Postoperative thoracic and low back pain following endovascular aortic repair associated with stenting location

Abstract

Background

We have noted that patients frequently complain of thoracic or low back pain after undergoing an endovascular aortic repair, which we speculated was caused by the indwelling stent.

Methods

We investigated the patients who underwent an elective thoracic or abdominal endovascular aortic repair (TEVAR or EVAR) and noted the location of stent, and postoperative pain. The incidence of either thoracic or low back pain at individual vertebra levels was determined, after which we fitted the sigmoidal function to the discrete data to obtain a cut-off line. The study patients were then divided into 2 groups using the cut-off line to compare the incidence of pain.

Results

We analyzed 96 patients (68 TEVAR, 28 EVAR). The incidence of thoracic pain was significantly higher in TEVAR as compared to EVAR (26.5% vs. 3.6%, P = 0.01), while that of low back pain was significantly higher in EVAR (35.7% vs. 16.2%, P = 0.04). With the cut-off line for thoracic pain set at the 12th thoracic vertebra, the incidence of thoracic pain was significantly higher in patients with the upper end of the stent above the cut-off as compared to at a lower point (26.5% vs. 3.6%, P = 0.01). As for low back pain, the cut-off line was set at the 9th thoracic vertebra, and the incidence of that pain was significantly higher in patients with the lower end of the stent below that line (30.9% vs. 0.0%, P < 0.01).

Conclusion

Thoracic and low back pain after an endovascular aortic repair procedure were associated with stenting site.

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Early aggressive intervention for infantile atopic dermatitis to prevent development of food allergy: a multicenter, investigator-blinded, randomized, parallel group controlled trial (PACI Study)—protocol for a randomized controlled trial

Atopic dermatitis is the first clinical manifestation of the atopic march, with the highest incidence in the first year of life. Those affected often go on to develop other allergic diseases including food all...

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Prognosis of Young Survivors of Gastric Cancer in China and the U.S.: Determining Long‐Term Outcomes Based on Conditional Survival

AbstractBackground.Young survivors of gastric cancer (GC) have better prognoses than elderly patients, yet their disease‐specific survival (DSS) has received little attention.Patients and Methods.Data on young patients (aged ≤40 years) with GC undergoing resections at three Chinese institutions (n = 542) and from the SEER database (n = 533) were retrospectively analyzed. Three‐year conditional disease‐specific survival (CS3) was assessed. The effects of well‐known prognostic factors over time were analyzed by time‐dependent Cox regression.Results.Overall, young Chinese patients with GC had a better 5‐year DSS than U.S. patients (62.8% vs. 54.1%; p < .05). The disease‐specific mortality likelihood of the entire cohort was not constant over time, with most deaths occurring during the first 3 years after surgery but peaking at 1 and 2 years in China and the U.S., respectively. Based on 5‐year survivorship, the CS3 rates of both groups were similar (90.9% [U.S.] vs. 91.5% [China]; p > .05). Cox regression showed that for Chinese patients, site, size, T stage, and N stage were independent prognostic factors at baseline (p < .05). For U.S. patients, grade, T stage. and N stage significantly affected DSS at baseline (p < .05). In both groups, only T stage continuously affected DSS within 3 years after gastrectomy. However, for both groups, the initial well‐known prognostic factors lost prognostic significance after 5 years of survival (all p > .05). Although the 5‐year DSS rates of young Chinese patients with T3 and T4a disease were significantly better than those of young U.S. patients, in each T stage, the CS3 of both regions trended toward consistency over time.Conclusion.For young patients with GC, the factors that predict survival at baseline vary over time. Although the initial 5‐year DSS is heterogeneous, insight into conditional survival will help clinicians evaluate the long‐term prognoses of survivors while ignoring population differences.Implications for Practice.With the increasing number of young survivors of gastric cancer (GC), it is essential for clinicians to understand the dynamic prognosis of these patients. Based on large data sets from China and the U.S, this study found that the prognostic factors that predict survival for young patients with GC at baseline vary over time. Although the initial 5‐year disease‐specific survival is heterogeneous, insight into conditional survival will help clinicians evaluate the long‐term prognoses of survivors while ignoring population differences. This knowledge may be more effective in helping young patients with GC to manage future uncertainties, especially when they need to make important life plans.

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Concomitant Medications and Risk of Chemotherapy‐Induced Peripheral Neuropathy

AbstractBackground.Peripheral neuropathy is the dose‐limiting toxicity of many oncology drugs, including paclitaxel. There is large interindividual variability in the neuropathy, and several risk factors have been proposed; however, many have not been replicated. Here we present a comprehensive study aimed at identifying treatment and physiopathology‐related paclitaxel‐induced neuropathy risk factors in a large cohort of well‐characterized patients.Patients and Methods.Analyses included 503 patients with breast or ovarian cancer who received paclitaxel treatment. Paclitaxel dose modifications caused by the neuropathy were extracted from medical records and patients self‐reported neuropathy symptoms were collected. Multivariate logistic regression analyses were performed to identify concomitant medications and comorbidities associated with paclitaxel‐induced neuropathy.Results.Older patients had higher neuropathy: for each increase of 1 year of age, the risk of dose modifications and grade 3 neuropathy increased 4% and 5%, respectively. Cardiovascular drugs increased the risk of paclitaxel dose reductions (odds ratio [OR], 2.51; p = .006), with a stronger association for beta‐adrenergic antagonists. The total number of concomitant medications also showed an association with dose modifications (OR, 1.25; p = .012 for each concomitant drug increase). A dose modification predictive model that included the new identified factors gave an area under the curve of 0.74 (p = 1.07 × 10−10). Preexisting nerve compression syndromes seemed to increase neuropathy risk.Conclusion.Baseline characteristics of the patients, including age and concomitant medications, could be used to identify individuals at high risk of neuropathy, personalizing chemotherapy treatment and reducing the risk of severe neuropathy.Implications for Practice.Peripheral neuropathy is a common adverse effect of many cancer drugs, including chemotherapeutics, targeted therapies, and immune checkpoint inhibitors. About 40% of survivors of cancer have functional deficits caused by this toxicity, some of them irreversible. Currently, there are no effective treatments to prevent or treat this neuropathy. This study, performed in a large cohort of well‐characterized patients homogenously treated with paclitaxel, identified concomitant medications, comorbidities, and demographic factors associated with peripheral neuropathy. These factors could serve to identify patients at high risk of severe neuropathy for whom alternative non‐neurotoxic alternatives may be considered.

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Initial Report of Second‐Line FOLFIRI in Combination with Ramucirumab in Advanced Gastroesophageal Adenocarcinomas: A Multi‐Institutional Retrospective Analysis

AbstractBackground.The randomized phase III RAINBOW trial established paclitaxel (pac) plus ramucirumab (ram) as a global standard for second‐line (2L) therapy in advanced gastric and gastroesophageal junction adenocarcinoma, together gastroesophageal adenocarcinoma (GEA). Patients (pts) receiving first‐line (1L) FOLFOX often develop neuropathy that renders continued neurotoxic agents in the 2L setting unappealing and other regimens more desirable. As such, FOLFIRI‐ram has become an option for patients with 2L GEA. FOLFIRI‐ramucirumab (ram) has demonstrated safety and activity in 2L colorectal cancer, but efficacy/safety data in GEA are lacking.Subjects, Materials, and Methods.Patients with GEA treated with 2L FOLFIRI‐ram between August 2014 and April 2018 were identified. Clinicopathologic data including oxaliplatin neurotoxicity rates/grades (G), 2L treatment response, progression‐free survival (PFS), overall survival (OS), safety, and molecular features were abstracted from three U.S. academic institutions. Kaplan‐Meier survival analysis was used to generate PFS/OS; the likelihood ratio test was used to determine statistical significance.Results.We identified 29 pts who received 2L FOLFIRI‐ram. All pts received 1L platinum + fluoropyrimidine, and 23 of 29 (79%) had post‐1L neuropathy; 12 (41%) had G1, and 11 (38%) had G2. Patients were evenly split between esophagus/gastroesophageal junction (12; 41%) and gastric cancer (17; 59%). Among evaluable pts (26/29), the overall response rate was 23% (all partial response) with a disease control rate of 79%. Median PFS was 6.0 months and median OS was 13.4 months among all evaluable pts. Six‐ and 12‐month OS were 90% (n = 18/20) and 41% (n = 7/17). There were no new safety signals.Conclusion.We provide the first data suggesting FOLFIRI‐ram is a safe, non‐neurotoxic regimen comparing favorably with the combination of pac + ram used in the seminal RAINBOW trial.Implications for Practice.Results of this study provide initial support for the safety and efficacy of second‐line (2L) FOLFIRI‐ramucirumab (ram) after progression on first‐line platinum/fluoropyrimidine in patients with gastroesophageal adenocarcinoma (GEA). The overall response, progression‐free survival, overall survival, and toxicity profile compare favorably with paclitaxel (pac) + ram and highlight the importance of the ongoing phase II RAMIRIS trial examining FOLFIRI‐ram versus pac + ram in 2L GEA (NCT03081143). FOLFIRI‐ram may warrant consideration for inclusion as an alternate regimen in consensus guidelines for GEA.

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Surgical repair of partial anomalous pulmonary venous return with intact atrial septum in a 65-year-old woman: a case report

Partial anomalous pulmonary venous return is a rare congenital cardiac anomaly that usually involves the right pulmonary vein and an atrial septal defect. Isolated partial anomalous pulmonary venous return wit...

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Biomarkers in Non-Complicated Pregnancy: Insights About Serum Myeloperoxidase and Ultrasensitive C-Reactive Protein

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0777-2090

Introduction Pregnancy is characterized by increased innate immune response, with low-grade systemic inflammation. The specific role of MPO during normal pregnancy remains not well understood. Therefore, the aim of this study was to evaluate plasma levels of MPO, hs-CRP, total leukocyte, absolute neutrophil and monocyte counts, in all trimesters of normal human pregnancy compared with non-pregnant controls. In addition, possible fluctuations of MPO according to different inflammatory conditions in the normal gestation were studied. Materials and methods Case-control study (n=84) developed with 63 normal pregnant women and 21 healthy non-pregnant women. Total leukocyte, absolute neutrophils and absolute monocytes count, hs-CRP and MPO were measured in non-pregnant women and normal human pregnancy. They were evaluated according to the 3 trimesters of pregnancy and systemic low grade inflammatory status, which was identified through increased hs-CRP levels. Results MPO levels in the normal pregnant women were not elevated in every 3 trimesters of pregnancy (P=0.456) or in systemic inflammation (P=0.446). The hs-CRP levels, total leukocyte, absolute neutrophil and monocyte counts are present in higher concentrations in normal pregnant women in relation to non-pregnant women. Conclusions The MPO did not show fluctuations in plasma levels during the 3 trimesters of gestation or in relation to different inflammation conditions. Considering MPO and hs-CRP levels are changed in high cardiovascular risk conditions and MPO levels (unlike hs-CRP) didn't increase during non complicated pregnancy, MPO could be a better biomarker than hs-CRP to monitor these patients.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Advanced Adrenocortical Carcinoma – What to do when First-Line Therapy Fails?

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0715-1946

Adrenocortical carcinoma is a rare endocrine malignant disease with a generally unfavorable but heterogeneous prognosis. Although even in advanced stages a subset of patients experiences long-term disease stabilisation, effective systemic treatment options are limited. Mitotane is the only approved drug and the combination of etoposide, doxorubicin and cisplatin (plus mitotane) is currently considered as treatment standard for advanced adrenocortical carcinoma based on the results of a large randomized phase III trial. However, progression-free survival is often limited and further treatment options are frequently needed. Here we summarize the current knowledge about second and third-line therapeutic modalities (local and systemic) in advanced disease. Following the recent ESE-ENSAT guidelines local therapies play an important role for these patients. Regarding systemic therapies the best data are available for gemcitabine+capecitabine or streptozotocin (both with or without mitotane). Furthermore, we introduce our own approach to patients with advanced adrenocortical carcinoma based on our experience as a large multidisciplinary clinic dedicated to the care of patients with this orphan disease.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

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Measurement of exhaled nitric oxide in young children with NIOX VERO

Fractional exhaled nitric oxide (FeNO) is a direct marker of Type 2 (T2)-driven inflammation in the airways and aids in the diagnosis of asthma.1, 2 FeNO is reproducible and easy to use in the clinic setting.3 - 5 FeNO measurement technique is often easier for younger children to master than spirometry6 and much less invasive than sputum induction or bronchoscopy.7, 8

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Development of a Pediatric Asthma Predictive Index for Hospitalization

Asthma is the third leading cause of hospitalization among children in the United States.1 Currently 6.2 million children in the U.S. have asthma.1 In 2014, the number of emergency department (ED) visits for asthma exacerbation in children less than 15 years old was approximately 820,000.2 Recently, the total estimated cost of asthma to society was $82 billion.3 There is currently no standard protocol for asthma admissions in the ED. This often leads to wide variation in management and disparities in care.

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DRUG RASH WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) SYNDROME HYPERSENSITIVITY MYOCARDITIS PRESENTING WITH CARDIOGENIC SHOCK

DRESS Syndrome can vary in presentation from mild to life threatening. We report a case of suspected DRESS myocarditis presenting with cardiogenic shock.

https://ift.tt/2KtCUyO

Commentary to accompany the paper: The Quality of Systematic Reviews Addressing Peripheral Nerve Repair and Reconstruction

The authors are to be commended for highlighting the need for further high quality evidence to assist surgical decision making in the management of nerve injuries and for encouraging critical appraisal of available studies. Whilst it cannot be the responsibility of the individual surgeon to undertake randomised control trials (RCTs) and systematically review (SR) all available literature it is our duty of care to ensure our knowledge is best updated and our privilege to safely action innovations in our field.

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An office based evaluation of various Itraconazole brands

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Early surgical management of traumatic dislocation of the tibialis posterior tendon: a case report and review of the literature

Traumatic dislocation of the tibialis posterior tendon at the ankle is a rare injury. Some of these cases are misdiagnosed as ankle sprains and are not treated properly. In addition, because the conservative t...

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Biliary duct stenosis after image-guided high-dose-rate interstitial brachytherapy of central and hilar liver tumors

Abstract

Objective

Image-guided high-dose-rate interstitial brachytherapy (iBT) with iridium-192 is an effective treatment option for patients with liver malignancies. Little is known about long-term radiation effects on the bile duct system when central hepatic structures are exposed to iBT. This retrospective analysis investigates the occurrence of posthepatic cholestasis (PHC) and associated complications in patients undergoing iBT.

Materials and methods

We identified patients who underwent iBT of hepatic malignancies and had point doses of ≥1 Gy to central bile duct structures. Patients with known bile duct-related diseases or prior bile duct manipulation were excluded.

Results

102 patients were retrospectively included. Twenty-two patients (22%) developed morphologic PHC after a median of 17 (3–54) months; 18 of them were treated using percutaneous transhepatic cholangiopancreatography drainage or endoscopic retrograde cholangiopancreatography. The median point dose was 24.8 (4.4–80) Gy in patients with PHC versus 14.2 (1.8–61.7) Gy in those without PHC (p = 0.028). A dose of 20.8 Gy (biological effective dose, BED_3/10 = 165/64.1 Gy) was identified to be the optimal cutoff dose (p = 0.028; 59% sensitivity, 24% specificity). Abscess/cholangitis was more common in patients with PHC compared to those without (4 of 22 vs. 2 of 80; p = 0.029). Median survival did not differ between patients with and without PHC (43 vs. 36 months; p = 0.571).

Conclusion

iBT of liver malignancies located near the hilum can cause PHC when the central bile ducts are exposed to high point doses. Given the long latency and absence of impact of iBT-induced PHC on median survival, the rate of cholestasis and complications seen in our patients appears to be acceptable.

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A pilot study of a novel biodegradable magnesium alloy airway stent in a rabbit model

Publication date: Available online 22 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Bangde Xue, Beibei Liang, Guangyin Yuan, Limin Zhu, Hao Wang, Zhaohui Lu, Zhiwei Xu

Abstract

Objective

To preliminarily investigate the feasibility of bioabsorption tracheal stenting for the therapeutic application of congenital tracheal stenosis (CTS).

Study Design

Experimental research.

Setting

Shanghai Children Medical Center, National Children's Medical Center.

Subjects

and Methods: Five kinds of magnesium alloys with different compositions were studied in this paper, a patented Mg–Nd–Zn–Zr alloy series namely JDBM (JiaoDa BioMg) and four Mg-Ca-Zn alloys. The cytotoxicity of alloys was evaluated by the MTS ([3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay in rabbit tracheal epithelial cells. Specific magnesium alloys had been immersed in the cell culture medium for 24 h. The tracheal stents that were made of magnesium alloy were implanted into the trachea of New Zealand rabbits and the ablation of the stent was monitored by fiber bronchoscopy. The routine blood examination was conducted prior to and following the stent placement. The rabbits were euthanized following 2–3 months of stenting. H&E staining of the main organs was conducted and the induction of apoptosis of the tracheal tissues was monitored.

Results

The cytotoxicity of the JDBM magnesium alloy was mild and lower than the remaining 4 alloys. The stents were placed successfully in five animals. The tracheal stents were successfully placed and gradually biodegradated as monitored by fiber bronchoscopy; no significant systemic inflammatory response was noted. No significant differences in the liver and/or kidney function prior to and following stent placement were noted. H&E staining indicated the absence of pathological changes in the trachea, liver, heart and/or kidney tissues. The apoptotic assay indicated that the apoptosis ratio of the tracheal tissues was comparable between rabbits with and without tracheal stenting.

Conclusion

The results suggested the feasibility of bioabsorption stents made of biodegradable magnesium alloys using in patients with tracheal stenosis, especially in infants.

https://ift.tt/2DVlc6R

Increased salivary fluid flow in children with newly diagnosed allergic rhinitis

Publication date: Available online 22 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Caixia Qiu, Si Ai, Xiangli Zhuang, Suping Huang, Jian Zheng

Abstract

Objectives

The pathogenesis of allergic rhinitis (AR) may involve dysregulation of the autonomic nervous system (ANS). Salivary fluid flow and salivary alpha-amylase (sAA) secretion are able to reflect the activity of parasympathetic (PNS) and sympathetic nervous system (SNS), respectively. The study aims to address the ANS profile in children with newly diagnosed AR by measuring the salivary secretion pattern.

Methods

We recruited thirty-three children with newly diagnosed AR and thirty-one age- and sex-matched healthy children as control. Saliva samples were collected in the morning and the salivary parameters, including salivary flow rate (SFR, ml/min) and sAA secretion rate (μg/min), were determined accordingly. We also measured the gene copy number of the sAA gene, AMY1, for each individual.

Results

We detected a significantly higher SFR in AR children compared with healthy control (2.20 ± 0.55 vs. 1.63 ± 0.61; p = 0.0002). Similar sAA secretion rate was observed between the two groups (312.8 ± 124.8 (Healthy) vs. 347.9 ± 114.0 (AR) μg/min; p = 0.2444). Besides, the two groups did not differ in AMY1 gene copy number (7.2 ± 2.3 (Healthy) vs. 7.7 ± 2.2 (AR); p = 0.3493).

Conclusions

Our results implicate an overactivity of the PNS while normal SNS activity in children with newly diagnosed AR. The findings support a contributing role of the ANS dysfunction in the pathogenesis of AR.

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Genetic screening involving 101 hot spots for neonates not passing newborn hearing screening and those random recruited in Dongguan

Publication date: Available online 22 November 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Yanhui Liu, Lixin Ye, Pengyuan Zhu, Jingfan Wu, Shujuan Tan, Jingguo Chen, Chunqiu Wu, Yukang Zhong, Yu Wang, Xiaoxia Li, Hailiang Liu

Abstract

In order to investigate essential molecular causes for hearing loss and mutation frequency of deafness-related genes, 1315 newborns who did not pass the Newborn Hearing Screening (NHS) (audio-no-pass) and 1000 random-selected infants were subjected to detection for 101 hotspot mutations in 18 common deafness-related genes. Totally, 23 alleles of 7 deafness genes were detected out. Significant difference (χ²=25.320, p=0.000) existed in causative mutation frequency between audio-no-pass group (81/1315, 6.160%) and random-selected cohort (18/1000, 1.80%). Of the genes detected out, GJB2 gene mutation was with significant difference (χ²=75.132, p=0.000) between audio-no-pass group (417/1315, 31.711%) and random-selected cohort (159/1000, 15.900%); c.109G>A was the most common allele, as well as the only one with significantly different allele frequency (χ²=79.327, p=0.000) between audio-no-pass group (392/1315, 16.84%) and random-selected cohort (140/1000, 7.55%), which suggested c.109G>A mutation was critical for newborns' hearing loss. This study performed detection for such a large scale of deafness-associated genes and for the first time compared mutations between audio-no-pass and random-recruited neonates, which not only provided more reliable DNA diagnosis result for medical practioners and enhanced clinical care for the newborns, but gave more accurate estimation for mutation frequency.

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The efficacy and safety of ciclesonide for the treatment of perennial allergic rhinitis: a systematic review and meta-analysis

Publication date: Available online 22 November 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Qi Yang, Fei Wang, Bin Li, Wenbin Wu, Dengpiao Xie, Li He, Nan Xiang, Yan Dong

Abstract

Introduction

Allergic rhinitis is a chronic inflammatory disease which affects 1 out of 6 individuals. Perennial allergic rhinitis accounts for 40% of AR cases. Ciclesonide is one of the relatively new intranasal steroid for allergic rhinitis.

Objective

The purpose of this study was to evaluate the efficacy and safety of ciclesonide in the treatment of perennial allergic rhinitis.

Methods

We searched Pubmed, Scientific Citation Index, Embase, Clinical Trial Registries for randomized controlled trials and Cochrane Central Register of Controlled Trials to find out the randomized controlled Trial comparing ciclesonide with placebo for PAR.

Results

Eight studies were included. In comparison with placebo groups, ciclesonide groups significantly decreased Reflective Total Nasal Symptom Score (MD = −0.56; 95% CI −0.72 to 0.39, p < 0.00001) with heterogeneity (p = 0.19, I² = 24%), Instantaneous Total Nasal Symptom Score (MD = −0.57; 95% CI −0.75 to −0.39, p < 0.00001) with heterogeneity (p = 0.34, I² = 11%). A significant effect for Reflective Nasal Symptom Score Subtotal (MD = −0.15; 95% CI −0.18 to −0.13, p < 0.00001; with heterogeneity, p = 0.12, I² = 24%) was also demonstrated. Rhinoconjunctivitis quality of life questionnaire score RQLQs (MD = −0.27; 95% CI −0.39 to −0.15, p < 0.00001; with heterogeneity, p = 0.58, I² = 0%) in the treatment of ciclesonide was also significantly reduced. In addition, the difference in Treatment-Emergent Adverse Events between the two groups was not significant.

Conclusion

Ciclesonide can improve perennial allergic rhinitis without increasing adverse events. Ciclesonide may be another valuable choice for perennial allergic rhinitis in the future.

Resumo

Introdução

A rinite alérgica é uma doença inflamatória crônica que afeta 1 a cada 6 indivíduos. A rinite alérgica perene é responsável por 40% dos casos de rinite alérgica. A ciclesonida é um dos corticosteroides intranasais mais novos para o tratamento dessa condição clínica.

Objetivo

O objetivo deste estudo foi avaliar a eficácia e segurança da ciclesonida no tratamento da rinite alérgica perene.

Método

Uma busca foi realizada nos bancos de dados Pubmed, Scientific Citation Index, Embase, e Clinical Trial Registries por ensaios clínicos randomizados e Cochrane Central Register of Controlled Trials por estudos controlados randomizados comparando ciclesonida com placebo no tratamento da rinite alérgica perene.

Resultados

Oito estudos foram incluídos. Em comparação com os grupos placebo, os grupos ciclesonida mostraram diminuição significante no escore do Reflective Total Nasal Symptom Score (rTNSS) (DM = −0,56; IC 95%: −0,72 a −0,39, p < 0,00001) com heterogeneidade (p = 0,19, I² = 24%), do Instantaneous Total Nasal Symptom Score (iTNSS) (DM = −0,57; IC95%: −0,75 a −0,39, p < 0,00001) com heterogeneidade (p = 0,34, I² = 11%). Um efeito significante no escore do Reflective Nasal Symptom Score (rNSS) Subtotal (DM = −0,15; IC 95%: −0,18 a −0,13, p < 0,00001; com heterogeneidade, p = 0,12, I² = 24%) também foi demonstrado. O escore do Rhinoconjunctivitis quality of life questionnaire score, RQLQs (DM = −0,27; IC 95%: −0,39 a −0,15, p < 0,00001; com heterogeneidade, p = 0,58, I² = 0%) também foi significantemente reduzido no tratamento com ciclesonida. Além disso, a diferença em relação aos eventos adversos emergentes do tratamento, entre os dois grupos não foi significante.

Conclusão

A ciclesonida pode melhorar a rinite alérgica perene sem aumentar os eventos adversos. Esse fármaco pode ser outra opção valiosa para a rinite alérgica perene no futuro.

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Evaluation of language in children with pre-lingual hearing loss and cochlear implant

Publication date: Available online 22 November 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Emille Mayara Scarabello, Dionísia Aparecida Cusin Lamônica, Marina Morettin Zupelari, Liége Franzini Tanamati, Patrícia Dominguez Campos, Kátia de Freitas Alvarenga, Adriane Lima Mortari Moret

Abstract

Introduction

The cochlear implant is an effective device for children with severe and/or profound prelingual hearing loss, since it provides considerable improvement in oral language acquisition through the auditory pathway. The use of a cochlear implant contributes to the development of auditory perception, favoring the acquisition of the linguistic processes related to communication skills, which might have a positive effect on other areas of development.

Objective

The aim of this study was to verify the performance of children using cochlear implants for expressive and receptive oral language.

Methods

This was a prospective cross-sectional study that used the following tests: Child language test in the phonology, vocabulary, fluency and pragmatics areas, and the Peabody Picture Vocabulary Test. Thirty children participated in this study, of both genders, aged between 36 and 72 months, with severe and/or profound bilateral sensorineural hearing loss, without other impairments and users of unilateral cochlear implant with full electrode insertion for a minimum of 12 months.

Results

The longer duration of the cochlear implant use, the younger age at surgery and the better performance at the auditory perception of speech influenced the performance in expressive and receptive oral language. Even though when compared to the normative language acquisition process, the results showed that these children had patterns of linguistic skills that are below their chronological age; the results indicate that these children are developing expressive and receptive oral language skills, and this is the outcome that should be taken into account in this study.

Conclusion

The longer duration of the cochlear implant use, the younger age at surgery and the better performance in the auditory perception of speech influenced the performance in expressive and receptive oral language skills, but not in all the studied semantic categories.

Resumo

Introdução

O implante coclear é um tratamento eficaz para crianças com deficiência auditiva pré-lingual de grau severo e/ou profundo, uma vez que proporciona melhoria considerável na aquisição da linguagem oral por meio da via auditiva. O uso do implante coclear contribui para o desenvolvimento da percepção auditiva favorecendo a aquisição dos processos linguísticos voltados à aquisição de habilidades comunicativas que poderá repercutir positivamente em outras áreas do desenvolvimento.

Objetivo

O objetivo deste estudo foi verificar o desempenho de crianças usuárias de implante coclear quanto à linguagem oral expressiva e receptiva.

Método

Trata-se de um estudo prospectivo transversal onde os seguintes testes foram utilizados: Teste de linguagem infantil nas áreas de fonologia, vocabulário, fluência e pragmática e Test de Vocabulário de Imágenes Peabody. Participaram deste estudo 30 crianças de ambos os sexos na faixa etária de 36 a 72 meses, com deficiência auditiva sensorioneural de grau severo e/ou profundo bilateral, sem outros comprometimentos e usuárias de implante coclear unilateral com inserção total dos eletrodos há, no mínimo, 12 meses.

Resultados

O maior tempo de uso do implante coclear, a menor idade na cirurgia e o melhor desempenho na percepção auditiva da fala influenciaram o desempenho na linguagem oral expressiva e receptiva. Embora comparativamente ao processo de aquisição normativo da linguagem os resultados encontrados revelaram que estas crianças demonstraram habilidades linguísticas em padrões abaixo de sua idade cronológica, os resultados apontaram que estas crianças estão em evolução da linguagem oral expressiva e receptiva, sendo este o resultado que deve ser valorizado neste estudo.

Conclusão

O maior tempo de uso do implante coclear, a menor idade na cirurgia e o melhor desempenho na percepção auditiva da fala influenciaram o desempenho na linguagem oral expressiva e receptiva, porém não em todas as categorias semânticas estudadas.

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Is the C reactive protein/albumin ratio a prognostic and predictive factor in sudden hearing loss?

Publication date: Available online 22 November 2018

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Ramazan Öçal, Fatma Ceyda Akin Öçal, Mustafa Gulluev, Necat Alatas

Abstract

Introduction

Sudden hearing loss is a significant otologic emergency. Previous studies have revealed a coexistence of sudden hearing loss with chronic inflammation. The predictive importance of C-reactive protein/albumin values as a prognostic factor has been shown in various inflammatory and tumoral conditions.

Objectives

The aim of this study was to determine whether the C-reactive protein/albumin ratio in sudden hearing loss can be used for prognostic purposes and whether there is a relationship between the neutrophil/lymphocyte ratio and the C-reactive protein/albumin ratio.

Methods

A retrospective examination was made of 40 patients diagnosed with idiopathic sudden hearing loss and a control group of 45 healthy subjects. The pure tone averages of all the patients were determined on first presentation and repeated at 3 months after the treatment. The patients were separated into 2 groups according to the response to treatment. The neutrophil/lynphocyte ratio and the C-reactive protein/albumin ratios were calculated from the laboratory tests.

Results

The patients included 16 females and 24 males with a mean age of 44.1 ± 14.2 years and the control group was composed of 23 females and 22 males with a mean age of 42.2 ± 13.8 years. The mean C-reactive protein/albumin ratio was 0.95 ± 0.47 in the patient group and 0.74 ± 0.13 in the control group. The difference was statistically significant (p = 0.009). The mean C-reactive protein/albumin ratio was 0.79 ± 0.12 in the response to treatment group and 1.27 ± 0.72 in the non-response group, with no significant difference determined between the groups (p = 0.418). The mean neutrophil/lymphocyte ratio was 3.52 ± 3.00 in the response to treatment group and 4.90 ± 4.60 in the non-response group, with no statistically significant difference determined between the groups (p = 0.261).

Conclusion

C-reactive/albumin ratio was significantly higher in patients with sudden hearing loss than in the control group. Although C-reactive protein/albumin ratio was found to be lower in sudden hearing loss patients who responded to treatment compared to those who did not, the difference between two groups was not statistically significant.

Resumo

Introdução

A perda auditiva neurossensorial súbita ou surdez súbita é uma emergência otológica significativa. Estudos anteriores revelaram uma coexistência dessa condição com inflamação crônica. A importância preditiva dos valores da relação proteína C-reativa/albumina como fator prognóstico tem sido demonstrada em várias condições inflamatórias e tumorais.

Objetivos

O objetivo deste estudo foi determinar se a relação proteína C-reativa/albumina na perda auditiva neurossensorial súbita pode ser utilizada para fins prognósticos e se existe uma associação entre as relações neutrófilo/linfócito e proteína C-reativa/albumina.

Método

Foram avaliados retrospectivamente 40 pacientes com diagnóstico de perda auditiva neurossensorial súbita idiopática e um grupo controle de 45 indivíduos saudáveis. As médias de tons puros de todos os pacientes foram determinadas na primeira consulta e repetidas 3 meses após o tratamento. Os pacientes foram separados em 2 grupos de acordo com a resposta ao tratamento. As relações neutrófilo/linfócito e proteína C-reativa/albumina foram calculadas a partir de testes laboratoriais.

Resultados

Os pacientes incluíam 16 mulheres e 24 homens, com média de idade de 44,1 ± 14,2 anos, e o grupo controle por 23 mulheres e 22 homens, com média de idade de 42,2 ± 13,8 anos. A média da relação proteína C-reativa/albumina foi de 0,95 ± 0,47 no grupo de pacientes e de 0,74 ± 0,13 no grupo controle, e a diferença foi estatisticamente significante (p = 0,009). A média da relação proteína C-reativa/albumina foi de 0,79 ± 0,12 do grupo com resposta ao tratamento e de 1,27 ± 0,72 no grupo sem resposta, sem diferença significante entre os grupos (p = 0,418). A média da relação neutrófilo/linfócito foi de 3,52 ± 3,00 no grupo com resposta ao tratamento e de 4,90 ± 4,60 no grupo sem resposta, sem diferença estatisticamente significativa entre os grupos (p = 0,261).

Conclusão

A relação proteína C-reativa/albumina foi significantemente maior nos pacientes com perda auditiva neurossensorial súbita do que no grupo controle. No entanto, embora a relação proteína C-reativa/albumina tenha sido menor nos pacientes com perda auditiva neurossensorial súbita que responderam ao tratamento em comparação a aqueles que não apresentaram resposta, a diferença entre os dois grupos não foi estatisticamente significante.

https://ift.tt/2DHCOlQ

MNP triggers nasal allergy by modulating dendritic cell properties

Publication date: Available online 23 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Xiao-Yu Liu, Yong-Jin Wu, Li-Juan Song, Xian-Hai Zeng, Shuai Wang, Jiang-Qi Liu, Li-Hua Mo, Xiao-Rui Geng, Li-Teng Yang, Rui-Di Xie, Xiao-Wen Zhang, Zhi-Gang Liu, Ping-Chang Yang

https://ift.tt/2BseySS

IgE-class-specific immunosuppression in offspring by administration of anti-IgE to pregnant mice

Publication date: Available online 22 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Hideaki Morita, Masato Tamari, Masako Fujiwara, Kenichiro Motomura, Yasuhiko Koezuka, Go Ichien, Kenji Matsumoto, Kimishige Ishizaka, Hirohisa Saito

https://ift.tt/2KqWKug

Transcriptome profiling of refractory atopic keratoconjunctivitis by RNA sequencing

Publication date: Available online 22 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Akira Matsuda, Yosuke Asada, Naomasa Suita, Satoshi Iwamoto, Toshiaki Hirakata, Norihiko Yokoi, Yasuyuki Ohkawa, Yukinori Okada, Takehiko Yokomizo, Nobuyuki Ebihara

Summary

We found upregulation of 47 immunoglobulin genes and 22 S. aureus infection-related genes in refractory atopic keratoconjunctivitis tissue by RNA-seq analysis, suggesting that lymphoid neogenesis and stimuli from infection are essential components of the disorder.

https://ift.tt/2BseBy2

Vaccination of non-allergic individuals with recombinant hypoallergenic fragments of birch pollen allergen Bet v 1: Safety, effects and mechanisms

Publication date: Available online 22 November 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Raffaela Campana, Katharina Marth, Petra Zieglmayer, Milena Weber, Christian Lupinek, Yury Zhernov, Olga Elisyutina, Musa Khaitov, Eva Rigler, Kerstin Westritschnig, Uwe Berger, Martin Wolkersdorfer, Fritz Horak, Friedrich Horak, Rudolf Valenta

Summary

This is the first double-blind, placebo-controlled study showing that vaccination with recombinant hypoallergenic allergen-derivatives is safe and induces sustained allergen-specific IgG responses which block allergic patients IgE binding to the allergen.

https://ift.tt/2Ks2PXn

Merkelzellkarzinom

Zusammenfassung

Das Merkelzellkarzinom ist ein seltener, hoch aggressiver Hauttumor des älteren Menschen. Er besitzt neuroendokrine Eigenschaften. Die Pathogenese ist mit chronischer UV-Licht-Exposition und dem Merkelzell-Polyomavirus assoziiert. Klinisch fällt das Merkelzellkarzinom durch einen solitären, kutan oder subkutan gelegenen, roten bis bläulichen Knoten auf. Da der Tumor frühzeitig lymphogen metastasiert, sind zum Zeitpunkt der Diagnosestellung in etwa 30 % der Fälle bereits lokoregionäre Metastasen vorhanden. Die häufigen Lokalrezidive sowie die regionäre und ferne Metastasierung zeigen sich meist innerhalb der ersten 2 bis 3 Jahre nach Erstdiagnose. Die erste Therapie nach Diagnosestellung besteht in der vollständigen operativen Entfernung des Primärtumors mit weitem Sicherheitsabstand sowie einer Sentinellymphknotenbiopsie. Anschließend sollte eine adjuvante Radiatio des Tumorbetts erfolgen. Durch eine zusätzliche Bestrahlung der regionären Lymphknotenstationen kann die Rate lokoregionärer Rezidive gesenkt werden. Für die systemische Therapie des fortgeschrittenen Merkelzellkarzinoms haben sich gegen die PD-1/PD-L1-Achse gerichtete Checkpoint-Inhibitoren als gut und dauerhaft wirksam erwiesen. Die vormals häufig eingesetzte Chemotherapie zeigt hingegen zwar mäßige bis gute Ansprechraten, diese sind jedoch in der Regel von sehr kurzer Dauer.

https://ift.tt/2Qeu5xP

Distribution of mast cells within the mouse heart and its dependency on Mitf

Publication date: January 2019

Source: Molecular Immunology, Volume 105

Author(s): Arnar Bragi Ingason, Fatich Mechmet, Diahann Alexandra Maria Atacho, Eiríkur Steingrímsson, Pétur Henry Petersen

Abstract

Although mast cell distribution has been described in both human and canine hearts, cardiac mast cells in mice have yet to be categorically localized. We therefore sought to describe mast cell distribution within the mouse heart and characterize their dependence on the Microphthalmia-associated transcription factor (Mitf). Cardiac mast cells were visualized using Toluidine Blue and avidin staining, and their distribution within the heart described. Cardiac mast cells were most prevalent in the epicardium (50%) or myocardium (45%). Less frequently, mast cells were noted in the endocardium (5%). Within the myocardium, 31% of the mast cells had perivascular location. By studying two different Mitf mutant strains, Mitf^mi−vga9 and Mitf^Mi-wh, we demonstrated that these mutations led to near-complete deficiency of cardiac mast cells. Accordingly, expression of the mMCP-4 and mMCP-5 genes was lost and chymase enzyme activity was severely reduced. Additionally, hearts from mice heterozygous for these Mitf mutations contained significantly fewer mast cells compared to wild-type mice. Our results demonstrated that the distribution of cardiac mast cells in mice is different from humans and dogs. Cardiac mast cells are dependent on Mitf expression, with loss-of-function mutation in the Mitf gene leading to near-complete lack of cardiac mast cells. Loss of a single Mitf allele is sufficient for relative mast cell deficiency.

https://ift.tt/2PU7GH6

Protective effect of ginsenoside Rg1 on LPS-induced apoptosis of lung epithelial cells

Publication date: Available online 22 November 2018

Source: Molecular Immunology

Author(s): Qijian Ji, Zhaozui Sun, Zhizhou Yang, Wei Zhang, Yi Ren, Weijun Chen, Mengya Yao, Shinan Nie

Abstract

Sepsis-induced acute lung injury (ALI) is a life-threatening medical condition with high mortality and morbidity in the critical care units. Though, it was commonly accepted that inflammation and apoptosis of lung epithelial cells played an essential role in the pathogenesis of ALI, the underlying mechanism remain unknown. In our study, we found that LPS-induced cell apoptosis could be counteracted by elevated cell autophagy. In LPS-treated MLE-12 cells, suppression of autophagy via 3-MA could aggravate LPS-induced apoptosis, while activation of autophagy via Rapamycin could effectively impair the apoptosis of MLE-12 cells induced by LPS. In order to further discover the molecular regulation mechanism between apoptosis and autophagy in LPS-treated MLE-12 cells, we demonstrated that autophagy could induced the expression of Nrf2, followed with the decrease of p-p65. Targeted inhibition of Nrf2 could induce enlarged cell apoptosis via increasing the level of p-p65. In addition, we demonstrated that ginsenoside Rg1 protected MLE-12 cells from LPS-induced apoptosis via augmenting autophagy and inducing the expression of Nrf2. Our data implicates that activation of autophagy and Nrf2 by ginsenoside Rg1 may provide a preventive and therapeutic strategy for ALI.

https://ift.tt/2R2WRPg

Isotropically weighted intravoxel incoherent motion brain imaging at 7T

Publication date: Available online 23 November 2018

Source: Magnetic Resonance Imaging

Author(s): Ivan I. Maximov, Sebastian Vellmer

Abstract

Perfusion magnetic resonance imaging (MRI) is a promising non-invasive technique providing insights regarding the brain's microvascular architecture in vivo. The scalar perfusion metrics can be used for quantitative diagnostics of various brain abnormalities, in particular, in the stroke cases and tumours. However, conventional MRI-based perfusion approaches such as dynamic contrast-enhanced perfusion imaging or arterial spin labelling have a few weaknesses, for instance, contrast agent deposition, low signal-to-noise ratio, limited temporal and spatial resolution, and specific absorption rate constraints. As an alternative, the intravoxel incoherent motion (IVIM) approach exploits an extension of diffusion MRI in order to estimate perfusion parameters in the human brain. Application of IVIM imaging at ultra-high field MRI might employ the advantage of a higher signal-to-noise ratio, and thereby the use of higher spatial and temporal resolutions.

In the present work, we demonstrate an application of recently developed isotropic diffusion weighted sequences to the evaluation of IVIM parameters at an ultra-high 7T field. The used sequence exhibits high immunity to image degrading factors and allows one to acquire the data in a fast and efficient way. Utilising the bi-exponential fitting model of the signal attenuation, we performed an extensive analysis of the IVIM scalar metrics obtained by a isotropic diffusion weighted sequence in vivo and compared results with a conventional pulsed gradient sequence at 7T. In order to evaluate a possible metric bias originating from blood flows, we additionally used a truncated b-value protocol (b-values from 100 to 200 s/mm² with the step 20 s/mm²) accompanied to the full range (b-values from 0 to 200 s/mm²). The IVIM scalar metrics have been assessed and analysed together with a large and middle vessel density atlas of the human brain. We found that the diffusion coefficients and perfusion fractions of the voxels consisting of large and middle vessels have higher values in contrast to other tissues. Additionally, we did not find a strong dependence of the IVIM metrics on the density values of the vessel atlas. Perspectives and limitations of the developed isotropic diffusion weighted perfusion are presented and discussed.

https://ift.tt/2Ksf2eQ

Sampling arterial input function (AIF) from peripheral arteries: Comparison of a temporospatial-feature based method against conventional manual method

Publication date: Available online 22 November 2018

Source: Magnetic Resonance Imaging

Author(s): Xiaowan Li, Christopher C. Conlin, Stephen T. Decker, Nan Hu, Michelle Mueller, Lillian Khor, Christopher Hanrahan, Gwenael Layec, Vivian S. Lee, Jeff L. Zhang

Abstract

It is often difficult to accurately localize small arteries in images of peripheral organs, and even more so with vascular abnormality vasculatures, including collateral arteries, in peripheral artery disease (PAD). This poses a challenge for manually sampling arterial input function (AIF) in quantifying dynamic contrast-enhanced (DCE) MRI data of peripheral organs. In this study, we designed a multi-step screening approach that utilizes both the temporal and spatial information of the dynamic images, and is presumably suitable for localizing small and unpredictable peripheral arteries. In 41 DCE MRI datasets acquired from human calf muscles, the proposed method took <5 s on average for sampling AIF for each case, much more efficient than the manual sampling method; AIFs by the two methods were comparable, with Pearson's correlation coefficient of 0.983 ± 0.004 (p-value < 0.01) and relative difference of 2.4% ± 2.6%. In conclusion, the proposed temporospatial-feature based method enables efficient and accurate sampling of AIF from peripheral arteries, and would improve measurement precision and inter-observer consistency for quantitative DCE MRI of peripheral tissues.

https://ift.tt/2BspQqv

Magnetic resonance imaging in the presence of projectiles and projectile fragments: Artefacts, image quality, rotation and movement

Publication date: Available online 22 November 2018

Source: Magnetic Resonance Imaging

Author(s): C. Hackenbroch, M. Wafa, S. Klinger, U.M. Mauer

Abstract

Background and purpose

Gunshot injuries have been considered a contraindication for MRI because of the risk of secondary dislodgement of retained metallic foreign bodies.

The objective of our study was to provide a systematic overview of the behaviour of projectiles and fragments in order to aid decision-making regarding the use of MRI in clinical practice.

Materials and methods

Ferromagnetic (n = 2) and non-ferromagnetic (n = 5) projectiles and fragments that were lodged in soft tissue (porcine masseter muscles) were examined using standard protocols at 1, 1.5 and 3 T, to simulate clinical situations as realistically as possible. CT was performed before and after every MRI to assess rotation and movement. Artefacts and image quality were analysed using Likert-type scales.

Results

Ferromagnetic projectiles were of poorer quality and showed larger artefacts and did not provide benefit for clinical practice compared to images of non-ferromagnetic material. Image quality of non-ferromagnetic projectiles varied widely (from very good to moderate) depending on the composition of the projectiles.

Field strength (1 T to 3 T) had no relevant influence on image quality.

Conclusions

Non-ferromagnetic projectiles are not a contraindication for MR imaging since there is no potential risk of secondary dislodgement. Image quality and the extent of artefacts, however, strongly depend on the type of ammunition used. The presence of ferromagnetic projectiles in or near vital anatomic structures is a contraindication for MRI because these objects may exhibit movement in response to magnetic fields. Knowledge of the type of projectile used appears to be important in order to guide patient management before an examination is performed.

https://ift.tt/2KseWnu

Brahma deficiency in keratinocytes promotes UV carcinogenesis by accelerating the escape from cell cycle arrest and the formation of DNA photolesions

Publication date: Available online 22 November 2018

Source: Journal of Dermatological Science

Author(s): Andrew W. Farrell, Gary M. Halliday, J. Guy Lyons

Abstract

Background

Ultraviolet radiation (UVR) is the principal cause of keratinocyte skin cancers. Previous work found that levels of the chromatin remodelling protein, Brahma (Brm), are diminished during the progression from actinic keratoses to cutaneous squamous cell carcinomas in humans, and its loss in UV-irradiated mouse skin causes epidermal hyperplasia and increased tumour incidence.

Methods

The skins of mice and mouse and human keratinocytes deficient in Brm were exposed to UVR and evaluated for cell cycle progression and DNA damage response.

Objective

To identify the mechanisms by which loss of Brm contributes to UVR-induced skin carcinogenesis.

Results

In both mouse keratinocytes and HaCaT cells, Brm deficiency led to an increased cell population growth following UVR exposure compared to cells with normal levels of Brm. Cell cycle analysis using a novel assay showed that Brm-deficient keratinocytes entered cell cycle arrest normally, but escaped from cell cycle arrest faster, enabling them to begin proliferating earlier. In mouse keratinocytes, Brm primarily affected accumulation in G₀/G₁-phase, whereas in HaCaT cells, which lack normal p53, accumulation in G2₀/G_M-phase was affected. Brm-deficient keratinocytes in mouse skin and human cell cultures also had higher levels of UVR-induced cyclobutane pyrimidine dimer photolesions. These effects occurred without any compensatory increase in DNA repair or cell death to remove photolesions or the cells that harbor them from the keratinocyte population.

Conclusion

The loss of Brm in keratinocytes exposed to UVR enables them to resume proliferation while harboring DNA photolesions, leading to an increased fixation of mutations and, consequently, increased carcinogenesis.

https://ift.tt/2PSLQnn

Taming hemodialysis-induced inflammation: Are complement C3 inhibitors a viable option?

Publication date: Available online 22 November 2018

Source: Clinical Immunology

Author(s): Dimitrios C. Mastellos, Edimara S. Reis, Ali-Reza Biglarnia, Meryl Waldman, Richard J. Quigg, Markus Huber-Lang, Marc A. Seelen, Mohamed R. Daha, John D. Lambris

Abstract

Owing to an increasing shortage of donor organs, the majority of patients with end-stage kidney disease remains reliant on extracorporeal hemodialysis (HD) in order to counter the lifelong complications of a failing kidney. While HD remains a life-saving option for these patients, mounting evidence suggests that it also fuels a vicious cycle of thromboinflammation that can increase the risk of cardiovascular disease. During HD, blood-borne innate immune systems become inappropriately activated on the biomaterial surface, instigating proinflammatory reactions that can alter endothelial and vascular homeostasis. Complement activation, early during the HD process, has been shown to fuel a multitude of detrimental thromboinflammatory reactions that collectively contribute to patient morbidity. Here we discuss emerging aspects of complement's involvement in HD-induced inflammation and put forth the concept that targeted intervention at the level of C3 might constitute a promising therapeutic approach in HD patients.

https://ift.tt/2R2T04K

Nuclear expression of onco-suppressors NM23-H1 and maspin are associated with lower recurrence rate in laryngeal carcinoma

Publication date: Available online 22 November 2018

Source: American Journal of Otolaryngology

Author(s): Gino Marioni, Giancarlo Ottaviano, Cosimo de Filippis, Elena Fasanaro, Benedetto Randon, Stefano Meneghesso, Luciano Giacomelli, Laura Astolfi, Stella Blandamura

Abstract

Purpose

The main aim of the study was to preliminarily investigate the possibly related role of nuclear onco-suppressors maspin and nm23-H1, a metastasis suppressor, in laryngeal squamous cell carcinoma (LSCC).

Materials and methods

Maspin expression pattern and nuclear nm23-H1 expression were ascertained in 62 consecutive LSCCs.

Results

Recurrence rate was significantly lower in patients with a nuclear maspin pattern of expression; nuclear nm23-H1 expression was significantly lower in patients who experienced disease recurrence. Disease free survival (DFS) was significantly longer in patients with maspin nuclear pattern or with nuclear nm23-H1 expression ≥10%. A significant association was found between nuclear nm23-H1 expression and maspin pattern of expression in LSCC. KNN discriminant analysis considered N status, maspin sub-cellular localization and nuclear nm32-H1 expression. The selected variables' accuracy in terms of relapse was 82%. Positive predictive accuracy was 100%, and negative predictive accuracy 79%.

Conclusions

Nuclear nm23-H1 expression and maspin pattern, also in association, show promise as recurrence indicators in LSCC. Further studies are needed to shed more light on the nm23-H1 mechanism of action in LSCC and thus find ways to restore nm23-H1 loss. These preliminary findings suggest that re-activating maspin functions might represent an important goal in the treatment of advanced LSCC.

https://ift.tt/2R8pMl4

Quality of life related to symptomatic outcomes in patients with vestibular schwannomas: A Canadian Centre perspective

Publication date: Available online 22 November 2018

Source: American Journal of Otolaryngology

Author(s): Andrea L.O. Hebb, Niki Erjavec, David P. Morris, Liam Mulroy, Manohar Bance, Nael Shoman, Simon Walling

Abstract

Patients with vestibular schwannomas (VS) typically present with hearing loss and tinnitus as well as variable cranial nerve dysfunctions. Surgical resection, stereotactic radiotherapy and/or conservative management employing serial magnetic resonance or computed tomography imaging serve as the main treatment options. Quality of life (QoL) may be impacted by the extent of tumour burden and exacerbated or relieved by treatment. Subjective assessment and quality of life inventories provide valuable information in client centered approaches with important implications for treatment. The intention of QoL measurements affecting VS patients within a clinical setting is to facilitate discussions regarding treatment options and objectively evaluate patient- centered clinical outcomes in a naturalistic setting.

https://ift.tt/2POTEq8

Atopic dermatitis at preschool age and contact allergy in adolescence: a population‐based cohort study

Abstract

Background

Atopic dermatitis (AD) is characterized by an impaired skin barrier that can allow enhanced penetration of allergens. It is not clear whether AD influences the risk of developing contact allergy.

Objectives

To examine the association between AD at preschool age and contact allergy at 16 years of age.

Methods

At 16 years of age, 2215 adolescents from the population‐based cohort BAMSE were included. These adolescents had been followed with repeated questionnaires regarding AD throughout childhood, and contact allergy was assessed by skin patch test at 16 years.

Results

AD at preschool age was associated with contact allergy to at least one of the tested substances at 16 years of age among boys (adjusted odds ratio [OR] 1.51, 95% confidence interval 1.03‐2.20), but not among girls (adjusted OR 0.77, 95% CI 0.54‐1.10). AD at preschool age was not associated with contact allergy to nickel in either boys or girls. In contrast, AD at preschool age was associated with contact allergy to fragrance mix I (adjusted OR 3.10, 95% CI 1.66‐5.80). This association was observed especially for AD at preschool age in combination with immunoglobulin E (IgE) sensitization to airborne or food allergens (adjusted OR 3.80, 95% CI 1.67‐8.61).

Conclusions

The results suggest that AD in early childhood may be associated with contact allergy to fragrances, but not to nickel, in adolescence.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BrMvD6

Clinical features and outcomes of spitzoid proliferations in children and adolescents

Summary

Background

Spitzoid proliferations range from Spitz nevi to melanomas, and there are few studies describing clinical features and outcomes in the pediatric population.

Objectives

Determine clinical features and outcomes of a large pediatric cohort with histopathologically‐confirmed Spitz tumors.

Methods

Retrospective cohort study of Boston Children's Hospital patients younger than 20 years with a histopathologic diagnosis of spitzoid proliferation from 1/1/1994 – 10/23/2012.

Results

Five hundred ninety‐five patients with 622 spitzoid proliferations were identified [median age = 7.4 years, (25^th, 75^th) quartiles = (4.6, 11.7) years]. Five hundred twelve (82.3%) proliferations were typical, 107 (17.2.%) were atypical, and 3 (0.5%) were melanomas. Median age at biopsy was 7.4, 7.2, and 17.2 years, respectively, and there was a significant difference in age at biopsy for patients with typical or atypical proliferations versus melanoma (p<0.01). Among samples with positive margins (n = 153), 55.1% (54/98) of typical proliferations, 77.4% (41/53) of atypical proliferations, and 100.0% (2/2) of melanomas were re‐excised. Six patients had sentinel lymph node biopsy performed, with 3 patients demonstrating nodes positive for melanocytic cells. With median follow‐up of 4.1 years for the full cohort, there were no related deaths.

Conclusion

Spitz tumors have strikingly benign outcomes in the pediatric population, though this study is limited by low number of melanomas and restriction to a single pediatric institution. Aggressive management recommendations should be reconsidered for children and adolescents with banal‐appearing Spitz nevi, based upon the clinically indolent behavior in this cohort.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Kue1mi

Atopic dermatitis at preschool age and contact allergy in adolescence: a population‐based cohort study

Abstract

Background

Atopic dermatitis (AD) is characterized by an impaired skin barrier that can allow enhanced penetration of allergens. It is not clear whether AD influences the risk of developing contact allergy.

Objectives

To examine the association between AD at preschool age and contact allergy at 16 years of age.

Methods

At 16 years of age, 2215 adolescents from the population‐based cohort BAMSE were included. These adolescents had been followed with repeated questionnaires regarding AD throughout childhood, and contact allergy was assessed by skin patch test at 16 years.

Results

AD at preschool age was associated with contact allergy to at least one of the tested substances at 16 years of age among boys (adjusted odds ratio [OR] 1.51, 95% confidence interval 1.03‐2.20), but not among girls (adjusted OR 0.77, 95% CI 0.54‐1.10). AD at preschool age was not associated with contact allergy to nickel in either boys or girls. In contrast, AD at preschool age was associated with contact allergy to fragrance mix I (adjusted OR 3.10, 95% CI 1.66‐5.80). This association was observed especially for AD at preschool age in combination with immunoglobulin E (IgE) sensitization to airborne or food allergens (adjusted OR 3.80, 95% CI 1.67‐8.61).

Conclusions

The results suggest that AD in early childhood may be associated with contact allergy to fragrances, but not to nickel, in adolescence.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BrMvD6

Clinical features and outcomes of spitzoid proliferations in children and adolescents

Summary

Background

Spitzoid proliferations range from Spitz nevi to melanomas, and there are few studies describing clinical features and outcomes in the pediatric population.

Objectives

Determine clinical features and outcomes of a large pediatric cohort with histopathologically‐confirmed Spitz tumors.

Methods

Retrospective cohort study of Boston Children's Hospital patients younger than 20 years with a histopathologic diagnosis of spitzoid proliferation from 1/1/1994 – 10/23/2012.

Results

Five hundred ninety‐five patients with 622 spitzoid proliferations were identified [median age = 7.4 years, (25^th, 75^th) quartiles = (4.6, 11.7) years]. Five hundred twelve (82.3%) proliferations were typical, 107 (17.2.%) were atypical, and 3 (0.5%) were melanomas. Median age at biopsy was 7.4, 7.2, and 17.2 years, respectively, and there was a significant difference in age at biopsy for patients with typical or atypical proliferations versus melanoma (p<0.01). Among samples with positive margins (n = 153), 55.1% (54/98) of typical proliferations, 77.4% (41/53) of atypical proliferations, and 100.0% (2/2) of melanomas were re‐excised. Six patients had sentinel lymph node biopsy performed, with 3 patients demonstrating nodes positive for melanocytic cells. With median follow‐up of 4.1 years for the full cohort, there were no related deaths.

Conclusion

Spitz tumors have strikingly benign outcomes in the pediatric population, though this study is limited by low number of melanomas and restriction to a single pediatric institution. Aggressive management recommendations should be reconsidered for children and adolescents with banal‐appearing Spitz nevi, based upon the clinically indolent behavior in this cohort.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Kue1mi

Corrigendum to “MMP-3 and MMP-8 in rat mandibular condylar cartilage associated with dietary loading, estrogen level, and aging” [Arch. Oral Biol. 97 (2019) 238–244]

Publication date: February 2019

Source: Archives of Oral Biology, Volume 98

Author(s): Jia Yu, Eerika Mursu, Matleena Typpö, Sakari Laaksonen, Hanna-Marja Voipio, Paula Pesonen, Aune Raustia, Pertti Pirttiniemi

https://ift.tt/2PQv33Y

The effect of unilateral lingual nerve injury on the kinematics of mastication in pigs

Publication date: Available online 22 November 2018

Source: Archives of Oral Biology

Author(s): Stéphane J. Montuelle, Rachel A. Olson, Hannah Curtis, JoAnna V. Sidote, Susan H. Williams

Abstract

Objective

This study evaluates the effect of unilateral lingual sensory loss on the spatial and temporal dynamics of jaw movements during pig chewing.

Design

X-ray Reconstruction of Moving Morphology (XROMM) was used to reconstruct the 3-dimensional jaw movements of 6 pigs during chewing before and after complete unilateral lingual nerve transection. The effect of the transection were evaluated at the temporal and spatial level using Multiple Analysis of Variance. Temporal variables include gape cycle and phase durations, and the corresponding relative phase durations. Spatial variables include the amplitude of jaw opening, jaw yaw, and of mandibular retraction-protraction.

Results

The temporal and spatial dynamics of jaw movements did not differ when chewing ipsi-versus contralateral to the transection. When compared to pre-transection data, 4 of the 6 animals showed significant changes in temporal characteristics of the gape cycle following the transection, irrespective of chewing side, but the specific response to the lesion was highly dependent on the animal. On the other hand, in affected individuals the amplitude of jaw movements was altered similarly in all 3 dimensions: jaw opening and protraction-retraction increased whereas jaw yaw decreased.

Conclusion

The variable impact of this injury in this animal model suggests that individuals use different compensatory strategies to adjust or maintain the temporal dynamics of the gape cycle. Because the amplitude of jaw movements are more adversely affected than their timing, results suggest that maintaining the tongue-jaw coordination is critical and this can come at the expense of bolus handling and masticatory performance.

https://ift.tt/2R8xvjd

Screening of hydrogel-based scaffolds for dental pulp regeneration—A systematic review

Publication date: Available online 22 November 2018

Source: Archives of Oral Biology

Author(s): K.A. Fukushima, M.M. Marques, T.K. Tedesco, G.L. de Carvalho, F. Gonçalves, H. Caballero-Flores, S. Morimoto, M.S. Moreira

Abstract

Objective

The aim of this systematic review was to evaluate the most appropriate hydrogel scaffold type (natural, synthetic or hybrid) to be applied with stem cells for dental pulp regeneration. The findings should help clinicians make an informed choice about the appropriate scaffold to be applied for this approach.

Design

Three electronic databases were searched (Medline, Web of Science and Scopus). The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).

Results

From 4,990 potentially relevant studies initially identified, 18 papers fulfilled the eligibility criteria and were considered for this review. Natural scaffolds were applied in most studies. Collagen was the most studied scaffold. In 5 of 10 studies, only growth factors were added to the constructs. Even without growth factors, these scaffolds containing stem cells were able to support the formation of dentin. The synthetic scaffolds were the least studied. Only 4 studies were selected, and in 3 of them, the same scaffold (Puramatrix) was evaluated. Puramatrix by itself was unable to form dental pulp when dental pulp stem cells were not present. Synthetic and hybrid hydrogels were unable to attract stem cells from the host. The presence of growth factors in these constructs seems to be of relevance since dental pulp tissue formation was achieved only when the hybrid scaffold was applied with growth factors.

Conclusion

All types of hydrogel-based scaffolds, when containing mesenchymal stem cells, are able to form connective tissue with different degrees of similarity to dental pulp. However, current data is too heterogeneous to compare and identify the advantages of any specific scaffold.

https://ift.tt/2PTWOJi

Molecular docking and in silico studies of the physicochemical properties of potential inhibitors for the phosphotransferase system of Streptococcus mutans

Publication date: Available online 22 November 2018

Source: Archives of Oral Biology

Author(s): Wbeimar Andrey Rivera-Péreza, Andrés Felipe Yépes-Pérez, Maria Cecilia Martínez-Pabóna

Abstract

This study identified potential inhibitory compounds of the phosphoenolpyruvate-sugar

Phosphotransferase system of S. mutans, specifically enzyme II mannose transporter (EII^Man) in its subunits IIA, IIB and IIC by means of a selection protocol and in silico molecular analysis.

Intervening the phosphotransferase system would compromise the physiological behavior and the pathogenic expression of S. mutans, and possibly other acidogenic bacteria that use phosphotransferases in their metabolism—making the phosphotransferase system a therapeutic target for the selective control of acidogenic microorganisms in caries control.

Several computational techniques were used to evaluate molecular, physicochemical, and toxicological aspects of various compounds. Molecular docking was used to calculate the binding potential (ΔG) between receptor protein subunits and more than 836,000 different chemical compounds from the ZINC database. Physicochemical parameters related to the compounds' pharmacokinetic and pharmacodynamic indicators were evaluated, including absorption, distribution, metabolism, excretion, and toxicity (ADMET), and chemical analysis characterized the compounds structures.

Thirteen compounds with EII binding potential of the phosphotransferase system of S. mutans and favorable ADMET properties were identified. Six spirooxindoles and three pyrrolidones stand out from the found compounds; unique structural characteristics of spirooxindoles and pyrrolidones associated with various reported biological activities like anti-microbial, antiinflammatory, anticancer, nootropic, neuroprotective and antiepileptic effects, among other pharmacological effects with surprising differences in terms of mechanisms of action.

Following studies will provide more evidence of the action of these compounds on the phosphotransferase system of S. mutans, and its possible applications.

https://ift.tt/2R9NWLR

Obesity, but not metabolic syndrome, as a risk factor for late-onset asthma in Japanese women

Publication date: Available online 23 November 2018

Source: Allergology International

Author(s): Yasuhiro Tomita, Yuma Fukutomi, Mari Irie, Kazuhiro Azekawa, Hiroaki Hayashi, Yosuke Kamide, Kiyoshi Sekiya, Yoichi Nakamura, Chiharu Okada, Terufumi Shimoda, Yoshinori Hasegawa, Masami Taniguchi

Abstract

Background

Several cross-sectional studies have suggested an association between obesity and asthma. However, few studies have investigated this relationship longitudinally, especially in middle-aged subjects. Although metabolic syndrome is a well-known risk factor for many non-communicable diseases, its contribution to asthma remains controversial.

Methods

From 2008, specific health checkups for metabolic syndrome have been conducted throughout Japan. To seek relationships of obesity and metabolic syndrome with late-onset asthma in Japan, we analyzed data collected from health insurance claims and specific health checkups for metabolic syndrome at three large health insurance societies. Among subjects aged 40–64 years (n = 9888), multivariate logistic regression analyses were performed to investigate the relationships of obesity and metabolic syndrome in fiscal year 2012 (from April 2012 to March 2013) with the incidence of late-onset asthma in the following two years (from April 2013 to March 2015).

Results

In women, BMI 25–29.9 kg/m² or ≥30 kg/m², waist circumference ≥90 cm, and waist-to-height ratio ≥0.5 were shown to be significant risk factors for asthma, with adjusted odds ratios (95% CI) of 1.92 (1.35–2.75), 2.24 (1.23–4.09), 1.89 (1.30–2.75), and 1.53 (1.15–2.03), respectively. Significance was retained even after adjustment for metabolic syndrome, and there were no significant relationships between metabolic syndrome itself and the incidence of asthma in men or women.

Conclusions

Only the obesity measures, not metabolic syndrome, were shown to be significant risk factors for the incidence of late-onset asthma but only in middle-aged Japanese women, and not in men.

https://ift.tt/2FEc08C

Airway innate lymphoid cells in the induction and regulation of allergy

Publication date: Available online 23 November 2018

Source: Allergology International

Author(s): Taylor A. Doherty, David H. Broide

Abstract

The recent discovery of innate lymphoid cells has revolutionized our understanding of the pathogenesis of immune diseases including allergy and asthma. Innate lymphoid cells (ILCs) are a heterogeneous collection of lymphocytes that lack antigen-specificity (non-T, non-B cells) and potently produce characteristic cytokines of T cell subsets (Th1, Th2, Th17). ILCs are divided into group 1 (ILC1s), group 2 (ILC2s), or group 3 (ILC3s). Similar to Th2 cells, ILC2s produce IL-4, IL-5, and IL-13, among others, and are present in increased numbers in samples from patients with many allergic disorders including asthma and chronic rhinosinusitis (CRS). Animal models have identified that ILC2s contribute to eosinophilic tissue infiltration, airway hyperresponsiveness, mucus production, as well as coordinate adaptive immune responses. Finally, recent studies support regulation of ILC2s by neuro-immune mechanisms as well as demonstrate a significant degree of plasticity between ILC subsets that may impact the immune responses in asthma and allergic airway diseases. Here, we review the current literature on ILC2s in human asthma and allergic airway diseases, as well as highlight some recent mechanistic insights into ILC2 function from in vitro studies and in vivo animal models.

https://ift.tt/2qZFT8W

Critical role of platelets in the production of thymus and activation-regulated chemokine in children: A case series study

Publication date: Available online 22 November 2018

Source: Allergology International

Author(s): Yuka Okura, Yutaka Takahashi, Ichiro Kobayashi

https://ift.tt/2FCFOCi

Endocrine and metabolic adverse effects of immune checkpoint inhibitors: an overview (what endocrinologists should know)

Abstract

Immune checkpoint inhibitors (ICIs) are novel anticancer agents, recently introduced with the aim of boosting the immune response against tumors. ICIs are monoclonal autoantibodies that specifically target inhibitory receptors on T cells: cytotoxic T lymphocyte antigen 4 (CTLA4), programmed death 1 (PD-1) and its ligand (PD-1L). ICIs also generate peculiar dysimmune toxicities, called immune-related adverse events (irAEs), that can potentially affect any tissue, and some may be life-threatening if not promptly recognized. The endocrine and metabolic side effects of ICIs are reviewed here, with a particular focus on their clinical presentation and management. They are among the most frequent toxicities (around 10%) and include hypophysitis, thyroid disorders, adrenalitis, and diabetes mellitus. Treatment is based on the replacement of specific hormone deficits, accompanied by immunosuppression (with corticosteroids or other drugs), depending on irAEs grade, often without the need of ICI withdrawal, except in more severe forms. Prompt recognition of endocrine and metabolic irAEs and adequate treatment allow the patients to continue a therapy they are benefiting from. Endocrinologists, as an integral part of the multidisciplinary oncologic team, need to be familiar with the unique toxicity profile of these anticancer agents. Practical recommendations for their management are proposed.

https://ift.tt/2FMFEbU

Efficacy and Safety of Brodalumab in Patients with Moderate-to-Severe Plaque Psoriasis and Skin of Color: Results from the Pooled AMAGINE-2/-3 Randomized Trials

Abstract

Background

Data on treatment outcomes in patients with psoriasis who have skin of color are limited. Brodalumab has shown efficacy in patients with moderate-to-severe plaque psoriasis.

Objective

Our objective was to evaluate the efficacy, safety, and health-related quality of life associated with brodalumab in patients with skin of color participating in two phase III, multicenter, randomized, double-blind, placebo- and active comparator–controlled studies (AMAGINE-2/-3).

Methods

Patients were self-categorized into racial subgroups (black, Asian, or white) or the non-mutually exclusive ethnic subgroup Hispanic/Latino. Patients were randomized to receive brodalumab 210 mg every 2 weeks (Q2W) or ustekinumab (45 mg in patients weighing ≤ 100 kg and 90 mg in patients weighing > 100 kg) for 52 weeks. Skin clearance was monitored using the Psoriasis Area and Severity Index (PASI) and Static Physician's Global Assessment (sPGA). Treatment-emergent adverse events (TEAEs) were summarized by treatment and racial and ethnic subgroup. Health-related quality of life was assessed using the Dermatology Life Quality Index (DLQI).

Results

During the 12-week induction phase, 613 patients received ustekinumab (black, n = 20; Asian, n = 24; white, n = 551; Hispanic/Latino, n = 68) and 1236 patients received brodalumab 210 mg Q2W (black, n = 36; Asian, n = 39; white, n = 1116; Hispanic/Latino, n = 132). At week 52, a total of 590 patients received continuous ustekinumab (black, n = 19; Asian, n = 23; white, n = 532; Hispanic/Latino, n = 64) and 339 patients were re-randomized to continue receiving brodalumab 210 mg Q2W (black, n = 10; Asian, n = 7; white, n = 308; Hispanic/Latino, n = 40). Among patients who received brodalumab 210 mg Q2W, skin clearance response rates were similar across racial and ethnic subgroups at week 12 and week 52; rates of 75%, 90%, and 100% improvement in PASI from baseline were also higher, as was sPGA score ≤ 1, than in patients who received ustekinumab across all racial and ethnic subgroups. Rates of TEAEs and ≥ 5-point improvement in DLQI score were similar across racial and ethnic subgroups.

Conclusions

Brodalumab 210 mg Q2W is well tolerated and efficacious across diverse racial and ethnic subgroups in patients with psoriasis, including black, Asian, white, and Hispanic/Latino patients.

Trial Registry

ClinicalTrials.gov identifier NCT01708603 (AMAGINE-2); NCT01708629 (AMAGINE-3).

https://ift.tt/2r130jy

A fatal case of Fournier’s gangrene during neoadjuvant radiotherapy for rectal cancer

Abstract

Purpose

To report the development of an ultimately fatal occurrence of Fournier's gangrene in a rectal cancer patient undergoing neoadjuvant radiotherapy without chemotherapy.

Methods

A 53-year-old male patient with G2 cT3 cN1a cM0 stage IIIB adenocarcinoma of the lower rectum and several comorbidities including ulcerative colitis was treated with 56 Gy to the primary tumor in 28 fractions because he declined the recommended simultaneous chemotherapy. He was also enrolled in the ketogenic diet arm of our KETOCOMP study, so that prospective measurements of blood parameters, quality of life, and body composition were made.

Results

The patient died 6 days after completion of radiotherapy due to septic shock associated with Fournier's gangrene reaching from the right buttock into the gluteal muscles and descending into the scrotum. In retrospect, there were several signs probably indicating the development of the gangrene: (i) a decline in bioelectrical phase angle; (ii) an accelerated weight and fat-free mass loss starting in the third week of radiotherapy; (iii) an increase in C-reactive protein (CRP) and concurrent drop in high-density lipoprotein (HDL) cholesterol and insulin-like growth factor(IGF)-1 concentrations; and (iv) the occurrence of a sharp pain in the perianal region reported in the fifth week of radiotherapy. Notably, his self-reported quality of life score was the same at the end of as before radiotherapy.

Conclusions

This case highlights the occurrence of Fournier's gangrene as an extremely rare but life-threatening complication during neoadjuvant radiotherapy for rectal cancer which should be refreshed in the awareness of radiation oncologists and radiologists.

https://ift.tt/2BrRtjg

Disseminated dermatophytosis due to Nannizzia gypsea (Microsporum gypseum) in an elderly patient

https://ift.tt/2DU1ad0

Lichen sclerosus et atrophicus diagnosed in a child accompanied with local periodontal attachment loss and maxillary deficiency: A rare case report

https://ift.tt/2S9TPbZ

Erratum to “Protective effect of an astaxanthin nanoemulsion against neomycin-induced hair-cell damage in zebrafish” [Auris Nasus Larynx 45 (2018) 20–25]

Publication date: Available online 23 November 2018

Source: Auris Nasus Larynx

Author(s): Yosuke Takemoto, Yoshinobu Hirose, Kazuma Sugahara, Makoto Hashimoto, Hirotaka Hara, Hiroshi Yamashita

https://ift.tt/2TBEqmy

Metastasis of adenoid cystic carcinoma from a submandibular gland to the larynx

Publication date: Available online 23 November 2018

Source: Auris Nasus Larynx

Author(s): Tomohiko Ishikawa, Masaru Tateda, Hidetoshi Oshima, Akari Sawada, Naomi Oka, Hiroyoshi Suzuki, Sho Hashimoto

Abstract

The present article discusses the first reported case of adenoid cystic carcinoma (ACC) metastasis from a submandibular gland to the larynx. Both treatments of distant metastasis of ACC and secondary laryngeal tumor are challenging. Despite its slow progression, ACC is associated with high rates of local recurrence, distant metastasis, and poor prognosis. Patients with secondary laryngeal cancer often have other concurrent metastatic lesions. Therefore, treatment selection should consider the biological behavior of the tumor and characteristics of the laryngeal lesion, along with the general condition and quality of life of the patient. The patient (55-year-old female) had a history of ACC of the right submandibular gland, removed surgically 9 years prior to the present consultation. Follow-up showed multiple pulmonary metastases. The patient complained of dysphonia lasting 3 months. Following the diagnosis of ACC metastasis to the larynx (supraglottic) and a neck lymph node via biopsy, we performed partial laryngectomy, left neck dissection, and tracheotomy. Histopathological examination showed an increase in the tumor grade over time. Two months after discharge, there was no obvious local recurrence or increase in lung metastasis.

https://ift.tt/2AbVoiq

Cardiac metastasis in a living patient with oral cancer

Publication date: Available online 22 November 2018

Source: Auris Nasus Larynx

Author(s): Hisami Fujio, Naoki Otsuki, Yuto Horichi, Shungaku Yanagisawa, Mari Nishio, Masanori Teshima, Hirotaka Shinomiya, Kazunobu Hashikawa, Ken-ichi Nibu

Abstract

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. Cardiac metastasis should be considered when unexplained and progressive decline of general health is observed, even in the absence of abnormalities on the electrocardiogram. Early diagnosis may be made by analyzing the chronological changes in the cardiac accumulation of fluorodeoxyglucose during positron emission tomography–computed tomography scan.

https://ift.tt/2Tz9vr7

Erratum to “Surgical outcomes in the treatment of temporal bone cerebrospinal fluid leak: A systematic review” [Auris Nasus Larynx 45 (2018) 903–910]

Publication date: Available online 22 November 2018

Source: Auris Nasus Larynx

Author(s): Federico Maria Gioacchini, Ettore Cassandro, Matteo Alicandri-Ciufelli, Shaniko Kaleci, Claudia Cassandro, Alfonso Scarpa, Massimo Re

https://ift.tt/2AeyLdk

Intensity modulated proton therapy (IMPT) – The future of IMRT for head and neck cancer

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Amy C. Moreno, Steven J. Frank, Adam S. Garden, David I. Rosenthal, Clifton D. Fuller, Gary B. Gunn, Jay P Reddy, William H. Morrison, Tyler D. Williamson, Emma B. Holliday, Jack Phan, Pierre Blanchard

Abstract

Radiation therapy plays an integral role in the management of head and neck cancers (HNCs). While most HNC patients have historically been treated with photon-based radiation techniques such as intensity modulated radiation therapy (IMRT), there is a growing awareness of the potential clinical benefits of proton therapy over IMRT in the definitive, postoperative and reirradiation settings given the unique physical properties of protons. Intensity modulated proton therapy (IMPT), also known as "pencil beam proton therapy," is a sophisticated mode of proton therapy that is analogous to IMRT and an active area of investigation in cancer care. Multifield optimization IMPT allows for high quality plans that can target superficially located HNCs as well as large neck volumes while significantly reducing integral doses. Several dosimetric studies have demonstrated the superiority of IMPT over IMRT to improve dose sparing of nearby organs such as the larynx, salivary glands, and esophagus. Evidence of the clinical translation of these dosimetric advantages has been demonstrated with documented toxicity reductions (such as decreased feeding tube dependency) after IMPT for patients with HNCs. While there are relative challenges to IMPT planning that exist today such as particle range uncertainties and high sensitivity to anatomical changes, ongoing investigations in image-guidance techniques and robust optimization methods are promising. A systematic approach towards utilizing IMPT and additional prospective studies are necessary in order to more accurately estimate the clinical benefit of IMPT over IMRT and passive proton therapy on a case-by-case basis for patients with sub-site specific HNCs.

https://ift.tt/2DCrSFX

HPV related head and neck squamous cell carcinoma: New evidences for an emerging spontaneous animal model

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Gennaro Altamura, Giuseppe Borzacchiello

https://ift.tt/2Q9B4bF

Prognostic factors and selection criteria in the retreatment of head and neck cancers

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Michael E. May, Elizabeth D. Cash, Craig L. Silverman, Rebecca A. Redman, Cesar A. Perez, Liz D. Wilson, Paul A. Tennant, Jeffrey M. Bumpous, Neal E. Dunlap

Abstract

Objectives

To determine predictors of treatment selection, outcome, and survival, we examined a cohort of previously irradiated head and neck squamous cell carcinoma (HNSCC) patients.

Materials and methods

We retrospectively analyzed 100 patients at our institution who were treated for recurrent or second primary (RSP) HNSCC, focusing on subgroups receiving reirradiation (ReRT) alone and those undergoing surgical salvage (SS) with or without post-operative reirradiation therapy (POReRT). Logistic regression modeling was performed to identify factors predictive of retreatment modality. Cox regression modeling was used to determine prognostic factors for progression free survival (PFS) and overall survival (OS).

Results

ReRT alone was less likely in current smokers and neck recurrences, with reirradiation more likely in primary site recurrences. POReRT was significantly more likely in patients with positive surgical margins (PSM), neck dissection, or organ dysfunction. POReRT omission negatively impacted PFS when PSM (HR: 8.894, 95% CI: 1.742–45.403) and perineural invasion (PNI) (HR: 3.391, 95% CI: 1.140–10.089) were present. Tracheostomy was associated with worse OS, but ReRT alone and POReRT improved OS. PSM correlated with worse OS, regardless of whether POReRT was given (HR: 14.260, 95% CI: 2.064–98.547).

Conclusion

This analysis confirms known factors for predicting outcome and shows nonsmoking status and primary site recurrence as predictors for ReRT alone. POReRT for PSM and PNI improves PFS. Tracheostomy patients are more likely to have ReRT due to acute toxicity not limiting treatment and POReRT improves OS compared to surgery alone. The presence of PSM negatively impacts survival which cannot be overcome by POReRT.

https://ift.tt/2DFdUmL

Rapid, non-invasive fluorescence margin assessment: Optical specimen mapping in oral squamous cell carcinoma

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Stan van Keulen, Nynke S. van den Berg, Naoki Nishio, Andrew Birkeland, Quan Zhou, Guolan Lu, Han-Wei Wang, Lyle Middendorf, Tymour Forouzanfar, Brock A. Martin, A. Dimitrios Colevas, Eben L. Rosenthal

Abstract

Objective

Surgical resection remains the primary treatment for the majority of solid tumors. Despite efforts to obtain wide margins, close or positive surgical margins (<5 mm) are found in 15–30% of head and neck cancer patients. Obtaining negative margins requires immediate, intraoperative feedback of margin status. To this end, we propose optical specimen mapping of resected tumor specimens immediately after removal.

Materials and methods

A first-in-human pilot study was performed in patients (n = 8) after infusion of fluorescently labeled antibody, panitumumab-IRDye800 to allow surgical mapping of the tumor specimen. Patients underwent standard of care surgical resection for head and neck squamous cell carcinoma (HNSCC). Optical specimen mapping was performed on the primary tumor specimen and correlated with pathological findings after tissue processing.

Results

Optical mapping of the specimen had a 95% sensitivity and 89% specificity to detect cancer within 5 mm (n = 160) of the cut surface. To detect tumor within 2 mm of the specimen surface, the sensitivity of optical specimen mapping was 100%. The maximal observed penetration depth of panitumumab-IRDye800 through human tissue in our study was 6.3 mm.

Conclusion

Optical specimen mapping is a highly sensitive and specific method for evaluation of margins within <5 mm of the tumor mass in HNSCC specimens. This technology has potentially broad applications for ensuring adequate tumor resection and negative margins in head and neck cancers.

https://ift.tt/2Qfqf7M

Oral cancer prevention worldwide: Challenges and perspectives

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Jean-Philippe Foy, Chloé Bertolus, Pierre Saintigny

https://ift.tt/2DF7VOG

Functional imaging early during (chemo)radiotherapy for response prediction in head and neck squamous cell carcinoma; a systematic review

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Roland M. Martens, Daniel P. Noij, Meedie Ali, Thomas Koopman, J. Tim Marcus, Marije R. Vergeer, Henrica de Vet, Marcus C. de Jong, C. René Leemans, Otto S. Hoekstra, Remco de Bree, Pim de Graaf, Ronald Boellaard, Jonas A. Castelijns

Abstract

This systematic review gives an extensive overview of the current state of functional imaging during (chemo)radiotherapy to predict locoregional control (LRC) and overall survival (OS) for head and neck squamous cell carcinoma. MEDLINE and EMBASE were searched for literature until April 2018 assessing the predictive performance of functional imaging (computed tomography perfusion (CTp), MRI and positron-emission tomography (PET)) within 4 weeks after (chemo)radiotherapy initiation. Fifty-two studies (CTp: n = 4, MRI: n = 19, PET: n = 26, MRI/PET: n = 3) were included involving 1623 patients. Prognostic information was extracted according the PRISMA protocol. Pooled estimation and subgroup analyses were performed for comparable parameters and outcome. However, the heterogeneity of included studies limited the possibility for comparison. Early tumoral changes from (chemo)radiotherapy can be captured by functional MRI and ¹⁸F-FDG-PET and could allow for personalized treatment adaptation. Lesions showed potentially prognostic intratreatment changes in perfusion, diffusion and metabolic activity. Intratreatment ADC_mean increase (decrease of diffusion restriction) and low SUV_max (persistent low or decrease of ¹⁸F-FDG uptake) were most predictive of LRC. Intratreatment persistent high or increase of perfusion on CT/MRI (i.e. blood flow, volume, permeability) also predicted LRC. Low SUV_max and total lesion glycolysis (TLG) predicted favorable OS. The optimal timing to perform functional imaging to predict LRC or OS was 2–3 weeks after treatment initiation.

https://ift.tt/2QhTW84

Lingual ectopic papillary thyroid carcinoma: Two case reports and review of the literature

Publication date: Available online 22 November 2018

Source: Oral Oncology

Author(s): Nai-si Huang, Wen-jun Wei, Ning Qu, Yu-long Wang, Yu Wang, Qing-hai Ji

Abstract

Ectopic thyroid occurs when it is not located on the normal thyroid compartment. While 90% of the ectopic thyroids were located at the base of the tongue, only 1% were lingual thyroid carcinoma (LTC). Only 56 LTC cases have been reported so far. Here we reported two cases of LTC. Patient 1 was a 47-year-old female with LTC and co-current sub-hyoid ectopic thyroid. She experienced major hematemesis and dyspnea requiring emergent tracheotomy. Patient 2 was a 61-year old female who was presented with LTC with multiple lymph node metastasis and bilateral lung metastasis. Both of the patients' lingual masses were removed via trans-submaxillary excisions. Pathology revealed ectopic papillary thyroid carcinoma. Then they were treated with radio-active iodine (RAI). These patients had full recovery and there were no complications. A review of literature was also presented.

https://ift.tt/2DE4Zlq

Enhanced Recovery After Surgery: Are the Principles Applicable to Adult and Geriatric Acute Care and Trauma Surgery?

Publication date: Available online 22 November 2018

Source: Anesthesiology Clinics

Author(s): Mandeep Singh, Reza Askari, Matthias Stopfkuchen-Evans

https://ift.tt/2FxWNFU

High-Density Lipoprotein Components and Functionality in Cancer: State-of-the-Art

Publication date: Available online 22 November 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Shiva Ganjali, Biagio Ricciuti, Matteo Pirro, Alexandra E. Butler, Stephen L. Atkin, Maciej Banach, Amirhossein Sahebkar

Cancer is the second leading cause of death in western countries, and thus represents a major global public health issue. Whilst it is well-recognized that diet, obesity, and smoking are risk factors for cancer, the role of low levels of high-density lipoprotein cholesterol (HDL-C) in cancer is less well appreciated. Conflicting evidence suggests that serum HDL-C levels may be either positively or negatively associated with cancer incidence and mortality. Such disparate associations are supported in part by the multitude of high-density lipoprotein (HDL) functions that can all have an impact on cancer cell biology. The aim of this review is to provide a comprehensive overview of the crosstalk between HDLs and cancer, focusing on the molecular mechanisms underlying this association.

https://ift.tt/2KqKiL1

Association between atopic dermatitis and extra-cutaneous bacterial and mycobacterial infections: A systematic review and meta-analysis

Publication date: Available online 22 November 2018

Source: Journal of the American Academy of Dermatology

Author(s): Linda Serrano, Kevin R. Patel, Jonathan I. Silverberg

Abstract

Background

Atopic dermatitis (AD) is associated with increased bacterial colonization and infection of skin, and multiple risk factors for extra-cutaneous infections. However, previous studies found conflicting results about whether AD is associated with increased extra-cutaneous infections.

Objectives

To determine whether extra-cutaneous bacterial and mycobacterial infections are increased in AD.

Methods

A systematic review was performed of all published observational studies with controls in MEDLINE, EMBASE, GREAT, Cochrane, and Web of Science that assessed extra-cutaneous infections in AD. Pooled meta-analysis was performed using random-effects weighting.

Results

Overall, 7 studies met inclusion criteria. All 7 studies found increased odds of at least one extra-cutaneous infection in AD, including endocarditis, meningitis, encephalitis, bone and joint infections, and sepsis. In pooled meta-analysis, AD in children and adults was associated with higher odds of ear infection (odds ratio [95% confidence interval]: 1.29 [1.16–1.43]), strep throat (2.31 [1.66–3.22]) and urinary tract infection (2.31 [1.66–3.22]), but not pneumonia (1.72 [0.75–3.98]). No publication bias was detected.

Limitations

Individual level data were not available.

Conclusions

AD patients have higher odds of extra-cutaneous infections. Future studies are needed to confirm these associations and determine their mechanisms.

https://ift.tt/2R6aTzz