Background There is increasing interest in the use of noninvasive biomarkers to reduce the risks posed by invasive biopsy for monitoring of solid organ transplants (SOT). One such promising marker is the presence of donor-derived cell-free DNA (dd-cfDNA) in the urine or blood of transplant recipients. Methods We systematically reviewed the published literature investigating the use of cfDNA in monitoring of graft health following SOT. Electronic databases were searched for studies relating cfDNA fraction or levels to clinical outcomes, and data including measures of diagnostic test accuracy (DTA) were extracted. Narrative analysis was performed. Results 95 manuscripts from 47 studies met the inclusion criteria (18 kidney, 7 liver, 11 heart, 1 kidney-pancreas, 5 lung, and 5 multiorgan). The majority were retrospective and prospective cohort studies, with 19 reporting DTA data. Multiple techniques for measuring dd-cfDNA were reported, including many not requiring a donor sample. dd-cfDNA falls rapidly within 2 weeks, with baseline levels varying by organ type. Levels are elevated in the presence of allograft injury, including acute rejection (AR) and infection, and return to baseline following successful treatment. Elevation of cfDNA levels are seen in advance of clinically apparent organ injury. Discriminatory power was greatest for higher grades of T cell mediated and antibody-mediated AR, with high negative predictive values. Conclusions cfDNA is a promising biomarker for monitoring the health of solid-organ transplants. Future studies will need to define how it can be used in routine clinical practice and determine clinical benefit with routine prospective monitoring. Corresponding Author: Simon R Knight, Oxford Transplant Centre, Nuffield Department of Surgical Sciences, Churchill Hospital, Old Road, Headington, OX3 7LE, United Kingdom. Tel: +44 (0) 1865 227131. E-mail: simon.knight@nds.ox.ac.uk Authorship SK conceived the study, authored the study protocol, developed and performed literature searches, screened references, analysed the data and wrote the manuscript. AT participated in study design, screened references, analysed the data and participated in the writing of the manuscript. MLF participated in study design and participated in the writing of the manuscript. Disclosures The authors declare no conflicts of interest relating to the content of this article. Funding This study received no external sources of funding. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2OROjgd
Πέμπτη 11 Οκτωβρίου 2018
A worldwide survey of Live liver donor selection policies at 24 centers with a combined experience of 19 009 adult living donor liver transplants
Background While surgical technique in LDLT has evolved with a focus on donor safety and recipient challenges, the donor selection criteria remain considerably disparate. Methods A questionnaire on donor selection was sent to 41 centers worldwide. 24 centers with a combined experience of 19009 LDLTs responded. Results Centers were categorized into predominantly LDLT (18) or DDLT (6), and high (10) or low volume (14) centers. At the majority of centers, the minimum acceptable GRWR was 1 features of metabolic syndrome. On biopsy, all considered macrovesicular and 50% considered microvesicular steatosis important. Nearly all (92%) rejected donors for early fibrosis, and minority for nonspecific granuloma or mild inflammation. Most anatomical anomalies except portal vein type D/E were acceptable at high volume centers. There was no standard policy for pre or peroperative cholangiogram. Conclusions This first large live liver donor survey provides insight into donor selection practices that may aid standardization between centers, with potential expansion of the donor pool without compromising safety. Corresponding author: Dr. AS Soin, Chairman, Chief Liver Transplant and Hepatobiliary Surgeon, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. e-mail IDs: absoin@gmail.com, arvinder.soin@medanta.org Authorship Page 1 Dr. Arvinder Singh Soin. FRCS. Chairman, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. e-mail ID: absoin@gmail.com. 2. Dr. Rohan Jagat Chaudhary. MS. Associate Consultant, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. e-mail ID: rohanjc1@gmail.com. 3. Dr. Hirak Pahari. MS. Fellow, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana 122001, India. e-mail ID: hirak.pahari@gmail.com. 4. Dr. Elizabeth Pomfret. MD. Division of Transplant Surgery, University of Colorado School of Medicine, 1635 Aurora Court, Aurora, CO, 80045, USA. E-mail ID: elizabeth.pomfret@ucdenver.edu Contributions: AS Soin: Conception of the work; data analysis and interpretation. Drafting the work, critical revision for important intellectual content and final approval of the version to be published. R J Chaudhary: Data acquisition, analysis and interpretation, drafting and final approval. H Pahari: Data acquisition, analysis and interpretation, drafting and final approval. E A Pomfret: Conception, critical revision and final approval of the version to be published. Disclosures: None. No conflict of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2ND0pVX
https://ift.tt/2ND0pVX
Commentary on Some Recent Theses Relevant to Combating Aging: October 2018
Rejuvenation Research, Ahead of Print.
https://ift.tt/2A7N4BD
High-flow oxygen via tracheostomy facilitates weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction: two case reports
Weaning from prolonged mechanical ventilation is extremely difficult in tracheostomized patients with restrictive pulmonary dysfunction. High-flow oxygen via tracheostomy supplies heated and humidified oxygen ...
https://ift.tt/2OhSbYx
Facets of Innate Immunity to Viral Infection
Viral Immunology, Ahead of Print.
https://ift.tt/2yu2s9g
Understanding the Role of Antiviral Cytokines and Chemokines on Neural Stem/Progenitor Cell Activity and Survival
Viral Immunology, Ahead of Print.
https://ift.tt/2OhdcCy
Seasonal patterns in alopecia areata, totalis, and universalis
To the Editor: Although seasonal patterns of pediatric alopecia areata (AA), totalis (AT), and universalis (AU) have been suspected clinically, there is limited research about whether disease flares follow a temporal pattern.1-3 Patients and families report increased hair loss during the winter, with cycles of regrowth in summer months. Through retrospective review of medical records, we sought to identify whether AA, AT, and AU flares show seasonal variation in pediatric patients and to characterize temporal patterns.
https://ift.tt/2OTpfWl
Lichen planus and lichenoid dermatoses
Having reviewed the diverse clinical subtypes of lichenoid disease and the postulated molecular basis thereof in the first article in this 2-part continuing medical education series, we discuss herein the existing and emerging treatment strategies in the most common clinical forms of lichenoid inflammation and provide an overview of their pharmacodynamics and evidence base. The scope of this review is not to exhaustively discuss treatment modalities for all lichenoid variants discussed in the previous article of this series.
https://ift.tt/2NCG1Ep
Lichen planus and lichenoid dermatoses
Deriving from the Greek word λειχήν for "tree moss" and the Latin word planus for "planar," lichen planus is a relatively uncommon and heterogeneous cutaneous disorder that typically develops in middle-aged adults. Despite the significant clinical burden associated with the disorder, little well-conducted molecular research has been undertaken, possibly because of heterogeneity impeding consistent and confident phenotyping. The multiple variants of lichenoid disease bear overlapping clinical and pathologic features despite manifesting as distinct clinical disorders.
https://ift.tt/2Nxbms9
Occurrence of aflatoxins in rice and in cassava ( Manihot esculenta ) products (meal, bread) produced in Guyana
Abstract
A survey was conducted on Guyana's main staple foods, rice, cassava meal and cassava bread to determine the presence and concentration of aflatoxins (AFs) using enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC) with fluorescence detection for concurrence. Aflatoxins are secondary metabolites of the fungus Aspergillus and can be a health risk to humans and animals. Results were compared with European Union Commission (EUC) maximum levels of total aflatoxins of 10 μg/kg. Various types of rice (paddy, steamed paddy, cargo rice, white rice and parboiled rice) were randomly collected either directly from the field and rice mills in Guyana during the November 2015/March 2016 season. Of the total 186 composite samples of rice fractions collected from field and mills, 10% (19) had AF concentrations greater than the maximum EUC level of 10 μg/kg. Fifteen samples had aflatoxin concentrations ranging from 10 to 171 μg/kg, mean 54.4 μg/kg; four samples were outliers. Since Guyanese consume mainly white and parboiled rice, composite samples were taken along the marketing chain at points of sale to determine the presence of AFs. Of the sixty samples of white rice collected, 6.7% (4) had AF concentrations greater than the EUC regulatory limits ranging from 31.9 to 131 μg/kg, mean 80.8 μg/kg. For the 57 samples of parboiled rice, 3.5% (2) samples exceeded the limit with values of 72.6 and 407 μg/kg. Forty (40) samples each of cassava meal and cassava bread were analysed fresh and after 2 months of storage, and no sample exceeded the ELISA detection limit of 0.5 μg/kg.
https://ift.tt/2pQepSQ
Heart toxicity from breast cancer radiotherapy
Abstract
Background
Late cardiac toxicities caused by (particularly left-sided) breast radiotherapy (RT) are now recognized as rare but relevant sequelae, which has prompted research on risk structure identification and definition of threshold doses to heart subvolumes. The aim of the present review was to critically discuss the clinical evidence on late cardiac reactions based on dose-dependent outcome reports for mean heart doses as well as doses to cardiac substructures.
Methods
A literature review was performed to examine clinical evidence on radiation-induced heart toxicities. Mean heart doses and doses to cardiac substructures were focused upon based on dose-dependent outcome reports. Furthermore, an overview of radiation techniques for heart protection is given and non-radiotherapeutic aspects of cardiotoxicity in the multimodal setting of breast cancer treatment are discussed.
Results
Based on available findings, the DEGRO breast cancer expert panel recommends the following constraints: mean heart dose <2.5 Gy; DmeanLV (mean dose left ventricle) < 3 Gy; V5LV (volume of LV receiving ≥5 Gy) < 17%; V23LV (volume of LV receiving ≥23 Gy) < 5%; DmeanLAD (mean dose left descending artery) < 10 Gy; V30LAD (volume of LAD receiving ≥30 Gy) < 2%; V40LAD (volume of LAD receiving ≥40 Gy) < 1%.
Conclusion
In addition to mean heart dose, breast cancer RT treatment planning should also include constraints for cardiac subvolumes such as LV and LAD. The given constraints serve as a clinicians' aid for ensuring adequate heart protection. The individual decision between sufficient protection of cardiac structures versus optimal target volume coverage remains in the physician's hand. The risk of breast cancer-specific mortality and a patient's cardiac risk factors must be individually weighed up against the risk of radiation-induced cardiotoxicity.
https://ift.tt/2EfkyC6
Soluble CTLA-4 as a favorable predictive biomarker in metastatic melanoma patients treated with ipilimumab: an Italian melanoma intergroup study
Abstract
CTLA-4 blockade by means of ipilimumab (IPI) potentiates the immune response and improves overall survival (OS) in a minority of metastatic melanoma (MM) patients. We investigated the role of soluble CTLA-4 (sCTLA-4) as a possible biomarker for identifying this subset of patients. sCTLA-4 levels were analyzed at baseline in sera from 113 IPI-treated MM patients by ELISA, and the median value (200 pg/ml) was used to create two equally sized subgroups. Associations of sCTLA-4 with best overall response (BOR) to IPI and immune-related adverse events (irAEs) were evaluated through logistic regression. Kaplan–Meier and Cox regression methods were used to analyze OS. A remarkable association between sCTLA-4 levels and BOR was found. Specifically, the proportion of patients with sCTLA-4 > 200 pg/ml in irSD or irPD (immune-related stable or progressive disease) was, respectively, 80% (OR = 0.23; 95%CL = 0.03–1.88) and 89% (OR = 0.11; 95%CL = 0.02–0.71) and was lower than that observed among patients in irCR/irPR (immune-related complete/partial response). sCTLA-4 levels increased during IPI treatment, since the proportion of patients showing sCTLA > 200 pg/ml after 3 cycles was 4 times higher (OR = 4.41, 95%CL = 1.02–19.1) than that after 1 cycle. Moreover, a significantly lower death rate was estimated for patients with sCTLA-4 > 200 pg/ml (HR = 0.61, 95%CL = 0.39–0.98). Higher baseline sCTLA-4 levels were also associated with the onset of any irAE (p value = 0.029), in particular irAEs of the digestive tract (p value = 0.041). In conclusion, our results suggest that high sCTLA-4 serum levels might predict favorable clinical outcome and higher risk of irAEs in IPI-treated MM patients.
https://ift.tt/2pR1pfv
Validation of classic and expanded criteria for endoscopic submucosal dissection of early gastric cancer: 7 years of experience in a Western tertiary cancer center
OBJECTIVE: Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center. METHODS: We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisher's exact test and chi-square tests, with 95% confidence intervals. RESULTS: In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (±11.7). The average procedure length was 113.9 minutes (±71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with "only-by-size" expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; ±14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014). CONCLUSION: These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries.
https://ift.tt/2NzKY0I
Regulation of HPV transcription
Human papillomavirus infection is associated with the development of malignant and benign neoplasms. Approximately 40 viral types can infect the anogenital mucosa and are categorized into high- and low-risk oncogenic human papillomavirus, depending on their association with the development of cervical carcinoma. High-risk human papillomavirus 16 and 18 are detected in 55% and 15% of all invasive cervical squamous cell carcinomas worldwide, respectively. Low-risk human papillomavirus 6 and 11 are responsible for 90% of genital warts and are also associated with the development of recurrent respiratory papillomatosis. Human papillomavirus preferentially infects mitotic active cells of the basal layer from both mucosal and cutaneous epithelium through microabrasions. The viral life cycle synchronizes with the epithelial differentiation program, which may be due, in part, to the binding of differentially expressed cellular transcription factors to the long control region throughout the various epithelial layers. This review aimed to summarize the current knowledge regarding the mechanisms by which viral gene expression is regulated and the influence of human papillomavirus heterogeneity upon this phenomenon. A better understanding of the regulatory mechanisms may elucidate the particularities of human papillomavirus-associated pathogenesis and may provide new tools for antiviral therapy.
https://ift.tt/2OXLhaA
Innate immunity and HPV: friends or foes
Most human papillomavirus infections are readily cleared by the host immune response. However, in some individuals, human papillomavirus can establish a persistent infection. The persistence of high-risk human papillomavirus infection is the major risk factor for cervical cancer development. These viruses have developed mechanisms to evade the host immune system, which is an important step in persistence and, ultimately, in tumor development. Several cell types, receptors, transcription factors and inflammatory mediators involved in the antiviral immune response are viral targets and contribute to tumorigenesis. These targets include antigen-presenting cells, macrophages, natural killer cells, Toll-like receptors, nuclear factor kappa B and several cytokines and chemokines, such as interleukins, interferon and tumor necrosis factor. In the present review, we address both the main innate immune response mechanisms involved in HPV infection clearance and the viral strategies that promote viral persistence and may contribute to cancer development. Finally, we discuss the possibility of exploiting this knowledge to develop effective therapeutic strategies.
https://ift.tt/2NCKGpJ
Human polyomaviruses and cancer: an overview
The name of the family Polyomaviridae, derives from the early observation that cells infected with murine polyomavirus induced multiple (poly) tumors (omas) in immunocompromised mice. Subsequent studies showed that many members of this family exhibit the capacity of mediating cell transformation and tumorigenesis in different experimental models. The transformation process mediated by these viruses is driven by viral pleiotropic regulatory proteins called T (tumor) antigens. Similar to other viral oncoproteins T antigens target cellular regulatory factors to favor cell proliferation, immune evasion and downregulation of apoptosis. The first two human polyomaviruses were isolated over 45 years ago. However, recent advances in the DNA sequencing technologies led to the rapid identification of additional twelve new polyomaviruses in different human samples. Many of these viruses establish chronic infections and have been associated with conditions in immunosuppressed individuals, particularly in organ transplant recipients. This has been associated to viral reactivation due to the immunosuppressant therapy applied to these patients. Four polyomaviruses namely, Merkel cell polyomavirus (MCPyV), Trichodysplasia spinulosa polyomavirus (TSPyV), John Cunningham Polyomavirus (JCPyV) and BK polyomavirus (BKPyV) have been associated with the development of specific malignant tumors. However, present evidence only supports the role of MCPyV as a carcinogen to humans. In the present review we present a summarized discussion on the current knowledge concerning the role of MCPyV, TSPyV, JCPyV and BKPyV in human cancers.
https://ift.tt/2OPcjRn
Pharmacogenetic testing in oncology: a Brazilian perspective
Pharmacogenetics, a major component of individualized or precision medicine, relies on human genetic diversity. The remarkable developments in sequencing technologies have revealed that the number of genetic variants modulating drug action is much higher than previously thought and that a true personalized prediction of drug response requires attention to rare mutations (minor allele frequency, MAF<1%) in addition to polymorphisms (MAF>1%) in pharmacogenes. This has major implications for the conceptual development and clinical implementation of pharmacogenetics. Drugs used in cancer treatment have been major targets of pharmacogenetics studies, encompassing both germline polymorphisms and somatic variants in the tumor genome. The present overview, however, has a narrower scope and is focused on germline cancer pharmacogenetics, more specifically, on drug/gene pairs for which pharmacogenetics-informed prescription guidelines have been published by the Clinical Pharmacogenetics Implementation Consortium and/or the Dutch Pharmacogenetic Working Group, namely, thiopurines/TPMT, fluoropyrimidines/UGT1A1, irinotecan/UGT1A1 and tamoxifen/CYP2D6. I begin by reviewing the general principles of pharmacogenetics-informed prescription, pharmacogenetics testing and the perceived barriers to the adoption of routine pharmacogenetics testing in clinical practice. Then, I highlight aspects of the pharmacogenetics testing of the selected drug-gene pairs and finally present pharmacogenetics data from Brazilian studies pertinent to these drug-gene pairs. I conclude with the notion that pharmacogenetics testing has the potential to greatly benefit patients by enabling precision medicine applied to drug therapy, ensuring better efficacy and reducing the risk of adverse effects.
https://ift.tt/2NzKOq8
Platelet activating factor receptor antagonists improve the efficacy of experimental chemo- and radiotherapy
Platelet activating factor is a lipid mediator of inflammation, and in recent decades, it has emerged as an important factor in tumor outcomes. Platelet activating factor acts by specific binding to its receptor, which is present in both tumor cells and cells that infiltrate tumors. Pro-tumorigenic effects of platelet activating factor receptor in tumors includes promotion of tumor cell proliferation, production of survival signals, migration of vascular cells and formation of new vessels and stimulation of dendritic cells and macrophages suppressor phenotype. In experimental models, blocking of platelet activating factor receptor reduced tumor growth and increased animal survival. During chemotherapy and radiotherapy, tumor cells that survive treatment undergo accelerated proliferation, a phenomenon known as tumor cell repopulation. Work from our group and others showed that these treatments induce overproduction of platelet activating factor-like molecules and increase expression of its receptor in tumor cells. In this scenario, antagonists of platelet activating factor markedly reduced tumor repopulation. Here, we note that combining chemo- and radiotherapy with platelet activating factor antagonists could be a promising strategy for cancer treatment.
https://ift.tt/2OPMfFG
Insulin Substrate Receptor (IRS) proteins in normal and malignant hematopoiesis
The insulin receptor substrate (IRS) proteins are a family of cytoplasmic proteins that integrate and coordinate the transmission of signals from the extracellular to the intracellular environment via transmembrane receptors, thus regulating cell growth, metabolism, survival and proliferation. The PI3K/AKT/mTOR and MAPK signaling pathways are the best-characterized downstream signaling pathways activated by IRS signaling (canonical pathways). However, novel signaling axes involving IRS proteins (noncanonical pathways) have recently been identified in solid tumor and hematologic neoplasm models. Insulin receptor substrate-1 (IRS1) and insulin receptor substrate-2 (IRS2) are the best-characterized IRS proteins in hematologic-related processes. IRS2 binds to important cellular receptors involved in normal hematopoiesis (EPOR, MPL and IGF1R). Moreover, the identification of IRS1/ABL1 and IRS2/JAK2V617F interactions and their functional consequences has opened a new frontier for investigating the roles of the IRS protein family in malignant hematopoiesis. Insulin receptor substrate-4 (IRS4) is absent in normal hematopoietic tissues but may be expressed under abnormal conditions. Moreover, insulin receptor substrate-5 (DOK4) and insulin receptor substrate-6 (DOK5) are linked to lymphocyte regulation. An improved understanding of the signaling pathways mediated by IRS proteins in hematopoiesis-related processes, along with the increased development of agonists and antagonists of these signaling axes, may generate new therapeutic approaches for hematological diseases. The scope of this review is to recapitulate and review the evidence for the functions of IRS proteins in normal and malignant hematopoiesis.
https://ift.tt/2NAzw4X
Duration of Antibiotic Therapy and Major Surgical Site Infection in Cochlear Implantation
This cohort study describes the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis.
https://ift.tt/2RKw8HQ
https://ift.tt/2RKw8HQ
Limitations to Association of Airway Disease Risk With Removal of Adenoids and Tonsils in Children
To the Editor Byars et al recently published a large case-control study based on data from Danish health registries. We believe that several important limitations in the study need to be addressed.
https://ift.tt/2EeL1Qg
https://ift.tt/2EeL1Qg
Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia
This retrospective cohort study of 293 children with oropharyngeal dysphagia examines hospitalization risk for those treated with proton pump inhibitors compared with those who were not.
https://ift.tt/2RGhnWF
https://ift.tt/2RGhnWF
Limitations to Association of Airway Disease Risk With Removal of Adenoids and Tonsils in Children—Reply
In Reply Four main issues were raised by Kitipornchai and Mackay and Lüscher et al. All of them appear invalid as challenges of our main results.
https://ift.tt/2Ecwl3S
https://ift.tt/2Ecwl3S
Empirical Proton Pump Inhibitor Therapy
For over a decade, publications in medical literature have raised several concerns regarding the use of proton pump inhibitors (PPIs). More recently, the pace of publication has quickened. This class of medications has been associated with pulmonary and gastrointestinal negative effects both in adults and children. For children, concern exists regarding elevated rates of viral and bacterial infections of the gastrointestinal tract, including Clostridium difficile, as well as increases in bacterial pneumonia. Changes in the microbiome may be related to these negative effects, and the length of PPI use may not matter. Although these concerns have been raised through studies that demonstrate correlation rather than cause and effect, word is getting out in gastroenterology, pediatrics, and neonatology. These findings have spread more slowly to those closely related fields of pulmonology and otolaryngology. These are fields in which physicians may be very comfortable and familiar with prescribing this class of medications to their pediatric patients, yet may be less aware of possible adverse effects than gastroenterologists and pediatricians.
https://ift.tt/2RHsFdh
https://ift.tt/2RHsFdh
Notice of Retraction for Schietroma et al
This Notice of Retraction is to retract an article by Schietroma et al.
https://ift.tt/2EcweFu
https://ift.tt/2EcweFu
Limitations to Association of Airway Disease Risk With Removal of Adenoids and Tonsils in Children
To the Editor The conclusion by Byars et al that the children who have had adenoidectomy and/or tonsillectomy are at a greater lifetime risk of airway disease may be supported by their data; however, their implication that surgery is causally related to this incidence is unfounded.
https://ift.tt/2RGS4nm
https://ift.tt/2RGS4nm
Comparison of Objective Outcomes in Dynamic Lower Facial Surgical Reanimation
This case series describes the use of temporalis tendon transfer or gracilis free muscle transfer to adjust the vector of smile and commissure position in patients with facial paralysis.
https://ift.tt/2EgBNTw
https://ift.tt/2EgBNTw
Cosmetics, Vol. 5, Pages 60: Anti-Aging Efficacy of Melatonin-Based Cream: Clinical and Instrumental Skin Evaluation
Cosmetics, Vol. 5, Pages 60: Anti-Aging Efficacy of Melatonin-Based Cream: Clinical and Instrumental Skin Evaluation
Cosmetics doi: 10.3390/cosmetics5040060
Authors: Massimo Milani Mario Puviani
Melatonin is a potent mitochondrial, cytoprotective and antioxidant molecule with potentially strong anti-aging properties. Topical melatonin has been shown to improve the clinical signs of skin aging. Melatosphere™ is a new lipid-based delivery system able to improve stability and skin penetration of melatonin when used in topical formulations. No clinical studies, using objective instrumental data, are available so far regarding the positive effect of Melatosphere™ in improving wrinkles in women with mild to moderate skin aging. In an open prospective, evaluator-blinded trial, we evaluate the effects on skin texture of two months of treatment with a Melatosphere™-based cream. Fifteen women aged >45 years with mild to moderate facial skin aging (Glogau score 2–4) participated in the trial, after providing their informed consent. An ANTERA 3D computer-assisted skin analysis evaluation for the assessment of coarse and fine wrinkles of the periorbital area and melanin content was performed at baseline and after two months of treatment. An evaluator-blinded Investigator Global Assessment (IGA) of skin elastosis, roughness, level of dyschromia, skin dryness and the presence of actinic damage was also performed at the same time points using a four-grade score from 0 (no sign) to 3 (severe sign). At baseline, the mean (SD) IGA score was 8.2 (1.0). After two months, the IGA score significantly decreased to 4.2 (1.4) (49% reduction) (p = 0.0007). ANTERA 3D evaluations showed a significant reduction in the coarse and fine wrinkle volume in the target area of −31% and −18%, respectively. Melanin content was reduced significantly by −17%. Topical melatonin carried in Melatosphere™ improves, in the short term, signs of skin aging evaluated clinically and using the ANTERA 3D device in women with mild to moderate skin aging.
https://ift.tt/2ydxcvI
The clinical value of assays detecting antibodies against domain I of β2-glycoprotein I in the antiphospholipid syndrome
Publication date: Available online 11 October 2018
Source: Autoimmunity Reviews
Author(s): Dongmei Yin, Bas de Laat, Katrien M.J. Devreese, Hilde Kelchtermans
Abstract
As the clinical symptoms of the antiphospholipid syndrome (APS) frequently occur irrespective of the syndrome, diagnosis predominantly depends on the laboratory assays measuring the level or function of antiphospholipid antibodies (aPLs). β2-glycoprotein I (β2GPI) is increasingly accepted as the most important target of aPLs. Anti-β2GPI antibodies constitute a heterogeneous population, but current in vivo and in vitro evidence show that especially the first domain (DI) of β2GPI contains an important pathogenic epitope. This epitope containing Glycine40-Arginine43 (G40-R43) has proven to be cryptic and only exposed when β2GPI is in its open conformation. A previous study demonstrated a highly variable exposure of the cryptic epitope in commercial anti-β2GPI assays, with implications on correct patient classification. Unexpectedly, recent unpublished data revealed impaired exposure of the pathogenic epitope in the commercially available anti-DI chemiluminescence immunoassay (CIA) assay detecting specific antibodies directed to DI.
In this review we summarize the laboratory and clinical performance characteristics of the different anti-DI assays in published data and conclude with inconsistent results for both the correlation of anti-DI antibodies with clinical symptoms and the added value of anti-DI antibodies in the classification criteria of APS. Additionally, we hypothesize on possible explanations for the observed discrepancies. Finally, we highly advise manufacturers to use normal pooled plasma spiked with the monoclonal anti-DI antibodies to verify correct exposure of the cryptic epitope.
https://ift.tt/2CCS8A9
The clinical value of assays detecting antibodies against domain I of β2-glycoprotein I in the antiphospholipid syndrome
Publication date: Available online 11 October 2018
Source: Autoimmunity Reviews
Author(s): Dongmei Yin, Bas de Laat, Katrien M.J. Devreese, Hilde Kelchtermans
Abstract
As the clinical symptoms of the antiphospholipid syndrome (APS) frequently occur irrespective of the syndrome, diagnosis predominantly depends on the laboratory assays measuring the level or function of antiphospholipid antibodies (aPLs). β2-glycoprotein I (β2GPI) is increasingly accepted as the most important target of aPLs. Anti-β2GPI antibodies constitute a heterogeneous population, but current in vivo and in vitro evidence show that especially the first domain (DI) of β2GPI contains an important pathogenic epitope. This epitope containing Glycine40-Arginine43 (G40-R43) has proven to be cryptic and only exposed when β2GPI is in its open conformation. A previous study demonstrated a highly variable exposure of the cryptic epitope in commercial anti-β2GPI assays, with implications on correct patient classification. Unexpectedly, recent unpublished data revealed impaired exposure of the pathogenic epitope in the commercially available anti-DI chemiluminescence immunoassay (CIA) assay detecting specific antibodies directed to DI.
In this review we summarize the laboratory and clinical performance characteristics of the different anti-DI assays in published data and conclude with inconsistent results for both the correlation of anti-DI antibodies with clinical symptoms and the added value of anti-DI antibodies in the classification criteria of APS. Additionally, we hypothesize on possible explanations for the observed discrepancies. Finally, we highly advise manufacturers to use normal pooled plasma spiked with the monoclonal anti-DI antibodies to verify correct exposure of the cryptic epitope.
https://ift.tt/2CCS8A9
Accounting for All Costs in the Total Cost of Chimeric Antigen Receptor T-Cell Immunotherapy—Reply
In Reply We appreciate the opportunity to respond to comments from Whittington and colleagues on our research letter, which estimated costs associated with the chimeric antigen receptor T-cell (CAR-T) immunotherapies tisagenlecleucel (Kymriah; Novartis) and axicabtagene ciloleucel (Yescarta; Kite Pharma). Using publicly available data sources and results from the clinical trials evaluating these agents, we estimated the costs directly related to the administration and adverse effects of CAR-T immunotherapies, including manufacturing costs, physician and facility costs for leukapheresis, administration of lymphodepletion therapy, administration of CAR-T therapy, and hospitalizations for cytokine-release syndrome. We estimated the average expected cost of treating a patient with tisagenlecleucel and axicabtagene ciloleucel at $510 963 and $402 647, respectively.
https://ift.tt/2yfr3zl
https://ift.tt/2yfr3zl
Androgen Deprivation Therapy and Dementia in Men With Prostate Cancer Receiving RT
This cohort study examines the association of androgen deprivation therapy with dementia in male veterans with prostate cancer who receive definitive radiotherapy.
https://ift.tt/2PtmrMC
https://ift.tt/2PtmrMC
Reassessment of 4-Cycle Etoposide and Cisplatin in Good-Risk Metastatic Germ Cell Tumors
This Viewpoint assesses the current recommendation of treatment regimens with and without bleomycin for patients with metastatic germ cell tumors of the testis.
https://ift.tt/2yd05II
https://ift.tt/2yd05II
Five-Year Risk of Cervical Precancer Following p16/Ki-67 Dual-Stain Triage of HPV-Positive Women
This prospective cohort study evaluates the 5-year risk of cervical precancer following p16/ki-67 dual-stain triage of HPV-positive women.
https://ift.tt/2RO7KFA
https://ift.tt/2RO7KFA
Plasma vs Tissue Next-Generation Sequencing in Non–Small Cell Lung Cancer
Although randomized clinical trial evidence of superior outcomes from using next-generation sequencing (NGS) in oncology clinical practice is still lacking, NGS has earned a place in the routine management of non–small cell lung cancer (NSCLC) for practical reasons. Non–small cell lung cancer is distinctive in that the portfolio of biomarker-driven targets with matched drugs approved by the US Food and Drug Administration or at least potentially available drugs is increasing so rapidly that performing a panel test has become more efficient and probably more cost-effective than testing for each mutation individually. Furthermore, tissue samples are not always available, and additional procedures to retrieve needed tissue entail potential risk and discomfort. A solution to this dilemma has been to perform a "liquid biopsy," in which the NGS is conducted on plasma rather than on tissue, obviating the need for invasive tissue biopsy. This more readily performed technique is already routinely used by many institutions, particularly when tissue biopsy specimens are unavailable. Like many other interventions in medicine, however, plasma-based NGS has been integrated into clinical practice without being evaluated in well-conducted prospective trials.
https://ift.tt/2EeFnh2
https://ift.tt/2EeFnh2
Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women
This cohort study of women in the Nurses' Health Study II assesses the association of obesity and weight gain since early adulthood with early-onset colorectal cancer.
https://ift.tt/2RIJO6s
https://ift.tt/2RIJO6s
Accounting for All Costs in the Total Cost of Chimeric Antigen Receptor T-Cell Immunotherapy
To the Editor Hernandez and colleagues estimated the total cost of chimeric antigen receptor T-cell (CAR-T) immunotherapy by presenting 11 patient-treatment pathways based on receipt of CAR-T infusion, development of cytokine release syndrome, and response to treatment. We agree that the treatment acquisition costs of tisagenlecleucel (Kymriah; Novartis) ($475 000 for pediatric leukemia) and axicabtagene ciloleucel (Yescarta; Kite Pharma) ($373 000 for adult lymphoma) are not an accurate representation of the total cost of CAR-T immunotherapy.
https://ift.tt/2EeFCIY
https://ift.tt/2EeFCIY
Plasma-Based Genotyping for Personalized Therapy in Metastatic Non–Small Cell Lung Cancer
This study assesses whether plasma-based next-generation sequencing was associated with improved mutation detection and enhanced delivery of personalized therapy in a real-world clinical setting of patients with non–small cell lung cancer.
https://ift.tt/2RFwAr0
https://ift.tt/2RFwAr0
Incorrect Surnames in Byline
In the article titled "Erythematous Velvety Plaque of the Scrotum and Penis," the surnames of 2 authors who appear in the byline have been tagged for correct display. Kae Jack Tay now displays as Tay KJ, and Valerie Huei Li Gan now displays as Gan VHL. The article was corrected online.
https://ift.tt/2EfT0fK
https://ift.tt/2EfT0fK
Error In Figure 1
In the Original Investigation titled "Fatal Toxic Effects Associated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-analysis," published online September 3, 2018, there was an error in Figure 1C. The fatality rate percentage for adrenal fatalities was not correctly presented. This article was corrected online.
https://ift.tt/2RI4AD5
https://ift.tt/2RI4AD5
Conditioned fear stress increases bone resorption in apical periodontitislesions in Wistar male rats
Publication date: Available online 10 October 2018
Source: Archives of Oral Biology
Author(s): Emisael Stênio Batista Gomes, Lucyana Conceição Farias, Luiz Henrique Silveira, Carlos Ícaro de Jesus, Rogério Gonçalves da Rocha, Guilherme Veloso Ramos, Hanna Thaynara Alves Teixeira Magalhães, Manoel Brito-Júnior, Sérgio Henrique Sousa Santos, Bruno Correia Jham, Alfredo Maurício Batista de Paula, André Luiz Sena Guimarães
Abstract
Objective
Because the impact of conditioned fear stress on apical bone resorption is unknown, the aim of the current studywas to use a rat model to evaluate the impact of conditioned fear stress on the bone resorption of inflammatory apical periodontitis lesions.
Methods
Twenty-five animals were divided into two groups. They underwent a surgical procedure in the first left lower molar tooth to expose the dental pulp and induce inflammatory apical periodontitis lesions through the retention of contamination (bacterial infection) during a 56-day period. The animals in the case group were stressed daily by using electrical stimuli (1.10 mA), whereas the animals in the control group were absent from the stressful stimuli (shocks). The open field test was performed to validate the stress methodology. The jaws were removed and collected for histological and radiographic analyses.
Results
Stressed animals presented increased levels of bone loss and inflammatory cells in the root apex in comparison with the control group (P = 0.0001). However, no radiographic differences were observed between the groups (P > 0.05).
Conclusions
Our results demonstrated that conditioned fear stress could modify a periapical lesion by increasing the size of bone loss there. Conditioned fear stress also increased the total number of inflammatory cells compared with the control group. Studies evaluating the impact of conditioned fear stress on human periapical inflammatory lesions should be encouraged.
https://ift.tt/2IP8uWV
Compensatory interactions between developing maxillary anterior teeth in a sample of twins
Publication date: Available online 10 October 2018
Source: Archives of Oral Biology
Author(s): Marianne Tadros, Alan H Brook, Sarbin Ranjitkar, Grant C Townsend
Abstract
Objectives
The objective of this study was to revisit the topic of compensatory interactions between maxillary anterior teeth during development advanced by Sofaer et al. (1971). We addressed the hypotheses listed by Sofaer and colleagues using data derived from our Australian twin sample to investigate whether final tooth size in permanent maxillary central incisors and canines showed evidence of developmental compensation for adjacent missing or microdont lateral incisors. Such compensation is one factor interacting in the complex system of dental development.
Materials and methods
A 2D image analysis system was used to measure crown height from the labial view, labiopalatal crown width from the incisal view, and mesiodistal crown width from both the labial (MDl) and incisal (MDi) views of the permanent maxillary central incisors and canines on the dental study model of twins enrolled in a longitudinal study of dental development.
Results
Developmental variations of maxillary lateral incisors influence the morphogenesis of the adjacent teeth. For example, individuals with one missing lateral incisor and one lateral incisor of average dimensions, had significantly larger central incisors than the control group for the MDl and MDi dimensions (p < 0.05). Of the 7 monozygotic twin pairs, 6 were discordant in maxillary anterior hypodontia and microdontia, and 13 out of 14 dizygotic twin pairs were discordant.
Conclusions
This study provides further evidence of developmental interactions in the maxillary anterior region, partially supporting Sofaer and colleagues' hypotheses. These interactions are part of a complex adaptive system involving genetic, epigenetic and environmental factors.
https://ift.tt/2pVoEW9
microRNA-199a may be involved in the pathogenesis of lupus nephritis via modulating the activation of NF-κB by targeting Klotho
Publication date: November 2018
Source: Molecular Immunology, Volume 103
Author(s): Hong Ye, Bofeng Su, Haizhen Ni, Linlin Li, Xuduan Chen, Xiaohan You, Huidi Zhang
Abstract
Klotho is considered to have renal protective effect by prohibiting the activation of the nuclear factor (NF)-κB pathway, while the role of microRNA-199a (miR-199a)/Klotho in lupus nephritis (LN) is still unknown. A single dose of pristane (0.5 ml) was intraperitoneally injected into 8 weeks-old female mice to establish the LN model. MiR-199a mimic or miR-199a inhibitor, Klotho plasmid or Klotho siRNA, and miR-199a inhibitor plus si-Klotho were transfected into lipopolysaccharides (LPS) stimulated human embryonic kidney 293 T (HEK293 T) cells. Western Blot was adopted to measure p-P65 expression. Tumor necrosis factor (TNF)-α and interleukin (IL)-1β in the supernatant were determined by enzyme-linked immunosorbent assay (ELISA). The expression of Klotho was suppressed by miR-199a through direct binding to the three prime untranslated regions (3'-UTR). The high miR-199a level was accompanied by low Klotho expression in the LN kidney. MiR-199a promoted LPS-induced NF-κB activation and improved the secretion of TNF-α and IL-1β by regulation of Klotho in HEK293 T cells. If miR-199a antagomir was administrated after 48 h of pristane administration, the expression of p-P65 and the secretion of TNF-α and IL-1β were significantly down-regulated in LN kidney. Although the direct involvement and detailed mechanism of miR-199a in LN still need further investigation, our data show that MiR-199a could regulate the activation of NF-κB by directly targeting Klotho.
https://ift.tt/2yukf05
Donor white blood cell survival and cytokine profiles following red blood cell transfusion in Australian major trauma patients
Publication date: November 2018
Source: Molecular Immunology, Volume 103
Author(s): Rena Hirani, Melinda M. Dean, Zsolt J. Balogh, Natalie J. Lott, Julie Seggie, Jeremy M. Hsu, Susan Taggart, Peter Maitz, Lesley Survela, Anthony Joseph, Mark Gillett, David O. Irving
Abstract
Background
The potential for the co-existence of genetically disparate cells (microchimerism) and associated cytokine profiles following red blood cell (RBC) transfusion in trauma patients has not been well characterized to date. This study investigated the incidence of surviving donor white blood cells (known as transfused-associated microchimerism (TAM)) and cytokine changes following blood transfusion in trauma patients.
Study design and methods
Trauma patients with an injury severity score (ISS) >12 who had been transfused between 2012–2016 with at least 5 units of RBC units over a 4 h period were recruited. Trauma patients with ISS > 12 who did not require blood transfusion were recruited as controls. The incidence of TAM was determined using a panel of insertion/deletion (InDel) bi-allelic polymorphisms. Selected pro- and anti-inflammatory cytokine profiles were analyzed using cytometric bead array.
Results
The transfused cohort (n = 40) had median ISS of 28 [12–66], received a median of 11 RBC units [4–114] and had median hospital length of stay of 35 days [1–152]. Only 11 (27.5%) patients returned for follow-up blood sampling after discharge. Of these, one patient showed an InDel pattern indicating the presence of TAM. No patients in the control cohort (n = 49) showed TAM. Cytokines IL-10 and IL-6 were found to be elevated in the transfused trauma patients.
Conclusion
In this cohort, TAM was found to occur in one patient of the 11 who received a blood transfusion. Elevated IL-6 and IL-10 cytokines were detected in those patients who were transfused. However, the incidence of TAM could not be correlated with the elevated cytokine profiles for this cohort.
https://ift.tt/2OkdUzb
Lesion of the thyroid cartilage
Publication date: Available online 10 October 2018
Source: European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): Z. Cavallier, J. Sarini, V. Maisongrosse, A. Dupret-Bories
https://ift.tt/2IOCgen
Safety profile after prolonged C3 inhibition
Publication date: December 2018
Source: Clinical Immunology, Volume 197
Author(s): Edimara S. Reis, Nadja Berger, Xin Wang, Sophia Koutsogiannaki, Robert K. Doot, Justin T. Gumas, Periklis G. Foukas, Ranillo R.G. Resuello, Joel V. Tuplano, David Kukis, Alice F. Tarantal, Anthony J. Young, Tetsuhiro Kajikawa, Athena M. Soulika, Dimitrios C. Mastellos, Despina Yancopoulou, Ali-Reza Biglarnia, Markus Huber-Lang, George Hajishengallis, Bo Nilsson
Abstract
The central component of the complement cascade, C3, is involved in various biological functions, including opsonization of foreign bodies, clearance of waste material, activation of immune cells, and triggering of pathways controlling development. Given its broad role in immune responses, particularly in phagocytosis and the clearance of microbes, a deficiency in complement C3 in humans is often associated with multiple bacterial infections. Interestingly, an increased susceptibility to infections appears to occur mainly in the first two years of life and then wanes throughout adulthood. In view of the well-established connection between C3 deficiency and infections, therapeutic inhibition of complement at the level of C3 is often considered with caution or disregarded. We therefore set out to investigate the immune and biochemical profile of non-human primates under prolonged treatment with the C3 inhibitor compstatin (Cp40 analog). Cynomolgus monkeys were dosed subcutaneously with Cp40, resulting in systemic inhibition of C3, for 1 week, 2 weeks, or 3 months. Plasma concentrations of both C3 and Cp40 were measured periodically and complete saturation of plasma C3 was confirmed. No differences in hematological, biochemical, or immunological parameters were identified in the blood or tissues of animals treated with Cp40 when compared to those injected with vehicle alone. Further, skin wounds showed no signs of infection in those treated with Cp40. In fact, Cp40 treatment was associated with a trend toward accelerated wound healing when compared with the control group. In addition, a biodistribution study in a rhesus monkey indicated that the distribution of Cp40 in the body is associated with the presence of C3, concentrating in organs that accumulate blood and produce C3. Overall, our data suggest that systemic C3 inhibition in healthy adult non-human primates is not associated with a weakened immune system or susceptibility to infections.
https://ift.tt/2EgbU6b
Significance of IgG4-positive cells in severe eosinophilic chronic rhinosinusitis
Publication date: Available online 11 October 2018
Source: Allergology International
Author(s): Takahisa Koyama, Shin Kariya, Yasuharu Sato, Yuka Gion, Takaya Higaki, Takenori Haruna, Tazuko Fujiwara, Akira Minoura, Soshi Takao, Yorihisa Orita, Kengo Kanai, Masami Taniguchi, Kazunori Nishizaki, Mitsuhiro Okano
Abstract
Background
IgG4 production is regulated by type 2 (IL-4 and IL-13) and regulatory (IL-10) cytokines involved in the pathophysiology of chronic rhinosinusitis (CRS). We sought to determine the pathophysiological characteristics of IgG4-positive cells in sinonasal tissues in CRS, especially eosinophilic CRS (ECRS).
Methods
IgG4-positive cells in uncinate tissues (UT) and nasal polyps (NP) were examined by immunohistochemistry. Associations between the number of IgG4-positive cells and clinicopathological factors were analyzed. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value of IgG4-positive cells in tissue that can predict the post-operative course.
Results
IgG4 was mainly expressed in infiltrating plasma and plasmacytoid cells, and the number of IgG4-positive cells was significantly higher in NP, especially those from severe ECRS patients, than in UT. In CRS patients, the number of IgG4-positive cells significantly and positively correlated with blood and tissue eosinophilia, radiological severity, and serum level of total IgE. The number of infiltrating IgG4-positive cells was significantly higher in patients with a poor post-operative course (sustained sinus shadow 6 months after surgery) than in those with a good one. The number of IgG4-positive cells in NP could discriminate patients with a good or a poor post-operative course (area under the curve: 0.769). Also, 73.3% sensitivity and 82.5% specificity were achieved when the cut-off value was set at 17 cells/high-power field.
Conclusions
Our results suggest that the local expression of IgG4 on cells may be used as a biomarker that reflects the pathophysiology of CRS, including the post-operative course.
https://ift.tt/2QDKNDA
A successful microsurgical approach to treating penile amputation following genital self mutilation
Abstract
We present the case of a 33-year-old male who presented to the Emergency Department having amputated his penis as a result of auditory hallucinations triggered by cannabis use. A successful microsurgical technique involving anastomosing the individual structures of the penile shaft enabled a successful cosmetic and functional outcome including restoration of erectile function.https://ift.tt/2A44ij2
Complete unilateral ureteral duplication encountered during intersphincteric resection for low rectal cancer
Abstract
Complete duplication of ureters is a very rare clinical entity that may either be asymptomatic or present with a variety of clinical findings. In the presented case a 51-year-old Caucasian female underwent an intersphincteric resection for low rectal cancer. Intraoperatively, during the standard bilateral recognition and mobilization of the ureters, complete unilateral duplication of the left ureter was incidentally detected, deriving from a single renal parenchyma. Such a congenital abnormality though constitutes a major risk-factor of accidental ureteral injury during operations including pelvis. Conclusively, meticulous exposure of both ureters combined with surgeons' unceasing awareness constitute the cornerstone of a safe operation.https://ift.tt/2QHHs6A
High-grade angiosarcoma presenting with cytology-negative hemorrhagic ascites
Abstract
Angiosarcomas are a rare subtype of soft-tissue sarcomas originating from the vascular endothelium. Both retroperitoneal and omental angiosarcomas tend to be aggressive and rapidly fatal if not amenable to early intervention. In this report, we describe an unusual case of high-grade angiosarcoma with cytology-negative hemorrhagic ascites and diffuse omental invasion. Multiple investigations into the origin of the hemorrhagic ascites, including cytological analysis, tumor marker measurements, serum-ascites albumin gradient calculation and frozen section pathological examination, failed to reveal a diagnosis. We conclude that malignancy should be considered in the differential diagnosis in the presence of suspicious cytology-negative hemorrhagic ascites and concomitant retroperitoneal and abdominal findings.https://ift.tt/2A4j21y
Distraction osteogenesis for brachymetatarsia using initial circular fixator and early trans-fixation metatarsal K—wires—a series of three cases†
Abstract
Brachymetatarsia is a rare forefoot deformity predominantly affecting the fourth metatarsal. Current treatment include gradual lengthening by distraction osteogenesis using an external fixator or single-stage lengthening with bone grafting or a combination of the above two procedures. Our aim was to assess outcomes and complications of a novel technique for gradual metatarsal lengthening using a circular fixator. The procedure was performed on three female patients with unilateral congenital shortening of the fourth ray. All participants reported aesthetic dissatisfaction as well as pressure related complications of the deformity and opted for lengthening and distraction osteogenesis using a frame. Mean duration of the treatment was 122 days and average length gained was 12 mm. The desired metatarsal length was achieved in all three patients with no significant complications. This method of treatment of brachymetatarsia is effective and reproducible. This a promising technique, owing to its low complication rates and efficacy in lengthening.https://ift.tt/2QHHcVa
Impairments of auditory-verbal short-term memory: do selective deficits of the input phonological buffer exist?
Publication date: Available online 11 October 2018
Source: Cortex
Author(s): Tim Shallice, Costanza Papagno
Abstract
The existence of the functional syndrome of auditory-verbal short-term storage impairment was used as strong supporting evidence for the presence of a phonological buffer in the first version of the Baddeley-Hitch working memory model. In later versions the syndrome corresponded to the selective impairment of the phonological input buffer. The present paper considers whether the correspondence between the functional syndrome, represented by 20 published cases, and a Baddeley-Hitch model component is still of value to memory theory. The following potential problems for the theoretical utility of the correspondence are considered:
1The apparent rarity of examples of the syndrome: are they outliers?
2Is short-term memory not merely the activation of long-term memory traces?
3Could the syndrome be due to failed interaction between perceptual and motor speech processing?
4Do some aspects of the syndrome not fit the Baddeley-Hitch model predictions?
5Has the Baddeley-Hitch model not been replaced by more powerful connectionist models?
6Could the syndrome arise from weakened speech perception processes?
It is argued that there are difficulties for each of these possibilities. It is held that the correspondence retains its value.
https://ift.tt/2C9mWrk
Vision of the upper limb fails to compensate for kinesthetic impairments in subacute stroke
Publication date: Available online 11 October 2018
Source: Cortex
Author(s): Jennifer A. Semrau, Troy M. Herter, Stephen H. Scott, Sean P. Dukelow
Abstract
Kinesthesia is an essential component of proprioception allowing for perception of movement. Due to neural injury, such as stroke, kinesthesia can be significantly impaired. Throughout neurorehabilitation, clinicians may encourage use of vision to guide limb movement to retrain impaired kinesthesia. However, little evidence exists that vision improves kinesthetic performance after stroke. We examined behavioral and neuroanatomical characteristics of kinesthesia post-stroke to determine if these impairments improve with vision.
Stroke subjects (N=281) performed a robotic kinesthetic matching task (KIN) without and with vision at ∼10 days post-stroke. A robotic exoskeleton moved the stroke-affected arm while subjects mirror-matched the movement with the opposite arm. Performance was compared to 160 controls. Spatial and temporal parameters were used to quantify kinesthetic performance. A Kinesthetic Task Score was calculated to determine overall performance on KIN without and with vision. Acute stroke imaging (N=236) was collected to determine commonalities in lesion characteristics amongst kinesthetic impairment groups.
Forty-eight percent (N=135) of subjects had post-stroke impairment in kinesthesia both without and with vision. Only 19% (N=52) improved to control-level performance with vision. Of the 48% of subjects that failed to improve with vision, many (N=77, 57%) had neglect and/or field deficits. Notably 58 subjects (43%) did not have these deficits and still failed to improve with vision. Subjects who failed to improve with vision often had lesions affecting corticospinal tracts, insula, and parietal cortex, specifically the supramarginal gyrus and inferior parietal lobule.
Many individuals could not use vision of the limb to correct for impaired kinesthesia after stroke. Subjects that failed to improve kinesthesia with vision had lesions affecting known sensorimotor integration areas. Our results suggest that integration of spatial information is impaired in many individuals post-stroke, particularly after parietal cortex damage. The result is a disconnect between kinesthetic and visuomotor processing necessary for visual limb guidance.
https://ift.tt/2CF5RXx
Stereotypic behaviours in frontotemporal dementia and progressive supranuclear palsy
Publication date: Available online 11 October 2018
Source: Cortex
Author(s): Sara Prioni, Veronica Redaelli, Paola Soliveri, Vincenza Fetoni, Federica Barocco, Paolo Caffarra, Augusto Scaglioni, Irene Tramacere, Floriano Girotti
Abstract
Introduction
The behavioural variant of frontotemporal dementia (bvFTD), and the Richardson variant of progressive supranuclear palsy (PSP-RS) share several clinical signs and symptoms. Since stereotypic behaviours are fairly common in bvFTD, and are also described in other degenerative dementias including Alzheimer's disease, and parkinsonisms with dementia, we aimed to examine the extent to which stereotypies also characterise PSP-RS.
Methods
We compared 53 bvFTD patients with 40 demented PSP-RS patients, seen consecutively as outpatients at four Italian Hospitals. Patients were assessed by the Neuropsychiatric Inventory (NPI); Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) for cognitive functions; Stereotypy Rating Inventory (SRI) for stereotypies; Unified Parkinson's Disease Rating Scale (UPDRS) for motor function; and Activities of Daily Living (ADL) to assess autonomy in daily life.
Results
The groups did not differ for age, illness duration, cognitive functions or total NPI score; PSP-RS had significantly more depressive symptoms and greater motor and autonomy compromise than bvFTD. The groups did not differ significantly on total SRI score, but bvFTD had significantly more cooking and eating stereotypies. Twenty-three (57.5%) PSP-RS and 43 (81%) bvFTD patients had at least one stereotypy; 16/23 (69.5%) PSP-RS and 9/43 (20.9%) bvFTD patients appeared aware of their stereotypies.
Conclusion
Stereotypies were common in our demented PSP-RS patients. Further studies on earlier stage non-demented PSP patients are required to ascertain whether stereotypies are characteristic of PSP in general or are confined to PSP-RS, and whether they may be used to suggest a PSP diagnosis early in disease course.
https://ift.tt/2C9mn0G
Pachyonychia congenita: A case report of a successful treatment with rosuvastatin in a patient with a KRT6A mutation
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2EfFEA8
Pachyonychia congenita: A case report of a successful treatment with rosuvastatin in a patient with a KRT6A mutation
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2EfFEA8
Deficiency of sun protection advertising exists in consumer magazines across demographic groups and varies by target demographic
Publication date: Available online 11 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): L.E. Wiznia, J. Wang, A.B. Steuer, N. Elbuluk
https://ift.tt/2Ca2tTh
Re-evaluating the Need for Routine Laboratory Monitoring in Isotretinoin Patients: A Retrospective Analysis
Publication date: Available online 11 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Radhika Shah, Daniela Kroshinsky
https://ift.tt/2CBOh6t
Galeatomy: A Useful Technique Aiding High-Tension Scalp Closures
Publication date: Available online 10 October 2018
Source: Journal of the American Academy of Dermatology
Author(s): Marjon Vatanchi, Roy C. Grekin
https://ift.tt/2C9CZFG
Advances in mechanisms of allergic disease 2017
Publication date: Available online 11 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Chrysanthi Skevaki, Harald Renz
Abstract
This review highlights advances in mechanisms of allergic disease, particularly type 2 innate lymphoid cells; TH2 lymphocytes; B cells; dendritic cells: microbiome and barrier function; eosinophils, mast cells. During the last year, considerable progress has been made in the further characterization of type 2 inflammation controlled by both adaptive (TH2) as well as innate (ILC2) effector cells. New pathways of lymphocyte activation, trafficking and recruitment, and effector cell mechanisms have been discovered. The plasticity of lymphocyte effector cell responses is another area where major progress has been achieved. Accumulating evidence will influence both our understanding of allergic disease but also our efforts for allergy prevention and treatment.
https://ift.tt/2IS0aW4
The specificity and definition of blood eosinophil
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Yan-Fang Xing, Yan-Hong Zhou, Ting Liu, Ding-Yun Feng, Jian-Hua Ren, Cong Wang, Si-Lu Tan, Wen-Hui Jiang
https://ift.tt/2pOKTww
Neuroplastic changes in the olfactory bulb associated with nasal inflammation in mice
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Sanae Hasegawa-Ishii, Atsuyoshi Shimada, Fumiaki Imamura
Abstract
Background
Rhinitis and rhinosinusitis are olfactory disorders caused by inflammation of the nasal passage and paranasal sinuses. Although chronic rhinosinusitis patients have smaller olfactory bulbs (OBs), there is limited knowledge regarding the influence of chronic nasal inflammation on OB neurons.
Objective
Repeated intranasal administration of lipopolysaccharide (LPS) that induced persistent nasal inflammation in mice caused a loss of olfactory sensory neurons (OSNs) and gliosis and synaptic loss in the OB within three weeks. The present study aimed to clarify the effects of long-term LPS treatment on the OB neurocircuit.
Methods
LPS was repeatedly administered into a mouse nostril for up to 24 weeks. For the recovery analyses, the mice received LPS for 10 weeks and were subsequently maintained without additional treatment for another 10 weeks. The effects of these treatments on the OB were histologically examined. Three or more mice were analyzed per group.
Results
Long-term repeated LPS administration caused OB atrophy, particularly in the layers along which OSN axons travel and in the superficial external plexiform layer (sEPL), in which tufted cells form synapses with interneurons. Interestingly, the OB recovered from atrophy following the cessation of LPS administration: the OB volume and sEPL thickness returned to the pretreatment level after the nontreatment period. In contrast, the regeneration of OSN was incomplete.
Conclusion
These results suggest that chronic nasal inflammation induces structural changes in a specific OB circuit related to tufted cells, while tufted cells retain a high degree of plasticity that enables recovery from structural damages after inflammation subsides.
Graphical abstract
https://ift.tt/2QMbF4r
Identification of bee venom Api m 1 IgE epitopes and characterization of corresponding mimotopes
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Abida Zahirović, Ana Koren, Peter Kopač, Borut Štrukelj, Peter Korošec, Mojca Lunder
https://ift.tt/2A4KJHv
Epithelial acid imbalance in eosinophilic esophagitis
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): David A. Hill, Jonathan M. Spergel
https://ift.tt/2QIypC6
Reply
Publication date: Available online 10 October 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Jeong H. Yun, Craig P. Hersh
https://ift.tt/2A4qOIQ
Multivariable model for predicting acute oral mucositis during combined IMRT and chemotherapy for locally advanced nasopharyngeal cancer patients
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Ester Orlandi, Nicola Alessandro Iacovelli, Tiziana Rancati, Alessandro Cicchetti, Paolo Bossi, Emanuele Pignoli, Cristiana Bergamini, Lisa Licitra, Carlo Fallai, Riccardo Valdagni, Anna Cavallo
Abstract
Introduction/objective
Oral and oropharyngeal mucositis (OM) represents a multifactorial and complex interplay of patient-, tumor-, and treatment-related factors. We aimed to build a predictive model for acute OM for locally advanced nasopharyngeal carcinoma (NPC) patients by combining clinical and dosimetric factors.
Materials/methods
A series of consecutive NPC patients treated curatively with IMRT/VMAT + chemotherapy at 70 Gy (2–2.12 Gy/fr) was considered. For each patient, clinical- tumor- and treatment-related data were retrospectively collected. oral cavity (OC) and parotid glands (PG, considered as a single organ) were selected as organs-at-risk (OARs). Acute OM was assessed according to CTCAE v4.0 at baseline and weekly during RT. Two endpoints were considered: grade ≥3 and mean grade ≥1.5. DVHs were reduced to Equivalent Uniform Dose (EUD). Dosimetric and clinical/treatment features selected via LASSO were inserted into a multivariable logistic model. Goodness of fit was evaluated through Hosmer-Lemeshow test and calibration plot.
Results
Data were collected for 132 patients. G ≥ 3 and mean G ≥ 1.5 OM were reported in 40 patients (30%). Analyses resulted in a 3-variables model for G ≥ 3 OM, including OC EUD with n = 0.05 (OR = 1.02), PG EUD with n = 1 (OR = 1.06), BMI ≥ 30 (OR = 3.8, for obese patients), and a single variable model for mean G ≥ 1.5 OM, i.e. OC EUD with n = 1 (mean dose) (OR = 1.07). Calibration was good in both cases.
Conclusion
OC mean dose was found to impact most on OM duration (mean G ≥ 1.5), while G ≥ 3 OM was associated to a synergic effect between PG mean dose and high dose received by small OC volumes, with BMI acting as a dose-modifying factor.
https://ift.tt/2A4h0hG
A novel scoring model to predict benefit of additional induction chemotherapy to concurrent chemoradiotherapy in stage II–IVa nasopharyngeal carcinoma
Publication date: November 2018
Source: Oral Oncology, Volume 86
Author(s): Liang Peng, Yu-Pei Chen, Cheng Xu, Ling-Long Tang, Lei Chen, Ai-Hua Lin, Xu Liu, Ying Sun, Jun Ma
Abstract
Objectives
Induction chemotherapy (IC) is gaining recognition for the treatment of nasopharyngeal carcinoma (NPC). We aimed to develop a model to predict benefit from additional IC to concurrent chemoradiotherapy (CCRT).
Materials and methods
From an NPC-specific database, 7413 patients with stage II–IVa disease who received CCRT with or without IC were included. Distant metastasis-free survival (DMFS) was the primary outcome and benefit from IC was evaluated by adjusted hazard ratio. Interaction terms between IC and other prognostic factors were identified in multivariate Cox model, and IC benefit score (ICBS) was calculated based on β coefficients from the Cox model.
Results
Nodal category, overall stage, and pre-treatment plasma Epstein–Barr virus DNA (log transformed as continuous variable) interacted with IC and determined ICBS. ICBS could discriminate patients who benefited differently from IC in terms of DMFS well, especially for patients with high and low ICBS. As for patients with medium ICBS, predictive performance of ICBS seemed reduced.
Conclusions
Based on the ICBS model, we proposed a decision-making process to help in clinical practice. Multi-institutional and prospective studies are warranted to further validate our findings.
https://ift.tt/2QJCsyi
Changing sexual practices: A possible link to oral cancer
Publication date: Available online 11 October 2018
Source: Oral Oncology
Author(s): Sameep S. Shetty, U.S. Vishal Rao
https://ift.tt/2CbllkY
Use of the index of ideality of correlation to improve models of eco-toxicity
Abstract
Persistent organic pollutants are compounds used for various everyday purposes, such as personal care products, food, pesticides, and pharmaceuticals. Decomposition of considerable part of the above pollutants is a long-time process. Under such circumstances, estimation of toxicity for large arrays of organic substances corresponding to the above category of pollutants is a necessary component of theoretical chemistry. The CORAL software is a tool to establish quantitative structure—activity relationships (QSARs). The index of ideality of correlation (IIC) was suggested as a criterion of predictive potential of QSAR. The statistical quality of models for eco-toxicity of organic pollutants, which are built up, with use of the IIC is better than statistical quality of models, which are built up without use of data on the IIC.
https://ift.tt/2EesRhB
Pooled Analysis of Clinical Data From Six GSK Studies to Investigate the Efficacy of a Dentifrice Containing 67% Weight by Weight (w/w) Sodium Bicarbonate on Gingivitis and Plaque Accumulation
Conditions: Gingivitis; Plaque Accumulation
Interventions: Other: Sodium bicarbonate; Other: Control Dentifrice
Sponsor: GlaxoSmithKline
Not yet recruiting
https://ift.tt/2NzrU2B
Interventions: Other: Sodium bicarbonate; Other: Control Dentifrice
Sponsor: GlaxoSmithKline
Not yet recruiting
https://ift.tt/2NzrU2B
Liquid Biopsy Evaluation and Repository Development at Princess Margaret
Conditions: Cancer; Breast Cancer; Lung Cancer; Colon Cancer; Ovarian Cancer; Melanoma; Lymphoma; Leukemia; Mutation; Lynch Syndrome; Cowden Syndrome; BRCA1 Mutation; BRCA2 Mutation; Uterine Cancer; Myeloma; Kidney Cancer; Head and Neck Cancer; Meningioma
Intervention:
Sponsor: University Health Network, Toronto
Recruiting
https://ift.tt/2OQW71S
Intervention:
Sponsor: University Health Network, Toronto
Recruiting
https://ift.tt/2OQW71S
Pooled Analysis of Clinical Data From Six GSK Studies to Investigate the Efficacy of a Dentifrice Containing 67% Weight by Weight (w/w) Sodium Bicarbonate on Gingivitis and Plaque Accumulation
Conditions: Gingivitis; Plaque Accumulation
Interventions: Other: Sodium bicarbonate; Other: Control Dentifrice
Sponsor: GlaxoSmithKline
Not yet recruiting
https://ift.tt/2NzrU2B
Interventions: Other: Sodium bicarbonate; Other: Control Dentifrice
Sponsor: GlaxoSmithKline
Not yet recruiting
https://ift.tt/2NzrU2B
Liquid Biopsy Evaluation and Repository Development at Princess Margaret
Conditions: Cancer; Breast Cancer; Lung Cancer; Colon Cancer; Ovarian Cancer; Melanoma; Lymphoma; Leukemia; Mutation; Lynch Syndrome; Cowden Syndrome; BRCA1 Mutation; BRCA2 Mutation; Uterine Cancer; Myeloma; Kidney Cancer; Head and Neck Cancer; Meningioma
Intervention:
Sponsor: University Health Network, Toronto
Recruiting
https://ift.tt/2OQW71S
Intervention:
Sponsor: University Health Network, Toronto
Recruiting
https://ift.tt/2OQW71S
This is what scientific societies are for. The CIBAL consensus
Publication date: November–December 2018
Source: Allergologia et Immunopathologia, Volume 46, Issue 6
Author(s): L. Garcia-Marcos
https://ift.tt/2NBtO2H
Cooking influence in tolerance acquisition in egg-induced acute food protein enterocolitis syndrome
Publication date: Available online 11 October 2018
Source: Allergologia et Immunopathologia
Author(s): S. Miceli Sopo, A. Romano, G. Bersani, C. Fantacci, L. Badina, G. Longo, G. Monti, S. Viola, S. Tripodi, G. Barilaro, I.D. Iacono, C. Caffarelli, C. Mastrorilli, S. Barni, F. Mori, L. Liotti, B. Cuomo, F. Franceschini, D. Viggiano, S. Monaco
Abstract
Background
Few studies on the age of resolution of Food Protein Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months.
Objective
We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw.
Methods
We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition.
Results
Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded.
Conclusions
It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES.
https://ift.tt/2OQVNQI
Focus group parental opinions regarding treatment with topical corticosteroids on children with atopic dermatitis
Publication date: Available online 10 October 2018
Source: Allergologia et Immunopathologia
Author(s): S. Veenje, H. Osinga, I. Antonescu, B. Bos, T.W. de Vries
Abstract
Introduction and objectives
Atopic dermatitis is common among children of 0–5 years old. Treatment consists of emollients and topical corticosteroids. Due to corticophobia, however, adherence to topical corticosteroids is low. Our aim was to find factors that influence opinions about topical corticosteroids among parents of children with atopic dermatitis.
Methods
A qualitative focus group study in secondary care with parents of children with atopic dermatitis. Questions concerned opinions, attitude, sources of information, and the use of topical corticosteroids.
Results
The parents indicated that they lack knowledge about the working mechanism and side effects of topical corticosteroids. Dermatologists and paediatricians emphasise the beneficial effects, whereas other healthcare workers and lay people often express a negative attitude.
Conclusions
This study gives a complete overview of factors influencing adherence. Treatment with topical corticosteroids can be improved by better informing parents about the working mechanisms, the use, and how to reduce the dose. Healthcare professionals need to be aware of the consequences of their negative attitude concerning topical corticosteroids.
https://ift.tt/2Ny5K0M
Evaluation of corrosion control products on a distribution system through crowdsourcing
Abstract
Crowdsourcing of citizens was used to determine the effectiveness of corrosion control in a water distribution system. This study examines the frequency and severity of "Red Water" complaints over a period of 4 years, and two different corrosion control chemicals, polyphosphate and zinc orthophosphate. The data revealed that the frequency of Red Water complaints was higher when using zinc orthophosphate while the severity (higher iron) was higher when using polyphosphates. Varying the dose of zinc orthophosphate to account for cold months induced a greater number of customer complaints. Moreover, corrosion coupons studies suggest similar performance of both corrosion inhibitor products. The corrosion and complaints might be driven by microbial-induced processes in which diatoms might play a significant role.
https://ift.tt/2A4ohhB
Development of a Donor Tissue Holding Technique for Descemet’s Membrane Endothelial Keratoplasty Using a 25-Gauge Graft Manipulator
Purpose: To report a modified surgical technique called the "donor tissue holding technique for Descemet's membrane endothelial keratoplasty (DMEK)" using a newly developed 25-gauge graft manipulator. Methods: Six consecutive patients exhibiting endothelial dysfunction were enrolled and treated by DMEK. In brief, after insertion of a DMEK donor into the anterior chamber, the edge of the roll was grasped using a graft manipulator and this grasp was maintained throughout the centering and opening of the roll (holding technique). The following parameters were evaluated in comparison to the previous 10 consecutive DMEK cases in which the no touch technique was used: time of graft unfolding, incidence of intra-/postoperative complications, and best spectacle-corrected visual acuity (BCVA) and endothelial cell density (ECD) 6 months after the procedure. Results: In both technique groups, neither intra- nor postoperative complications were noted in any case. No differences were observed between the two groups in postoperative BCVA (p = 0.88). Also, no differences were observed between the two groups in postoperative ECD (holding technique group: 2,108.3 cells/mm2, no touch technique group: 1,491.7 cells/mm2) (p = 0.08) Most notably, the time of graft unfolding prior to filling with air was significantly reduced in the holding technique group (305.5 s) compared to that of the no touch technique group (1,310.0 s; p = 0.01). Conclusions: This donor tissue holding technique enabled rapid and safe DMEK in a reproducible manner, even in Asian eyes with shallow anterior chambers with high vitreous pressure.
Case Rep Ophthalmol 2018;9:431–438
https://ift.tt/2PABdkw
Case Rep Ophthalmol 2018;9:431–438
https://ift.tt/2PABdkw
Multi-wavelength laser treatments of spider nevi
Abstract
Spider nevi (SN) are one of common vascular diseases. Different treatment techniques have been described for SN previously, including electrocoagulation, argon laser, pulsed dye lasers (PDL), pulsed potassium titanylphosphate laser (KTP), and 1064-nm neodymium yttrium-aluminum-garnet (Nd:YAG) laser. These methods are effective but may require good technical management, multiple treatments, and often result in scarring or pigmentation. Multi-wavelength laser combined with 595-nm PDL followed by 1064-nm Nd:YAG and can be selectively absorbed by hemoglobin in vessels. The 595-nm laser can target shallow vessels whereas the 1064-nm laser may target deeper vessels due to the different penetration capacities of these wavelengths. Moreover, Nd:YAG absorption is remarkable increased following by PDL treatment. Multi-wavelength laser treatments have been successfully used for vascular diseases but there is little experience in SN therapy. Consequently, these treatment parameters have not been established for SN, particularly in Asian patients with Fitzpatrick skin type (FST) IV. Report experience with using multi-wavelength laser for SN treatment in Asian patients with FST IV. Forty-three SN lesions received multi-wavelength laser treatments via a PDL followed by an Nd:YAG laser. The treatment was performed at 7 mm spot size at 9.5–11 J/cm2, 10 ms with PDL, followed by Nd:YAG at 40–50 J/cm2, 15 ms. The laser treatments were performed with a single pass without overlap. Complete resolution was observed in 40 lesions and an 80–90% improvement in the other three lesions after one treatment session. One patient had superficial scarring. Four patients had hyperpigmentation that resolved within 3 months. Multi-wavelength laser treatments are fast and effective interventions for SN treatment in Asian patients with minimal adverse effects when appropriate parameters are set.
https://ift.tt/2C8iw40
Nasal Symptom Questionnaire: Our Proposed Scoring System and Prognostic Factors in Chronic Rhinosinusitis
ORL
https://ift.tt/2QH0cCY
Effects of dehydroepiandrosterone (DHEA) supplementation on sexual function in premenopausal infertile women
Abstract
Purpose
To investigate the effects of dehydroepiandrosterone (DHEA) supplementation on female sexual function in premenopausal infertile women of advanced ages.
Methods
This observational study was conducted in an academically affiliated private fertility center. Patients included 87 premenopausal infertile women, 50 of whom completed the study including the Female Sexual Function Index (FSFI) questionnaires and comprehensive endocrine evaluation before and 4–8 weeks after initiating 25 mg of oral micronized DHEA TID.
Results
Age of patients was 41.1 ± 4.2 years, BMI 24.4 ± 6.1 kg/m2, 86% were married, and 42% were parous. Following supplementation with DHEA, all serum androgen levels increased (each P < 0.0001), while FSH levels decreased by 2.6 ± 4.4 from a baseline of 10.3 ± 5.4 mIU/mL (P = 0.009). The FSFI score for the whole study group increased by 7% (from 27.2 ± 6.9 to 29.2 ± 5.6; P = 0.0166). Domain scores for desire increased by 17% (P = 0.0004) and by 12% for arousal (P = 0.0122); lubrication demonstrated an 8% trend towards improvement (P = 0.0551), while no changes in domain scores for orgasm, satisfaction, or pain were observed. Women in the lowest starting FSFI score quartile (<25.7), experienced a 6.1 ± 8.0 (34%) increase in total FSFI score following DHEA supplementation. Among these women, improvements in domain categories were noted for desire (40%), arousal (46%), lubrication (33%), orgasm (54%), satisfaction (24%), and pain (25%).
Conclusions
This uncontrolled observational study implies that supplementation with DHEA improves sexual function in older premenopausal women with low baseline FSFI scores.
https://ift.tt/2A4ji0s
Increased IL17‐expressing γδ T Cells in Seborrheic Dermatitis‐like Lesions of the Mpzl3 Knockout Mice
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yewVsN
Sequential cyclic changes of hair roots revealed by dermoscopy demonstrate a progressive mechanism of diffuse alopecia areata over time
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2Pst41P
CIC fusion-positive sarcoma of the spermatic cord
Abstract
In addition to germ cell tumors and tumors of the sex cord stroma, the WHO classification of testis and paratesticular tumors also contains malignant soft tissue tumors. Among them, liposarcomas of the spermatic cord are the most common entities. Other mesenchymal tumors with smooth muscle, skeletal muscle, fibroblastic/myofibroblastic, or nerve sheath differentiation are rare. Ewing sarcoma is composed of uniform small round cells and typically characterized by translocations of the EWSR1 gene. In rare cases, Ewing sarcoma-like tumors lack an EWSR1 gene fusion. Some of these tumors harbor a specific CIC translocation. However, Ewing-like sarcoma has up to now never been described in the testis or spermatic cord. The present case describes the first EWSR1-negative, undifferentiated round cell sarcoma with CIC translocation of the spermatic cord. Potential differential diagnoses are discussed.
https://ift.tt/2OgunnX
Prevalence of degenerative joint disease of the temporomandibular joint: a systematic review
Abstract
Objectives
The purpose of this systematic review was to evaluate evidence about the prevalence of degenerative joint disease (DJD) of the temporomandibular joints (TMJ).
Materials and methods
We performed search on electronic databases and gray literature from their inception to January 2018. Studies reporting prevalence data of DJD on TMJ were included. DJD was assessed through clinical and imaging diagnosis. Studies risk of bias was evaluated using the Critical Appraisal Checklist for Studies Reporting Prevalence Data.
Results
From 1082 studies, 32 were identified, and the sample size included 3435 subjects. They were clustered into two groups: the first comprised studies that reported prevalence of DJD in TMJ secondary to rheumatic systemic diseases like juvenile idiopathic arthritis (JIA) and rheumatoid arthritis (RA) and the second group comprised studies that reported prevalence of DJD on temporomandibular disorder patients. The prevalence of DJD on JIA patients ranged from 40.42% (n = 47) to 93.33% (n = 15) and on RA patients from 45.00% (n = 20) to 92.85% (n = 56). Among TMD patients, the prevalence of DJD reported according to patients ranged from 18.01% (n = 1038) to 84.74% (n = 118) and reported according to joints ranged from 17.97% (n = 178) to 77.23% (n = 224).
Conclusion
This review attempts to high prevalence of DJD in patients with systemic rheumatic disease and a less prevalent, but still high, occurrence in patients with TMD without systemic involvement.
Clinical relevance
Specialist doctors and dentists should be alert to not underestimate and to correctly diagnose DJD of the TMJ early in patients with rheumatic disease and TMD.
https://ift.tt/2A4iTes
Severe hyperchylomicronemia in two infants with novel APOC2 gene mutation
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
https://ift.tt/2EfGbSJ
Prevalence of overweight and obesity and anthropometric reference centiles for Albanian children and adolescents living in four Balkan nation-states
Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print
https://ift.tt/2RIlBgj
Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: A double-blind prospective, randomised study
BACKGROUND Cleft defects are common craniofacial malformations which require early surgical repair. These patients are at high risk of postoperative airway obstruction and respiratory failure. Cleft surgery may require high doses of opioids which may contribute to these complications. OBJECTIVES To compare the effectiveness of proximal and distal approaches to blocking the maxillary nerve in patients undergoing cleft lip or cleft palate surgery. DESIGN Randomised, controlled and double-blind study. SETTING The current study was carried out in Guwahati (Assam, India) between April 2014 and June 2014. PATIENTS A total of 114 patients older than 6 months who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included coagulation disorders, peripheral neuropathy or chronic pain syndrome, infection in the puncture site, allergy to local anaesthetics, lack of consent and language problems or other barriers that could impede the assessment of postoperative pain. INTERVENTIONS Patients were randomly assigned to one of two groups: proximal group (bilateral suprazygomatic maxillary nerve blocks) and distal group (bilateral infraorbital nerve blocks for cleft lip repair and bilateral greater and lesser palatine nerve blocks and nasopalatine nerve block for cleft palate surgery). MAIN OUTCOME MEASURE The primary endpoint was the percentage of patients requiring extra doses of opioids. Secondary endpoints included pain scores, respiratory and nerve block-related complications during the first 24 h. RESULTS In the intra-operative period, there was a significant reduction of nalbuphine consumption in the proximal group (9.1 vs. 25.4%, P = 0.02). The percentage of patients requiring intra-operative fentanyl was lower in the proximal group (16.4 vs. 30.5%, P = 0.07). There were no differences in either postoperative pain scores or in postoperative complications. No technical failure or block-related complications were reported. CONCLUSION Bilateral suprazygomatic maxillary nerve block is an effective and safe alternative to the traditional peripheral nerve blocks for cleft lip and cleft palate surgery, in a mixed paediatric and adult population. Correspondence to Gaston Echaniz, Department of Anesthesiology, Vall d'Hebron Hospital, Department of Surgery, Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron, 119-129, Barcelona 08035, Spain. E-mail: grcechaniz@vhebron.net Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology
https://ift.tt/2QHkxZ6
https://ift.tt/2QHkxZ6
Measurement of forces applied using a Macintosh direct laryngoscope compared with a Glidescope video laryngoscope in patients with predictors of difficult laryngoscopy: A randomised controlled trial
BACKGROUND In patients with predictive features associated with easy direct laryngoscopy, videolaryngoscoy with the GlideScope has been shown to require less force when compared with Macintosh direct laryngoscopy. OBJECTIVE The aim of this study was to compare forces applied with Glidescope vs. Macintosh laryngoscopes in patients with predictive features associated with difficult direct laryngoscopy. DESIGN A prospective randomised study. SETTING Toronto General Hospital, a university tertiary centre in Canada. PATIENTS Forty-four patients aged over 18 years, with one or more features of difficult intubation, undergoing elective surgery requiring single-lumen tracheal intubation. INTERVENTION We measured the force applied to oropharyngeal tissues by attaching three FlexiForce Sensors (A201-25) to the concave surface of Macintosh and GlideScope laryngoscope blades. Anaesthetists or experienced anaesthesia residents performed laryngoscopies with both devices in a randomised sequence. MAIN OUTCOME MEASURES The primary outcome was peak force. The secondary outcomes were average force and impulse force. The latter is the integral of the force over the time during which the force acted. RESULTS Complete data were available for 40 individuals. Peak and average forces decreased with GlideScope (17 vs. 21 N, P = 0.03, and 6 vs. 11 N, P
https://ift.tt/2A4QCoh
https://ift.tt/2A4QCoh
Modified ROTEM for the detection of rivaroxaban and apixaban anticoagulant activity in whole blood
BACKGROUND Rapid detection of the anticoagulant effect of oral factor Xa (FXa) inhibitors may be essential in several emergency clinical situations. Specific assays quantifying the drugs are performed in plasma and require a turnaround time that is too long to be useful in emergency situations. Rotational thromboelastometry (ROTEM) is a whole blood coagulation assay of blood viscoelasticity and could be of interest for FXa inhibitor detection in emergency. However, conventional ROTEM reagents only detect high amounts of inhibitors. OBJECTIVE The aim of this study was first to assess the effect of whole blood components on the viscoelastic measurement of the effects of FXa inhibitors, an second to evaluate whether a modified ROTEM, triggered with a low amount of tissue factor and a saturating amount of phospholipid vesicles, can reliably detect low levels of FXa inhibitor activity in whole blood. DESIGN Diagnostic test study. SETTINGS A university research laboratory. From November 2014 to April 2016. PATIENTS Sixty-six patients: 30 treated with rivaroxaban, 17 with apixaban and 19 without treatment. INTERVENTION ROTEM was triggered with 2.5 pmol l−1 of tissue factor and 10 μmol l−1 of phospholipid vesicles. MAIN OUTCOME MEASURES Modified ROTEM parameters were measured in different experimental conditions: platelet-poor plasma (PPP), platelet-rich plasma, PPP supplemented with fibrinogen and reconstituted whole blood with various haematocrit levels adjusted between 30 and 60%. Modified ROTEM was further validated using whole blood from patients who were either treated or not treated with FXa inhibitors. RESULTS Modified ROTEM allowed detection of as little as 25 ng ml−1 FXa inhibitors in PPP, with at least a 1.4-fold increase of the clotting time (P ≤ 0.02). Neither changes of fibrinogen concentration nor variations of platelet count or haematocrit precluded FXa inhibitor detection. A lengthened modified ROTEM clotting time of more than 197 s allowed detection of FXa inhibitor concentrations above 30 ng ml−1 in whole blood with 90% sensitivity and 85% specificity. CONCLUSION Modified ROTEM may be applicable in emergency situations for the detection of FXa inhibitors in whole blood. Correspondence to Charles M. Samama, MD, PhD, FCCP, Department of Anaesthesia and Intensive Care Medicine, Cochin University Hospital, 27 rue du Faubourg St Jacques, 75014 Paris, France Tel: +33 1 42 34 85 51/+33 6 62 14 86 64; fax: +33 1 58 41 14 15; e-mail: marc.samama@aphp.fr Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology
https://ift.tt/2QHkoF2
https://ift.tt/2QHkoF2
Effects of dehydroepiandrosterone (DHEA) supplementation on sexual function in premenopausal infertile women
Abstract
Purpose
To investigate the effects of dehydroepiandrosterone (DHEA) supplementation on female sexual function in premenopausal infertile women of advanced ages.
Methods
This observational study was conducted in an academically affiliated private fertility center. Patients included 87 premenopausal infertile women, 50 of whom completed the study including the Female Sexual Function Index (FSFI) questionnaires and comprehensive endocrine evaluation before and 4–8 weeks after initiating 25 mg of oral micronized DHEA TID.
Results
Age of patients was 41.1 ± 4.2 years, BMI 24.4 ± 6.1 kg/m2, 86% were married, and 42% were parous. Following supplementation with DHEA, all serum androgen levels increased (each P < 0.0001), while FSH levels decreased by 2.6 ± 4.4 from a baseline of 10.3 ± 5.4 mIU/mL (P = 0.009). The FSFI score for the whole study group increased by 7% (from 27.2 ± 6.9 to 29.2 ± 5.6; P = 0.0166). Domain scores for desire increased by 17% (P = 0.0004) and by 12% for arousal (P = 0.0122); lubrication demonstrated an 8% trend towards improvement (P = 0.0551), while no changes in domain scores for orgasm, satisfaction, or pain were observed. Women in the lowest starting FSFI score quartile (<25.7), experienced a 6.1 ± 8.0 (34%) increase in total FSFI score following DHEA supplementation. Among these women, improvements in domain categories were noted for desire (40%), arousal (46%), lubrication (33%), orgasm (54%), satisfaction (24%), and pain (25%).
Conclusions
This uncontrolled observational study implies that supplementation with DHEA improves sexual function in older premenopausal women with low baseline FSFI scores.
https://ift.tt/2A4ji0s
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