Head and Neck Diseases by Alexandros G.Sfakianakis: 11/20/18

Τρίτη 20 Νοεμβρίου 2018

Probiotic Supplementation for Prevention of Atopic Dermatitis in Infants and Children: A Systematic Review and Meta-analysis

Abstract

Background

Probiotic supplementation in early life may be effective in preventing atopic dermatitis (AD); however, results regarding efficacy have been controversial.

Objective

The aim of our study was to investigate the effect of probiotic supplementation on the risk of AD.

Methods

We systematically searched PubMed, EBSCO, Embase and Web of Science databases up to 8 March 2018 for potentially relevant studies regarding probiotic supplementation and AD. Included infants and children were those with probiotic exposure in utero and/or after birth who were not previously diagnosed with AD. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) and used the Jadad and Newcastle–Ottawa scales to assess methodologic quality.

Results

A total of 28 studies met the inclusion criteria. Compared with controls, probiotic treatment was associated with a reduced risk of AD (OR 0.69; 95% CI 0.58–0.82, P < 0.0001). The use of probiotics during both the prenatal and the postnatal period significantly reduced the incidence of AD (OR 0.67; 95% CI 0.54–0.82); however, analysis of studies of probiotics given prenatally only or postnatally only did not reach statistical significance.

Conclusions

Our meta-analysis showed that probiotic supplementation during both the prenatal and the postnatal period reduced the incidence of AD in infants and children. Our findings suggest that starting probiotic treatment during gestation and continuing through the first 6 months of the infant's life may be of benefit in the prevention of AD.

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Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial

BACKGROUND Axillary and infraclavicular brachial plexus blocks are commonly used for upper limb surgery. Clinicians require information on the relative benefits of each to make a rational selection for specific patients and procedures. OBJECTIVES The main objective of the study was to compare axillary and infraclavicular brachial plexus block in terms of the incidence and severity of tourniquet pain. DESIGN Single blinded, randomised trial. SETTING University affiliated hospital, level-1 trauma centre. PATIENTS Age more than 18 years, ASAI-III patients undergoing orthopaedic surgery distal to the elbow, with an anticipated tourniquet duration of more than 45 min were recruited. INTERVENTIONS Patients underwent either ultrasound guided axillary brachial plexus block or infraclavicular block (ICB). MAIN OUTCOME MEASURES Incidence of tourniquet pain (onset, severity, associated haemodynamic changes) and block characteristics (block performance/onset times, distribution, incidence of adverse events, patient satisfaction) were recorded. RESULTS Eighty two patients (40 in the axillary block and 42 in the ICB group) were recruited. The incidence (5/36 and 3/35; P = 0.71), onset time mean (SD) were 73.0 (14.8) and 86.6 (5.7) min (P = 0.18) and severity (mild/moderate; 4/1 and 1/2; P = 0.51) of tourniquet pain were similar in the two groups. The incidence of paraesthesia during block performance, and block performance time were greater in the axillary block group (P = 0.0054 and 0.012, respectively). The volume of local anaesthetic administered was greater in the ICB group (P

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Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial

Utility of Skin Biopsy and Culture in the Diagnosis and Classification of Chronic Ulcers: A Single-Institution, Retrospective Study

Abstract: In the United States, chronic ulcers affect 6.5 million people, with a cost of ≈$20 million annually. The most common etiology of chronic ulcers in the United States is venous stasis, followed by arterial insufficiency and neuropathic ulcers. Less common causes of chronic ulcers include infection, inflammatory etiologies such as vasculitis and pyoderma gangrenosum, and neoplastic causes. Obtaining skin biopsy and tissue culture can be helpful in diagnosing unusual causes of chronic ulcers; however, there are little data on the diagnostic utility of skin biopsy in rendering a definitive diagnosis of the etiology of chronic ulcers. A retrospective study of all skin ulcers biopsied during a 10-year period at the University of Washington was undertaken. Re-excisions and surgical wounds were excluded. A total of 270 ulcer biopsy specimens were included. In 48% of cases, no specific diagnosis could be rendered histologically. 44.8% of chronic ulcers biopsied were due to atypical causes, with neoplasms (basal cell carcinoma, squamous cell carcinoma, melanoma, and cutaneous T-cell lymphoma) being the most common. Vasculitis and pyoderma gangrenosum each represented 1.5% of rendered diagnoses. Concomitant skin culture was performed in 28.9% of cases, and special stains [acid-fast bacilli, Brown and Brenn (B&B), Grocott's methenamine silver, and periodic acid-Schiff stains] were performed in 34.0%. Although more than half (49 of 78) of tissue cultures were positive, only 6.8% (12 of 175) of special stains on tissue sections were positive. We conclude that although the etiology of many ulcers cannot be determined by routine histology alone, skin biopsy of ulcers remains a critical part of the workup given that when a specific cause can be determined, atypical etiologies, including neoplasms, represent a significant proportion of chronic ulcers. Limitations of our study include referral bias. Our results also confirm the higher diagnostic yield of conventional tissue culture compared with special tissue stain biopsies of skin ulcers. Correspondence: Shiva Khoobyari, MD, Department of Pathology, University of Washington Medical Center, Box 357470, 1959 NE Pacific Street, Seattle, WA 98195 (e-mail: Skhoob@uw.edu) S. Khoobyari and T. I. Miller had equal contribution. The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Concurrent Metastatic Merkel Cell Carcinoma and Cutaneous Squamous Cell Carcinoma in the Same Lymph Node

Abstract: The coexistence of Merkel cell carcinoma (MCC) and squamous cell carcinoma (SCC) in the same cutaneous lesion is well known. The pathogenesis is believed to be distinct from conventional polyomavirus-related MCC, and it has a more aggressive course. Metastasis of MCC and SCC to the same lymph node is exceedingly rare with only one previously reported case in the English literature. To the best of our knowledge, this is the second case of MCC and SCC with metastasis to the same lymph node. Our case demonstrates the aggressive nature of the combined MCC and SCC in the setting of immunosuppression. Correspondence: Lubna Suaiti, MBChB, MSc, Department of Pathology/Dermatopathology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1072 (e-mail: lsuaiti@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Linear IgA Bullous Dermatosis Preceding the Diagnosis of Primary Sclerosing Cholangitis and Ulcerative Colitis: A Case Report

Abstract: Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering disorder seen in the pediatric and adult populations that is often linked to a medication, infection, or underlying gastrointestinal, hepatobiliary, or autoimmune disease. In this study, we describe the case of a 23-year-old white man whose presentation and diagnosis of LABD ultimately led to the discovery of underlying primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). His dermatitis resolved with topical steroids and dapsone, and he is undergoing systemic treatment for his UC and PSC. This exceptional case further validates the association between LABD with UC, strengthens that with PSC, and underscores the importance of alerting clinicians to consider conducting a systemic workup in addition to thorough medication history on making the diagnosis of LABD. Correspondence: Jaroslaw Jedrych, MD, PhD, UPMC Dermatology, 3708 Fifth Avenue Fifth Floor, Suite 500.68, Pittsburgh, PA 15213 (e-mail: jedrychj@upmc.edu). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Late-Onset Nevus Comedonicus With Follicular Epidermolytic Hyperkeratosis—Case Report and Review of the Literature

Abstract: Nevus comedonicus is a rare cutaneous follicular hamartoma, characterized by the clustering of papules with firm, blackened horny buffers. It is usually present at birth or during childhood, although few cases of late-onset disease have been described. We present a case of postmenopausal-onset nevus comedonicus in a 55-year-old white woman without relevant medical history. Skin biopsy showed the typical features of several cyst-dilated follicular structures occupied by keratotic material and the peculiar finding of epidermolytic hyperkeratosis of the follicular epithelial walls. A brief review of the clinical and histological features of other similar cases published in the literature is performed. Correspondence: Ramona Zanniello, MD, Section of Dermatology, University of Cagliari, via Ospedale 54, 09124 Cagliari, Italy (e-mail: ramonazanniello@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Positive Antinucleolar Antibodies on Direct Immunofluorescence of Lesional Skin of a Patient With Limited Systemic Sclerosis

No abstract available

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Proliferating Neurocristic Hamartoma Arising in a Giant Congenital Nevus: Comparative Genomic Hybridization Findings

Abstract: Neurocristic cutaneous hamartomas (NCHs) are rarely reported tumors with divergent differentiation derived from persistently active pluripotent cells from the neural crest. They result from aberrant development of the neuromesenchyme, and they can express fibrogenic, melanocytic, and/or neurosustentacular differentiation. Thus, congenital melanocytic nevus also represents a neurocristic dysplasia of the skin in which cells are melanogenic cells arrested in development located in the reticular dermis, and nodular proliferative neurocristic hamartoma may arise within a congenital melanocytic nevus. The real importance of NCHs is that, although few cases have been reported in the literature, some cases have shown development of melanoma. Moreover, the only previously reported case of a similar "proliferative neurocristic nodule" analyzed with comparative genomic hybridization showed an aberration pattern similar to melanoma. We present a rare case of NCH associated with a congenital nevus in a 7-year-old boy, with classical histological and immunohistochemical features suggesting a "proliferative neurocristic hamartoma". Comparative genomic hybridization assay showed that chromosomal aberrations were absent in the congenital nevus, whereas, interestingly, the proliferative neurocristic proliferation had an aberration pattern similar to proliferative nodules with gains or losses of entire chromosomes only, similar to typical proliferative nodules and supporting the benign behavior of this lesion. Correspondence: Maria Concepcion Garrido, MD, PhD, Dpto. de Anatomía Patológica, Hospital Universitario 12 de Octubre, Avda de Córdoba s/n, 28041 Madrid, Spain (e-mail: mariagarridoruiz@gmail.com). The authors declare no conflicts of interest. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Helicobacter pylori antimicrobial resistance during a 5‐year period (2013‐2017) in northern Spain and its relationship with the eradication therapies

Abstract

Background

Antibiotic resistance is the main cause for Helicobacter pylori therapy failure. Frequently, empirical regimens have been recommended in patients with various H. pylori eradication failures. In patients with H. pylori‐resistant to various families of antibiotics, the treatment guided by antimicrobial susceptibility testing allows the achievement of good eradication rates.

Aim

To evaluate the effectiveness of susceptibility‐guided antimicrobial treatment for H. pylori infection in patients with resistance to one or various families of antibiotics.

Methods

A total of 3170 consecutive patients infected by H. pylori during 2013‐2017 were tested for antimicrobial susceptibility. 66.6% patients showed resistance to one antimicrobial, 18.9% to two, and 2.4% to three families of antibiotics. A cohort of 162 H. pylori‐positive patients were enrolled in this study. Forty‐three with single H. pylori resistance to clarithromycin (CLR) were treated with omeprazole (PPI), amoxicillin (AMX), and levofloxacin (LVX)—OAL (31 subjects) or omeprazole, AMX, and metronidazole (MTZ)—OAM (12 patients) and 77 patients with dual H. pylori resistance (51 to CLR and MTZ, 12 to CLR plus LVX, and 14 to MTZ plus LVX) received OAL or OBTM (PPI, bismuth subcitrate, tetracycline, and MTZ), OAM, and OAC, respectively. Other 42 patients with triple H. pylori resistance (CLR, LVX, and MTZ) were treated with PPI, AMX, and rifabutin—OAR (18 subjects), PPI, AMX, and doxycycline—OAD (8), OADB (7), OBTM (6), and ODBR (3). All subjects received standard doses for 10 days. Eradication rate was confirmed by ¹³C‐UBT. Adverse events were assessed by a questionnaire.

Results

Intention‐to‐treat analysis demonstrates that eradication rates using triple therapies in patients with H. pylori resistance to one and to two families of antibiotics were 93% and 94.8%, respectively. In subjects with H. pylori‐resistant to three families of antibiotics, cure rate was higher in naïve patients treated with OAR‐10 days compared to those treated with bismuth‐containing quadruple therapies (90% vs 75%). Adverse events were limited (18 of 162, 11.1%), all of them mild‐moderate.

Conclusions

The implementation of susceptibility‐guided triple therapy for 10 days leads to eradication rate ≥95% in naïve patients with H. pylori resistance to one or two families of antimicrobials. In naïve patients with H. pylori resistance to three families, OAR treatment achieved a 90% of eradication.

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Helicobacter pylori antimicrobial resistance during a 5‐year period (2013‐2017) in northern Spain and its relationship with the eradication therapies

Abstract

Background

Aim

To evaluate the effectiveness of susceptibility‐guided antimicrobial treatment for H. pylori infection in patients with resistance to one or various families of antibiotics.

Methods

Results

Conclusions

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Reversible dilated cardiomyopathy as a complication of adrenal cortex insufficiency: a case report

Cardiovascular manifestations associated with Addison's disease are previously documented. We described a case of an 11-year-old girl who developed dilated cardiomyopathy as a complication to Addison's disease...

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Association of Modified‐FOLFIRINOX‐Regimen‐Based Neoadjuvant Therapy with Outcomes of Locally Advanced Pancreatic Cancer in Chinese Population

AbstractLessons Learned. Modification of FOLFIRINOX significantly improves safety and tolerability in Chinese patients with locally advanced pancreatic cancer.Patients with locally advanced pancreatic cancer benefit from neoadjuvant therapy and experience a much better survival than patients with upfront surgery.Background.The objective of this study was to evaluate the efficacy of modified‐FOLFIRINOX (mFOLFIRINOX) regimens in Chinese patients with locally advanced pancreatic cancer (LAPC) and to compare outcomes between patients with LAPC treated with mFOLFIRINOX‐based neoadjuvant therapy (LAPC‐N) and patients with LAPC who underwent upfront surgery (LAPC‐S).Methods.Forty‐one patients with LAPC‐N were enrolled prospectively. Imaging features, chemotherapy response, adverse events, perioperative complications, histology, and survival were analyzed. Seventy‐four patients with resectable pancreatic cancer (RPC) (from April 2012 to November 2017) and 19 patients with LAPC‐S (from April 2012 to March 2014) were set as observational cohorts, and data were collected retrospectively. LAPC‐N patients with adequate response underwent surgical treatment, whereas continuous chemotherapy was given to LAPC‐N patients who were not deemed resectable after treatment, and the response was re‐evaluated every 2 months.Results.Forty‐one patients with LAPC received mFOLFIRINOX with a response rate of 37.1%. The most common severe adverse events were neutropenia and anemia. mFOLFIRINOX‐based neoadjuvant therapy contributed to a remarkable decrease in CA19‐9 level and tumor diameter. Fourteen LAPC‐N patients underwent surgery (LAPC‐N‐S) after downstaging. Compared with LAPC‐N‐S cases, LAPC‐S patients had longer operative time, more blood loss, and a higher risk of grade 5 complications. The median overall survival (OS) and progression‐free survival (PFS) of LAPC‐N‐S patients were 27.7 months and 19.3 months, respectively, which were similar to those of patients with RPC (30.0 months and 23.0 months) and much longer than those of patients with LAPC‐S (8.9 months and 7.6 months), respectively.Conclusion.Neoadjuvant chemotherapy such as the mFOLFIRINOX regimen can be recommended for Chinese patients with LAPC after dose modification. Patients with LAPC‐N who underwent surgery obtained significantly improved survival compared with patients in the observational LAPC‐S cohort, who did not undergo neoadjuvant therapy.

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Evidence Underlying Recommendations and Payments from Industry to Authors of the National Comprehensive Cancer Network Guidelines

AbstractBackground.The National Comprehensive Cancer Network (NCCN) guidelines are among the most widely used guidance in oncology. It is critical to understand the extent to which the recommendations in these guidelines are supported by evidence and to investigate whether these recommendations have been influenced by payments from industry to authors.Materials and Methods.We examined the quality and consistency of evidence, as scored by guidelines authors, for systemic treatment incorporated in the NCCN guidelines. Payments data in 2015 were manually abstracted using the Open Payments database, which discloses all payments between the industry and American physicians. Correlations between the percentage of authors who received payments and the proportion of recommendations developed from low‐level evidence per guideline were calculated using Spearman rank correlation.Results.In total, 1,782 recommendations were identified in 29 guidelines, of which 1,282 (71.9%) were based on low‐quality or low‐consistency evidence (low‐level evidence), including "case reports or clinical experience only" (18.9%). A substantial proportion (31/143, 21.7%) of category 1 (the highest level) recommendations were based on low‐level evidence. The majority of authors (87.1%) received payments from industry. However, no association was found between the prevalence of payments among authors and the percentage of recommendations developed from low‐level evidence per guideline.Conclusion.The majority of systemic treatment recommendations in the NCCN guidelines are based on low‐level evidence, including more than one in five category 1 recommendations. Payments from industry were prevalent among authors. However, industrial payments among authors were not associated with inclusion of regimen/agent for which there is no conclusive evidence in the guidelines.Implications for Practice.The authors found that the majority (71.9%) of systemic treatment recommendations issued in the current National Comprehensive Cancer Network guidelines were based on low‐level evidence. Physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions.

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ER Doctor, Pharmacist Among Dead in Chicago Hospital Shooting

Doctors unite in mourning on Twitter and vent at the NRA, using #ThisIsOurLane.
Medscape Medical News

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FDA OKs Gamifant, First Drug for Rare Immune Disease HLH

Emapalumab is an interferon gamma-blocking antibody that fills an unmet medical need for patients with primary hemophagocytic lymphohistiocytosis, the FDA says.
FDA Approvals

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Gastroesophageal Reflux in Asymptomatic Patients with Diabetes: An Impedance Study Diabetes, Obesity and Gastroesophageal Reflux

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0783-2327

Introduction Gastroesophageal reflux disease (GERD) is more frequent in patients with diabetes mellitus (DM).The aim of the present study was to evaluate GER in asymptomatic patients with DM using 24-h pH impedance. Materials and Methods 19 healthy controls and 35 patients with DM without typical GERD symptoms were enrolled in the study. A 24-h pH-impedance study, esophageal manometry and gastroscopy were performed on all patients with DM. In the control group, an impedance study was performed on all subjects, and gastroscopy and esophageal manometry were performed on those who consented to the procedures.Patients with diabetes were categorized as obese [body mass index (BMI)>30 kg/m2] or non-obese (BMI<30 kg/m2) and both groups were compared with healthy controls. Results The mean BMI was similar in the control group (27.3±2.6 kg/m2) and the diabetic group (28.7±5 kg/m2)(p>0.05).Erosive esophagitis was found in 7.5% of the DM group. Esophageal dysmotility was higher in diabetics compared to the control group (45.5 vs. 11%, p=0.04). Neuropathy was found to be an independent risk factor for dysmotility. The mean DeMeester score (DMS) (25.6±32.5 vs. 11.2±17, p=0.01) and bolus exposure time (2.1±1.3 vs.1.3±1.3 min, p=0.009) were higher in the DM group compared with the control group.The difference was mainly observed between obese diabetics and the control group (p<0.05). The mean DMS, pathologic acid reflux, and esophageal dysmotility rate were higher in patients without complications of DM (p<0.05). BMI was higher in these patients than in patients with complications. Conclusion Acid reflux is common in patients with diabetes.GER is associated with the existence of obesity rather than hyperglycemia.
[...]

Article in Thieme eJournals:
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Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Thyroid hormones have major effects on the heart and palpitations and irregular heart rhythms are frequent symptoms caused by hyperthyroidism. Because of this, hyperthyroidism is associated with increased cardiac problems. Read More…

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Clinical Thyroidology®for the Public – Highlighted Article

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

Feedback & Suggestions

The post Clinical Thyroidology<sup>®</sup>for the Public – Highlighted Article appeared first on American Thyroid Association.

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Double Fogarty balloon catheter technique for difficult to retrieve esophageal foreign bodies

Foreign body ingestion is common, especially in the pediatric population. Plans for retrieval should be tailored to the specific esophageal foreign bodies.

https://ift.tt/2zji4O2

Effectiveness of discovery learning using a mobile otoscopy simulator on knowledge acquisition and retention in medical students: a randomized controlled trial

Portable educational technologies, like simulators, afford students the opportunity to learn independently. A key question in education, is how to pair self-regulated learning (SRL) with direct instruction. A ...

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Long term follow-up demonstrating stability and patient satisfaction of minimally invasive punch technique for percutaneous bone anchored hearing devices

Cardiac metastasis in a living patient with oral cancer

Cardiac metastasis from head and neck cancers are very rare. Metastases to heart are mostly diagnosed at autopsy, and seldom found while patients are alive. Patients with cardiac metastasis do not present with specific symptoms in the early stages, and diagnosis is often delayed until the disease has advanced significantly. Here, we report a 66-year-old lady who was diagnosed with cardiac metastasis 10 months after surgical resection of oral cancer. She died one month following the discovery of cardiac metastasis.

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Surgical deroofing in the treatment of patients with auricular pseudocyst

An auricular pseudocyst is a fluid filled cavity, characterized by a lack of epithelium, in the intra-cartilaginous space. Clinically, it presents as a painless lump on the upper anterior surface of the ear. Various treatment methods have been discussed in the literature, including aspiration, incision and drainage, or steroid injection. However, these approaches are associated with a high rate of recurrence and results are often esthetically unsatisfactory; therefore, a need for improved treatment approaches remains.

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Occurrence of ochratoxin A in typical salami produced in different regions of Italy

Abstract

A total of 172 different salamis were purchased from farms and small salami factories located in four Italian regions (Piedmont, Veneto, Calabria, and Sicily) and analyzed for the presence of ochratoxin A (OTA). Analysis was performed by high-performance liquid chromatography coupled to a fluorimetric detector (HPLC-FLD). The detection limit (LOD) for the method used was 0.05 μg/kg, while the quantitation limit (LOQ) was 0.20 μg/kg; the average recovery rate was 89.1%. OTA was detected in 22 salamis, and 3 samples exceeded the Italian guidance value for OTA in pork meat (1 μg/kg). In particular, what emerges from this research is the high percentage of spicy salamis among positive samples (68.2%, 15 out of 22), although spicy salamis are only 27.3% of the total number of samples collected and analyzed. Red chili pepper contaminated by OTA could be responsible for the presence of the mycotoxin in these spicy salamis. It follow that, also the control of some ingredients used in the manufacture of these meat products, like spices, should not be neglected.

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Cyclical Hypersensitivity, Anaphylaxis and Related Hormonal Reaction

Case Report

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Title: Where does worsening asthma end and an asthma exacerbation begin?

When does worsening asthma end, and an asthma exacerbation begin?

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EARLY BIRD CATCHES THE SPOT: ACUTE FIXED DRUG ERUPTION

Fixed drug eruption (FDE) is a recurring cutaneous reaction that characteristically occurs in the same location(s) upon re-exposure to the same drug. Lesions normally appear 8 hours and up to 2 weeks after drug administration.

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AllergyWatch - Feb-19

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): John J. Oppenheimer, Vivian Hernandez-Trujillio, Stanley M. Fineman

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"Drug Allergy in children and adults: is it the double X chromosome?"

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Allison Norton, Ana Dioun Broyles

https://ift.tt/2QYDUNN

Racial differences in Atopic Dermatitis

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Patrick M. Brunner, Emma Guttman-Yassky

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The Glycerin Associated Pain (GAP) Study

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Christopher A. Coop, Karen Barker, Scott Dickson, Troy Baker, Kirk Waibel

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Immediate-hypersensitivity reactions to proton pump inhibitors – experience in a medical department

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Joana Sofia Pita, João Azevedo, Rosa-Anita Fernandes, Carlos Loureiro, Ana Todo Bom

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Asthma in the Melting Pot

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Margee Louisias, Lakiea Wright, Wanda Phipatanakul

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Inpatient Beta-lactam test-dose Protocol promotes Antimicrobial Stewardship in Patients with History of Penicillin Allergy

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Keith A. Sacco, Benjamin P. Cochran, Kevin Epps, Mark Parkulo, Alexei Gonzalez-Estrada

Abstract

Background

Penicillin allergy is the most commonly reported drug allergy in hospitalized patients, resulting in increased second-line antibiotic use, nosocomial infections, and healthcare utilization. Given that the vast majority of patients are not truly allergic, a safe strategy that empowers the admitting physician is needed.

Objective

To assess the impact on antibiotic prescribing practices for hospitalized patients with penicillin allergy using a validated intervention.

Methods

An intervention was implemented to educate providers on management of patients with penicillin allergy using a validated risk-stratification algorithm to guide testing and antibiotic use. 30 days of control data using current standard of care was compared with 60 days of post-intervention data measuring documentation of penicillin allergy history and antibiotic selection.

Results

The relative use of cephalosporin and penicillin antibiotics increased by 121.2% (p=0.027) and 256% (p=0.043) respectively without an increase in adverse drug reactions. There was a decrease in the use of broad-spectrum antibiotics; vancomycin 67.2% (p=0.036), quinolones 33.3% (p=0.31), carbapenems 81.9% (p=0.080), and aztreonam 73.8% (p=0.180).

Conclusion

The antibiotic choice in patients admitted to the hospital with a reported penicillin allergy can be improved by better evaluation of the allergy history and the use of a risk stratification guideline.

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Implementation of the NIAID Peanut Allergy Guidelines: Outcomes and Experience

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Amanda L. Pratt, Jonathan A. Hemler

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A CASE OF CARRAGEENAN ALLERGY IN A PEDIATRIC PATIENT

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): H. Kular, J. Dean, V. Cook

Introduction

Carrageenan is a common food additive obtained from Eucheuma, Chrondrus, and Gigartina species of seaweed. It is used in dairy, processed meat, sauces, pharmaceuticals and other food products as a thickener and stabilizer. It's soluble fiber properties are used to alter the consistency, appearance, and nutritional properties of food. Although it has been reported to cause adverse gastrointestinal effects, reports of IgE-mediated allergy appear limited to a case of anaphylaxis to carrageenan-containing barium enema. We present a unique case of carrageenan allergy in a pediatric patient.

Case Description

A 10-month-old male presented for assessment after developing lip angioedema immediately following ingestion of icing from a fruit cake. He had no associated urticaria, respiratory distress, hypotension, or gastrointestinal symptoms. He had a history of eczema, and was known to tolerate milk, egg, soy, peanuts, hazelnuts, and other cake icing without adverse reactions. Skin prick testing to the cake icing produced a positive wheal measuring 11 by 5 mm. Skin prick testing to cow's milk and melon contained in the cake was negative. A detailed ingredient list revealed carrageenan as an ingredient. Skin prick testing to carrageenan produced a positive wheal measuring 10 by 8 mm. Instructions regarding carrageenan avoidance were provided along with an epinephrine-auto-injector and anaphylaxis action plan.

Discussion

To our knowledge, this is the first reported case describing IgE-mediated reaction following carrageenan ingestion. Carrageenan continues to be a common food additive. This case highlights the importance of recognizing carrageenan as a potential cause of IgE-mediated reactions in unexplained food allergy presentations.

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INDEX OF ORAL AND POSTER ABSTRACT AUTHORS: * = Presenting Author

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s):

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Author disclosures

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s):

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THE DIFFICULT MANAGEMENT OF THREE PATIENTS WITH NETHERTON SYNDROME

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): R. Saenz, M. Chen, A. Ahmed, Y. Gernez

Introduction

Netherton Syndrome (NS) is a rare congenital ichthyosis characterized by generalized scaling, erythema, and epidermal barrier defects due to homozygous defects in the SPINK5 gene that encodes for the serine protease inhibitor LEKT1. When mutated, the SPINK5 gene results in the breakdown and thinning of the stratum corneum. The ichthyosis of NS is difficult to manage, and we discuss the result of several systemic treatments attempted, including IVIG and dupilumab.

Case description

We describe three patients with NS, ranging in age from 9 months to 31 years. Infections among these three patients are common and range from recurrent skin infections and upper respiratory infections, to multi-organism bacteremia and sepsis complicated by metabolic acidosis, requiring ICU admission. Additionally, multiple food allergies were noted in one patient. Labs demonstrate a variety of immune abnormalities including mixed T and B cell lymphopenias, impaired cytotoxicity, intermittent eosinophilia, and significant elevations in IgE. Our genetic studies reveal several previously unidentified variants in SPINK5 that appear to cause clinical disease. Our three patients were started on IVIG. While prior studies demonstrated significant clinical improvement in patients on IVIG, only minimal to moderate subjective skin improvement was noted in two of the patients. In one patient, dupilumab was used in the context of increased IgE and eosinophilia, but to date has not proven useful.

Discussion

These cases provide insight into complexity of NS and challenge the existing theory that IVIG provides favorable outcomes. We suggest that new systemic/targeted therapeutics should be attempted for treatment of NS.

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RECURRENT ERYTHEMA MULTIFORME, RESOLVED AFTER IMMULOGLOBULIN REPLACEMENT THERAPY IN A PATIENT WITH NORMAL IMMUNOGLOBULIN LEVELS

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): A. McInerney, S. Siegel

Introduction

While immunoglobulin has been used for Stevens-Johnson syndrome (SJS), its use in erythema multiforme (EM) is limited. Our case describes recurrent EM after SJS with antibiotic exposure and Mycoplasma pneumoniae infection, with normal immunoglobulin levels, which failed standard treatment but resolved following immunoglobulin replacement therapy (IRT).

Case Description

A 13-year-old boy developed fever, cough, and rash progressing to generalized sloughing bullae, with dyspnea that deteriorated to emphysematous lung changes. The lesions were targetoid with erythematous base, dusky center, including mucosa. Symptoms developed after treatment for presumed pneumonia with amoxicillin-clavulanate. He was admitted with SJS and Mycoplasma pneumoniae. Steroids, azithromycin, and acyclovir were given. Biopsy was consistent with EM. He was discharged on azithromycin, doxycycline, and valacyclovir for persistent lesions, although HSV titers and cultures were negative. Immune work-up was unremarkable. He lacked immunity to multiple pathogens, despite vaccination, but responded to re-immunization. Immunoglobulins remained normal. Lesions recurred frequently, with minimal response to steroids, and flares with weaning. IRT was administered during re-admission with near resolution. He was then started on IRT therapy. Steroids were weaned without recurrence.

Discussion

Traditionally described secondary to HSV, Mycoplasma and medications are implicated frequently in pediatric EM. Standard treatment includes prolonged antivirals, antibiotics, and steroids. With treatment failure, immunosuppressants, anti-malarials, and IRT are used. However, controlled trials and consistent data are lacking. As our patient demonstrates, IVIG's immunomodulatory effect can facilitate resolution of recurrent EM. Furthermore, prophylactic use for infections may prevent recurrence. Finally, IVIG represents an alternative to immunosuppressants in pediatric patients with recalcitrant EM despite normal immunoglobulins.

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DRESS TO TEN: IS THIS A CONTINUUM?

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): F. Khan, J. Simonaire, N. Klaiber, S. Kumar

Introduction

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a potentially life-threatening severe cutaneous adverse drug reaction (SCAR) that can be triggered by medications. Toxic Epidermal Necrolysis (TEN) is also a type of SCAR. To the best of our knowledge, we present a first known clear case of DRESS which progressed to clinical TEN and was successfully treated.

Case Description

A 17-year old female was started on Lamotrigine and Escitalopram for a mood disorder. One week later, she developed tender cervical lymphadenopathy, fevers, and abdominal discomfort. About 2.5 weeks after starting these two medications, she developed a raised, pruritic, erythematous rash on her arms. Although the medication was discontinued, she failed to improve and developed facial angioedema, hepatic failure, eosinophilia and atypical lymphocytosis - all concerning signs for DRESS. Skin biopsy confirmed perivascular lymphocytic infiltrate with scattered eosinophils supporting DRESS. She was treated with intravenous immunoglobulin and eventually discharged home with a resolving rash. As Prednisone was tapered, the patient was readmitted with concerns for relapsing DRESS. She went on to develop TEN with mucosal involvement as well as greater than 30 percent skin involvement. She was successfully treated with a combination of Cyclosporine and high dose Prednisone.

Discussion

There is paucity of literature on SCAR overlap syndromes and we acknowledge the ambiguity and difficulty with this diagnosis given the overlapping presentation with SCAR syndromes. Although the mortality rate tends to be quite high for SCAR overlap syndromes, our patient was successfully treated with a combination of IVIG, steroids and Cyclosporine.

Progression towards TEN.

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A MYSTERIOUS RASH AROUND SURGICAL WOUNDS

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): W. Jithpratuck, D. Kays, P. Sriaroon

Introduction

Contact dermatitis (CD) that occurs shortly after a surgery is often caused by a direct irritant effect of medical products or, infrequently, a delayed type hypersensitivity. Various agents have been reported to cause CD including topical medications, surgical instruments, and surgical glue. We present a patient who developed rash around surgical wounds. Skin patch testing identified the causative agent of his CD.

Case Description

A 15-year-old male presented with new onset of pruritic papulovesicular rash three weeks following Nuss procedure, a minimally invasive pectus excavatum repair using a metal bar. The rash initially appeared on upper extremities and chest wall around surgical wounds (Figure 1A). Later, new erythematous lesions occurred on foreskin of penis. Patient denied other systemic symptoms or prior history of metal or medication allergy. A delayed hypersensitivity to nickel or other components of stainless steel used in the pectus bar was suspected. Surgical removal of the bar was contemplated. A trial of oral prednisone 30mg BID led to resolution of the rashes (Figure 1B). Blood test for metal-lymphocyte proliferation assay was unremarkable. Skin patch test was negative to nickel and metal disc, and confirmed a reaction to 2-octyl cyanoacylate (surgical glue) (Figure 1C).

Discussion

Delayed-type hypersensitivity to surgical glue should be considered in patients who develop rash around surgical wounds. Evaluation of surgery-related CD requires a thorough understanding of procedure steps and potential exposures to medical products. Patch test can aid in identification of the offending agent and allow a recommendation of alternative products to avoid recurrence.

Graphical abstract for this article Figure. A. Rash around surgical wounds Figure 1B. Improvement of rash after a 5-day course of prednisone 30 mg BID treatment Figure 1C. Positive patch test to 2-octyl cyanoacrylate (Dermabond® surgical glue)

https://ift.tt/2PDhPaR

HAND DERMATITIS IN A SURGEON: A DIFFICULT PROBLEM AND A THREE-PRONGED SOLUTION

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): S. Mahapatra, L. Caraballo, V. Dimov, F. Eidelman

Introduction

Hand dermatitis is a common problem affecting up to 25% of health workers, it can be caused by contact dermatitis (CD). CD is categorized as irritant in 80% of patients and allergic in 20%.

Case Description

A 42-year old male surgeon with a history of recurrent eczematous lesions on hands and trunk presented with a recurrence of pruritic rash. The rash had persisted despite using OTC hydrocortisone, triamcinolone and OTC moisturizers. Hand dermatitis interfered with his work as a surgeon. Patch testing for allergic contact dermatitis was positive for 1, 3-diphenylguanidine, ammonium persulfate, carba mix, cinnamic aldehyde, cocamidopropyl betaine, coconut diethanolamide (cocamide DEA), colophony, formaldehyde, fragrance mix, hydrocortisone-17-butyrate, Iodopropynyl butylcarbamate, lidocaine-HCl and propylene glycol. The glove materials (1, 3-diphenylguanidine, carba mix), fragrances, preservatives (propylene glycol) and topical steroids were correlated with the patient's symptoms. After contact dermatitis was confirmed with patch testing, a targeted avoidance was recommended. Treatment modalities were adjusted. Triamcinolone and hydrocortisone were eliminated based on patch test results (triamcinolone 0.1% cream contained propylene glycol). Symptoms improved with: 1. topical calcineurin inhibitor (tacrolimus); 2. avoidance of irritants and allergens based on skin patch test; 3. use of barrier protection such as cotton undergloves.

Discussion

Hand dermatitis can have a potentially devastating effect on a surgeon's career based on the limitations it imposes on the ability to practice. The three-pronged approach described above can offer a clinical solution to a difficult problem.

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AN EVOLVING DIAGNOSIS OF A DIFFUSE ERYTHRODERMIC RASH

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): M. Kuder, F. Hsieh

Introduction

Lymphocytic variant hypereosinophilic syndrome (L-HES) is a rare condition that can be challenging to diagnose. In patients presenting with an erythrodermic skin rash and eosinophilia, it is imperative to review the L-HES diagnostic criteria and periodically reassess for alternative etiologies, particularly with disease progression.

Case Description

A 39-year-old female presented with a 4-year history of an erythematous, confluent plaque-like rash. Initially, her skin biopsy demonstrated granulomatous dermatitis with necrobiosis but no eosinophils. She had a peripheral absolute eosinophil count of 1100/uL. Her bone marrow biopsy demonstrated a CD4+, CD3-T-cell population with small, non-necrotizing granulomas and no clonal eosinophilia. She was diagnosed with L-HES and started on high-dose glucocorticoids with initial skin improvement; however, skin symptoms subsequently progressed, covering 90% of her body surface area. She was then managed as cutaneous sarcoidosis, but treatment with methotrexate and leflunomide did not improve symptoms. Given her persistent symptoms, she underwent repeat skin biopsy, which demonstrated cutaneous T-cell lymphoma. Symptoms improved with romidepsin.

Discussion

This patient had initial findings suggestive of L-HES but did not meet L-HES diagnostic criteria. She never had an absolute eosinophil count >1500/uL, nor tissue biopsy demonstrating eosinophil-mediated organ damage. Her disease progression led to re-evaluation and a malignancy diagnosis. Although patients with L-HES can progress to cutaneous T-cell lymphoma, clonal CD4+, CD3- T cells can be found in primary cutaneous T-cell lymphoma without prior HES diagnosis. This case illustrates the importance of continued diagnostic inquiry when the diagnosis is unclear and symptoms progress despite therapy.

https://ift.tt/2PE3ivq

IMPROVEMENT OF SYSTEMIC SCLEROSIS-LIKE SYMPTOMS AFTER THERAPY FOR MULTIPLE MYELOMA

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): S. Davuluri, A. Tieng, G. Franchin, M. Niazi

Introduction

Systemic sclerosis is known to carry an increased risk of malignancy. In this report we describe a rare case of systemic sclerosis as the presenting sign of amyloidosis associated with multiple myeloma.

Case Description

A 59-year-old woman presented to the clinic with a 6-month history of bilateral hand pain and puffiness. Physical examination revealed melasma, multiple enlarged right supraclavicular lymph nodes, and sclerodactyly. Laboratory tests were positive for antinuclear antibodies (1:160) in a nucleolar pattern and nephrotic range proteinuria (>8g/day). The initial impression was systemic sclerosis associated arthritis and patient was treated with hydroxychloroquine, resulting in slight improvement in her range of motion. Computed tomography of the neck showed mildly enlarged right supraclavicular lymph nodes measuring up to 1.6 centimeters in diameter. Biopsy of a cervical lymph node revealed malignant lymphoma. Bone marrow biopsy showed plasma cell myeloma (>80%); serum immunoelectrophoresis revealed elevated levels of free kappa lambda light chains (8447 mg per liter; reference range, 3.3-19.4). Initial management included cyclophosphamide, bortezomib, and dexamethasone, resulting in significant improvement in joint pain. Furthermore, she developed multiple periorbital papules. A biopsy of her left upper eyelid lesion demonstrated apple-green birefringence after Congo red staining, compatible with a diagnosis of amyloidosis.

Discussion

This patient initially presenting with a picture suggestive of systemic sclerosis was subsequently diagnosed with multiple myeloma and amyloidosis. She developed significant improvement in the range of motion of her finger joints as well as the skin tautness after initiating chemotherapy.

https://ift.tt/2R0qoJq

IATROGENIC SYSTEMIC ALLERGIC CONTACT DERMATITIS FROM CETIRIZINE AND LEVOCETIRIZINE

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): D. Lei, C. Guo, P. Greenberger

Introduction

H1 antihistamines are frequently utilized in the management of dermatitis-associated pruritus; they may be overlooked and are rarely considered as an etiology for dermatitis.

Case Description

A 76-year-old woman with a history of allergic rhinitis and hypertension was referred for one year of pruritic, erythematous papules/plaques scattered throughout the body, worse over sun-exposed areas. Prior dermatologic evaluation and biopsy were suggestive of allergic contact dermatitis. Patch testing was positive for fragrance mix, ethylenediamine, and balsam of peru. The patient discontinued all products containing these substances without improvement. She continued to develop new lesions. There were no new medications except cetirizine and then levocetirizine, which she continued for the management of pruritus. She was treated with multiple courses of systemic and topical corticosteroids, and hydroxychloroquine, without resolution. The patient was advised to discontinue levocetirizine, avoid cetirizine, and initiate fexofenadine. At follow up at two weeks and one year later, she reported complete resolution of the rash after discontinuation of levocetirizine.

Discussion

Piperazine derivative antihistamines, such as hydroxyzine, cetirizine, and levocetirizine, share a similar structure with ethylenediamine, which is a common etiology of contact dermatitis. Hypersensitivity to H1 antihistamines is rare. Continued use of H1antihistamines, despite lack of improvement or worsening of symptoms, may be incorrectly interpreted as a failure of response to treatment. Development of generalized dermatitis induced by cetirizine or levocetirizine is rarely reported. This case illustrates the importance of re-evaluation in patients who fail to respond to treatment with consideration of piperazine derivative H1 antihistamines as a possible trigger.

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ATYPICAL PRESENTATION OF SCABIETIC URTICARIAL VASCULITIS

Publication date: November 2018

Source: Annals of Allergy, Asthma & Immunology, Volume 121, Issue 5, Supplement

Author(s): J. Hanna, T. Bingemann

Introduction

Pruritic rash with burrows is pathognomonic for scabies. Classic lesions are seen less frequently as the incidence has increased. Our patient presented with none of the classic findings of scabies and biopsy features consistent with urticarial vasculitis.

Case Description

75-year old male presented with a generalized urticarial eruption for 1 month that burned and itched, and was accompanied by post-inflammatory hyperpigmentation. No new medications had been started. No family members had similar symptoms. Multiple urticarial plaques were noted with post-inflammatory changes without burrows. Dermatographism was present. Skin biopsy showed dense perivascular and superficial interstitial infiltrate, leukocytoclasis, and smudged small vessel walls. No mites or eggs were identified. No eosinophilia was present. Autoimmune work up and complement were normal. Treatment with Colchicine, Dapsone, Prednisone, and Hydroxychloroquine led to initial improvement but then relapse. When he was not improving, we sent him to dermatology again and they did not recommend any changes. As medications were changed, lesions again improved and then worsened. He called complaining of persistent lesions. When he was seen at that point, he had developed typical features of scabies and was treated with topical Permethrin and oral Ivermectin and rash completely subsided. After he improved, he was tapered off Dapsone without recurrence of his symptoms.

Discussion

Urticarial vasculitis is an uncommon presentation of scabies with frequently delayed diagnosis. This case serves as a reminder to reassess the diagnosis if the patient does not respond as expected to treatment and adds to the cases of scabies with atypical presentations.

https://ift.tt/2R3LxCI

Insights into the regeneration of skin from Acomys, the spiny mouse

Abstract

Members of the Acomys genus, known as spiny mice, are unique among mammals in being perfectly capable of regenerating large areas of skin that have been removed. During this regenerative process hairs, sebaceous glands, erector pili muscles, adipocytes and the panniculus carnosus all regenerate and the dermis does not scar. We review here the processes that the epidermis and the individual components of the dermis undergo in the regeneration process of the spiny mouse, the molecules that have been identified as potentially being important in regeneration and relate this to what has been proposed as playing a role in studies from the lab mouse, Mus musculus. Differences in the immune systems of spiny mice and lab mice are also highlighted as this is suggested to play a part not only in the perfect wound healing that embryos display but also in regeneration in lower vertebrates.

https://ift.tt/2R0s4T5

How chemotherapy and radiotherapy damage the tissue: Comparative biology lessons from feather and hair models

Abstract

Chemotherapy and radiotherapy are common modalities for cancer treatment. While targeting rapidly growing cancer cells, they also damage normal tissues and cause adverse effects. From the initial insult such as DNA double strand break, production of reactive oxygen species (ROS), and a general stress response, there are complex regulatory mechanisms that control the actual tissue damage process. Besides apoptosis, a range of outcomes for the damaged cells are possible including cell cycle arrest, senescence, mitotic catastrophe, and inflammatory responses and fibrosis at the tissue level. Feather and hair are among the most actively proliferating (mini‐)organs, and are highly susceptible to both chemotherapy and radiotherapy damage, thus provide excellent, experimentally tractable model systems for dissecting how normal tissues respond to such injuries. Taking a comparative biology approach to investigate this has turned out to be particularly productive. Started in chicken feather and then extended to murine hair follicles, it was revealed that in addition to p53‐mediated apoptosis, several other previously overlooked mechanisms are involved. Specifically, Shh, Wnt, mTOR, cytokine signaling, and ROS‐mediated degradation of adherens junctions have been implicated in the damage and/or reparative regeneration process. Moreover, we show here that inflammatory responses, which can be prominent upon histological examination of chemo‐ or radiotherapy‐damaged hair follicle, may not be essential for the hair loss phenotype. These studies point to fundamental, evolutionarily conserved mechanisms in controlling tissue responses in vivo, and suggest novel strategies for the prevention and management of adverse effects that arise from chemo‐ or radiotherapy.

https://ift.tt/2PI3da0

A Sensorimotor View of Verbal Working Memory

Publication date: Available online 20 November 2018

Source: Cortex

Author(s): Bradley R. Buchsbaum, Mark D'Esposito

https://ift.tt/2PG2TJ2

Space counts! Brain correlates of spatial and numerical representations in synaesthesia

Publication date: Available online 20 November 2018

Source: Cortex

Author(s): Isabel Arend, Kenneth Yuen, Sarit Ashkenazi, Avishai Henik

Abstract

Over-learned semantic representations, such as numbers, are strongly associated with space in normal cognition, and in the phenomenon called number-space synaesthesia. In number-space synaesthesia, numbers are linked to spatial locations in an idiosyncratic way. Synaesthetes report numbers as belonging to a specific location, or feelings that a specific location is the right location for that number. What does really differentiate synaesthetes from non-synaesthetes with respect to their number-space representation? Here we present a number-space synaesthete, MkM, whose number-space representation dramatically differs from that of controls. We examined the impact of spatial distance with respect to MkM's mental number line, and numerical distance with respect to the conceptualized horizontal representation of numbers. In a behavioural experiment, MkM and controls performed number comparison tasks in which they reported either the larger numerical value (number task) or the larger stimulus (physical task) (Experiment 1). A spatial distance effect was found only for MkM. In a brain imaging experiment, MkM and controls compared a single presented digit with an internal reference (Experiment 2). Consistent with the behavioural results, spatial distance elicited significant brain activations only for MkM in different cortical sites including the left supramarginal gyrus. Numerical distance elicited significant brain activations only for controls in the left somatosensory cortex and in the right operculum. We propose that two types of representation are accessed in synaesthesia: one derived by the semantic coding of numbers across space (described by the mental number line), and an explicit spatial representation derived from the position of number within the synaesthetic association. The level of overlap between these two forms of representation depends on the shape of the synaesthetic number-space association.

https://ift.tt/2R3BIER

Meta-analysis of the visuospatial aftereffects of prism adaptation, with two novel experiments

Publication date: Available online 19 November 2018

Source: Cortex

Author(s): Robert D. McIntosh, Bethany MA. Brown, Louise Young

Abstract

We present a meta-analysis of the effects of visuomotor adaptation to leftward displacing prisms on visuospatial judgements in healthy people, as assessed by perceptual (landmark) and manual versions of the line bisection task. To supplement previously published datasets, we report two novel experiments: Experiment 1 (n=12) found null effects of adaptation to 10° leftward prisms on spatial bias in the landmark task, and Experiment 2 (n=24) found null effects of 12° leftward prisms on spatial bias in a computerised line bisection task. Including these data, we considered 17 experiments for the landmark task (total n = 256), and 12 experiments for line bisection (total n = 172), in which participants were adapted for between 7 and 20 minutes to prism strengths from 8 to 17°. A random-effects meta-analysis, with prism strength and exposure duration as moderators, confirmed robust rightward shifts in visuospatial judgements following leftward prism adaptation. The average standardised effect sizes (Cohen's d) were similar between tasks, increasing by around 0.1 per degree of prismatic displacement, and being boosted by a long (10 minute +) period of exposure. However, the quality of evidence and precision of prediction was superior for the landmark task, with a higher signal-to-noise ratio within studies, and less heterogeneity between studies. We suggest that line bisection responses may be contaminated by sensorimotor aftereffects, and that the landmark task is a more suitable method for measuring true visuospatial aftereffects of prism adaptation. To harness these effects, we recommend that researchers should expose participants to 15° (or higher) leftward prisms for more than ten minutes, with upwards of 250 pointing movements. Power calculations should take account of heterogeneity in the true effect size between studies; and further investigation of the factors underlying this heterogeneity will help to refine optimally-effective methods.

https://ift.tt/2PJsUav

Using tDCS to facilitate motor learning in speech production: The role of timing

Publication date: Available online 19 November 2018

Source: Cortex

Author(s): Adam Buchwald, Holly Calhoun, Stacey Rimikis, Mara Steinberg Lowe, Rebecca Wellner, Dylan Edwards

Abstract

There exists debate regarding the extent to which transcranial direct current stimulation (tDCS) can affect or enhance human behavior. Here, we examined a previously unexplored domain: speech motor learning. We investigated whether speech motor learning in unimpaired participants can be enhanced using a single-session tDCS experiment, and investigated whether the timing of tDCS relative to a behavioral task affected performance. Participants (N=80) performed a twenty minute learning task with nonwords containing non-native consonant clusters (e.g., GDEEVOO), and were assigned to groups receiving either sham or active tDCS either immediately before or during the task. Both accuracy and properties of errors were examined throughout the course of the practice task, and then practice was compared to a retention period 30 minutes later (R1) and two days later (R2). For cluster and whole-(non)word accuracy measures, acquisition was observed for all groups during the practice session. Compared to the beginning of practice, the tDCS-Before group showed significantly greater improvement than both the sham group and the tDCS-During group at R1. An effect was also observed for vowel duration in errors (/gdivu/→ [gədivu]), with the tDCS-Before group showing significant shortening of vowel errors throughout practice. Overall, the findings suggest that tDCS can improve speech motor learning, and that the improvement may be greater when tDCS is applied immediately before practice, warranting further exploration of this new domain for tDCS research.

https://ift.tt/2R0pH2D

Metacognition and self-awareness in Multiple Sclerosis

Publication date: Available online 19 November 2018

Source: Cortex

Author(s): Audrey Mazancieux, Céline Souchay, Olivier Casez, Chris J.A. Moulin

Abstract

Although a large range of literature on awareness and metacognition focuses on different neurological populations, little attention has been paid to Multiple Sclerosis (MS). This paper gathers literatures related to studies of anosognosia and the theoretical construct of metacognition which both offer a means to operationalize and measure awareness in MS. We focused on both a clinical concern, regarding the relationship between subjective and objective evolution of cognitive performance, and the theoretical issue of metacognitive processes implicated in disease awareness. We identified 26 papers with findings related to awareness of cognitive impairment in MS using questionnaire-based or performance-based methods. We found support for the idea that the relationship between subjective evaluation and neuropsychological evaluation depends on disease duration and is strongly modulated by other variables, such as mood state. We propose that the metacognitive deficit for memory tasks in this population arises from memory impairment. Finally, we discuss methodological issues, variability in MS patients, and the domain specificity of metacognitive impairment.

https://ift.tt/2PG68QS

Targeting interferon activity to dendritic cells enables in vivo tolerization and protection against EAE in mice

Publication date: Available online 19 November 2018

Source: Journal of Autoimmunity

Author(s): Anje Cauwels, Sandra Van Lint, Dominiek Catteeuw, Shengru Pang, Franciane Paul, Elke Rogge, Annick Verhee, Marco Prinz, Niko Kley, Gilles Uzé, Jan Tavernier

Abstract

Type I Interferon (IFN) is widely used for multiple sclerosis (MS) treatment, but its side effects are limiting and its mechanism of action still unknown. Furthermore, 30–50% of MS patients are unresponsive, and IFN can even induce relapses. Fundamental understanding of the cellular target(s) of IFN will help to optimize treatments by reducing side effects and separating beneficial from detrimental effects. To improve clinical systemic IFN usage, we are developing AcTaferons (Activity-on-Target IFNs = AFNs), optimized IFN-based immunocytokines that allow cell-specific targeting.

In experimental autoimmune encephalitis (EAE) in mice, high dose WT mIFNα could delay disease, but caused mortality and severe hematological deficits. In contrast, AFN targeted to dendritic cells (DC, via Clec9A) protected without mortality or hematological consequences. Conversely, CD8-targeted AFN did not protect and exacerbated weight loss, indicating the presence of both protective and unfavorable IFN effects in EAE. Comparing Clec9A-, XCR1-and SiglecH-targeting, we found that targeting AFN to plasmacytoid (p) and conventional (c) DC is superior and non-toxic compared to WT mIFN. DC-targeted AFN increased pDC numbers and their tolerogenic potential, evidenced by increased TGFβ and IDO synthesis and regulatory T cell induction. In addition, both regulatory T and B cells produced significantly more immunosuppressive TGFβ and IL-10.

In conclusion, specific DC-targeting of IFN activity induces a robust in vivo tolerization, efficiently protecting against EAE, without noticeable side effects. Thus, dissecting positive and negative IFN effects via cell-specific targeting may result in better and safer MS therapy and response rates.

https://ift.tt/2qT4qN2

Induction of immune responses by a novel recombinant fusion protein of enterovirus A71 in BALB/c mice

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Nipatha Issaro, Fenfang Wu, Lei Weng, Mi Zhou, Zhaoxiang Fang, Sisi Huang, Vinothkumar Rajamanickam, Min Liu, Haishan Tian, Xiaokun Li, Chao Jiang

Abstract

Fusion protein technology is used in biotechnology and medical developments. In this study, recombinant fusion proteins from enterovirus A71 (EV-A71) subgenotype B5, Thailand were designed based two surface proteins (VP1 and VP2) and an internal protein (VP4), and named "VP0" (consisting of VP4-VP2) and "EV71" (consisting of VP4-VP2-VP1), respectively. The recombinant fusion proteins VP0 and EV71 were expressed in insect cells and successfully produced and secreted into the media. Both recombinant fusion proteins were shown to have immunogenic properties in BALB/c mice when formulated with Freund's complete/incomplete adjuvant (FA). Interestingly, EV71 formulated with FA- induced a level of IgG antibodies level similar to that induced by the recombinant protein VP1 formulated with FA (the positive control). Our results showed that VP1 alone is better at eliciting a strong cell-mediated immune response. Nontheless, EV71 formulated with FA was capable of inducing lymphocyte proliferation and increasing the cytokine-related mRNA expression levels of interferon-γ (IFN-γ), interleukin-2 (IL-2), and IL-10 in mice after immunization. Additionally, the number of CD4⁺ and CD8⁺ T lymphocyte cells after stimulation with purified EV71 in splenic cell culture showed highly specific CD4⁺ and CD8⁺ T-cell production. We suggest that EV71, which consists of VP4-VP2-VP1, could be used as the foundation for developing a novel recombinant fusion protein-based vaccine for EV-A71.

https://ift.tt/2A7fDha

Clinical features of poorly differentiated thyroid papillary carcinoma

Publication date: Available online 19 November 2018

Source: Auris Nasus Larynx

Author(s): Masaaki Higashino, Yusuke Ayani, Tetsuya Terada, Yoshitaka Kurisu, Yoshinobu Hirose, Ryo Kawata

Abstract

Objective

To investigate the clinical feature of the poorly differentiated thyroid papillary carcinoma.

Methods

We investigate retrospectively 276 thyroid papillary carcinoma patients who underwent initial treatment at our Department who underwent initial treatment at our Department during the 13-year period from 2000 to 2012. We examine the pathological samples of papillary carcinoma retrospectively to investigate the prevalence of a poorly differentiated component in the tumor. Then the disease-specific survival rate, metastasis-free survival rate, and relapse-free survival rate were compared between patients with or without a poorly differentiated component. In addition, well differentiated carcinoma and poorly differentiated carcinoma were compared in relation to the age, sex, TNM stage, and recurrent laryngeal nerve infiltration.

Results

It was considered appropriate to define tumors with a poorly differentiated component of 10% or more as poorly differentiated carcinoma. There was a significant difference of the T classification but not the N classification between well and poorly differentiated thyroid papillary carcinomas. The disease-specific survival rate, metastasis-free survival rate, and relapse-free survival rate of patients with poorly differentiated carcinoma was significantly lower than that of patients with well differentiated carcinoma, and we considered that this might be due to the higher frequency of local infiltration in patients with poorly differentiated tumors.

Conclusion

The higher relapse rate compared with well differentiated carcinoma suggests that careful postoperative follow-up of patients with poorly differentiated carcinoma is important, particularly surveillance of distant metastasis.

https://ift.tt/2PG2Ahw

Squamous Cell Carcinoma of the Head and Neck in Children

Publication date: Available online 20 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Natasha D. Dombrowski, Nikolaus E. Wolter, Alexandria L. Irace, Caroline D. Robson, Antonio R. Perez-Atayde, Jennifer W. Mack, Reza Rahbar

Abstract

Objective

To discuss the presentation, evaluation, and management of squamous cell carcinoma of the head and neck in the pediatric population.

Methods

Medical records of pediatric (≤20 years) patients treated for squamous cell carcinoma of the head and neck between 1996 and 2016 were reviewed. Data pertaining to clinical presentation, diagnostic methods, treatment plan, complications, recurrence, follow-up, or outcome were collected.

Results

Eleven patients were diagnosed with squamous cell carcinoma. Seven of these patients had medical histories significant for prior malignancies, immunosuppressant therapy, and/or genetic syndromes. Lesions were identified in the oral cavity (n = 5, 45.5%), lip/upper lip (n = 3, 27.3%), larynx (n = 2, 18.2%), and nasal cavity (n = 1, 9.1%). Tumors were most commonly treated with surgical excision alone. Three patients underwent irradiation (2 adjuvant and 1 without surgery) and chemotherapy (1 adjuvant, 1 neoadjuvant, and 1 without surgery). Of these patients, one reported complications of hearing loss, loss of dentition, and laryngeal stenosis. Two patients developed local recurrence at 1 month and 5 years post-operatively, respectively. One patient developed an orocutaneous fistula and subsequently died. No other complications were reported. Median follow-up time was 4.6 years (interquartile range: 2.4-8.4 years). Complications of radiation included: laryngeal stenosis, wound breakdown, and orocutaneous fistula.

Conclusion

Squamous cell carcinoma is rare in the pediatric population. Most frequently, it is associated with previous malignancies, immunosuppressant therapy, and/or genetic conditions. Complete surgical excision is recommended to obviate the need for radiation whenever possible.

https://ift.tt/2PGNyIl

Airway findings in children with tracheostomies: When is diagnostic bronchoscopy and laryngoscopy indicated?

Publication date: Available online 19 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Banafsheh Sharif-Askary, Tracy Z. Cheng, Clifford S. Brown, James C. Campbell, Keven Seung Yong Ji, Eileen M. Raynor

Abstract

Objectives

To determine the utility of diagnostic laryngoscopy and bronchoscopy in children with tracheostomies and to describe the incidence of airway findings.

Methods

Retrospective cohort study examining children with tracheostomies who underwent direct laryngoscopy and bronchoscopy (DLB) at Duke University Hospital between 2008 and 2016.

Results

A total of 81 patients who underwent 114 bronchoscopies met inclusion criteria. The median time between tracheostomy and first DLB was 13 months (IQR 4.25-14.75). Sixty-six patients were diagnosed with findings on DLB (81.5%). Suprastomal granulation tissue was the most common complication (59.0%), followed by increased tracheal secretions (23%), stomal and peristomal granulation (13.2%), tracheal ulcer (3.3%), and suprastomal collapse (1.6%). The proportion of patients with airway findings who underwent endoscopy >6 months post-tracheostomy was higher than those <6 months post-tracheostomy, although this did not reach statistical significance (90.6% vs. 75.5%, p=0.087). However, when examining tracheostomy-related findings, the proportion of patients with airway findings who underwent DLB >6 months post-tracheostomy (61%) compared to <6 months post-tracheostomy (36%) was significantly different (p = 0.026). Patients who were symptomatic before bronchoscopy were more likely to have positive findings (91.9% vs. 72.7%, p=0.027) and patients were more likely to be symptomatic if they had DLB >6 months after tracheostomy versus <6 months after tracheostomy (68.8% vs. 30.6%; p<0.001).

Conclusion

The high incidence of airway findings, especially tracheostomy-related findings, noted on DLB supports the continued use of airway endoscopies in children post-tracheostomy. Timing of DLB may play a role in determining utility with evaluation and symptomatic patients should be more closely monitored as they demonstrate higher rates of airway findings.

https://ift.tt/2QZ5dHF

Injection Laryngoplasty in Neonates and Young Children with Unilateral Vocal Fold Immobility

Publication date: Available online 19 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Stephen Z. Shapiro, Scott E. Brietzke, Sweeti V. Shah, Samuel T. Ostrower

Introduction

Although injection laryngoplasty (IL) is a well-accepted treatment strategy in older children and adults with unilateral vocal fold immobility (UVFI), its efficacy and safety have not been well studied in neonates and young children.

Objectives

The main objective of this study was to evaluate the clinical and radiographic effects of IL on aspiration & dysphagia in neonates and young children with UVFI.

Methods

This was a retrospective chart review of infants and children who underwent IL at a tertiary children's hospital. The primary endpoints were improved aspiration and avoidance of gastrostomy tube placement. Additional endpoints included adverse airway and swallowing effects of IL.

Results

Eight patients were included in this case series. A total of 10 injection laryngoplasties were performed. Average corrected age of patients undergoing IL was 1.22 years(range 0.5-3.6y). Seven out of 8 patients had preoperative modified barium swallow (MBS). Five out of seven showed improvement in aspiration. Three out of six (50%) patients who did not have gastrostomy tube preoperatively, were able to avoid gastrostomy tube. No adverse effects were noted following IL. One patient with severe tracheomalacia ultimately required tracheostomy 5 months after IL.

Conclusion

Injection laryngoplasty appears to be a safe and effective therapeutic option in neonates and young children with unilateral vocal cord immobility and associated aspiration. It may be an effective treatment to improve aspiration and avoid gastrostomy tube placement. Further investigation is warranted.

Level Of Evidence

https://ift.tt/2PK8YnJ

Evaluation of hepatic function using dynamic contrast-enhanced magnetic resonance imaging in melanocortin 4 receptor-deficient mice as a model of nonalcoholic steatohepatitis

Publication date: Available online 19 November 2018

Source: Magnetic Resonance Imaging

Author(s): Tomomi Yamada, Yuto Kashiwagi, Takemi Rokugawa, Hideaki Kato, Haruyo Konishi, Tadateru Hamada, Ryohei Nagai, Yusaku Masago, Michiko Itoh, Takayoshi Suganami, Yoshihiro Ogawa, Kohji Abe

Abstract

Introduction

Melanocortin 4 receptor-deficient (MC4R-KO) mice fed a high-fat diet (HFD) develop liver pathology similar to human nonalcoholic steatohepatitis (NASH). However, although liver histology and blood biochemistry have been reported, hepatic function has not been evaluated. In the present study, we evaluated hepatic function in MC4R-KO mice fed an HFD using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with gadolinium‑ethoxybenzyl‑diethylenetriamine pentaacetic acid (Gd-EOB-DTPA).

Materials and methods

Wild type (WT) mice and MC4R-KO mice were fed a standard diet (SD) or an HFD for 20 weeks. The hepatic signal intensity was obtained from DCE-MRI images, and relative enhancement (RE), the time to maximum RE (T_max), and the half-life of RE elimination (T_1/2) were calculated. Histopathological analysis was then performed.

Results

Histological analysis with nonalcoholic fatty liver disease activity score (NAS) revealed that MC4R-KO mice fed an HFD achieved the NAS of 5. There was moderate fibrosis in MC4R-KO mice fed an HFD. DCE-MRI with Gd-EOB-DTPA showed that T_max and T_1/2 were significantly longer in MC4R-KO mice fed an HFD compared with wild type (WT) mice (T_max, WT, 3.9 ± 0.4 min; MC4R-KO, 7.4 ± 1.5 min; T_1/2, WT, 23.7 ± 1.9 min; MC4R-KO, 62.5 ± 18.5 min). T_max and T_1/2 were significantly correlated with histopathologic score (steatosis vs. Tmax, rho = 0.48, P = 0.04; steatosis vs. T_1/2, rho = 0.50, P = 0.03; inflammation vs. Tmax, rho = 0.55, P = 0.02; inflammation vs. T_1/2, rho = 0.61, P < 0.01; ballooning vs. T_1/2, rho = 0.51, P = 0.03;fibrosis vs T_max, rho = 0.72, P < 0.01; fibrosis vs T_1/2, rho = 0.75, P < 0.01).

Conclusions

MC4R-KO mice fed an HFD developed obesity and NASH. The liver kinetics of Gd-EOB-DTPA were significantly different in MC4R-KO mice fed an HFD from WT mice, and correlated with the histopathologic score. These results suggest that MC4R-KO mice fed an HFD mimic the hepatic pathology and liver function of human NASH, and therefore might be useful for the study of hepatic dysfunction during the fibrotic stage of NASH.

https://ift.tt/2zlh38p

Comparison of dynamic contrast-enhanced magnetic resonance imaging and contrast-enhanced ultrasound for evaluation of the effects of sorafenib in a rat model of hepatocellular carcinoma

Publication date: Available online 19 November 2018

Source: Magnetic Resonance Imaging

Author(s): Nina M. Muñoz, Adeeb A. Minhaj, Kiersten L. Maldonado, Charles V. Kingsley, Andrea C. Cortes, Houra Taghavi, Urszula Polak, Jennifer M. Mitchell, Joe E. Ensor, James A. Bankson, Asif Rashid, Rony Avritscher

Abstract

Objectives

To compare the accuracy of contrast-enhanced ultrasound (CEUS) and Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for the assessment of changes in tissue vascularization as result of sorafenib treatment in a rat model of hepatocellular carcinoma (HCC).

Methods

Male Buffalo rats with orthotopic liver tumors treated daily with 7.5 mg/kg sorafenib via oral gavage for 2 weeks (n = 9) were subject to DCE-MRI and CEUS 2 weeks after tumor implantation - right before treatment initiation - and also after treatment completion - right before tumor harvest. Untreated animals (n = 10) were used as control. Tumor tissue sections were stained for hematoxylin-eosin, pimonidazole, and CD34 for quantitative assessment of necrosis, hypoxia, and microvessel density (MVD), respectively.

Results

Of all the DCE-MRI parameters that were evaluated, only volume transfer constant (K^trans) measurements were significantly lower in sorafenib-treated tumors (0.18 vs 0.33 min⁻¹, p < 0.01), indicating a substantial decrease in vascular permeability caused by the therapy. This reduction was associated with decreased MVD (3.9 vs 10.8% CD34+ cells, p < 0.01), higher tumor necrosis (31.9 vs 21.8%, p < 0.001) and hypoxia (19.7 vs 10.5% pimonidazole binding, p < 0.01). Moreover, statistical analysis demonstrate significant correlation of DCE-MRI K^trans with histopathologic tissue necrosis (r = −0.537, p < 0.05) and MVD (r = 0.599, p < 0.05). Interestingly, none of the CEUS measurements were significantly different between the control and treatment groups, and did not show statistical correlation with any of the histopathological parameters assessed (p > 0.05).

Conclusions

Sorafenib-induced reduction in vascular permeability in this preclinical model of HCC is detected more accurately through DCE-MRI than CEUS, and DCE-MRI parameters strongly correlate with histopathological changes in tissue vascularization and tissue necrosis.

https://ift.tt/2OSbfbe

Macrophage Response and Surface Analysis of Dental Cementum after Treatment with High Intensity Focused Ultrasound

Publication date: Available online 19 November 2018

Source: Archives of Oral Biology

Author(s): U. Daood, A.S. Fawzy

Abstract

Objective

To investigate effects of HIFU on macrophage phenotype, surface micro-topography and nano-scale surface mechanical properties of dental cementum.

Materials and Methods

Root discs (2 mm thickness) were cut apical to CEJ and sectioned into quadrants. HIFU setup with bowl-shaped piezo ceramic transducer submerged in a water tank was used for exposure on each specimen for 15 s, 30 s or 60 s. The specimens of the control group were left without any HIFU exposure. HIFU was generated with a continuous sinusoidal wave of 120Vpp amplitude, 250 KHZ resonance-frequency and highest ultrasonic pressure of ~10 bar at the focus. Specimens for SEM were viewed, and micro-topography characterization performed, using AFM and Ra parameter and surface area (SA) calculated by specialized SPM surface analysis software. For nano-indentation testing, experiments were carried out using AFM. Macrophage cell isolation and culturing was performed on cementum to receive the HIFU treatment at different time periods. Raman spectroscopy were scanned to create spectra perpendicular to the cementum substrate to analyze generation of standard spectra for Raman intensity ratio of hydroxyapatite normalized to the peaks ν₁ 960 cm^-1. Data was expressed as means ± standard deviations and analyzed by one-way ANOVA in term of Ra, SA, H and E_r. Different points for fluorescence intensity ratio were analyzed by Raman using Wilcoxon rank sum test.

Results

HIFU exposure at 60 s removed the smear layer and most of cementum appeared smoothened. AFM characterisation, showed a slight decrease in the irregularity of the surface as exposure time increased. Intact macrophages can be identified in control and all experimental HIFU groups. The level of fluorescence for the control and HIFU 15 and 30 s were low as compared to HIFU 60 s.

Conclusion

If HIFU can be successfully implemented, it may be a possible alternative to current methods used in periodontal therapy to achieve smooth root surfaces.

Graphical abstract

Graphical abstract for this article

https://ift.tt/2Q6P7P4

Comparing oral health in patients with different levels of dental anxiety

Abstract

Background

Dental Anxiety is still today one of the most common fears and is therefore a great challenge for every dental practitioner. The aim of this study was to identify patients with dental anxiety using the Dental Anxiety Scale and comparing different levels of dental anxiety with oral health using DMF-T and DMF-S index.

Methods

This study questioned 1549 patients over the course of three years (2002–2005). DAS questionnaires were handed out before treatment and the state of oral health was evaluated using DMF-T and DMF-S.

Results

There is no significant relation between high anxiety and the global DMF-T Score (p = 0.237), missing teeth (p = 0.034) and filled teeth (p = 0.237). There is however a significant increase in destroyed teeth, the higher the level of dental anxiety in the patient (p < 0.0001). There is as well a significant relationship between the global DMF-S Score (p = 0.042) and dental anxiety. No relationship was found comparing missing surfaces (p = 0.107) and filled surfaces (p = 0.516) with dental anxiety. Destroyed 16 surfaces are, however, significantly higher in patients with more dental anxiety (p < 0.0001). A higher dental anxiety therefore often causes minimalistic dentistry to fail due to more teeth being destroyed.

Conclusions

Patients with dental anxiety still have a worse oral hygiene than patients without dental anxiety. It is still necessary, in this time of caries prevention rather than over-treatment, to be educated so that patients suffering dental fear receive the right treatment.

https://ift.tt/2DOPisv

Leukoderma induced by Rhododendrol is different from leukoderma of vitiligo in pathogenesis: a novel comparative morphological study

Background

Rhododendrol (Rhododenol®), an inhibitor of tyrosinase activity, is used as a skin‐whitening component. Many cases of leukoderma after the application have been reported, termed Rhododenol‐induced leukoderma (RIL). The aim of this study was to clarify the pathogenesis of RIL morphologically through comparison with vitiligo.

Methods

We examined 14 cases of RIL and 15 cases of vitiligo using routine histopathology and immunohistochemistry. Thirteen cases of RIL, 6 cases of vitiligo and specimens of the RIL mouse model were evaluated by electron microscopy.

Results

There were common findings in RIL and vitiligo at the light‐microscopic level: a) vacuolar changes in the dermoepidermal junction, b) melanophages in the papillary dermis, c) perifollicular lymphocyte infiltration, d) loss or decrease of basal melanin pigment and e) decrease of melanocytes in the lesions. The ultrastructural observations demonstrated specific findings of RIL: 1) remaining melanocytes in depigmented lesions, 2) inhomogeneous melanization in melanocytes and 3) degenerated melanosomes in melanocytes. Some of the findings were observed in a RIL mouse model. Furthermore, it is notable that cell organelles of melanocytes were intact in our RIL cases.

Conclusions

Morphological changes of RIL targeting melanosomes in melanocytes without degeneration of organelles reflect the reversible clinical course of most cases.

https://ift.tt/2DCcs4i

The Concurrence of Cortical Surface Area Expansion and White Matter Myelination in Human Brain Development

Abstract

The human brain undergoes dramatic structural changes during childhood that co-occur with behavioral development. These age-related changes are documented for the brain's gray matter and white matter. However, their interrelation is largely unknown. In this study, we investigated age-related effects in cortical thickness (CT) and in cortical surface area (SA) as parts of the gray matter volume as well as age effects in T₁ relaxation times in the white matter. Data from N = 170 children between the ages of 3 and 7 years contributed to the sample. We found a high spatial overlap of age-related correlations between SA and T₁ relaxation times of the corresponding white matter connections, but no such relation between SA and CT. These results indicate that during childhood the developmental expansion of the cortical surface goes hand-in-hand with age-related increase of white matter fiber connections terminating in the cortical surface.

https://ift.tt/2OUiPlQ

Person-Based Brain Morphometric Similarity is Heritable and Correlates With Biological Features

Abstract

The characterization of the functional significance of interindividual variation in brain morphometry is a core aim of cognitive neuroscience. Prior research has focused on interindividual variation at the level of regional brain measures thus overlooking the fact that each individual brain is a person-specific ensemble of interdependent regions. To expand this line of inquiry we introduce the person-based similarity index (PBSI) for brain morphometry. The conceptual unit of the PBSI is the individual person's brain structural profile which considers all relevant morphometric measures as features of a single vector. In 2 independent cohorts (total of 1756 healthy participants), we demonstrate the foundational validity of this approach by affirming that the PBSI scores for subcortical volume and cortical thickness in healthy individuals differ between men and women, are heritable, and robust to variation in neuroimaging parameters, sample composition, and regional brain morphometry. Moreover, the PBSI scores correlate with age, body mass index, and fluid intelligence. Collectively, these results suggest that the person-based measures of brain morphometry are biologically and functionally meaningful and have the potential to advance the study of human variation in multivariate brain imaging phenotypes in healthy and clinical populations.

https://ift.tt/2zgM0ug

Voluntary Wheel Running Exercise Evoked by Food-Restriction Stress Exacerbates Weight Loss of Adolescent Female Rats But Also Promotes Resilience by Enhancing GABAergic Inhibition of Pyramidal Neurons in the Dorsal Hippocampus

Abstract

Adolescence is marked by increased vulnerability to mental disorders and maladaptive behaviors, including anorexia nervosa. Food-restriction (FR) stress evokes foraging, which translates to increased wheel running exercise (EX) for caged rodents, a maladaptive behavior, since it does not improve food access and exacerbates weight loss. While almost all adolescent rodents increase EX following FR, some then become resilient by suppressing EX by the second–fourth FR day, which minimizes weight loss. We asked whether GABAergic plasticity in the hippocampus may underlie this gain in resilience. In vitro slice physiology revealed doubling of pyramidal neurons' GABA response in the dorsal hippocampus of food-restricted animals with wheel access (FR + EX for 4 days), but without increase of mIPSC amplitudes. mIPSC frequency increased by 46%, but electron microscopy revealed no increase in axosomatic GABAergic synapse number onto pyramidal cells and only a modest increase (26%) of GABAergic synapse lengths. These changes suggest increase of vesicular release probability and extrasynaptic GABA_A receptors and unsilencing of GABAergic synapses. GABAergic synapse lengths correlated with individual's suppression of wheel running and weight loss. These analyses indicate that EX can have dual roles—exacerbate weight loss but also promote resilience to some by dampening hippocampal excitability.

https://ift.tt/2OUGL8u

Silent Synapse Unsilencing in Hippocampal CA1 Neurons for Associative Fear Memory Storage

Abstract

Clarifying learning-induced synaptic plasticity in hippocampal circuits is critical for understanding hippocampal mechanisms of memory acquisition and storage. Many in vitro studies have demonstrated learning-associated plasticity at hippocampal synapses. However, as a neural basis of memory encoding, the nature of synaptic plasticity underlying hippocampal neuronal responses to memorized stimulation remains elusive. Using in vivo whole-cell recording in anaesthetized adult rats and mice, we investigated synaptic activity of hippocampal CA1 pyramidal cells (PCs) in response to a flash of visual stimulation as the conditioned stimulus (CS) in associative fear conditioning. We found that shortly (<3 days) after conditioning, excitatory synaptic responses and spiking responses to the flash CS emerged in a large number (~70%) of CA1 PCs, a neuronal population previously unresponsive to the flash before conditioning. The learning-induced CA1 excitatory responsiveness was further indicated to result from postsynaptic unsilencing at flash-associated silent synapses, with NMDA receptor-gated responses we recently reported in naive animals. Our findings suggest that associative fear learning can induce excitatory responsiveness to the memorized CS in a large population of CA1 neurons, via a process of postsynaptic unsilencing at CA1 silent synapses, which may be critical for hippocampal acquisition and storage of associative memory.

https://ift.tt/2ze9eRN

Double Fogarty balloon catheter technique for difficult to retrieve esophageal foreign bodies

Abstract

Background

Foreign body ingestion is common, especially in the pediatric population. Plans for retrieval should be tailored to the specific esophageal foreign bodies.

Case presentation

We present a difficult to retrieve esophageal foreign body in a 3-year-old girl who ingested a 2 cm glass pebble. Intraoperatively, attempts using conventional optical forceps and retrieval baskets were unsuccessful due to the size and smooth texture of the object. A novel strategy using double Fogarty embolectomy balloon catheters for retrieval of blunt esophageal foreign bodies was devised and described.

Conclusion

The double fogarty retrieval technique described appeared to be safe and efficacious, allowing for extraction of large esophageal foreign bodies under direct visualization.

https://ift.tt/2Kk2hTA

Long term follow-up demonstrating stability and patient satisfaction of minimally invasive punch technique for percutaneous bone anchored hearing devices

Abstract

Objective

Minimally Invasive Ponto Surgery (MIPS) was recently described to facilitate the placement of percutaneous bone anchored hearing devices. As early adopters of this new procedure, we sought to perform a quality assurance project using our own small prospective cohort to justify this change in practice. We chose to examine device stability and to gauge our patients' perspective of the surgery and their overall satisfaction with the process.

Methods

A total of 12 adult patients who underwent MIPS between 2016 and 2017 with a minimum post-operative follow-up of 12 months were included in this study. A prospective MIPS research clinic was used to follow patients, assess the implant site soft tissue status and gather qualitative information through patient interviews and surveys.

Results

The mean (SD) soft tissue status score averages using the IPS Scale were low for inflammation 0.1 (0.1), pain 0.1 (0.1), skin height 0.2 (0.1) and total IPS score 0.4 (0.3) indicating minimal soft tissue changes. Patient experiences with MIPS were overwhelmingly positive in reports through the MIPS modified SSQ-8. All patients reported speedy recoveries and no long-term complications. There were zero device losses.

Conclusion

The series presented in this paper represents the first MIPS cohort with long term follow-up to be published to date in North America. Our findings conclude both device stability and patient satisfaction with no loss of fixtures. Consequently, we have adopted MIPS as our procedure of choice for the placement of all percutaneous BAHDs.

https://ift.tt/2BljRDV

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 20 Νοεμβρίου 2018

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