transplanted islets within minutes, contributing to the need, in most patients, for islets from more than 1 donor. Low molecular dextran sulfate (LMW-DS) has been shown in experimental settings to inhibit IBMIR. Methods The CIT-01 study was a phase II, multicenter, open label, active control, randomized study. Twenty-four subjects were randomized to peritransplant intraportal and systemic treatment with either LMW-DS or heparin, targeting an APTT of 150±10 and 50±5 seconds respectively. C-peptide response was measured with a mixed meal tolerance test at 75 and 365 days after transplant. Results LMW-DS was safe and well tolerated with similar observed adverse events (mostly attributed to immunosuppression) as in the heparin arm. There was no difference in the primary endpoint (stimulated C-peptide 75±5 days after the first transplant) between the 2 arms (1.33±1.10 versus 1.56±1.36 ng/mL, p=0.66). Insulin requirement, metabolic parameters, Clarke and HYPO score, quality of life and safety were similar between the 2 treatments groups. Conclusions Even with low dosing, LMW-DS showed similar efficacy in preventing IBMIR to promote islet engraftment when compared to "state-of-the art" treatment with heparin. Furthermore, no substantial differences in the efficacy and safety endpoints were detected, providing important information for future studies with more optimal dosing of LMW-DS for the prevention of IBMIR in islet transplantation. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Corresponding author: Bengt von Zur-Mühlen, Department of Transplantation surgery, University hospital in Uppsala, S-751 85 Uppsala, Sweden, Phone: + 476 18 611 31 70; E-mail: bengt.muhlen@medsci.uu.se ClinicalTrials.gov ID: NCT00789308 Authorship page Authorship: B.Z-M. and T.L. contributed equally B.Z-M. contributed to the design of the study, analysed the data, performed pre and posttransplant care of the patients and wrote the article T.L. designed the study, analysed the data, performed pre and posttransplant care of the patients and wrote the article L.B. executed analysis plan, coordinated DCC protocol, managed data and statistical analysis, assisted writing final study report and edited the article C.B. designed the study and edited the article N.D.B. designed the study, provided safety oversight as the NIAID Medical Monitor and edited the article W.C. designed the study, managed data and statistical analysis T.E. designed the study and coordinated the study with the Clinical Islet Transplantation Consortium, NIDDK and the DSMB A.F. contributed to the design of the study, performed pre and posttransplant care of the patients and edited the article J.G. designed the study and cleared regulatory pathways T.J. contributed to the design of the study, performed pre and posttransplant care of the patients and edited the article C.J. contributed to the design of the study, performed pre and posttransplant care of the patients and edited the article Y.M. contributed to the design of the study, coordinated study and funding M.R. contributed to the design of the study and edited the article T.S. executed analysis plan, coordinated DCC protocol, managed data and statistical analysis, assisted writing final study report and edited the article G.T. contributed to the design of the study, performed pre and posttransplant care of the patients and edited the study B.N. designed the study, performed experiments, analysed the data and wrote the article O.K. conceived, designed and directed the study, performed islet isolation, analysed the data and wrote the article Conflicts of interest: The authors have no financial disclosures to report. Funding: The study was funded by grants from: The National Institute of Allergy and Infectious Disease of the National Institutes of Health (2U01AI065192-06) The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) as the funding agency for the DCC at University of Iowa (U01DK070431) Swedish Medical Research Council (K2015-54X-12219-19-4 and K2013-64X-08268-26-3) Swedish national strategic research initiative EXODIAB (Excellence Of Diabetes Research in Sweden) Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2xcHKdc

Liraglutide, a Glucagon-Like Peptide-1 Receptor Agonist, Attenuates Development of Cardiac Allograft Vasculopathy in a Murine Heart Transplant Model

Background Advances in immunosuppressive therapy have significantly improved short-term but not long-term survival of cardiac transplant recipients; this is largely due to severe cardiac allograft vasculopathy (CAV). Glucagon-like peptide-1 receptor (GLP-1R)-based therapy exerts physiological effects on the cardiovascular system in addition to its traditional role in controlling glucose. We have investigated the effects of liraglutide, a GLP-1R agonist, on the development of CAV in a murine heart transplant model. Methods Heterotopic murine cardiac transplantation was performed with a major histocompatibility complex class II (MHC-II)-mismatched model. Recipient mice were subcutaneously administered vehicle (0.9% saline solution) or liraglutide (300 μg-1kg-112 h-1) from the day of transplantation. Allografts were harvested at 2 or 8 weeks and histologically analyzed. Inflammatory infiltrates were measured by immunohistochemistry, and immunofluorescence and western blotting analyzes were used to evaluate GLP-1R expression and markers of endothelial-to-mesenchymal transition (EndMT) in cardiac allografts and human coronary artery endothelial cells (HCAECs) challenged with transforming growth factor-beta 1 (TGF-β1). Results GLP-1R was predominantly localized to vascular endothelial cells and was up-regulated in cardiac allografts after liraglutide treatment. Liraglutide ameliorated CAV and cardiac fibrosis with reduced inflammatory cell infiltration and down-regulated expression of adhesion molecules. Liraglutide inhibited EndMT in allografts and attenuated EndMT by inhibiting Smad3 activation in TGF-β1-treated HCAECs. Conclusions Administration of liraglutide from the time of transplantation up-regulated GLP-1R in the transplanted heart and reduced cardiac fibrosis, inflammation, and CAV development. Therefore, liraglutide may be a novel therapy for CAV. Corresponding author: Yan-wen Shu, PhD, Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan 430022, China. (shuyanwen@yahoo.com). Corresponding author: Jun Yang, PhD, Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No.1095, Wuhan 430030, Hubei Province, China. (jy@tjh.tjmu.edu.cn). Authorship J.Y, Z.-M.W., and Y.-W.S. conceived and designed the experiments. Z.-M.W., X.-F.H, Y.-K.L., D.-X.M., G.-Y.Z., M.-J.W., and Y.-N.X. performed the experiments. J.Y., Z.-M.W. and X.-F.H. analyzed the data. J.Y. and Z.-M.W. wrote the paper. Disclosure The authors declare no conflicts of interest. Funding The study was supported by the National Nature Science Foundation of China (No. 81373169 to JY). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2NIwlMy

Proven Immunologically-Mediated Drug Hypersensitivity in Children with A History of Multiple Drug Intolerances

Children may be referred to pediatric allergy clinics for reactions to multiple drugs. Multiple drug hypersensitivity (MDH) is defined as immunologically-mediated hypersensitivity to two or more chemically different drugs.

https://ift.tt/2COY8Xs

Formation characteristics of carbonaceous and nitrogenous disinfection by-products depending on residual organic compounds by CGS and DAF

Abstract

Allogenic organic matter (AOM) composed of extracellular and intracellular organic matter (EOM and IOM) is a major precursor of halogenated carbonaceous and nitrogenous disinfection by-products (C-DBPs and N-DBPs) upon chlorination. The EOM and IOM extracted from Microcystis aeruginosa were analyzed based on bulk parameters and organic fractions with different molecular weight by liquid chromatography with organic carbon detection (LC-OCD). It investigated the efficiency of a conventional gravity system (CGS) and dissolved air flotation (DAF) in the removal of organic precursors, together with measurement of the formation of four major trihalomethanes (THMs) and haloacetonitriles (HANs) in treated water upon chlorination. The results showed that EOM accounted for 59% of building blocks and humic substances, whereas for IOM, 54% were low molecular weight (LMW) neutrals. Both CGS and DAF showed 57–59% removal of dissolved organic carbon (DOC) from EOM and IOM. Regarding DON removal, DAF was found to be more effective, i.e., 8% higher than CGS for EOM. Moreover, the removal of LMW acids and neutrals (not easy to remove and are major precursors of DBPs) from EOM and IOM by DAF was higher than from CGS. The amounts of DBPs measured in all the samples treated for interchlorination were much lower than in the samples for prechlorination. Although the precursors of EOM had a higher concentration than in IOM, THMs and HANs were detected for IOM at a higher concentration, which might be attributed to higher amounts of aromatic, aliphatic moisture and protein compounds in the IOM. Comparatively, DAF showed lower THM and HAN values than CGS water, particularly for IOM. Also, DAF showed a sharp decrease in THMs and an insignificant increase in HANs according to time.

https://ift.tt/2x9SKsN

Prospective study on metal ceramic crowns in private practice settings: 20-year results

Abstract

Objectives

Posterior metal ceramic crowns are still widely used as a standard treatment. The aim of this study was to obtain long-term data on their clinical performance.

Material and Methods

Ten private practitioners participated in this prospective practice-based study. Patients were provided with two crowns each. Two groups were formed. The single crown group comprised 95 patients with 190 crowns. The retainer crown group comprised 138 patients with fixed dental prostheses and 276 retainer crowns.

Results

For the primary outcome "loss of tooth or crown," 20-year survival rates of 78.8% in the single crown group and 67.8% in the retainer crown group were found. Veneering ceramic defects occurred rather frequently, resulting in respective 20-year technical success rates of 74.2% for single crowns and 62.9% for retainer crowns. However, veneering ceramic defects causing crown losses were very rare events.

Conclusions

The results contribute to our knowledge on long-term outcomes of treatments with metal ceramic crowns and show high survival and success rates over 20 years.

Clinical relevance

Posterior metal ceramic crowns are a highly reliable option in private practice settings.

https://ift.tt/2oZGnv0

Human health risks of Hg, As, Mn, and Cr through consumption of fish, Ticto barb ( Puntius ticto ) from a tropical river, Bangladesh

Abstract

Metals tend to accumulate in higher organisms, e.g., fish and human through biomagnification effects in food chain. So, their presence in any component of the environment has become a global ecosystem and health concern. Here, we measured four health concerned metals like As, Cr, Mn, and Hg via inductively coupled plasma-mass spectrometry (ICP-MS) and analyzed applying some chemometrics for the assessment of human health risk through consumption of Puntius ticto, a very commonly consumed small fish in Bangladesh. The average concentration (wet weight) of metals was in the following descending order: Hg (0.006 mg/kg) > Cr (0.004 mg/kg) > Mn (0.003 mg/kg) > As (0.002 mg/kg). Hg level exceeded the provisional tolerable weekly intake (PTWI), and all other metals were within the permissible limit. The estimated daily intake (EDI) index of heavy metals showed that all the concentration levels were under the recommended daily intake (RDA) except Hg. Increased level of Hg is of particular concern to human health due to its biomagnification nature and can cause several neurological and physiological disorders including kidney failure. The total target hazard quotients (TTHQs) and carcinogenic risk (CR) matrices revealed that the intakes of Hg and As through fish consumption were higher than the recommended values, indicating consumers' remain non-carcinogenic and carcinogenic (THQ > 1; CR > 10⁻⁵) health risks for lifetime consumption. Multivariate analyses (cluster and principal component) explained the sources of heavy metals in the study area originating from both anthropogenic and geological origin.

https://ift.tt/2D1BgEz

Baccharis dracunculifolia (Asteraceae) essential oil toxicity to Culex quinquefasciatus (Culicidae)

Abstract

The control of mosquitoes by means of chemical insecticides has been a problem, mainly due to the possibility of resistance developed by insects to xenobiotics. For this reason, demand for botanical insecticides has increased. In this sense, the present work aims to verify the susceptibility and morphological and biochemical alterations of Culex quinquefasciatus larvae after exposure to essential oil (EO) of leaves of Baccharis dracunculifolia. To observe the larvicidal action, larvae were exposed to EO at concentrations of 25, 50, 100, and 200 mg/L, until their emergence to adults. The control group was exposed to deionized water and dimethyl sulfoxide. Morphological analyses were also carried out using hematoxylin and eosin, mercury bromophenol blue, Nile blue, and periodic acid Schiff. Biochemical analyses of total glucose, triacylglyceride (TAG), protein, and acetylcholinesterase levels were performed. The phytochemical analysis of the EO showed (E)-nerolidol as the major compound (30.62%). Larvae susceptibility results showed a LC₅₀ of 34.45 mg/L for EO. Morphological analysis showed that there were histological changes in midgut. For biochemical analyses, the glucose level in the larvae exposed to EO for 24 h decreased significantly, unlike the TAG levels, which increased. The total protein level of the larvae also increased after exposure for 24 h, and acetylcholinesterase levels decreased significantly. Taking all our data into account, we can conclude that EO causes destabilization in larva, leading to histological changes, metabolic deregulation and, consequently, their death.

https://ift.tt/2QsEcN9

Stress response of NAD + -dependent formate dehydrogenase in Gossypium hirsutum L. grown under copper toxicity

Abstract

Cotton (Gossypium hirsutum L.), which is not directly involved in the food chain, appears to be a suitable candidate to remove heavy metals from the food chain and to be a commercial plant which could be planted in contaminated soils. The key point of this approach is selection of the right genotype, which has heavy metal resistance or hyperaccumulation properties. Therefore, in the present study, two G. hirsutum genotypes, Erşan-92 and N-84S, were grown under copper stress and investigated to obtain further insights about the heavy metal tolerance mechanisms of plants by focusing on the expression of NAD⁺-dependent formate dehydrogenase (FDH). In accordance with the results, which were obtained from RT-PCR analysis and activity measurements, in the Erşan-92 root tissue, FDH activity increased significantly with increasing metal concentrations and a 6.35-fold higher FDH activity was observed in the presence of 100-μM Cu. As opposed to Erşan-92, the maximum FDH activity in the roots of N-84S, which were untreated with copper as the control plants, was measured as 0.0141-U mg⁻¹ g⁻¹ FW, and the activity decreased significantly with the increasing metal concentrations. The metallothionein (GhMT3a) transcript level of the plants grown in a medium containing different Cu concentrations showed nearly the same pattern as that of the FDH gene transcription. It was observed that while the tolerance of N-84S in the lower Cu concentration reduces remarkably, Erşan-92 continues to struggle up to 100-μM Cu. The results of the SOD analysis also confirm this activity of Erşan-92 against the Cu stress.

https://ift.tt/2COL3xj

Facile synthesis of Fe 3 O 4 @MOF-100(Fe) magnetic microspheres for the adsorption of diclofenac sodium in aqueous solution

Abstract

In this research, the adsorptive removal of diclofenac sodium, one of the representative pharmaceuticals and personal care products, from aqueous solution using Fe₃O₄@MOF-100(Fe) magnetic microspheres was studied for the first time. The Fe₃O₄@MOF-100(Fe) microspheres exhibit strong magnetism and stability, which were observed as a core-shell structure. The maximum adsorption capacity of Fe₃O₄@MOF-100(Fe) for diclofenac sodium can reach 377.36 mg L⁻¹, which was higher than most of the adsorbents reported. The adsorption kinetics follows the pseudo-second-order kinetic equation. And the adsorption equilibrium of DCF can be described with Langmuir isotherm. In the cycle experiment, Fe₃O₄@MOF-100(Fe) material performed high adsorption efficiency for low-concentration diclofenac sodium solution, and the removal rate can still reach 80% after 5 cycles of adsorption without desorption. The mechanisms including electrostatic interaction, H-bond interaction, and π-π interaction that coexisted in the adsorption processes would be of benefit to enhance the adsorption capacity. The Fe₃O₄@MOF-100(Fe) magnetic microspheres offer exciting opportunities for further application.

https://ift.tt/2QsE5RJ

Lifestyle chemical carcinogens associated with mutations in cell cycle regulatory genes increases the susceptibility to gastric cancer risk

Abstract

In the present study, we correlated the various lifestyle habits and their associated mutations in cell cycle (P21 and MDM2) and DNA damage repair (MLH1) genes to investigate their role in gastric cancer (GC). Multifactor dimensionality reduction (MDR) analysis revealed the two-factor model of oral snuff and smoked meat as the significant model for GC risk. The interaction analysis between identified mutations and the significant demographic factors predicted that oral snuff is significantly associated with P21 3′UTR mutations. A total of five mutations in P21 gene, including three novel mutations in intron 2 (36651738G > A, 36651804A > T, 36651825G > T), were identified. In MLH1 gene, two variants were identified viz. one in exon 8 (37053568A > G; 219I > V) and a novel 37088831C > G in intron 16. Flow cytometric analysis predicted DNA aneuploidy in 07 (17.5%) and diploidy in 33 (82.5%) tumor samples. The G2/M phase was significantly arrested in aneuploid gastric tumor samples whereas high S-phase fraction was observed in all the gastric tumor samples. This study demonstrated that environmental chemical carcinogens along with alteration in cell cycle regulatory (P21) and mismatch repair (MLH1) genes may be stimulating the susceptibility of GC by altering the DNA content level abnormally in tumors in the Mizo ethic population.

https://ift.tt/2CQAEkP

FGF23 beyond Phosphotropic Hormone

Publication date: Available online 11 September 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Yuichi Takashi, Seiji Fukumoto

Fibroblast growth factor (FGF) 23 is a bone-derived phosphotropic hormone that regulates phosphate and vitamin D metabolism. FGF23 mainly affects kidney function via the FGF receptor (FGFR)/α-Klotho complex. The physiological roles of FGF23 and α-Klotho in the regulation of mineral homeostasis have been well established. In addition, recent studies have reported that FGF23 has various effects on many other tissues, sometimes in an α-Klotho-independent manner, especially under pathological conditions. However, how FGF23 works in these tissues without α-Klotho is not entirely clear. Here we review the recent reports concerning the actions of FGF23 on various tissues and discuss the remaining questions about FGF23.

https://ift.tt/2p3zSqS

Influence of preoperative voice assessment on treatment plan prior to airway surgery

The Laryngoscope, EarlyView.

https://ift.tt/2xa3qqz

Trajectories of Nevus Development From Age 3 to 16 Years in the Colorado Kids Sun Care Program Cohort

This longitudinal cohort study describes nevus acquisition from the ages of 3 to 16 years among white youths and evaluates variation by sex, Hispanic ethnicity, and body sites that are chronically vs intermittently exposed to the sun.

https://ift.tt/2MpSvyy

Management of Flat Pigmented Spitz and Reed Nevi in Children

This database study evaluated the efficacy of monitoring flat symmetric pigmented spitzoid-looking lesions in prepubertal children.

https://ift.tt/2x7LduJ

Glycolic Acid Plus Lovastatin-Cholesterol Combination Cream to Treat Congenital Ichthyoses

This case series evaluates the use of topical glycolic acid plus a lovastatin-cholesterol combination cream to treat autosomal recessive congenital ichthyoses.

https://ift.tt/2MpSj2i

Picosecond Laser Treatment for Acquired Bilateral Nevus of Ota–like Macules

This report of cases describes the use of picosecond laser to treat acquired bilateral nevus of Ota–like macules.

https://ift.tt/2x8aBQK

Use of propofol for prevention of post-delivery nausea during cesarean section: a double-blind, randomized, placebo-controlled trial

Abstract

Purpose

Nausea and vomiting are common, undesirable symptoms during cesarean section. We conducted this study to assess the antiemetic properties of propofol for the prevention and immediate treatment of post-delivery nausea and vomiting during cesarean section under combined spinal–epidural anesthesia.

Methods

Eighty women undergoing elective cesarean delivery under combined spinal–epidural anesthesia were randomized to receive either propofol at a plasma concentration of 1000 ng/mL or normal saline immediately after clamping of the umbilical cord. The incidence of post-delivery nausea and vomiting, patients requiring rescue antiemetic, bispectral index, sedation score, and the incidence of hypotension were assessed intraoperatively. Satisfaction and neonatal behavioral neurological assessments were evaluated postoperatively.

Results

The incidence of nausea was significantly lower in the propofol group compared to the placebo group (25% versus 60%, P < 0.001). The incidence of retching and vomiting showed no significant difference between the two groups. Propofol 20 mg as a rescue antiemetic was significantly effective in both the groups. Satisfaction level of patients and obstetricians in the propofol group was higher than in the placebo group. There was no statistical difference in the incidence of hypotension between the two groups both pre- and post-delivery. There was no difference in postoperative neonatal behavioral neurological assessment between groups.

Conclusion

Propofol at a plasma concentration of 1000 ng/mL significantly reduced the incidence of post-delivery nausea compared to placebo, but had no effect on reducing retching or vomiting episodes during cesarean section.

https://ift.tt/2MonUBq

Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery

Publication date: Available online 11 September 2018

Source: Auris Nasus Larynx

Author(s): Fatma Tulin Kayhan, Arzu Karaman Koc, Ibrahim Erdim

Abstract

Objective

Although glottic level is an off-label use of da Vinci system, the feasibility and early-term outcomes of transoral robotic surgery (TORS) for the treatment of early-stage (Tis, T1, T2) glottic carcinoma have been documented. But little is known about the oncological outcomes. We investigated the oncological outcomes of TORS in patients followed at least three years and mean follow-up time was over five years.

Methods

We retrospectively investigated patients with early glottic carcinoma (Tis, T1, T2) who underwent TORS cordectomy in a tertiary hospital between January 2010 and June 2018.

Results

Forty-eight patients were enrolled in the study. Mean follow-up time was 65.6 ± 16.6 months. Only one patient died and overall survival rate was found 97.9%. Local recurrence occurred in five patients and disease free survival rate was found 89.6%. Anterior commissure involvement was occurred in 6 (12.5%) patients and local recurrence was seen two of them (33.3%). Synechia complication was occurred in 8 (16.7%) patients and local recurrence was seen three of them (36.7%). Although local recurrence rate was high in both anterior commissure involvement and synechia, only synechia reached to statistical significance for local recurrence (p: 0.027). The recurrences of four patients were treated with radiation therapy (RT) and the remaining one patient underwent total laryngectomy. Laryngeal preservation rate was found 97.9%.

Conclusion

Our investigation of the oncological outcomes of TORS on early-stage glottic carcinoma revealed that TORS has similar results when compared with transoral laser microsurgery and RT in terms of recurrence, laryngeal preservation and survival rates. Synechia is also a cautionary complication for recurrence and must be followed closely. We expect that TORS usage will be wider if robotic technology works on innovative developments oriented to glottic area.

https://ift.tt/2CL2eQx

Calu-3 epithelial cells exhibit different immune and epithelial barrier responses from freshly isolated primary nasal epithelial cells in vitro

Epithelial cell lines are often used to evaluate the effect of exogenous/endogenous stimuli on epithelial barrier function and innate immune responses in allergic airway diseases, without clear view on differe...

https://ift.tt/2CPA7zB

Extracellular vesicles in cancer immune responses: roles of purinergic receptors

Abstract

Extracellular vesicles (EVs) are nano- to micro-scale membrane-enclosed vesicles that are released from presumably all cell types. Tumor cells and immune cells are prodigious generators of EVs often with competing phenotypes in terms of immune suppression versus immune stimulation. Purinergic receptors, proteins that bind diverse purine nucleotides and nucleosides (ATP, ADP, AMP, adenosine), are widely expressed across tissues and cell types, and are prominent players in immune and tumor cell nucleotide metabolism. The effects of purinergic receptor stimulation or agonism tend to produce inflammatory responses that may aid immune stimulation but may also provoke various immune suppression mechanisms, particularly in the tumor microenvironment. EVs released by cells following receptor stimulation are frequently pro-inflammatory, but often also pro-thrombolytic; these EVs may generate an environment that favors tumor progression at the cost of an effective immune response. Purinergic signaling pathways are becoming more recognized as valuable targets in various therapeutic scenarios, including cancer. It is possible that some of those clinically relevant compounds might also impact EV secretion and/or phenotype, which would hopefully capitalize on the immune stimulatory properties of purinergic signaling while minimizing the immune suppressive consequences. This review covers a relatively understudied area in EV biology, but even so, focuses almost exclusively on the purinergic receptors in a very limited capacity. There is much more to evaluate and incorporate into our understanding of extracellular nucleotides in EV biology, and we hope this work prompts further discovery.

https://ift.tt/2OeXGTA

Picket-fences in the plasma membrane: functions in immune cells and phagocytosis

Abstract

Recent studies of molecular mobility in the plasma membrane have revealed that diffusion is restricted by cytoskeletal networks or fences. Transmembrane protein "pickets" that reversibly associate with the membrane-associated skeleton and with the pericellular coat impede the movement of unattached bystander molecules. While membrane picket-fences were originally described as barriers to free diffusion in more passive cell types such as fibroblasts, they have particularly important functions in the more dynamic immune cells. In phagocytes, such fences curtail spontaneous activation and their disassembly facilitates stimulation by target particles, fostering receptor clustering and the exclusion of phosphatases from the phagocytic cup. In this review, we describe the nature of the cellular cytoskeleton and of the exoskeleton created by the pericellular coat, their association with transmembrane pickets, and the modulation of molecular mobility during phagocytosis.

https://ift.tt/2N62q1n

Facial perception of infants with cleft lip and palate with/without the NAM appliance

Abstract

Objective

This study aimed to assess adults' subjective perception of infants with a unilateral cleft lip and palate (UCLP) with and without a nasoalveolar molding (NAM) appliance compared to those of controls concerning (1) adult gaze patterns and (2) emotional valence.

Methods

This interdisciplinary study was performed by (1) the Department of Orthodontics and (2) the Department for Psychiatry and Psychotherapy, University Medical Center Goettingen, using eye tracking and a 10-point Likert scale questionnaire. Eye movements and valence rating of 30 unaffected adults (15 women, 15 men; mean age: 25.5 years, standard deviation [SD] = 7.5) were recorded while presenting them infants in three picture categories (1) infant with UCLP, (2) infant with UCLP and inserted NAM appliance and (3) infant without UCLP. Total fixation time in two main areas of interest (AOI upper/lower face) was measured according to picture category as well as participants' valence rating regarding infants' appearance.

Results

In pictures of infants with UCLP or UCLP and NAM appliance participants had longer fixation times on AOI lower face compared to reconstructed pictures of infants without UCLP. No significant effect of a NAM appliance on gaze patterns could be detected. The valence of pictures of infants with UCLP was rated more negative compared to pictures of unaffected infants. An inserted NAM appliance improved this rating.

Conclusions

The results bolster the assumption that facial disruptions like UCLP alter adults' perception of infants. Even though the NAM appliance is not able to re-establish usual adult gaze patterns, it can help to improve adults' emotional assessment.

https://ift.tt/2Nb532b

Atypical case of mucous membrane pemphigoid in a 26-year-old man

A 26-year-old Caucasian man with no previous history of chemical injury presenting with an inability to open his right eye was investigated for mucous membrane pemphigoid and treated. Examination was notable for symblepharon of the right eye and impetigo-like lesions on the face and neck. A biopsy with immunohistochemical analysis was significant for linear deposits of C3 and immunoglobulin G at the level of the epithelial basement membrane, confirming the diagnosis of mucous membrane pemphigoid. Although mucous membrane pemphigoid classically presents bilaterally in women in the sixth and seventh decades of life, our patient was a young man with unilateral cicatrising conjunctivitis who may have been easily misdiagnosed without a high index of suspicion. A biopsy is required in cases of cicatrising conjunctivitis so that even atypical cases such as the one presented herein can be appropriately managed.

https://ift.tt/2MoAgtw

Hit by the wave: a case of painful Horners and intramural haematoma of the carotid

Carotid artery dissection from rupture of the vasa vasorum is under-recognised. We report the case of a 60-year-old woman presenting to our hospital with a 2-week history of right-sided headache, neck pain, unequal pupils and ptosis after being hit by a wave on the beach. She was diagnosed with painful Horner's syndrome. MR angiogram revealed dissection of the right internal carotid artery with an intramural haematoma without an intimal flap. A diagnosis of carotid artery dissection from rupture of the vasa vasorum was made. Initial antithrombotic (aspirin and clexane) were stopped as she was deemed a low stroke risk with no signs of ischaemia on MR brain. Her clinical course was uneventful with resolution of the intramural haematoma seen on repeat MR angiogram.

https://ift.tt/2p0J0g7

Acute gastric volvulus presenting as a pseudo cardiac tamponade

Description

Gastric volvulus is defined as rotation of the stomach or part of the stomach by more than 180°, creating a closed loop obstruction. Typically, its clinical presentation includes abdominal pain, distension, nausea and vomiting. Diagnosis requires a high suspicion index as it can be easily misdiagnosed with other abdominal problems such as stomach distension or subocclusive syndrome. CT scan has proven to be both highly sensitive and specific when differentiating these processes.1

A woman in their early 80s with no relevant medical background presented at out hospital with nausea and progressive dyspnoea for 3 days. She did not mention chest pain, cough, fever or other symptoms. Physical examination revealed tachycardia (122 bpm), tachypnoea (35 bpm), low arterial pressure (90/67 mm Hg), diminished heart sounds, jugular ingurgitation and basal left hypophonesis. Chest radiography (figure 1) showed massive hiatal hernia and urgent tomography (figure 2) confirmed...

https://ift.tt/2MlQl2R

Enterolithiasis in posterior urethral diverticulum: an uncommon complication following surgery for anorectal malformation

Description

A posterior urethral diverticulum (PUD) may be formed when a part of the terminal rectal stump is left attached to the posterior urethra during fistula ligation in surgery for anorectal malformation (ARM).

A 13-year-old boy presented with the complaints of burning micturition, postvoid dribbling and vague pain in the left lower abdomen for the last 4 months. The child had high ARM and underwent all three stages of surgery (colostomy, transabdominal pull-through procedure and colostomy closure) elsewhere. On evaluation, the plain X-ray pelvis showed huge, multiple radio-opaque shadows in the region of the bladder (figure 1A). On an ultrasound, these acoustic shadows caused by the stones appeared to be posterior to the bladder and could not be appreciated well in full bladder state. A CT scan further confirmed these radio-opaque shadows to be posterior, but not within the urinary bladder and anterior to the rectum (figure...

https://ift.tt/2p0sWuL

Anaplastic large cell lymphoma in a pregnant Filipino woman successfully treated with prepartum and postpartum chemotherapy

Diagnosis of a malignancy during pregnancy presents a dilemma regarding the work-up and treatment of the patient. This report presents a 42-year-old woman on her 23rd week of pregnancy with multiple enlarging fungating violaceous skin masses. Biopsy of the dominant mass revealed anaplastic large cell lymphoma. Due to the progressive enlargement and increase in number of the masses, the patient was given two cycles of chemotherapy (doxorubicin, vincristine, cyclophosphamide and prednisone) before delivering a live baby boy via spontaneous vaginal delivery, Apgar 9.9, at 37 4/7 weeks. After delivery, she completed four more cycles of treatment. A full-body positron emission tomography scan done 2 months after the last chemotherapy showed no evidence of disease. The patient is doing well with no evidence of disease 9 months after treatment. Her baby is thriving and has no gross deformities and no developmental delays.

https://ift.tt/2MpImBQ

Bladder calculi causing irreducible urogenital prolapse

Over 200 000 surgeries for vaginal prolapse are done annually, and these are rarely urgent. However, when the rare event of bladder stones causes incarcerated procidentia, surgical intervention should not be delayed, due to unrelenting pain and end-organs effects. We present such a case below. A 71-year-old woman presents to our department with massive uterovaginal and rectal procidentia. This massive prolapse was found to be irreducible due to numerous dahllite stones in the bladder, and was causing obstructive uropathy with left-sided hydronephrosis. A multidisciplinary approach was necessary to surgically correct the prolapse and implement complete removal of all the stones. The simultaneous occurrence of uterovaginal prolapse, rectal prolapse and urolithiasis is uncommon. Stone formation is a result of chronically infected urine presenting a nidus for stone formation. This presentation has occurred very rarely over the last 70 years of the world's literature. Surgical cures can be achieved by either the vaginal or abdominal routes but should be treated emergently to alleviate pain, prevent renal impairment from obstructive uropathy and decrease infectious morbidity.

https://ift.tt/2oZu7dQ

Invasive mediastinal aspergillosis presenting as superior vena cava syndrome in an immunocompetent patient

Invasive aspergillosis (IA) is a disease of the immunocompromised with a predilection for the lungs, although dissemination to all organs is possible. Its diagnosis remains a challenge due to the absence of specific clinical manifestations and laboratory findings. In most cases, diagnosis is eventually made via invasive methods. It carries with it a high mortality due to late diagnosis and delayed treatment. Here, we report a fascinating case of a young, otherwise healthy, immunocompetent patient that presented to us with superior vena cava syndrome and a mediastinal mass. It was anticipated that a malignancy would be found on further workup but, in fact, what was eventually discovered was a case of IA. Our report accentuates the significance of including IA as a differential while diagnosing a mediastinal mass in an immunocompetent host as patient outcome is determined by timely diagnosis and treatment.

https://ift.tt/2MpIcKK

Emphysematous pyelonephritis: outcomes of conservative management and literature review

Emphysematous pyelonephritis (EPN) is a rare, necrotising infection of the renal parenchyma, predominantly associated with Escherichia coli infection and unless promptly recognised and dealt with, it carries a poor prognosis. The current treatment is one of antimicrobial therapies together with nephrectomy in a majority of patients. We report an elderly man with multiple comorbidities with a diagnosis of EPN whose condition improved with antimicrobial and supportive therapy, and no surgical intervention was required.

https://ift.tt/2p4nczX

Severe subcutaneous emphysema in a term neonate

Description

The baby was born by elective caesarean section because of breech presentation, at 38+6 weeks of gestation with an Apgar score of 9 at 1 min, 9 at 5 min and a birth weight of 4.02 kg. She was noted to be grunting at 20 min of age and had O₂ saturations of 55% in air and therefore commenced on O₂ by face mask initially, followed by continuous positive airway pressure (CPAP) at a pressure of 5 cm as O₂ requirements remained high (up to 60%). CPAP pressure did not need to be increased further as the O₂ requirement came down to 40% and remained between 30% and 40% for the subsequent 24 hours. Initial capillary blood gas at 2 hours of age (on CPAP 5 cm, FiO₂ 0.35) showed: pH 7.28; pCO₂ 7.05; pO₂ 7.15 and BE –2. Repeat capillary blood gas at 4 hours (on CPAP 5 cm, FiO₂ 0.35) showed: pH 7.30; pCO₂ 6.95; pO₂...

https://ift.tt/2MlPxel

When duality of renal duplexity and duplicity coexists

Description

A 25-year-old male patient presented with complaints of right flank pain and recurrent episodes of urinary tract infections (UTIs) since childhood.

He had no history of fever, haematuria, urinary incontinence or voiding lower urinary tract symptoms. Per abdominal examination was unremarkable, and there was no renal tenderness.

His complete blood haemogram and renal function tests were normal. On evaluation with ultrasound Kidney Ureter Bladder (KUB) and CT urography, there was presence of bilateral duplex kidneys with bilateral duplication of ureter with poorly functioning upper pole moiety of right duplex kidney with gross hydronephrosis and thinned out renal cortex with normal lower pole as shown in figure 1.

Figure 1

Three-dimensional reconstructed CT urography film showing bilateral duplex kidney with duplicated ureters with poorly functioning upper pole of right kidney.

Tc99m-diethylenetriaminepentacetate scan was done which confirmed non-functioning upper pole moiety of right...

https://ift.tt/2p0Z3KL

Severe disease due to CCDC40 gene variants and the perils of late diagnosis in primary ciliary dyskinesia

Primary ciliary dyskinesia (PCD) can manifest in the neonatal period with severe respiratory distress. We describe a child with PCD who presented at term with severe neonatal respiratory distress, persistent right upper lobe collapse and failure to thrive who underwent lobectomy prior to the diagnosis of PCD at the age of 3 years. This case report illustrates the severe spectrum of lung disease associated with coiled-coil domain containing protein 40 (CCDC40) gene variants in patients with PCD.

https://ift.tt/2MlPgYR

Status dystonicus: a diagnosis delayed

Status dystonicus, also known as the dystonic storm or dystonic crisis, is rare but may prove fatal due to respiratory and bulbar complications. In adults, the condition is rare and possibly under-reported. The lack of awareness of this condition among emergency and acute physicians may lead to an incorrect or delayed diagnosis, which should be avoided. We report a case of a 23-year-old man with athetoid cerebral palsy who presented to a district general hospital with uncontrolled dystonic movements, which were diagnosed as status dystonicus. This was successfully treated with intravenous clonidine, with full recovery returning to baseline functional state.

https://ift.tt/2CN4JSr

Facial perception of infants with cleft lip and palate with/without the NAM appliance

Abstract

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https://ift.tt/2Nb532b

Acute Invasive Fungal Rhinosinusitis: Frozen Section Histomorphology and Diagnosis with PAS Stain

Abstract

Acute invasive fungal rhinosinusitis (AIFRS) is a fulminant infection in immunocompromised patients requiring rapid diagnosis (DX), frequently made on frozen section (FS) of sinonasal biopsies, followed by prompt surgical debridement. However, FS interpretation is often difficult and DX sometimes not possible. In this study we sought to characterize reasons for misinterpretation and methods to improve diagnostic accuracy. The FS slides from 271 biopsies of suspected AIFRS in a 16-year period were reviewed and the morphologic features evaluated for their utility in DX. Recurring specific patterns of necrosis were identified, which to our knowledge have not been described in the literature. Although they provide strong evidence for AIFRS, identifying fungus consistently in necrotic tissue is essential for DX. Clues to identifying fungus and pitfalls in misidentification were identified, but even with expert knowledge of these, a gap in accurate DX remained. The key to FS DX of AIFRS is to improve fungus identification in necrotic tissues. Methods had been sought in the past to stain fungus at FS without consistent success. The Periodic Acid Schiff's Reaction for Fungi was modified by our histopathology department for use on frozen tissue (PASF-fs) resulting in effective staining of the fungus. It stained fungus on all 62 positive slides when applied retrospectively over hematoxylin and eosin (H&E) stained FSs and used prospectively at FS for DX. Although knowledge of histologic morphology on FS is important, the crucial value of this study is the novel use of PASF-fs to identify fungus in the DX of AIFRS.

https://ift.tt/2Og1TGZ

Acute Invasive Fungal Rhinosinusitis: Frozen Section Histomorphology and Diagnosis with PAS Stain

Abstract

https://ift.tt/2Og1TGZ

MRI-guided localization of the dominant intraprostatic lesion and dose analysis of volumetric modulated arc therapy planning for prostate cancer

Abstract

Purpose

Primary radiation therapy is a curative treatment option for prostate cancer. The aim of this study was to evaluate the detection of the dominant intraprostatic lesion (DIL) with magnetic resonance imaging (MRI) for radiotherapy treatment planning, the comparison with transrectal ultrasound (TRUS)-guided biopsies and the examination of the dose distribution in relation to the DIL location.

Materials and methods

In all, 54 patients with treatment planning MRI for primary radiotherapy of prostate cancer from 03/2015 to 03/2017 at the Universitätsklinikum Würzburg were identified. The localization of the DIL was based on MRI with T2- and diffusion-weighted imaging. After registration of the MR image sets within Pinnacle³ (Philips Radiation Oncology Systems, Fitchburg, WI, USA), the dose distribution was analyzed. The location of the DIL was compared to the pathology reports in a side-based manner.

Results

The DIL mean dose (Dmean) was 77.51 ± 0.77 Gy and in 50/51 cases within the tolerance range or exceeded the prescribed dose. There was a significant difference in Dmean between ventral (n = 21) and dorsal (n = 30) DIL (77.87 ± 0.67 vs. 77.26 ± 0.77 Gy; p = 0.005). MRI-guided localization showed an accuracy and sensitivity of up to 78.8% and 82.1% for inclusion of secondary lesions, respectively.

Conclusion

Up to 82.1% of histologically verified intraprostatic lesions were identified in the context of MRI-guided radiotherapy treatment planning. As expected, dorsal DIL tend to be minimally underdosed in comparison to ventral DIL. Adequate dose coverage was achieved in over 98% of patients.

https://ift.tt/2x5ANvi

Factors determining parenting stress in mothers of children with atopic dermatitis

Publication date: Available online 11 September 2018

Source: Allergology International

Author(s): Chikae Yamaguchi, Takeshi Ebara, Rikuya Hosokawa, Masaki Futamura, Yukihiro Ohya, Midori Asano

Abstract

Background

Atopic dermatitis (AD) influences a child's emotional and social well-being, as well as his or her physical health. The influence of AD on the daily lives of parents and caregivers has also been documented. This study examined how parenting stress is affected by demographic background, characteristics of children's AD, and their family systems.

Methods

The participants were mothers of children, aged 2–6 years old, who had been diagnosed with AD. The predictive power of a model of parenting stress was examined using multiple regression analysis (stepwise), with parenting stress (PSI-SF) as the dependent variable, and children's demographics, including characteristics of AD; parents' demographics; QoL of families of children with AD (JCMV-CADIS); and family functioning (FAI) as independent variables. We handled missing values using a multiple imputation method.

Results

The pooled coefficients obtained from the multiple regression analysis after multiple imputation indicated that "family cohesion," "family system flexibility," "emotions related to social factors" and "occupation of mother" determined parenting stress. Lower family cohesion and family system flexibility predicted higher parenting stress. The high impact of "emotions related to social factors" on families' QoL predicted higher parenting stress. Full-time work by mothers predicted lower parenting stress.

Conclusions

The current results reveal that "family cohesion," "family system flexibility," "emotions related to social factors" and "full-time work by mothers" predicted parenting stress of mothers who had children with AD.

https://ift.tt/2CLFtf6

An unusual case of intestinal obstruction due to internal herniation from adhesions between two appendices epiploicae

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Abstract

Internal hernia of the small bowel is a rare finding especially in previously non-operated abdomen. Such a hernia occurring due to involvement of appendices epiploicae is an even rare instance with less than five reported cases in the literature. We encountered a 75-year-old male who had internal herniation of small bowel through an aperture created by adhesion between two appendices epiploicae in a previously virgin abdomen. Laparotomy and division of adhesion was performed to manage him successfully. Even in a virgin abdomen, a high index of suspicion along with early intervention is the key to reduction in mortality and morbidity in cases intestinal obstruction.

https://ift.tt/2OemZFE

Cecal volvulus caused by internal herniation after roux-en-y gastric bypass surgery

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Abstract

Cecal volvulus is the rotation of a mobile cecum resulting in a large bowel obstruction. We present the case of a 55-year-old female who underwent a roux-en-y gastric bypass in 2003 and presented to the emergency department with worsening abdominal pain, distention and obstipation. Roentgenogram demonstrated a 14 cm colon suggestive of sigmoid volvulus, but CT scan showed rectal contrast abruptly ending in the distal transverse colon, mesenteric swirling and a distended cecum, consistent with cecal, rather than sigmoid, volvulus. Upon surgical exploration the majority of the small bowel, cecum and ascending colon had herniated through the transverse mesocolon defect created during her prior gastric bypass. The bowel was reduced through the mesenteric defect, and an ileocecectomy was performed. This is, to our knowledge, the first reported case of cecal volvulus caused by an internal hernia through a mesocolon defect created during a prior roux-en-y gastric bypass operation.

https://ift.tt/2p0FQsD

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τετάρτη 12 Σεπτεμβρίου 2018

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