Progression of ductal carcinoma in situ to invasive breast cancer: comparative genomic sequencing

Abstract

Several models have been described as potential mechanisms for the progression of ductal carcinoma in situ (DCIS) to invasive breast cancer (IBC). The aim of our study was to increase our understanding of DCIS progression by using massive parallel sequencing of synchronous DCIS and IBC. We included patients with synchronous DCIS and IBC (n = 4). Initially, IBC and normal tissue were subjected to whole exome sequencing. Subsequently, targeted sequencing was performed to validate those tumor-specific variants identified by whole exome sequencing. Finally, we analyzed whether those specific variants of the invasive component were also present in the DCIS component. There was a high genomic concordance between synchronous DCIS and IBC (52 out of 92 mutations were present in both components). However, the remaining mutations (40 out of 92) were restricted to the invasive component. The proportion of tumor cells with these mutations was higher in the invasive component compared to the DCIS component in a subset of patients. Our findings support the theory that the progression from DCIS to IBC could be driven by the selection of subclones with specific genetic aberrations. This knowledge improves our understanding of DCIS progression, which may lead to the identification of potential markers of progression and novel therapeutic targets in order to develop a more personalized treatment of patients with DCIS.

https://ift.tt/2QoC4oy

The role of pre-operative α-blockade in patients with normotensive phaeochromocytoma or paraganglioma: A retrospective cohort study

No abstract available

https://ift.tt/2Oz1GSl

Comparison of a novel clinical score to estimate the risk of REsidual neuromuscular block Prediction Score and the last train-of-four count documented in the electronic anaesthesia record: A retrospective cohort study of electronic data on file

BACKGROUND Residual neuromuscular block (rNMB) after surgery is not difficult to identify if proper neuromuscular monitoring is used, but many clinicians do not use quantitative neuromuscular monitoring. OBJECTIVE The aim of this study was to develop a REsidual neuromuscular block Prediction Score (REPS) to predict postoperative rNMB and compare the predictive accuracy of the prediction score with train-of-four count (TOFC) measurement at the end of a surgical case. DESIGN Retrospective cohort study of data on file. DATA SOURCE Electronic patient data and peri-operative data on vital signs, administered medications, and train-of-four ratio (TOFR) obtained in the postoperative recovery rooms [postanaesthesia care unit (PACU)] at Massachusetts General Hospital in Boston, Massachusetts, USA. PATIENTS Quantitative TOFR measurements obtained on admission to the PACU were available from 2144 adult noncardiac surgical patients. MAIN OUTCOME MEASURE Presence of rNMB at PACU admission, defined as a TOFR of less than 0.9. RESULTS In the score development cohort (n=2144), rNMB occurred in 432 cases (20.2%). Ten independent predictors for residual paralysis were identified and used for the score development. The final model included: hepatic failure, neurological disease, high-neostigmine dose, metastatic tumour, female sex, short time between neuromuscular blocking agent administration and extubation, aminosteroidal neuromuscular blocking agent, BMI more than 35, absence of nurse anaesthetist and having an experienced surgeon. The model discrimination by C statistics was 0.63, 95% confidence interval (0.60 to 0.66), and risk categories derived from the REPS had a higher accuracy than the last documented intra-operative TOFC for predicting rNMB (net reclassification improvement score 0.26, standard error 0.03, P 

https://ift.tt/2IBhwGR

Association of pre-operative troponin levels with major adverse cardiac events and mortality after noncardiac surgery: A systematic review and meta-analysis

BACKGROUND Circulating cardiac troponin levels are powerful predictors of prognosis in many clinical settings, but their association with outcomes after noncardiac surgery is unclear. OBJECTIVES The aim of this systematic review was to summarise current evidence on the association of pre-operative troponin elevation with postoperative major adverse cardiac events (MACE) and mortality in patients undergoing noncardiac surgery. DESIGN Systematic review of observational studies with meta-analysis. DATA SOURCES PubMed, EMBASE and Science Citation Index Expanded (ISI Web of Science) from their inception to 1 October 2017. ELIGIBILITY CRITERIA Observational studies reporting the associations between pre-operative troponin levels and MACE and all-cause mortality after noncardiac surgeries were included. RESULTS Ten studies met the eligibility criteria. The entire body of evidence addressing the research question was based on a total of 10 371 patients: 4.7 to 68.3% (median 23.8%) of patients had elevated troponin levels before surgery. Elevated pre-operative troponin was significantly associated with short-term MACE (seven studies, 5180 patients: odds ratio (OR) 6.92, 95% confidence interval (CI) 3.85 to 12.42), short-term mortality (five studies, 6103 patients: OR 4.23, 95% CI 2.27 to 7.89) and long-term mortality (two studies, 760 patients: OR 2.51, 95% CI 1.47 to 4.29). The associations remained significant when only multivariate-adjusted results were analysed. Overall, the reviewers' certainty about the summary estimates of the associations was very low. CONCLUSION Current evidence suggests that pre-operative high troponin levels are significantly associated with adverse cardiac events and mortality after noncardiac surgery. TRIAL REGISTRATION This systematic review was registered in the International Prospective Register of Systematic Reviews (Centre for Reviews and Dissemination 42017077837).

https://ift.tt/2OyuxWX

Oral ulcer due to dabigatran capsule

Description 

An 80-year-old man with cerebral infarction and no neurological deficits was hospitalised for right empyema. Although the patient's condition improved with antimicrobial therapy and right thoracic drainage, a swelling in his right cheek was observed during clinical rounds. Oral examination revealed ulceration on the right buccal mucosa (figure 1A) with an embedded blue solid matter (figure 1B), which was removed. After confirming the history of prescribed medications, the removed matter was determined to be a dabigatran capsule (figure 1C), and oral ulcer due to dabigatran was suspected. With conservative measures, re-epithelialisation was achieved within 2 weeks.

Figure 1

(A) Oral ulcer on the right buccal mucosa, (B) the removed solid matter, (C) the dabigatran capsule.

Dabigatran is currently used as an alternative to warfarin for venous thromboembolism and non-valvular atrial fibrillation. Dabigatran is formulated with...

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Haemodilution and head-down tilting induce functional injury in the rat optic nerve: A model for peri-operative ischemic optic neuropathy

BACKGROUND Mechanisms of peri-operative ischaemic optic neuropathy remain poorly understood. Both specific pre-operative and intra-operative factors have been examined by retrospective studies, but no animal model currently exists. OBJECTIVES To develop a rodent model of peri-operative ischaemic optic neuropathy. In rats, we performed head-down tilt and/or haemodilution, theorising that the combination damages the optic nerve. DESIGN Animal study. SETTING Laboratory. ANIMALS A total of 36 rats, in four groups, completed the functional examination of retina and optic nerve after the interventions. INTERVENTIONS Anaesthetised groups (n>8) were supine (SUP) for 5 h, head-down tilted 70° for 5 h, head-down tilted/haemodiluted for 5 h or SUP/haemodiluted for 5 h. We measured blood pressure, heart rate, intra-ocular pressure and maintained constant temperature. MAIN OUTCOME MEASUREMENTS Retinal function (electroretinography), scotopic threshold response (STR) (for retinal ganglion cells) and visual evoked potentials (VEP) (for transmission through the optic nerve). We imaged the optic nerve in vivo and evaluated retinal histology, apoptotic cells and glial activation in the optic nerve. Retinal and optic nerve function were followed to 14 and 28 days after experiments. RESULTS At 28 days in head down tilted/haemodiluted rats, negative STR decreased (about 50% amplitude reduction, P = 0.006), VEP wave N2-P3 decreased (70% amplitude reduction, P = 0.01) and P2 latency increased (35%, P = 0.003), optic discs were swollen and glial activation was present in the optic nerve. SUP/haemodiluted rats had decreases in negative STR and increased VEP latency, but no glial activation. CONCLUSION An injury partly resembling human ischaemic optic neuropathy can be produced in rats by combining haemodilution and head-down tilt. Significant functional changes were also present with haemodilution alone. Future studies with this partial optic nerve injury may enable understanding of mechanisms of peri-operative ischaemic optic neuropathy and could help discover preventive or treatment strategies.

https://ift.tt/2OzA7Z3

Deep vs. moderate neuromuscular blockade during laparoscopic surgery: A systematic review and meta-analysis

BACKGROUND Previous studies have reported that deep neuromuscular block (posttetanic-count 1 to 2 twitches) improves surgical conditions during laparoscopy compared with moderate block (train-of-four count: 1 to 2 twitches). However, comparisons of surgical conditions were made using different scales and assessment intervals with variable results. OBJECTIVE To explore the heterogeneity of previous comparisons between deep and moderate neuromuscular block. DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched from inception to October 2017. ELIGIBILITY CRITERIA Our meta-analysis included RCTs comparing the effects of deep with moderate neuromuscular block on surgical field conditions during laparoscopic surgery. The frequency of excellent or good operating conditions on a surgical rating scale was compared. Heterogeneity was assessed by subgroup analyses. RESULTS Eleven RCTs involving 844 patients were included. On the surgical rating scale, the frequency of excellent or good operating conditions was higher with deep block compared with a moderate block (odds ratio 2.83, 95% confidence interval 1.34 to 5.99, P = 0.007, I2 = 59%). We analysed surgical rating according to the number of assessments made. There was a significant difference in surgical rating with multiple assessments, but no difference when the assessment was made on only one occasion. A significant difference in rating was noted with variable abdominal pressures; there was no significant difference with the same fixed abdominal pressure. Trial sequential analysis demonstrated that the cumulative z-curve crossed the O′Brien–Fleming significance boundary. However, required information size was not achieved. CONCLUSION Deep block was associated with excellent or good surgical rating more frequently than moderate block. However, this finding was not consistent on subgroup analyses based on frequencies of assessment of surgical conditions and abdominal pressure. Further studies are required to address the heterogeneity and power shortage demonstrated by the trial sequential analysis.

https://ift.tt/2IBhm2d

Intra-operative cutaneous temperature monitoring with zero-heat-flux technique (3M SpotOn) in comparison with oesophageal and arterial temperature: A prospective observational study

BACKGROUND Continuous monitoring of core temperature is essential during major surgery as a way of improving patient safety. Oesophageal probes or specific arterial catheters are invasive methods used in this setting. A new noninvasive device based on zero-heat-flux (ZHF) technique (SpotOn) seems promising but has been poorly investigated during rapid core temperature changes (RCTC). OBJECTIVE To assess the accuracy of a SpotOn sensor vs. an oesophageal probe or specific arterial catheter during a slow change in core temperature of less than 1 °C within 30 min and RCTC ≥ 1 °C within 30 min. DESIGN Prospective observational study. SETTING Operating rooms at the University Hospital of Poitiers, France. PATIENTS Fifty patients scheduled for major abdominal surgery under general anaesthesia were enrolled from June 2015 to March 2016. Data from 49 patients were finally analysed. Among these, 15 patients were treated with hyperthermic intraperitoneal chemotherapy. INTERVENTION Each patient had a ZHF sensor placed on the skin surface of the forehead (TempZHF) and an oesophageal probe (TempEso) used as a reference method. Twenty-two patients also had a thermodilution arterial catheter (TempArt) placed in the axillary artery. MAIN OUTCOME MEASURES Core temperature was continuously recorded from the three devices after induction of anaesthesia. Comparison of temperature measurements between methods was made using the Bland and Altman method during two separate periods according to the speed of core temperature changes. RESULTS Compared with TempEso, bias and limits of agreement for TempZHF were 0.1 ± 0.5 °C during slow core temperature changes periods and 0.6 ± 1.8 °C during RCTC periods (P = 0.0002). Compared with TempArt, these values were −0.1 ± 0.4 and 0.5 ± 1.7 °C, respectively (P = 0.0039). The ZHF sensor was well tolerated. CONCLUSION A SpotOn sensor using the ZHF method seems reliable for core temperature monitoring during abdominal surgery when variations in core temperature are slow rather than rapid. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02869828.

https://ift.tt/2Oxxfw0

Comparison of noninvasive and minimally invasive pulse contour analysis to measure stroke volume during major surgery: A prospective observational study

No abstract available

https://ift.tt/2IBhbnz

Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness: A systematic review and meta-analysis

BACKGROUND The accuracy of respiratory variation of the inferior vena cava (rvIVC) in predicting fluid responsiveness, particularly in spontaneously breathing patients is unclear. OBJECTIVES To consider the evidence to support the accuracy of rvIVC in identifying patients who are unlikely to benefit from fluid administration. DESIGN Systematic review and meta-analysis. DATA SOURCE We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILCAS and WHO Clinical Trial Registry from inception to June 2017. ELIGIBILITY CRITERIA Case–control or cohort studies that evaluated the accuracy of rvIVC in living adult humans were included. A study was included in the meta-analysis if data enabling construction of 2 × 2 tables were reported, calculated or could be obtained from authors and met the above cited criteria. RESULT A total of 23 studies including 1574 patients were included in qualitative analysis. The meta-analysis involved 20 studies and 761 patients. Pooled sensitivity and specificity of rvIVC in 330 spontaneously breathing patients were 0.80 [95% confidence interval (CI) 0.68 to 0.89] and 0.79 (95% CI 0.60 to 0.90). Pooled sensitivity and specificity of rvIVC in 431 mechanically ventilated patients were 0.79 (95% CI 0.67 to 0.86) and 0.70 (95% CI 0.63 to 0.76). CONCLUSION Decreased inferior vena caval respiratory variation is moderately accurate in predicting fluid unresponsiveness both in spontaneous and mechanically ventilated patients. The findings of this review should be used in the appropriate clinical context and in conjunction with other clinical assessments of fluid status. IDENTIFIER CRD 42017068028.

https://ift.tt/2OwOM7D

Device or target? A paradigm shift in airway management: Implications for guidelines, clinical practice and teaching

No abstract available

https://ift.tt/2IBpm3g

Bilateral parameatal cysts with associated hypospadias presenting in a newborn baby

Description 

A male infant presented to the neonatal team on day 1 of life with concerns over cysts on his penis. He had been born at term in good condition following an emergency caesarean section for face presentation and suboptimal cardiotocograph. There was no relevant antenatal history of note and no significant family history.

He had a normal examination other than his genitalia. He had a coronal hypospadias with two symmetrical cystic lesions measuring 2–3 mm each on the glans penis, just distal and lateral to the opening of the urethral meatus on the ventral surface (figure 1). There was no obvious discharge or surrounding erythema. By day 2, there was some mild superficial ulceration of the cyst surfaces. Both testes were palpable in his scrotum. He was discharged home after confirmation of a good urinary stream.

Figure 1

Male genitalia demonstrating two parameatal urethral...

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Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study

BACKGROUND Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions. OBJECTIVES The current study investigated if deep compared with no NMB improved the surgical view during laparoscopic ventral hernia repair. DESIGN Crossover study. SETTING The study was carried out at Herlev and Gentofte Hospital, University of Copenhagen, Denmark and conducted from May 2015 until February 2017. PARTICIPANTS A total of 34 patients were randomised in an investigator-initiated, assessor-blinded crossover design of deep vs. no NMB during laparoscopic ventral hernia repair. INCLUSION CRITERIA Adults scheduled for elective laparoscopic ventral hernia repair. EXCLUSION CRITERIA Known allergy to any study medication, known homozygous variants in the butyrylcholinesterase gene, severe renal disease, neuromuscular disease, lactating or pregnant women, any indication for rapid sequence induction. INTERVENTIONS Deep NMB was established with rocuronium and reversed with sugammadex. Anaesthesia was conducted with propofol and remifentanil. MAIN OUTCOME MEASURES The primary outcome was evaluation of surgical view assessed on a five-point rating scale. Other outcomes included the surgical conditions during laparoscopic suturing of the hernia defect. RESULTS We found no difference in ratings for the surgical view when comparing deep with no NMB: mean −0.1 (95% confidence interval −0.4 to 0.2) (P = 0.521, paired t test). However, deep compared with no NMB improved the rating score for surgical conditions while suturing the hernia defect (P = 0.012, Mann–Whitney U test). No differences were found in either total length of surgery (P = 0.76) or hernia suturing time (P = 0.81). CONCLUSION Deep compared with no NMB did not change the rating score of the surgical view immediately after introduction of trocars during laparoscopic ventral hernia repair, but the surgical condition were improved during suturing of the hernia. TRIAL REGISTRATION ClinicalTrials.gov, NCT02247466.

https://ift.tt/2IDAX1w

Sarcoidosis and HIV infection in a native Saudi man

Sarcoidosis is a rare condition among native Saudis. It typically presents with asymptomatic chest radiographs, exertional breathlessness and cough. The coexistence of sarcoidosis and HIV is also rare, and the overlap of the symptoms makes their differential diagnosis challenging. Nevertheless, the outcome of sarcoidosis is favourable with or without the presence of HIV. We present a case of a 55-year-old native Saudi man with extremely atypical sarcoidosis presentation coexisting with HIV. This case highlights the association between the two pathologies, and the difficulties encountered in establishing a proper diagnosis in the presence of two overlapping diseases.

https://ift.tt/2y69C4n

End-tidal carbon dioxide monitoring improves patient safety during propofol-based sedation for breast lumpectomy: A randomised controlled trial

BACKGROUND The use of sedation is becoming more commonplace. Although pulse oximetry is a standard monitoring procedure during sedation, it cannot accurately detect early hypoventilation. End-tidal carbon dioxide (EtCO2) monitoring can be an earlier indicator of airway compromise; however, the existing literature is limited to a few studies with varying outcomes. OBJECTIVES To evaluate whether EtCO2 monitoring decreases the incidences of CO2 retention and apnoeic events in propofol-based sedation. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Two hundred women (aged 18 to 65 years, ASA physical status 1 or 2) who were scheduled for breast lumpectomy between June 2017 and August 2017. INTERVENTIONS Patients were allocated randomly to receive either standard monitoring or standard monitoring and EtCO2 monitoring. MAIN OUTCOME MEASURES The primary outcome was the incidence of CO2 retention. The secondary outcomes were the number of actions taken to restore ventilation, variations in PaCO2 and pH, the frequency of apnoea and the recovery time. RESULTS CO2 retention occurred significantly less often in the EtCO2 monitoring group (10 vs. 87%; P 

https://ift.tt/2OF9XVa

Heart of the matter: reverse takotsubo syndrome in an anthracycline-exposed oncology patient

A 24-year-old man with acute myelogenous leukaemia and a history of anthracycline treatment is hospitalised for non-anthracycline chemotherapy. He develops new-onset heart failure requiring intesive care unit (ICU) admission during his stay. There is debate as to the aetiology of his heart failure, whether anthracycline cardiotoxicity or takotsubo syndrome. He is diuresed and discharged home with close follow-up. Ultimately, the retrospective use of two-dimensional speckle-tracking echocardiography derived strain helps diagnose reverse takotsubo syndrome.

https://ift.tt/2ycJa8a

Haemodynamic evaluation and optimisation of brain-dead donors with oesophageal Doppler during organ harvesting: A feasibility study

No abstract available

https://ift.tt/2IzQcIV

Cardiac arrest due to critical stenosis of a bicuspid aortic valve mimicking left main coronary artery occlusion on ECG

A 49-year-old man presented to the emergency room after a cardiac arrest. On arrival, the patient's ECG showed ST-segment elevations in the aVR and anteroseptal leads with diffuse ST depression suggestive of left main coronary artery occlusion. Subsequent coronary catheterisation showed normal coronaries but revealed severe stenosis of his bicuspid aortic valve. A surgical replacement of the aortic valve was performed, and the patient recovered successfully.

https://ift.tt/2xTpfMj

Dexamethasone concentration affecting rocuronium-induced neuromuscular blockade and sugammadex reversal in a rat phrenic nerve-hemidiaphragm model: An ex vivo study

BACKGROUND The concentration range of dexamethasone that inhibits neuromuscular blockade (NMB) and sugammadex reversal remains unclear. OBJECTIVE To evaluate the effects of dexamethasone on rocuronium-induced NMB and sugammadex reversal. DESIGN Ex vivo study. SETTING Asan Institute for Life Sciences, Asan Medical Center, Korea, from July 2015 to November 2015. ANIMALS One hundred sixty male Sprague–Dawley rats. INTERVENTIONS We assessed the effect of four concentrations of dexamethasone [0, 0.5, 5 (clinical concentrations) and 50 μg ml−1 (experimental concentration)] on partial NMB on 40 phrenic nerve–hemidiaphragm preparations (n=10 per concentration). Once the first twitch of train-of-four (TOF) had been depressed by 50% with rocuronium, dexamethasone was administered. To assess the effect of dexamethasone on sugammadex reversal, 120 phrenic nerve–hemidiaphragm preparations were used in three subexperiments (n=40 per experiment), using three administration regimens of rocuronium–equimolar sugammadex: a single dose, a split-dose (split 1/2 and 1/2) and a reduced split-dose (split 1/2 and 1/4). After complete NMB was achieved, dexamethasone and sugammadex were administered. MAIN OUTCOME MEASURES The change in the first twitch height, the recovery time to a TOF ratio at least 0.9, and the TOF ratio at 30 min were evaluated. RESULTS There were no significant differences in the first twitch height among groups (P = 0.532). With a single dose of sugammadex, dexamethasone did not affect the recovery time to a TOF ratio at least 0.9 (P = 0.070). After using a split-dose of sugammadex, the recovery time to a TOF ratio at least 0.9 was delayed only at a concentration of 50 μg ml−1 of dexamethasone. With a reduced split-dose of sugammadex, the TOF ratio at 30 min was lowered only by a concentration of 50 μg ml−1 of dexamethasone (P 

https://ift.tt/2OtK1f5

Pericardial effusion as first presentation of disseminated non-Hodgkins lymphoma

A 46-year-old woman with quiescent lupus presented with worsening pleuritic chest pain and dyspnoea. Bedside echocardiogram confirmed large pericardial effusion with cardiac tamponade. Emergency bedside pericardiocentesis was performed. Pericardial fluid cytology confirmed diffuse large B cell lymphoma, stage four on positron emission tomography. Conventional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy achieved good response in all sites except the pericardium. Progressive cardiac involvement was complicated by atrioventricular conduction block requiring permanent pacemaker. Second-line palliative chemotherapy was performed.

https://ift.tt/2ydGkjr

Postoperative stroke: The picture is out of focus

No abstract available

https://ift.tt/2IBoVG5

Hereditary angioedema: a mother diagnosing her child using Google as a diagnostic aid

Hereditary angioedema (HAE), due to C1-inhibitor deficiency, is a rare autosomal dominant and potentially life-threatening disease characterised by recurrent oedema attacks of skin, mucosa and viscera. Due to the rarity and the fact that symptoms of HAE imitate other forms of angioedema and other conditions, HAE may be misdiagnosed, especially in emergency settings. Consequently, patients with HAE may experience significant delays in diagnosis. Without an accurate diagnosis patients with HAE may not receive proper treatment. At times 'Doctor Google' may be an important tool in establishing the diagnosis. The aim of this case report is to emphasise the importance of listening to patients and relatives and being humble to 'Doctor Google'. Furthermore, the aim is to remind all healthcare personal of HAE and the importance of considering the rare differential diagnoses to common symptoms.

https://ift.tt/2xTp8jR

Duration of the action of rocuronium in patients with BMI of less than 25: An observational study

BACKGROUND The duration of rocuronium in patients with BMI more than 30 kg m−2 is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m−2 is unclear. OBJECTIVE The objective of this study was to investigate whether a BMI less than 25 kg m−2 affects the duration of rocuronium in doses adjusted for actual body weight. DESIGN A prospective, observational, single-centre study. SETTING The operating room of a teaching hospital from 1 June 2008 to 30 June 2015. PATIENTS Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI 

https://ift.tt/2OGNs29

Translational pain research: an update from European Pain Federation educational platform

No abstract available

https://ift.tt/2ICEzRB

Correction: Severe capillary leak syndrome with cardiac arrest triggered by influenza virus infection

Ebdrup L, Druey KM, Mogensen TH. Severe capillary leak syndrome with cardiac arrest triggered by influenza virus infection. BMJ Case Rep 2018. doi: 10.1136/bcr-2018-226108.

In this published article, an author's name has been misspelt.

The correct name is Kirk M Druey.

https://ift.tt/2xToYZN

Borderline Mucinous Testicular Tumour: Diagnostic and Management difficulties

A 45-year-old man presented with right-sided testicular swelling and pain. An examination found a tender, firm right testis, a clinically normal left testis and no palpable lymphadenopathy. Tumour and inflammatory markers were within normal limits. A scrotal ultrasound scan showed an intratesticular, avascular lesion measuring 4.4x2.6x1.8 cm. A CT scan of his chest/abdomen/pelvis (CT C/A/P) showed no metastatic or primary lesions. An elective right-inguinal orchidectomy was subsequently performed. Histopathology showed a cystic mucinous tumour lined with intestinal-type epithelium. Differentials of metastatic adenocarcinoma, possibly of a gastrointestinal origin, a monodermal teratoma, or a borderline mucinous tumour of the testicle (BMTT) were considered. Following 12 p genetic studies and a colonoscopy, both of which found no abnormalities, a presumptive diagnosis of a BMTT was made. The patient is to have an annual urological review with a CT C/A/P and 5 yearly colonoscopies.

https://ift.tt/2ye2Qss

An open-label pilot study on preventing glucocorticoid-induced diabetes mellitus with linagliptin

Numerous patients develop diabetes in response to glucocorticoid therapy. This study explored the efficacy, safety, and preventive potential of the dipeptidyl peptidase-4 inhibitor, linagliptin (TRADJENTA®), i...

https://ift.tt/2P9cBzm

The role of pre-operative α-blockade in patients with normotensive phaeochromocytoma or paraganglioma: A retrospective cohort study

No abstract available

https://ift.tt/2Oz1GSl

Comparison of a novel clinical score to estimate the risk of REsidual neuromuscular block Prediction Score and the last train-of-four count documented in the electronic anaesthesia record: A retrospective cohort study of electronic data on file

BACKGROUND Residual neuromuscular block (rNMB) after surgery is not difficult to identify if proper neuromuscular monitoring is used, but many clinicians do not use quantitative neuromuscular monitoring. OBJECTIVE The aim of this study was to develop a REsidual neuromuscular block Prediction Score (REPS) to predict postoperative rNMB and compare the predictive accuracy of the prediction score with train-of-four count (TOFC) measurement at the end of a surgical case. DESIGN Retrospective cohort study of data on file. DATA SOURCE Electronic patient data and peri-operative data on vital signs, administered medications, and train-of-four ratio (TOFR) obtained in the postoperative recovery rooms [postanaesthesia care unit (PACU)] at Massachusetts General Hospital in Boston, Massachusetts, USA. PATIENTS Quantitative TOFR measurements obtained on admission to the PACU were available from 2144 adult noncardiac surgical patients. MAIN OUTCOME MEASURE Presence of rNMB at PACU admission, defined as a TOFR of less than 0.9. RESULTS In the score development cohort (n=2144), rNMB occurred in 432 cases (20.2%). Ten independent predictors for residual paralysis were identified and used for the score development. The final model included: hepatic failure, neurological disease, high-neostigmine dose, metastatic tumour, female sex, short time between neuromuscular blocking agent administration and extubation, aminosteroidal neuromuscular blocking agent, BMI more than 35, absence of nurse anaesthetist and having an experienced surgeon. The model discrimination by C statistics was 0.63, 95% confidence interval (0.60 to 0.66), and risk categories derived from the REPS had a higher accuracy than the last documented intra-operative TOFC for predicting rNMB (net reclassification improvement score 0.26, standard error 0.03, P 

https://ift.tt/2IBhwGR

Association of pre-operative troponin levels with major adverse cardiac events and mortality after noncardiac surgery: A systematic review and meta-analysis

BACKGROUND Circulating cardiac troponin levels are powerful predictors of prognosis in many clinical settings, but their association with outcomes after noncardiac surgery is unclear. OBJECTIVES The aim of this systematic review was to summarise current evidence on the association of pre-operative troponin elevation with postoperative major adverse cardiac events (MACE) and mortality in patients undergoing noncardiac surgery. DESIGN Systematic review of observational studies with meta-analysis. DATA SOURCES PubMed, EMBASE and Science Citation Index Expanded (ISI Web of Science) from their inception to 1 October 2017. ELIGIBILITY CRITERIA Observational studies reporting the associations between pre-operative troponin levels and MACE and all-cause mortality after noncardiac surgeries were included. RESULTS Ten studies met the eligibility criteria. The entire body of evidence addressing the research question was based on a total of 10 371 patients: 4.7 to 68.3% (median 23.8%) of patients had elevated troponin levels before surgery. Elevated pre-operative troponin was significantly associated with short-term MACE (seven studies, 5180 patients: odds ratio (OR) 6.92, 95% confidence interval (CI) 3.85 to 12.42), short-term mortality (five studies, 6103 patients: OR 4.23, 95% CI 2.27 to 7.89) and long-term mortality (two studies, 760 patients: OR 2.51, 95% CI 1.47 to 4.29). The associations remained significant when only multivariate-adjusted results were analysed. Overall, the reviewers' certainty about the summary estimates of the associations was very low. CONCLUSION Current evidence suggests that pre-operative high troponin levels are significantly associated with adverse cardiac events and mortality after noncardiac surgery. TRIAL REGISTRATION This systematic review was registered in the International Prospective Register of Systematic Reviews (Centre for Reviews and Dissemination 42017077837).

https://ift.tt/2OyuxWX

Deep vs. moderate neuromuscular blockade during laparoscopic surgery: A systematic review and meta-analysis

BACKGROUND Previous studies have reported that deep neuromuscular block (posttetanic-count 1 to 2 twitches) improves surgical conditions during laparoscopy compared with moderate block (train-of-four count: 1 to 2 twitches). However, comparisons of surgical conditions were made using different scales and assessment intervals with variable results. OBJECTIVE To explore the heterogeneity of previous comparisons between deep and moderate neuromuscular block. DESIGN Systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched from inception to October 2017. ELIGIBILITY CRITERIA Our meta-analysis included RCTs comparing the effects of deep with moderate neuromuscular block on surgical field conditions during laparoscopic surgery. The frequency of excellent or good operating conditions on a surgical rating scale was compared. Heterogeneity was assessed by subgroup analyses. RESULTS Eleven RCTs involving 844 patients were included. On the surgical rating scale, the frequency of excellent or good operating conditions was higher with deep block compared with a moderate block (odds ratio 2.83, 95% confidence interval 1.34 to 5.99, P = 0.007, I2 = 59%). We analysed surgical rating according to the number of assessments made. There was a significant difference in surgical rating with multiple assessments, but no difference when the assessment was made on only one occasion. A significant difference in rating was noted with variable abdominal pressures; there was no significant difference with the same fixed abdominal pressure. Trial sequential analysis demonstrated that the cumulative z-curve crossed the O′Brien–Fleming significance boundary. However, required information size was not achieved. CONCLUSION Deep block was associated with excellent or good surgical rating more frequently than moderate block. However, this finding was not consistent on subgroup analyses based on frequencies of assessment of surgical conditions and abdominal pressure. Further studies are required to address the heterogeneity and power shortage demonstrated by the trial sequential analysis.

https://ift.tt/2IBhm2d

Intra-operative cutaneous temperature monitoring with zero-heat-flux technique (3M SpotOn) in comparison with oesophageal and arterial temperature: A prospective observational study

BACKGROUND Continuous monitoring of core temperature is essential during major surgery as a way of improving patient safety. Oesophageal probes or specific arterial catheters are invasive methods used in this setting. A new noninvasive device based on zero-heat-flux (ZHF) technique (SpotOn) seems promising but has been poorly investigated during rapid core temperature changes (RCTC). OBJECTIVE To assess the accuracy of a SpotOn sensor vs. an oesophageal probe or specific arterial catheter during a slow change in core temperature of less than 1 °C within 30 min and RCTC ≥ 1 °C within 30 min. DESIGN Prospective observational study. SETTING Operating rooms at the University Hospital of Poitiers, France. PATIENTS Fifty patients scheduled for major abdominal surgery under general anaesthesia were enrolled from June 2015 to March 2016. Data from 49 patients were finally analysed. Among these, 15 patients were treated with hyperthermic intraperitoneal chemotherapy. INTERVENTION Each patient had a ZHF sensor placed on the skin surface of the forehead (TempZHF) and an oesophageal probe (TempEso) used as a reference method. Twenty-two patients also had a thermodilution arterial catheter (TempArt) placed in the axillary artery. MAIN OUTCOME MEASURES Core temperature was continuously recorded from the three devices after induction of anaesthesia. Comparison of temperature measurements between methods was made using the Bland and Altman method during two separate periods according to the speed of core temperature changes. RESULTS Compared with TempEso, bias and limits of agreement for TempZHF were 0.1 ± 0.5 °C during slow core temperature changes periods and 0.6 ± 1.8 °C during RCTC periods (P = 0.0002). Compared with TempArt, these values were −0.1 ± 0.4 and 0.5 ± 1.7 °C, respectively (P = 0.0039). The ZHF sensor was well tolerated. CONCLUSION A SpotOn sensor using the ZHF method seems reliable for core temperature monitoring during abdominal surgery when variations in core temperature are slow rather than rapid. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02869828.

https://ift.tt/2Oxxfw0

Comparison of noninvasive and minimally invasive pulse contour analysis to measure stroke volume during major surgery: A prospective observational study

No abstract available

https://ift.tt/2IBhbnz

Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness: A systematic review and meta-analysis

BACKGROUND The accuracy of respiratory variation of the inferior vena cava (rvIVC) in predicting fluid responsiveness, particularly in spontaneously breathing patients is unclear. OBJECTIVES To consider the evidence to support the accuracy of rvIVC in identifying patients who are unlikely to benefit from fluid administration. DESIGN Systematic review and meta-analysis. DATA SOURCE We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILCAS and WHO Clinical Trial Registry from inception to June 2017. ELIGIBILITY CRITERIA Case–control or cohort studies that evaluated the accuracy of rvIVC in living adult humans were included. A study was included in the meta-analysis if data enabling construction of 2 × 2 tables were reported, calculated or could be obtained from authors and met the above cited criteria. RESULT A total of 23 studies including 1574 patients were included in qualitative analysis. The meta-analysis involved 20 studies and 761 patients. Pooled sensitivity and specificity of rvIVC in 330 spontaneously breathing patients were 0.80 [95% confidence interval (CI) 0.68 to 0.89] and 0.79 (95% CI 0.60 to 0.90). Pooled sensitivity and specificity of rvIVC in 431 mechanically ventilated patients were 0.79 (95% CI 0.67 to 0.86) and 0.70 (95% CI 0.63 to 0.76). CONCLUSION Decreased inferior vena caval respiratory variation is moderately accurate in predicting fluid unresponsiveness both in spontaneous and mechanically ventilated patients. The findings of this review should be used in the appropriate clinical context and in conjunction with other clinical assessments of fluid status. IDENTIFIER CRD 42017068028.

https://ift.tt/2OwOM7D

Device or target? A paradigm shift in airway management: Implications for guidelines, clinical practice and teaching

No abstract available

https://ift.tt/2IBpm3g

Haemodilution and head-down tilting induce functional injury in the rat optic nerve: A model for peri-operative ischemic optic neuropathy

BACKGROUND Mechanisms of peri-operative ischaemic optic neuropathy remain poorly understood. Both specific pre-operative and intra-operative factors have been examined by retrospective studies, but no animal model currently exists. OBJECTIVES To develop a rodent model of peri-operative ischaemic optic neuropathy. In rats, we performed head-down tilt and/or haemodilution, theorising that the combination damages the optic nerve. DESIGN Animal study. SETTING Laboratory. ANIMALS A total of 36 rats, in four groups, completed the functional examination of retina and optic nerve after the interventions. INTERVENTIONS Anaesthetised groups (n>8) were supine (SUP) for 5 h, head-down tilted 70° for 5 h, head-down tilted/haemodiluted for 5 h or SUP/haemodiluted for 5 h. We measured blood pressure, heart rate, intra-ocular pressure and maintained constant temperature. MAIN OUTCOME MEASUREMENTS Retinal function (electroretinography), scotopic threshold response (STR) (for retinal ganglion cells) and visual evoked potentials (VEP) (for transmission through the optic nerve). We imaged the optic nerve in vivo and evaluated retinal histology, apoptotic cells and glial activation in the optic nerve. Retinal and optic nerve function were followed to 14 and 28 days after experiments. RESULTS At 28 days in head down tilted/haemodiluted rats, negative STR decreased (about 50% amplitude reduction, P = 0.006), VEP wave N2-P3 decreased (70% amplitude reduction, P = 0.01) and P2 latency increased (35%, P = 0.003), optic discs were swollen and glial activation was present in the optic nerve. SUP/haemodiluted rats had decreases in negative STR and increased VEP latency, but no glial activation. CONCLUSION An injury partly resembling human ischaemic optic neuropathy can be produced in rats by combining haemodilution and head-down tilt. Significant functional changes were also present with haemodilution alone. Future studies with this partial optic nerve injury may enable understanding of mechanisms of peri-operative ischaemic optic neuropathy and could help discover preventive or treatment strategies.

https://ift.tt/2OzA7Z3

Deep neuromuscular blockade and surgical conditions during laparoscopic ventral hernia repair: A randomised, blinded study

BACKGROUND Laparoscopic ventral hernia repair is a common surgical procedure. However, muscle contractions and general muscle tension may impair the surgical view and cause difficulties suturing the hernial defect. Deep neuromuscular blockade (NMB) paralyses the abdominal wall muscles and may help to create better surgical conditions. OBJECTIVES The current study investigated if deep compared with no NMB improved the surgical view during laparoscopic ventral hernia repair. DESIGN Crossover study. SETTING The study was carried out at Herlev and Gentofte Hospital, University of Copenhagen, Denmark and conducted from May 2015 until February 2017. PARTICIPANTS A total of 34 patients were randomised in an investigator-initiated, assessor-blinded crossover design of deep vs. no NMB during laparoscopic ventral hernia repair. INCLUSION CRITERIA Adults scheduled for elective laparoscopic ventral hernia repair. EXCLUSION CRITERIA Known allergy to any study medication, known homozygous variants in the butyrylcholinesterase gene, severe renal disease, neuromuscular disease, lactating or pregnant women, any indication for rapid sequence induction. INTERVENTIONS Deep NMB was established with rocuronium and reversed with sugammadex. Anaesthesia was conducted with propofol and remifentanil. MAIN OUTCOME MEASURES The primary outcome was evaluation of surgical view assessed on a five-point rating scale. Other outcomes included the surgical conditions during laparoscopic suturing of the hernia defect. RESULTS We found no difference in ratings for the surgical view when comparing deep with no NMB: mean −0.1 (95% confidence interval −0.4 to 0.2) (P = 0.521, paired t test). However, deep compared with no NMB improved the rating score for surgical conditions while suturing the hernia defect (P = 0.012, Mann–Whitney U test). No differences were found in either total length of surgery (P = 0.76) or hernia suturing time (P = 0.81). CONCLUSION Deep compared with no NMB did not change the rating score of the surgical view immediately after introduction of trocars during laparoscopic ventral hernia repair, but the surgical condition were improved during suturing of the hernia. TRIAL REGISTRATION ClinicalTrials.gov, NCT02247466.

https://ift.tt/2IDAX1w

End-tidal carbon dioxide monitoring improves patient safety during propofol-based sedation for breast lumpectomy: A randomised controlled trial

BACKGROUND The use of sedation is becoming more commonplace. Although pulse oximetry is a standard monitoring procedure during sedation, it cannot accurately detect early hypoventilation. End-tidal carbon dioxide (EtCO2) monitoring can be an earlier indicator of airway compromise; however, the existing literature is limited to a few studies with varying outcomes. OBJECTIVES To evaluate whether EtCO2 monitoring decreases the incidences of CO2 retention and apnoeic events in propofol-based sedation. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Two hundred women (aged 18 to 65 years, ASA physical status 1 or 2) who were scheduled for breast lumpectomy between June 2017 and August 2017. INTERVENTIONS Patients were allocated randomly to receive either standard monitoring or standard monitoring and EtCO2 monitoring. MAIN OUTCOME MEASURES The primary outcome was the incidence of CO2 retention. The secondary outcomes were the number of actions taken to restore ventilation, variations in PaCO2 and pH, the frequency of apnoea and the recovery time. RESULTS CO2 retention occurred significantly less often in the EtCO2 monitoring group (10 vs. 87%; P 

https://ift.tt/2OF9XVa

Haemodynamic evaluation and optimisation of brain-dead donors with oesophageal Doppler during organ harvesting: A feasibility study

No abstract available

https://ift.tt/2IzQcIV

Dexamethasone concentration affecting rocuronium-induced neuromuscular blockade and sugammadex reversal in a rat phrenic nerve-hemidiaphragm model: An ex vivo study

BACKGROUND The concentration range of dexamethasone that inhibits neuromuscular blockade (NMB) and sugammadex reversal remains unclear. OBJECTIVE To evaluate the effects of dexamethasone on rocuronium-induced NMB and sugammadex reversal. DESIGN Ex vivo study. SETTING Asan Institute for Life Sciences, Asan Medical Center, Korea, from July 2015 to November 2015. ANIMALS One hundred sixty male Sprague–Dawley rats. INTERVENTIONS We assessed the effect of four concentrations of dexamethasone [0, 0.5, 5 (clinical concentrations) and 50 μg ml−1 (experimental concentration)] on partial NMB on 40 phrenic nerve–hemidiaphragm preparations (n=10 per concentration). Once the first twitch of train-of-four (TOF) had been depressed by 50% with rocuronium, dexamethasone was administered. To assess the effect of dexamethasone on sugammadex reversal, 120 phrenic nerve–hemidiaphragm preparations were used in three subexperiments (n=40 per experiment), using three administration regimens of rocuronium–equimolar sugammadex: a single dose, a split-dose (split 1/2 and 1/2) and a reduced split-dose (split 1/2 and 1/4). After complete NMB was achieved, dexamethasone and sugammadex were administered. MAIN OUTCOME MEASURES The change in the first twitch height, the recovery time to a TOF ratio at least 0.9, and the TOF ratio at 30 min were evaluated. RESULTS There were no significant differences in the first twitch height among groups (P = 0.532). With a single dose of sugammadex, dexamethasone did not affect the recovery time to a TOF ratio at least 0.9 (P = 0.070). After using a split-dose of sugammadex, the recovery time to a TOF ratio at least 0.9 was delayed only at a concentration of 50 μg ml−1 of dexamethasone. With a reduced split-dose of sugammadex, the TOF ratio at 30 min was lowered only by a concentration of 50 μg ml−1 of dexamethasone (P 

https://ift.tt/2OtK1f5

Postoperative stroke: The picture is out of focus

No abstract available

https://ift.tt/2IBoVG5

Duration of the action of rocuronium in patients with BMI of less than 25: An observational study

BACKGROUND The duration of rocuronium in patients with BMI more than 30 kg m−2 is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m−2 is unclear. OBJECTIVE The objective of this study was to investigate whether a BMI less than 25 kg m−2 affects the duration of rocuronium in doses adjusted for actual body weight. DESIGN A prospective, observational, single-centre study. SETTING The operating room of a teaching hospital from 1 June 2008 to 30 June 2015. PATIENTS Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI 

https://ift.tt/2OGNs29

Translational pain research: an update from European Pain Federation educational platform

No abstract available

https://ift.tt/2ICEzRB

Advancing Freund's and AddaVax Adjuvant Regimens Using CpG Oligodeoxynucleotides

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy, Ahead of Print.


https://ift.tt/2xWYmH5

Effect of biodiesel on PAH, OPAH, and NPAH emissions from a direct injection diesel engine

Abstract

Polycyclic aromatic hydrocarbon (PAH), oxy- and nitro-derivate PAH (OPAH and NPAH) emissions from a direct injection diesel engine fueled with conventional fossil diesel (D), waste cooking oil biodiesel (B100), and their two blends (B20 and B50) were compared. The results show that B100 can reduce low molecular weight PAHs such as naphthalene, acenaphthylene, and fluorene as much as 90% compared with diesel. However, the emissions of high molecular weight PAHs including benzo[b]fluoranthene, benzo[k]fluoranthene, and benzo[a]pyrene decrease slightly when using B100. The emission levels for PAHs and OPAHs present comparable, while NPAH emission levels are five to ten times lower than those of PAHs and OPAHs. Compared with diesel, PAH and NPAH emissions significantly decrease. On the contrary, an increase trend of OPAH emission has been observed with adding biodiesel. For the specific parent PAHs and its oxygenated and nitrated derivatives, the fractions of parent PAHs gradually decrease with increasing biodiesel content in the blends, while the corresponding oxygenated and nitrated derivative fractions observably increase, especially for the high molecular weight compounds. Considering the increase of OPAH and NPAH fractions in total particle-phase PAHs when using biodiesel, in-depth biodiesel cytotoxicity assessment should be conducted.

https://ift.tt/2IAnvvn

The content of the potentially toxic elements, iron and manganese, in the grapevine cv Tamjanika growing near the biggest copper mining/metallurgical complex on the Balkan peninsula: phytoremediation, biomonitoring, and some toxicological aspects

Abstract

Plants growing in areas polluted by heavy metals represent excellent models for the investigations related to their potentials for hazardous metals accumulation which further may help in the estimation of plant practical biomonitoring and phytoremediation potentials. In this study, the potentials of the grapevine cultivar Tamjanika from a highly polluted region in Eastern Serbia, with intensive copper mining and metallurgical activities, were estimated in regard to the potentially toxic elements such as iron and manganese; the potential danger from these metals through fruit consummation is also considered. Used methods were the following: ICP-OES analysis, calculation of biological coefficients, the Pearson correlation study, one-way ANOVA, and hierarchical cluster analysis. The results revealed that a great majority of the recorded concentrations in different plant organs were in the range of normal concentrations, as well as that the calculated accumulation rates for both metals were very low. The data also pointed to generally minimal to moderate enrichment by these metals which represents totally dissimilar situation in comparison with other heavy metals detected in the very same plant samples. The results of this study suggested that the investigated plants of the grapevine cv Tamjanika assimilated iron and manganese predominately according to their individual needs, and confirmed that the utilization of this plant species can be very effective in different biomonitoring procedures and also in the phytoremediation procedure known as phytostabilization. At the same time, it was obvious that even in aggressive circumstances its fruit was protected from some serious contamination and kept pretty safe for consummation.

https://ift.tt/2O3PUA4

Effects of Vitamin D levels and supplementation on atopic dermatitis: A systematic review

Pediatric Dermatology, EarlyView.


https://ift.tt/2OCjdcg

The use of rituximab in treatment of epidermolysis bullosa acquisita: Three new cases and a review of the literature

Dermatologic Therapy, EarlyView.


https://ift.tt/2DTLbvZ

Anterior, frontal congenital triangular alopecia, redundancy in therapy without improvement

Dermatologic Therapy, EarlyView.


https://ift.tt/2O22cJ6

Correction to: Adsorption and removal of chromium (VI) contained in aqueous solutions using a chitosan-based hydrogel

The original publication of this paper contains an error. The correct 4th heading in Table 1 should be "Non-linear sips isotherm". The original article has been corrected.

https://ift.tt/2PaNE6K

The use of rituximab in treatment of epidermolysis bullosa acquisita: Three new cases and a review of the literature

Dermatologic Therapy, EarlyView.


https://ift.tt/2DTLbvZ

Anterior, frontal congenital triangular alopecia, redundancy in therapy without improvement

Dermatologic Therapy, EarlyView.


https://ift.tt/2O22cJ6

Recombinant NS3 Protein Induced Expression of Immune Modulatory Elements in Hepatic Stellate Cells During Its Fibrotic Activity

Viral Immunology, Ahead of Print.


https://ift.tt/2IBa0vz

Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Thyroid nodules are very common, occurring in up to 50% of patients. The best imaging method for evaluation of thyroid nodules is ultrasound. The American Thyroid Association guidelines for management of thyroid nodule offers a system for classifying thyroid nodules from benign to very low, low, intermediate and highly suspicious for thyroid cancer depending on the findings of ultrasound. Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology^®for the Public – Highlighted Article appeared first on American Thyroid Association.

https://ift.tt/2P9kyVc

Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Thyroid nodules are very common, occurring in up to 50% of patients. The best imaging method for evaluation of thyroid nodules is ultrasound. The American Thyroid Association guidelines for management of thyroid nodule offers a system for classifying thyroid nodules from benign to very low, low, intermediate and highly suspicious for thyroid cancer depending on the findings of ultrasound. Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology^®for the Public – Highlighted Article appeared first on American Thyroid Association.

https://ift.tt/2P9kyVc

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

The authors regret that one of the author's given name was missing and a typographical error was present in Reference 26 of the above article. These are presented correctly in this article.

https://ift.tt/2y9wbnO

LAP it up, fuzz ball: a short history of LC3-associated phagocytosis

Jennifer Martinez

https://ift.tt/2DXyY9M

Reviewers’ list December 2018

https://ift.tt/2Rn8pgK

Management and outcome of epistaxis under direct oral anticoagulants: a comparison with warfarin

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2Oxvw9P

FDA Clears Omadacycline (Nuzyra) for Two Infections

Omadacycline is a modernized tetracycline with broad-spectrum activity that is designed to overcome tetracycline resistance.
FDA Approvals

https://ift.tt/2IyIRJz

Peanut allergy – individual molecules as a key to precision medicine

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2NkuvgH

Impact of route of administration on genotoxic estrogens concentrations using oral vs. transdermal estradiol in girls with turner syndrome

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


https://ift.tt/2OwOHk7

Efficacy and Safety of Antibiotic Therapy in Early Cutaneous Lyme Borreliosis

This network meta-analyses of 19 randomized clinical trials conducted in the United States and Europe examines antibiotic agents and treatment modalities to assess treatment effectiveness and drug-related adverse outcomes in early cutaneous Lyme borreliosis.

https://ift.tt/2O39PiD

Exercise for Leg Ulcers

In this issue of JAMA Dermatology, Jull et al use meta-analysis to suggest an additional healing benefit of exercise in patients with venous leg ulcers (VLUs). Combining and analyzing data from 5 relatively small studies (the largest with 63 participants), the authors found that 61% of participants (57 of 94) who exercised and received compression healed at 12 weeks compared with 46% (44 of 96) of participants who received compression alone. Although the type of exercise administered varied among the trials, the results were driven by 2 studies that used progressive resistance exercises involving calf muscle strengthening coupled with physical activity (walking). In addition to providing rationale for an adjunctive therapeutic modality for patients with VLUs, this article also highlights the power of properly performed meta-analysis to provide clarity where previously none existed.

https://ift.tt/2P31Kqp

Alopecia Universalis and Chronic Graft-vs-Host Disease Treated With Ruxolitinib

This case report describes alopecia universalis and chronic graft-vs-host disease occurring after allogenic hematopoietic stem-cell transplantation and treated with ruxolitinib.

https://ift.tt/2NZNpyK

Introducing “Images in Dermatology”

It is often said that dermatology is a "visual specialty." While it is more than that, there is no escaping the central importance of the clinical examination to dermatologic diagnosis. The appearance, the morphology, the shape and distribution of lesions—these features are the illustration of illness, the manifestation of cutaneous or even systemic disease. The critical role of the physical examination, imparting the ability to make a diagnosis visually, is part of the art of dermatology and is shared by few other medical specialties.

https://ift.tt/2P9rvFE

Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers

This systematic review and meta-analysis of 5 clinical trials examines the association of different exercise interventions with venous leg ulceration healing when used as an adjuvant to any form of compression.

https://ift.tt/2O39Q6b

Acrodermatitis Continua of Hallopeau

This case report describes the occurrence of acrodermatitis continua of Hallopeau being mistaken for recurrent cellulitis.

https://ift.tt/2P5R4Yb

Enhanced photocatalytic activity of BiVO 4 powders synthesized in presence of EDTA for the decolorization of rhodamine B from aqueous solution

Abstract

Bismuth vanadate (BiVO₄) powders were successfully synthesized in presence of EDTA via microwave irradiation and used as photocatalysts in the oxidation reaction of rhodamine B (rhB) under visible light. Different concentrations of EDTA (0.5 to 10%) to chelate Bi³⁺ ions were employed on the BiVO₄ synthesis. Under the presence of EDTA, a monoclinic crystalline structure was obtained, whereas a mixture of monoclinic and tetragonal phases was observed in the absence of EDTA. In addition, the use of different EDTA concentrations promoted the formation the different shapes of particles. The BiVO₄ sample synthesized with low concentration of EDTA (0.5%) exhibited about 85% of rhB decolorization in 300 min at pH 7.5. Therefore, this high efficiency can be attributed to a combination of intrinsic properties such as the morphology type and monoclinic structure of BiVO₄ particles.

https://ift.tt/2yaYUIJ

Effective industrial regeneration of arsenic poisoning waste selective catalytic reduction catalyst: contaminants removal and activity recovery

Abstract

In this work, an environmental friendly industrial regeneration approach has been proposed to remove the surface poisoning and recover the catalytic activity of waste V₂O₅-WO₃/TiO₂ catalyst. Alkaline treatment and acid wash are combined for the waste catalyst regeneration process, which is applied for the arsenic and alkali metal removal, respectively. The crystal structure was well maintained as anatase phase and the surface area was increased during the regeneration, which is favorable for the following active component addition step and regenerated process. The XPS results illustrated that the surface contaminants (arsenic and sodium) were removed and V(IV) was loaded on the regenerated catalyst. Based on the deNO_x evaluations, the catalytic activity of the regenerated sample is increased to the level of commercial fresh catalyst. The present industrial regeneration process provides a promising method for the comprehensive recovery of waste catalyst and further understanding in the field of secondary resource recycle.

https://ift.tt/2xXD64b

Photobiomodulation effect on the proliferation of adipose tissue mesenchymal stem cells

Abstract

The use of mesenchymal stem cells (MSCs) in tissue engineering has been extensively investigated. The greater the proliferation of this cellular group, the greater the regenerative and healing capacity of the tissue to which they belong. In this context, photobiomodulation (PBM) is an efficient technique in proliferation of distinct cell types. However, its parameters and mode of action are still unclear and require further investigation. This study aimed to evaluate the PBM action with different energies in MSCs of adipose tissue (hASCs). We used hASCs, seeded in 24-well plates, with 3 × 10⁴ cells per well, in culture media. We used a total of four experimental groups, one with hASCs and simulated PBM and three other groups, which received PBM irradiation at 24, 48, and 72 h, with a 660-nm laser and power of 40 mW and energy of 0.56, 1.96, and 5.04 J. We performed analyses of MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromidefor) and trypan blue to evaluate cell proliferation and viability, 1 h after PBM irradiation. Software Graph PadPrism 7.0 was used. Intergroup comparisons were performed with ANOVA two-way and we used the Tukey post hoc test. Mitochondrial activity evaluated by MTT revealed the statistical difference in the first 24 h for group with more high energy when compared to control group; and in the 72 h for two irradiated groups when compared to the control group. The trypan blue test showed significant differences at the end of the experiment for two irradiated groups LG1 (4.52 × 10⁴ ± 0.2) and LG2 (4.85 × 104 ± 0.8), when compared to the control group (1.87 × 10⁴ ± 0.7). Both tests failed to be statistically different at the end of the experiment for groups LG1 and LG2 and observed a reduction in cellular mitochondrial growth and activity for group LG3. We conclude that PBM with energy close to 0.56 and 1.96 J promote proliferation of hASCs, and higher energy, such as 5.04 J, can be harmful.

https://ift.tt/2yf2x0i

Fasting glucagon-like peptide 1 concentration is associated with lower carbohydrate intake and increases with overeating

Abstract

Purpose

Glucagon-like peptide 1 (GLP-1) is an incretin hormone that appears to play a major role in the control of food intake. The aim of this investigation was to evaluate and quantify the association of circulating GLP-1 concentration with ad libitum total calorie and macronutrient intake.

Methods

One-hundred and fifteen individuals (72 men) aged 35 ± 10 years were admitted for an inpatient study investigating the determinants of energy intake. Ad libitum food intake was assessed during 3 days using a reproducible vending machine paradigm. Fasting plasma GLP-1 concentrations were measured on the morning of the first day and on the morning of the fourth day after ad libitum feeding.

Results

Plasma GLP-1 concentrations increased by 14% after 3 days of ad libitum food intake. Individuals overate on average 139 ± 45% of weight-maintaining energy needs. Fasting plasma GLP-1 on day 1 was negatively associated with carbohydrate intake (r = − 0.2, p = 0.03) and with daily energy intake from low fat–high simple sugar (r = − 0.22, p = 0.016).

Conclusion

Higher plasma GLP-1 concentrations prior to ad libitum food intake were associated with lower carbohydrate intake and lower simple sugar ingestion, indicating a possible role of the GLP-1 in the reward pathway regulating simple sugar intake.

Trial registration

ClinicalTrials.gov identifier: NCT00342732.

https://ift.tt/2OvQrKr

Dr David Pothier 1973‐2018

Clinical Otolaryngology, EarlyView.


https://ift.tt/2Oycmkl

T1–D–T2 correlation of porous media with compressed sensing at low-field NMR

Publication date: Available online 2 October 2018

Source: Magnetic Resonance Imaging

Author(s): Yan Zhang, Lizhi Xiao, Xin Li, Guangzhi Liao

Abstract

3D Laplace NMR can distinguish different components of confined fluid in sedimentary rocks, which is important to oil industry. However, the measurement time for such experiments is very long, which hinders the application in some cases such as NMR well logging. In this research, we accelerated T₁–D–T₂ experiment with compressed sensing (CS) method at low-field NMR. Simulation was first performed to examine the CS reconstruction method. The experiments were subsequently implemented on a 2 MHz spectrometer (Oxford instrument), which has a similar magnetic field strength to well logging tool. The T₁, D and T₂ information are obtained by the inversion recovery, pulsed field gradients and Carr–Purcell–Meiboom–Gill (CPMG) method, respectively. The subsampling is applied in T₁ and D dimensions with pseudo-random sampling. The measurement time reduced from 3 h to 0.6 h with CS method and a relative error of around 5% is achieved for data with signal-to-noise ratio of 28. The water and oil peaks are clearly distinguished in the correlation maps from subsampled data. The samples with different oil-water ratio and glass bead volume fraction were measured to examine the sensitivity of this method. In addition, diffusion and relaxation properties of the correlation maps are discussed.

https://ift.tt/2DRXE3i

Evaluation of benchtop NMR Diffusion Ordered Spectroscopy for small molecule mixture analysis

Publication date: Available online 2 October 2018

Source: Magnetic Resonance Imaging

Author(s): Evan R. McCarney, Robin Dykstra, Petrik Galvosas

Abstract

Diffusion Ordered Spectroscopy (DOSY) is an attractive method for analyzing chemical mixtures in the liquid state because it separates spectra by the molecular weight of the associated molecule. It has been compared with hyphenated chromatographic and analytical methods such LC-MS and has broad potential in servicing those same applications including forensics, reaction analysis, quality control, and fraud detection. Benchtop NMR can collect quality spectra on small molecules, however, lacks the chemical shift dispersion of high field instruments, can suffer from spectral overlap common in mixtures, and the diminished sensitivity of the lower field compounds these problems. In this work, we show that existing high field pulse sequences and processing methods perform well at 43 MHz. Spectra from molecular mixtures where the constituents had 20% differences in diffusion coefficients and significant overlap were able to be matched to a bespoke spectral library and identified correctly. In addition, spectra from mixtures with constituents that have severe overlap in the spectrum and differ by 50% in diffusion coefficients were also able to be match and identified correctly. The combination of benchtop NMR and easy implementation of modern pulse sequences and processing show promise of bringing these useful methods to chemistry laboratories in research and industrial environments.

https://ift.tt/2zNZ5M9

Antimicrobial and antifouling properties of versatile PPSU/carboxylated GO nanocomposite membrane against Gram-positive and Gram-negative bacteria and protein

Abstract

Biofouling is a serious issue in membrane-based water and wastewater treatment as it critically compromises the efficacy of the water treatment processes. This investigation demonstrates the antimicrobial and antifouling properties of a nanocomposite membrane system composed of carboxyl-functionalized graphene oxide (COOH-GO) and polyphenylsulfone (PPSU). The PPSU/COOH-GO nanocomposite membrane exhibited excellent antimicrobial properties, achieving maximum bacteriostasis rates of 74.2% and 81.1% against the representative Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa, respectively) and 41.9% against the representative Gram-positive bacterium (Staphylococcus aureus). The PPSU/COOH-GO nanocomposite membrane inhibited the attachment, colonization, and the biofilm formation of three species. Antifouling was assessed through filtration experiments using a model foulant bovine serum albumin (BSA). The fouling mechanisms were investigated by Hermia's models (complete blocking, intermediate blocking, standard blocking, and cake formation), and the analysis involved fitting the volumetric flux decline experimental data to models. The fouling study revealed a less irreversible fouling and increased flux recovery ratio for the PPSU/COOH-GO nanocomposite membrane. Complete blocking of pores and cake formation were the major fouling mechanisms for the membrane.

https://ift.tt/2O3Ndyg

TGF-β1-induced airway smooth muscle cell proliferation involves TRPM7-dependent calcium influx via TGFβR/SMAD3 (Revision)

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Ming Chen, Wei Zhang, Jianting Shi, Shanping Jiang

Abstract

Background

TRPM7 in mast cells plays a key role in asthma. However, the effect of TRPM7 on TGF-β1-induced airway smooth muscle cell (ASMC) proliferation remains unclear. Therefore, we designed this study to explore whether TRPM7 is involved in TGF-β1-induced ASMC proliferation.

Methods

An asthmatic mouse model was established, and the expressions of TGF-β1 and TRPM7 in mice lungs were detected using enzyme-linked immunosorbent assay (ELISA) and western blotting. In addition, murine ASMCs were cultured and stimulated with TGF-β1. Possible TGF-β1 and TRPM7 interactions were examined using RT-PCR and western blotting analyses with ASMCs. The effect of TRPM7 knockdown on ASMC calcium influx was assessed by the fluorescent indicator indo-1. MTT and flow cytometry were applied to evaluate the effects of TRPM7 knockdown on ASMC proliferation and apoptosis.

Results

TGF-β1 elevated the expression of TRPM7 via TGFβR/SMAD3. Knocking down TRPM7 decreased the intracellular Ca²⁺ concentration and cellular proliferation of ASMCs, although apoptosis remained unaffected.

Conclusions

Our initial findings suggest that TRPM7 inhibition may prevent asthma-induced airway remodeling.

https://ift.tt/2P90zpC

Hearing loss in preschool children from a low income South African community

Publication date: Available online 3 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Shouneez Yousuf Hussein, De Wet Swanepoel, Faheema Mahomed-Asmail, Leigh Biagio de Jager

Abstract

Objective

This study aimed to determine and describe hearing loss among preschool children in a South African community representative of typical low- and middle income countries (LMIC).

Method

Children between the ages of 3-6 years received a hearing screening at their early childhood development (ECD) center. If a child failed the hearing screening, he/she was seen for a follow-up rescreen and diagnostic assessment if necessary at their ECD center or closest referral clinic. Diagnostic testing consisted of otoscopy, tympanommetry and pure-tone diagnostic audiometry.

Results

A total of 6424 children were screened at ECD centers with a referral rate of 24.9%. Follow-up assessments were conducted on 45.3% (725) of these children. Diagnostic testing revealed that 9.3% of children presented with impacted cerumen and 18.7% presented with a hearing loss (56.5% binaural). Binary logistic regression revealed no gender or age effects (p>0.05). Conductive hearing loss (65.2%) was the most common type of hearing loss found in children.

Conclusions

Most preschool children who failed the hearing screening and received a diagnostic assessment were in need of intervention services for conductive hearing losses, followed by sensorineural and mixed losses.

https://ift.tt/2P8o6qP

Maternal risk factors for severe microtia/atresia in China: A case-control study

Publication date: Available online 3 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Qiang Liu, Xinmiao Fan, Shuang Liu, Li Wang, Yulin Jiang, Xiaowei Chen

Abstract

Objective

Microtia/atresia is a severe malformation of the external ear. Previous studies have reported the potential risk factors on microtia, whereas few focused on severe microtia/atresia. The aim of the study was to investigate the effects of maternal exposure to environmental risk factors in patients with severe microtia/atresia in China.

Methods

A case-control study was conducted. Cases were patients with severe microtia/atresia who presented to PUMCH between January 2014 and October 2017. A total of 322 patients with severe microtia/atresia were enrolled and 322 normal controls matched 1:1 with the patients by sex, age and nationality were enrolled. The designed questionnaires were completed and data were gathered. Odds ratios were estimated with logistic regression models along with 95% confidence intervals in severe microtia/atresia.

Results

Most cases were males(68.6%), and the cases were observed more common in unilateral(80.7%), right-sided (54.0%). Multivariate logistic regression analysis showed that threatened abortion (OR 4.066,95% CI = 2.360–7.007), NSAIDs (OR 2.576,95% CI = 1.079–6.148), virus infection (OR 1.933,95% CI = 1.148–3.256), anemia (OR 1.902,95% CI = 1.026–3.526), miscarriages (OR 1.804,95% CI = 1.425–2.285), maternal age (OR 1.079,95% CI = 1.015–1.148) and paternal age (OR 1.061,95% CI = 1.003–1.122) were associated with a higher risk of severe microtia/atresia.

Conclusion

These results support that some maternal risk factors could be associated with severe microtia/atresia.

https://ift.tt/2xVqnz8

The pedicled levator labii superioris alaeque nasi flap: A durable single-stage option for reconstruction of full-thickness nasal defects

Publication date: Available online 2 October 2018

Source: American Journal of Otolaryngology

Author(s): I.I. Kevin Moore, Richard Thompson, Timothy Lian

Abstract

Importance

Repair of full-thickness nasal defects can often be associated with multi-stage operations that can result in significant physical and psychological morbidity for patients. We present a single-stage option for reconstruction of these defects.

Objective

Demonstrate the utility of the pedicled levator labii superioris alaeque nasi flap and consistency of its vascular pedicle.

Design

Anatomical study using fresh cadavers.

Setting

Academic medical center.

Main outcome and measures

Evaluation of vascular anatomy of pedicled flap and measurements of distances with relationship to facial anatomic landmarks.

Results

With few noted anatomic variations, the vascular pedicle of the pedicled levator labii superioris alaeque nasi flap arises from the superior labial artery and is reliably located within 1 cm lateral and inferior of the nasal sill.

Conclusions and relevance

As a robust single-stage option, the pedicled levator labii superioris alaeque nasi flap can serve as a powerful option in the arsenal of the reconstructive surgeon. The technique for harvest is simple with attention to a few anatomic variations as described herein, and excellent results can be obtained with proper application.

https://ift.tt/2RgYz05

Response to letter

Publication date: Available online 2 October 2018

Source: American Journal of Otolaryngology

Author(s): Margaret I. Engelhardt, Alexandra C.G. Fonseca, Zhen J. Huang, Zi Yang Jiang, Sancak Yuksel, Soham Roy

https://ift.tt/2P5o4ji

Tongue psoriasis: Clinical aspects and analysis of epidemiological associations in 313 children, with a systematic literature review

Publication date: October 2018

Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 10

Author(s): D. Pourchot, C. Chiaverini, E. Bourrat, S. Barbarot, P. Vabres, T. Hubiche, C. Droicourt, M. Piram, I. Kupfer-Bessaguet, M. Ferneiny, E. Puzenat, X. Balguérie, A. Beauchet, A.-C. Bursztejn, E. Mahé, Groupe de recherche de la Société française de dermatologie pédiatrique

Summary

Background

Little information is available on the prevalence and clinical aspects of tongue involvement in children with psoriasis. The aim was to evaluate the prevalence, clinical aspects and risk factors concerning tongue involvement in children with psoriasis.

Patients and methods

This study was carried out in two stages. We performed a multicentre, cross-sectional study in 23 French dermatology centers. All children seen for psoriasis during the one-year study were systematically included. The clinical features of the tongue and of psoriasis were recorded. Association with clinical aspects of psoriasis and comorbidities was evaluated. We then carried out a literature review to evaluate the prevalence of tongue involvement in children with psoriasis and its positive predictive value for psoriasis. A search was conducted in the PUBMED database using the following keywords: "child" and "psoriasis" and ("tongue" or "glossitis" or "migratory glossitis" or "benign migratory glossitis" or "geographic tongue" or "fissured tongue").

Results

7.7% of the 313 children with psoriasis had tongue involvement. The clinical aspects were geographic tongue (4.2%), fissured tongue (2.8%) and both (0.64%). There was no association between tongue involvement and the clinical characteristics of the children. Two hundred and ninety-five articles were referenced and 3 were analysed. Psoriasis is very rare in cases of tongue abnormalities.

Conclusion

The prevalence of tongue involvement was 7.7% in children with psoriasis. No clinical or epidemiological association was shown. Tongue involvement does not modify the management of psoriasis. In the literature review it was not possible to evaluate either the prevalence of tongue involvement in psoriasis or the positive predictive value thereof.

Résumé

Introduction

Il y a peu d'informations dans la littérature sur les atteintes de la langue au cours du psoriasis de l'enfant. L'objectif était d'évaluer la fréquence, les aspects cliniques et les facteurs de risque d'atteinte linguale chez les enfants psoriasiques.

Patients et méthodes

Ce travail a été effectué en deux étapes : (1) une étude transversale a été menée dans 23 centres dermatologiques français, notant les aspects cliniques de la langue et du psoriasis chez les enfants atteints de psoriasis, ainsi que les associations et les comorbidités ; (2) une revue systématique de la littérature a ensuite été effectuée afin d'évaluer la prévalence l'atteinte linguale chez l'enfant et sa valeur prédictive du psoriasis. Une recherche a été réalisée en interrogeant la base de données PUBMED. Les mots clés saisis étaient : « child » et « psoriasis » et (« tongue » ou « glossitis » ou « migratory glossitis » ou « benign migratory glossitis » ou « geographic tongue » ou « fissured tongue »).

Résultats

(1) Parmi 313 enfants atteints de psoriasis 7,7 % présentaient une atteinte linguale sous forme de langue géographique (4,2 %), langue fissurée (2,8 %) ou les deux (0,6 %). L'atteinte linguale n'était associée à aucune particularité démographique ou clinique, ni aucune comorbidité. (2) Parmi 295 articles référencés, 3 ont finalement été retenus. Le psoriasis reste très rare en cas d'anomalie linguale.

Conclusion

La prévalence de l'atteinte linguale chez les enfants psoriasiques était de 7,7 %. Aucune association clinique ou épidémiologique n'a été montrée. L'atteinte linguale ne modifie pas la prise en charge du psoriasis. La revue systématique de la littérature ne permettait pas d'évaluer une prévalence de l'atteinte linguale dans le psoriasis ni la valeur prédictive positive de cette atteinte.

https://ift.tt/2zNYgTG

Editorial board

Publication date: October 2018

Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 10

Author(s):

https://ift.tt/2IzR4xa

What Is the Non-calcifying Langerhans Cell-Rich Variant of Calcifying Epithelial Odontogenic Tumor?

https://ift.tt/2RmQ43G

What Is the Non-calcifying Langerhans Cell-Rich Variant of Calcifying Epithelial Odontogenic Tumor?

https://ift.tt/2RmQ43G

What Is the Non-calcifying Langerhans Cell-Rich Variant of Calcifying Epithelial Odontogenic Tumor?

https://ift.tt/2RmQ43G

Retrieval of a retained video capsule endoscope with laparoscopic surgery

Abstract

Capsule endoscopy (CE) is commonly used for examining and diagnosing gastrointestinal disease, especially small bowel disease. Capsule retention is a well-known and significant complication of CE and requires surgical or endoscopic removal. Most reports described the retrieval of retained CE via laparotomy. We report a case of successful retrieval of the capsule using laparoscopic surgery.

https://ift.tt/2RgKWxX

An autologous dendritic cell vaccine polarizes a Th-1 response which is tumoricidal to patient-derived breast cancer cells

Abstract

Breast cancer remains one of the leading causes of cancer-associated death worldwide. Conventional treatment is associated with substantial toxicity and suboptimal efficacy. We, therefore, developed and evaluated the in vitro efficacy of an autologous dendritic cell (DC) vaccine to treat breast cancer. We recruited 12 female patients with stage 1, 2, or 3 breast cancer and matured their DCs with autologous tumour-specific lysate, a toll-like receptor (TLR)-3 and 7/8 agonist, and an interferon-containing cocktail. The efficacy of the vaccine was evaluated by its ability to elicit a cytotoxic T-lymphocyte response to autologous breast cancer cells in vitro. Matured DCs (≥ 60% upregulation of CD80, CD86, CD83, and CCR7) produced high levels of the Th1 effector cytokine, IL12-p70 (1.2 ng/ml; p < 0.0001), compared to DCs pulsed with tumour lysate, or matured with an interferon-containing cocktail alone. We further showed that matured DCs enhance antigen-specific CD8 + T-cell responses to HER-2 (4.5%; p < 0.005) and MUC-1 (19%; p < 0.05) tetramers. The mature DCs could elicit a robust and dose-dependent antigen-specific cytotoxic T-lymphocyte response (65%) which was tumoricidal to autologous breast cancer cells in vitro compared to T-lymphocytes that were primed with autologous lysate loaded-DCs (p < 0.005). Lastly, we showed that the mature DCs post-cryopreservation maintained high viability, maintained their mature phenotype, and remained free of endotoxins or mycoplasma. We have developed a DC vaccine that is cytotoxic to autologous breast cancer cells in vitro. The tools and technology generated here will now be applied to a phase I/IIa clinical trial.

https://ift.tt/2O1u6Fd

The challenge of choosing the correct biologic for the correct asthma patient

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Panida Sriaroon, Thomas B. Casale

https://ift.tt/2xUJtW1

Closing the gap: Understanding African American asthma knowledge and beliefs

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Jade B. Tam-Williams, Bridgette L. Jones

Abstract

Background

African American children are disproportionately affected by asthma (13% vs 8% non-Hispanic white Americans) and experience 30% higher asthma-related deaths than whites. Knowledge regarding asthma and asthma treatment among African Americans has been postulated as a potential contributor to this observed health disparity. Compared with the amount of studies on asthma, few investigations provide insight into the baseline knowledge and beliefs of African Americans regarding asthma.

Objective

Assess knowledge and beliefs regarding asthma symptoms, diagnosis, treatment, prognosis, and stigmas in a general community sample of African Americans.

Methods

Using community-based participatory research techniques, we developed and implemented a cross-sectional survey to explore asthma knowledge and beliefs among African American adults in a Midwestern city.

Results

Among the 158 African American adults who completed the survey, general asthma knowledge was good, with awareness of the genetic contribution to asthma and general asthma symptomatology (eg, 92% aware of nighttime cough as a symptom). However, asthma-related misconceptions were also revealed. Thirty-three percent of respondents were concerned about addiction to asthma medication, and 60% of respondents believed that inhaled corticosteroids were dangerous or did not know.

Conclusion

This study reveals important insights into asthma knowledge and beliefs among African Americans that may be used to address disparities in asthma outcomes in this population.

https://ift.tt/2y9OWra

Management of food allergies and asthma in schools

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Michele N. Pham, Julie Wang

https://ift.tt/2xUrLBJ

In vitro allergy testing: Where are we now?

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Irene J. Mikhail, Elizabeth Erwin

https://ift.tt/2ybaUtZ

Pediatric bronchial hyperresponsiveness and asthma phenotypes

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Miles Weinberger

https://ift.tt/2xULMIE

Editorial Board

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s):

https://ift.tt/2ydkRqE

Information for Authors

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s):

https://ift.tt/2xYoxNE

Table of Contents

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s):

https://ift.tt/2y6hHFc

Information for Readers

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s):

https://ift.tt/2xWd6pL

Occupational exposure to furry animals and asthma: The complex interconnection between work and everyday life

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Gennaro Liccardi, Luigino Calzetta, Manlio Milanese, Mariano Scaglione, Paola Rogliani

https://ift.tt/2ydCFBV

Authors' response

Publication date: October 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 4

Author(s): Anh Dao, David I. Bernstein

https://ift.tt/2xWRARR

Ifetroban in Treating Patients With Malignant Solid Tumors at High Risk of Metastatic Recurrence

Conditions:   Anatomic Stage II Breast Cancer;   Anatomic Stage IIA Breast Cancer;   Anatomic Stage IIB Breast Cancer;   Anatomic Stage III Breast Cancer;   Anatomic Stage IIIA Breast Cancer;   Anatomic Stage IIIB Breast Cancer;   Anatomic Stage IIIC Breast Cancer;   Clinical Stage II Esophageal Adenocarcinoma;   Clinical Stage II Esophageal Squamous Cell Carcinoma;   Clinical Stage II Gastric Cancer;   Clinical Stage II Gastroesophageal Junction Adenocarcinoma;   Clinical Stage IIA Esophageal Adenocarcinoma;   Clinical Stage IIA Gastric Cancer;   Clinical Stage IIA Gastroesophageal Junction Adenocarcinoma;   Clinical Stage IIB Esophageal Adenocarcinoma;   Clinical Stage IIB Gastric Cancer;   Clinical Stage IIB Gastroesophageal Junction Adenocarcinoma;   Clinical Stage III Esophageal Adenocarcinoma;   Clinical Stage III Esophageal Squamous Cell Carcinoma;   Clinical Stage III Gastric Cancer;   Clinical Stage III Gastroesophageal Junction Adenocarcinoma;   Distal Esophagus Squamous Cell Carcinoma;   Esophageal Carcinoma;   Estrogen Receptor Negative;   HER2/Neu Negative;   Limited Stage Small Cell Lung Carcinoma;   Malignant Solid Neoplasm;   Non-Small Cell Lung Carcinoma;   Pancreatic Adenocarcinoma;   Pathologic Stage II Esophageal Adenocarcinoma;   Pathologic Stage II Esophageal Squamous Cell Carcinoma;   Pathologic Stage II Gastric Cancer;   Pathologic Stage II Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIA Esophageal Adenocarcinoma;   Pathologic Stage IIA Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIA Gastric Cancer;   Pathologic Stage IIA Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIB Esophageal Adenocarcinoma;   Pathologic Stage IIB Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIB Gastric Cancer;   Pathologic Stage IIB Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage III Esophageal Adenocarcinoma;   Pathologic Stage III Esophageal Squamous Cell Carcinoma;   Pathologic Stage III Gastric Cancer;   Pathologic Stage III Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIA Esophageal Adenocarcinoma;   Pathologic Stage IIIA Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIIA Gastric Cancer;   Pathologic Stage IIIA Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIB Esophageal Adenocarcinoma;   Pathologic Stage IIIB Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIIB Gastric Cancer;   Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIC Gastric Cancer;   Postneoadjuvant Therapy Stage II Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage II Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage II Gastric Cancer;   Postneoadjuvant Therapy Stage II Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage III Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage III Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage III Gastric Cancer;   Postneoadjuvant Therapy Stage III Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIA Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIA Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage IIIA Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIB Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIB Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage IIIB Gastroesophageal Junction Adenocarcinoma;   Progesterone Receptor Negative;   Prognostic Stage II Breast Cancer;   Prognostic Stage IIA Breast Cancer;   Prognostic Stage IIB Breast Cancer;   Prognostic Stage III Breast Cancer;   Prognostic Stage IIIA Breast Cancer;   Prognostic Stage IIIB Breast Cancer;   Prognostic Stage IIIC Breast Cancer;   Stage I Pancreatic Cancer;   Stage IA Pancreatic Cancer;   Stage IB Pancreatic Cancer;   Stage II Lung Cancer;   Stage II Pancreatic Cancer;   Stage IIA Lung Cancer;   Stage IIA Pancreatic Cancer;   Stage IIB Lung Cancer;   Stage IIB Pancreatic Cancer;   Stage III Lung Cancer;   Stage IIIA Lung Cancer;   Stage IIIB Lung Cancer;   Stage IIIC Lung Cancer;   Triple-Negative Breast Carcinoma
Interventions:   Drug: Ifetroban Sodium;   Other: Placebo
Sponsors:   Vanderbilt-Ingram Cancer Center;   Cumberland Pharmaceuticals
Not yet recruiting

https://ift.tt/2IySZ5f

GSK3359609 Plus Tremelimumab for the Treatment of Advanced Solid Tumors

Condition:   Neoplasms
Interventions:   Drug: GSK3359609;   Drug: Tremelimumab;   Drug: Docetaxel;   Drug: Paclitaxel;   Drug: Cetuximab
Sponsors:   GlaxoSmithKline;   MedImmune LLC
Not yet recruiting

https://ift.tt/2Ox7onJ

Concurrent Neoadjuvant Chemoradiotherapy Plus Durvalumab (MEDI4736) in Resectable Stage II/IIIa NSCLC

Condition:   Potentially Resectable Stage II/IIIa NSCLC
Intervention:   Drug: durvalumab
Sponsor:   Yonsei University
Not yet recruiting

https://ift.tt/2Iz3gOT

Ifetroban in Treating Patients With Malignant Solid Tumors at High Risk of Metastatic Recurrence

Conditions:   Anatomic Stage II Breast Cancer;   Anatomic Stage IIA Breast Cancer;   Anatomic Stage IIB Breast Cancer;   Anatomic Stage III Breast Cancer;   Anatomic Stage IIIA Breast Cancer;   Anatomic Stage IIIB Breast Cancer;   Anatomic Stage IIIC Breast Cancer;   Clinical Stage II Esophageal Adenocarcinoma;   Clinical Stage II Esophageal Squamous Cell Carcinoma;   Clinical Stage II Gastric Cancer;   Clinical Stage II Gastroesophageal Junction Adenocarcinoma;   Clinical Stage IIA Esophageal Adenocarcinoma;   Clinical Stage IIA Gastric Cancer;   Clinical Stage IIA Gastroesophageal Junction Adenocarcinoma;   Clinical Stage IIB Esophageal Adenocarcinoma;   Clinical Stage IIB Gastric Cancer;   Clinical Stage IIB Gastroesophageal Junction Adenocarcinoma;   Clinical Stage III Esophageal Adenocarcinoma;   Clinical Stage III Esophageal Squamous Cell Carcinoma;   Clinical Stage III Gastric Cancer;   Clinical Stage III Gastroesophageal Junction Adenocarcinoma;   Distal Esophagus Squamous Cell Carcinoma;   Esophageal Carcinoma;   Estrogen Receptor Negative;   HER2/Neu Negative;   Limited Stage Small Cell Lung Carcinoma;   Malignant Solid Neoplasm;   Non-Small Cell Lung Carcinoma;   Pancreatic Adenocarcinoma;   Pathologic Stage II Esophageal Adenocarcinoma;   Pathologic Stage II Esophageal Squamous Cell Carcinoma;   Pathologic Stage II Gastric Cancer;   Pathologic Stage II Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIA Esophageal Adenocarcinoma;   Pathologic Stage IIA Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIA Gastric Cancer;   Pathologic Stage IIA Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIB Esophageal Adenocarcinoma;   Pathologic Stage IIB Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIB Gastric Cancer;   Pathologic Stage IIB Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage III Esophageal Adenocarcinoma;   Pathologic Stage III Esophageal Squamous Cell Carcinoma;   Pathologic Stage III Gastric Cancer;   Pathologic Stage III Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIA Esophageal Adenocarcinoma;   Pathologic Stage IIIA Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIIA Gastric Cancer;   Pathologic Stage IIIA Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIB Esophageal Adenocarcinoma;   Pathologic Stage IIIB Esophageal Squamous Cell Carcinoma;   Pathologic Stage IIIB Gastric Cancer;   Pathologic Stage IIIB Gastroesophageal Junction Adenocarcinoma;   Pathologic Stage IIIC Gastric Cancer;   Postneoadjuvant Therapy Stage II Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage II Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage II Gastric Cancer;   Postneoadjuvant Therapy Stage II Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage III Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage III Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage III Gastric Cancer;   Postneoadjuvant Therapy Stage III Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIA Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIA Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage IIIA Gastroesophageal Junction Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIB Esophageal Adenocarcinoma;   Postneoadjuvant Therapy Stage IIIB Esophageal Squamous Cell Carcinoma;   Postneoadjuvant Therapy Stage IIIB Gastroesophageal Junction Adenocarcinoma;   Progesterone Receptor Negative;   Prognostic Stage II Breast Cancer;   Prognostic Stage IIA Breast Cancer;   Prognostic Stage IIB Breast Cancer;   Prognostic Stage III Breast Cancer;   Prognostic Stage IIIA Breast Cancer;   Prognostic Stage IIIB Breast Cancer;   Prognostic Stage IIIC Breast Cancer;   Stage I Pancreatic Cancer;   Stage IA Pancreatic Cancer;   Stage IB Pancreatic Cancer;   Stage II Lung Cancer;   Stage II Pancreatic Cancer;   Stage IIA Lung Cancer;   Stage IIA Pancreatic Cancer;   Stage IIB Lung Cancer;   Stage IIB Pancreatic Cancer;   Stage III Lung Cancer;   Stage IIIA Lung Cancer;   Stage IIIB Lung Cancer;   Stage IIIC Lung Cancer;   Triple-Negative Breast Carcinoma
Interventions:   Drug: Ifetroban Sodium;   Other: Placebo
Sponsors:   Vanderbilt-Ingram Cancer Center;   Cumberland Pharmaceuticals
Not yet recruiting

https://ift.tt/2IySZ5f