No abstract available
https://ift.tt/2BFWyEO
Τετάρτη 28 Νοεμβρίου 2018
A Comparison of Spinal Anesthesia Versus Monitored Anesthesia Care With Local Anesthesia in Minimally Invasive Fetal Surgery
BACKGROUND: Minimally invasive fetal surgery is commonly performed to treat twin-to-twin transfusion syndrome with selective fetoscopic laser photocoagulation and twin-reversed arterial perfusion sequence using radiofrequency ablation. Although an increasing number of centers worldwide are performing these procedures, anesthetic management varies. Both neuraxial anesthesia and monitored anesthesia care with local anesthesia are used at different institutions. We sought to determine the efficacy and outcomes of these 2 anesthetic techniques for fetal procedures at our institution. METHODS: All patients undergoing minimally invasive fetal surgery for twin-to-twin transfusion syndrome or twin-reversed arterial perfusion sequence over a 6-year time period (2011–2016) were reviewed. Patients receiving monitored anesthesia care with local anesthesia were compared with those receiving spinal anesthesia in both selective fetoscopic laser photocoagulation and radiofrequency ablation fetal procedures. The primary outcome examined between the monitored anesthesia care and spinal anesthesia groups was the difference in conversion to general anesthesia using a noninferiority design with a noninferiority margin of 5%. Secondary outcome measures included use of vasopressors, procedure times, intraoperative fluids administered, maternal complications, and unexpected fetal demise within 24 hours of surgery. RESULTS: The difference in failure rate between monitored anesthesia care and spinal was −0.5% (95% CI, −4.8% to 3.7%). Patients receiving monitored anesthesia care plus local anesthesia were significantly less likely to need vasopressors, had a shorter presurgical operating room time, and received less fluid (P
https://ift.tt/2KGW0BE
https://ift.tt/2KGW0BE
Speaker Gender Representation at the American Society of Anesthesiology Annual Meeting: 2011–2016
The American Society of Anesthesiologists (ASA) Annual Meeting is the primary venue for anesthesiologists to present research, share innovations, and build networks. Herein, we describe gender representation for physician speakers at the Annual Meeting relative to the specialty overall. Details of ASA Annual Meeting presentations for individuals and panels were abstracted from the ASA archives for 2011–2016. Observed speaker gender composition was compared to expected composition based on the gender distribution of members of the ASA. There were 5167 speaker slots across 2025 presentations and panels. Of the speaker slots, 3874 were assigned to men and 1293 to women. Speaker slot gender composition was relatively consistent between 2011 and 2016 (annual percentage 22.3%–27.7% women, trend test P = .062). ASA membership composition of women increased slightly over the study period (24%–28%). The overall observed number of women in speaker slots over the study period did not differ significantly from what would be expected based on the ASA membership composition (25.0% observed vs 25.9% expected; P = .153). However, the percentage of single speakers who were women was significantly less than would be expected based on the ASA gender distribution (20.2% observed vs 25.9% expected; P
https://ift.tt/2BDGLGq
https://ift.tt/2BDGLGq
The Impact of Postoperative Intensive Care Unit Admission on Postoperative Hospital Length of Stay and Costs: A Prespecified Propensity-Matched Cohort Study
BACKGROUND: In this prespecified cohort study, we investigated the influence of postoperative admission to the intensive care unit versus surgical ward on health care utilization among patients undergoing intermediate-risk surgery. METHODS: Of adult surgical patients who underwent general anesthesia without an absolute indication for postoperative intensive care unit admission, 3530 patients admitted postoperatively to an intensive care unit were matched to 3530 patients admitted postoperatively to a surgical ward using a propensity score based on 23 important preoperative and intraoperative predictor variables. Postoperative hospital length of stay and hospital costs were defined as primary and secondary end points, respectively. RESULTS: Among patients with low propensity for postoperative intensive care unit admission, initial triage to an intensive care unit was associated with increased postoperative length of stay (incidence rate ratio, 1.69 [95% CI, 1.59–1.79]; P
https://ift.tt/2KNdMDn
https://ift.tt/2KNdMDn
General Anesthesia Alters the Diversity and Composition of the Intestinal Microbiota in Mice
Dysbiosis of the intestinal microbiota has been shown to result in altered immune responses and increased susceptibility to infection; as such, the state of the intestinal microbiome may have profound implications in the perioperative setting. In this first-in-class study, we used 16s ribosomal RNA sequencing and analysis in a mouse model of general anesthesia to investigate the effects of volatile anesthetics on the diversity and composition of the intestinal microbiome. After 4-hour exposure to isoflurane, we observed a decrease in bacterial diversity. Taxonomic alterations included depletion of several commensal bacteria including Clostridiales. These data identify volatile anesthetics as potential contributors to microbial dysbiosis in the postoperative patient. Accepted for publication October 17, 2018. Funding:This work was supported by grants from the National Institutes of Health (R01 GM120519-01). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Cyrus D. Mintz, MD, PhD, The Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross Bldg 370, Baltimore, MD 21205. Address e-mail to Cmintz2@jhmi.edu. © 2018 International Anesthesia Research Society
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https://ift.tt/2BFWmp4
Remote Surveillance Technologies: Realizing the Aim of Right Patient, Right Data, Right Time
The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans. Improved predictions can reduce alarm fatigue. In addition, data are now automatically queriable on a real-time basis such that they can be fed back to clinicians in a time frame that allows for meaningful intervention. These advancements are key components of successful remote surveillance systems. Anesthesiologists have the opportunity to be at the forefront of remote surveillance in the care they provide in the operating room, postanesthesia care unit, and intensive care unit, while also expanding their scope to include high-risk preoperative and postoperative patients on the general care wards. These systems hold the promise of enabling anesthesiologists to detect and intervene upon changes in the clinical status of the patient before adverse events have occurred. Importantly, however, significant barriers still exist to the effective deployment of these technologies and their study in impacting patient outcomes. Studies demonstrating the impact of remote surveillance on patient outcomes are limited. Critical to the impact of the technology are strategies of implementation, including who should receive and respond to alerts and how they should respond. Moreover, the lack of cost-effectiveness data and the uncertainty of whether clinical activities surrounding these technologies will be financially reimbursed remain significant challenges to future scale and sustainability. This narrative review will discuss the evolving technical components of remote surveillance systems, the clinical use cases relevant to the anesthesiologist's practice, the existing evidence for their impact on patients, the barriers that exist to their effective implementation and study, and important considerations regarding sustainability and cost-effectiveness. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication October 18, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jeanine P. Wiener-Kronish, MD, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, GRB 4–444, Boston, MA 02114. Address e-mail to jwiener-kronish@partners.org. © 2018 International Anesthesia Research Society
https://ift.tt/2BEnWTO
https://ift.tt/2BEnWTO
Simple method to attain symmetry for rib cartilage graft
Rhinoplasty is one of the most craft-worthy procedures in plastics surgery. It requires precise symmetry to ensure a satisfactory surgical outcome. Here we introduce a simple, economical yet efficient method designed to enhance and perfect autologous rib graft symmetry for nasal implants. There are no sources of financial support for this paper. ©2018American Society of Plastic Surgeons
https://ift.tt/2TXzMiG
https://ift.tt/2TXzMiG
Proliferative Lesions Found at Reduction Mammoplasty: Incidence and Implications in 995 Breast Reductions
PURPOSE: Reduction mammoplasty relieves symptomatic macromastia. Pathology specimens occasionally reveal unsuspected proliferative lesions or carcinoma. Few studies examine incidence, risk factors, and outcomes in this population. METHODS: Retrospective review was performed between 2000 and 2012. Pathology was categorized as benign, proliferative, or cancer (DCIS or invasive). RESULTS: Five hundred seventy-two patients had 995 reduction mammoplasties (85% bilateral, 15% unilateral). Cancer was detected in 23 (2.3%) specimens and proliferative lesions in 137 (13.8%). Compared to patients with benign pathology, patients with proliferative lesions or cancer were older (p0.5). Forty-one percent of patients with proliferative lesions and no history of cancer had a change in management with increased surveillance, hormones, radiation, chemotherapy, or surgery. If there was a history of cancer, fifty-four percent had a change in management. Of patients with DCIS or cancer, all received oncologic treatment. CONCLUSIONS: Proliferative lesions of the breast may be more common that previously reported. Age and a history of breast cancer increase risk for proliferative lesions. All should be referred to oncology as nearly half of these patients will have a change in management. Presented at the American Association of Plastic Surgeons Meeting in Austin, Tx 2017. Financial Disclosure Statement: The authors have no relevant financial relationships to disclose. This work was not supported by any sources of external funding. This work has not previously been published. All authors agree on the content of this manuscript and have contributed to its production. Corresponding Author: Amy S. Colwell, MD, Associate Professor Harvard Medical School, Massachusetts General Hospital , 55 Fruit Street, WACC 435, Boston, MA 02214, acolwell@mgh.harvard.edu ©2018American Society of Plastic Surgeons
https://ift.tt/2TTGO8l
https://ift.tt/2TTGO8l
Assessing the Quality of Microvascular Breast Reconstruction Performed in the Urban Safety-Net Setting – A Doubly Robust Regression Analysis
Background: Safety-Net Hospitals (SNH) serve vulnerable populations, however, care delivery may be of lower quality. Microvascular IBR, relative to other IBR subtypes, is sensitive to the performance of SNH with regards to clinical outcomes and an important quality marker. Our aim is to assess the quality of care associated with the SNH setting. Methods: The 2012-2014 National Inpatient Sample (NIS) was used to identify patients who underwent microvascular IBR after mastectomy. SNH were defined by the proportion of Medicaid patients. Primary outcomes of interest were rates of medical, surgical inpatient complications and prolonged length of stay (pLOS). A doubly-robust approach i.e. propensity score and multivariate regression, was used to analyze the impact of patient and hospital-level characteristics on outcomes. Results: A total of 858 patients comprised our analytic cohort following propensity matching. There were no significant differences in the odds of surgical and medical inpatient complications among SNH patients relative to their matched counterparts. Black (OR 2.95, p
https://ift.tt/2Av6a3l
https://ift.tt/2Av6a3l
Cost-Effectiveness Analysis of Silicone vs. Saline Implant-Based Breast Reconstruction Using the BREAST-Q
Background: The most common type of breast reconstruction is implant-based breast reconstruction. Implant type has been reported to impact quality of life outcomes. Therefore, we sought to evaluate the cost-effectiveness of saline implants versus silicone. Methods: We retrospectively reviewed data from patients who underwent breast reconstruction with saline or silicone implants at our institution. This included type of procedure, Acellular Dermal Matrix (ADM) use, complications, and number of revisions. Costs were estimated using the Center for Medicare and Medicaid Services physician fee schedule and hospital costs. Effectiveness was measured using Breast-Q-adjusted life years (Breast-QALY), a measure of years of perfect breast health, based on Breast-Q data collected before mastectomy and reconstruction and at 12-months after final reconstruction. The incremental cost-effectiveness ratio (ICER) was obtained for silicone and saline reconstruction. Results: We identified 134 women, among which 77 (57%) underwent silicone and 57 (43%) underwent saline breast reconstruction. The cost of saline reconstruction was $1,288.23 less compared to silicone. Breast-QALYs were 28.11 for saline versus 23.57 for silicone, demonstrating higher cost-effectiveness for saline. The ICER for saline was (-)$283.48, or $283.48 less per year of perfect breast-related health post-reconstruction than silicone. Conclusion: Our results indicate that saline breast reconstruction may be more cost-effective compared with silicone at 12 months post-final reconstruction. Silicone was both more expensive and less effective than saline. However, given the relatively small cost difference, surgeon and patient preference may be important in determining type of implant used. Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Funding: None. Presentations: The study was presentated at the annual meeting of the American Society of Reconstructive Microsurgery (January 13-16, 2018, Phoenix, AZ) and was accepted for presentation at the American Society of Breast Surgeons (May 2-6, 2018, Orlando, FL). Ethical Approval: This study was approved by the Johns Hopkins Medicine Institutional Review Board under protocol #IRB00046361. This study conforms to the Declaration of Helsinki ethical principles for medical research. Corresponding author: Carisa M. Cooney, MPH, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287, Email: Ccooney3@jhmi.edu, Phone: 443-287-4629 ©2018American Society of Plastic Surgeons
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https://ift.tt/2TUSYOo
Locational Relationship Between the Lateral Border of the Frontalis Muscle and the Superior Temporal Line
Background: The frontalis is a representative target muscle for botulinum neurotoxin type A injections aimed at treating horizontal wrinkles in the forehead region. However, a lack of information regarding the shape and thickness of the frontalis may lead to unexpected side effects. Methods: This study dissected hemifaces of 44 embalmed Korean and Thai cadavers and performed ultrasound examinations on 20 healthy Korean volunteers. Two anatomical types were identified: (1) the lateral portion of the frontalis covered the superior temporal line (STL) in type I, and (2) the lateral border of the frontalis (LF) and the STL almost coincided in type II. A horizontal line was drawn laterally from the midpoint between the metopion and the glabella while landmarks F1, F2, and F3 were defined as points where this horizontal reference line intersected with vertical lines from the midpoint of the pupil, the lateral canthus, and the lateral orbital rim, respectively. Results: Type I was more common than type II [84% (37/44) vs 16% (7/44)]. When the LF ran along the border, there were no cases in which the STL was not visible. The mean minimum distance in type I was 10.53 mm. The muscle thicknesses at F1, F2, and F3 were 1.80±0.44 mm (mean±SD), 1.61±0.37 mm, and 0.11±0.04 mm, respectively. Conclusions: This study yielded data on the location and thickness of the LF. An anatomical-study-based ultrasound-guided injection technique can achieve reliable results when noninvasive treatment is applied to the forehead area. Financial Disclosure Statement: None of the authors have financial supports from commercial, academic, or political organizations or people regarding this study. The institutional ethics committee approved the study, and the participants provided written informed consents after the study had been fully explained to them (IRB No. 2-2017-0023). Corresponding author: Hee-Jin Kim, DDS, PhD, Room 601, Department of Oral Biology, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Rep. of Korea, hjk776@yuhs.ac ©2018American Society of Plastic Surgeons
https://ift.tt/2AySSmD
https://ift.tt/2AySSmD
Predictable Location of Breast Sensory Nerves for Breast Re-innervation
Background: The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves, which are at risk for injury or loss during a mastectomy. Providing re-innervation after mastectomy was introduced almost 20 years ago, but it is not widely performed, perhaps due to the difficulty of locating a recipient nerve. We have performed cadaveric dissections to allow for precise anatomical localization of the lateral intercostal branch providing breast sensation. Materials and Methods: Bilateral chest dissections were performed on 10 female cadavers. The lateral intercostal nerve providing sensation to breast tissue was identified. The distance from sternum, mid-clavicular line, and lateral pectoralis minor, as well as nerve diameter, was measured. Results: The nerve was successfully identified bilaterally in all cadavers. The majority of nerves (16/20) exited from under the 4th rib. The average distance from the sternum was 13.1cm (range 10-15cm, standard deviation 1.3cm) and from the mid-clavicular line was 11.8cm (range 8-16cm, standard deviation 2.2cm). The nerve exited at the lateral border of the pectoralis minor or within 2cm from the lateral border for all cadavers. The diameter of the nerve was consistently 2mm. The nerve traveled under the thoracodorsal vessels, aiding in identification. Conclusion: We provide the predictable location of the lateral intercostal nerve providing sensation to the breast. We hope that by enabling surgeons to locate this nerve, more well-done studies will be performed investigating technqiues and outcomes for breast re-innervation. Disclosures: none Corresponding Author: Risal Djohan, MD, Cleveland Clinic Foundation, Crile Building, Mail Code A60, 2049 East 100th Street, Cleveland, OH 44195, Email: Djohanr@ccf.org, Phone: 216-445-2433 ©2018American Society of Plastic Surgeons
https://ift.tt/2TVhn6o
https://ift.tt/2TVhn6o
Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy
Abstract
Background
Pharyngocutaneous fistula is a major wound complication of total laryngectomy. Surgical sealants may be used to increase the strength and/or integrity of surgical repairs. The purpose of this study was to present our evaluation of the feasibility and utility of the application of sealant to the pharyngeal repair with the aim of reducing pharyngocutaneous fistula incidence.
Methods
This was a prospective single‐blind randomized controlled study; patients undergoing primary total laryngectomy for advanced carcinoma of the larynx were randomized into control and treatment (albumin‐polyaldehyde sealant applied to pharyngeal repair) groups. Relevant patient, disease, and management‐related factors were recorded.
Results
Forty‐five patients were included (23 controls and 22 who received treatments). No difference in the incidence of pharyngocutaneous fistula was observed between the 2 groups. No treatment‐related complications occurred.
Conclusion
Feasibility of application of an albumin‐polyaldehyde surgical sealant to the pharyngeal repair was demonstrated, however, a pharyngocutaneous fistula‐preventative effect was not observed. Larger animal and clinical studies are encouraged to clarify this finding.
https://ift.tt/2rd6qjr
Posterior Reversible Encephalopathy Syndrome due to Hypomagnesemia: A Case Report and Literature Review
Background. Hypomagnesemia can cause various unspecific neurological complications, which can lead to diagnostic confusion. One of these complications is the posterior reversible encephalopathy syndrome (PRES), which is extremely uncommon and has been reported only twice in the English-language literature. Case presentation. We report the case of a 60-year-old man who presented with PRES involving only the cerebellar hemispheres and associated with hypomagnesemia. After excluding all the other possible etiologies of PRES, we started magnesium replacement therapy, which led to a remarkable but fluctuating clinical and chemical improvement. A full recovery with no need for further supplementation was achieved only after discontinuation of a proton pump inhibitor. Conclusions. This case highlights the role of magnesium in the pathophysiology of PRES; thereby, underlying hypomagnesemia should be considered in every PRES case with unclear etiology.
https://ift.tt/2KEnxUh
Pallister–Hall syndrome with orofacial narrowing and tethered cord: a case report
Pallister–Hall syndrome is a rare, autosomal dominant, genetic disorder characterized by different congenital abnormalities: hypothalamic hamartoblastoma, bifid or shortened epiglottis, polydactyly, renal anom...
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Der p 1‐specific regulatory T cell response during house dust mite allergen immunotherapy
Abstract
Background
Allergen‐specific immunotherapy (AIT) is the only available treatment for allergic diseases that can induce specific immune tolerance to allergens. The key mechanisms involved in this process include changes in allergen‐specific regulatory T (Treg) cells.
Methods
We studied 25 allergic rhinitis patients undergoing subcutaneous house dust mite‐specific immunotherapy. Peripheral blood mononuclear cells were studied before, after 10 weeks, 30 weeks and 3 years of AIT. Der p 1‐specific T regulatory cell responses was investigated by characterization of Der p 1‐MHC‐class II tetramer‐positive cells and correlated with nasal symptom score.
Results
Twelve of 25 AIT patients matched with their MHC‐class II expression to the Der p 1 peptide‐MHC‐class II tetramers. A significant increase in the numbers of Der p 1‐specific FOXP3+Helios+CD25+CD127‐ Treg cells after 30 weeks was observed, which slightly decreased after 3 years of AIT. In contrast, Der p 1‐specific immunoglobulin‐like transcript 3 (ILT3)+CD25+ Treg cells decreased substantially from baseline after 3 years of AIT. ILT3+ Treg cells displayed compromised suppressive function and low FOXP3 expression. In addition, Der p 1‐specific IL‐10 and IL‐22 responses have increased after 30 weeks, but only IL‐10+ Der p 1‐specific Treg cells remained present at high frequency after 3 years of AIT. Increased number of FOXP3+Helios+, IL‐10+ and decreased ILT3+ Treg cell responses correlated with improved allergic symptoms.
Conclusion
The results indicate that AIT involves upregulation of the activated allergen‐specific Treg cells and downregulation of dysfunctional allergen‐specific Treg cells subset. Correction of dysregulated Treg cells responses during AIT is associated with improved clinical response.
This article is protected by copyright. All rights reserved.
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Eine seltene Ursache der asymptomatischen Arteria carotis interna Dissektion
Laryngo-Rhino-Otol
DOI: 10.1055/a-0798-3615
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2P8pU26
Letter To The Editor- Sentinel lymph node biopsy in melanoma: Which hot nodes should be harvested and is blue dye really necessary?
We read with great interest the review by dr. Ranson and collegues about sentinel lymph node biopsy in melanoma, which hot nodes should be harvested and whether blue dye is really necessary. First of all, we congratulate the author on an excellent paper, but we also feel that there are some issues that need to be addressed.
https://ift.tt/2KGhqyO
LATISSIMUS DORSI BREAST RECONSTRUCTION WITH OR WITHOUT IMPLANTS: A COMPARISON BETWEEN OUTCOME AND PATIENT SATISFACTION
The Latissimus Dorsi (LD) flap is largely used in breast reconstruction. The aim of this study is to evaluate the advantage of the LD flap in association with implant compared to LD breast reconstruction in association with lipofilling to add additional volume, by assessing the number of revision procedures, the length of hospitalization, the complication rate and patient satisfaction.
https://ift.tt/2BEgwQk
Cartilage exposure following autologous microtia reconstruction: an algorithmic treatment approach
Successful reconstruction of microtia involves fabrication of a cartilaginous framework and provision of thin, durable, soft tissue cover. Vascular compromise of this skin envelope can lead to exposure of the underlying cartilage, resulting in cartilage resorption and distortion of the final form of the ear construct. We describe our algorithm for management of this complication.
https://ift.tt/2KGh1fM
A Four-Year Retrospective Assessment of Post-Operative Complications in Immunosuppressed Patients Following Mohs Micrographic Surgery
Solid organ transplant and immunosuppressive medications confer higher risk of complications like infection and dehiscence due to larger defect size, complex repair, and impaired healing. Dermatologists should take into account the higher risk of complications when counseling and managing immunosuppressed solid organ transplant recipients undergoing Mohs surgery.
https://ift.tt/2KGU8sh
A Cross-Sectional Survey and Analysis of Dermatology Foundation Career Development Award Recipients
The DF's CDA Program has had a major favorable impact on the academic workforce and supported innovations that have led to improved patient care. Each dollar of CDA funding through 2015 (i.e., $36.2 M) can be linked to over $10 and $12 in grant support through 2015 and 2017, respectively.
https://ift.tt/2KDvLf8
Clindamycin versus clindamycin plus rifampicin in Hidradenitis Suppurativa treatment: clinical and ultrasound observations
The aim of the study was to assess and compare the clinical efficacy of clindamycin versus clindamycin plus rifampicin in HS patients, after 8 weeks of treatment, according to Hidradenitis Suppurativa Clinical Response measure. Study results suggest that clindamycin in mono-therapy may be a useful and safety alternative to the combination of clindamycin and rifampicin regardless of the clinical stage of HS.
https://ift.tt/2BEaj6N
Human Oncoviruses: Mucocutaneous Manifestations, Pathogenesis, Therapeutics, and Prevention (Part II: Hepatitis Viruses, Human T-cell Leukemia Viruses, Herpesviruses, and Epstein-Barr Virus)
In 1964, the first human oncovirus, Epstein-Barr virus (EBV), was identified in Burkitt lymphoma cells. Since then, six other human oncoviruses have been identified: human papillomavirus (HPV), Merkel cell polyomavirus (MCPyV), hepatitis B and C viruses (HBV and HCV), human T-cell lymphotropic virus-1 (HTLV-1), and human herpesvirus-8 (HHV-8). These viruses are causally linked to 12% of all cancers, many of which have mucocutaneous manifestations. Additionally, oncoviruses are associated with many benign mucocutaneous diseases.
https://ift.tt/2BEa2Rj
Human Oncoviruses: Mucocutaneous Manifestations, Pathogenesis, Therapeutics, and Prevention (Part I: Papillomaviruses and Merkel cell polyomavirus)
In 1964, the first human oncovirus, Epstein-Barr virus (EBV), was identified in Burkitt lymphoma cells. Since then, six other human oncoviruses have been identified: human papillomavirus (HPV), Merkel cell polyomavirus (MCPyV), hepatitis B and C viruses (HBV and HCV), human T-cell lymphotropic virus-1 (HTLV-1), and human herpesvirus-8 (HHV-8). These viruses are causally linked to 12% of all cancers, many of which have mucocutaneous manifestations. Additionally, oncoviruses are associated with multiple benign mucocutaneous diseases.
https://ift.tt/2KI7qVq
Psoriasis and Hidradenitis Suppurativa: A Large-scale Population-based Study
How does this article integrate into what was already known This large-scale study reveals a significant association between psoriasis and hidradenitis suppurativa, and supports previous case reports and small studies. How does it change practice? That is, what does the article mean to the practice of dermatology and what should you do as a result of having read this article? What should change in the way you practice Awareness of this association is valuable to physicians treating patients with psoriasis, and systemic therapies confirmed as effective for both conditions may be preferred in patients with dual diagnosis.
https://ift.tt/2BE9ECl
Impaired eating‐related quality of life in chronic rhinosinusitis
Background
Despite the tremendous burden of smell and taste dysfunction in patients with chronic rhinosinusitis (CRS), objective measures of smell and taste fail to fully account for eating‐related disruptions in CRS patient quality of life (QOL). In this study we sought to investigate the driving force behind impaired eating‐related QOL in CRS patients.
Methods
Adult CRS patients were prospectively enrolled and answered a series of surveys relating to smell, taste, overall sinus‐specific QOL, and depression. Patients with both smell‐related and taste‐related eating complaints were considered to have impaired eating‐related QOL. Clinical demographics, objective chemosensory scores, and endoscopy scores were collected.
Results
Seventy patients were enrolled and 23% showed impaired eating‐related QOL. In multivariable analyses, patients with aspirin‐exacerbated respiratory disease (AERD) showed 10.7 times higher odds of impaired eating‐related QOL (odds ratio [OR] 10.72; 95% confidence interval [CI], 1.09 to 105.09; p = 0.042); meanwhile, for every 1‐point increase in depression scores, the odds of impaired eating‐related QOL increased by 1.3 (OR 1.31; 95% CI, 1.10 to 1.57; p = 0.003). For every 1‐point decrease in orthonasal olfactory threshold, the odds of impaired eating‐related QOL increased by 1.9 times (OR 1.85; 95% CI, 1.14 to 3.00; p = 0.013). Symptom scores, polyp status, endoscopic scores, and other olfactory measures did not remain significant after adjusting for other variables in forward‐selection multivariable modeling.
Conclusion
Disruptions in eating‐related QOL cannot be fully explained by objective smell or taste testing alone. We identified AERD and depression as independent risk factors for greater odds of impaired eating‐related QOL in CRS. Improved orthonasal threshold scores were independently associated with better eating‐related QOL.
https://ift.tt/2KHcbie
From stem cells protection to skin microbiota balance: Orobanche rapum extract, a new natural strategy
Summary
Background
Healthy skin is a delicate balance between skin renewal and microbiota homeostasis, and its imbalance promotes premature aging and dermatological disorders. Skin stem cells are key actors in this process but their sensitivity to aging and external stressors such as UV reduces the skin renewal power. The skin microbiota has been recently described as active in the healthy skin, and its imbalance could trigger some disorders.
Aims
We hypothesized that reactivation of stem cells and maintenance of microbiota could be a disruptive strategy for younger and healthier skin. We thus developed a new plant extract that restores the entire skin renewal process by sequential activation from stem cells stimulation to microbiota protection.
Methods
We studied stem cells comportment in the presence of Orobanche rapum extract by survivin immunocytochemistry and caspases 3 and 9 dosages. We also analyzed epidermal differentiation markers by immunohistochemistry and lipids organization by GC/MS At the clinical level, we investigated the impact of O. rapum extract on microbiota and on skin aspect.
Results
We demonstrated an active protection of skin stem cells through the maintenance of their clone‐forming capacity and resistance to UV through the overexpression of survivin coupled to caspases inhibition. Furthermore, we showed the restoration of epidermal differentiation markers and ceramide biosynthesis favorable to orthorhombic organization. Clinical studies, including microbiota analysis, showed an active skin surface renewal coupled with microbiota protection.
Conclusion
We evidenced that our active ingredient is able to stimulate skin rejuvenation while protecting the cutaneous microbiota, creating healthier skin and thereby beauty.
https://ift.tt/2zukycu
From stem cells protection to skin microbiota balance: Orobanche rapum extract, a new natural strategy
Summary
Background
Healthy skin is a delicate balance between skin renewal and microbiota homeostasis, and its imbalance promotes premature aging and dermatological disorders. Skin stem cells are key actors in this process but their sensitivity to aging and external stressors such as UV reduces the skin renewal power. The skin microbiota has been recently described as active in the healthy skin, and its imbalance could trigger some disorders.
Aims
We hypothesized that reactivation of stem cells and maintenance of microbiota could be a disruptive strategy for younger and healthier skin. We thus developed a new plant extract that restores the entire skin renewal process by sequential activation from stem cells stimulation to microbiota protection.
Methods
We studied stem cells comportment in the presence of Orobanche rapum extract by survivin immunocytochemistry and caspases 3 and 9 dosages. We also analyzed epidermal differentiation markers by immunohistochemistry and lipids organization by GC/MS At the clinical level, we investigated the impact of O. rapum extract on microbiota and on skin aspect.
Results
We demonstrated an active protection of skin stem cells through the maintenance of their clone‐forming capacity and resistance to UV through the overexpression of survivin coupled to caspases inhibition. Furthermore, we showed the restoration of epidermal differentiation markers and ceramide biosynthesis favorable to orthorhombic organization. Clinical studies, including microbiota analysis, showed an active skin surface renewal coupled with microbiota protection.
Conclusion
We evidenced that our active ingredient is able to stimulate skin rejuvenation while protecting the cutaneous microbiota, creating healthier skin and thereby beauty.
https://ift.tt/2zukycu
SDHx gene detection and clinical Phenotypic analysis of multiple paraganglioma in the head and neck
Objectives
The goal of this study was to detect and explore the mechanisms of the succinate dehydrogenase (SDH) complex subunit‐related gene mutations in cases of multiple paraganglioma (PGL) in the head and neck.
Methods
In Beijing Tongren Hospital (Capital Medical University, Beijing, People's Republic of China) between January 2013 and February 2017, 23 cases of head and neck multiple PGL were evaluated by genetic sequencing. From these cases, four hereditary families and 10 cases with sporadic occurrences were found. Gene mutations, including SDHD, SDHB, SDHC, SDHAF2, VHL and RET in germ cells and somatic cells, were detected by gene capture and high throughput sequencing.
Results
In family 1, 12 instances of SDHD gene mutation were detected, eight of which manifested as bilateral carotid body tumor (CBT) with one bilateral malignant CBT. In family 2, three cases of SDHD mutation were found with one case of bilateral CBT and two cases of unilateral CBT. In family 3, two cases of SDHD gene mutation were found, both characterized by vagus PGL and pheochromocytoma. Of the 10 patients with sporadic manifestations, five cases of SDHD gene mutation and one case of RET gene mutation were detected. Two novel gene mutations, c.387_393del7 mutation of SDHD gene and c.3247A>G mutation of RET gene, were also detected.
Conclusion
In patients with multiple PGL in the head and neck, these are accompanied by a genetic mutation of the germ cell. In this case study, this mutation was most commonly a mutation of the SDHD gene.
Level of Evidence
4. Laryngoscope, 2018
https://ift.tt/2zu7yDM
When to replace legacy cochlear implants for technological upgrades: Indications and outcomes
Objective
To determine indications, surgical efficacy, and audiologic outcomes of replacing Advanced Bionics Clarion C1.2 internal devices (Advanced Bionics, LLC, Valencia, CA) as a means of technology upgrade.
Study Design
Retrospective review, case series.
Methods
Ten patients were initially implanted as a child (mean age = 3.87 years) and underwent cochlear implant reimplantation (CIR) with current Advanced Bionics internal device as a young adult (mean duration of implant use = 15.66 years). Demographic data and pre‐ and post‐CIR speech perception scores were collected.
Results
Technology upgrade was the primary (9) or secondary (1) motivation for CIR. No surgical complications were noted, and full insertion was obtained in nine cases. Intraoperative impedance levels and neural response imaging measures were within normal limits for eight patients. At most recent post‐CIR follow‐up evaluation, all patients (100%) performed within or better than the 95% confidence interval of their pre‐CIR word and sentence recognition scores; and 55.6%, 50.0%, and 50.0% of patients performed above the 95% confidence interval of their pre‐CIR scores for the CNC words, sentences in quiet, and sentences in noise, respectively.
Conclusion
Post‐CIR audiological benefit was stable or improved compared to pre‐CIR results in all categories by 3 months after reactivation. Given these results, patients who are unable to use the most current external processors due to incompatibility with a legacy internal device could consider reimplanation to optimize their overall performance with a cochlear implant.
Level of Evidence
4. Laryngoscope, 2018
https://ift.tt/2P6N9cX
Vocal motor control and central auditory impairments in unilateral vocal fold paralysis
Objectives
To evaluate differences in vocal motor control and central auditory processing between treated unilateral vocal fold paralysis (UVFP) and healthy control cohorts.
Study Design
Cross‐sectional.
Methods
Ten UVFP study patients treated by type I thyroplasty with stable voices were compared to 12 control subjects for vocal motor control using a pitch perturbation response task and central auditory processing performance using a battery of complex sound intelligibility assays that included adverse temporal and noise conditions. Standard clinical evaluations of voice production and peripheral audiometric sensitivity were performed.
Results
Vocal motor control was impaired in treated UVFP. The UVFP cohort exhibited a 32.5% reduction in the instantaneous, subconscious compensatory response to pitch feedback perturbation in the interval between 150 ms and 550 ms following onset (P < 0.0001, linear mixed effects model). This impairment cannot simply be ascribed to vocal motor capacity insufficiency in the UVFP cohort because both cohorts demonstrated comparable functional capacity to perform the vocal motor task. The UVFP cohort also showed greater propensity for central auditory processing impairment (P < 0.05), notably for temporal compression and added noise challenges.
Conclusion
Combined central vocal motor control and auditory processing impairments in treated UVFP highlight reciprocal interdependency of sensory and motor systems. This pilot study suggests that peripheral motor impairment of the larynx can degrade central auditory processing, which in turn may contribute to vocal motor control impairment. A more complete restoration communicative function in UVFP will require deeper understanding of sensory, motor, and sensorimotor aspects of the human communication loop.
Level of Evidence
3b Laryngoscope, 2018
https://ift.tt/2ztJdOe
Correlating laryngoscopic appearance of laryngeal lesions with histopathology
Objectives/Hypothesis
Meticulous scrutiny of laryngeal lesions with laryngoscopes and microscopes often identify angiogenic activity, one of the hallmarks of neoplastic and preneoplastic lesions. The aim of this study was to determine if there is an association between laryngoscopic appearance and histopathology of laryngeal lesions based on operative biopsies.
Study Design
Retrospective case‐control study.
Methods
One hundred forty‐four laryngeal biopsies from 92 patients between 2015 and 2017 met inclusion criteria. Cases were patients who had biopsy‐proven laryngeal dysplasia or malignancy. Controls were patients who had benign laryngeal pathology. All of the laryngeal lesions had either keratosis or vascular stippling, an indication of angiogenic activity. Medical records, videostroboscopies and operative findings of these patients were reviewed. Multivariable logistic regression was used to examine the correlation between laryngoscopic appearance of laryngeal lesions and presence or absence of dysplasia and invasive carcinoma.
Results
Fifty percent of the 144 laryngeal lesions were classified either as dysplastic or malignant by histopathology. Vascular stippling was present in 31% of all laryngeal lesions. On logistic regression, vascular stippling was significantly associated with dysplastic and malignant lesions (P = .0018). Overall sensitivity and specificity of vascular stippling and the presence of dysplasia and malignancy were 51% and 89%, respectively.
Conclusions
Laryngoscopic and microscopic appearance of vascular stippling could inform clinicians on diagnostic sampling of suspicious laryngeal lesions that reduces delay in diagnosis. The low sensitivity of vascular stippling underlies the importance of maintaining high clinical suspicion and proceeding to the operating theater for adequate tissue sampling.
Level of Evidence
3 Laryngoscope, 2018
https://ift.tt/2P5ppG4
Primär kutane Lymphome – eine Fallserie von 163 Patienten
Zusammenfassung
Hintergrund
Neben einem breiten, klinisch vielgestaltigen Spektrum bekannter primär kutaner Lymphome, für die eine Inzidenz von 1–3:100.000 angegeben wird, werden jedes Jahr weitere Entitäten präzisiert und definiert. Ziel ist die Darstellung einer Fallserie aus dem klinischen Alltag.
Methodik
Innerhalb eines Zeitraumes von 6 Jahren und 2 Monaten wurden Patienten mit kutanen Lymphomen in der Klinik für Dermatologie und Venerologie am Universitätsklinikum Freiburg registriert. Die Mycosis fungoides (MF) mit ihren Varianten, Sézary-Syndrome (SS), CD30+-lymphoproliferative Erkrankungen, Einzelfälle seltener kutaner Lymphome und Subkollektive der B‑Zell-Lymphome sind erfasst. Die große Anzahl der MF-Fälle erlaubte zusätzlich auch die quantitative Analyse der angewendeten Therapien.
Ergebnisse
Die Auswertung von 163 primär kutanen Lymphomen mit jährlich 16 bis 25 Neudiagnosen ergab 111 Fälle mit einer MF einschließlich 9 besonderer MF-Varianten (68,1 %), 15 primär kutane CD30+-lymphoproliferative Erkrankungen (9,2 %), dominierend mit 10 Fällen einer lymphomatoiden Papulose (LyP) neben 5 primär kutanen anaplastisch großzelligen Lymphomen (PCALCL), 6 SS (3,68 %) und 24 kutane B‑Zell-Lymphome (14,72 %). Drei Fälle seltener Varianten primär kutaner T/NK(natürliche Killerzellen)-Zell-Lymphome werden gesondert ausgeführt. Es waren 82 % der MF-Fälle im Stadium IA/IB. Für die Stadien I–III wurden therapeutisch in einem absteigenden Ranking Glukokortikoide und diverse UV-Therapien, Bexaroten, Interferon-α, Methotrexat und extrakorporale Photopherese eingesetzt.
Schlussfolgerungen
Lymphomdiagnosen gehören in ein weites differenzialdiagnostisches Spektrum. Die hier dargestellte Registrierung stellt häufige Befunde dar und zeigt seltene Varianten. Man diagnostiziert nur, was man kennt. Dementsprechend können Fallsammlungen, zu denen wir ermutigen möchten, zur Aufarbeitung und Spezifizierung von Entitäten beitragen.
https://ift.tt/2KLZSRX
Warum Andrologie in der Dermatologie
Zusammenfassung
Die Andrologie entwickelte sich vor mehr als 100 Jahren, um der Gynäkologie eine spezifische Männermedizin v. a. in der Reproduktionsmedizin an die Seite zu stellen. Die ersten Impulse zur klinischen und wissenschaftlichen Entwicklung des Faches gingen in Deutschland von Dermatologen aus. Die Dermatologie darf daher als Mutterdisziplin der Andrologie angesehen werden. Im Jahr 2003 wurde der Sichtbarkeit der Andrologie im medizinischen Fächerkanon durch die Einführung einer Zusatzbezeichnung für Dermatologen, Endokrinologen und Urologen Rechnung getragen, da auch die beiden anderen medizinischen Disziplinen sich mehr und mehr mit andrologischen Fragestellungen beschäftigten. Heute sind die Urologen sowohl unter den Mitgliedern der Gesellschaft für Andrologie als auch unter den Ärzten mit der Zusatzbezeichnung in der Mehrheit. In der Dermatologie gibt es neben den reproduktionsmedizinischen Fragestellungen viele weitere Topics, die den Einschluss der Andrologie lohnen. Deshalb wird die Einbindung dieses Faches nicht nur aus historischen Gründen gepflegt. Die Andrologie ist eine lebendige Subdisziplin in der Dermatologie, und junge Dermatologen sollten zur Beschäftigung mit ihr motiviert sein.
https://ift.tt/2KJnt5G
Linear lipoatrophy following intra‐articular triamcinolone acetonide injection mimicking linear scleroderma
Abstract
A 12‐year‐old female with oligoarticular juvenile inflammatory arthritis developed an atrophic linear plaque involving the left medial forearm and proximal arm 7 months after intra‐articular triamcinolone injection for arthritis. The plaque spontaneously resolved without treatment over approximately one year. It is important to recognize this rare complication of intra‐articular steroid injection in order to avoid potential misdiagnosis as linear scleroderma and subsequent immunosuppressive treatment.
https://ift.tt/2BDI604
Assesment of Transient Palmoplantar Keratoderma With Bullous Pemphigoid
This case series study of 6 patients describes the clinical and immunologic characteristics of bullous pemphigoid associated with transient palmoplantar keratoderma.
https://ift.tt/2zykqbU
https://ift.tt/2zykqbU
Erythematous Papule on the Glans Penis
A 60-year-old man with a history of IgA kappa multiple myeloma was referred for evaluation of an indolent, erythematous papule on his glans penis of 2 weeks' duration; he denied sexual risk behavior and reported no recent changes in medication. What is your diagnosis?
https://ift.tt/2P8eb3x
https://ift.tt/2P8eb3x
Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England
This population-based study assesses the national incidence of cutaneous and metastatic cutaneous squamous cell carcinoma in England from 2013 through 2015.
https://ift.tt/2zvwYRl
https://ift.tt/2zvwYRl
Creating a Partnership Between Dermatologists and Geriatricians
To the Editor We read with great interest and enthusiasm the recent Viewpoint by Linos et al about the need to create a coherent framework to address geriatric dermatologic issues. We agree that older adults are a rapidly expanding and vulnerable segment of the population who require special attention by dermatologists.
https://ift.tt/2P6W3Hi
https://ift.tt/2P6W3Hi
Creating a Partnership Between Dermatologists and Geriatricians—Reply
In Reply We thank Drs Mundluru and Lee for their thoughtful response to our Viewpoint titled "Geriatric Dermatology—A Framework for Caring for Older Patients With Skin Disease." We agree that we need to create practical collaborations that simultaneously support increased knowledge of dermatology in the field of geriatrics while also broadening the knowledge and application of geriatrics in the field of dermatology. We share a common goal—to improve the care of older adults with skin disease. Collaboration is essential. We support the proposed approach to improving the content of dermatology in geriatrics fellowships.
https://ift.tt/2zwTbi3
https://ift.tt/2zwTbi3
Patch Testing and Allergen-Specific Inhibition in a Patient Taking Dupilumab
This case report describes changes in repeated patch test results in a patient receiving dupilumab therapy.
https://ift.tt/2P7eag8
https://ift.tt/2P7eag8
Expert-Level Diagnosis of Nonpigmented Skin Cancer by Combined Convolutional Neural Networks
This study compares the accuracy of a convolutional neural network–based classifier with that of physicians with different levels of experience at classifying dermoscopic and close-up images of nonpigmented lesions.
https://ift.tt/2zvwP0f
https://ift.tt/2zvwP0f
Utility of Naltrexone Treatment for Chronic Inflammatory Dermatologic Conditions
This systematic review examines the literature on low- and high-dose naltrexone to summarize evidence about the drug's potential use in treatment of chronic inflammatory conditions of the skin.
https://ift.tt/2P6M44Y
https://ift.tt/2P6M44Y
Inhibitory effects of Sanguisorba officinalis root extract on HYBID (KIAA1199)‐mediated hyaluronan degradation and skin wrinkling
Abstract
Objectives
Hyaluronan (HA), an important constituent of extracellular matrix in the skin, has many biological activities such as hydration that contributes to firmness and bounciness of the skin. We have reported that reduction of HA in the papillary dermis and overexpression of HYBID (HYaluronan Binding protein Involved in hyaluronan Depolymerization, alias KIAA1199 or CEMIP), a key molecule for HA degradation in skin fibroblasts, are implicated in facial skin wrinkling in Japanese and Caucasian women. However, little or no information is available for substances which inhibit the HYBID‐mediated HA degradation.
Methods
Inhibition of Sanguisorba officinalis root extract and ziyuglycoside I, one of the components of Sanguisorba officinalis root extract, to the HYBID‐mediated HA degradation was assessed by size‐exclusion chromatography of HA depolymerized by stable transfectants of HYBID in HEK293 cells (HYBID/HEK293 cells) or normal human skin fibroblasts (Detroit 551 cells and NHDF‐Ad cells). The HYBID mRNA and protein expression was examined by quantitative real‐time PCR and immunoblotting in the skin fibroblasts treated with Sanguisorba officinalis root extract, and size distribution of newly produced HA was evaluated by preparing metabolically radiolabeled HA. A double‐blind, randomized, and placebo‐controlled study was carried out in the 21 healthy Japanese women, who were topically treated with the formulation containing Sanguisorba officinalis root extract or the placebo on each side of the face including crow's foot area.
Results
Sanguisorba officinalis root extract, but not ziyuglycoside I, abolished HYBID‐mediated HA degradation by HYBID/HEK293 cells. Sanguisorba officinalis root extract also inhibited HYBID‐mediated HA degradation in skin fibroblasts by down‐regulating HYBID mRNA and protein expression. Although control untreated skin fibroblasts produced polydispersed HA, the cells treated with Sanguisorba officinalis root extract produced only high‐molecular‐weight HA. Treatment with Sanguisorba officinalis root extract‐formulated lotion significantly improved skin elasticity, and reduced skin wrinkling scores at the outer eye corner compared with the placebo formulation.
Conclusion
Sanguisorba officinalis root extract showed an anti‐HYBID‐mediated HA degradation activity and anti‐wrinkle activity on human facial skin, which is accompanied by the improvement in elasticity. Our study provides the possibility of a new strategy to inhibit HYBID‐mediated HA degradation for anti‐wrinkle care.
This article is protected by copyright. All rights reserved.
https://ift.tt/2FMUwqF
A High-Intensity Jump-Based Aquatic Exercise Program Improves Bone Mineral Density and Functional Fitness in Postmenopausal Women
Rejuvenation Research, Ahead of Print.
https://ift.tt/2DN4gyt
The Difficult Secondary Tracheoesophageal Puncture: A Technique for Safe Insertion
ORL 2019;81:10–15
https://ift.tt/2KDaHFP
Proceeding report of the Second Symposium on Hidradenitis Suppurativa Advances (SHSA) 2017
Abstract
The 2nd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 03‐05 November 2017 in Detroit, Michigan, USA. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA, and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This was the second annual meeting of the SHSA with experts from different disciplines arriving from North America, Europe and Australia, in a joint aim to discuss most recent innovations, practical challenges and potential solutions to issues related in the management and care of Hidradenitis Suppurativa patients. The last session involved clinicians, patients and their families in an effort to educate them more about the disease.
This article is protected by copyright. All rights reserved.
https://ift.tt/2BEF8bF
Subglottic acute lymphoblastic leukaemia
Acute lymphoblastic leukaemia (ALL) is one of the the most common malignancies of childhood and can occasionally present as acute airway obstruction. We present the unusual case of a 1-year-old boy who was referred to our Paediatric Otolaryngology (ENT) clinic with a recurrent history of croup. This is the first reported case of localised ALL presenting as a subglottic mass in a paediatric patient. It highlights the need to have a broader differential diagnosis in children presenting with 'recurrent croup' including extramedullary presentation of leukaemia and to have a low threshold for performing endoscopy in such cases.
https://ift.tt/2zsdehC
Metformin-associated lactic acidosis precipitated by liraglutide use: adverse effects of aggressive antihyperglycaemic therapy
Older patients with type 2 diabetes are prone to developing adverse events with aggressive antihyperglycaemic therapy. Metformin-associated lactic acidosis (MALA) is one such rare, life-threatening adverse drug effect. We report the case of a 70-year-old man with a glycated haemoglobin of 7.9% who was on a stable, maximally tolerated dose of metformin for managing his type 2 diabetes. He was initiated on liraglutide injections with hopes to achieve better glycaemic control, but developed unrelenting nausea and vomiting during the third week of treatment. He presented to the hospital with these symptoms and was noted to have severe MALA. He sustained an in-hospital cardiac arrest requiring emergent resuscitation along with vasopressor and mechanical ventilator support. He underwent continuous venovenous haemodiafiltration to remove metformin and correct the acidosis, following which he stabilised and supportive therapy was weaned off. He was discharged from the hospital on insulin therapy with incomplete renal recovery.
https://ift.tt/2P7O10V
Corynebacterium striatum prosthetic valve endocarditis with severe aortic regurgitation successfully treated with transcatheter aortic valve replacement
We describe the case of a 69-year-old man with a history of bioprosthetic aortic valve replacement who presented with Corynebacterium striatum prosthetic valve endocarditis (PVE) complicated by severe aortic insufficiency with refractory cardiogenic shock despite antibiotic therapy. He was considered a prohibitive-risk surgical candidate due to co-morbid conditions and off-label valve-in-valve transcatheter aortic valve replacement (TAVR) was performed after detailed multidisciplinary evaluation. He recovered well without recurrent infection following completion of antibiotics and transthoracic echocardiogram at 12 months showed a normal functioning prosthetic valve. To our knowledge, this is the first reported case of native or PVE treated with TAVR.
https://ift.tt/2zucOXY
Insertion of a Dumon Y-stent via a permanent tracheostoma without using a rigid bronchoscope
A 63-year-old man who had received a permanent tracheostoma after oesophageal cancer surgery developed fistulas in the left and right main bronchi and suffered repeated aspiration pneumonia. Placing an indwelling Dumon Y-stent using a rigid bronchoscope is an option to treat fistula and stenosis at the tracheal bifurcation, but in some cases, it may be difficult to use a rigid bronchoscope in patients with a permanent tracheostoma. In this study, we report placing a Dumon Y-stent in a patient with a permanent tracheostoma using a specially modified stent and forceps instead of a rigid bronchoscope.
https://ift.tt/2ztDAQ6
Foot drop post varicella zoster virus
Leg pain and weakness can often be seen in a musculoskeletal physiotherapy outpatient setting. While the differential diagnoses for neuropathic pain and weakness is often spine related, this unusual cause for polyradiculopathy is less commonly seen. Shingles is not something routinely seen in a physiotherapy department but is usually associated with skin eruptions and pain but less so with motor loss. The purpose of this case report is to therefore raise awareness that this presentation can occur and should not be mistaken for spinal radiculopathy.
https://ift.tt/2P6YZnb
Dandy-Walker variant with precocious puberty: a rare association
Precocious puberty is characterised by premature appearance of secondary sexual characteristics before the age of 7 years in girls and 9 years in boys. Dandy-Walker malformation comprises a spectrum of intracranial malformations of the posterior fossa. We present a case of a 7-year-old male child who has presented with features of central precocious puberty and on further evaluation has been found to have Dandy-Walker variant and secondary hypothyroidism. The following case report describes this association which is extremely rare and has never been described in literature.
https://ift.tt/2zyfBzk
Hiding in plain sight: a brain lesion in a patient with a history of colon and breast cancer
We present a case of a 76-year-old woman who was admitted to our hospital with a low Glasgow Coma Scale score. She had a medical history of breast and colon cancer. The CT scan showed possible diagnosis of brain metastasis. However, the MRI scan showed this to be a completely different diagnosis.
https://ift.tt/2P1X2sp
Does ocular inflammation play a role in xeroderma pigmentosum with endothelial dysfunction: an immunological study
We report a case of xeroderma pigmentosum (XP) with endothelial dysfunction where the analysis of tears revealed elevated levels of proinflammatory cytokines, even in the absence of active inflammation and neovascularisation of the ocular surface. Although the role of ultraviolet (UV) radiation-induced inflammation in the occurrence of ocular manifestations of XP is known, little is published on the molecular mechanisms and there are no reports quantifying the presence of inflammatory cytokines in the tears of patients with ocular involvement of XP. Tear analysis demonstrated an increase in inflammatory cytokines and chemokines, especially interleukin-8 (2.38 ng/µg), tumour necrosis factor alpha (0.87 ng/µg) and granulocyte monocyte colony stimulating factor (0.44 ng/µg) as compared with the control eye. Effective management of the underlying UV-induced inflammation and promoting DNA repair may play a vital role in managing ocular manifestations and its sequelae in patients of XP.
https://ift.tt/2zuIWus
Self-Reported Skin Changes by a Selected Number of Astronauts after Long-Duration Mission on ISS as Part of the Skin B Project
Background: One of the most challenging and important factors of manned space missions is to keep astronauts healthy on orbit. In a study on 46 ISS crew members who were on 6-month (average) missions, skin rashes were the most self-reported event. Furthermore, among notable events, 40% were classified as skin rashes/hypersensitivities. Thus, especially skin conditions during space travel are of major clinical interest and require further research. Aims: The aim of the study was to determine skin conditions in space flight among US and European astronauts, especially taking into account the terrestrial skin conditions as well as on-orbit skin care habits. Methods: A preflight questionnaire was given to the astronauts asking about their terrestrial skin care habits and skin conditions/atopy before launch. In addition, they were asked to fill out a postflight questionnaire asking about their on-orbit skin care routine and whether any special observations regarding the skin were made during flight. Results: A total of 23 skin symptoms were recorded by 8 nonatopic astronauts (mean age: 41 years) during the mission. The symptoms were peeling (21.74%), rash (17.39%), dryness (13.04%), severe dryness (8.70%), reddening (8.70%), itchiness (8.70%), bruising (4.35%), skin sensitivity (4.34%), bumps (4.35%), acne (4.35%) and slow healing of contusions and lacerations (4.35%). Especially the hands and feet were affected by skin problems. As a result of this examination, it was shown that the skin symptoms correlate with poor hygiene on orbit, whereas the factor "environment" on the ISS plays a minor role. Surprisingly, 2 astronauts even experienced positive effects on their skin. Conclusion: Based on these preliminary data, it is important to pay more attention to skin hygiene and maintenance in space.
Skin Pharmacol Physiol 2019;32:52–57
https://ift.tt/2AulH3E
Skin Pharmacol Physiol 2019;32:52–57
https://ift.tt/2AulH3E
Current Data on Effects of Long-Term Missions on the International Space Station on Skin Physiological Parameters
Background: Skin reaction to spaceflight has not really been studied yet, although the skin has a very important barrier function to protect the body and can contribute to a more general understanding of physiology. It is proposed here to make a more thorough investigation of the skin during long-term spaceflight, using noninvasive techniques. Aims: The aim of the present Skin-B study is to investigate the kinetics and range of possible skin modifications during long-duration spaceflights and their recovery. Methods: In order to investigate the effect on skin physiological parameters during spaceflight, measurements were carried out on 6 astronauts with respect to skin hydration, transepidermal water loss/barrier function, and surface evaluation of the living skin in orbit. Additional measured parameters on the ground were skin elasticity, skin density and thickness, as well as microcirculation. Results: Data from the Skin-B subjects (n = 6) contradict the results obtained in the previous pilot study SkinCare (n = 1 subject). In the present study, no deterioration of the skin was found but rather an improvement in skin hydration and skin barrier function, and no changes or improvement in the appearance of the skin surface. Furthermore, the skin density and skin thickness as well as skin elasticity values were unchanged from pre-flight values. Conclusion: In conclusion, we found that spaceflight under present conditions has no negative impact on skin physiological parameters.
Skin Pharmacol Physiol 2019;32:43–51
https://ift.tt/2TTNTpu
Skin Pharmacol Physiol 2019;32:43–51
https://ift.tt/2TTNTpu
Pancreatic Progenitors: There and Back Again
Publication date: Available online 28 November 2018
Source: Trends in Endocrinology & Metabolism
Author(s): Juan Domínguez-Bendala, Mirza Muhammad Fahd Qadir, Ricardo Luis Pastori
Adult pancreatic regeneration is one of the most contentious topics in modern biology. The long-held view that the islets of Langerhans can be replenished throughout adult life through the reactivation of ductal progenitor cells has been replaced over the past decade by the now prevailing notion that regeneration does not involve progenitors and occurs only through the duplication of pre-existing mature cells. Here we dissect the limitations of lineage tracing (LT) to draw categorical conclusions about pancreatic regeneration, especially in view of emerging evidence that traditional lineages are less homogeneous and cell fates more dynamic than previously thought. This new evidence further suggests that the two competing hypotheses about regeneration are not mutually exclusive.
https://ift.tt/2QnFxqZ
Laundry detergents and detergent residue after rinse directly disrupt tight junction barrier integrity in human bronchial epithelial cells
Publication date: Available online 27 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Ming Wang, Ge Tan, Andrzej Eljaszewicz, Yifan Meng, Paulina Wawrzyniak, Swati Acharya, Can Altunbulakli, Patrick Westermann, Anita Dreher, Liying Yan, Chengshuo Wang, Mubeccel Akdis, Luo Zhang, Kari C. Nadeau, Cezmi A. Akdis
Abstract
Background
Defects in epithelial barrier have recently been associated with asthma and other allergies. The influence of laundry detergents on human bronchial epithelial cells (HBECs) and their barrier function remain unknown.
Objective
We investigated the effects of laundry detergents on cytotoxicity, barrier function, transcriptome and epigenome in HBECs.
Methods
Air-liquid interface cultures of primary HBECs from healthy control subjects, asthma and chronic obstructive pulmonary disease patients were exposed to laundry detergents and detergent residue after rinse. The cytotoxicity and epithelial barrier function were evaluated. RNA sequencing, assay for transposase accessible chromatin with high-throughput sequencing and DNA methylation arrays were used for checking transcriptome and epigenome.
Results
Laundry detergents and rinse residue showed dose dependent toxic effect to HBECs with irregular cell shape and leakage of lactate dehydrogenase after 24h exposure. A disrupted epithelial barrier function was found with decreased transepithelial electric resistance, increased paracellular flux and stratified tight junction immunostaining in HBECs exposed to laundry detergent at 1:25,000 dilutions or rinse residue at further 1:10 dilutions. RNA sequencing analysis showed that lipid metabolism, apoptosis progress and epithelial-derived alarmins related genes were up-regulated, while cell adhesion related genes were down-regulated by laundry detergent at 1:50,000 dilutions after 24h exposure without substantially affecting chromatin accessibility and DNA methylation.
Conclusion
Our data demonstrate that laundry detergents even at a very high dilution and rinse residue show significant cell toxic and directly disruptive effects on the tight junction barrier integrity of HBECs without affecting the epigenome and tight junction genes expression.
https://ift.tt/2Sl6c5r
Early B cell developmental impairment with progressive B cell deficiency in NFKB2 mutated CVID disease without autoimmunity
Publication date: Available online 28 November 2018
Source: Clinical Immunology
Author(s): Vassilios Lougaris, Daniele Moratto, Manuela Baronio, Tiziana Lorenzini, Stefano Rossi, Luisa Gazzurelli, Maria Pia Bondioni, Alessandro Plebani
Abstract
This study provides evidence for a novel role for NFKB2 in human B cell development in the bone marrow and in the periphery, leading to progressive peripheral B cell deficiency not always combined with autoimmune phenomena, broadening thus the clinical spectrum of NFKB2 mutated CVID disease and implying an essential role for NFKB2 in early human B cell development.
https://ift.tt/2E3ATca
The role and clinical significance of programmed cell death- ligand 1 expressed on CD19+B-cells and subsets in systemic lupus erythematosus
Publication date: Available online 28 November 2018
Source: Clinical Immunology
Author(s): Xiao-Yun Jia, Qing-qing Zhu, Yuan-Yuan Wang, Yang Lu, Zhi-Jun Li, Bai-Qing Li, Jie Tang, Hong-Tao Wang, Chuan-Wang Song, Chang-Hao Xie, Lin-Jie Chen
Abstract
Background
Programmed cell death-1 (PD-1) and programmed death-ligand 1 (PD-L1)-targeted therapies have enhanced T-cell response and demonstrated efficacy in the treatment of multiple cancers. However, the role and clinical significance of PD-L1 expression on CD19+ B-cells and their subsets, with particular reference to systemic lupus erythematosus (SLE), have not yet been studied in detail.
Objective
The present study aimed to investigate PD-L1 expression on CD19+ B-cells and their subsets, in addition to exploring its possible role in Tfh-cell activation and B-cell differentiation in SLE.
Methods
Frequencies of CD19+ B-cells, their subsets, PD-L1 and Tfh cells in the peripheral blood of SLE patients and healthy controls (HCs) were determined using cytometry. The clinical data of SLE patients were recorded in detail, and the correlation between their laboratory parameters, clinical parameters and disease activity indices was statistically analyzed. CD19+PD-L1+B-cells and CD19+PD-L1− B-cells were sorted and cultured with a stimulant, following which the supernatants were collected for immunoglobulin G and anti-double stranded DNA detection via enzyme-linked immunosorbent assay.
Results
In SLE patients, CD19+B-cells and partial subgroups were enriched in peripheral blood. Also, the observed increase in the frequency of CD19+PD-L1+B-cells was significantly associated with a higher disease activity index. An in vitro culture test demonstrated that the amounts of anti-dsDNA and immunoglobulin G secreted by the CD19+PD-L1+B-cells of SLE patients and HCs were vastly different. In addition, a strong correlation existed between the frequencies of CD19+PD-L1+B-cells and defined Tfh cells of SLE patients.
Conclusion
This study demonstrated that the expression of CD19+PD-L1+B-cells in the peripheral blood of SLE patients was abnormal, and that disease-related laboratory parameters and clinical indicators were correlated. CD19+PD-L1+B-cells were enriched and played a critical role in activating the pathogenic T-cell and B-cell responses in patients with SLE.
https://ift.tt/2Sk6R79
Robustly reconstructing magnetic resonance images via structure decomposition
Publication date: Available online 28 November 2018
Source: Magnetic Resonance Imaging
Author(s): Xiaomei Yang, Wen Xu, Ruisen Luo, Xiujuan Zheng, Kai Liu
Abstract
In magnetic resonance (MR) imaging, for highly under-sampled k-space data, it is typically difficult to reconstruct images and preserve their original texture simultaneously. The high-degree total variation (HDTV) regularization handles staircase effects but still blurs textures. On the other hand, the non-local TV (NLTV) regularization can preserve textures, but will introduce additional artifacts for highly-noised images. In this paper, we propose a reconstruction model derived from HDTV and NLTV for robust MRI reconstruction. First, an MR image is decomposed into a smooth component and a texture component. Second, for the smooth component with sharp edges, isotropic second-order TV is used to reduce staircase effects. For the texture component with piece-wise constant background, NLTV and contourlet-based sparsity regularizations are employed to recover textures. The piece-wise constant background in the texture component contributes to accurately detect non-local similar image patches and avoid artifacts introduced by NLTV. Finally, the proposed reconstruction model is solved through an alternating minimization scheme. The experimental results demonstrate that the proposed reconstruction model can effectively achieve satisfied quality of reconstruction for highly under-sampled k-space data.
https://ift.tt/2RjQTcV
Dual-contrast pCASL using simultaneous gradient-echo/spin-echo multiband EPI
Publication date: Available online 27 November 2018
Source: Magnetic Resonance Imaging
Author(s): Ke Zhang, Volker J. Sturm, Lukas R. Buschle, Artur Hahn, Seong Dae Yun, N. Jon Shah, Martin Bendszus, Sabine Heiland, Heinz-Peter Schlemmer, Christian H. Ziener, Felix T. Kurz
Abstract
A 2D gradient-echo EPI is commonly employed for arterial spin labeling (ASL) readout to achieve fast whole brain coverage measurements. However, such a readout suffers from susceptibility artifacts induced by magnetic field inhomogeneities. To reduce these susceptibility effects, single–shot spin-echo EPI was proposed to be used for acquisitions in continuous ASL (CASL). To minimize functional and physiological variations, a gradient-echo (GE)/spin-echo (SE) dual-echo EPI readout of the CASL sequence is needed for a comparison between GE- and SE-based determination of cerebral blood flow (CBF). In this study, we employed a simultaneous GE/SE multiband EPI as the readout of a pseudo-CASL (pCASL) sequence. Motor cortex activations derived from a finger-tapping task and functional networks from resting state fMRI were compared for both GE and SE contrasts. Direct comparison of SE and GE contrasts revealed that GE ASL provides an improved sensitivity of functional activity in finger-tapping and in resting-state imaging. SE ASL, on the other hand, suffered less from susceptibility artifacts induced by magnetic field inhomogeneities and pulsatile flow artifacts.
https://ift.tt/2Q38J7B
Magnolol attenuates the inflammation and enhances phagocytosis through the activation of MAPK, NF-κB signal pathways in vitro and in vivo
Publication date: January 2019
Source: Molecular Immunology, Volume 105
Author(s): Hongce Chen, Wuyu Fu, Hongyuan Chen, Siyuan You, Xiawan Liu, Yujiao Yang, Yao Wei, Jun Huang, Wen Rui
Abstract
Magnolol is a natural extract and the main bioactive component from Chinese medicine-Magnolia. We speculate that it's functional action might be associated with the anti-inflammatory effects of magnolol. Herein, the main purpose was to elucidate the phagocytic immune function and anti-inflammatory activities associated. The toxicity of magnolol on U937 and LO-2 cells was assayed by MTT, flow cytometry and laser scanning confocal microscope was utilized to detect the phagocytosis effect on U937 cells, C57BL/6 mice and the follow-up hematoxylin-eosin staining methods were used to evaluate its bioactivity in vivo. The results showed that magnolol had dose dependent effects on enhancement of phagocytosis ability and significantly inhibited the NO production at the concentration range from10 to 40 μM. Furthermore, Magnolol significantly reduced the gene expression and protein release of IL-1β and TNF-α. However, the p-ERK1/2 in MAPK signaling pathway was not significantly affected by magnolol, whereas p-JNK and p-P38 were down-regulated. Magnolol also inhibited the expression of p-IκBα and p-P65 of NF-κB signaling pathways. The loss of body weight and the shorter length of colon were significantly improved in DSS-treated colitis C57BL/6 mice after the administration of magnolol. The cytokines of pro-inflammatory factors TNF-α, IL-6 and IL-1β attenuated significantly in a concentration dependent manner. The histopathological manifestations of 5–20 mg/kg after the treatment magnolol were markedly improved in the DSS-treated mice. These findings showed that magnolol exerted an anti-inflammatory effect through immunoregulatory phagocytosis, MAPK and NF-κB signaling pathways. Our results provide experimental evidence and theory basis for research on anti-inflammatory effects for magnolol as a potentially anti-inflammatory drug candidate.
Graphical abstract
https://ift.tt/2r7aG3S
E. coli induced larger neutrophils in the peritoneal cavity of mice with severe septic peritonitis
Publication date: January 2019
Source: Molecular Immunology, Volume 105
Author(s): Yilan Song, Guang Yang, Zhiqin Li, Peiyan Zhao, Lei Yang, Cuiyun Cui, Shiyu Xing, Liying Wang, Yongli Yu
Abstract
Neutrophils, classified as professional phagocytes, are crucial in killing bacteria and preventing inflammation. When studying the roles of neutrophils in the development of the septic peritonitis induced by E. coli, we noticed some of the larger cells existed among peritoneal lavage fluid cells (PLCs). Besides the large size, their nuclei are segmented and flat, and squeezed to the marginal zone of the inner membrane. The cells, therefore, were designated as E. coli induced larger neutrophils (e-Neus). Further studies showed that, the e-Neus were ly6G positive, indicating the e-Neus were a type of neutrophils. The enlarged cell size and marginal nucleus of the e-Neus were caused by engulfing abundant of E. coli, marking the active participation of the e-Neus in clearance of E. coli. Functionally, the e-Neus generated reactive oxygen species (ROS) and IL-10. Furthermore, the occurrence and accumulation of the e-Neus were closely correlated with the severity of septic peritonitis and mortality of the mice. Overall, the e-Neus presented here may enrich the understandings on neutrophil transitions in response to various insults, and could be used to evaluate the severity of septic peritonitis induced by E. coli.
https://ift.tt/2FLPfQ6
Toll like receptor induces Ig synthesis in Catla catla by activating MAPK and NF-κB signalling
Publication date: January 2019
Source: Molecular Immunology, Volume 105
Author(s): Bhakti Patel, Rajanya Banerjee, Madhubanti Basu, Saswati S. Lenka, Mahismita Paichha, Mrinal Samanta, Surajit Das
Abstract
The molecular crosstalk of proximal innate immune receptor signaling mediated by Toll-like receptors (TLRs) is crucial in generating an adaptive immune response. The extracellular-signal regulated kinases (ERK) participate in propagating intracellular signals initiated by stimulated TLRs to transcription factors eliciting cytokine release. Although ERK signaling has been extensively studied in mammalian counterparts, very little is known about its existence in carps and its role in augmentation of immunoglobulin (Ig) synthesis. Therefore, to gain insights into the efficacy of MAP kinase cascade in orchestrating fish antigen receptor generation, Catla catla fingerlings were induced with various TLR agonists or pathogen associated molecular patterns (PAMPs). Analysis of upstream signaling events revealed that PAMPs stimulated the tissues leading to a significant upregulation (P < 0.001, One-way ANOVA) of different TLRs (TLR2, TLR3, TLR4 and TLR5) followed by activation of MyD88 dependent and independent pathway. Activation of ERK and NF-κB mediated cytokine production consequently triggered the enhanced expression of IgZ and IgM as was evident by qRT-PCR analysis, flow cytometry, immunoblotting and ELISA. Pretreatment with ERK inhibitor (UO126) antagonized PAMPs mediated TLR stimulation, leading to sequential downregulation of MyD88/NF-κB/cytokines via interrupting ERK/NF-κB signaling axis. Together these results demonstrate that TLR stimulation triggers IgZ and IgM production via activation of ERK and NF-κB in C. catla indicating that NF-κB mediated cytokine production and ERK1/2 signaling is not only functional in fish, but may be crucial for generation of Ig repertoire in lower vertebrates.
Graphical abstract
https://ift.tt/2rbuPWk
Unveiling the regulation of NKT17 cell differentiation and function
Publication date: January 2019
Source: Molecular Immunology, Volume 105
Author(s): Ageliki Tsagaratou
Abstract
Invariant natural killer T cells (iNKTs) are distinct from conventional T cells. iNKT cells express a semi-invariant T cell receptor (TCR) that can specifically recognize lipid antigens presented by CD1d, an MHC class I-like antigen-presenting molecule. Currently, iNKT cells are distinguished in three functionally distinct subsets. Each subset is defined by lineage-specifying factors: T-bet shapes the fate of NKT1 subset that mainly secretes IFNγ, Gata3 specifies the NKT2 subset that produces robustly IL-4 whereas RORγt seals the differentiation of NKT17 subset that secretes IL-17. In the present review, the focus is placed on the regulation of NKT17 specification and their function.
https://ift.tt/2FNqX8t
Palmatine attenuated dextran sulfate sodium (DSS)-induced colitis via promoting mitophagy-mediated NLRP3 inflammasome inactivation
Publication date: January 2019
Source: Molecular Immunology, Volume 105
Author(s): Chu-Tian Mai, Mei-Mei Wu, Chun-Li Wang, Zi-Ren Su, Yuan-Yuan Cheng, Xiao-Jun Zhang
Abstract
Activation of NLRP3 inflammasomes is crucial in the pathological process of Ulcerative colitis (UC), which could be negatively regulated by PINK1/Parkin-driven mitophagy. Palmatine is a herb derived isoquinoline alkaloid with potent anti-inflammatory and anti-bacteria activities. In present study, we evaluated the effect of palmatine on dextran sulfate sodium (DSS)-induced mice colitis and examined whether its effect is exerted by promoting mitophagy-mediated NLRP3 inflammasome inactivation. The result showed that palmatine (40, 100 mg/kg) significantly prevented bodyweight loss and colonic shortening in DSS mice, and reduced the disease activity index and histopathologic score. The levels of MPO, IL-1β, TNF-α and the number of F4/80+ cells in colon of DSS mice were remarkably decreased by palmatine. Moreover, palmatine suppressed NLRP3 inflammasomes activation, but enhanced the expression of the mitophagy-related proteins involving LC3, PINK1 and Parkin in colonic tissue of DSS mice. These effects was consistent with the in vitro data revealing that palmatine inhibited the activation of NLRP3 inflammasomes, while promoted the expression and mitochondrial recruitment of PINK1 and Parkin in THP-1 cell differentiated macrophages. Furthermore, the effect of palmatine on THP-1 cells was neutralized by a mitophagy inhibitor Cyclosporin A (CsA) and PINK1-siRNA. In parallel, CsA significantly attenuated the therapeutic effect of palmatine in DSS mice, illustrating that the anti-colitis effect of palmatine is closely related to mitophagy. Taken together, the current results demonstrated that palmatine protected mice against DSS-induced colitis by facilitating PINK1/Parkin-driven mitophagy and thus inactivating NLRP3 inflammasomes in macrophage.
Graphical abstract
https://ift.tt/2r8C3ux
Editorial board
Publication date: December 2018
Source: Annales de Dermatologie et de Vénéréologie, Volume 145, Issue 12
Author(s):
https://ift.tt/2E2hRmw
Clindamycin versus clindamycin plus rifampicin in Hidradenitis Suppurativa treatment: clinical and ultrasound observations
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Raffaele Dante Caposiena Caro, Maria Vittoria Cannizzaro, Elisabetta Botti, Cosimo Di Raimondo, Eleonora Di Matteo, Roberta Gaziano, Luca Bianchi
Abstract
Background
Antibiotics are recognized as first-line treatments for Hidradenitis Suppurativa (HS), but there is limited data on their efficacy.
Objective
Evaluate the efficacy of oral clindamycin versus clindamycin plus rifampicin in HS patients.
Methods
Sixty mild to moderate-severe HS patients classified according IHS4 and Hurley scores, were subdivided into two groups of 30 patients each (Group A receiving clindamycin+rifampicin and Group B treated with clindamycin alone), and retrospectively studied. The main outcome was to evaluate and compare the clinical and ultrasound response between groups after 8 weeks of treatment according to Hidradenitis Suppurativa Clinical Response (HiSCR).
Results
After the treatment, 17/30 patients in Group A and 19/30 in Group B met the primary outcome. Both groups showed a similar improvement of IHS4, while DLQI and Pain VAS improved more in Group B. In particular, nodules and abscesses count reduction was similar between the two groups. Whereas, the number of draining tunnels decreased more in Group B. The factors significantly associated with HiSCR were age, BMI, IHS4 and absence of axillary involvement. The disease free survival was similar between the two groups.
Limitations
The study was not randomized or placebo-controlled.
Conclusion
Clindamycin may be a useful treatment alternative to antibiotic combination regardless of HS clinical stage.
https://ift.tt/2P91mGi
A Four-Year Retrospective Assessment of Post-Operative Complications in Immunosuppressed Patients Following Mohs Micrographic Surgery
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Pallavi Basu, Alina Goldenberg, Natasha Cowan, Robert Eilers, Jennifer Hau, Shang I. Brian Jiang
Abstract
Background
Many patients undergoing Mohs micrographic surgery for basal and squamous cell carcinomas are immunocompromised, yet post-operative complications associated with different types of immunosuppression are largely unstudied.
Objective
To determine the incidence and nature of post-operative complications in immunosuppressed patients undergoing Mohs surgery.
Methods
A retrospective cross-sectional chart review of patient characteristics, clinical characteristics, and complications.
Results
Compared to immunocompetent cases, univariable analysis showed immunosuppression was associated with 9.6 times the odds of post-operative complication (p=0.003). Solid organ transplant recipients had 8.824 higher odds (p=0.006) and immunosuppressive therapy use displayed 5.775 higher odds (p=0.021). Surgical site infection (2.5%) and dehiscence (0.51%) were more prevalent among immunosuppressed patients, with an overall complication rate of 5.4% in this population. Multivariable analysis of the association between immunosuppression and post-operative complication closely trended toward, but did not meet, significance (p=0.056).
Limitations
This was a single-center, retrospective study. Other limitations include lack of non-solid organ transplants, limited medication data on non-transplant patients, and exclusion of cases with double transplants or multiple sources of immunosuppression.
Conclusions
Immunosuppression overall, particularly solid organ transplant and immunosuppressive therapy use, places patients at higher risk for post-operative complications including surgical site infection and wound dehiscence following MMS.
https://ift.tt/2zuQFsx
Cutaneous extranodal natural killer/T-cell lymphoma: Clinical implications of whole blood Epstein-Barr virus DNA
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Se Jin Oh, Ji-Hye Park, Jong Hee Lee, Dong-Youn Lee
https://ift.tt/2P7zjqJ
Response to tofacitinib therapy of eyebrows and eyelashes in alopecia areata
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Lucy Y. Liu, Brett A. King
https://ift.tt/2zvzS8F
Psoriasis and Hidradenitis Suppurativa: A Large-scale Population-based Study
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Khalaf Kridin, Michal Shani, Yochai Schonmann, Shani Fisher, Guy Shalom, Doron Comaneshter, Erez Batat, Arnon D. Cohen
Abstract
Background
The coexistence of psoriasis and hidradenitis suppurativa (HS) has been described, but the association between these conditions is yet to be firmly established.
Objectives
To study the association between psoriasis and HS using a large-scale real-life computerized database.
Methods
A cross-sectional study was conducted comparing the prevalence of HS among patients with psoriasis and among age-, sex- and ethnicity-matched control subjects.
Results
A total of 68,836 patients with psoriasis and 68,836 controls were included in the study. The prevalence of HS was increased in patients with psoriasis as compared to the control group (0.3% vs. 0.2%, respectively; OR, 1.8; 95% CI, 1.5-2.3; P<0.001). In a multivariate analysis adjusting for smoking, obesity, and other comorbidities, psoriasis was still associated with HS (OR, 1.8; 95% CI, 1.4-2.2; P<0.001). Patients with coexistent psoriasis and HS were significantly younger (39.0±15.7 vs. 42.6±21.2 years; P=0.015) and had a higher prevalence of obesity (35.1% vs. 25.3%; P=0.001) and smoking (58.5% vs. 37.3%; P<0.001) as compared to patients with psoriasis alone.
Limitations
Retrospective data collection.
Conclusions
A positive association was observed between HS and psoriasis. Further longitudinal observational studies are necessary to establish these findings in other study populations.
https://ift.tt/2P9Gv5T
Human Oncoviruses: Mucocutaneous Manifestations, Pathogenesis, Therapeutics, and Prevention (Part I: Papillomaviruses and Merkel cell polyomavirus)
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Christopher T. Haley, Uyen Ngoc Mui, Ramya Vangipuram, Peter L. Rady, Stephen K. Tyring
Abstract
In 1964, the first human oncovirus, Epstein-Barr virus (EBV), was identified in Burkitt lymphoma cells. Since then, six other human oncoviruses have been identified: human papillomavirus (HPV), Merkel cell polyomavirus (MCPyV), hepatitis B and C viruses (HBV and HCV), human T-cell lymphotropic virus-1 (HTLV-1), and human herpesvirus-8 (HHV-8). These viruses are causally linked to 12% of all cancers, many of which have mucocutaneous manifestations. Additionally, oncoviruses are associated with multiple benign mucocutaneous diseases. Research regarding the pathogenic mechanisms of oncoviruses as well as virus-specific treatment and prevention is rapidly evolving. Preventative vaccines for HPV and HBV are already available. This review discusses the mucocutaneous manifestations, pathogenesis, diagnosis, treatment, and prevention of oncovirus-related diseases. Part I of the review focuses on diseases associated with HPV and MCPyV, while part II focuses on diseases associated with HBV, HCV, HTLV-1, HHV-8, and EBV.
https://ift.tt/2zsL2LG
Alopecia Areata and Poliosis: A Retrospective Analysis of 258 Cases
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Young Bin Lee, Myungsoo Jun, Won-Soo Lee
https://ift.tt/2P1LSUx
A Cross-Sectional Survey and Analysis of Dermatology Foundation Career Development Award Recipients
Publication date: Available online 28 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Chris Boris, George Cotsarelis, Janet A. Fairley, Bruce U. Wintroub, Kim B. Yancey
Abstract
Background
The Dermatology Foundation (DF) has a comprehensive Career Development Award (CDA) Program.
Objective
To assess the impact of this Program, a cross-sectional survey of recipients receiving support between 1990 and 2012 was performed.
Methods
Award recipients completed a questionnaire concerning their career status and record of research funding. To verify self-reported funding data, information about each awardee was extracted from the NIH RePORTER database and used to define funding acquired by CDA recipients.
Results
84% of CDA recipients responded to the survey. 213 awardees (79%) hold full- or part-time positions in academic medicine. Approximately 70% of award recipients in academic medicine have received federal research funding. The NIH RePORTER database and other sources indicated that funding acquired by CDA recipients through 2015 and 2017 was approximately $365.4 M and $451.8 M, respectively. Each dollar of DF CDA funding through 2015 (i.e., $36.2 M) was linked to over $10 of grant support through 2015 and $12 through 2017.
Limitations
This cross-sectional survey was retrospective and (in part) self-reported.
Conclusions
The DF has succeeded in supporting the career development of basic, translational, and clinical investigators and fostered the promotion and retention of these individuals in academic medicine.
https://ift.tt/2zvzQO5
Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment
Abstract
Background
Compulsive exercise has been recognized as a highly prevalent symptom in eating disorders (ED) for over 100 years and is associated with poor short-term and long-term treatment outcome. Progress in understanding and treatment of compulsive exercise will remain limited as long as no consensus framework for definition and assessment of compulsive exercise exists, as results cannot be compared across clinical studies.
Based on existing literature, it was our aim to propose a transdiagnostic definition and a clinical assessment for compulsive exercise, that can be applied to adolescent and adult patients with ED.
Method
During a series of meetings of experienced clinicians at a highly specialized hospital for eating disorders, we elaborated a transdiagnostic definition of compulsive exercise in ED. Additionally, we derived a clinical interview for the assessment of compulsive exercise and its different subtypes.
Results
The core criterion when defining and assessing compulsive exercise is a pathologically increased exercise pattern characterized by 1) excessive exercise that a patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly, and 2) exercise that is aimed at preventing or reducing distress or at preventing some dreaded consequence. A second necessary criterion is the physical or psychological burden caused by compulsive exercise, i.e., that it is time-consuming, significantly interferes with the patient's daily routine, occupational functioning or social relationships or is continued despite medical injury, illness, or lack of enjoyment. Insight that compulsive exercise is excessive or unreasonable was added as an optional criterion.
Compulsive exercise manifests itself in three different subtypes: 1) vigorous exercise, 2) marked increase in daily movement, or 3) motor restlessness.
The above criteria must be met during the past 6 months, together with one of the three subtypes of compulsive exercise.
Conclusions
The proposed criteria aim to foster the discussion around definition and assessment of compulsive exercise with the goal of reaching an international consensus in the near future.
Providing a consistent framework for researchers and clinicians would considerably advance understanding and treatment of compulsive exercise in ED patients.
https://ift.tt/2BElb4N
Change in endolymphatic hydrops 2 years after endolymphatic sac surgery evaluated by MRI
Publication date: Available online 27 November 2018
Source: Auris Nasus Larynx
Author(s): Kayoko Higashi-Shingai, Takao Imai, Tomoko Okumura, Atsuhiko Uno, Tadashi Kitahara, Arata Horii, Yumi Ohta, Yasuhiro Osaki, Takashi Sato, Suzuyo Okazaki, Takefumi Kamakura, Yasumitsu Takimoto, Yoshiyuki Ozono, Yoshiyuki Watanabe, Ryusuke Imai, Yukiko Hanada, Kazuya Ohata, Ryohei Oya, Hidenori Inohara
Abstract
Objective
This study was performed to determine whether endolymphatic sac surgery improves vestibular and cochlear endolymphatic hydrops 2 years after sac surgery and to elucidate the relationship between the degree of improvement of endolymphatic hydrops and the changes in vertigo symptoms, the hearing level, and the summating potential/action potential ratio (−SP/AP ratio) by electrocochleography (ECochG) in patients with Ménière's disease (MD).
Methods
Twenty-one patients with unilateral MD who underwent sac surgery were included in this study. All patients underwent gadolinium-enhanced magnetic resonance imaging (Gd-MRI) before and 2 years after sac surgery. We evaluated the difference in vestibular and cochlear endolymphatic hydrops between before and after surgery in both ears and compared these findings with the frequency of vertigo attacks, hearing level, and ECochG findings.
Results
In affected ears, the presence of vestibular endolymphatic hydrops and the frequency of vertigo attacks significantly decreased after surgery. However, affected ears showed no significant improvement in the presence of cochlear endolymphatic hydrops or the −SP/AP ratio by ECochG; there was also no significant improvement or deterioration in the hearing level.
Conclusion
The present findings suggest that sac surgery reduces vestibular endolymphatic hydrops and prevents aggravation of cochlear endolymphatic hydrops, and these changes lead to a reduction of vertigo attacks and suppress the progression of hearing impairment associated with vertigo attacks.
https://ift.tt/2RiDMIV
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