Head and Neck Diseases by Alexandros G.Sfakianakis: 10/17/18

Τετάρτη 17 Οκτωβρίου 2018

Button battery removed from the stomach resulting in a missed aortoesophageal fistula – a multidisciplinary approach to rescuing a very young patient: a case report

While coins are still the most common foreign bodies swallowed by children, ingestion of batteries has become more frequent among children due to the increasing access to electronic toys and devices.

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A painless glomus tumor: a case report

Glomus tumor is a benign and vascular hamartoma that originates from the neuromyoarterial cells of the normal glomus apparatus in the reticular dermis. The etiology of glomus tumors is unknown. It usually pres...

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Ideal treatment strategy for chylous mesenteric cyst: a case report

A mesenteric chylous cyst is defined as a cyst occurring in the mesentery of the gastrointestinal tract anywhere from the duodenum to the rectum and is diagnosed most often during the fifth decade of life.

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Bilateral Spontaneous Hyphemas in a Patient with Aplastic Anemia

Bilateral spontaneous hyphemas are a rare ophthalmic event. Aplastic anemia is a hematologic condition with well-documented manifestations in the posterior segment but not the anterior segment. We present a patient with aplastic anemia without obvious risk factors for hyphema who developed bilateral spontaneous hyphemas. To our knowledge, this is the first reported case of bilateral spontaneous hyphemas in a patient with aplastic anemia.
Case Rep Ophthalmol 2018;9:444–448

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Detection of Candida Endophthalmitis in a Newborn Using Handheld Spectral-Domain Optical Coherence Tomography

In a newborn with candidemia, two retinal lesions were seen without external inflammatory signs or reaction in the anterior chamber or vitreous. However, handheld spectral domain-optical coherence tomography (HH SD-OCT) images show that one of the retinal lesions had a "firework display" projecting to the vitreous that was not identified in indirect ophthalmoscopy. This finding suggested a Candida endophthalmitis. HH SD-OCT findings allowed us to make an accurate diagnosis and, therefore, modified the decision-making process in the treatment of the pathology.
Case Rep Ophthalmol 2018;9:439–443

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Thrombus straddling a patent foramen ovale, pulmonary embolism and paradoxical embolism: a rare trifecta

Description

A 55-year-old male presented to the emergency room after awakening with left facial droop, left-sided weakness and garbled speech. Vitals were significant for hypotension (73/43 mm Hg) and hypothermia (35.3°C). Physical examination was significant for left facial droop, dysarthria, bilateral upper extremity strength 4/5, bilateral lower extremity strength 3/5. Laboratory tests were significant for leucocytosis of 16.9x10⁹/L thou/mcL, lactic acid 2.5 mmol/L, creatinine 3.07 mg/dL and troponin 0.07 ng/mL.

Chest X-ray revealed no acute process. Head CT revealed no acute process with old right basal ganglia and right frontal lobe infarcts. Head and neck magnetic resonance angiography (MRA) revealed no blockages or aneurysmal dilatations. Brain MRI revealed three areas of diffusion restriction in left temporal occipital lobe, compatible with acute infarcts. Tissue plasminogen activator was not given since he was outside the window. Stroke work-up was ordered, pancultures were sent, broad-spectrum antibiotics were started, and he was sent to the intensive care unit.

Transthoracic...

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Pelvic hydatid: the great masquerader

Description

A 52-year-old man presented with urinary frequency and occasional lower abdominal pain for 4 months. His uroflow study and postvoid residual urine were normal and his digital rectal examination had grade 2 prostatic enlargement. His urinary symptoms were attributed to benign prostatic hyperplasia, and he was prescribed tamsulosin (0.4 mg) and solifenacin (5 mg) for his symptoms. One week later he only had partial relief of symptoms, thus an ultrasound was done that showed a cystic lesion abutting the urinary bladder in the region of right iliac fossa (figure 1). A contrast-enhanced CT (CECT) scan was then done, which showed a cystic lesion (3.8x4 cm) with enhancing internal septa and peripheral wall enhancement abutting the urinary bladder (figure 2). There was no other cyst in the abdomen so a provisional diagnosis of primary pelvic peritoneal hydatid cyst was made. We then carried out a cystoscopy to...

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Development of acquired haemophilia A in a patient treated with alemtuzumab for multiple sclerosis

This case illustrates a 36-year-old man who presented with a factor VIII (FVIII) inhibitor (acquired haemophilia A) with cutaneous bleeding and a significant thigh haematoma. No traditional risk factors for the development of a FVIII inhibitor were identified. However, previous treatment with alemtuzumab for multiple sclerosis was noted in the patient's history. Alemtuzumab is an anti-CD52 monoclonal antibody and is known to be associated with the development of a number of autoimmune conditions, with a delay in onset of these conditions as long as 5 years after the cessation of treatment. To our knowledge, there have only been three previously documented cases of a FVIII inhibitor in the setting of alemtuzumab therapy. This case adds further evidence to the current body of literature suggesting alemtuzumab as a causative agent for the development of an FVIII inhibitor.

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Meningococcemia: rare but life-threatening

Description

A previously healthy 5-month old girl, presented at the emergency department with high fever (40°C), vomiting and nasal congestion. She had no abnormalities on physical exam and was discharged home with diagnosis of a probable viral infection, after excluding urinary infection.

Ten hours later, the infant was readmitted with purpuric lesions and prostration (figure 1), rapidly presenting with labial cyanosis, capillary refill of 6 s, tachycardia, hypotension and anuria (cold shock). The patient was empirically treated with ceftriaxone and vancomycin, started inotropic and ventilator support, having been transferred to a hospital with a paediatric intensive care unit with a refractory shock, purpuric rash and disseminated intravascular coagulation (figure 2).

Figure 1

Petechiae and purpuric lesions only on the thoracoabdominal region.

Figure 2

Purpura fulminans with necrosis of extremities.

Blood workout revealed leucopenia (2.600/mm³) with neutropenia (2.00/mm³),...

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Endoscopic resection of a huge orbital ethmoidal mucocele masquerading as dacryocystocele

Paranasal mucoceles are cystic masses lined with epithelium thought to result from chronic obstruction of an impaired sinus ostia. If sufficiency large, they can cause ophthalmological sequelae including diplopia, visual acuity, globe displacement as well as the rhinological symptoms of facial pain and headache. We present the case of a 57-year-old man who presented with a 1-year history of epiphora and right globe prominence with associated diplopia. Imaging demonstrated a mass located within the medial aspect of the orbit, closely associated to the lamina papyracea and nasolacrimal duct consistent with a dacryocystocele. An alternate diagnosis of an ethmoidal mucocele was considered preoperatively following rhinologist opinion. Complete endoscopic resection of the cyst was undertaken. Histopathology confirmed diagnosis of an ethmoidal mucocele. Our report highlights mucocele should be considered in patients with chronic symptoms secondary to a mass situated in the nasolacrimal duct without radiological orbital bone destruction.

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Influenza A: another cause of SIADH?

The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a frequent cause of hyponatraemia. It is a dilutional hyponatraemia secondary to impaired urinary dilution in the absence of renal disease or any identifiable non-osmotic stimulus known to induce antidiuretic hormone secretion. SIADH can arise secondary to various respiratory tract infections; however, the association between SIADH and influenza A infection is described in only a few cases in the literature. The authors present a case report of influenza A that may have caused a profound SIADH-related hyponatraemia.

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Verruciform xanthoma overlying inflammatory linear verrucous epidermal nevus and in broad segmental distribution

A 17-year-old woman presented with moderately itchy, non-progressive, linearly arranged verrucous plaques over dorsum of left foot since early childhood. Two years ago, she developed slowly increasing, verrucous exophytic growth in posterior most aspect of linear verrucous plaque. One year ago, she also developed multiple, linearly arranged, fleshy plaques with surface crusting over lateral aspect of right leg extending to thigh. Biopsy from both verrucous lesion on left foot and fleshy plaque on right leg showed an exophytic growth with significant papillomatosis, neutrophils in stratum corneum, acanthosis and infiltration of papillary dermis with foamy macrophages that were CD 68 positive, features compatible with verruciform xanthoma (VX). Biopsy from linear verrucous plaque over left foot was consistent with inflammatory linear verrucous epidermal nevus (ILVEN). A diagnosis of segmental VX and VX overlying ILVEN was made.

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Churg-Strauss vasculitis presenting with steroid-responsive left ventricular cardiac mass

A 35-year-old black Saudi man, with a known case of bronchial asthma and allergic rhinitis since childhood, presented with joint pain and swelling, orthopnoea, paroxysmal nocturnal dyspnoea and lower extremity oedema. On examination, we found jugular venous distension, bilateral basal crepitation, wheezing and diffuse synovitis. Investigations were notable for peripheral blood eosinophilia, pericardial effusion and elongated structure in the left ventricular outflow tract on echocardiography, mediastinal and hilar lymphadenopathy and right upper lobe infiltrate on high-resolution CT scan. Pulmonary infiltrate biopsy confirmed eosinophilic vasculitis. Intracardiac mass resolved shortly after pulse steroids indicating an inflammatory mass.

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Correction: Vacuum-assisted right atrial infected clot extraction due to persistent bacteraemia: a percutaneous approach for the management of right-sided endocarditis

Ahmed M, Montford JH, Lau E. Vacuum-assisted right atrial infected clot extraction due to persistent bacteraemia: a percutaneous approach for the management of rightsided endocarditis. BMJ. doi:10.1136/bcr-2018-226493.

The previous version of this manuscript contains an error in author's surname namely Jaime Hernandez Montford. It should read as:

Jaime Hernandez Montfort

instead of

Jaime Hernandez Montford

Also, the location of Baystate Medical Center should read as:

Baystate Medical Center, Springfield, MA, USA

Instead of

Baystate Medical Center, Springfield, Illinois, USA

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Resolved heart tamponade and controlled exophthalmos, facial pain and diabetes insipidus due to Erdheim-Chester disease

A 69-year-old woman suffering from exophthalmos and facial pain came to us referred for aetiological diagnosis of exophthalmos. Orbital MRI showed thinned extrinsic ocular musculature, intraconal fat infiltration, retro-ocular compression and thickening of maxillary and sphenoid sinus walls. She had been suffering from diabetes insipidus for the last 7 years. During our diagnosis process, she presented signs of cardiac tamponade. Transthoracic heart ultrasound revealed large pericardial effusion and a heterogeneous mass that compressed the right ventricle. No osteosclerotic lesions on appendicular bones were present. Pericardiocentesis temporarily controlled tamponade and corticoid therapy temporarily abated exophthalmos. Pericardiectomy definitively resolved tamponade. Histological examination of pericardial tissue was conclusive of Erdheim-Chester disease. Exophthalmos responded to pegylated interferon-alpha-2a. Facial bone pain disappeared after zoledronic acid and interferon treatment. During interferon therapy, the patient suffered from a severe generalised desquamative exanthema that slowly resolved after discontinuing interferon. Diabetes insipidus remains controlled with desmopressin.

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Regulation of metabolic supply and demand during B cell activation and subsequent differentiation

Takeshi Egawa | Deepta Bhattacharya

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Forced oscillatory parameters in reversibility testing as predictors for chronic cough responsive to ICS/LABA

The cough guidelines recommend that asthma should always be considered as a potential etiology of chronic cough.1,2 The presence of airway hyperresponsiveness is consistent with, but not diagnostic of, cough due to mild asthma.A definitive diagnosis cannot be made until resolution of cough is achieved with specific therapy, including inhaled corticosteroid/long-acting β2 agonist (ICS/LABA) or ICS. Airway reversibility testing is often used to diagnose cough due to mild asthma; however, reversibility of forced expiratory volume in 1 second (FEV1) is smaller in mild asthma than in moderate asthma because baseline FEV1 values are normal or nearly normal in most patients with mild asthma.

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Tumor necrosis factor-alpha inhibitors for the treatment of pyoderma gangrenosum not associated with inflammatory bowel diseases: a multicenter retrospective study

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Use of multifilament nylon floss in onychocryptosis

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Vulvar Cancer Association with Groin Hidradenitis Suppurativa: A Large, Urban, Midwestern U.S. Patient Population Study

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Hydrocolloid Dressing Application for the Treatment of Pediatric Onychodystrophies

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Antioxidant supplements in combination with phototherapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials

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What do Patients Undergoing Mohs Micrographic Surgery Value? Results of a Patient Values Survey based on OAS-CAHPS

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Epidemiology of Nickel Sensitivity: Retrospective Cross-Sectional Analysis of North American Contact Dermatitis Group (NACDG) Data 1994-2014

Detailed analyses of trends in nickel sensitivity in North America are lacking. Clinicians should be aware of a significant increase in nickel sensitivity over time (14.3% to 20.1% from 1994 to 2014) and significant increase in current clinical relevance of reactions over time (44.1% to 51.6% from 1994 to 2014).

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Correction: Prevalence and Progression Rate of Diabetic Retinopathy in Type 2 Diabetes Patients in Correlation with the Duration of Diabetes

Exp Clin Endocrinol Diabetes 2018; 126: e2-e2
DOI: 10.1055/a-0757-3796

[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Cardivascular Risk Profile in Patients with Diabetes and Acromegaly or Cushing’s Disease – Analysis from the DPV Database

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0600-9649

Background Although diabetes is a common complication of acromegaly or Cushing´s disease, there are only few detailed studies with a focus on cardiovascular risk, metabolic control or diabetes therapy. Here, we provide a comprehensive characterization from the longitudinal DPV (Diabetes Patienten Verlaufsdokumentation) registry. Methods Patients from the registry≥18 years of age with diabetes and acromegaly or Cushing´s disease were compared to patients with type 1 diabetes or type 2 diabetes using the statistical software SAS 9.4. Results Patients with diabetes and acromegaly (n=52) or Cushing's disease (n=15) were significantly younger at diabetes onset (median age 50.1 and 45.0 vs. 59.0 years in type 2 diabetes; both p<0.05). Dyslipidemia was common in both diseases (71.0% and 88.9% vs. 71.8% in type 2 diabetes; n.s.), while hypertension was most frequent in acromegaly (56.8% vs. 20.9% in type 1 diabetes, p<0.00001). 36.5% of patients with acromegaly and 46.7% with Cushing´s disease receive insulin, compared to 50.4% with type 2 diabetes. Oral antidiabetic drugs were used in 36.5% of patients with acromegaly and 40% with Cushing´s disease, with a predominance of biguanides and dipeptidyl peptidase-4 inhibitors. HbA1c was well controlled in both groups (median 7.0% and 6.5%; vs. 7.2% in type 2 diabetes). Conclusion Patients with acromegaly are at a high risk for cardiovascular disease, reflected by dyslipidemia and hypertension. A high proportion of patients with diabetes in acromegaly or Cushing´s disease receives insulin. Based on a multicenter register, a sufficient number of patients with rare forms of diabetes can be analyzed.
[...]

Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Hedgehog signaling pathway and vitamin D receptor gene variants as potential risk factors in odontogenic cystic lesions

Abstract

Objectives

Genetic variants in the hedgehog signaling pathway and VDR gene are involved in inflammatory responses and neoplastic transformation. Current study investigated whether single-nucleotide polymorphisms in the hedgehog pathway genes PTCH1, GLI1, SMO, and VDR contribute to susceptibility to odontogenic cystic lesions, odontogenic keratocysts, or inflammatory radicular cysts.

Material and methods

Current study examined polymorphisms of PTCH1 (rs357564) and PTCH1 insertion (IVS1-83), GLI1 (rs2228224, rs2228226), SMO (rs2228617), and VDR (rs2228570, rs731236, rs7975232). A case-control study was conducted on 41 keratocyst cases, 43 radicular cyst cases, and control group of 93 healthy individuals without cystic lesions, radiographically confirmed. Single-nucleotide polymorphisms were assessed by real-time and TaqMan SNP genotyping assays, while PTCH1 insertion 18 bp IVS1-83 polymorphism was determined by PCR.

Results

The difference in genotype distribution between keratocyst cases and control group was observed for PTCH1 IVS1-83 and GLI1 rs2228224 polymorphism (p = 0.022, p = 0.030, respectively). Homozygous mutant GG genotype within GLI1 rs2228224 is associated with increased susceptibility for odontogenous keratocysts, with adjusted odds ratio of 4.098 (confidence interval of 1.482–11.328, p = 0.007).

Conclusion

GLI1 rs2228224 and PTCH1 polymorphisms could predispose to odontogenic keratocysts.

Clinical relevance

Variants in hedgehog signaling pathway genes, such as GLI1 and PTCH1, and vitamin D receptor gene, might be considered as molecular risk factors in odontogenic cystic lesions and potential targets for novel therapeutic approaches.

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Single-Nucleotide Polymorphisms in NOD1, RIPK2, MICB, PLCE1, TNF, and IKBKE Genes Associated with Symptomatic Dengue in Children from Colombia

Viral Immunology, Ahead of Print.

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The expression of MHC class II molecules on murine breast tumors delays T-cell exhaustion, expands the T-cell repertoire, and slows tumor growth

Abstract

The expression of MHC class II molecules (MHCII) on tumor cells correlates with survival and responsiveness to immunotherapy. However, the mechanisms underlying these observations are poorly defined. Using a murine breast tumor line, we showed that MHCII-expressing tumors grew more slowly than controls and recruited more functional CD4⁺ and CD8⁺ T cells. In addition, MHCII-expressing tumors contained more TCR clonotypes expanded to a larger degree than control tumors. Functional CD8⁺ T cells in tumors depended on CD4⁺ T cells. However, both CD4⁺ and CD8⁺ T cells eventually became exhausted, even in MHCII-expressing tumors. Treatment with anti-CTLA4, but not anti-PD-1 or anti-TIM-3, promoted complete eradication of MHCII-expressing tumors. These results suggest tumor cell expression of MHCII facilitates the local activation of CD4⁺ T cells, indirectly helps the activation and expansion of CD8⁺ T cells, and, in combination with the appropriate checkpoint inhibitor, promotes tumor regression.

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Dosimetric and volumetric effects in clinical target volume and organs at risk during postprostatectomy radiotherapy

Abstract

Purpose

To assess the reproducibility of the dose–volume distribution of the initial simulation CT, generated using volumetric modulated arc therapy (VMAT) planning, during the radiotherapy of the prostatic bed based on weekly cone beam CTs (CBCT).

Methods

Twenty-three patients, after radical prostatectomy were treated with adjuvant or salvage radiotherapy between July and December 2016 and considered for this evaluation. Weekly CBCT scans (n = 138) were imported into the treatment planning system, and the clinical tumor volume (CTV), the rectum and the bladder were contoured. The initially calculated dose distribution and the dose–volume histograms generated from weekly CBCTs were compared. The prostatic fossa dose coverage was assessed by the proportion of the CTV fully encompassed by the 95% and 98% isodose lines. Rectal and bladder volumes receiving 50, 60 and 65 Gy during the treatment were compared to the initial plan, with statistical significance determined using the one-sample t‑test.

Results

Marked variations in the total organ volume of the rectum and the bladder were observed. The correlation between rectum volume and V₅₀ was not significant (p = 0.487), while the bladder volume and V₅₀ demonstrated a significant correlation. There was no correlation between urinary bladder volume and CTV. The change in rectal volume correlated significantly with CTV. The dose coverage (D_98% and D_95%) to the prostatic bed could be achieved for all patients due to the ventral shift in the volume differences of the rectum.

Conclusion

Weekly CBCTs can be considered as adequate verification tools to assess the interfractional variability of the CTV and organs at risk. The proven volume changes in the urinary bladder and the rectum do not compromise the final delivered dose in the CTV.

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Association of Caffeine and Caffeinated Coffee Intake With Risk of Incident Rosacea in Women

This large cohort study of participants in the Nurses' Health Study II evaluates the association between risk of incident rosacea in women and caffeine intake, including caffeinated coffee consumption.

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One More Reason to Continue Drinking Coffee—It May Be Good for Your Skin

Who does not love a study that validates one of life's habitual pleasures? Whether it is an iced latte, a double espresso, or simply a hot cup of brown liquid in the hospital cafeteria, many of us in medicine have an emotional attachment as well as a physiologic dependence on coffee.

https://ift.tt/2EtLE8w

Utility of Test Result Monitoring in Patients Taking Terbinafine or Griseofulvin for Dermatophyte Infections

This study assesses the rate and utility of monitoring laboratory test result abnormalities in adults and children taking terbinafine and griseofulvin for treatment of dermatophyte infections.

https://ift.tt/2RXJQaO

Cicatrizing Blepharoconjunctivitis During Dupilumab Treatment and an Algorithm for Its Management

This case report describes a patient who developed cicatrizing blepharoconjunctivitis while undergoing dupilumab treatment and proposes an algorithm for the management of dupilumab-associated conjunctivitis.

https://ift.tt/2EutbsG

Open-Label, Multicenter, Phase Ⅱ Study of Docetaxel and Cisplatin Combined With Nimotuzumab As First-Line Treatment in Patients With Recurrent or Metastatic Nasopharyngeal Carcinoma

Condition: Over Survival
Intervention: Drug: Docetaxel and Cisplatin and Nimotuzumab
Sponsor: Sun Yat-sen University
Not yet recruiting

https://ift.tt/2yqWy9H

Phase II Study of Perioperative Immunotherapy in Patients With Advanced Non-Virally Associated Squamous Cell Carcinoma

Conditions: Cancer; Carcinoma; Squamous Cell Carcinoma; Head and Neck Cancer
Interventions: Biological: Atezolizumab; Biological: Emactuzumab
Sponsors: University of California, San Francisco; Genentech, Inc.
Not yet recruiting

https://ift.tt/2yFYSsK

Open-Label, Multicenter, Phase Ⅱ Study of Docetaxel and Cisplatin Combined With Nimotuzumab As First-Line Treatment in Patients With Recurrent or Metastatic Nasopharyngeal Carcinoma

Condition: Over Survival
Intervention: Drug: Docetaxel and Cisplatin and Nimotuzumab
Sponsor: Sun Yat-sen University
Not yet recruiting

https://ift.tt/2yqWy9H

Phase II Study of Perioperative Immunotherapy in Patients With Advanced Non-Virally Associated Squamous Cell Carcinoma

Effectiveness of Antiemetic Regimens for Highly Emetogenic Chemotherapy‐Induced Nausea and Vomiting: A Systematic Review and Network Meta‐Analysis

AbstractBackground.It is important to control chemotherapy‐induced nausea and vomiting (CINV) to maintain dose intensity and patients' quality of life. The National Comprehensive Cancer Network guidelines suggest combination therapy of antiemetic agents. The growing number of antiemetic regimens, and in particular the growing use of regimens containing antagonists to the Nk‐1 receptor (NK1RAs) and the antipsychotic drug olanzapine (OLZ), call for the re‐evaluation of the optimal regimen for CINV. This study assessed the efficacy and safety of antiemetic regimens for highly emetogenic chemotherapy, using Bayesian network meta‐analysis.Methods.Randomized trials that compared different antiemetic regimens were included. We strictly followed Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. The main outcomes were the odds ratio (OR) for overall complete response (absence of vomiting). We conducted network meta‐analysis within a Bayesian model to combine the direct and indirect evidence. Safety was assessed from the trial description. All statistical tests were two‐sided.Results.We systematically reviewed 27 randomized control trials (13,356 participants), which compared 12 different antiemetic regimens: serotonin‐3 receptor antagonist (5HT3), 5HT3 + dexamethasone (Dex), palonosetron (PAL), PAL + Dex, PAL at 0.75 mg (PAL0.75), PAL0.75 + Dex, NK1RA + 5HT3 + Dex, NK1RA + PAL + Dex, an oral combination of netupitant and palonosetron (NEPA) + Dex, OLZ + 5HT3 + Dex, OLZ + PAL + Dex, and OLZ + NK1RA + 5HT3 + Dex. An NK1RA + 5HT3 + Dex regimen and an NK1RA + palonosetron + Dex regimen gave a higher complete response (CR) rate than the reference regimen, 5HT3 + Dex (OR, 1.75; 95% credibility interval [95% CrI], 1.56–1.97, and OR, 2.25; 95% CrI, 1.66–3.03, respectively). A regimen containing NEPA was more effective in producing CR than conventional regimens without NEPA or olanzapine. Further analysis, based on the surface under the cumulative ranking probability curve, indicated that olanzapine‐containing regimens were the most effective in producing CR.Conclusion.Our meta‐analysis supports the conclusion that olanzapine‐containing regimens are the most effective for CINV of highly emetogenic chemotherapy. We confirmed that NK1RA + PAL + Dex is the most effective of conventional regimens. Substituting olanzapine for an Nk‐1 receptor antagonist may offer a less costly and more effective alternative for patients.Implications for Practice.Nausea and vomiting during chemotherapy often pose difficulties for patients and doctors, making it hard to continue the proper therapy and to maintain the quality of life. This article gives insights into the optimal choice of medicine to treat nausea during chemotherapy. The findings reported here provide readers with a robust efficacy ranking of antinausea medicine, which can be used as a reference for the best possible treatment. Furthermore, the 70% less costly drug, olanzapine, is suggested to be equally effective to aprepitant in reducing nausea and vomiting. The possibility of offering a cost‐effective treatment to a wider range of the population is discussed.

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Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma: A Multi-Center Cohort Study in Korea

Thyroid, Ahead of Print.

https://ift.tt/2yMtysa

Transcriptional Responses of Streptococcus gordonii and Fusobacterium nucleatum to Coaggregation

Molecular Oral Microbiology, Volume 0, Issue ja, -Not available-.

https://ift.tt/2QQZYtc

Secukinumab is Superior to Ustekinumab in Clearing Skin in Patients with Moderate to Severe Plaque Psoriasis (16-Week CLARITY Results)

Abstract

Introduction

Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, has demonstrated superior efficacy to ustekinumab in the phase 3b CLEAR study of moderate to severe plaque psoriasis. Here, we report 16-week results from CLARITY, a second head-to-head trial comparing secukinumab with ustekinumab.

Methods

In the phase 3b CLARITY study, patients were randomized 1:1 to receive subcutaneous secukinumab 300 mg or ustekinumab per label. The co-primary objectives were to demonstrate the superiority of secukinumab over ustekinumab at Week 12 in relation to the proportion of patients with (1) 90% or more improvement from baseline Psoriasis Area and Severity Index (PASI 90) and (2) a score of 0/1 (clear/almost clear) on the modified Investigator's Global Assessment (IGA mod 2011 0/1). Key secondary objectives were also assessed, as was Dermatology Life Quality Index (DLQI) 0/1 (no impact of skin disease on patients' quality of life) response. Missing values were handled by multiple imputation except for DLQI 0/1, where last observation carried forward techniques were utilized.

Results

Both co-primary objectives were met: secukinumab was superior to ustekinumab for the proportion of patients achieving a PASI 90 (66.5% vs. 47.9%) and IGA mod 2011 0/1 response (72.3% vs. 55.4%) at Week 12 (p < 0.0001). PASI 90 responses were greater with secukinumab compared to ustekinumab from as early as Week 4 (16.7% vs. 4.0%) and out to Week 16 (76.6% vs. 54.2%). Similarly, IGA mod 2011 0/1 findings were greater with secukinumab at Week 4 (26.9% vs. 7.8%) and at Week 16 (78.6% vs. 59.1%). DLQI 0/1 response rates were also greater with secukinumab compared to ustekinumab at Week 4 (33.9% vs. 18.0%), Week 12 (64.0% vs. 51.7%), and Week 16 (68.4% vs. 55.9%).

Conclusion

The results of this study confirm the superior efficacy of secukinumab over ustekinumab in treating patients with moderate to severe psoriasis.

Trial Registration

Clinicaltrials.gov Identifier, NCT02826603.

Funding

Novartis Pharma AG, Basel, Switzerland.

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Patient reported outcome measures for soft tissue facial reconstruction: a systematic review and evaluation of the quality of their measurement properties

Background: A patient's health-related quality of life (HRQoL) can be significantly impacted by facial scarring and disfigurement. Facial soft tissue reconstruction should aim to improve HRQoL, with outcomes measured from the patient's perspective using patient-reported outcome measures (PROMs). This systematic review identifies PROMs for soft tissue facial reconstruction and appraises their methodological and psychometric properties using up-to-date methods. Methods: A systematic search of MEDLINE, EMBASE, PsychINFO and Cochrane was performed in line with the PRISMA guidelines. Identified PROMs were assessed using the updated COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) checklist. Psychometric properties were also assessed and a modified GRADE analysis was performed to aid in recommendations for future PROM use. Results: Thirty-four studies covering 9 PROMs were included. Methodological quality and psychometric evidence was variable. FACE-Q, Skin Cancer Index (SCI), Patient Outcome of Surgery – Head/Neck (POS-Head/Neck) and the Derriford Appearance Scale 59/24 all demonstrated high enough evidence to be recommended as having potential for inclusion in future studies. Conclusion: This is the first systematic review to identify and critically appraise PROMs for soft tissue facial reconstruction using internationally accepted criteria. Four PROMs were deemed to have adequate levels of methodological and psychometric evidence, although further studies should be conducted before their routine use in patients undergoing facial reconstruction. Through the use of psychometrically well-validated PROMs it is hoped that patients' concerns can be truly appreciated, level of care improved, and the quality of reconstructive options offered progressed. Meetings: This work has not yet been presented at any meetings. Acknowledgements: We would like to acknowledge the help of Anne Powell, retired librarian at Abertawe Bro Morgannwg University Health Board. Conflicts of Interest and Funding: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. This work has received no specific funding. Mr Thomas Dobbs is funded by the Welsh Clinical Academic Training Fellowship. Author role: TD, HH and ISW developed the idea for this systematic review. TD, JG, AT, BP performed the literature review and data extraction. TD and SH assessed all included papers according to the methodology. TD produced the first draft of the manuscript and all authors were then involved in editing to reach the final, submitted version. Corresponding Author: Mr Thomas Dobbs, The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea. SA6 6NL, e: tomdobbs@doctors.org.uk ©2018American Society of Plastic Surgeons

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Dysexecutive disorders and their diagnosis: a position paper

Publication date: Available online 17 October 2018

Source: Cortex

Author(s): Olivier Godefroy, Olivier Martinaud, Pauline Narme, Pierre-Alain Joseph, Chrystèle Mosca, Eugénie Lhommée, Thierry Meulemans, Virginie Czernecki, Céline Bertola, Pierre Labauge, Marc Verny, Anne Bellmann, Philippe Azouvi, Claire Bindschaedler, Eric Bretault, Claire Boutoleau-Bretonniere, Philippe Robert, Hermine Lenoir, Marianne Krier, Martine Roussel

Abstract

Although executive function disorders are among the most prevalent cognitive impairments a consensus on diagnostic criteria has yet to be reached. With a view to harmonizing these criteria, the present position paper (i) focuses on the main dysexecutive disorders, (ii) examines recent approaches in both the behavioral and cognitive domains, (iii) defines diagnostic boundaries for frontal syndrome, (iv) reports on the frequency and profile of the executive function disorders observed in the main brain diseases, and (v) proposes an operationalization of diagnostic criteria. Future work must define the executive processes involved in human adaptive behavior, characterize their impairment in brain diseases, and improve the management of these conditions (including remediation strategies and rehabilitation).

https://ift.tt/2RWkSZ5

A Touching Sight:EEG/ERP Correlates for the Vicarious Processing of Affectionate Touch

Publication date: Available online 16 October 2018

Source: Cortex

Author(s): Annett Schirmer, Francis McGlone

Abstract

Observers can simulate aspects of other people's tactile experiences. We asked whether they do so when faced with full-body social interactions, whether emerging representations go beyond basic sensorimotor mirroring, and whether they depend on processing goals and inclinations. In an EEG/ERP study, we presented line-drawn, dyadic interactions with and without affectionate touch. In an explicit and an implicit task, participants categorized images into touch vs no-touch and same vs opposite sex interactions, respectively. Modulations of central Rolandic rhythms implied that affectionate touch displays engaged sensorimotor mechanisms. Additionally, the late positive potential (LPP) being larger for images with as compared to without touch pointed to an involvement of higher order socio-affective mechanisms. Task and sex modulated touch perception. Sensorimotor responding, indexed by Rolandic rhythms, was fairly independent of the task but appeared less effortful in women than in men. Touch induced socio-affective responding, indexed by the LPP, declined from explicit to implicit processing in women and disappeared in men. In sum, this study provides first evidence that vicarious touch from full-body social interactions entails shared sensorimotor as well as socio-affective experiences. Yet, mental representations of touch at a socio-affective level are more likely when touch is goal relevant and observers are female. Together, these results outline the conditions under which touch in visual media may be usefully employed to socially engage observers.

https://ift.tt/2Erjtan

How the visual brain detects emotional changes in facial expressions: Evidence from driven and intrinsic brain oscillations

Publication date: Available online 16 October 2018

Source: Cortex

Author(s): Rafaela R. Campagnoli, Matthias J. Wieser, L. Forest Gruss, Lisa M. McTeague, Maeve R. Boylan, Andreas Keil

Abstract

The processing of facial expressions is often studied using static pictorial cues. Recent work, however, suggests that viewing changing expressions more robustly evokes physiological responses. Here, we examined the sensitivity of steady-state visual evoked potentials and intrinsic oscillatory brain activity to transient emotional changes in facial expressions. Twenty-two participants viewed sequences of grayscale faces periodically turned on and off at a rate of 17.5 Hz, to evoke flicker steady-state visual evoked potentials (ssVEPs) in visual cortex. Each sequence began with a neutral face (flickering for 2290 ms), immediately followed by a face from the same actor (also flickering for 2290 ms) with one of four expressions (happy, angry, fearful, or another neutral expression), followed by the initially presented neutral face (flickering for 1140 ms). The amplitude of the ssVEP and the power of intrinsic brain oscillations were analyzed, comparing the four expression-change conditions. We found a transient perturbation (reduction) of the ssVEP that was more pronounced after the neutral-to-angry change compared to the other conditions, at right posterior sensors. Induced alpha-band (8-13 Hz) power was reduced compared to baseline after each change. This reduction showed a central-occipital topography and was strongest in the subtlest and rarest neutral-to-neutral condition. Thus, the ssVEP indexed involvement of face-sensitive cortical areas in decoding affective expressions, whereas mid-occipital alpha power reduction reflected condition frequency rather than expression-specific processing, consistent with the role of alpha power changes in selective attention.

https://ift.tt/2RU06t7

Les toxidermies graves sont-elles évitables ?

Publication date: Available online 16 October 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): J.-L. Schmutz

https://ift.tt/2EqpmEP

Intraoperative Hypothermia is Associated With Reduced Acute Kidney Injury After Spine Surgery Under General Anesthesia: A Retrospective Observational Study

Background: Although hypothermia is known to have protective effects against ischemic injuries, the effects of hypothermia on kidney injury have not yet been elucidated. Therefore, this study aimed to identify the association between intraoperative hypothermia and postoperative acute kidney injury (AKI) in patients who underwent spine surgery under general anesthesia. Methods: In this retrospective observational study, we analyzed the medical records of adult patients who underwent elective spine surgery between January 2010 and March 2018. Patients were classified into the normothermia group (36.5 to 37.5°C), mild hypothermia group (35 to 36.5°C), and hypothermia group (

https://ift.tt/2NMjGEt

Cognitive Aids for the Diagnosis and Treatment of Neuroanesthetic Emergencies: Consensus Guidelines on Behalf of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee

Cognitive aids and evidence-based checklists are frequently utilized in complex situations across many disciplines and sectors. The purpose of such aids is not simply to provide instruction so as to fulfill a task, but rather to ensure that all contingencies related to the emergency are considered and accounted for and that the task at hand is completed fully, despite possible distractions. Furthermore, utilization of a checklist enhances communication to all team members by allowing all stakeholders to know and understand exactly what is occurring, what has been accomplished, and what remains to be done. Here we present a set of evidence-based critical event cognitive aids for neuroanesthesia emergencies developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) Education Committee. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Amie L. Hoefnagel, MD, Department of Anesthesiology, University of Florida College of Medicine—Jacksonville, 2nd Floor, Clinical Center, 655 West 8th Street, C72, Jacksonville, FL 32209 (e-mail: amie.hoefnagel@jax.ufl.edu). Received August 7, 2018 Accepted August 27, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

https://ift.tt/2pZiu7i

Regional Versus General Anesthesia: Effect of Anesthetic Techniques on Clinical Outcome in Lumbar Spine Surgery A Prospective Randomized Controlled Trial

Background: There are only a few prospective clinical trials investigating the effects of different anesthetic techniques on clinical outcomes after lumbar spine surgery. The purpose of this study was to evaluate clinical outcomes in patients receiving general (GA) and regional anesthesia (RA) for lumbar spine surgery. Methods: This was a single-center, 2-arm, trial in which 100 patients undergoing lumbar spine surgery were randomized to receive either RA or GA (50 per group). The primary endpoint was morphine consumption during the first postoperative 48 hours. In addition, anesthesia time, transition time (defined as time from end of surgery to admission to the postoperative anesthesia care unit), visual analogue scale (VAS) for pain, and patient satisfaction at hospital discharge were recorded. Results: There was no difference in the primary endpoint (cumulative morphine consumption at 48 h) between the 2 anesthesia types. Anesthesia and transition times were significantly shorter in the RA compared with the GA group—anesthesia time 125.4±23.6 minutes for GA versus 99.4±13.5 minutes for RA, transition time 22.5 minutes for GA versus 10.0 minutes for RA (both P

https://ift.tt/2NLZF0K

The profiling of axial spondyloarthritis patient candidate to a biologic therapy: Consensus from a Delphi-panel of Italian experts

Publication date: Available online 16 October 2018

Source: Autoimmunity Reviews

Author(s): Ennio Giulio Favalli, Andrea Becciolini, Roberto Caporali, Monica Todoerti, Florenzo Iannone, Liliana Dinoia, Marco Sebastiani, Amelia Spinella, Elisa Gremese, Francesco Cianci, Fabiola Atzeni, Francesca Bandinelli, Gianfranco Ferraccioli, Giovanni Lapadula, GISEA Study Group

Abstract

Objective

The project aimed to collect expert consensus statements for the profiling of patients with axial spondyloarthritis (axSpA) candidate to biologic agents (bDMARDs) treatment, in order to better define the drivers for the best treatment choice.

Methods

The 6 more interesting topics about axSpA patient profiling were identified by the project steering committee and a panel of axSpA Italian experts. A systematic literature review (SLR) was performed for each of the selected topics according to the PICO format. Two rounds of a modified Delphi process were conducted. In the 1st round, the steering committee evaluated the results of the SLR in order to formulate statements for each topic. In the 2nd round, the experts panel discussed, rephrased when needed, and voted the level of agreement (on a 5-point Likert-type scale) for each statement. Consensus was defined as ≥66% agreement.

Results

The topics selected for the analysis were the differential efficacy of available bDMARDs on enthesitis/dactylitis, uveitis, radiographic progression and cardiovascular involvement, and the clinical response in non radiographic-axSpA and in patients receiving a second-line bDMARD. The Delphi rounds formulated 19 statements, all reaching the defined level of consensus in a second round including 25 rheumatologists highly skilled in the management of axSpA.

Conclusion

Identified consensus statements can help clinicians to apply to routine-care settings the results from clinical studies and international recommendations, providing a guide for individualization of treatment strategy in axSpA patients.

https://ift.tt/2pZzDOd

Ciliated HPV-Related Carcinoma: A Diagnostic Challenge on Frozen Section

Abstract

Oropharyngeal squamous cell carcinomas associated with high risk HPV show a wide morphological spectrum, including papillary, adenosquamous, lymphoepithelioma-like and sarcomatoid. We report an interesting case of ciliated HPV-related carcinoma arising from tonsillar tissue in a 55-year-old man which was associated with HPV33. This rare variant has been described in only a handful of cases in the literature, and to our knowledge this is the first case specifically associated with HPV33. The presence of cilia is a potential diagnostic problem as it has been traditionally considered a feature of benignancy, and could pose a particular challenge on frozen section. The diagnostic challenges, differential diagnosis of this tumor and the association with HPV33 are discussed.

https://ift.tt/2PDdVuB

The profiling of axial spondyloarthritis patient candidate to a biologic therapy: Consensus from a Delphi-panel of Italian experts

Publication date: Available online 16 October 2018

Source: Autoimmunity Reviews

Abstract

Objective

Methods

Results

Conclusion

https://ift.tt/2pZzDOd

Defining the Molecular Genetics of Dermoscopic Naevus Patterns

Melanocytic naevi are common melanocytic proliferations that may simulate the appearance of cutaneous melanoma. Naevi commonly harbour somatic mutations implicated in melanomagenesis but in most cases lack the necessary genomic alterations required for melanoma development. While the mitogen-activated protein kinase pathway and ultraviolet radiation strongly contribute to naevogenesis, the somatic mutational landscape of dermoscopic naevus subsets distinguishes some of the molecular hallmarks of naevi in relation to melanoma. We herein discuss the classification of naevi and theories of naevogenesis and review the current literature on the somatic alterations in naevi and melanoma. This review focusses on the clinical-dermoscopic-pathological and genomic correlation of naevi that shapes the current understanding of naevi.
Dermatology

https://ift.tt/2NKNXUg

The styloglossus muscle: A critical landmark in onclogy and mandibular preservation surgery for squamous cell carcinoma of the lateral oropharynx

Publication date: Available online 16 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): O. Laccourreye, R.K. Orosco, F. Rubin, F.C. Holsinger

Abstract

Goal

To document the role of the styloglossus muscle (SG) in the oncologic staging and mandibular preservation surgery for squamous cell carcinoma of the lateral oropharynx (SCCLO).

Method

Based on a search conducted within the Pubmed, Embase, and Cochrane databases, using the key words SG muscle, parapharyngeal space and oropharynx, the authors discuss the embryology, physiology, anatomy and radiology of this muscle as well as its role in the oncologic staging and mandibular preservation surgery of SCCLO.

Results

The most specific radiologic exam to evaluate the involvement of SG muscle in SCCLO is magnetic resonance imaging (MRI). Radiologic invasion of the SG muscle, at the time of MRI, leads to reclassify as T4a many tumors considered as T1-3 at the time of clinical and/or on computerized tomography evaluation. This must lead to extreme care when comparing oncologic results from series published prior and after the MRI era. When transoral resection of the SG muscle is advocated for SCCLO, one must know that this maneuver brings numerous arterial and venous structures within the operative field. If difficulties to achieve safe margins of resection and/or to control bleeding are encountered, a simple trans cervical maneuver described herein is most useful.

Conclusion

The importance of the SG muscle should be emphasized as a touchstone for staging and surgeon's guide to mandibular preservation surgery of SCCLO. The various approaches allowing the control of this muscle and its vascular environment must be taught at the time of initial training.

https://ift.tt/2P2yGCL

Gut microbiota translocation promotes autoimmune cholangitis

Publication date: Available online 17 October 2018

Source: Journal of Autoimmunity

Author(s): Hong-Di Ma, Zhi-Bin Zhao, Wen-Tao Ma, Qing-Zhi Liu, Cai-Yue Gao, Liang Li, Jinjun Wang, Koichi Tsuneyama, Bin Liu, Weici Zhang, Yongjian Zhou, M. Eric Gershwin, Zhe-Xiong Lian

Abstract

Gut microbiota and bacterial translocation have been implicated as significant contributors to mucosal immune responses and tolerance; alteration of microbial molecules, termed pathogen-associated molecular patterns (PAMP) and bacterial translocation are associated with immune pathology. However, the mechanisms by which dysregulated gut microbiota promotes autoimmunity is unclear. We have taken advantage of a well-characterized murine model of primary biliary cholangitis, dnTGFβRII mice, and an additional unique construct, toll-like receptor 2 (TLR2)-deficient dnTGFβRII mice coined dnTGFβRIITLR2^−/− mice to investigate the influences of gut microbiota on autoimmune cholangitis. Firstly, we report that dnTGFβRII mice manifest altered composition of gut microbiota and that alteration of this gut microbiota by administration of antibiotics significantly alleviates T-cell-mediated infiltration and bile duct damage. Second, toll-like receptor 2 (TLR2)-deficient dnTGFβRII mice demonstrate significant exacerbation of autoimmune cholangitis when their epithelial barrier integrity was disrupted. Further, TLR2-deficiency mediates downregulated expression of tight junction-associated protein ZO-1 leading to increased gut permeability and bacterial translocation from gut to liver; use of antibiotics reduces microbiota translocation to liver and also decreases biliary pathology. In conclusion, our data demonstrates the important role of gut microbiota and bacterial translocation in the pathogenesis of murine autoimmune cholangitis.

https://ift.tt/2NQuiSY

Editorial Board and Contents

Publication date: November 2018

Source: Trends in Endocrinology & Metabolism, Volume 29, Issue 11

Author(s):

https://ift.tt/2RUtZtm

The speech perception after cochlear implantation: The hearing gain difference according to the implant systems is important?

Publication date: Available online 16 October 2018

Source: Auris Nasus Larynx

Author(s): Jeong Hun Jang, Hyoung Ah Mun, Oak-Sung Choo, Hun Yi Park, Yun-Hoon Choung

Abstract

Objective

The outcome of cochlear implantation (CI) is affected by various factors, including the manufacturer of the device. We validated the factors contributing to postoperative performance and evaluated the influence of different company devices on pure tone thresholds and postoperative performance.

Methods

Our study included 56 postlingually deaf adults who underwent CI between June 2005 and March 2016. The ears were divided into groups according to the implant manufacturer: A (n = 32 ears) and B (n = 24 ears) groups. The prognostic factors for CI outcome were evaluated using speech perception at 3, 6 and 12 months postoperatively and compared across devices.

Results

The duration of hearing aid use, age at CI, and mean pure tone threshold with the implant were correlated with postoperative speech perception. The mean pure tone thresholds with the implant (averages of 0.25, 0.5, 1, 2, 4 and 6 kHz) were 27.9 ± 3.7 dB HL in the group A and 33.5 ± 5.6 dB HL in the group B (P < 0.01). The open-set monosyllabic word, open-set disyllabic word and open-set sentence scores were not significantly different between the groups at 3, 6 and 12 months postoperatively.

Conclusion

The mean pure tone threshold with implant differed between the devices; however, no device-related effect on postoperative performance was observed. Additional multifactorial analyses are needed to clarify the relationship between free-field pure tone threshold with implant and postoperative speech perception.

https://ift.tt/2CSku9G

Human papillomavirus-related multiphenotypic sinonasal carcinoma: An emerging tumor type with a unique microscopic appearance and a paradoxical clinical behaviour

Publication date: December 2018

Source: Oral Oncology, Volume 87

Author(s): Justin A. Bishop, William H. Westra

Abstract

Human papillomavirus (HPV) is well established as a causative factor in most squamous cell carcinomas of the oropharynx (OPSCC). Indeed, a growing awareness over the past two decades that HPV-OPSCC is a distinct form of head and neck cancer has had a profound impact on diagnostic and clinical practices. The sinonasal tract is a second anatomic "hot spot" for HPV-related head and neck carcinomas, but certain pathologic features and the clinical behavior of HPV-related carcinomas at this site remain unclear. The enigmatic nature of HPV-positive sinonasal carcinomas is especially true for an emerging form recently designated as HPV-related multiphenotypic sinonasal carcinoma (HMSC). HMSC has come to the attention of the pathology community largely owing to its highly unusual microscopic appearance: it exhibits mixed salivary gland (e.g. adenoid cystic carcinoma) and squamous differentiation. At the same time, HMSC is largely unknown by the clinical community despite an unexpected clinical behavior that could affect therapy. HMSC is characterized by high grade histologic features, locally destructive growth, advanced T stage, and a propensity for local recurrence; and yet it appears to have little potential for metastatic spread or lethal behavior. This review will describe the unique pathologic features of HMSC, discuss its distinction from adenoid cystic carcinoma and squamous cell carcinoma, and draw attention to a behavior that departs from the expected clinical course of most high grade carcinomas of the head and neck.

https://ift.tt/2J1TuF7

Immunosuppression for immunodeficiency- getting smarter

Publication date: Available online 17 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Duan Lucy, Grunebaum Eyal

https://ift.tt/2P4riXH

RhoH deficiency induces psoriasis-like chronic dermatitis by promoting TH17 cell polarization

Publication date: Available online 17 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Norimasa Tamehiro, Kyoko Nishida, Yu Sugita, Kunihiro Hayakawa, Hiroyo Oda, Takeshi Nitta, Miwa Nakano, Akiko Nishioka, Reiko Yanobu-Takanashi, Motohito Goto, Tadashi Okamura, Reiko Adachi, Kazunari Kondo, Akimichi Morita, Harumi Suzuki

Abstract

Background

RhoH is a membrane-bound adaptor protein involved in proximal TCR signaling. Therefore, RhoH plays critical roles in the differentiation of T cells, however the function of RhoH in effecter phase of T cell response have not been fully characterized.

Objective

To explore the role of RhoH in inflammatory immune responses, we investigated the involvement of RhoH in the pathogenesis of psoriasis.

Method

We analyzed effector T cell and systemic inflammation in wild-type and RhoH-null mice. RhoH expression in T cells in human PBMC was quantified by RT-PCR.

Results

RhoH deficiency in mice induced T_H17 polarization during effector T cell differentiation, thereby inducing psoriasis-like chronic dermatitis. Ubr5 and nr2f6 expression levels decreased in RhoH-deficient T cells, resulting in increased protein levels and DNA binding activity of RORγt. The consequential increase in IL-17 and IL-22 production induced T cells to differentiate into T_H17 cells. Furthermore, IL-22BP/Fc chimeric protein reduced psoriatic inflammation in RhoH deficient mice. Expression of RhoH in T cells was lower in psoriatic patients with much severe symptoms.

Conclusion

Our results indicated that RhoH inhibits T_H17 differentiation and thereby plays a role in the pathogenesis of psoriasis. Additionally, IL-22BP has therapeutic potential for the treatment of psoriasis.

Graphical abstract

Graphical abstract for this article

https://ift.tt/2PBXiPO

Engulfment of mast cell secretory granules upon skin inflammation boosts dendritic cell migration and priming efficiency

Publication date: Available online 17 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Jan Dudeck, Julia Froebel, Johanna Kotrba, Christian H.K. Lehmann, Diana Dudziak, Stephan Speier, Sergei A. Nedospasov, Burkhart Schraven, Anne Dudeck

ABSTRACT

Background

Mast cells (MCs) are best known as key effector cells of allergic reactions but they also play an important role in host defense against pathogens. Despite increasing evidence for a critical impact of MCs on adaptive immunity, the underlying mechanisms are poorly understood.

Objective

Here, we monitored MC intercellular communication with dendritic cells (DCs), MC activation and degranulation and tracked the fate of exocytosed MC granules during skin inflammation.

Methods

Using a strategy to stain intracellular MC granules in vivo we tracked the MC granules fate following skin inflammation induced MC degranulation. Further, exogenous MC granules were applied to MC-deficient mice by intradermal injection. MC granule effects on DC functionality and adaptive immune responses in vivo were assessed by combining intravital multiphoton microscopy with flow cytometry and functional assays.

Results

We demonstrate that dermal DCs engulf the intact granules exocytosed by MCs upon skin inflammation. Subsequently, the engulfed MC granules are actively shuttled to skin-draining lymph nodes (LNs) and finally degraded inside DCs within the lymphoid tissue. Most importantly, MC-granule uptake promotes DC maturation and migration to skin-draining LNs, partially via MC-derived TNF, and boosts their T cell priming efficiency. Surprisingly, exogenous MC granules alone are sufficient to induce a prominent DC activation and T cell responses.

Conclusion

Our study highlights a unique feature of peripheral MCs to impact on lymphoid tissue borne adaptive immunity over distance by modifying DC functionality via the delivery of granule-stored mediators.

Graphical abstract

Graphical abstract for this article

https://ift.tt/2P332oN

Plasma tryptase elevation during aspirin-induced reactions in aspirin-exacerbated respiratory disease (AERD)

Publication date: Available online 16 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Katherine N. Cahill, Katherine Murphy, Joseph Singer, Elliot Israel, Joshua A. Boyce, Tanya M. Laidlaw

https://ift.tt/2PAvStH

In Utero Diagnoses of Strikingly Similar Presentations of Complete Atrioventricular Septal Defects in a Pair of Dizygotic Twins Concordant for Trisomy 21

Trisomy 21, or Down syndrome (DS), is a genetic disorder affecting approximately 1 in 500–750 live births. The prevalence of DS has increased over the past two decades, correlating with a rise in the proportion of pregnancies complicated by advanced maternal age. There is also a correlation between advanced maternal age and dizygotic twinning rates. There is an increased risk of at least one twin being affected in dizygotic pregnancies compared to singletons. However, despite this greater relative risk, reports of concordance of DS in both dizygotic twins are very rare. Congenital heart disease (CHD) occurs in roughly 40% of individuals with DS, but there can be considerable phenotypic variation. The most common, atrioventricular septal defect accounts for only 40% of CHD seen in DS. There is also a higher incidence of CHD in twins, but also with a low incidence of concordance. There have been only five reported cases of concordant DS in dizygotic twins with confirmed chromosomal analyses; none of which describe concordant congenital heart disease. Here, we describe an unusual case of dizygotic twins of differing genders concordant for both Down syndrome and congenital heart disease of a strikingly similar presentation.

https://ift.tt/2OrTcNP

New magnet array design for downhole NMR azimuthal measurement

Publication date: Available online 16 October 2018

Source: Magnetic Resonance Imaging

Author(s): Sihui Luo, Lizhi Xiao, Xin Li, Guangzhi Liao, Huabing Liu, Zhengduo Wang, Zhe Sun, Wei Liu, Yangyang Xu

Abstract

In low-field NMR, depth information and radial profile information of downhole formation can be easily acquired with the help of static gradient magnetic field produced by permanent magnets, called downhole NMR imaging. Based on the hypothesis that the formation is homogeneous, average signals detected by centralized or decentralized sensors can provide enough information for petrophysical parameters. In fact, the inhomogeneity of formation may have serious impact on description of the characteristics of formation and oil/gas location which is rarely studied in NMR well-logging. To improve this, we design and implement a new quadrupolar magnet array aimed at achieving azimuthal measurement in this paper. A new quadrupolar magnet array is consisted of four bread-shaped magnets combined with additional small hexangular magnets to produce enough strength and high homogeneity of static field along with circumferential direction at deeper DOI (depth of investigation). Azimuthal measurements are achieved by using coil array combined with quadrupolar magnet array.

https://ift.tt/2EAUC4a

Correction to: Abstracts

In Poster Sessions, the author name G. Khlestova was incorrectly presented as 'K. Galina' in the authorship group for Abstract PS-18-017 (page S151). The name has been corrected in the authorship group shown above.

https://ift.tt/2QQPcmC

The impact of isolated maternal hypothyroxinemia during the first and second trimester of gestation on pregnancy outcomes: an intervention and prospective cohort study in China

Abstract

Objectives

To explore the effect of isolated maternal hypothyroxinemia (IMH) during the first and second trimester of gestation on pregnancy outcomes. To explore whether levothyroxine (L-T4) treatment of women who had IMH identified in the first trimester improves pregnancy outcomes.

Methods

Women in the early pregnancy in the iodine-sufficient area (n = 3398) were recruited to this prospective cohort study (ChiCTR-TRC-12002326). Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were detected. Women with IMH before 12 weeks chose to receive L-T4 or remain untreated. The L-T4 dose was adjusted to attain a normal FT4 and TSH level. Pregnancy outcomes were evaluated during follow-up.

Results

IMH in the first trimester was not associated with increased risk of adverse pregnancy outcome compared with controls. The incidence of macrosomia (p = 0.022) and gestational hypertension (p = 0.018) was significantly higher in IMH identified in the second trimester of gestation compared with controls. IMH identified in the second trimester of gestation was a risk factor for macrosomia [adjusted odds ratio (aOR) 1.942, 95% CI 1.076–3.503, p = 0.027] and gestational hypertension (aOR 4.203, 95% CI 1.611–10.968, p < 0.01), when body mass index in the early pregnancy was < 25 kg/m².

Conclusions

IMH in the first trimester did not increase the risk of adverse outcomes irrespective of whether women received L-T4 treatment. However, IMH identified in the second trimester was associated with increased risk of adverse pregnancy outcome. The results suggest that thyroid function follow-up during the second trimester is necessary, even if thyroid function is normal during the first trimester.

https://ift.tt/2pYhVdN

SHOX gene deletion screening by FISH in children with short stature and Madelung deformity and their characteristics

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

https://ift.tt/2CSbt0k

Basal characteristics and first year responses to human growth hormone (GH) vary according to diagnostic criteria in children with non-acquired GH deficiency (naGHD): observations from a single center over a period of five decades

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

https://ift.tt/2QSQBJt

Ciliated HPV-Related Carcinoma: A Diagnostic Challenge on Frozen Section

Abstract

https://ift.tt/2PDdVuB

Ciliated HPV-Related Carcinoma: A Diagnostic Challenge on Frozen Section

Abstract

https://ift.tt/2PDdVuB

Anti-neutrophil cytoplasmic antibody-associated hypertrophic cranial pachymeningitis and otitis media: a review of literature

Abstract

Background and objective

It has been recognized that anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides may lead to hypertrophic pachymeningitis (HP) or intractable otitis media (OM). To our knowledge, few cases of coexistent ANCA-related HP and OM have been described previously. To increase awareness of this disease, we reviewed the literature describing patients with HP and intractable OM in a population with AAV to guide clinical decision making for otolaryngologists.

Methods

PubMed was searched with the following terms: ANCA-associated vasculitis, otitis media, and hypertrophic pachymeningitis. Only patients with concomitant AAV, OM and HP were considered and included in this review.

Results

A total of 243 articles were reviewed, and of these, 6 met inclusion criteria. Headache, cranial polyneuropathy, and intractable OM with effusion or granulation were common. Serum MPO–ANCA positivity was most common in Asian patients. Almost all patients had dural mater thickening on gadolinium-enhanced magnetic resonance imaging of the brain. Corticosteroids plus an immunosuppressant was more effective and most patients had improved hearing after treatment, but approximately 50% of subjects had disease relapse.

Conclusion

In this review, we summarized the current knowledge on the clinical features, diagnosis, treatment, and pathogenesis of this disease. We should carefully detect the potential cases of ANCA-related HP and OM in patients with intractable OM, HP, or AAV, and make the optimal treatment plan to avoid long-term neurological complications and irreversible hearing loss. Furthermore, due to an increased possibility of relapse, close follow-up, including a hearing test, ANCA titers, imaging examination, and detection of toxic and side effects of immunosuppressive therapy, are necessary.

https://ift.tt/2RWYwql

The disease of Sigmund Freud: oral cancer or cocaine-induced lesion?

Abstract

Purpose

Sigmund Freud, the father of modern psychoanalysis, suffered from what was considered to be a malignant tumour spreading from the back of his palate. He underwent numerous surgical interventions and radiation therapy over the course of 16 years. Such a long survival casts a shadow of doubt on the diagnosis of oral cancer that was given to Freud.

Methods

The book "Freud: Living and Dying", in which the personal physician of Freud described in detail his patient's fight with oral cancer, was reviewed. Current and past evidence, as well as epidemiological data, on oral cancer and cocaine-induced midline destructive lesions were also reviewed.

Results

Tobacco and cocaine are both responsible for oral lesions and Freud was a dedicated cigar smoker as well as a user and defender of cocaine. Freud's medical records indicate that the main cause of Freud's oral disease was excessive smoking. On the other hand, the diagnosis of oral cancer does not seem to be entirely consistent with the 16-year-long survival of Freud. Freud used cocaine regularly in the 1890s, as reported by his personal physician, and it is possible that he continued taking it beyond that time period without feeling the need to inform his doctor.

Conclusions

It is possible that the lesion that progressively and very slowly eroded the splanchnocranial structures of Freud was not a bona-fide cancerous malignancy, but rather, the necrotizing effect of cocaine use that has been previously reported to be responsible for some massive facial destructive lesions.

https://ift.tt/2PEj19Z

Non-Hodgkin’s Lymphoma of the Middle Ear Presenting as Mastoiditis

Lymphoma originating from the middle ear is rare. The diagnosis of lymphoma as with other cancers of the temporal bone is often made late, and this has a negative implication on the treatment and prognosis of the condition. The delay of diagnosis is mainly due to the similar presentation shared with other benign conditions of the middle ear. We present a case of a 62-year-old man who was treated as a case of chronic otitis media for a period of time before presenting with advanced symptoms; a final diagnosis of lymphoma of the middle ear was given. Other similar cases in the literature are discussed and reviewed. Severe and persistent symptoms of the middle ear should raise red flags and warrant detailed investigations.

https://ift.tt/2CngBIX

Bertolotti’s syndrome: an underdiagnosed cause for lower back pain

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Abstract

Bertolotti's syndrome refers to the presence of pain associated to the anatomical variant of sacralization of the last lumbar vertebra. It is often a factor that is not addressed in the evaluation and treatment of lower back pain. The presence of a lumbosacral transitional vertebra is a common finding among general population with a prevalence that ranges between 4 and 30%, however, this finding is rarely associated to the cause of lower back pain and thus, the prevalence of Bertolotti's syndrome in general population is unknown doe to underdiagnosis. The sacralization of the fifth lumbar vertebra has been related to changes in the anatomy and biomechanics of the spine with no general agreement to its clinical significance, however Bertolotti's syndrome should be considered as a differential diagnosis for lower back pain, therefore, its pathophysiology, epidemiology and treatment must be a topic of general knowledge to physicians that often treat this condition.

https://ift.tt/2P6tfCT

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):768

Authors:

PMID: 30326519 [PubMed - in process]

https://ift.tt/2yoHE3J

Highlights.

Highlights.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):767

Authors:

PMID: 30326518 [PubMed - in process]

https://ift.tt/2yLY7OG

Errors in Figure 2 and Figure 3.

Errors in Figure 2 and Figure 3.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):851

Authors:

PMID: 30326517 [PubMed - in process]

https://ift.tt/2ymC7L7

Commercial Claims-Based Comparison of Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Patients With Oropharyngeal Squamous Cell Carcinoma.

Commercial Claims-Based Comparison of Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Patients With Oropharyngeal Squamous Cell Carcinoma.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 20;:

Authors: Sher DJ, Agiro A, Zhou S, Day AT, DeVries A

Abstract
Importance: Definitive radiotherapy (RT) and primary surgery (PS) are considered to be equally viable local therapy modalities for oropharyngeal squamous cell carcinoma (OPSCC). The comparative effectiveness of these therapies is often debated, and treatment decisions are based on a paucity of comparative data.
Objective: To examine the differences in overall survival and key toxic effects in patients with OPSCC treated with RT and PS.
Design, Setting, and Participants: This retrospective cohort analysis used the HealthCore Integrated Research Database to identify 884 patients diagnosed with OPSCC from January 1, 2007, to December 31, 2014. Patients were categorized as receiving definitive RT (with or without chemotherapy) or PS (with or without adjuvant RT or chemoradiotherapy). Administrative claims data were linked with state cancer registries from California, Connecticut, Georgia, Kentucky, New York, and Ohio. Data analysis was performed from February 29, 2016, to February 6, 2018.
Exposures: Definitive RT or PS.
Main Outcomes and Measures: Overall survival was analyzed using Cox proportional hazards regression. Risks of gastrostomy dependence, esophageal stricture, and osteoradionecrosis were determined through claims and analyzed using logistic regression.
Results: A total of 884 patients (608 [68.8%] in the RT group and 276 [31.2%] in the PS group; mean [SD] age, 61.5 [10.7] years; 727 [82.2%] male; 842 [95.3%] white) were included in this study. The 3-year overall survival was 76% among patients treated with RT and 81% among patients treated with PS (hazard ratio, 0.76; 95% CI, 0.54-1.01). On multivariable analysis, increasing age, female sex, and low income were associated with inferior survival; treatment type was not. Patients treated with RT were more likely to have gastrostomy dependence within the first year (391 [64.3%] vs 127 [46.0%]; adjusted OR, 0.57; 95% CI, 0.42-0.77). After treating chemotherapy as an effect modifier, there was no difference between modalities. Treatment type was not associated with esophageal stricture or osteoradionecrosis risk. Mean costs were approximately $100 000 for payers and $5000 for patients, with no adjusted differences between RT and PS.
Conclusions and Relevance: This study suggests that RT and PS are equally viable treatment options for OPSCC; therefore, local therapy decisions may be individualized to each patient. However, the frequent addition of chemotherapy was associated with increased gastrostomy dependence among patients undergoing RT, which may be relevant in clinical decision making.

PMID: 30326060 [PubMed - as supplied by publisher]

https://ift.tt/2COOLGG

Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children.

Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:

Authors: Lüscher M, Thrane JF, Homøe P

PMID: 30326056 [PubMed - as supplied by publisher]

https://ift.tt/2yIRRr4

Outcomes of Open vs Endoscopic Skull Base Surgery in Patients 70 Years or Older.

Outcomes of Open vs Endoscopic Skull Base Surgery in Patients 70 Years or Older.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 20;:

Authors: Stephenson ED, Lee SE, Adams K, Farquhar DR, Farzal Z, Ebert CS, Ewend M, Sasaki-Adams D, Thorp BD, Zanation AM

Abstract
Importance: The use of skull base surgery in patients 70 years or older is increasing, but its safety in this age group has not been evaluated to date.
Objectives: To describe outcomes in a cohort of patients 70 years or older undergoing skull base surgery and to evaluate whether age, type of disease process, and approach (endoscopic vs traditional open surgery) are associated with increased intraoperative and postoperative complications in this population.
Design, Setting, and Participants: This retrospective cohort study analyzed a population-based sample of 219 patients 70 years or older from a database of 1720 patients who underwent skull base surgery at University of North Carolina Hospitals, Chapel Hill, a tertiary referral center, between October 2007 and June 2017. Data were collected from June 2016 to July 2017 and analyzed in July 2017 and August 2017.
Exposure: Skull base surgery.
Main Outcomes and Measures: Data collected included demographic characteristics, surgical approach, and disease process. Intraoperative findings and postoperative complications were analyzed by age, surgical approach, and malignancy status.
Results: Of the 219 patients, 166 were aged 70.0 to 79.9 years and 53 patients were older than 80 years (mean [SD] age, 76.4 [4.7] years); 120 (54.8%) were men and 160 (73.7%) were white. There were 161 (73.5%) endoscopic and 58 (26.5%) open operations. The most common pathologic processes among the 219 patients were nonsellar malignant (81 [37.0%]), nonsellar benign (53 [24.2%]), and pituitary (49 [22.4%]) tumors. The most common intraoperative and postoperative complications were intraoperative major bleeding (5 of 219 patients [2.3%]) and postoperative bleeding (9 [4.1%]). Thirty-day mortality was zero. There was no clinically meaningful difference in complications between patients aged 70.0 to 79.9 years vs those older than 80 years, endoscopic vs open surgery, or benign vs malignant neoplasms. Specifically, between the endoscopic and open surgery groups, there was no difference in intraoperative major bleeding (3.9%; 95% CI, -0.7% to 12.9%), postoperative cerebrospinal fluid leak (-0.6%; 95% CI, -3.4% to 5.6%), or postoperative bleeding (1.5%; 95% CI, -3.9% to 10.6%).
Conclusions and Relevance: Skull base surgery is a safe option in persons 70 years or older, with similar outcomes across age ranges, surgical approaches, and disease processes.

PMID: 30326054 [PubMed - as supplied by publisher]

https://ift.tt/2yl9Owu

Clinical Application of 3-Dimensional Printing Technology for Patients With Nasal Septal Deformities: A Multicenter Study.

Clinical Application of 3-Dimensional Printing Technology for Patients With Nasal Septal Deformities: A Multicenter Study.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 20;:

Authors: Kim DH, Yun WS, Shim JH, Park KH, Choi D, Park MI, Hwang SH, Kim SW

Abstract
Importance: Studies have shown the controllability and porosity of polycaprolactone as well as the use of 3-dimensional (3-D) printing for nasal reconstruction in animal models. The utility of polycaprolactone with 3-D technology in nasal cartilaginous framework reconstruction in humans remains unknown.
Objective: To investigate the safety and efficacy of 3-D printed, bioresorbable polycaprolactone nasal implants.
Design, Setting, and Participants: This multicenter clinical trial comprised 20 patients with caudal septal deviations who underwent septoplasty, which used a 3-D printed polycaprolactone mesh, at 2 centers in South Korea. Patients were included if they were aged 18 to 74 years and had nasal septal deviations, Nasal Obstruction Symptom Evaluation scores greater than 20, and persistent nasal obstructions. Twenty-two patients met the inclusion criteria, but 2 patients were excluded before the operation. The study was conducted from July 1, 2016, to June 30, 2017.
Main Outcomes and Measures: The change in total Nasal Obstruction Symptom Evaluation score between the preoperative examination and the week 12 postoperative examination was the primary outcome. Changes in bilateral nasal cavity minimum cross-sectional area and volume on acoustic rhinometry at weeks 4 and 12 after the operation as well as changes in the nasal cavity cross-sectional area at the osteomeatal unit and nasal septum angle in the paranasal sinus on computed tomography after week 12 were among the secondary outcomes.
Results: Of the 20 patients included in the study, 4 (20%) were female, 16 (80%) were male, with a mean (SD) age of 34.95 (11.96) years. The preoperative and week 12 postoperative results revealed significant changes in the minimal cross-sectional areas on acoustic rhinometry (0.41 [SD, 0.39] vs -0.11 [SD, 0.18]; difference, 0.42; 95% CI, 0.23-0.61), nasal septum angles on computed tomography (11.22 [SD, 6.57] vs 2.89 [SD, 3.12]; difference, 8.33; 95% CI, 5.08-11.58), and Nasal Obstruction Symptom Evaluation scores (73.50 [SD, 19.88] vs 3.75 [SD, 6.26]; difference, 69.75; 95% CI, 59.22-80.28). The surgeons' convenience level with the procedure was favorable (visual analog scale score [SD], 90.90 [9.45]), and so were the patients' symptom improvements and satisfaction after 12 weeks (visual analog scale score [SD], 88.30 [9.87]).
Conclusions and Relevance: The 3-D printed, homogeneous, composite, microporous polycaprolactone nasal implant demonstrated proper mechanical support and thinness with excellent biocompatibility and surgical manipulability. Polycaprolactone may be a clinically biocompatible material for use in various craniofacial reconstructions in the future.

PMID: 30326042 [PubMed - as supplied by publisher]

https://ift.tt/2yH8ZgZ

An Unusual Entity Presenting as Bilateral Cervical Lymphadenopathy.

An Unusual Entity Presenting as Bilateral Cervical Lymphadenopathy.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 20;:

Authors: Shahi S, Gautam D, Pantha T

PMID: 30326034 [PubMed - as supplied by publisher]

https://ift.tt/2yhUwbS

Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children.

Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:

Authors: Kitipornchai L, Mackay SG

PMID: 30326001 [PubMed - as supplied by publisher]

https://ift.tt/2yJMOXn

Association of the Duration of Antibiotic Therapy With Major Surgical Site Infection in Cochlear Implantation.

Association of the Duration of Antibiotic Therapy With Major Surgical Site Infection in Cochlear Implantation.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:

Authors: Sayed-Hassan A, Hermann R, Chidiac F, Truy E, Guevara N, Bailleux S, Deguine O, Baladi B, Gallois Y, Bozorg-Grayeli A, Lerosey Y, Godey B, Parietti-Winkler C, Pereira B, Mom T, and the Otolaryngology–Head and Neck Surgical Infection Survey Group (OSS Group) of Clermont-Ferrand

Abstract
Importance: Infection after cochlear implantation is a rare but serious event that can lead to meningitis. There is no consensus on prevention of infection in these patients, and each center applies its own strategy.
Objective: To describe the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis.
Design, Setting, and Participants: Retrospective cohort study of patients who underwent cochlear implantation between January 1, 2011, and July 8, 2015, with a postoperative follow-up of 1 to 3 years. In this multicenter study at 8 French university centers, 1180 patients (509 children and 671 adults) who underwent cochlear implantation during this period were included.
Interventions: Prolonged antibiotic treatment vs single-dose antibiotic prophylaxis.
Main Outcomes and Measures: Major infection and explantation.
Results: Among 1180 patients (509 children [51.7% female] with a mean [SD] age of 4.6 [3.8] years and 671 adults [54.9% female] with a mean [SD] age of 54.8 [17.0] years), 12 patients (1.0%) developed a major infection, with 4 infections occurring in the prolonged antibiotic treatment group and 8 infections occurring in the antibiotic prophylaxis group (odds ratio, 2.45; 95% CI, 0.73-8.17). Children (9 of 509 [1.8%]) were more likely to develop infection than adults (3 of 671 [0.4%]). Among children, 4 infections occurred in the prolonged antibiotic group (n = 344), and 5 infections occurred in the antibiotic prophylaxis group (n = 158) (odds ratio, 2.78; 95% CI, 0.74-10.49). Among adults, 3 infections occurred in the antibiotic prophylaxis group (n = 365), whereas no infections occurred in the prolonged antibiotic treatment group (n = 290).
Conclusions and Relevance: After cochlear implantation, infection was rare, was less common among those who received prolonged antibiotic treatment, and was less likely to occur in adults than in children.

PMID: 30325991 [PubMed - as supplied by publisher]

https://ift.tt/2yhUtwI

Empirical Proton Pump Inhibitor Therapy in Children.

Empirical Proton Pump Inhibitor Therapy in Children.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:

Authors: Prager JD

PMID: 30325988 [PubMed - as supplied by publisher]

https://ift.tt/2yKqJrR

Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia.

Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:

Authors: Duncan DR, Mitchell PD, Larson K, McSweeney ME, Rosen RL

Abstract
Importance: Proton pump inhibitors (PPI) are commonly prescribed to children with oropharyngeal dysphagia and resultant aspiration based on the assumption that these patients are at greater risk for reflux-related lung disease. There is little data to support this approach and the potential risk for increased infections in children treated with PPI may outweigh any potential benefit.
Objective: The aim of this study was to determine if there is an association between hospitalization risk in pediatric patients with oropharyngeal dysphagia and treatment with PPI.
Design, Setting, and Participants: We performed a retrospective cohort study to compare the frequency and length of hospitalizations for children who had abnormal results on videofluoroscopic swallow studies that were performed between January 1, 2015, and December 31, 2015, and who were or were not treated with PPI, with follow-up through December 31, 2016. Records were reviewed for children who presented for care at Boston Children's Hospital, a tertiary referral center. Participants included 293 children 2 years and younger with evidence of aspiration or penetration on videofluoroscopic swallow study.
Exposures: Groups were compared based on their exposure to PPI treatment.
Main Outcomes and Measures: The primary outcomes were hospital admission rate and hospital admission nights and these were measured as incident rates. Multivariable analyses were performed to determine predictors of hospitalization risk after adjusting for comorbidities. Kaplan-Meier curves were created to determine the association of PPI prescribing with time until first hospitalization.
Results: A total of 293 patients with a mean (SD) age of 8.8 (0.4) months and a mean (SD) follow-up time of 18.15 (0.20) months were included in the analysis. Patients treated with PPI had higher admission rates (Incidence rate ratio [IRR], 1.77; 95% CI, 1.16-2.68) and admission nights (IRR, 2.51; 95% CI, 1.36-4.62) even after adjustment for comorbidities. Patients with enteral tubes who were prescribed PPIs were at the highest risk for admission (hazard ratio [HR], 2.31; 95% CI, 1.24-4.31).
Conclusions and Relevance: Children with aspiration who are treated with PPI have increased risk of hospitalization compared with untreated patients. These results support growing concern about the risks of PPI use in children.

PMID: 30325987 [PubMed - as supplied by publisher]

https://ift.tt/2ymtIHp

Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children-Reply.

Limitations to the Association of Risk of Airway Disease With Removal of Adenoids and Tonsils in Children-Reply.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:

Authors: Byars SG, Stearns SC, Boomsma JJ

PMID: 30325985 [PubMed - as supplied by publisher]

https://ift.tt/2yKqHAf

Comparison of Objective Outcomes in Dynamic Lower Facial Reanimation With Temporalis Tendon and Gracilis Free Muscle Transfer.

Comparison of Objective Outcomes in Dynamic Lower Facial Reanimation With Temporalis Tendon and Gracilis Free Muscle Transfer.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:

Authors: Oyer SL, Nellis J, Ishii LE, Boahene KD, Byrne PJ

Abstract
Importance: Facial paralysis affects patients' physical, social, and psychological function. Dynamic smile reanimation can mitigate these effects, but there are limited data to guide the surgeon in selecting the best reanimation procedure for each patient.
Objective: To compare quantitative changes in oral commissure symmetry and smile excursion following temporalis tendon transfer (T3) and gracilis free muscle transfer.
Design, Setting, and Participants: Retrospective case series of 28 adults with unilateral facial paralysis seeking dynamic lower facial reanimation at a tertiary academic medical center between July 1, 2010, and July 30, 2014. Data were analyzed from May 1, 2016, to June 30, 2016.
Interventions: Minimally invasive T3 (n = 14) compared with gracilis free muscle transfer (n = 14).
Main Outcomes and Measures: Measured symmetry of the oral commissure between the healthy and paralyzed sides in the horizontal, vertical, and angular dimension and excursion of the paralyzed commissure following reanimation compared with the healthy commissure.
Results: Of the 28 patients, 19 (68%) were women; mean (SD) age was 51.7 (17) years. Commissure symmetry during smile improved significantly for the T3 patients in the vertical and angular dimensions, and the gracilis free muscle transfer patients had significant improvement in the vertical and horizontal dimensions. Commissure excursion significantly improved in both groups following surgery, with a larger improvement seen in the gracilis free muscle transfer group (11.3 mm; 95% CI, 7.0 to 15.5 mm) compared with the T3 group (4.8 mm; 95% CI, 0.2 to 9.3 mm), with a mean difference of 6.5 mm (95% CI, 0.7 to 12.4 mm; Cohen d, 0.86). Postoperative smile excursion of the paralyzed side was within 1.0 mm of the healthy side in the gracilis free muscle transfer group (95% CI, -2.1 to 4.0 mm).
Conclusions and Relevance: Temporalis tendon transfer and gracilis free muscle transfer both improve oral commissure symmetry and excursion in facial paralysis. The improvement in smile excursion appears to be larger in patients treated with gracilis free muscle transfer and, on average, the excursion approximates the contralateral healthy side.

PMID: 30325983 [PubMed - as supplied by publisher]

https://ift.tt/2yqsZoJ

Notice of Retraction: Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, Amicucci G. Dexamethasone for the Prevention of Recurrent Laryngeal Nerve Palsy and Other Complications After Thyroid Surgery: A Randomized Double-blind Placebo-Controlled Trial. JAMA Otolaryngol Head Neck Surg. 2013;139(5):471-478.

Notice of Retraction: Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L, Amicucci G. Dexamethasone for the Prevention of Recurrent Laryngeal Nerve Palsy and Other Complications After Thyroid Surgery: A Randomized Double-blind Placebo-Controlled Trial. JAMA Otolaryngol Head Neck Surg. 2013;139(5):471-478.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 11;:

Authors: Piccirillo JF, Bauchner H

PMID: 30325981 [PubMed - as supplied by publisher]

https://ift.tt/2yMqGM0

Helicobacter pylori VacA, a distinct toxin exerts diverse functionalities in numerous cells: An overview

Helicobacter, EarlyView.

https://ift.tt/2EtK9rb

Helicobacter pylori VacA, a distinct toxin exerts diverse functionalities in numerous cells: An overview

Helicobacter, EarlyView.

https://ift.tt/2EtK9rb

Preemptive intravenous ibuprofen application reduces pain and opioid consumption following thyroid surgery

Publication date: Available online 16 October 2018

Source: American Journal of Otolaryngology

Author(s): Vahit Mutlu, Ilker Ince

Abstract

Objective

The primary aim of this study was to investigate the effects of preemptive a single dose IV ibuprofen on postoperative 48 h opioid consumption and postoperative pain in patients undergoing thyroidectomy.

Methods

The study included 40 patients aged 18 to 65, scheduled for elective thyroidectomy. Patients were randomly divided into 2 groups. Control group (n = 20) received 100 mL saline solution 15 min before surgery, while study group (n = 20) received 800 mg IV ibuprofen in 100 mL saline. The same general anesthesia protocol was applied in both groups, and all operations were performed by the same surgical team using the same technique. Postoperative analgesia was assessed using a visual analogue scale (VAS) and the amount of consumption of 48 h postoperative fentanyl with patient-controlled analgesia (PCA) and additional analgesia requirements were recorded. When additional analgesia was required, 1000 mg IV paracetamol was used.

Results

VAS scores in the ibuprofen group were found lower than the control group in the all-time points (p < 0.05). Opioid consumption in the 48 h was significantly higher in the control group than the ibuprofen group (p < 0.001). Using of rescue analgesia was significantly higher in the control group than the ibuprofen group, statistically (p < 0.05). A significant difference was observed between two groups in terms of side effects of fentanyl consumption (nausea and vomiting) (p < 0.001).

Conclusion

To use preemptive a single dose IV ibuprofen decreases pain scores and postoperative opioid consumption in patients following thyroidectomy. Additionally, this application increase the patient comfort reducing nausea and vomiting in early postoperative period.

https://ift.tt/2NLI8WG

BTK inhibition ameliorates kidney disease in spontaneous lupus nephritis

Publication date: Available online 16 October 2018

Source: Clinical Immunology

Author(s): Samantha A. Chalmers, Elizabeth Glynn, Sayra J. Garcia, Mark Panzenbeck, Josephine Pelletier, Janice Dimock, Elise Seccareccia, Todd Bosanac, Sara Khalil, Christian Harcken, Deborah Webb, Gerald Nabozny, Jay S. Fine, Donald Souza, Elliott Klein, Leal Herlitz, Meera Ramanujam, Chaim Putterman

Abstract

Lupus nephritis is a common disease manifestation of SLE, in which immune complex deposition and macrophage activation are important contributors to disease pathogenesis. Bruton's tyrosine kinase (BTK) plays an important role in both B cell and FcgammaR mediated myeloid cell activation. In the current study, we examined the efficacy of BI-BTK-1, a recently described irreversible BTK inhibitor, in the classical NZB × NZW F1 (NZB/W) and MRL/lpr spontaneous mouse models of SLE. NZB/W mice were randomly assigned to a treatment (0.3 mg/kg, 1 mg/kg, 3 mg/kg and 10 mg/kg) or control group and began treatment at 22 weeks of age. The experimental setup was similar in MRL/lpr mice, but with a single treated (10 mg/kg, beginning at 8–9 weeks of age) and control group. A separate experiment was performed in the MRL/lpr strain to assess the ability of BI-BTK-1 to reverse established kidney disease. Early treatment with BI-BTK-1 significantly protected NZB/W and MRL/lpr mice from the development of proteinuria, correlating with significant renal histological protection, decreased anti-DNA titers, and increased survival in both strains. BI-BTK-1 treated mice displayed a significant decrease in nephritis-associated inflammatory mediators (e.g. LCN2 and IL-6) in the kidney, combined with a significant inhibition of immune cell infiltration and accumulation. Importantly, BI-BTK-1 treatment resulted in the reversal of established kidney disease. BTK inhibition significantly reduced total B cell numbers and all B cell subsets (immature, transitional, follicular, marginal zone, and class switched) in the spleen of NZB/W mice. Overall, the significant efficacy of BI-BTK-1 in ameliorating multiple pathological endpoints associated with kidney disease in two distinct murine models of spontaneous lupus nephritis provides a strong rationale for BTK inhibition as a promising treatment approach for lupus nephritis.

https://ift.tt/2RWxeAH

National ENT workforce planning in the United Kingdom; An increasing cause for concern?

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

https://ift.tt/2J3rRLI

Tattoos among Professional ATP and WTA Tennis Players

Dermatology

https://ift.tt/2AeP4YM

Diagnostic Accuracy of the McGill Thyroid Nodule Score in Pediatric Patients

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

https://ift.tt/2pWdYGD

Issue Information ‐ Instructions for Authors

Clinical Endocrinology, Volume 89, Issue 5, Page 679-680, November 2018.

https://ift.tt/2NKTGsU

Issue Information ‐ TOC and Editorial Board

Clinical Endocrinology, Volume 89, Issue 5, Page 533-534, November 2018.

https://ift.tt/2pWdUqn

Corrigendum: Worse Health‐Related Quality of Life at long‐term follow‐up in patients with Cushing's disease than patients with cortisol producing adenoma. Data from the ERCUSYN

Clinical Endocrinology, Volume 89, Issue 5, Page 678-678, November 2018.

https://ift.tt/2NKNy3T

Scaffold Materials and Dental Stem Cells in Dental Tissue Regeneration

Abstract

Purpose of Review

Tissue engineering, as a multidisciplinary approach, is a research topic in medicine, but also in dentistry, to build structures, such as enamel, the dentin-pulp complex, the periodontium, or even whole teeth. The purpose of this review is to describe the latest developments in dental tissue engineering, where some of them will change our treatment concepts in dentistry in the near future, and to discuss hurdles and challenges.

Recent Findings

Sophisticated scaffold materials for dental tissue engineering can be fabricated today. No longer only bioinert, but tailor-made for specific applications, biomimetic and bioactive through biochemical and physical cues, growth and differentiation factors, they are able to elicit specific cellular responses, and thus control new tissue formation. Dental stem cells can not only be isolated from various sources but used for their paracrine activity, synergistic effects with epithelial cells exploited, and their behavior modulated by epigenetics. A better understanding of the interplay between cell differentiation and immune and inflammatory stimuli is crucial for the regeneration of tissues, which are constantly confronted with microorganisms. Examples for recent developments include commercially available products for the treatment of initial enamel lesions, a pilot clinical study for dentin-pulp complex regeneration, preclinical trials using cell sheets for periodontal regeneration, and the investigation of various cell sources for whole-tooth engineering.

Summary

This review highlights recent advances in dental tissue engineering, discusses some of the shortcomings and describes visions and future challenges.

https://ift.tt/2OroHaJ

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τετάρτη 17 Οκτωβρίου 2018

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