Head and Neck Diseases by Alexandros G.Sfakianakis: 10/12/18

Παρασκευή 12 Οκτωβρίου 2018

Sleeping beauty syndrome presenting with insomnia

A young man previously diagnosed with Kleine-Levin syndrome (KLS) presented with abnormal behaviour over the last 8 days. This included decreased sleeping hours and appetite, hypersexuality, aggressiveness and visual hallucinations. All blood tests and investigations in the emergency department yielded normal results. A preliminary diagnosis of a KLS episode with psychosis was made and the patient was started on a regimen of aripiprazole 10 mg once daily along with lorazepam 2 mg intravenously in two divided doses in the event of agitation or insomnia. On discharge 5 days later, the patient had returned to his premorbid level of functioning and was willing to follow up in the neurology clinic. He was discharged on aripiprazole 10 mg once daily and lorazepam 2 mg two times daily as needed for 2 weeks to help with his agitation and insomnia, as well as lithium carbonate 400 mg at night.

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Takotsubo syndrome with severe bradycardia initiated by seizure: Is the implantation of a permanent pacemaker necessary?

Although arrhythmias are frequent in patients with Takotsubo syndrome (TTS), data on sick sinus syndrome remain elusive. Here, we report a case of TTS initiated by a seizure as a physical trigger that led to sinus arrest. The patient presented with cardiogenic shock and bradycardia which required intensive cardiovascular care. However, in the subacute phase of TTS, the sinus function recovered significantly, and pacemaker implantation was deferred.

https://ift.tt/2Eg1l2Y

Living donor renal transplant in a patient with end-stage renal disease due to Hermansky-Pudlak syndrome

Hermansky-Pudlak syndrome (HPS) is a rare genetic disorder characterised by oculocutaneous albinism, bleeding diathesis and end-stage renal disease (ESRD), due to interstitial deposition of ceroid lipofuscin. Renal transplantation is potentially a definitive treatment option for patients with ESRD due to HPS. Herein, we describe the case of a 55-year-old male patient with HPS that successfully underwent a living donor kidney transplant. We also emphasise the importance of multidisciplinary input during the preoperative, perioperative and postoperative phases in this high-risk clinical scenario.

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Living donor liver transplantation and situs inversus totalis: cutting the Gordian knot

Liver transplantation for biliary atresia splenic malformation syndrome associated with situs inversus totalis is a challenging task due to the complexity of associated malformations and the technical proficiency required to overcome them. We present the case of a 6-month-old infant who underwent liver transplantation for biliary atresia. A reduced left lateral segment liver graft from a live donor (his mother) was implanted. The postoperative period was uneventful, and the child remained well on follow-up. Thus, such rare congenital anomalies no longer prove to be a deterrent for successful liver transplantation.

https://ift.tt/2EfGpt2

Unusual case of unilateral conductive hearing loss: chronic lymphocytic leukaemia

This presentation reports a novel case of chronic lymphocytic leukaemia (CLL), presenting with an early cutaneous lesion within the external auditory canal, in a patient being assessed for conductive hearing loss. It has previously been reported that infiltrative CLL can involve the head and neck; however, isolated external ear canal involvement is rare. Given that the incidence of CLL in Australia is rising, this case highlights the importance of considering CLL as a differential diagnosis for presentations of unilateral conductive hearing loss.

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Corneal ulcer as the presenting feature of type 2 diabetes mellitus

A 60-year-old woman, with no significant medical or ophthalmic history, presented with a unilateral large corneal ulcer and hypopyon. Despite a severely injected conjunctiva and large corneal epithelial defect, the patient denied any discomfort in the eye. The ulcer was extremely slow to heal requiring prolonged treatment with topical and systemic broad-spectrum antibiotics. Due to the corneal opacification, fundal examination was not possible. Subsequent examination of the fellow eye revealed an appearance consistent with proliferative diabetic retinopathy. She was given treatment with panretinal laser photocoagulation. There was no history of diabetes and the patient denied experiencing any of the classical symptoms of hyperglycaemia. With blood tests revealing a raised plasma glucose and Haemoglobin A1c (HbA1c), a new diagnosis of diabetes mellitus was made. With the commencement of treatment for diabetes, there were signs of improvement in the corneal appearance.

https://ift.tt/2EjtOVF

Mesenteric panniculitis: diagnostic precision

A previously healthy 74-year-old woman was admitted with vespertine fever, tremors, shivers and loss of appetite within the previous month. Blood tests revealed an elevated C reactive protein serum level. Serologies for infection were negative. Blood cultures grew no organisms. Colonoscopy revealed normal findings. CT showed typical findings of mesenteric panniculitis with infiltration of mesenteric fat that was circumscribed by hyperattenuating capsule and contained enlarged homogenous lymph nodes. The histopathological analysis from mesenterium revealed non-specific signs of chronic inflammation. On institution of prednisolone, the clinical symptoms subsided, and we replaced it with azathioprine after 1 month. After 12 months of therapy, the patient remained asymptomatic, normalised the serological inflammatory markers and repeat CT revealed normal mesenteric fat.

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Bilateral congenital eventration of diaphragm: keep in mind, the other side

Eventration of diaphragm is an uncommon disorder in which diaphragmatic muscle is replaced by fibroelastic tissue, either partially or completely. Bilateral eventration is even rarer. We present a case of bilateral eventration of diaphragm in newborn with a fibroelastic sac on left side and diaphragmatic eventration with good muscular lips on right side. The right-sided diaphragmatic eventration was not evident initially, but manifested after surgical repair of the left-sided eventration.

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Cerebrospinal fluid hydrocele caused by scrotal migration of a ventriculoperitoneal shunt

A 6-month-old boy presented with painless right hemiscrotal swelling. The scrotal ultrasound revealed a cerebrospinal fluid hydrocele caused by the migration of a ventriculoperitoneal shunt (VPS) catheter tip into the right hemiscrotum and associated undescended left testis. Earlier, he underwent a VPS placement for hydrocephalus secondary to neonatal bacterial meningitis and ventriculitis. The patient was treated with bilateral herniotomy, left-sided orchidopexy and repositioning of VPS into the peritoneal cavity.

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Methicillin-sensible Staphylococcus aureus causing endocarditis, with cerebral and orthopaedic complications, in a 17-month-old child with no risk factor

We report a case of Staphylococcus aureus endocarditis, with large vegetation, in a 17-month-old male infant, complicated with meningitis, ischaemic strokes and osteoarthritis leading to haemorrhagic stroke by aneurysm rupture. He did not present any risk factor for endocarditis. The final course was favourable through, after valve replacement. The strain was sensible to methicillin and belongs to complex clonal 398, with accessory gene regulator I. We did not found immunodeficiency.

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Unilateral localized extraocular muscle metastasis by lobular breast carcinoma

Here is a case of an isolated orbital metastasis in a previously diagnosed metastatic breast cancer of a 46-year-old woman presenting diplopia and pain in her left eye. The magnetic resonance showed a suspected metastatic localisation in the upper left oblique muscle, which was confirmed by the fine-needle aspiration biopsy. The systemic therapy with liposomal doxorubicin as well as local stereotactic radiotherapy showed a gradual improvement of the local symptoms and signs.

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A snotty nose: more than just a cold

Description

A healthy 3-year-old girl presented with a 5-day history of right-sided cheek and eye swelling and pain, associated with right-sided green nasal discharge. Examination revealed diffuse erythematous swelling around the right cheek, jawline and eye. Oral antibiotics for suspected periorbital cellulitis were ineffective. Blood inflammatory markers and ultrasound of her neck and parotid glands were normal. She was discharged as having viral parotitis. Antibiotics and nasal drops were later restarted for clinical sinusitis; however, she showed no improvement, now having 3 weeks of right-sided facial swelling with thick green and intermittently bloody nasal discharge. Further history revealed possible squint, mastication pain and breathing difficulty through the right nostril.

Cranial imaging (figure 1) demonstrated a large central but predominantly right-sided nasopharyngeal tumour, extending into the ethmoid sinuses and orbits (with medial recti distortion), infratemporal fossa and pterygoid muscles and anterior and middle cranial fossae. There was...

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Disseminated nocardiosis with infective endocarditis of a transplanted heart

Nocardiosis is caused by various species of Nocardia and typically occurs as an opportunistic infection. It frequently disseminates, most often involving the lungs, subcutaneous tissues and central nervous system. It has rarely been reported to affect native heart valves. We report the case of a 64-year-old man with disseminated nocardiosis involving the brain, lungs, muscle and tricuspid valve of a transplanted heart. Following antimicrobial therapy, the patient improved clinically and there was no evidence of residual infection on follow-up imaging. This case highlights the presentation of nocardiosis, current therapeutic guidelines and the question of prophylaxis against Nocardia in immunocompromised patients.

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Toxic epidermal necrolysis: the red eye and red herrings in casualty

A 38-year-old woman presented to casualty with bilateral red eyes associated with a recent upper respiratory tract infection. This was initially diagnosed as conjunctivitis, however systemic review revealed an erythematous facial and skin rash, mildly swollen lips and mild swallowing difficulties. The patient was referred for an urgent medical assessment, by which time she was found to have erythema affecting 54% of her body surface area and diagnosed with suspected toxic epidermal necrolysis (TEN). She rapidly deteriorated over 24 hours with a spreading blistering skin rash and airway compromise requiring urgent intubation and admission to the intensive treatment unit (ITU). Subsequent skin biopsies confirmed the diagnosis of TEN, attributed to recent use of ibuprofen. Treatment included broad-spectrum antibiotics and high-dose corticosteroids. The patient had a prolonged hospital stay and developed severe scarring of the ocular surface. She was discharged home and remains under continuing outpatient follow-up with ophthalmology and dermatology teams.

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Neonate with urinary ascites but no hydronephrosis: unusual presentation of posterior urethral valves

Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.

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Acute pancreatitis-induced takotsubo cardiomyopathy and cardiogenic shock treated with a percutaneous left ventricular assist device

A 63-year-old man was admitted for severe acute pancreatitis. On day 3 of hospitalisation, he developed shortness of breath and acute pulmonary oedema. Echocardiogram revealed global hypokinesis with a left ventricular ejection fraction of 20%, and he was diagnosed with takotsubo cardiomyopathy. He developed cardiogenic shock which was treated successfully with a percutaneous left ventricular assist device. His left ventricular ejection fraction improved by hospital follow-up 3 weeks later.

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Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

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Stage III Kienböcks disease treated with hyperbaric oxygen: the role of an unusual approach to a rare condition

Kienböck's disease is a rare condition characterised by avascular necrosis of the lunate bone. Its natural history and aetiopathogenesis have not yet been clarified, nor are its triggering factors identified. We present a case of a 17-year-old male gymnast, without relevant medical/family history, with stage IIIA Kienböck's disease diagnosed in 2016. Initially, submitted to conservative treatment that proved to be insufficient. Consequently, surgical treatment was proposed, but refused. The patient instead underwent experimental treatment with hyperbaric oxygen (120 sessions, 100% oxygen at 2.5 atm, for 70 min periods, once daily, five times per week). In April 2018, a favourable clinical and radiological evolution was observed, with an improvement in the patterns of pain, motion and strength and an almost complete involution of the process of aseptic necrosis of the semilunar. To the best of our knowledge, this is the first report of Kienböck's disease treated with hyperbaric oxygen.

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Case of newly diagnosed bilateral anorchia in a 42-year-old male patient

A 42-year-old African man presented with hypogonadic phenotypical features, including gynoid body distribution, gynaecomastia, absent facial and truncal hair and micropenis. He denied ever experiencing development of male secondary sex characteristics. Endocrine testing revealed hypergonadotropic hypogonadism and undetectable AMH. Human chorionic gonadotropin (hCG) stimulation test failed to increase testosterone levels. Peripheral blood karyotype was 46, XY. Clinical examination and abdominal/pelvic/scrotal ultrasound and MRI failed to identify any testicular structures/remnants. Given the clinical course and the biochemical–radiological presentation, the diagnosis of bilateral anorchia was made (after more than four decades of its probable onset), and surgical exploration was decided against. The patient was subsequently started on monthly intramuscular testosterone experiencing progressive normal virilisation.

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Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome

A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO₂) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO₂ ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made. Based on patient preference to avoid intubation and following a multidisciplinary approach, we decided to initiate venovenous extracorporeal membrane oxygenation (VV-ECMO) as an alternative strategy to mechanical ventilation. Though he ultimately required brief mechanical ventilation during ECMO cannulation, the patient spent a total of 5 days on VV-ECMO and a total of 8 days in the intensive care unit. Six days after discharge, his pulmonary function test demonstrated no significant abnormalities. We present a rare case of early initiation of VV-ECMO in a patient with severe ARDS that served as a bridge to recovery.

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Baclofen-Loaded Poly (d,l-Lactide-Co-Glycolic Acid) Nanoparticles for Neuropathic Pain Management: In Vitro and In Vivo Evaluation

Rejuvenation Research, Ahead of Print.

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IgE Test in Secretions of Patients with Respiratory Allergy

Abstract

Purpose of Review

IgE is a key player in multiple inflammatory airway diseases. Ample literature demonstrates its presence in mucosa of patients with allergic rhinitis (AR), local allergic rhinitis (LAR), asthma, or chronic rhinosinusitis with nasal polyposis (CRSwNP).

Recent Findings

Current evidence shows that high-affinity IgE in blood stream of allergic individuals derives mainly from the mucosae. Also, mucosal synthesis of IgE can occur in the absence of systemic atopy, and may be relevant in atopic and non-atopic phenotypes of rhinitis as demonstrated in LAR. Specific IgE (sIgE) detection varies depending on technique used for sample collection and its measurement. sIgE detection is highly specific for diagnosis of LAR. Moreover, measurement of sIgE in secretions could be useful in monitoring response to allergen-specific immunotherapy in both AR and LAR phenotypes.

Summary

This review will focus on recent developments in the role of IgE in respiratory diseases, and the clinical implications of its measurement in secretions.

https://ift.tt/2IRCxwT

Möglichkeiten und Grenzen der Eigenfetttransplantation

Mithilfe der autologen Transplantation von abgesaugtem subkutanem Fettgewebe lassen sich gute Ergebnisse zum Beispiel bei der Brustvergrößerung erzielen. Der folgende Beitrag beschreibt verschiedene Möglichkeiten, wie Patientinnen und Patienten erfolgreich mit der sogenannten BEAULI™-Methode behandelt werden können.

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Aus dem Nähkästchen: fünf Tipps und Tricks für Eingriffe an der Haut

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FOBI präsentiert breites Spektrum der ästhetischen Medizin

Die 26. Fortbildungswoche für praktische Dermatologie und Venerologie bot ihren Besuchern in München Ende Juli auch eine Vielzahl ästhetischer Fortbildungsthemen an. Einige der Highlights finden Sie im folgenden Kongressbericht.

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Sklerosierung statt Operation

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Neues Verfahren gegen Cellulite

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Pflege bei irritierender Aknetherapie

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Symptomorientierte Therapie der Rosazea

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Allergan benennt neue Führungskräfte für Deutschland

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Was brennt Ihren Patienten unter den Nägeln?

Nägel dienen dem Schutz und der Stabilität der Finger- und Zehenkuppen sowie der taktilen Sensibilität und fungieren an den Fingern als Greifwerkzeuge. Gleichzeitig stellen kranke Nägel eine kosmetische Einschränkung dar. Nagelerkrankungen verdienen daher ausreichende Beachtung und eine intensive Behandlung.

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Zusatz zur Lokalanästhesie und Notfallmedikation

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Lifestyle und der Einfluss auf die ästhetische Medizin

Jennifer Ceaser ist eine US-amerikanische Journalistin mit Sitz in Berlin. Seit über 15 Jahren veröffentlicht sie regelmäßig in Print- und Online-Publikationen wie New York Magazine, New York Post, The Independent, London Evening Standard, Conde Nast Traveler. Mit dem Experten Dr. Dirk Gröne spricht sie über den Einfluss der modernen Medien auf das Patientenverhalten.

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Inhaltsverzeichnis

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Auf stürmischer See

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Therapie der androgenetischen Alopezie

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Alopecia androgenetica der Frau

Zusammenfassung

Aufgrund der Vielgestaltigkeit der Ausfallsmuster und der zahlreichen möglichen Ursachen betrachten viele Ärzte Haarausfall bei Frauen als crux medicorum. Doch das Problem ist beherrschbar. Grundsätzlich ist zu unterscheiden, ob der Haarausfall durch hormonelle oder nicht hormonelle Ursachen bedingt ist und ob im Fall einer androgenetischen Alopezie eine manifeste Hyperandrogenämie oder nur eine erhöhte Sensitivität der Haarfollikel gegenüber Androgenen vorliegt.

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Speicherung und Aufbewahrung von Patientendaten vs. DSGVO

Die Datenschutzgrundverordnung (DSGVO) hat nicht nur der Ärzteschaft umfassende neue Verpflichtungen auferlegt, sondern auch den Patienten neue Auskunfts- und Löschungsansprüche eingeräumt. Diese Ansprüche stehen nun neben den bisherigen gesetzlichen Regelungen im Raum, sodass zu beleuchten ist, welche Rangordnung unter den Normen besteht. Nur dadurch lässt sich klären, ob die neuen Regelungen der DSGVO die Verpflichtungen der Ärzteschaft auch an dieser Stelle erweitern und was künftig zu beachten ist.

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Laserlipolyse zur selektiven Fettzerstörung und Fettgewinnung

In der letzten Zeit sorgt die Laserlipolyse als minimalinvasives Verfahren für einen Aufwärtstrend dieser operativen Technik, wobei diese vorrangig zur Fettreduktion und Straffung der Haut eingesetzt werden kann. Neuerdings wird die Laserlipolyse auch für die Gewinnung von vitalen kleinzelligen Fettzellen und „stromal vascular fraction"(SVF)-Zellen gezielt verwendet, welche anschließend für den regenerativen Gewebeaufbau im Rahmen eines autologen Lipotransfers zur Verfügung stehen.

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Narbenbehandlung mit Radiofrequenz-Needling

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Epstein–Barr Virus and Grave's Disease

Viral Immunology, Volume 31, Issue 8, Page 539-539, October 2018.

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Zika Virus Alters the Expression Profile of microRNA-Related Genes in Liver, Lung, and Kidney Cell Lineages

Viral Immunology, Volume 31, Issue 8, Page 583-588, October 2018.

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Diabetes Is Associated with Cognitive Decline in Middle-Aged Patients

Metabolic Syndrome and Related Disorders, Ahead of Print.

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Design and Application of 3D-Printed Photometers Controlled with an Arduino

3D Printing and Additive Manufacturing, Ahead of Print.

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The Prevalence and Psychological Impact of Cyberbullying on Undergraduate Students at an HBCU

Violence and Gender, Ahead of Print.

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Claudin‐1 expression decreases with increasing pathological grade in actinic keratosis and may be a marker of high‐risk actinic keratosis

Clinical and Experimental Dermatology, EarlyView.

https://ift.tt/2EiEvrL

Claudin‐1 expression decreases with increasing pathological grade in actinic keratosis and may be a marker of high‐risk actinic keratosis

Clinical and Experimental Dermatology, EarlyView.

https://ift.tt/2EiEvrL

2018 Van Meter Lectureship presented by Carmelo Nucera, MD, PhD

Carmelo Nucera, MD, PhD

2018 Van Meter Lectureship "The role of a new thyroid-specific long non-coding RNA (lincRNA) in drug resistance and iodine metabolism in BRAFV600E thyroid cancer" presented by Carmelo Nucera, MD, PhD

October 11, 2018—The American Thyroid Association (ATA) announces with pleasure that the 2018 Van Meter Award has been presented to Dr. Carmelo Nucera, currently Assistant Professor in the Department of Pathology and at the Cancer Center and Cancer Research Institute of Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. He is also an Associate Member at the Broad Institute of Harvard and MIT and Faculty member at the Center for Vascular Biology Research (CVBR) at BIDMC, which is dedicated to "improve human health by using genomics to advance our understanding of the biology and treatment of human disease, and to help lay the groundwork for a new generation of therapies."

The Van Meter Award recognizes outstanding contributions to research on the thyroid gland or related subjects by an investigator who is age 45 or under. Dr. Nucera has given the prestigious Van Meter Lecture on October 4 at 8:05 am, during this year's ATA Annual Meeting in Washington, DC from October 3 to 7. The award winner and the title of his lecture are kept secret until the time of the presentation. Dr. Nucera spoke on "The role of a new thyroid-specific long non-coding RNA (lincRNA) in drug resistance and iodine metabolism in BRAF^V600E thyroid cancer".

Dr. Nucera was born in Reggio Calabria (Italy), and received his MD summa cum laude in 2000 from the Medical and Surgery School at the University of Messina, Italy, where he also spent his residency in Endocrinology and Metabolic Diseases. During his residency he coordinated a local unit doing ultrasound screening of thyroid nodules, for the Ministry of Italian Scientific and Technological Research. He was also a Research Fellow and Coinvestigator at the Regina Elena Cancer Institute and Gemelli Medical School University Hospital in Rome, where he studied cloning techniques, molecular and cellular biology techniques, and transgenic mouse models for maternal thyroid hormone action during embryo-fetal development. At the Institute of Endocrinology of the University of Catania, he studied DNA automated sequencing and RNA extraction techniques for human thyroid tumors.

Dr. Nucera received his PhD in Experimental Endocrinology and Metabolic Diseases funded through the Italian Ministry of Scientific Research and Education, and completed his thesis on "novel mechanisms of BRAF^V600E-driven thyroid cancer progression" at the Division of Endocrine Surgery at Massachusetts General Hospital (MGH), and at BIDMC at Harvard Medical School.

He was also a post-doctoral research fellow at the same Division at MGH/Harvard. In the years following, Dr. Nucera acted as Attending Physician-Scientist at courses, workshops, and symposia, primarily at Harvard Medical School but also at the ATA.

His academic appointments have included Instructor in the Division of Cancer Biology and Angiogenesis in the Department of Pathology at BIDMC and, for the past five years, Assistant Professor in the Division of Experimental Pathology at the same institution at Harvard Medical School.

Dr. Nucera is primarily engaged in translational thyroid cancer research, as well as in teaching and tutoring medical students, post-docs, PhD students, and College students. He currently focuses on biomarker discovery such as regulatory long intergenic non-coding RNAs (LincRNA) and murine preclinical and co-clinical trials for targeted therapies for super-precision medicine. He is actively developing an independent research program at the BIDMC/Harvard, focused on a preclinical/translational model of patient-derived thyroid cancers and the role of the BRAF^V600E gene mutation in metastatic thyroid cancer. Since his residency, Dr. Nucera has investigated the cellular details of thyroid tumors. His goals have been, among others, to:

Determine the role of the BRAF gene mutation in human thyroid cancer microenvironment
Understand the autocrine and paracrine pathways by which BRAF^V600E (serine/threonine-protein kinase) and tyrosine kinase VEGFR2 (one of the vascular endothelial growth factors) promote aggressiveness in papillary thyroid cancer
Assess the role of stem-cell like pericytes in the mechanisms of drug resistance to targeted therapies in BRAF^V600E thyroid cancer
Unravel the clonal evolution of BRAF^V600E thyroid cancer treated with targeted therapies

Among the many mentees he has formally supervised are several post-doctoral research fellows, with whom he has collaborated on research studies and papers. For the past decade, Dr. Nucera has given presentations to his medical colleagues, nationally and internationally, concerning the details of his cellular research, thyroid cancer research, tumor modeling, targeted gene therapies, and clinical trials. As principal investigator (PI), he has successfully advanced many basic and clinical-translational projects and collaborations. His research expertise has been enhanced by his teaching experience at Harvard Medical School, resulting in his obtaining major grants as PI from the NIH and National Cancer Institute.

Dr. Nucera has served on the ATA Research and Internet Communications Committees and is a member of the Annual Thyroid Congress Program for the ATA. He has been recently nominated basic research Chair of the ATA Research Committee for 2018.

He is a reviewer for dozens of medical journals, including the New England Journal of Medicine, Frontiers in Oncology, the Journal of the National Cancer Institute, and the ATA's Thyroid. He is an Associate Editor for both Frontiers in Endocrinology and Discoveries. And he has received frequent honors and prizes for his research since medical school.

In his relatively brief career, Dr. Nucera has achieved much more in his research into thyroid oncology and gene therapy than many people over a lifetime. That commitment makes him a very worthy recipient for the prestigious 2018 Van Meter Award from the American Thyroid Association.

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The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 95^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health. These efforts are carried out via several key endeavors:

The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
Annual scientific meetings
Biennial clinical and research symposia
Research grant programs for young investigators
Support of online professional, public, and patient educational programs
Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

The post 2018 Van Meter Lectureship presented by Carmelo Nucera, MD, PhD appeared first on American Thyroid Association.

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2018 Van Meter Lectureship presented by Carmelo Nucera, MD, PhD

Carmelo Nucera, MD, PhD

2018 Van Meter Lectureship "The role of a new thyroid-specific long non-coding RNA (lincRNA) in drug resistance and iodine metabolism in BRAFV600E thyroid cancer" presented by Carmelo Nucera, MD, PhD

Determine the role of the BRAF gene mutation in human thyroid cancer microenvironment
Understand the autocrine and paracrine pathways by which BRAF^V600E (serine/threonine-protein kinase) and tyrosine kinase VEGFR2 (one of the vascular endothelial growth factors) promote aggressiveness in papillary thyroid cancer
Assess the role of stem-cell like pericytes in the mechanisms of drug resistance to targeted therapies in BRAF^V600E thyroid cancer
Unravel the clonal evolution of BRAF^V600E thyroid cancer treated with targeted therapies

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The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
Annual scientific meetings
Biennial clinical and research symposia
Research grant programs for young investigators
Support of online professional, public, and patient educational programs
Development of guidelines for clinical management of thyroid disease and thyroid cancer

The post 2018 Van Meter Lectureship presented by Carmelo Nucera, MD, PhD appeared first on American Thyroid Association.

https://ift.tt/2ISoE1y

Olopatadine/Mometasone Combination Nasal Spray Improves Seasonal Allergic Rhinitis Symptoms in an Environmental Exposure Chamber Study

GSP301 nasal spray is a fixed-dose combination of the antihistamine olopatadine hydrochloride and the corticosteroid mometasone furoate intended for seasonal allergic rhinitis (SAR) treatment.

https://ift.tt/2EgogLD

Usefulness of dermoscopy/dermatoscopy to improve the clinical and histopathologic diagnosis of skin cancers

Multiple studies have shown that dermoscopy increases the sensitivity and specificity for the detection of skin cancers compared to naked-eye examination. Dermoscopy can also lead to the detection of thinner and smaller cancers. Furthermore, dermoscopy leads to more precise selection of lesions requiring excision. In essence, dermoscopy helps clinicians differentiate benign from malignant lesions through the presence or absence of specific dermoscopic structures. Therefore, since most dermoscopic structures have direct histopathologic correlates, dermoscopy can allow the prediction of certain histologic findings present in skin cancers, thus helping select management and treatment options for select types of skin cancers.

https://ift.tt/2RNKV4y

Dermoscopy/dermatoscopy and dermatopathology correlates of cutaneous neoplasms

Dermoscopy is increasingly used by clinicians (dermatologists, family physicians, podiatrists, doctors of osteopathic medicine, etc.) to inform clinical management decisions. Dermoscopic findings and/or images provided to pathologists offer an important insight into the clinician's diagnostic and management thought process. However, with limited dermoscopic training in dermatopathology, dermoscopic descriptions and images provided in the requisition form will provide little value to pathologists.

https://ift.tt/2EjwHpI

Case 31-2018: A 37-Year-Old Man with a Self-Inflicted Gunshot Wound

Presentation of Case. Dr. Jordan P. Bloom (Surgery): A 37-year-old man was admitted to the surgical intensive care unit (ICU) of this hospital because of a self-inflicted gunshot wound. The patient had been in his usual state of health until 2 days before admission. That evening, while he was at…

https://ift.tt/2Ef2JTu

A Tricky Diagnosis

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors' commentary follows. Stage. A 70-year-old man…

https://ift.tt/2NyvWIF

Case 29-2018: A 31-Year-Old Woman with Infertility

Presentation of Case. Dr. Caitlin Sacha (Obstetrics and Gynecology): A 31-year-old woman with infertility was referred to the fertility center of this hospital by a surrogate parenting agency to discuss the possibility of family building with an oocyte donor and a gestational carrier. The patient…

https://ift.tt/2NDOE1E

Effect of TiF 4 varnish on microbiological changes and caries prevention: in situ and in vivo models

Abstract

Objective

The aim of this study was to evaluate microbiological changes, oral soft tissue toxicity, and caries-preventive effect of an experimental titanium tetrafluoride (TiF₄) varnish compared with a commercially available fluoride varnish (NaF), using in situ and in vivo models.

Materials and methods

The treatment groups were the following: TiF₄ varnish (experimental varnish), Duraphat® (fluoride positive control), placebo varnish (no fluoride), and no treatment (negative control). The varnishes were applied once over the enamel surface using a microbrush. For the in vivo study, 48 Wistar rats were infected with Streptococcus sobrinus 6715, received a treatment, and were submitted to a cariogenic challenge. After 4 weeks, S. sobrinus, oral soft tissue toxicity, presence, and severity of caries were evaluated. For the in situ study, 12 volunteers took part in this randomized crossover, double-blind study performed in four phases of 14 days each. They used intraoral appliances containing four enamel specimens that received the varnish according treatment group. After 24 h, the varnish was removed and plaque accumulation was allowed. A 20% sucrose solution was dripped over the enamel blocks (10×/day for 5 min each). Total streptococci, S. mutans, Lactobacillus, Candida spp. counts, and presence of white spot lesions were evaluated. Lesion depth was also quantified by micro-CT.

Results

For the in vivo study, the fluoride (F-varnishes) showed a statistically significant reduction in the percentage of S. sobrinus compared to the negative control (p < 0.05). Toxicological analysis revealed no abnormalities in oral tissues of rats from all groups, and both F-varnishes reduced the number and severity of caries lesions, without significant differences (p < 0.05). No statistical differences in microbiological counts were seen for the in situ experiment (p > 0.05). However, the specimens treated with TiF₄ exhibited lower percentage of white spot lesions and the lesion depth was significantly reduced by F-varnishes (p < 0.05).

Conclusions

F-varnishes showed reduction in the percentage of S. sobrinus in vivo, no oral soft tissue toxicity, and a caries-preventive effect in vivo and in situ.

Clinical relevance

NaF varnish is largely used due its capacity to form CaF₂-like layer on enamel. Therefore, development of studies focused on other fluoride compounds such as a TiF₄ varnish, which may have greater efficacy than NaF against tooth demineralization, is important.

https://ift.tt/2EeERiY

The prevalence of benign paroxysmal positional vertigo in patients with osteoporosis

Abstract

Background

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. There is some evidence that osteoporosis is a risk factor for BPPV.

Objective

To determine the prevalence of BPPV in patients with proven osteoporosis.

Materials and methods

We examined 187 new consecutive patients who attended our osteoporosis clinic. All patients had proven osteoporosis (DEXA scan resulting in a T score ≤ − 2.5). Patients completed a screening questionnaire assessing the presence of episodic vertigo provoked by changes in head position. When we suspected the presence of BPPV, we performed a Dix–Hallpike manoeuvre and a supine roll test. If the diagnostic procedure was positive, a (therapeutic) canalith repositioning manoeuvre (CRM) was performed.

Results

Twelve out of 187 patients had a history of typical vertigo compatible with BPPV. In four patients, the presence of BPPV was confirmed by means of a positive Dix–Hallpike manoeuvre. The prevalence of BPPV in this population of patients with osteoporosis was 2.1% (95% CI 0.8–5.4%).

Conclusion

The prevalence of BPPV in patients with osteoporosis is low. Based on this study, we suggest that there does not seem to be a relation between osteoporosis and BPPV.

https://ift.tt/2EeoGlW

Age-dependent loss of induced regulatory T cell function exacerbates liver ischemia-reperfusion injury

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Rui Liu, Shaopeng Zhang, Wenxuan Ma, Hao Lu, Ji Gao, Xiaojie Gan, Zheng Ju, Jian Gu, Ling Lu

Abstract

Previous studies demonstrate that the number of induced regulatory T cells (iTregs) increases in aged mice. However, these studies do not characterize iTregs across different ages or how these immune modulators contribute to the dysregulation of immunity in murine disease models. Therefore, this study aimed to examine the relationship between age and iTreg function using a mouse model of hepatic ischemia-reperfusion injury (IRI). In this model, aged-mice suffered more serious injury than Young-mice, with higher serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and higher histological scores from liver biopsies. iTregs isolated from Young-mice exhibited stronger immunosuppressive ability in vitro and had a greater response during IRI in vivo. In addition, aged-mice that were pretreated with iTregs generated in Young-mice (Y-iTregs) had alleviated injury compared with mice pretreated with iTregs from aged-mice (A-iTregs) or no treatment group. Adoptive transfer of iTregs ameliorated liver IRI and promoted liver recovery with decreased levels of interferon-γ (IFN-γ) and interleukin-17 (IL-17). These results demonstrate that the exacerbated IRI observed in aged-mice is a result of decreased iTreg function. Therefore, improving iTreg function is important for disease treatment in elder patients.

https://ift.tt/2CdnH2r

Prostaglandin E2 facilitates Hepatitis B virus replication by impairing CTL function

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Xiaoyan Li, Tingting Xie, Lifen Gao, Chunhong Ma, Xiaoyun Yang, Xiaohong Liang

Abstract

Reversal of T cell dysfunction is a novel and promising approach for the treatment of chronic diseases. PGE2, one of most studied Prostaglandins, exhibits strong and versatile immunoregulation activity on different immune cells including T cells, and has become a promising therapeutic target. Here we found that compared to healthy donors, patients with chronic Hepatitis B virus (HBV) infection had significantly elevated serum PGE2 level. Importantly, serum PGE2 concentration correlated with viral load and liver damage in Chronic hepatitis B(CHB)patients. In AAV-HBV1.2 mouse model, administration of PGE2 analogue promoted HBV replication, while antagonists for EP2 and EP4, two important receptors for PGE2, inhibited virus replication. However, PGE2 analogue had no significant effect on the growth and virus replication in cultured HBV-harboring hepatocyte cell line. Further analysis showed that high PGE2 level in CHB patients correlated with high Tim-3 expression and low level of perforin and granzme B in CD8 + T cells. In parallel, blockade of PGE2 signaling restored the function of CD8 + T cells and controls HBV infection. Depletion of CD8 + T cells almost abrogated the effects of PGE2 on HBV replication. These findings identify PGE2 as a negative regulator for CD8 + T cells contributing to HBV persistence and the intervention of PGE2 signaling might be of potentially translational significance.

https://ift.tt/2CFGDrM

Introduction to the Special Issue: The tumor microenvironment and molecular regulation of innate immune cells

Publication date: Available online 11 October 2018

Source: Molecular Immunology

Author(s): Sandra E. Nicholson, Stephanie S. Watowich

https://ift.tt/2CdXwZO

Penile bulb sparing in prostate cancer radiotherapy

Abstract

Objective

This study aimed to assess the reduction in dose to the penile bulb (PB) achieved by MRI-based contouring following drinking and endorectal balloon (ERB) instructions.

Patients and methods

A total of 17 prostate cancer patients were treated with intensity-modulated radiation therapy (IMRT) and interstitial brachytherapy (IBT). CT and MRI datasets were acquired back-to-back based on a 65 cm³ air-filled ERB and drinking instructions. After rigid co-registration of the imaging data, the CT-based planning target volume (PTV) used for treatment planning was retrospectively compared to an MRI-based adaptive PTV and the dose to the PB was determined in each case. The adapted PTV encompassed a caudally cropped CT-based PTV which was defined on the basis of the MRI-based prostate contour plus an additional 5 mm safety margin.

Results

In the seven-field IMRT treatment plans, the MRI-based adapted PTV achieved mean (D_mean) and maximum (D_max) doses to the PB which were significantly lower (by 7.6 Gy and 10.9 Gy, respectively; p <0.05) than those of the CT-contoured PTV. For 6 patients, the estimated PB D_max (seven-field IMRT and IBT) for the adapted PTV was <70 Gy, whereas only 1 patient fulfilled this criterium with the CT-based PTV.

Conclusion

MRI-based contouring and seven-field IMRT-based treatment planning achieved dose sparing to the PB. Whereas the comparison of MRI and CT contouring only relates to external beam radiotherapy (EBRT) sparing, considering EBRT and IBT shows the improvement in PB sparing for the total treatment.

https://ift.tt/2IRsIzg

Related Biomarkers of Neurocognitive Impairment in Children with Obstructive Sleep Apnea

Publication date: Available online 12 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yewen Shi, Huanan Luo, Haiqin Liu, Jin Hou, Yani Feng, Jinwei Chen, Liang Xing, Xiaoyong Ren

Abstract

Objectives

Different experiment approaches have demonstrated that children with obstructive sleep apnea (OSA) exhibit neurocognitive and behavioral deficits. This review summarized the potential biomarkers of OSA-associated neurocognitive impairment in children.

Methods

A scoping review of studies on children with OSA that evaluated the potential value of different markers in identifying neurocognitive impairment was undertaken. Additionally, the biomarkers were categorized according to the different research methods, including brain imaging studies, serological indicators and urine markers.

Results

Majority of the studies that evaluated blood biomarkers, plasma insulin growth factor-1 (IGF-1) and Alzheimer's disease (AD)-related biomarkers appeared to exhibit a favorable profile, and could discriminate between OSA children with or without neurocognitive impairments. Brain imaging studies and urinary neurotransmitters could also be helpful for screening OSA cognitive morbidity in children.

Conclusion

Due to limited research methods available in children, the cognitive susceptibility of children with OSA has been rarely studied. The main reason for this may be the limited research methods in children. Numerous study populations of children and complex psychological tests are required, which involve major labor and costs.Multi-center prospective studies are needed to identify suitable biomarkers for the timely prediction and effective intervention to prevent neurocognitive impairment in children with OSA and to explore futuer opportunities in this arena.

https://ift.tt/2QM6wZU

Clinical Validation and Reproducibility of Endoscopic Airway Measurement in Pediatric Aerodigestive Evaluation

Publication date: Available online 11 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Christian R. Francom, Cameron A. Best, Ryan G. Eaton, Victoria Pepper, Amanda J. Onwuka, Christopher K. Breuer, Meredith N. Merz Lind, Jonathan M. Grischkan, Tendy Chiang

ABSTRACT

Background

Endoscopic airway measurement (EAM) combines optical endoscopic instruments with open source image processing to accurately obtain airway dimensions. Preclinical models have demonstrated EAM as an accurate technique of airway measurement with the added advantage of characterizing multilevel stenosis, non-circular lesions, and distal obstruction. The aim of this prospective clinical study was to compare EAM to airway measurements obtained from endotracheal tube approximation (ETTA) during pediatric aerodigestive evaluation and to evaluate reproducibility of EAM across practitioners.

Methods

Thirty-seven pediatric patients undergoing routine microlaryngoscopy and bronchoscopy at a single tertiary care children's hospital were prospectively recruited. Patients undergoing emergent procedures were excluded. Two blinded reviewers performed airway measurements using ImageJ (NIH) as previously described and average values were compared to ETTA measurements. Additional EAMs were obtained from an ex vivo airway model by 28 separate clinicians and were analyzed by the same reviewers to evaluate reproducibility.

Results

EAM and ETTA measurements were themselves significantly different (p = 0.0003); however, the average absolute difference between the two methods was small (Mean: 0.5 mm, 95%CI: -2.6 to 1.6 mm). There were notable differences between raters such that estimates of raters with more experience were more similar to ETTA. Despite observed differences between EAM and ETTA, endoscopic airway measurement was highly correlated with ETTA (p = 0.0002, Spearman r = 0.4185), and strong agreement was observed (Bias: -0.4974 ± 1.083 mm, 95% LOA: -2.62 to 1.625 mm).

Conclusion

Clinical use of EAM is a valid and precise approach for quantification of airway luminal dimensions. This method may provide advantages over traditional ETTAs for evaluation of asymmetric airway morphology in the pediatric population.

https://ift.tt/2A6Mow7

Findings from Aetiological Investigation of Auditory Neuropathy Spectrum Disorder in Children referred to Cochlear Implant Programs

Publication date: Available online 11 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): K. Rajput, M. Saeed, J. Ahmed, M. Chung, C. Munro, S. Patel, C. Leal, D Jiang, R. Nash

Abstract

Objectives

Auditory neuropathy spectrum disorder (ANSD) is an audiological diagnosis characterised by hearing dysfunction in the presence of intact outer hair cell function in the cochlea. ANSD is thought to account for 7-10% of all childhood permanent hearing impairment, and can result from a range of pathological processes. This paper describes the rationale, methods and findings from the aetiological investigation of ANSD.

Methods

Retrospective audit of four cochlear implant programmes.

Results

97 patients were identified. 79% of patients were identified before the age of one. Prematurity and jaundice were the most frequently identified aetiological factors. 33 patients had cochlear nerve deficiency on imaging. Genetic diagnoses identified included otoferlin, SX010 gene, connexin 26 and A1FM1 gene mutations. ANSD was seen in conjunction with syndromes including Kallman syndrome, CHARGE syndrome, X-linked deafness, SOTOS syndrome, Brown Vieletto Van Laere syndrome, and CAPOS syndrome.

Discussion

We present a two-level system of aetiological investigation that is clinically practical. Patients with ANSD sufficiently severe to consider cochlear implantation are generally identified at an early age. Aetiological investigation is important to guide prognosis and identify comorbidity.

Conclusion

Prematurity and jaundice are the most commonly identified aetiological factors in ANSD. Imaging findings identify crucial factors in a significant minority. An important minority may have genetic and syndromic diagnoses that require further management.

https://ift.tt/2QMM37n

Child development skills and language in toddlers with cleft lip and palate

Publication date: Available online 11 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Maria Gabriela Cavalheiro, Dionísia Aparecida Cusin Lamônica, Simone Rocha de Vasconsellos Hage, Luciana Paula Maximino

Abstract

Introduction

Children born with cleft lip and palate (CLP) are exposed to several risk factors for developmental delay.

Methods

This cross-sectional and descriptive study compared the performance of gross motor, adaptive fine motor, social-personal and language skills in children with non-syndromic cleft lip and palate (age = 36 to 47 months, n = 30) matched as to chronological age and gender. The evaluation instruments were Denver Developmental Screening Test II and MacArthur Communicative Development Inventory – part D, employed for the receptive and expressive vocabulary checklist. Intergroup comparisons were performed using t tests and Chi-square tests. The Pearson correlation coefficient was used to verify the inter-category correlation (p≤0.05).

Results

There was statistically significant difference in gross motor, adaptive fine motor, and language skills, both in receptive and expressive aspects, in the comparison between groups. In the personal-social area, children with CLP presented performance below the expected, without statistically significant difference between groups.

Conclusions

Children with CLP are at risk for developmental disorders and should be monitored from early childhood to minimize the deleterious effects of this risk condition.

https://ift.tt/2A6HeAe

Improvement in diagnostic delays over time in patients with hereditary angioedema: findings from the Icatibant Outcome Survey

The objective of this analysis was to evaluate the change over time in age at first symptoms, age at diagnosis, and delay in diagnosis using data from the Icatibant Outcome Survey (IOS). Patients with a diagno...

https://ift.tt/2OTShVB

Utility of CD8 score by automated quantitative image analysis in head and neck squamous cell carcinoma

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Douglas J. Hartman, Fahad Ahmad, Robert E. Ferris, David Rimm, Liron Pantanowitz

Abstract

Introduction

In head and neck squamous cell carcinoma (HNSCC) high numbers of tumor infiltrating CD8 T cells in the tumor microenvironment are associated with better outcome. However, no investigators have employed automated image analysis on whole slide images to permit CD8 scores for use in clinical practice. The aim of this study was to develop and validate an image analysis algorithm to automatically quantify CD8 T cells in patients with oropharyngeal HNSCC.

Materials and Methods

Using brightfield image analysis results were cross-validated with fluorescence based quantification (AQUA™). A nuclear image algorithm designed to run on whole slide images was optimized to manual count. The algorithm was locked down and used on a cohort of whole tissue sections from HNSCC patients. Multivariate clinicopathologic parameters and outcomes were statistically correlated with image analysis results.

Results

Linear correlation between manual counts and the customized CD8 algorithm was 0.943. A total of 74 oropharyngeal HNSCC cases were analyzed for CD8 immune cell infiltrate using this image analysis algorithm. A CD8 immune cell density above 136 cells/mm² was associated with median survival of 18 years compared to 5 years. When multivariate modeling was performed, HPV infection was the only predictor of survival; however, when HPV was excluded only CD8 cell density predicts survival.

Conclusions

We report the successful technical development and clinical validation of an image algorithm to automate CD8 immune cell density for oropharyngeal HNSCC. Employing brightfield image analysis on entire tumor sections instead of tumor subcompartments permits this strategy to be widely implemented.

https://ift.tt/2NDayBO

Routine surveillance scanning in HNSCC: Lung screening CT scans have value but head and neck scans do not

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Austin J. Iovoli, Alexis J. Platek, Luke Degraaff, Chong Wang, William D. Duncan, Kimberly E. Wooten, Hassan Arshad, Vishal Gupta, Moni A. Kuriakose, Wesley L. Hicks, Mary E. Platek, Anurag K. Singh

Abstract

Objectives

To examine the utility of computed tomography (CT) imaging during routine surveillance for the detection of recurrent head and neck squamous cell carcinoma (HNSCC).

Materials/methods

Clinical characteristics of HNSCC patients treated between 2008 and 2017 with radiation therapy or concurrent chemoradiation were abstracted from medical records. In patients who achieved a complete response to treatment by positron emission tomography scan, surveillance CT scans were conducted to the maxillofacial area, neck, and chest every 3 months in year 1, every 6 months in year 2, and every 12 months in years 3 and beyond.

Results

Within the entire cohort (n = 534), complete response was achieved in 446 patients (83.5%); of these, 84 (15.7%) patients had a recurrence. Among the 84 patients with disease recurrence, 25 (30%) patients remained alive, of which 15 (18%) underwent successful salvage treatment and became free of disease. Lung screening CT scans detected failure in 8 of these successfully salvaged patients. Among the 8 patients successfully salvaged for locoregional recurrence, 3 failures were asymptomatic at onset and detected by laryngoscope or dental exam. The remaining 5 failures were symptomatic and detected upon work up prompted by symptoms. Maxillofacial and neck surveillance CT imaging failed to detect any successfully salvaged patients.

Conclusions

Routine surveillance for HNSCC patients with lung CT imaging had value but routine head and neck CT scans failed to identify any successfully salvaged patients. Given this finding, routine CT imaging surveillance in HNSCC patients should be restricted to annual lung screening with low-dose chest CT.

https://ift.tt/2OZggmi

Dental radiographic findings in 18 individuals with SATB2 -associated syndrome

Abstract

Objective

To characterize the radiographic dental phenotype of individuals with SATB2-associated syndrome (SAS).

Materials and methods

Participants were evaluated by a multidisciplinary team during a concurrent clinic conducted during the 1st international SAS family meeting held in 2017 at a single institution. Whenever possible, panoramic and/or periapical radiographs were obtained in clinic or previously obtained and provided by the caregiver.

Results

Of the 37 individuals evaluated, 18 (12 males, median age 8.5 years) underwent radiographic examination. Dental radiographs revealed anomalies in all individuals starting at 2 years of age. The most consistent finding was delayed development of the mandibular second bicuspids (83%) with other common radiographic findings including delayed development of the roots of the permanent teeth (78%), severely rotated (56%) or malformed teeth (44%), and taurodontism (44%).

Conclusions

Dental anomalies are fully penetrant and can be documented radiographically in all individuals with SAS.

Clinical relevance

Dental radiographic findings of delayed second premolar development and delayed development of permanent root formation, especially concurrent with findings of taurodontism and malformed teeth, support a clinical suspicion for SAS and should help differentiate SAS from other neurodevelopmental syndromes.

https://ift.tt/2QLYeRM

Left-shifting prism adaptation boosts reward-based learning

Publication date: Available online 12 October 2018

Source: Cortex

Author(s): S. Schintu, M. Freedberg, Z. Alam, S. Shomstein, E.M. Wassermann

Abstract

Visuospatial cognition has an inherent lateralized bias. Individual differences in the direction and magnitude of this bias are associated with asymmetrical D2/3 dopamine binding and dopamine system genotypes. Dopamine level affects feedback-based learning and dopamine signaling asymmetry is related to differential learning from reward and punishment. High D2 binding in the left hemisphere is associated with preference for reward. Prism adaptation (PA) is a simple sensorimotor technique, which modulates visuospatial bias according to the direction of the deviation. Left-deviating prism adaptation (LPA) induces rightward bias in healthy subjects, it is therefore possible that the right side of space increases in saliency along with left hemisphere dopaminergic activity. Right-deviating prism adaptation (RPA) has been used mainly as a control condition because it does not modulate behavior in healthy individuals. Since LPA induces a rightward visuospatial bias as a result of left hemisphere modulation, and higher dopaminergic activity in the left hemisphere is associated with preference for rewarding events we hypothesized that LPA would increase the preference for learning with reward. Healthy volunteers performed a computer-based probabilistic classification task before and after LPA or RPA. Consistent with our predictions, PA altered the preference for rewarded vs. punished learning, with the LPA group exhibiting increased learning from reward. These results suggest that PA modulates dopaminergic activity in a lateralized fashion.

https://ift.tt/2QMO5o5

The hippocampus of birds in a view of evolutionary connectomics

Publication date: Available online 11 October 2018

Source: Cortex

Author(s): Christina Herold, Philipp Schlömer, Isabelle Mafoppa-Fomat, Julia Mehlhorn, Katrin Amunts, Markus Axer

Abstract

The avian brain displays a different brain architecture compared to mammals. This has led the first pioneers of comparative neuroanatomy to wrong conclusions about bird brain evolution by assuming that the avian telencephalon is a hypertrophied striatum. Based on growing evidence from divers analysis demonstrating that most of the avian forebrain is pallial in nature, this view has substantially changed during the past decades. Further, birds show cognitive abilities comparable to or even exceeding those of some mammals, even without a "six-layered" cortex. Beside higher associative regions, most of these cognitive functions include the processing of information in the hippocampal formation that shares a homologue structure in birds and mammals. Here we show with 3D polarized light imaging that the hippocampal formation of pigeons like the mammalian hippocampal formation shows regional specializations along the anterior-posterior axis in connectivity. In addition, different levels of adult neurogenesis were observed in the subdivisions of the hippocampal formation per se and in the most caudal regions pointing towards a functional specialization along the anterior-posterior axis. Taken together our results point to species specific morphologies but still conserved hippocampal characteristics of connectivity, cells and adult neurogenesis if compared to the mammalian situation. Here our data provides new aspects for the ongoing discussion on hippocampal evolution and mind.

https://ift.tt/2A6E9Ab

Processing inflectional morphology: ERP evidence for decomposition of complex words according to the affix structure

Publication date: Available online 11 October 2018

Source: Cortex

Author(s): Stefanie Regel, Andreas Opitz, Gereon Müller, Angela D. Friederici

Abstract

This study investigated the processing of inflectional morphology by registrating event-related brain potentials (ERPs) during sentence reading. In particular, we examined nouns combined with affixes that have distinct structural characteristics as proposed by morphological theory. Affixes were either complex consisting of functionally distinguishable subparts as occurring for German plural morphology, or simple consisting of one part only. To test possible differences in processing these affixes we compared grammatical nouns (e.g., Kartons (cartons)) to ungrammatical ones (e.g., *Kartonen) in two different syntactic contexts represented by a complex, or simple affix. The ERPs showed that ungrammatical nouns consisting of complex affixes elicited a left anterior negativity (LAN) reflecting enhanced morphosyntactic processing, which was absent for equivalent nouns consisting of simple affixes. This finding suggests that inflected words are decomposed dependent on the affix structure, whereby the affixes themselves seem to consist of morphological subparts in accordance with current morphological theories (Müller, 2007; Noyer, 1992). Moreover, ungrammatical nouns elicited early (reduced P200) and late (P600) ERP components relative to their grammatical equivalents, which implies an engagement of syntactic processes presumably based on intially enhanced pre-lexical processing of these irregularized nouns. The findings are discussed with respect to theoretical and neuropsychological accounts to inflectional morphology.

https://ift.tt/2QOSIy5

Bi-cephalic Parietal and Cerebellar direct current stimulation interferes with early error correction in Prism Adaptation: toward a complex view of the neural mechanisms underlying visuomotor control

Publication date: Available online 11 October 2018

Source: Cortex

Author(s): Francesco Panico, Laura Sagliano, Dario Grossi, Luigi Trojano

Abstract

Prism Adaptation (PA) represents a valid tool to assess short-term visuomotor plasticity. Two adaptive processes are involved during PA: recalibration, contributing to early error compensation, and spatial realignment, contributing to after-effect development. Classical models on PA posit that adaptive mechanisms underlying PA rely on segregated regions in the brain. Indeed, they ascribe recalibration to the activity of the Posterior Parietal Cortex (PPC) and spatial realignment to the activity of the Cerebellum. The present experiment challenges the idea of a clear-cut separation of the role of the brain areas involved in PA, proposing an interpretation in terms of interrelated brain regions. To this purpose we interfered with the activity of the PPC and the Cerebellum by means of complementary protocols of stimulation.

Bi-cephalic transcranial Direct Current Stimulation was delivered simultaneously on the PPC and the Cerebellum during PA in two groups of participants receiving real stimulation with opposite polarities (anode on PPC and cathode on Cerebellum or vice-versa) and in a control group (Sham stimulation). Differences in mean errors between groups were analyzed. Results show that the two groups of real stimulation exhibited larger displacements in early error compensation compared to the Sham Group, but they did not differ from each other. No group difference was found in late error compensation and after-effect. In conclusion, the present findings provide the first direct evidence that a brain circuit connecting the PPC and the Cerebellum is involved in early stages of visuomotor adaptation, and pave the way for updating classical models of PA.

https://ift.tt/2A6LGim

Large-scale temporo-parieto-frontal networks for motor and cognitive motor functions in the primate brain

Publication date: Available online 11 October 2018

Source: Cortex

Author(s): Elena Borra, Giuseppe Luppino

Abstract

The extent to which neural circuits and mechanisms underlying sensory, motor, and cognitive cortical functions in the human brain are shared with those of other animals, especially non-human primates, is currently a key issue in the field of comparative neuroscience. Cortical functions result from the conjoint function of different, reciprocally connected areas working together as large-scale functionally specialized networks, which can be investigated in human subjects thanks to the development of non-invasive functional and connectional imaging techniques. In spite of their limitations in terms of spatial and temporal resolution, these techniques make it possible to address the issue of how and to what extent the neural mechanisms for different cortical functions differ from those of non-human primates. Indeed, 30 million years of independent evolution have resulted in significant differences between the brains of humans and macaques, which are the experimental model system phylogenetically closest to humans for obtaining highly detailed anatomical and functional information on the organization of cortical networks. In the macaque brain, architectonic, connectional, and functional data have provided evidence for functionally specialized large-scale cortical networks involving temporal, parietal, and frontal areas. These networks appear to play a primary role in controlling different aspects of motor and cognitive motor functions, such as hand action organization and recognition, or oculomotor behavior and gaze processing. In the present review, based on the comparison of these data with data from human studies, we will argue that there is clear evidence for human counterparts of these networks. These human and macaque putatively homolog networks appear to share phylogenetically older neural mechanisms, which, in the evolution of the human lineage, could have been exploited and differentiated, resulting in the emergence of human-specific higher-order cognitive functions. These considerations are fully in line with the notion of "neural reuse" in primate evolution.

https://ift.tt/2QOSFSV

Primary motor cortex crucial for action prediction: a tDCS study

Publication date: Available online 11 October 2018

Source: Cortex

Author(s): Riccardo Paracampo, Mirella Montemurro, Manuel de Vega, Alessio Avenanti

Abstract

The neural network underlying action observation – i.e., the action observation network – forms an anticipatory representation of observed actions. Although correlational studies suggest that the motor cortex (M1) might be involved in this anticipatory coding, it is unclear whether M1 is also causally essential for making accurate predictions about observed actions. To test the functional relevance of M1 to action prediction, we used offline monopolar transcranial direct current stimulation (tDCS). In four tDCS groups of healthy participants, we administered 15 minutes of anodal or cathodal constant currents of 1 or 2 mA over the left M1 before participants performed two tasks requiring them to make predictions about the outcomes of reaching-grasping human actions (Action Prediction, AP) or non-human movements (Non-human Prediction, NP). In each group, participants received sham and active tDCS in two separate sessions. We found that 2mA cathodal tDCS (c-tDCS_2mA) selectively impaired accuracy in the AP task, but not in the NP task. No change in performance was found following anodal or 1-mA tDCS protocols. Additionally, no change was found following 2mA c-tDCS administered over a control site. These findings show task-, polarity-, intensity- and site-specific disruption of AP abilities following c-tDCS_2mA over M1. Thus, our study establishes specific tDCS parameters for effective M1 stimulation in AP and highlights the functional relevance of the motor system to making accurate predictions about the outcomes of human actions.

https://ift.tt/2A6wDoQ

IL-33 drives influenza-induced asthma exacerbations by halting innate and adaptive anti-viral immunity

Publication date: Available online 12 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Lara Ravanetti, Annemiek Dijkhuis, Tamara Dekker, Yanaika S. Sabogal Pineros, Abilash Ravi, Barbara S. Dierdorp, Jonas S. Erjefält, Michiko Mori, Stelios Pavlidis, Ian M. Adcock, Navin L. Rao, René Lutter

Abstract

Background

Influenza virus triggers severe exacerbations of asthma for which no adequate treatment is available. It is known that IL-33 levels correlate with exacerbation severity, but its role in the immune-pathogenesis of exacerbations has remained elusive.

Objective

We hypothesized that IL-33 is necessary to drive asthma exacerbations. We intervened with the IL-33 cascade and sought to dissect its role, also in synergy with TSLP, in airway inflammation, anti-viral activity and lung function. We aimed to unveil the major source of IL-33 in the airways and IL-33-dependent mechanisms that underlie severe asthma exacerbation.

Methods

Mild asthmatic patients were experimentally infected with rhinovirus. Mice were chronically exposed to house dust mite (HDM) extract and then infected with influenza to resemble key features of exacerbations in humans. Interventions included anti–IL-33-receptor ST2 and/or anti–TSLP.

Results

We identified bronchial ciliated cells and Type-II alveolar cells as a major local source of IL-33 during virus-driven exacerbation in humans and mice, respectively. By blocking ST2 we demonstrated that IL-33 and not TSLP was necessary to drive exacerbations. IL-33 enhanced AHR and airway inflammation by suppressing innate and adaptive anti-viral responses and by instructing epithelial cells and dendritic cells (DCs) of HDM-sensitized mice to dampen IFN-β expression and prevent the Th1-promoting DCs phenotype. IL-33 also boosted luminal NETosis and halted cytolytic anti-viral activities, but did not affect the Th2-response.

Conclusion

Interventions targeting the IL-33/ST2 axis could prove an effective acute, short-term therapy for virus-induced asthma exacerbation.

Graphical abstract

Graphical abstract for this article

https://ift.tt/2Pui1Fh

Clinical characteristics and surgical outcome in USP8 -mutated human adrenocorticotropic hormone-secreting pituitary adenomas

Abstract

Purpose

somatic mutations in the ubiquitin-specific protease 8 (USP8) gene have recently been described in patients with Cushing's disease (CD). The aim of the study is to verify whether USP8 mutation may predict early and late outcome of pituitary surgery in patients with CD operated at a single institution.

Methods

We performed a retrospective genetic analysis of 92 adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. Specimens were screened for USP8 hotspot mutations in the exon 14 with Sanger sequencing. Hormonal and surgical data were compared between USP8 variant carriers and wild-type tumors.

Results

USP8 variants were detected in 22 adenomas (23.9%) with higher prevalence in women (28.9% vs. 5.3% in men; p < 0.05). No significant difference in hormonal levels and tumoral features in relation to USP8 status was observed. Interestingly, USP8-variant carriers were more likely to achieve surgical remission than wild-type adenomas (100% vs. 75.7%; p = 0.01). Conversely, recurrence of CD occurred in 23% of USP8-mutated patients and in 13% of patients with wild-type adenoma. The recurrence-free survival did not differ significantly between the two groups (p = 0.42).

Conclusions

ACTH-secreting pituitary adenomas carrying somatic USP8 mutations are associated with a greater likelihood of surgical remission in patients operated by a single neurosurgeon. Recurrence rates are not related with USP8-variant status.

https://ift.tt/2QLdLkY

Preoperative Evaluation: Is It Time to View It as a Component of Perioperative Optimization?

Publication date: Available online 11 October 2018

Source: Anesthesiology Clinics

Author(s): Lee A. Fleisher

https://ift.tt/2yhrppc

Reliability of palatal rugoscopy for sexual dimorphism in forensic dentistry: a systematic literature review and meta-analysis

Publication date: Available online 11 October 2018

Source: Archives of Oral Biology

Author(s): Ramon Nazareno Menezes Andrade, Walbert de Andrade Vieira, Ítalo de Macedo Bernardino, Ademir Franco, Luiz Renato Paranhos

Abstract

Objective

This study aimed to assess the validity of palatal rugoscopy for sexual dimorphism in the casework routine of forensic dentistry.

Design

A systematic literature reviews was established following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) and Cochrane guidelines. Six electronic databases were searched as the primary source of information. "Grey literature" was included to avoid selection and publication bias. As a secondary source of information, the reference lists of the eligible studies were also consulted to increase the search spectrum. Methodological quality and risk of bias were assessed with Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews. Statistic tests, namely the meta-analysis of diagnostic accuracy, Cochran Q test, and I2 test, were performed to verify the heterogeneity between the eligible studies.

Results

The systematic search resulted in 263 studies, out of each 8 fulfilled the inclusion criteria. An additional eligible article was included after the search in reference lists. From the 9 studies that underwent qualitative data extraction, six were selected for quantitative analysis. The meta-analysis of grouped sex estimates showed sensitivity and specificity rates of 89% and 83%, respectively. The Area Under the Curve reached 0.93. High heterogeneity and important methodological limitations were detected among the studies.

Conclusion

Palatal rugoscopy seems to have discriminant power for sexual dimorphism. However, the limitations found specifically in each study and the strong heterogeneity across studies suggest that palatal rugoscopy lacks evidence-based confirmation for reliable application as a sole tool for sexual dimorphism in practice.

https://ift.tt/2ISJu0T

Arginine methylation of FOXP3 is crucial for the suppressive function of regulatory T cells

Publication date: Available online 11 October 2018

Source: Journal of Autoimmunity

Author(s): Yuki Kagoya, Hiroshi Saijo, Yukiko Matsunaga, Tingxi Guo, Kayoko Saso, Mark Anczurowski, Chung-Hsi Wang, Kenji Sugata, Kenji Murata, Marcus O. Butler, Cheryl H. Arrowsmith, Naoto Hirano

Abstract

Forkhead box transcription factor 3 (FOXP3) plays a pivotal role in the suppressive function of regulatory T cells. In addition to mRNA levels, FOXP3 activity can also be controlled by posttranslational mechanisms, which have not been studied in a comprehensive manner. Through extensive screening using selective inhibitors, we demonstrate that the inhibition of type I protein arginine methytransferases (PRMTs) attenuates the suppressive functions of regulatory T cells. FOXP3 undergoes methylation on arginine residues at positions 48 and 51 by interacting with protein arginine methyltransferase 1 (PRMT1). The inhibition of arginine methylation confers gene expression profiles representing type I helper T cells to FOXP3⁺ T cells, which results in attenuated suppressive activity. A methylation-defective mutant of FOXP3 displays less potent activity to suppress xenogeneic graft-versus-host disease in vivo. These results elucidate an important role of arginine methylation to enhance FOXP3 functions and are potentially applicable to modulate regulatory T cell functions.

https://ift.tt/2RKZgio

Clinical characteristics and surgical outcome in USP8 -mutated human adrenocorticotropic hormone-secreting pituitary adenomas

Abstract

Purpose

Methods

Results

Conclusions

https://ift.tt/2QLdLkY

Impact of chelation timing on gadolinium deposition in rats after contrast administration

Publication date: Available online 12 October 2018

Source: Magnetic Resonance Imaging

Author(s): John P. Prybylski, Carla Coste Sanchez, Michael Jay

Abstract

Objective

To determine if gadolinium (Gd) can be rechelated once released from Gd-based contrast agents (GBCAs) and deposited in vivo. Despite extensive research comparing GBCAs and GBCA formulations as well as the ongoing debate about their risks of deposition and the role of Gd release, it remains unknown if retained Gd can be eliminated by administering chelating agents.

Materials and methods

Rats were injected intravenously with 10 doses of 1 mmol/kg gadodiamide and treated with intravenous Zn-DTPA (30 μmol/kg) concomitantly or 1, 4 or 8 h after GBCA administration (N = 3 rats per group). After euthanization, tissues were harvested three days after the last dose of gadodiamide and tissue Gd concentrations were assessed by ICP-MS. Additionally, a simulation of a single 0.1 mmol/kg gadopentetate dose with 30 μmol/kg DTPA given either concomitantly or within the first 24 h after GBCA was run; simulated tissue Gd concentrations were compared with those observed in rats to determine if simulated trends were accurate.

Results

Concomitant DTPA did not produce a significant reduction in Gd concentration in any organ for rats. There was a time-dependent trend in liver Gd reduction. The 1 h timepoint was associated with a non-significant increase in kidney, brain and femur Gd relative to untreated controls. There were no significant deviations from the model-predicted Gd changes.

Discussion

Both the simulation and rat study did not identify major benefits for chelation at the doses given, despite the simulation assuming all Gd deposited in tissues is unchelated. The potential redistribution in the rat study provide a compelling result that may impact the clinical relevance of further work investigating rechelation of Gd. Future work should further describe the three-dimensional dose-time-response relationship for preventing Gd deposition, and how that relates to long-term Gd toxicities.

https://ift.tt/2CfCvh0

Application of low-field, 1H/13C high-field solution and solid state NMR for characterisation of oil fractions responsible for wettability change in sandstones

Publication date: Available online 12 October 2018

Source: Magnetic Resonance Imaging

Author(s): Igor Shikhov, Donald S. Thomas, Aditya Rawal, Yin Yao, Bulat Gizatullin, James M. Hook, Siegfried Stapf, Christoph H. Arns

Abstract

Asphaltene adsorption on solid surfaces is a standing problem in petroleum industry. It has an adverse effect on reservoir production and development by changing rock wettability, plugging pore throats, and affects oil transport through pipelines. Asphaltene chemistry constitutes important part of the ageing process as part of petrophysical studies and core analysis. The mechanisms and contribution of various oil components to adsorption processes is not fully understood. To investigate the kinetics of the ageing process and address the relative contribution of different oil components, we prepared three sets of sandstone core plugs aged in different oil mixtures over various time intervals. Cores were then re-saturated with decane to evaluate their wetting state using low-field NMR relaxometry by monitoring a change of surface relaxivity. Adsorbed deposits were then extracted from cores for solution-state NMR analysis. Their ¹H and ¹H-¹³C correlation spectra obtained using heteronuclear single quantum coherence (HSQC) technique were matched to spectra of four SARA (saturates, aromatics, resins and asphaltenes) components of oil mixtures to deduce components of deposits and inter-component interactions. We notice that wettability reversal of rock is inversely proportional to initial asphaltene concentration. Analysis of deposits reveals an increase in their aliphatic content over ageing time, which is accompanied by a change of the morphology of the pore space due to cluster aggregates forming a network. Results suggest that the ageing process in respect to the wetting state of rock samples consists of three distinctive stages: (i) an early-time period, when the fraction of most polar asphaltenes creates a discontinuous layer corresponding to mixed-wet state; (ii) an intermediate-time interval, at which the full grain coverage may be achieved (at favourable chemical environment) corresponding to strong oil-wetting; (iii) a late-time stage, where intense macro-aggregates accumulation occurs, changing the pore space integrity. It is likely asphaltene-aliphatic interactions leading to growth of sub-micron size macro-aggregates.

https://ift.tt/2CK37bc

Dermatology Calendar

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s):

https://ift.tt/2CH07wb

Use of sterile urine cups as sharps containers during Mohs micrographic surgery stages

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Jessica Olander, Misha Miller, Mariah Brown

https://ift.tt/2Cd6E0r

Platelet-rich plasma for the treatment of lichen planopilaris

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Abhijeet Kumar Jha

https://ift.tt/2CESXbS

Camp Discovery: Changing lives for 25 years

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Mark V. Dahl

https://ift.tt/2CfBWDU

Supervision, autonomy, and medical error in the teaching clinic

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Jack P. Cossman, Miaoyuan Wang, Alison A. Fischer

https://ift.tt/2CFmty6

Seasonal patterns in alopecia areata, totalis, and universalis

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

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

https://ift.tt/2Cc3Kt6

Increased severity and epidermal alterations in persistent versus evanescent skin lesions in adult-onset Still disease

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Elina Zuelgaray, Maxime Battistella, Camille Sallé de Chou, Marie-Dominique Vignon-Pennamen, Michel Rybojad, Antoine Petit, Florence Cordoliani, François Chasset, Claude Bachmeyer, Laurence Fardet, Bruno Fautrel, Patrice Cacoub, Dan Lipsker, Martine Bagot, Jean-David Bouaziz

https://ift.tt/2CEvJCP

Teaching pediatric dermoscopy in a resource-limited setting

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Emily A. Gurnee, Rebecca C. Obeng, Benjamin K. Stoff

https://ift.tt/2C9CdbH

Transforming acne care by pediatricians: An interventional cohort study

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Jenna Borok, Jeremy Udkoff, Florin Vaida, James Murphy, Francesca Torriani, Andrea Waldman, Jusleen Ahluwalia, Lawrence F. Eichenfield

https://ift.tt/2CGWpmj

Knowledge of melanoma and nonmelanoma skin cancer among general dermatology patients

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Adriane A. Levin, Bichchau Michelle Nguyen

https://ift.tt/2Cd6Dtp

Comparison of long-term cosmetic outcomes for different treatments of superficial basal cell carcinoma

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Maud H.E. Jansen, Fabienne H.J. Koekelkoren, Patty J. Nelemans, Aimee H.M.M. Arits, Marieke H. Roozeboom, Nicole W.J. Kelleners-Smeets, Klara Mosterd

https://ift.tt/2CGWhmP

Store and forward teledermatology improves dermatology knowledge among referring primary care providers: A survey-based cohort study

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Girish C. Mohan, Gabriel E. Molina, Robert Stavert

https://ift.tt/2Cey5Y6

Clinical, trichoscopic, and histopathologic characteristics of patients with alopecia and hypothyroidism: An observational study

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Sergio Enrique Leal-Osuna, Diana Emma Becerril-Parra, Fátima Tinoco-Fragoso, Ana Beatriz García-Gil, María Elisa Vega-Memije, Lorena Lammoglia-Ordiales

https://ift.tt/2CGW6Ib

Steroid-induced changes noted on trichoscopy of patients with frontal fibrosing alopecia

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): David Saceda-Corralo, Óscar M. Moreno-Arrones, Pablo Fonda-Pascual, Cristina Pindado-Ortega, Ángela Hermosa-Gelbard, Ana R. Rodrigues-Barata, Sergio Vañó-Galván

https://ift.tt/2C9BRSp

Maintenance of therapeutic response after 1 year of apremilast combination therapy compared with monotherapy for the treatment of plaque psoriasis: A multicenter, retrospective study

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Arvin Ighani, Jorge R. Georgakopoulos, Neil H. Shear, Scott Walsh, Jensen Yeung

https://ift.tt/2CEglpX

Effect of petrolatum coating on fast-absorbing gut suture

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Jason R. Susong, James R. Neiner

https://ift.tt/2C9BK9r

Bringing big data from social media reviews to quality improvement

Publication date: November 2018

Source: Journal of the American Academy of Dermatology, Volume 79, Issue 5

Author(s): Severine Cao, Gideon P. Smith

https://ift.tt/2CGAEmA

Mixed Reality With Hololens® Exercise Protocol

Condition: Healthy Volunteers
Interventions: Other: Mixed reality; Other: Conventional exercise group
Sponsor: Centro Universitario La Salle
Not yet recruiting

https://ift.tt/2NCe4MX

Post-radiation Dental Disease Amongst Head and Neck Cancer Patients

Conditions: Head and Neck Cancer; Caries, Dental; Periodontal Diseases; Radiotherapy Side Effect
Intervention: Radiation: Radiotherapy (curative) for head and neck cancer
Sponsors: Belfast Health and Social Care Trust; Queen's University, Belfast
Not yet recruiting

https://ift.tt/2OSrZDk

Mixed Reality With Hololens® Exercise Protocol

Condition: Healthy Volunteers
Interventions: Other: Mixed reality; Other: Conventional exercise group
Sponsor: Centro Universitario La Salle
Not yet recruiting

https://ift.tt/2NCe4MX

Post-radiation Dental Disease Amongst Head and Neck Cancer Patients

Drilling and control of the internal auditory canal by fixed endoscope

Publication date: Available online 11 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): X. Dubernard, J.-C. Kleiber, M. Makeieff, A. Bazin, A. Chays

Abstract

Preservation of vestibular structures, particularly the posterior semicircular canal, is essential to ensure hearing preservation in addition to complete tumour resection during retrosigmoid surgical resection of a vestibular schwannoma. Drilling of the internal auditory canal (IAC) is a delicate step, during which these structures can be accidentally perforated. The orientation of the IAC results in the formation of poorly visible zones that can predispose to perforation of these structures when drilling is performed with a microscope. Hand-held endoscopy exposes all of the operative field, but immobilizes one of the surgeon's hands, making this surgery even more delicate. Fixed endoscopy is a solution that gives the surgeon greater freedom of movement, while ensuring precise control of the surgical procedure. It allows identification and avoidance of vestibular structures, while allowing resection as close as possible to the tumour. The schwannoma can be entirely cleaved when the fundus of the IAC is correctly controlled, while sparing the facial and cochlear nerves.

https://ift.tt/2PwjZF0

French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) guidelines concerning the role of otorhinolaryngologists in the management of paediatric obstructive sleep apnoea syndrome: Follow-up protocol for treated children

Publication date: Available online 11 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Akkari, R. Marianowski, F. Chalumeau, P. Fayoux, N. Leboulanger, P.J. Monteyrol, M. Mondain, Groupe de Travail de la SFORL

Abstract

Objectives

The authors present the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) clinical practice guidelines concerning the role of otorhinolaryngologists in the management of paediatric obstructive sleep apnoea syndrome (OSAS). This chapter is devoted to the follow-up protocol for children treated for OSAS.

Methods

A multidisciplinary task force was commissioned to carry out a review of the scientific literature on this topic. On the basis of the articles selected and the personal experience of each member of the task force, guidelines were drafted and graded as A, B or C or expert opinion according to a decreasing level of scientific evidence, and were then reviewed by a reading committee, independently of the task force. The final guidelines were established at a consensus meeting.

Results

Short-term, medium-term and long-term clinical follow-up and complementary investigations are necessary in view of the risk of residual OSAS, and the risk of recurrence of OSAS related to adenoid and tonsillar regrowth following adenotonsillectomy, the treatment most commonly performed. The modalities of follow-up after surgery, continuous positive airway pressure (CPAP) ventilation, orthodontic treatment, myofascial rehabilitation, and drug therapy are described. The indications for nasal endoscopy and sleep studies as part of follow-up are specified.

https://ift.tt/2yeptxE

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Παρασκευή 12 Οκτωβρίου 2018

Abstract

Purpose of Review

Recent Findings

Summary

Zusammenfassung

2018 Van Meter Lectureship "The role of a new thyroid-specific long non-coding RNA (lincRNA) in drug resistance and iodine metabolism in BRAFV600E thyroid cancer" presented by Carmelo Nucera, MD, PhD

2018 Van Meter Lectureship "The role of a new thyroid-specific long non-coding RNA (lincRNA) in drug resistance and iodine metabolism in BRAFV600E thyroid cancer" presented by Carmelo Nucera, MD, PhD

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