Human Papillomavirus-Related Multiphenotypic Sinonasal Carcinoma with Unique HPV type 52 Association: A Case Report with Review of Literature

Abstract

Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC) is a recently described distinctive clinicopathologic entity defined by association to high risk HPV, localization to sinonasal tract and close histologic resemblance to salivary gland tumors. Lack of awareness of its pathologic features and biology among pathologists and oncologists make this entity susceptible to misdiagnosis and erroneous management. Herein, we illustrate a case of HMSC of the nasal cavity associated with heretofore unreported subtype HPV-52 and discuss the challenges associated with diagnosis and management of this rare tumor. A 48-year-old woman with intermittent epistaxis for 6 months presented with a nasal mass and underwent middle turbinectomy. Histology showed a tumor with features typical of adenoid cystic carcinoma (ACC) in the form of basaloid cells and cribriform architecture. However, careful inspection revealed findings uncommon in ACC; such as surface pagetoid tumor spread, areas of solid sheets of myoepithelial cells accompanied by increased mitotic figures which prompted immunohistochemistry. Multidirectional differentiation into ductal (CK7, AE1/AE3) and myoepithelial (p63, p40, S100, calponin) lineage together with strong and diffuse immunopositivity for p16 distinguished this tumor from ACC. HPV genotyping was positive for high risk HPV subtype HPV52, which confirmed the diagnosis of HMSC. HPV-related multiphenotypic sinonasal carcinoma is an under-recognized unique clinicopathologic entity that needs awareness to avoid mistaking it for commoner salivary gland tumors. Making accurate diagnosis of this newly-described tumor is imperative in order to understand its biology and to develop optimal therapeutic strategies.

https://ift.tt/2NDfJqm

Post-traumatic bilateral vesicocutaneous fistula of thighs treated with buccal mucosa graft urethroplasty and cyanoacrylate glue instillation: a novel treatment for management of a complicated fistula

Post-traumatic vesicocutaneous fistula (VCF) is a rare variant of urinary fistulas. These fistulas may externally communicate to abdomen, perineum, buttocks, scrotum or very rarely thigh. These fistulas usually develop at a variable time duration after trauma and are usually preceded with thigh swelling or abscess formation followed by spontaneous rupture. We, hereby, report a case of VCF of bilateral thighs with associated penobulbar urethral stricture after road traffic accident which was managed with dual modality of buccal mucosa graft urethroplasty surgery and cyanoacrylate glue injection in the fistulous tracts. To the best of our knowledge, this is first report of bilateral VCFs communicating externally to thighs. In literature, very few cases of VCFs of thigh are reported and are rarely managed with adhesive glue application.

https://ift.tt/2xFonL8

Cushings reflex secondary to neck haematoma following thyroidectomy

Neck haematoma following thyroid surgery can present with respiratory distress which is generally attributed to airway obstruction. We recently had a 63-year-old female patient who underwent total thyroidectomy for toxic nodular goitre. However, within 4 hours of surgery, she developed sudden respiratory distress which was managed by prompt evacuation of the neck haematoma. Just before the haematoma evacuation, the patient had hypertension and bradycardia along with the distress. The arterial blood gas analysis sampled at that time was normal. Intraoperatively, the tracheal framework was found rigid and non-pliable. Considering the various clinical–biochemical findings observed, we think that the cause of the respiratory distress in the index case was transiently elevated intracranial pressure, secondary to bilateral internal jugular veins' compression. We hypothesise that in many patients with immediate postoperative neck haematoma, the Cushing's reflex would at least contribute partly, if not solely to the respiratory distress.

https://ift.tt/2DwRF3T

Three differently timed presentations of dermatomyositis associated with advanced ovarian cancer

Each of the three patients reported in this article presented with dermatomyositis at various stages of their advanced ovarian cancer. Dermatomyositis was the presenting feature and preceded the diagnosis of ovarian cancer by several months in one patient. In another patient, dermatomyositis occurred just prior to the scheduled third cycle of palliative chemotherapy after surgical debulking for stage 4 disease. The third patient presented with pathognomonic diagnostic features of dermatomyositis after ovarian cancer recurrence. Diagnosis was delayed in at least two of these patients; however, once appropriately diagnosed, each patient responded well to immunomodulatory treatment. In one patient, initiation of oral prednisolone seemed to correlate with a steady improvement in her proximal myopathy. A pulsed methylprednisolone approach was used in another patient with conversion to a tapering dose of oral prednisolone to good effect. In the patient in whom the most severe myopathy affecting bulbar muscle groups was demonstrated, an infusion of 5 days of intravenous immunoglobulin produced an eventual improvement in her steroid-refractory myopathy.

https://ift.tt/2xBDS6M

A survey of physician practices on the inpatient medical stabilization of patients with avoidant/restrictive food intake disorder

Abstract

Background

Avoidant/restrictive food intake disorder (ARFID) was added to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition in 2013. ARFID can result in impaired growth and significant nutritional deficiency; individuals with ARFID may be so nutritionally compromised that they require medical stabilization in a hospital. Prior to the new diagnostic criteria, it is unclear how patients now diagnosed with ARFID may have been medically stabilized when hospitalized. Our study aim was to assess the inpatient medical management of adolescents with ARFID.

Methods

United States-based physician members of the Society for Adolescent Health and Medicine's Eating Disorder Special Interest Group's listserv or the National Eating Disorders Quality Improvement Collaborative were invited to participate in an anonymous survey regarding their practices of care for hospitalized patients with ARFID.

Results

Thirty-seven (44.6%) of 83 physicians completed the survey; 73.0% (n = 27) of respondents medically admitted patients with ARFID. Half of respondents who admitted did not use any protocol for refeeding; 55% of those with a protocol used an anorexia nervosa treatment protocol. Solid food and nasogastric feeds were most commonly used for nutritional rehabilitation. Few typically prescribed medications in the hospital during medical stabilization.

Conclusions

There is considerable variability of practice in the treatment of hospitalized patients with ARFID. An important next step is to test the efficacy of protocols for anorexia nervosa in treating ARFID patients.

https://ift.tt/2IeLVKN

DNA as a self-antigen: nature and regulation

Chetna Soni | Boris Reizis

https://ift.tt/2Q8eQ5R

Macrophage Activation Syndrome, Glomerulonephritis, Pericarditis, and Retinal Vasculitis as Initial Presentation of Systemic Lupus Erythematosus

Macrophage activation syndrome (MAS) is a rare manifestation of systemic lupus erythematosus (SLE) with potentially life-threatening consequences. To the best of our knowledge, this is the first case reported in literature for a constellation of MAS, glomerulonephritis, pericarditis, and retinal vasculitis as initial presentation of SLE. Despite extensive multisystem involvement of his disease, the patient responded well to initial steroid treatment, with mycophenolate mofetil successfully added as a steroid-sparing agent. Our case highlights the importance of multispecialty collaboration in the diagnosis and management of SLE with multisystem involvement.

https://ift.tt/2Q8i6OR

An international survey-based study on colorectal cancer pathology reporting—guidelines versus local practice

Abstract

Different guidelines for colorectal cancer (CRC) pathology reporting have been published. We aimed to identify differences between publicly available CRC reporting guidelines and to survey pathologists from different countries to establish the degree of guideline implementation in local routine practice. We compared all core and non-core items of CRC reporting guidelines to identify discrepancies. We then created a survey, which was sent out to 782 pathologists practicing in 30 different countries. It included questions on the demographics of the reporting pathologist as well as resection specimen handling and microscopic evaluation, grading, staging, and additional techniques, such as immunohistochemistry or molecular pathology. First, core and non-core items of five national CRC reporting guidelines were compared and 12 items were found to differ. Different items are considered core or non-core by different guidelines and more than one TNM staging edition was applied across guidelines. The survey was completed by 143 pathologists from 30 countries. We identified differences between local practice and guidelines with potential clinical impact, e.g., tumor budding was never reported by 28.7% of responders, although it has prognostic value for survival in stage II CRC. This is the first international study comparing CRC pathology reporting guidelines with real-world local practices. There are differences in CRC pathology reporting guidelines and in guideline implementation into local practice, both with potential impact on patient care. Harmonization of datasets, use of templates, and audits of local pathology practice are needed to ensure best possible quality of CRC pathology reporting.

https://ift.tt/2N3yxtE

Acute effects of photobiomodulation therapy (PBMT) combining laser diodes, light-emitting diodes, and magnetic field in exercise capacity assessed by 6MST in patients with COPD: a crossover, randomized, and triple-blinded clinical trial

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by dyspnea, as well as musculoskeletal and systemic manifestations. Photobiomodulation therapy (PBMT) with use of low-level laser therapy (LLLT) and/or light-emitting diode therapy (LEDT) is an electrophysical intervention that has been found to minimize or delay muscle fatigue. The aim of this study was to evaluate the acute effect of PBMT with combined use of lasers diodes, light-emitting diodes (LEDs), magnetic field on muscle performance, exercise tolerance, and metabolic variables during the 6-minute stepper test (6MST) in patients with COPD. Twenty-one patients with COPD (FEV₁ 46.3% predicted) completed the 6MST protocol over 2 weeks, with one session per week. PBMT/magnetic field or placebo (PL) was performed before each 6MST (17 sites on each lower limb, with a dose of 30 J per site, using a cluster of 12 diodes 4 × 905 nm super-pulsed laser diodes, 4 × 875 nm infrared LEDs, and 4 × 640 nm red LEDs; Multi Radiance Medical™, Solon, OH, USA). Patients were randomized into two groups before the test according to the treatment they would receive. Assessments were performed before the start of each protocol. The primary outcomes were oxygen uptake and number of steps, and the secondary outcome was perceived exertion (dyspnea and fatigue in the lower limbs). PBMT/magnetic field applied before 6MST significantly increased the number of steps during the cardiopulmonary exercise test when compared to the results with placebo (129.8 ± 10.6 vs 116.1 ± 11.5, p = 0.000). PBMT/magnetic field treatment also led to a lower score for the perception of breathlessness (3.0 [1.0–7.0] vs 4.0 [2.0–8.0], p = 0.000) and lower limb fatigue (2.0 [0.0–5.0] vs 4.0 [0.0–7.0], p = 0.001) compared to that with placebo treatment. This study showed that the combined application of PBMT and magnetic field increased the number of steps during the 6MST and decreased the sensation of dyspnea and lower limb fatigue in patients with COPD.

https://ift.tt/2xzYEDK

Eosinophilic Dermatosis of Myeloproliferative Disease in a Young Adult With Diffuse Large B-Cell Lymphoma

Abstract: Exaggerated insect bite reactions present as exuberant papular and vesiculobullous lesions in patients with hematologic malignant neoplasms. The most commonly reported hematological malignancy with exaggerated insect bite reactions is chronic lymphocytic leukemia. Other reported reactions have been seen in patients with mantle cell lymphoma. Clinical presentation may vary with many patients unaware of a previous insect bite. Therefore, the terms "exaggerated bite-like reaction" and "eosinophilic dermatosis of myeloproliferative disease" have been proposed. The lesions may wax and wane or persist for many years, and they seem to be unrelated to the underlying hematologic disorder course or therapy. In some circumstances, the lesions may actually precede the diagnosis of the hematological malignancy. In this study, we describe a case of "eosinophilic eruption of myeloproliferative disease" associated with diffuse large B-cell lymphoma in a young adult. To the best of our knowledge, this is the first case reported in association with diffuse large B-cell lymphoma. Correspondence: Katrin Kiavash, MD, Department of Pathology, Roger Williams Medical Center, Boston University, 14 Shadow Farm Way, Wakefield, RI 02879 (kiavashkatrin@yahoo.com). K. Kiavash and A. Jencks have equal contribution to this manuscript and both are considered as first authors. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2OSdRqf

Cutaneous Mastocytosis With Predominant Infiltration of Promastocytes

Abstract: Mastocytosis is a heterogeneous group of disorders with a variable clinical course, ranging from indolent disease with normal life expectancy to highly aggressive disease. In the skin, mast cells may show a spindle-shape appearance or appear as round cells with wide, polygonal cytoplasm. In this study, we present a case series of 4 patients with cutaneous childhood-onset mastocytosis in whom skin mast cells showed striking nuclear pleomorphism with bilobed and multilobed nuclei. Such finding does not seem to represent a malignant phenotype of the disease in the skin, although the true biological significance and the potential prognostic impact remain to be determined. Correspondence: Nicole Knöpfel, MD, Department of Dermatology, Hospital Infantil Universitario Niño Jesús, C/Menéndez Pelayo, 65, Madrid 28009, Spain (e-mail: nicole.knopfel@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zsQPkL

Mucinous Metaplasia of the Vulva in Zoon Vulvitis and Lichen Sclerosus et Atrophicus. Description of 3 Additional Cases of a Rarely Reported Histopathologic Finding

Abstract: Mucinous metaplasia of the vulva (MMV) is a histopathologic finding that has been reported previously in only 3 patients and needs to be distinguished from vulvar extramammary Paget disease. We report 3 additional instances of MMV associated to Zoon vulvitis and vulvar lichen sclerosus et atrophicus. Histochemical and immunohistochemical studies were performed on biopsies from erythematous and erosive vulvar lesions of 3 women aged 64, 80 and 84 years, with features of Zoon vulvitis (2 cases) and lichen sclerosus et atrophicus (1 case). Mucin-containing epithelial cells were present on the uppermost layers of the squamous epithelium. On immunohistochemical study the metaplastic cells were positive for cytokeratin 7, epithelial membrane antigen and carcinoembryonic antigen, thus mimicking the phenotype of Paget disease. MMV is most likely related to chronic inflammation. Cytological and architectural features allow for distinction from Paget disease because the mucin-containing cells of mucinous metaplasia of the vulva lack atypia and are predominantly located on the most superficial layers of the surface epithelium. Correspondence: Carlos Santonja, MD, Anatomía Patológica, Hospital Universitario Fundación Jiménez Díaz, Avenida de los Reyes Católicos, 2, 28040 Madrid, Spain (e-mail: csantonja@fjd.es). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2OPzDuR

Brooke–Spiegler Syndrome: Two Patients From a Turkish Family With Multiple Familial Trichoepithelioma

No abstract available

https://ift.tt/2zu23W3

Follicle and Sebaceous Gland Multinucleated Cells in Measles

Abstract: We report the case of a 32-year-old man with measles in which skin biopsy helped to establish a definitive diagnosis. Follicular involvement is a common histopathologic feature of measles. Multinucleated epidermal and follicular cells are distinctive findings. Correspondence: Jorge Magdaleno-Tapial, MD, Department of Dermatology, Hospital General Universitario de Valencia, Avenida Tres Creus, 2, 46014 Valencia, Spain (e-mail: jormagta@gmail.com). J. Magdaleno-Tapial wrote most of the original draft of the paper. C. Valenzuela-Oñate, M. Giacaman-von der Weth, and B. Ferrer-Guillén have participated in writing the paper. M. García-Legaz Martínez and P. Hernández-Bel have followed the patient. V. Alegre-de Miquel and Á. Martínez-Domenech have performed the histological study of the samples. V. Alegre-de Miquel has followed the patient and has reviewed the pertinent raw data on which conclusions of this study are based. All authors have read and approved the final version of the manuscript submitted. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2OQggC2

Langerhans Cell Histiocytoma: A Benign Histiocytic Neoplasm of Diverse Lines of Terminal Differentiation

Abstract: Langerhans cell (LC) histiocytoma is a neonatal tumor that often consists of a single, ulcerated nodule. Systemic involvement is rare, and LC histiocytoma is considered to be a variant of congenital, self-healing LC histiocytosis (also referred to as Hashimoto–Pritzker disease). In view of its low prevalence, LC histiocytoma is not always diagnosed in a clinical examination and requires histological confirmation. Furthermore, the histological and molecular features of LC histiocytoma have not been well characterized. Here, we report on 6 cases of this rare disease and review the corresponding literature. LC histiocytoma differs from classical self-healing LC histiocytosis with regard to the pathological features; we found that LC histiocytoma was associated with massive infiltration by histiocytes of various sizes and shapes (although often large) throughout the dermis and the superficial subcutis. Epidermotropism was rare, mitotic figures were not inconspicuous, and necrotic or calcified areas were often present. Immunohistochemical assessment revealed a mixture of different types of histiocytes (with CD1a+ CD207+, CD1a+ CD207−, and CD1a− CD207− CD163+ cells). Genetic testing was performed in 5 cases; it revealed a BRAF mutation (p.V600E and p.485_490delinsF) in 2 cases, a HRAS mutation (p.T58I) in 1 case, a combination of 2 PTEN mutations in another case (p.I224M and p. R234W), and no mutations in the fifth case. All the lesions regressed spontaneously, and none recurred during follow-up. Correspondence: Sylvie Fraitag, MD (e-mail: Sylvie.fraitag@aphp.fr). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2zu4QP7

Acute Appearance Concerns in Patients Undergoing Mohs Surgery: A Single-Institution Cross-Sectional Study

No abstract available

https://ift.tt/2NB0XR3

Eccrine Porocarcinoma: New Insights and a Systematic Review of the Literature

BACKGROUND Eccrine porocarcinoma (EPC) is a rare cutaneous neoplasm with high potential for morbidity and mortality. Due to its rarity, there is a paucity of data profiling diagnosis, work-up, and management. OBJECTIVE To consolidate reported information on demographics, diagnostics, clinical behavior, treatment modalities, and patient outcomes in EPC to provide a reference tool to optimize diagnosis and management. METHODS A comprehensive PubMed search was performed from 1963 to November 2017 using PRISMA guidelines. This yielded 155 articles detailing 206 cases of porocarcinoma. RESULTS Eccrine porocarcinoma most often presents in elderly patients on the head and neck or lower limbs. Metastatic disease at presentation is not uncommon (22%). Primary tumor location is significantly correlated with presence of metastasis (p = .038). The most common treatment is excision followed by Mohs micrographic surgery (MMS), although the outcomes after MMS were superior to those after surgical excision. CONCLUSION This systematic review of individual patient data reveals that all patients should have a histological diagnosis with imaging considered for high-risk cases. Primary tumor location should also be considered in diagnostic and therapeutic decision-making. Although wide local excision (WLE) is currently the first-line treatment, MMS is becoming increasingly used, with evidence indicating improved outcomes as compared to those seen with WLE.

https://ift.tt/2Q6rGlo

Prospective Multicenter Clinical Trial of a Temperature-Controlled Subcutaneous Microneedle Fractional Bipolar Radiofrequency System for the Treatment of Cellulite

BACKGROUND A bipolar fractional radiofrequency (RF) device was developed to generate cutaneous thermal injuries using a temperature-controlled microneedle electrode array. OBJECTIVE Evaluate safety and efficacy of a novel subcutaneous microneedle RF for treatment of posterolateral thigh cellulite. METHODS The study design was an institutional review board-approved multicenter clinical trial after a per-protocol analysis. Fifty subjects with Nurnberger–Muller Grade II or III cellulite were enrolled at 4 treatment centers and received 1 subcutaneous microneedle RF treatment (67°C/4-second duration). Efficacy was evaluated by blinded grading by 3 dermatologists using randomized, standardized photographs and investigator grading at baseline, 1-, 3-, and 6-month follow-up. As per the Food and Drug Administration, treatment success was defined by ≥1-point improvement on dimple number or severity of undulation irregularities scales by at least 2 of 3 blinded physicians. Study subjects' self-assessments and satisfaction questionnaires and procedural pain levels and adverse events were monitored. RESULTS Blinded physician evaluations revealed a procedural success rate of 93% at 6-month follow-up. Procedural pain level was 3.74 ± 1.96 on a 10-point scale. There were no adverse events. Seventy-five percent of subjects were satisfied with the results at 6-month follow-up. CONCLUSION The results indicate that subcutaneous microneedle RF treatment is safe and effective for long-term treatment of Type II and III cellulite in a single session.

https://ift.tt/2NDMRyv

Cold Panniculitis After Cryolipolysis Treatment of the Abdomen

No abstract available

https://ift.tt/2Q1ULya

Efficacy Using a Modified Technique for Tissue Stabilized-Guided Subcision for the Treatment of Mild-to-Moderate Cellulite of the Buttocks and Thighs

BACKGROUND Cellulite can be significantly improved using vacuum-assisted tissue stabilized-guided subcision (TS-GS). However, the treatment of shallow and linear cellulite has remained problematic. OBJECTIVE In this retrospective study, we describe a modified technique of vacuum-assisted TS-GS. The aim is to demonstrate that this new limited-release technique is an effective treatment for long ripples and interconnected shallow dimples, which are characteristic of mild-to-moderate cellulite. METHODS Patients with mild-to-moderate cellulite were treated with limited-release vacuum-assisted TS-GS. All subcisions were performed at the 6-mm depth and a minimum of 3 mm between each dimple. Using a 4-point scale, 2 raters graded cellulite improvement on evaluation of prephotographs and postphotographs. RESULTS A total of 23 female patients were included in this study. The pre- and post-treatment photographs were correctly identified in 22 of the 23 patients (95.6%). The average cellulite improvement was 2.9 of 4 for the buttocks and 2.8 of 4 for the posterior thighs. Global cellulite improvement was reported at 3.1 of 4. CONCLUSION The results demonstrate that modified, limited-release, vacuum-assisted TS-GS can be an effective and safe method for the treatment of long ripples and shallow dimples that are characteristics of mild-to-moderate cellulite.

https://ift.tt/2NHFUMD

Novel Fasciotomy Technique for the Keystone Flap

No abstract available

https://ift.tt/2Q1UviG

Adipose Stromal Vascular Fraction Gel Grafting: A New Method for Tissue Volumization and Rejuvenation

BACKGROUND The clinical outcomes of fat grafting vary and are technique-dependent. Stromal vascular fraction (SVF) gel is a novel, mechanically processed fat product with high concentrations of adipose tissue–derived stem cells and other SVF cells. This study evaluated the volumization and rejuvenation effects of SVF-gel. OBJECTIVE This study evaluated the volumization and rejuvenation effects of SVF-gel. METHODS This retrospective, single-center study included 126 patients who underwent SVF-gel grafting and 78 who underwent conventional lipoinjection for various indications from March 2015 to February 2017. Patient satisfaction and secondary surgery rates were evaluated. Samples of transferred SVF-gel were harvested and examined histologically. RESULTS All patients showed improvements in facial augmentation and contour. Patients in the SVF-gel group experienced mild postoperative swelling and a low secondary surgery rate (10.9%). Assessment of patient-rated satisfaction on a 5-point Likert scale found that 77.3% of patients in the SVF-gel group were satisfied (54.5%) or very satisfied (22.8%) with their outcomes. By comparison, 53.8% of patients who underwent conventional lipoinjection were satisfied (48.7%) or very satisfied (5.1%). Moreover, SVF-gel showed effective antiwrinkle and skin rejuvenation effects. Hematoxylin–eosin staining showed a normal adipose tissue structure in transferred SVF-gel. CONCLUSION Stromal vascular fraction gel is effective for both volumization and rejuvenation, and may be superior to conventional lipoinjection for facial recontouring.

https://ift.tt/2NG9rGo

Marginal Mandibular Injury After Treatment With Cryolipolysis

No abstract available

https://ift.tt/2Q6ufnl

Endovenous Thermal Ablation of Recurrent Varicose Veins due to Residual Great Saphenous Venous Insufficiency After Saphenous Venous Surgery: A Comparative Study

BACKGROUND Redo surgery for recurrent varicose veins of the great saphenous vein (GSV) is technically more challenging than the initial surgery. OBJECTIVE To compare 980 and 1,470-nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) for the treatment of residual GSV insufficiency after saphenofemoral ligation ± stripping. MATERIALS AND METHODS Thirty-seven limbs in 29 patients with recurrent varicose veins were retrospectively evaluated. Patients were divided into 3 groups: 980-nm EVLA (group A), 1,470-nm EVLA (group B), and RFA (group C). Duplex ultrasonography, Venous Clinical Severity Score (VCSS), and adverse events were examined at intervals of 1 week, 1, 3, 6, and 12 months. RESULTS Complete closure was achieved in 35 (94.6%) limbs at 12 months. Venous Clinical Severity Score decrease in group C (3.6 ± 0.5) was significantly (p

https://ift.tt/2NFlW55

Retrospective Multistudy Analysis of Axillary Odor Reduction After Microwave Treatment

No abstract available

https://ift.tt/2Q5g9Ti

Efficacy of 1,550-nm Erbium-Glass Fractional Laser Treatment and Its Effect on the Expression of Insulin-Like Growth Factor 1 and Wnt/β-Catenin in Androgenetic Alopecia

BACKGROUND A new treatment for androgenetic alopecia (AGA) is a 1,550-nm erbium-glass (Er:Glass) fractional laser. The wound healing process associated with this treatment is believed to be due to the stimulation of hair regrowth. Both the Wingless-related integration site (Wnt) proteins and insulin-like growth factor 1 (IGF-1) are important molecules that promote new hair growth. OBJECTIVE The aim of this study was to evaluate the efficacy of 1,550-nm Er:Glass fractional laser treatment and determine the gene expression of IGF-1 and Wnt/β-catenin in patients with AGA. METHODS Twenty-three patients with AGA were enrolled. They received 12 treatments at 2-week intervals. A scalp biopsy was performed to evaluate mRNA levels of Wnt10A and IGF-1. Histopathologic samples were collected. RESULTS Significant increases in hair count and shaft diameter that occurred from Month 4 until the end of the study were observed. Histological results showed increases in the follicular unit, anagen hair count, and the anagen:telogen ratio. No up-regulation of Wnt10A and IGF-1 mRNA was observed. CONCLUSION The 1,550-nm Er:Glass fractional laser treatment can increase hair density and shaft diameter in patients with AGA. The mechanisms by which 1,550-nm Er:Glass laser treatment induces new hair growth may not be limited to Wnt10A/β-catenin or IGF-1 expression.

https://ift.tt/2NHVEzp

Reconstruction of Large Auricular and External Auditory Canal Defect With Novel Guiding Sutures Placed in a Spoke Wheel Pattern

No abstract available

https://ift.tt/2Q6udMf

The Safety and Efficacy of Treatment With a 1,927-nm Diode Laser With and Without Topical Hydroquinone for Facial Hyperpigmentation and Melasma in Darker Skin Types

BACKGROUND The nonablative, fractional, 1,927-nm diode laser is theoretically a safe and effective treatment for hyperpigmentation and melasma in darker skin and may potentiate topical cosmeceutical delivery. OBJECTIVE To evaluate the use of a nonablative, fractional, 1,927-nm diode laser with and without topical 2% hydroquinone (HQ) cream for moderate-to-severe facial hyperpigmentation in Fitzpatrick skin Types III–V. METHODS Forty adults underwent 4 laser treatments at 2-week intervals and were randomized to daily application of 2% HQ cream or moisturizer. Follow-ups were conducted 4 and 12 weeks after the final laser treatment. RESULTS Hydroquinone and moisturizer groups demonstrated Mottled Pigmentation Area and Severity Index improvements of approximately 50% at post-treatment Weeks 4 and 12. Blinded investigator–assessed hyperpigmentation and photodamage improved significantly for both the groups at post-treatment Weeks 4 and 12. Subject satisfaction improved significantly in both the groups by post-treatment Week 4. Although investigator-rated Global Aesthetic Improvement Scale scores were significantly better in the HQ group at post-treatment Week 12, satisfaction was higher among those using moisturizer. No adverse events were noted. CONCLUSION The nonablative, fractional, 1,927-nm diode laser produced significant improvement in hyperpigmentation in Fitzpatrick skin Types III–V by 4 weeks, with maintenance of results at 12 weeks after treatment even without HQ.

https://ift.tt/2NIA91v

Dog Ear Regression in Function of Skin Elasticity

No abstract available

https://ift.tt/2Q7iEUX

A Comparison Study of the Nonablative Fractional 1565-nm Er: glass and the Picosecond Fractional 1064/532-nm NdYAG Lasers in the Treatment of Striae Alba A Split Body Double-Blinded Trial

BACKGROUND Few effective treatments exist for striae alba, which are the mature stage of stretch marks. OBJECTIVE To evaluate the efficacy of the nonablative fractional 1,565-nm Erbium-glass (Er:glass) and the picosecond fractional 1,064/532-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) lasers in the treatment of striae alba. MATERIALS AND METHODS Twenty subjects with striae alba on the bilateral abdomen were treated with either the nonablative fractional 1565-nm Er:glass or the picosecond fractional 1,064/532-nm Nd:YAG laser, with a total of 3 treatments 3 weeks apart. RESULTS A 31% (1.25/4) texture improvement was noted for both the fractional 1,565-nm Er:glass laser and the picosecond fractional 1,064/532-nm Nd:YAG laser. The degree of atrophy was improved by 30% (1.19/4) with the 1,565-nm Er:glass laser and 35% (1.38/4) with the picosecond 1,064/532-nm Nd:YAG laser. A 48% (1.9/4) subject overall assessment of improvement was noted with the fractional 1565-nm Er:glass laser and 45% (1.8/4) improvement with the picosecond fractional 1,064/532-nm Nd:YAG laser. There was no significant change in striae density with either laser. The picosecond laser was rated as less painful during all 3 sessions (p = .002) and had a shorter healing time (p = .035). The nonablative fractional 1,565-nm Er:glass and the picosecond fractional 1,064/532-nm Nd:YAG lasers were equally efficacious in improving striae alba.

https://ift.tt/2NFj6x5

Pemphigus Foliaceus Demonstrating Pathergy After Mohs Micrographic Surgery

No abstract available

https://ift.tt/2Q4g6He

High-Fluence Light-Emitting Diode–Generated Red Light Modulates the Transforming Growth Factor-Beta Pathway in Human Skin Fibroblasts

BACKGROUND Skin fibrosis is a significant medical problem with limited available treatment modalities. The key cellular characteristics include increased fibroblast proliferation, collagen production, and transforming growth factor-beta (TGF-B)/SMAD pathway signaling. The authors have previously shown that high-fluence light-emitting diode red light (HF-LED-RL) decreases cellular proliferation and collagen production. OBJECTIVE Herein, the authors investigate the ability of HF-LED-RL to modulate the TGF-B/SMAD pathway. MATERIALS AND METHODS Normal human dermal fibroblasts were cultured and irradiated with a commercially available hand-held LED array. After irradiation, cell lysates were collected and levels of pSMAD2, TGF-Beta 1, and TGF-Beta I receptor were measured using Western blot. RESULTS High-fluence light-emitting diode red light decreased TGF-Beta 1 ligand (TGF-B1) levels after irradiation. 320 J/cm2 HF-LED-RL resulted in 59% TGF-B1 and 640 J/cm2 HF-LED-RL resulted in 54% TGF-B1, relative to controls. 640 J/cm2 HF-LED-RL resulted in 62% pSMAD2 0 hours after irradiation, 65% pSMAD2 2 hours after irradiation, and 95% 4 hours after irradiation, compared with matched controls. High-fluence light-emitting diode red light resulted in no significant difference in transforming growth factor-beta receptor I levels compared with matched controls. CONCLUSION Skin fibrosis is a significant medical problem with limited available treatment modalities. Light-emitting diode–generated red light is a safe, economic, and noninvasive modality that has a body of in vitro evidence supporting the reduction of key cellular characteristics associated with skin fibrosis.

https://ift.tt/2NFD7DQ

Successful Hair Transplantation for Scarring Alopecia Associated With Incontinentia Pigmenti

No abstract available

https://ift.tt/2Q6VhuV

Hidradenitis Suppurativa After Radical Surgery—Long-Term Follow-up for Recurrences and Associated Factors

BACKGROUND Hidradenitis suppurativa (HS) is a chronic debilitating skin disease in inverse body areas. Wide excision is recommended in Hurley Stages II to III, but the rate and symptoms of recurrences in long-term follow-up remain unclear. OBJECTIVE To analyze the allocation of recurrences regarding the operative field, the onset and quality of HS symptoms as well as factors associated with recurrences in long-term follow-up. MATERIAL AND METHODS Forty-eight patients with Hurley Stage III disease who had undergone 91 wide excisions from 2010 to 2015 were clinically examined regarding postoperative complications and allocation and quality of recurrences. To determine the risk of recurrence, possible surgery, and lifestyle-related associated factors were investigated. RESULTS Postoperative recurrences of HS were seen in 54.2%. Most recurrences (inflamed nodules) were detected in a

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A Port-Wine Stain Treated With Pulsed Dye Laser: A Complication From Contaminated Makeup

No abstract available

https://ift.tt/2Q7iCwj

Comparing SLNE With or Without Preoperative Hybrid SPECT/CT in Melanoma

Condition:   Melanoma
Interventions:   Procedure: SLNE with preoperative hybrid SPECT/CT;   Procedure: Standard SLNE
Sponsor:   University Hospital, Essen
Not yet recruiting

https://ift.tt/2N3M44C

Comparing SLNE With or Without Preoperative Hybrid SPECT/CT in Melanoma

Condition:   Melanoma
Interventions:   Procedure: SLNE with preoperative hybrid SPECT/CT;   Procedure: Standard SLNE
Sponsor:   University Hospital, Essen
Not yet recruiting

https://ift.tt/2N3M44C

The glomus tumor resorbed bone and teeth in the mandible: a case report

Abstract

Background

A glomus tumor is a rare neoplasm usually found in the dermis or subcutaneous tissue of the extremities. It is rare for the glomus tumor to occur on the head and face. Only 26 glomus tumors of the oral region and affected bone have been reported in the English-language literature (Table 1). We report a case of a glomus tumor at the mandible. As a new point, the glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible.

Case presentation

The patient was a 44-year-old Japanese man who complained swelling of the right mandible. Radiographic examination showed a multilocular radiolucency area in the left mandible. Radiographic findings on our case resembled those of a common benign tumor. The lesion occupied to the premolar and molar area and revealed that the tumor resorbed the roots of the teeth. The lesion was removed surgically with the buccal cortical bone and buccal mucosa in contact with the mass of the tumor. The mass fully excised intraorally under general anesthesia, and the inferior alveolar nerve in contact with the mass was preserved.

The specimen was pathologically diagnosed as a glomus tumor. Immunohistochemical staining was positive for vimentin, muscle-specific actin/HHF35, and calponin. A hairline-shaped area of positive staining for type IV collagen surrounding the tumor cells was also observed. In contrast, staining for alpha-SMA, cytokeratin (AE1/AE3), cytokeratin (CAM5.2), CK19, CD31, CD34, CD68, p63, S-100, Factor VIII, and desmin was all negative. The Ki-67 labeling index was almost 1%.

A recurrent tumor was again detected in the site below the primary tumor at an 8-year follow-up, and it was surgically removed. The patient has had no symptoms of recurrence in 2 years after the second operation.

Conclusion

The glomus tumor resorbed a bone and teeth roots when the tumor progressed into the mandible. The immunohistochemical features of the tumor were consistent with those described in previous reports. It is important to completely remove the Glomus tumor.

https://ift.tt/2Q1Uzz5

Insulin allergy can be successfully managed by a systematic approach

Type I insulin allergy can be a challenging condition, and there is no international consensus on how to establish the diagnosis. Measurement of specific IgE and skin testing have been cornerstones in the diag...

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Bronchial Blocker Use in the Difficult Airway Patient Requiring Lung Isolation: Clarification as to What Blockers Are Actually Available

No abstract available

https://ift.tt/2DuByE4

Intraoperative Considerations for Transgender Patients

No abstract available

https://ift.tt/2QXTfOL

In Response

No abstract available

https://ift.tt/2Dt9VeD

In Response

No abstract available

https://ift.tt/2QYBE9r

Programmed Intermittent Bolus Regimen for Erector Spinae Plane Blocks in Children: A Retrospective Review of a Single-Institution Experience

With few published reports on erector spinae plane block use in children, limited guidance on perioperative local anesthetic dosing exists. We present a series of 22 patients who received erector spinae plane catheters with programmed intermittent bolus for various surgeries. Median loading dose of 0.4 mL/kg (interquartile range [IQR], 0.1 mL/kg) ropivacaine 0.5%, intraoperative bolus of 0.3 mL/kg/h (IQR, 0.1 mL/kg) ropivacaine 0.2%, and a postoperative programmed intermittent bolus regimen of maximum 0.6 mg/kg/h resulted in highest pain scores on postoperative day 1 with a median score of 1.7 of 10 (IQR, 1.8) and highest morphine equivalents consumed on postoperative day 2 with a median score of 0.16 mg/kg up to 120 hours after surgery. Accepted for publication August 22, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Ban C. H. Tsui, MD, FRCPC, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, 300 Pasteur Dr, 3rd Floor, Room H3584, MC 5640, Stanford, CA 94305. Address e-mail to bantsui@stanford.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2Dw32Ji

Acute Stroke Management in the First 24 Hours: A Practical Guide for Clinicians

No abstract available

https://ift.tt/2QYBvmp

Obstetric Anesthesiology in the United States: Current and Future Demand for Fellowship-Trained Subspecialists

No abstract available

https://ift.tt/2Dwkcqq

Lack of Bias Evaluation and Inadequate Study Selection May Produce Misleading Results

No abstract available

https://ift.tt/2QYBgrv

Should We Always Continue β-Blocking Agents Preoperatively?

No abstract available

https://ift.tt/2DGm1RN

Is Tube Thermosoftening Helpful for Videolaryngoscope-Guided Nasotracheal Intubation?: A Randomized Controlled Trial

BACKGROUND: Thermosoftening of the endotracheal tube (ETT) and telescoping the ETT into a rubber catheter have been suggested as a method for reducing epistaxis during nasotracheal intubation (NTI). However, thermosoftening technique is known to make it difficult to navigate the ETT into trachea without the use of Magill forceps during NTI. The cuff inflation technique has been suggested as an effective alternative to the use of Magill forceps to improve the oropharyngeal navigation of the ETT, irrespective of their stiffness, during direct laryngoscope-guided NTI. We evaluated whether thermosoftening of the ETT telescoped into rubber catheters has an additional benefit in reducing nasal injury. Simultaneously, we also evaluated whether thermosoftening of the ETT worsened orotracheal navigability during cuff inflation-supplemented videolaryngoscope-guided NTI. METHODS: One hundred forty patients were randomly assigned to 1 of the 2 groups depending on whether the ETT was softened by warming or not. The primary outcome was the incidence of epistaxis during NTI. The secondary outcome was nasotracheal navigability of the ETT, assessed by navigation grade and time required for insertion of ETT in each phase (from nose to oropharynx, from oropharynx to glottic inlet aided by cuff inflation if needed, and from glottic inlet to trachea). RESULTS: The ETTs were successfully inserted through the selected nostril of all 140 patients. In the thermosoftening group, the incidence and severity of epistaxis was significantly lower (7% vs 51%; difference of 44.2%; 95% confidence interval, 29.9%–56.2%; P .99 and P = .054, respectively) and from the glottic inlet to the trachea (P > .99 and P = .750, respectively) between the 2 groups. In both groups, all ETTs could be navigated into the trachea without the use of Magill forceps. CONCLUSIONS: Supplemented with cuff inflation during videolaryngoscope-guided NTI, thermosoftening of the ETT telescoped into rubber catheters has a substantial benefit because it significantly reduces the incidence of epistaxis without worsening the oropharyngeal navigability of the ETT. Accepted for publication August 17, 2018. Funding: None. The authors declare no conflicts of interest. This study was approved by the Institutional Ethics Committee (institutional review board [IRB] approval number 2017-03-020, IRB contact information: Institutional Review Board, Hallym University Kangnam Sacred Heart Hospital, B1, 12, Siheung-daero 187-gil, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. E-mail: dandelionc@hallym.or.kr. Reprints will not be available from the authors. Address correspondence to Joo Hyun Jun, MD, PhD, Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea. Address e-mail to ilpleut@naver.com. © 2018 International Anesthesia Research Society

https://ift.tt/2QRHvxv

Multimodal General Anesthesia: Theory and Practice

Balanced general anesthesia, the most common management strategy used in anesthesia care, entails the administration of different drugs together to create the anesthetic state. Anesthesiologists developed this approach to avoid sole reliance on ether for general anesthesia maintenance. Balanced general anesthesia uses less of each drug than if the drug were administered alone, thereby increasing the likelihood of its desired effects and reducing the likelihood of its side effects. To manage nociception intraoperatively and pain postoperatively, the current practice of balanced general anesthesia relies almost exclusively on opioids. While opioids are the most effective antinociceptive agents, they have undesirable side effects. Moreover, overreliance on opioids has contributed to the opioid epidemic in the United States. Spurred by concern of opioid overuse, balanced general anesthesia strategies are now using more agents to create the anesthetic state. Under these approaches, called "multimodal general anesthesia," the additional drugs may include agents with specific central nervous system targets such as dexmedetomidine and ones with less specific targets, such as magnesium. It is postulated that use of more agents at smaller doses further maximizes desired effects while minimizing side effects. Although this approach appears to maximize the benefit-to-side effect ratio, no rational strategy has been provided for choosing the drug combinations. Nociception induced by surgery is the primary reason for placing a patient in a state of general anesthesia. Hence, any rational strategy should focus on nociception control intraoperatively and pain control postoperatively. In this Special Article, we review the anatomy and physiology of the nociceptive and arousal circuits, and the mechanisms through which commonly used anesthetics and anesthetic adjuncts act in these systems. We propose a rational strategy for multimodal general anesthesia predicated on choosing a combination of agents that act at different targets in the nociceptive system to control nociception intraoperatively and pain postoperatively. Because these agents also decrease arousal, the doses of hypnotics and/or inhaled ethers needed to control unconsciousness are reduced. Effective use of this strategy requires simultaneous monitoring of antinociception and level of unconsciousness. We illustrate the application of this strategy by summarizing anesthetic management for 4 representative surgeries. 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. Accepted for publication June 11, 2018. Funding: This work was supported by the National Institutes of Health (Bethesda, MD): R01 GM104948 (to E.N.B.) and P01GM118269 (to E.N.B.); and by the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA. Conflicts of Interest: See Disclosures at the end of the article. A glossary of terms is available in the Appendix. Reprints will not be available from the authors. Address correspondence to Emery N. Brown, MD, PhD, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Grey-Jackson 444, Boston, MA 02114. Address e-mail to enb@neurostat.mit.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2DvSLgp

Performance of Air Seal of Flexible Reinforced Laryngeal Mask Airway in Thyroid Surgery Compared With Endotracheal Tube: A Randomized Controlled Trial

BACKGROUND: Flexible reinforced laryngeal mask airway (FLMA®) has gained popularity in thyroid surgery, but air leak and displacement are still concerns. METHODS: In this randomized, single-blinded, noninferiority, controlled trial, we randomized patients scheduled for elective radical thyroidectomy to an endotracheal tube (ETT) group or a FLMA group. The primary outcomes were ventilation leak volume, peak airway pressure, and partial pressure of end-tidal carbon dioxide (PetCO2). Data for primary outcomes were collected after insertion of ETT/FLMA, at incision, and at 10-minute intervals during surgery. Ten milliliters, 5 cm H2O, and 10 mm Hg were used as the noninferiority deltas for ventilation leak volume, peak airway pressure, and PetCO2, respectively. We assessed noninferiority of FLMA to ETT on the primary outcomes over time using the results of a linear mixed-effects model. The position of FLMA mask was evaluated before and after surgery, and the airway complications were recorded. RESULTS: A total of 132 patients were included: 65 in ETT group and 67 in FLMA group. Differences (FLMA group minus ETT group) of ventilation leak volume, peak airway pressure, and PetCO2 from the mixed-effects models were 2.09 mL (98.3% confidence interval [CI], –6.46 to 10.64), −0.60 cm H2O (98.3% CI, –2.15 to 0.96), and 1.02 mm Hg (98.3% CI, 0.04–1.99), respectively. Score of fiber-optic position of FLMA was significantly higher after surgery than before. There was no severe shift, loss of the mask seal, regurgitation, or aspiration in the FLMA group. One patient in the FLMA group experienced brief and easily controlled laryngospasm. CONCLUSIONS: In thyroid surgery, FLMA is noninferior to ETT in the peak airway pressure and PetCO2 although mild to moderate mask shift could occur during surgical manipulation. There is no evidence for a higher complication rate when FLMA is used. Accepted for publication July 27, 2018. Funding: None. 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). Clinical Trial Number: ChiCTR-IOR-15006602. LMA Flexible and LMA Classic are registered trademarks of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Jie Yi, MD, Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China. Address e-mail to easyue@163.com. © 2018 International Anesthesia Research Society

https://ift.tt/2R0ndlB

Fulminant Intracranial Hypertension Managed With Temporary Lumbar Drain

No abstract available

https://ift.tt/2QXUCwX

Anticancer Agent‐Induced Life‐Threatening Skin Toxicities: A Database Study of Spontaneous Reporting Data

AbstractStevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially life‐threatening cutaneous and mucosal adverse reactions to drugs. Nevertheless, the connection to anticancer agents remains unclear. To provide insight into the association of such adverse reactions with anticancer agents, we analyzed the profile of anticancer agent‐induced SJS and TEN in the Japanese population. Of the 9,738 SJS/TEN events recorded in a database of spontaneous reporting data, 485 (5%, further categorized as SJS, 384 events, 79%; TEN, 101 events, 21%) were identified as anticancer agent‐induced, and 53 of these (11%) were fatal. Multivariate logistic regression analyses indicated that, compared with patients using other drugs, those using anticancer drugs had lower incident risk of death (hazard ratio [HR], 0.592; p = .0006), longer median time to onset of SJS/TEN (18 vs. 11 days; p < .0001; multivariate Cox regression: HR, 0.66; p < .0001), and a higher likelihood of developing SJS/TEN later than 70 days after initiation of the suspected causal agent (15% vs. 7%; p < .0001), highlighting the need for vigilance and continuous monitoring for SJS/TEN in patients treated with anticancer agents.Implications for Practice.Life‐threatening skin toxicities induced by anti‐cancer agents indicated significantly lower incident risk of death and longer time to onset of symptoms than for those induced by other drugs.

https://ift.tt/2IfdO5q

Perceptions of Oncologists About Sharing Clinic Notes with Patients

AbstractIn a large survey (n = 809) conducted to understand how oncologists differ from nononcologists regarding routinely sharing visit notes with patients, oncologists were less likely to agree patient safety would improve (p = .03) or that patients would be offended after reading notes (p = .01); however, they agreed with nononcologists that sharing notes would lead to less candid documentation (69% vs. 73%; p = .39). Oncologists share a high level of worry about the impact of sharing notes on documentation practices, a concern that will need to be addressed as the practice of sharing visit notes expands to cancer care.

https://ift.tt/2NBLcJu

A Phase II Trial of Pazopanib in Patients with Metastatic Alveolar Soft Part Sarcoma

Lessons Learned. Pazopanib shows a modest efficacy in metastatic alveolar soft part sarcoma.Clinical outcomes were comparable to those in previous studies using antiangiogenic drugs.Further prospective studies evaluating the benefit of pazopanib in alveolar soft part sarcoma with a larger sample are warranted to validate results.Background.Alveolar soft part sarcoma (ASPS) is a rare mesenchymal malignant tumor characterized by an unbalanced translocation, t(X;17)(p11.2;q25), which leads to the fusion of ASPSCR1 to the TFE3 transcription factor. Because this results in the upregulation of angiogenesis‐related transcripts, antiangiogenic drugs have been used in ASPS patients.Methods.This open‐label, single‐arm, multicenter, investigator‐initiated phase II trial was designed to evaluate efficacy and safety of pazopanib 800 mg once daily in patients with metastatic ASPS. The primary endpoint was investigator‐assessed overall response rate (ORR), and secondary endpoints were toxicity, progression‐free survival (PFS), and overall survival (OS). 68Ga‐RGD (Arg‐Gly‐Asp) positron emission tomography (PET) scan and gene expression profiling using NanoString platform were performed for biomarker analysis.Results.Six patients with histologically confirmed metastatic ASPS were enrolled between December 2013 and November 2014. Among six patients, one achieved a partial response (PR) (ORR 16.7%) and five patients showed stable disease (SD). With a median follow‐up of 33 months (range 18.7–39.3 months), median PFS was 5.5 months (95% confidence interval [CI] 3.4–7.6 months), and median OS was not reached. There were no severe toxicities except one patient with grade 3 diarrhea.Conclusion.Pazopanib showed modest antitumor activity with manageable toxicities for patients with metastatic ASPS.

https://ift.tt/2IejMUj

Response to Oral Immediate‐Release Opioids for Breakthrough Pain in Patients with Advanced Cancer with Adequately Controlled Background Pain

AbstractBackground.There is limited evidence about the response of breakthrough pain (BTP) to the most commonly used oral immediate‐release (IR) opioids. Our aim was to determine response rate to oral IR opioids for BTP control in patients with advanced cancer.Materials and Methods.In this prospective study, palliative care outpatients, with advanced cancer and adequately managed background pain, were asked to complete a self‐administered survey. We assessed patients' baseline demographics, pain characteristics, alcoholism (CAGE questionnaire), tobacco and substance abuse, and Edmonton Symptom Assessment Scores (ESAS). We determined the effectiveness of oral IR BTP opioids by using a 7‐point Likert scale ranging from "very ineffective" to "very effective." "Effective" and "very effective" were defined a priori as a good response to IR opioids for BTP.Results.Of 592 evaluable patients, 192 (32%) had background pain of ≤3 (ESAS pain scale 0–10). Among these 192 patients, 152 (79%) reported BTP, 143/152 (94%) took oral IR opioids for BTP, and 127/143 (89%) responded to a median dose of 10% of the total morphine equivalent daily dose. In univariate logistic regression analysis, younger age (odds ratio [OR], 0.94 per year; p = .008), higher ESAS scores for pain (OR, 1.32; p = .012), anxiety (OR, 1.24; p = .017), and dyspnea (OR, 1.31; p = .007) had statistically significant association with poor response to IR opioids for BTP. In multicovariate logistic regression, adjusted for age, a higher ESAS dyspnea score was significantly associated with poor response to oral IR opioids (OR, 1.44; p = .002).Conclusion.The vast majority of patients with advanced cancer with adequately controlled background pain reported a good response to oral IR opioids for BTP, supporting their use in clinical practice.Implications for Practice.Oral immediate‐release opioids are standard treatment for cancer breakthrough pain. However, information regarding treatment response to these commonly used opioids is limited. This study provides information that the vast majority of patients with advanced cancer, with adequately controlled background pain, reported good response to oral immediate release opioids for managing their breakthrough pain episodes. Results of this study support the use of conventional oral immediate release opioids that are relatively inexpensive and readily available for management of breakthrough pain in patients with advanced cancer.

https://ift.tt/2ND7Wcn

Landmark-based midsagittal plane analysis in patients with facial symmetry and asymmetry based on CBCT analysis tomography

Abstract

Purpose

Reconstruction of the facial midplane is relevant in anthropometry, orthodontics, maxillofacial surgery, and the accurate measurement of symmetry deviation is relevant in many fields of medicine especially when planning surgical treatment. In the literature, three different means of midplane generation have been published; however, there is currently no consensus regarding the approach to use. Morphometric methods are used to determine the true midsagittal plane (MSP), but its use in clinical practice is difficult. A regression plane based on N‑ANS-PNS landmarks reportedly approximates the morphometric MSP. As these points are vulnerable, we investigated which combination of landmarks can be substituted in symmetric and asymmetric faces.

Patients and methods

Thirty symmetric and 30 asymmetric faces were analyzed on cone-beam computed tomography scans. A total of 50 regression planes were generated based on three unpaired landmarks and 35 regression planes were generated based the midpoints of paired landmarks. The Na-ANS-PNS plane was used as reference plane, and the mean angle between it and each generated MSP was calculated. The differences from the reference plane were compared by t‑test between the groups.

Results

In the symmetric group, 86% of angles deviated by <5° using unpaired points, whereby 74% of angles deviated by <5° for paired points. Between the two groups 50% of planes from midline points, and 77% of planes from paired points were significantly different. All planes deviated more in the asymmetric group.

Conclusions

The N‑ANS-PNS reference plane can be substituted with the following combinations: ANS-G-Ba, ANS-G-S, ANS-S-De, PNS-G-Ba, PNS-S-Ba, PNS-ANS-G, and PNS-N-Ba.

https://ift.tt/2pBszXY

Newborn hearing screening protocols and their outcomes: A systematic review

Publication date: Available online 25 September 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Amisha Kanji, Katijah Khoza-Shangase, Nomfundo Moroe

Abstract

Objective

To conduct a review of the most current research in objective measures used within newborn hearing screening protocols with the aim of exploring the actual protocols in terms of the types of measures used and their frequency of use within a protocol, as well as their outcomes in terms of sensitivity, specificity, false positives, and false negatives in different countries worldwide.

Methods

A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Electronic databases such as PubMed, Google Scholar and Science Direct were used for the literature search. A total of 422 articles were identified, of which only 15 formed part of the current study. The 15 articles that met the study's criteria were reviewed. Pertinent data and findings from the review were tabulated and qualitatively analysed under the following headings: country; objective screening and/or diagnostic measures; details of screening protocol; results (including false positive and negative findings, sensitivity and/or specificity), conclusion and/or recommendations. These tabulated findings were then discussed with conclusions and recommendations offered.

Results

Findings reported in this paper are based on a qualitative rather than a quantitative analysis of the reviewed data. Generally, findings in this review revealed firstly, that there is a lack of uniformity in protocols adopted within newborn hearing screening. Secondly, many of the screening protocols reviewed consist of two or more tiers or stages, with transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) being most commonly used. Thirdly, DPOAEs appear to be less commonly used when compared to TEOAEs. Lastly, a question around routine inclusion of AABR as part of the NHS protocol remains inconclusively answered.

Conclusions

There is sufficient evidence to suggest that the inclusion of AABR within a NHS programme is effective in achieving better hearing screening outcomes. The use of AABR in combination with OAEs within a test-battery approach or cross-check principle to screening is appropriate, but the inclusion of AABR to facilitate appropriate referral for diagnostic assessment needs to be systematically studied.

https://ift.tt/2NF8QVq

Onkologie und Versorgung in Fach- und Publikumsmedien

https://ift.tt/2Q5wnM1

Follow-up in children with non-obese and non-autoimmune subclinical hypothyroidism

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


https://ift.tt/2pAQNl9

Cosmetics, Vol. 5, Pages 56: Hair Strengthening Evaluation of Anisotropic Osmolite Solutions (Inositol + Arginine): Cross-Talk between Dermal Papilla Fibroblast and Keratinocytes of the Outer Root Sheath Using a µHair Follicle 3D Model

Cosmetics, Vol. 5, Pages 56: Hair Strengthening Evaluation of Anisotropic Osmolite Solutions (Inositol + Arginine): Cross-Talk between Dermal Papilla Fibroblast and Keratinocytes of the Outer Root Sheath Using a µHair Follicle 3D Model

Cosmetics doi: 10.3390/cosmetics5040056

Authors: Gianni Baratto Elisa Caviola Marisa Meloni Nicola Lionetti Adriana Bonfigli Maurizio Sironi Stefano Pieraccini Marc Oliver Luisa Coderch Luigi Rigano

The hair follicle (HF) is a dynamic &ldquo;mini-organ&rdquo; which undergoes bi-continuous cycles of growth, destruction and rest. The molecular mechanisms underlying the HF cycle are complex yet not fully understood. Anyhow, it is clear that the epithelial&ndash;mesenchymal interactions, and in particular the cross-talk between dermal papilla fibroblast (DPF) and the keratinocytes of the outer root sheath (ORSK) play a pivotal role. Aim of this study is the evaluation of the biological activity of anisotropic osmolyte solutions on the HF cycle. As reported in recent studies, dermal papilla cells deeply modify their gene expression profile when cultured as monolayers, but their transcriptional pattern can be partially restored when they are cultured as 3-dimensional spheroids. This draws our attention to the discovery that the spatial distribution of cells in the growth medium is fundamental in order to produce a verisimilar model. Therefore, we used the hanging drop technology to produce a scaffold-free micro-tissue model applied to a DPF-ORSK co-culture in order to create a &micro;HF 3-dimensional model. As a result, this system was capable of evaluating the efficacy of the anisotropic osmolyte solutions on the progressive increase of the follicle turnover and &lsquo;health&rsquo;. Moreover, an in silico model was used in order to screen the most promising combination of osmolyte molecules. In vivo objective evaluations were finally carried out on volunteers having hair disorders.

https://ift.tt/2Q6cMLF

Landmark-based midsagittal plane analysis in patients with facial symmetry and asymmetry based on CBCT analysis tomography

Abstract

Purpose

Reconstruction of the facial midplane is relevant in anthropometry, orthodontics, maxillofacial surgery, and the accurate measurement of symmetry deviation is relevant in many fields of medicine especially when planning surgical treatment. In the literature, three different means of midplane generation have been published; however, there is currently no consensus regarding the approach to use. Morphometric methods are used to determine the true midsagittal plane (MSP), but its use in clinical practice is difficult. A regression plane based on N‑ANS-PNS landmarks reportedly approximates the morphometric MSP. As these points are vulnerable, we investigated which combination of landmarks can be substituted in symmetric and asymmetric faces.

Patients and methods

Thirty symmetric and 30 asymmetric faces were analyzed on cone-beam computed tomography scans. A total of 50 regression planes were generated based on three unpaired landmarks and 35 regression planes were generated based the midpoints of paired landmarks. The Na-ANS-PNS plane was used as reference plane, and the mean angle between it and each generated MSP was calculated. The differences from the reference plane were compared by t‑test between the groups.

Results

In the symmetric group, 86% of angles deviated by <5° using unpaired points, whereby 74% of angles deviated by <5° for paired points. Between the two groups 50% of planes from midline points, and 77% of planes from paired points were significantly different. All planes deviated more in the asymmetric group.

Conclusions

The N‑ANS-PNS reference plane can be substituted with the following combinations: ANS-G-Ba, ANS-G-S, ANS-S-De, PNS-G-Ba, PNS-S-Ba, PNS-ANS-G, and PNS-N-Ba.

https://ift.tt/2pBszXY

Detection of Tannerella forsythia bspA and prtH genotypes among periodontitis patients and healthy subjects – a case - control study

Publication date: Available online 24 September 2018

Source: Archives of Oral Biology

Author(s): Krishnan Mahalakshmi, Padma Krishnan, S.C. Chandrasekaran

Abstract

Background

T. forsythia a gram negative, anaerobe inhabits the mature biofilm present at sites expressing progressive periodontitis. It is a part of "red complex" group which contributes to the pathogenesis of periodontitis. The BspA protein and prtH gene encoded cysteine protease play a vital role in the virulence of T. forsythia. The present study aims to detect the two genotypes (bspA and prtH) in periodontitis and healthy subjects.

Materials & Method

Subgingival plaque samples were collected from periodontitis patients and healthy subjects (Chronic Periodontitis n = 128, Aggressive Periodontitis n = 72, healthy subjects n = 200). The samples were screened for the presence of T. forsythia 16S rRNA, bspA and prtH genotypes by Polymerase Chain Reaction. The prevalence of the genotypes between periodontitis patients and healthy subjects was compared with Pearson's Chi-square test. A P value of < 0.05 was considered to be statistically significant.

Results

The prevalence for T. forsythia in Chronic Periodontitis (n = 128), Aggressive Periodontitis (n = 72) and health (n = 200) was 73.4%, 59.7% and 10.5% respectively. The prevalence of T.forsythia bspA/prtH genotypes was 81.90%/43.60%, 88.40%/53.50% and 33.30%/14.3% in Chronic Periodontitis, aggressive Periodontitis and health respectively. Compared to healthy subjects, the odds of detecting T.forsythia 16S rRNA was 18.53 times high in individuals with periodontitis (P = 0.0001).

Conclusion

The high odds ratio of T.forsythia 16S rRNA among periodontitis strongly suggests its role in periodontitis. In addition, the high prevalence of T. forsythia bspA genotype among Chronic Periodontitis signifies it as a useful marker for chronic periodontitis.

https://ift.tt/2xDZway

In This Issue

https://ift.tt/2xBIWb5

Differences in cytoarchitecture of Broca’s region between human, ape and macaque brains

Publication date: Available online 24 September 2018

Source: Cortex

Author(s): Nicola Palomero-Gallagher, Karl Zilles

Abstract

Areas 44 and 45 have been identified in non-human primates as homologs of the human Broca region. Distribution of large and smaller pyramids and the ventro-lateral localization in the posterior frontal lobe enable their identification in non-human primates. Since only humans hold the ability of language, it has been hypothesized that differences in microstructure may, together with other anatomical factors, e.g. white matter tract connectivity, volumes of cortical areas and their molecular differentiation, be responsible for the lack (non-human primates) or ability (humans) of language. We sought to identify microstructural differences, by quantitatively studying the cytoarchitecture of areas 44 and 45 using layer-specific grey level indices (volume proportion of neuropil and cell bodies) in serially sectioned and cell body stained human, bonobo, chimpanzee, gorilla, orangutan and Macaca fascicularis brains. The main results are the interspecies differences in neuropil volume relative to cell bodies in all layers of both areas which allows a grouping of the different species into three major groups: Homo sapiens has the largest, great apes a markedly lower, and macaque the lowest neuropil volume. This indicates considerably more space for local and interregional connectivity in human brains, which matches recent studies of fiber tracts and spacing of cortical minicolumns because increasing connectivity also requires more space for axons and dendrites in the neuropil. The evolutionary enlargement of neuropil is, therefore, a major structural difference between humans and non-human primates which may correspond to the underlying functional differences.

https://ift.tt/2pxWDDE

The anaphylatoxin C3a primes model colonic epithelial cells for expression of inflammatory mediators through Gαi

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Justin D. McCarthy, Qi Cao, Nathaniel Winsor, Johan Van Limbergen, Andrew W. Stadnyk

Abstract

Multiple studies have identified that complement becomes activated during inflammation of the intestines yet it is unclear what roles the split complement molecules play. The epithelium, in particular, may be impacted and accordingly, we first discovered that colonic cell lines indeed possess the C5aR. Here we examined whether these cells also possess the C3aR. We determined that T84, HT-29 and Caco2 all possess C3aR mRNA and protein; T84 and HT29 were used to further explore the consequence of C3a binding the C3aR. C3a led to increased mRNA for CXCL2, CXCL8 and CXCL11. Polarized T84 monolayers responded to apically applied C3a with increased CXCL8 mRNA more rapidly than if the C3a was applied basolaterally. Polarized monolayers also increased permeability when treated with C3a. ERK1/2 was activated by C3a and the increase in CXCL8 mRNA was ERK-dependent in both T84 and HT-29. C3a resulted in activation of Gαi, determined by the ERK1/2 signal showing sensitivity to pertussis toxin. The transmembrane signal was further mapped to include Ras and c-Raf. Finally, we show that the C3aR is expressed by primary cells in mouse enteroids. We conclude that complement activation will contribute to the epithelial response during inflammation through C3a binding to the C3aR including by priming the cells to upregulate mRNA for selected chemokines.

https://ift.tt/2Q5qCxV

A Systematic Review of Evidence-Based Treatments for Prurigo Nodularis

Publication date: Available online 25 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Azam A. Qureshi, Laura E. Abate, Gil Yosipovitch, Adam J. Friedman

Abstract

Prurigo nodularis is a chronic dermatologic condition involving the development of multiple cutaneous nodules in the setting of intractable pruritus. Given emerging treatment options for this difficult-to-treat condition, a current review of therapeutics is needed. A systematic review was performed for clinical studies investigating prurigo nodularis treatment published from 1990 to present including at least 5 subjects. A total of 35 articles were assigned a level of evidence according to the Oxford Center for Evidence-based Medicine. All five studies investigating topical agents, including corticosteroids, calcineurin inhibitors, calcipotriol, and capsaicin, conveyed some beneficial effect with level of evidence 2b or higher. Six of eight reports investigating photo- and photochemotherapy achieved levels of evidence 2b or greater and showed good partial response rates. Thalidomide was studied by six reports providing evidence of good symptom response, but only two of which were rated level 2b or greater. Cyclosporine and methotrexate have demonstrated benefit in four combined studies, albeit with level four evidence. Pregabalin, amitriptyline, paroxetine, fluvoxamine, and neurokinin-1 receptor antagonists have demonstrated promising evidence in five level 2b studies. Higher-powered studies and additional randomized controlled trials are needed for evaluation of safe and efficacious systemic treatment options for prurigo nodularis.

https://ift.tt/2NAckZo

Analytic and clinical validity of thyroid nodule mutational profiling using droplet digital polymerase chain reaction

Recent guidelines for the management of thyroid nodules incorporate mutation testing as an adjunct for surgical decision-making, however current tests are costly with limited accuracy. Droplet digital PCR (ddP...

https://ift.tt/2pAALHJ

Systematic review and meta-analysis of risk-reductive dental strategies for medication related osteonecrosis of the jaw among cancer patients: Approaches and strategies

Publication date: Available online 24 September 2018

Source: Oral Oncology

Author(s): Rama Jayaraj, Chellan Kumarasamy, Suja Ramalingam, Arikketh Devi

https://ift.tt/2OKfy97

Using Advances in Skin Imaging Technology and Genomics for the Early Detection and Prevention of Melanoma

Dermatology

https://ift.tt/2xxufWL

Prediction of tongue obstruction observed from drug induced sleep computed tomography by cephalometric parameters

Publication date: Available online 24 September 2018

Source: Auris Nasus Larynx

Author(s): Rashu Mittal, Li-Ang Lee, Cheng Hui Lin, Li-Jen Hsin, Navdeep Bhusri, Hsueh-Yu Li

Abstract

Objective

To elucidate potential role of cephalometric measurements to predict tongue base obstruction as observed on drug Induced Sleep Computed Tomography (DIS-CT).

Methods

Study included 35 patients with moderate to severe sleep apnea who underwent DIS-CT & cephalometric examination to assess tongue base obstruction.

Results

Statistically significant difference was noted for SNA angle & Mandibular posterior airway space (PAS) among groups with total tongue obstruction versus Non-total tongue obstruction identified on DIS-CT.

Conclusion

Lateral cephalogram can be used as a standard screening tool with commonly used skeletal and soft tissue parameters to predict the possibility of tongue collapse/obstruction during sleep in patient with moderate to severe OSAS.

https://ift.tt/2OPAsnt

Efficacy and safety assessment of expiratory positive airway pressure (EPAP) mask for OSAHS therapy

Publication date: Available online 24 September 2018

Source: Auris Nasus Larynx

Author(s): Yaxuan Liu, Yangyang Ying, Jaffar S. Pandu, Yan Wang, Shuang Dou, Yanzhong Li, Dedong Ma

Abstract

Objective

We have designed the expiratory positive airway pressure (EPAP) mask to provide a new sort of therapeutic strategies for Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). And this study aims to assess the safety, efficacy and compliance of the EPAP therapy.

Methods

40 healthy volunteers were enrolled to measure the end-tidal carbon dioxide pressure (PETCO₂) while being treated by EPAP mask. 40 symptomatic moderate or severe OSAHS patients (AHI ≥ 15/h) recruited were equally divided into two groups randomly and treated with CPAP or mask for a week respectively. After a week of washing out, the patients were applied with exchanged therapeutic methods for another week. The PSG was performed at the end of each week of treatment with device-on.

Results

There were no significant differences of PETCO₂ under different exhaled positive pressure level between CPAP, EPAP therapies and non-therapy for the healthy volunteers (P > 0.05). After being treated, among the OSAHS patients in the two groups, the ESS scores and AHI decreased, and minimum SaO₂ and mean SaO₂ increased significantly (all P > 0.05). There was no significant differences of the efficacy between EPAP and CPAP therapy.

Conclusions

EPAP mask therapy was safe and reliable with significant efficacy for selected OSAHS patients. However, the compliance needs further improvement.

https://ift.tt/2zsxRL6

Exercise-Induced Anaphylaxis Associated With the Use of Bee Pollen

Publication date: Available online 25 September 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Kara B. McNamara, Lily Pien

https://ift.tt/2IdbDPJ

Morphea/lokalisierte Sklerodermie und extragenitaler Lichen sclerosus

Zusammenfassung

Die lokalisierte Sklerodermie (LoS) ist eine sehr heterogene Bindegewebserkrankung, die durch eine progrediente Sklerosierung der Haut mit möglicher Beteiligung extrakutaner Strukturen gekennzeichnet ist. Sowohl Kinder als auch Erwachsene können betroffen sein, zeigen aber unterschiedliche Häufigkeiten in den einzelnen Subtypen der Erkrankung. Die Erkrankung kann sich klinisch an der Haut je nach Subtyp sehr unterschiedlich darstellen. Aus diesem Grund wurden bereits eine Reihe von Klassifikationen entwickelt und in der Literatur beschrieben. Im Wesentlichen werden 5 Subgruppen differenziert, die durch horizontale bzw. vertikale Ausdehnung der Gewebsschädigung definiert sind und die je nach Ausprägung der kutanen und der subkutanen Beteiligung die Lebensqualität der betroffenen Patienten massiv einschränken können. Eine kausale Therapie existiert bisher nicht, trotzdem sollten die zur Verfügung stehenden Medikamenten bei progressiven Subtypen früh eingesetzt werden, um schwerwiegende funktionelle und kosmetische Beeinträchtigungen zu verringern bzw. zu vermeiden. Lichen sclerosus (LS) tritt genital und extragenital, ebenfalls sowohl bei Kindern als auch bei Erwachsenen, auf. Die extragenitale Form, auf die der vorliegende Beitrag fokussiert, kommt häufiger bei Erwachsenen vor. Auch hier ist die Genese der Erkrankung noch nicht aufgedeckt, und kausale Therapieformen stehen ebenfalls noch nicht zur Verfügung. Die Therapie orientiert sich an LoS.

https://ift.tt/2xNEPbw

Preoperative Serum Thyroglobulin Level as a Useful Predictive Marker to Differentiate Thyroid Cancer

Introduction: Thyroid cancer is the most common endocrine system cancer. Although fine-needle aspiration biopsy is the most commonly used method for diagnosis, it is not always sufficient. The aim of this study was to investigate the influence of preoperative serum thyroglobulin (Tg) concentration on differentiated thyroid cancer risk. Material and Methods: A total of 133 patients who underwent total thyroidectomy due to various indications at the Ear-Nose-Throat Department, Ataturk University Medical School, between April 2015 and December 2015, were included in this prospective study. Histopathological diagnosis and preoperative Tg levels were compared. Receiver operating characteristic (ROC) analysis was used for detection of the cut-off to discriminate malignant from benign thyroid masses using preoperative Tg as a variable. Results: Malignant pathology (differentiated thyroid carcinoma) was detected in 59 out of 133 patients (44.4%) and benign pathology in 74 (55.6%). A statistically significant difference in preoperative Tg value was detected between malignant and benign cases (p #x3c; 0.05). Conclusion: The prevalence of differentiated thyroid carcinoma was higher among patients with a preoperative serum Tg value #x3e; 188.5 ng/mL, and this may thus be used as a marker for the diagnosis of this malignancy.
ORL

https://ift.tt/2DrB7dp

Thrombin lag time is increased in children with mild asthma

Publication date: Available online 24 September 2018

Source: Allergologia et Immunopathologia

Author(s): B.T. Koksal, I. Eker, N.Y. Ozbek, I. Dogan, O. Y. Ozbek

Abstract

Background

Inflammation and coagulation are closely linked events. Thrombin is the key enzyme in coagulation system and also has roles in inflammation.

Objective

The aim of our study was to evaluate thrombin generation in children with mild asthma.

Methods

Forty-two children with mild asthma and 49 healthy children were included in the study. All patients performed spirometry. Thrombin generation tests (TGT) were performed with a calibrated automated thrombogram (CAT) in children without asthma exacerbation during the last six months. During CAT assay thrombogram curves were obtained. The area under the curve showed endogenous thrombin potentials and indicated the total amount of endogenous thrombin generated; the peak height showed the highest thrombin value, thrombin lag time and time to thrombin peak were measured.

Results

Thrombin lag time was significantly longer in children with asthma (3.98 ± 1.2 min) compared to those in the control group (3.29 ± 0.6 min) (p < 0.01). Children with asthma also had longer thrombin tail time compared to the control group (19.5 ± 8.9 min vs. 16.7 ± 2.9 min, p = 0.02). Thrombin peak was inversely correlated with FEF 25–75 (r = −0.41, p < 0.01). Thrombin lag time was inversely correlated with FEF 25–75 (r = −0.39, p < 0.01).

Conclusion

Inflammation in mild asthma seems to disturb coagulation but this disturbance may not be so strong as to increase thrombin levels and may only affect the initiation phase of thrombin generation.

https://ift.tt/2NzTBgy

Th17 cells in Bulgarian children with chronic obstructive lung diseases

Publication date: Available online 24 September 2018

Source: Allergologia et Immunopathologia

Author(s): T. Velikova, S. Lazova, P. Perenovska, K. Tumangelova-Yuzeir, D. Miteva, P. Velikov, E. Ivanova-Todorova, D. Kyurkchiev, G. Petrova

Abstract

Introduction and objectives

Th17 lymphocytes are now widely believed to be critical in various chronic pulmonary diseases. However, there is still a small number of investigations regarding children. We aimed to assess the percentage of Th17 lymphocytes and IL-17A in peripheral blood of children with chronic obstructive lung diseases.

Patients and methods

We included a total of 42 children: 20 with bronchial asthma (BA), 12 with cystic fibrosis (CF) and 10 healthy children without a history of allergies, aged 4–17 years. Th17 cells (CD3+CD4+CD161+CCR6+) were determined in peripheral blood by flow cytometry. The concentration of serum IL-17A was measured by ELISA.

Results

The BA patients had a significantly higher percentage of Th17 (12.40 ± 1.16%) compared to the CF children (7.64 ± 0.87%, p = 0.0035) and healthy (7.25 ± 0.45%, p = 0.008). Stratifying the BA group, we found higher levels of Th17 in patients with severe BA (p = 0.03), whereas patients with moderate BA had Th17 cells close to those in CF and healthy children. We found that patients with better control of BA had Th17 closer to those with CF (p = 0.98) than BA children with poor control (p < 0.001) (post hoc, Bonferroni correction). CF patients with concomitant P. aeruginosa infection showed slightly higher percentages of Th17 cells than those without infection (8.08 ± 3.09% vs. 6.25 ± 2.42%, p = 0.294).

Conclusions

The percentage of Th17 cells was significantly increased in the peripheral blood of children with severe BA compared to the children with moderate BA, which suggests that the former could possibly benefit from future target therapies.

https://ift.tt/2Ds2NPB

Study of Voice Disorders Among School Teachers in Goa

Abstract

Teachers are heavy voice users, and they suffer from voice problems more frequently than other occupational voice users. Various studies have demonstrated that teachers speak longer than other professionals and that school teachers in particular, are at risk for voice problems such as vocal fatigue and vocal nodules. The present study is undertaken to study the prevalence of voice disorders in the teachers in different schools at any time and accesses the relationship of different working conditions like class room size, background noise, number of hours taught every day and role of chalk allergy in development of these voice disorders. The study was carried out on 133 school teachers with self reporting of voice problems through detailed questionnaire. A significant number of teachers, more so females had voice problems attributed to various factors. Voice amplification and reduction of background noise along with measures to control allergy are suggested.

https://ift.tt/2N1D13Z

Effect of vitamin D supplementation along with weight loss diet on meta‐inflammation and fat mass in obese subjects with vitamin D deficiency: a double‐blind placebo‐controlled randomized clinical trial

Clinical Endocrinology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xBIB8u

Correction to: Glucose in Conjunction with Multiple Laser Pulses on Laser Treatment of Port-wine Stain: An in vivo Study

In the originally published article, the title was incorrectly copied from another article. The correct title is "Glucose in Conjunction with Multiple Laser Pulses on Laser Treatment of Port-wine Stain: An in vivo Study", which is also shown above.

https://ift.tt/2xBIf1E

Nasal Reconstruction Using a Customized Three‐Dimensional–Printed Stent for Congenital Arhinia: Three‐Year Follow‐up

The Laryngoscope, EarlyView.


https://ift.tt/2IbUR3w

Trends in Postinterview Communication Practices

The Laryngoscope, EarlyView.


https://ift.tt/2pxpmbI

The Role of Maxillofacial Prosthetics for the Surgically Treated Patient at National Cancer Institute–Designated Comprehensive Cancer Centers

The Laryngoscope, EarlyView.


https://ift.tt/2IcCkEr

Prediction of Postoperative Vocal Fold Function After Intraoperative Recovery of Loss of Signal

The Laryngoscope, EarlyView.


https://ift.tt/2pxZ3SL

An Evaluation of the Program‐Specific Paragraph in the Otolaryngology Residency Application

The Laryngoscope, EarlyView.


https://ift.tt/2IbSwpm

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

The Laryngoscope, EarlyView.


https://ift.tt/2pvHsuO

Saliva Pepsin Detection and Proton Pump Inhibitor Response in Suspected Laryngopharyngeal Reflux

The Laryngoscope, EarlyView.


https://ift.tt/2Ihjk7O

Higher Complication Rates in Self‐Inflicted Gunshot Wounds After Microvascular Free Tissue Transfer

The Laryngoscope, EarlyView.


https://ift.tt/2pzW1xy

Gene Expression Subtype Predicts Nodal Metastasis and Survival in Human Papillomavirus–Negative Head and Neck Cancer

The Laryngoscope, EarlyView.


https://ift.tt/2IcoDFh

Upper‐Airway Stimulation Before, After, or Without Uvulopalatopharyngoplasty: A Two‐Year Perspective

The Laryngoscope, EarlyView.


https://ift.tt/2pyjnDB

Successful treatment of dermatomyositis with low‐dose naltrexone

Dermatologic Therapy, EarlyView.


https://ift.tt/2PXQf3C

Anti‐desmoglein‐1 levels as predictor of prednisolone tapering in pemphigus vulgaris patients treated with rituximab

Dermatologic Therapy, EarlyView.


https://ift.tt/2O6NNuy

Circumcision is still the gold standard in management of plasma cell balanitis

Dermatologic Therapy, EarlyView.


https://ift.tt/2Q2r7c5

Is skin microneedling a good alternative method of various skin defects removal

Dermatologic Therapy, EarlyView.


https://ift.tt/2Oaxugc

The therapeutic effect of tanshinone IIA on Propionibacterium acnes‐induced inflammation in vitro

Dermatologic Therapy, EarlyView.


https://ift.tt/2Q2l4V2

A case series of dupilumab‐treated allergic contact dermatitis patients

Dermatologic Therapy, EarlyView.


https://ift.tt/2ObsKH2

Short‐ and long‐term effects of two emollients on itching and skin restoration in xerotic eczema

Dermatologic Therapy, EarlyView.


https://ift.tt/2Q2vYKo

Study of Voice Disorders Among School Teachers in Goa

Abstract

Teachers are heavy voice users, and they suffer from voice problems more frequently than other occupational voice users. Various studies have demonstrated that teachers speak longer than other professionals and that school teachers in particular, are at risk for voice problems such as vocal fatigue and vocal nodules. The present study is undertaken to study the prevalence of voice disorders in the teachers in different schools at any time and accesses the relationship of different working conditions like class room size, background noise, number of hours taught every day and role of chalk allergy in development of these voice disorders. The study was carried out on 133 school teachers with self reporting of voice problems through detailed questionnaire. A significant number of teachers, more so females had voice problems attributed to various factors. Voice amplification and reduction of background noise along with measures to control allergy are suggested.

https://ift.tt/2N1D13Z

Successful treatment of dermatomyositis with low‐dose naltrexone

Dermatologic Therapy, EarlyView.


https://ift.tt/2PXQf3C

Anti‐desmoglein‐1 levels as predictor of prednisolone tapering in pemphigus vulgaris patients treated with rituximab

Dermatologic Therapy, EarlyView.


https://ift.tt/2O6NNuy

Circumcision is still the gold standard in management of plasma cell balanitis

Dermatologic Therapy, EarlyView.


https://ift.tt/2Q2r7c5

Is skin microneedling a good alternative method of various skin defects removal

Dermatologic Therapy, EarlyView.


https://ift.tt/2Oaxugc

The therapeutic effect of tanshinone IIA on Propionibacterium acnes‐induced inflammation in vitro

Dermatologic Therapy, EarlyView.


https://ift.tt/2Q2l4V2

A case series of dupilumab‐treated allergic contact dermatitis patients

Dermatologic Therapy, EarlyView.


https://ift.tt/2ObsKH2

Short‐ and long‐term effects of two emollients on itching and skin restoration in xerotic eczema

Dermatologic Therapy, EarlyView.


https://ift.tt/2Q2vYKo

Dabrafenib plus trametinib in BRAF K601E‐mutant melanoma

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2zs2AYu

Does Helicobacter pylori infection increase the risk of Barrett's esophagus and esophageal adenocarcinoma?

Helicobacter, EarlyView.


https://ift.tt/2NFW1KP

A case of necrotizing infundibular crystalline folliculitis

International Journal of Dermatology, EarlyView.


https://ift.tt/2OQSyW6

Serum carcinoembryonic antigen as a clinical marker in hypohidrosis

International Journal of Dermatology, EarlyView.


https://ift.tt/2zrZUKt

Infectious skin disorders encountered in a pediatric emergency department of a tertiary care hospital in Argentina: a descriptive study

International Journal of Dermatology, EarlyView.


https://ift.tt/2OOb2GN

Dabrafenib plus trametinib in BRAF K601E‐mutant melanoma

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2zs2AYu

Does Helicobacter pylori infection increase the risk of Barrett's esophagus and esophageal adenocarcinoma?

Helicobacter, EarlyView.


https://ift.tt/2NFW1KP

A Case of Nail Psoriasis Successfully Treated with Intralesional Methotrexate

Abstract

Psoriasis is a chronic inflammatory disease affecting the skin, nails, and joints. About 61% of psoriatic patients have nail involvement that can cause a significant social problem. Treating nail psoriasis is challenging but can improve the health outcomes and quality of life of patients. Treatment options available for nail psoriasis including topical therapy, intralesional injections, and systemic and biologic agents have various side effects and some benefits. Management is currently inconclusive. Intralesional injection of methotrexate in nail psoriasis was previously documented in few cases. We present a case of nail psoriasis successfully treated with low-dose intralesional methotrexate with no significant side effects in a 48-year-old psoriatic patient. Given the various side effects of conventional topical and systemic therapies limiting their use, we conclude that intralesional methotrexate injection seems to be a safe and effective treatment option for nail psoriasis. However, large controlled studies are needed.

https://ift.tt/2xNTdAB

Multinucleate Cell Angiohistiocytoma: Case Report and Literature Review

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Oea21w

Post‐Radiation Vascular Lesions of the Breast

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2Q8a9JF

Co‐existence of Langerhans cell histiocytosis and reticulohistiocytosis with initial presentation of skull lesions: A case report

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.


https://ift.tt/2xNTnbb

One‐year follow‐up results of hair removal using an 810 nm diode laser

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2zsitOV

Cosmeceutical potential of geranium and calendula essential oil: Determination of antioxidant activity and in vitro sun protection factor

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2OPdaOz

One‐year follow‐up results of hair removal using an 810 nm diode laser

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2zsitOV

Cosmeceutical potential of geranium and calendula essential oil: Determination of antioxidant activity and in vitro sun protection factor

Journal of Cosmetic Dermatology, EarlyView.


https://ift.tt/2OPdaOz

Increased risk of severe course of pemphigus in patients with pemphigus‐associated alopecia: a prospective observational study

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Q5AF6q

Silver nanoparticles induce Egr‐1‐dependent psoriasin expression via the ERK and p38 pathways

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2ObgGWg

Increased risk of severe course of pemphigus in patients with pemphigus‐associated alopecia: a prospective observational study

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2Q5AF6q

Silver nanoparticles induce Egr‐1‐dependent psoriasin expression via the ERK and p38 pathways

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2ObgGWg