The effectiveness of topical therapy combined with 308‐nm excimer laser on vitiligo compared to excimer laser monotherapy in pediatric patients

Abstract

We evaluated the efficiency of using a 308‐nm excimer laser with either tacrolimus, pimecrolimus, or halometasone for the treatment of childhood vitiligo. Patients who received combined treatments had significantly higher rates of repigmentation in comparison with individuals who underwent excimer laser alone therapy. Moreover, patients who received treatment with excimer laser and halometasone had significantly higher rates of repigmentation, even higher than individuals who were treated with tacrolimus combined or pimecrolimus combined. This regimen was more effective on the face, neck, and limbs. We conclude that the use of a combined excimer laser and halometasone cream has a greater therapeutic effect than laser alone.

https://ift.tt/2QES7CC

Pain therapy for the elderly patient: is opioid-free an option?

Purpose of review Chronic noncancer pain is an increasing problem in elderly because of rising life expectancy together with an increase of potentially painful medical conditions. Concomitantly, adequate treatment of elderly is often limited by coexisting diseases and polypharmacy.This review summarizes the most important specifics presented by elderly patients and discusses the pharmacological and nonpharmacological options of pain management. Recent findings A comprehensive pain assessment is a prerequisite for effective pain management. However, this can be a major challenge in patients who are unable to communicate adequately, that is, in patients with dementia. A recently developed electronic tool assessing automated facial expression and clinical behavioral indicators may help to solve this problem. The discussion about benefits and harms of opioids in elderly goes on. Although some authors underline the lack of efficacy together with the potential problems, such as, abuse, others report a beneficial effect in terms of pain relief, functional activities and disability. In addition, opioids have become an important treatment option in patients with restless legs syndrome. Various topical treatment options (i.e. capsaicin patch) and nonpharmacological interventions have been proven to be beneficial in elderly. Summary Adequate pain management of elderly patients constitutes numerous pharmacological options including nonopioids, opioids, coanalgesics and topical agents. Due to age-related characteristics, all systemic analgesics have to be given very cautiously ('start low, go slow'). Whenever possible, treatment should be performed as a multimodal approach based on the biopsychosocial model of chronic pain. Correspondence to Shahnaz Christina Azad, MD, PhD, Department of Anesthesiology and Pain Medicine, Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377 Munich, Germany. Tel: +49 89440074464; fax: +49 89440074469; e-mail: shahnaz.azad@med.uni-muenchen.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2L0Hd4A

Ergonomics in endoscopic sinus surgery

Purpose of review Awareness of ergonomics is growing into surgical specialties including otolaryngology. Most otolaryngologists experience occupational physical discomfort, and daily incorporation of standard ergonomic principles may alleviate some of this pain. Recent findings Further demonstration of surgery-related physical discomfort has been documented based on surveys of general otolaryngologists and subspecialty rhinologists. One study utilized surface electromyography to document physical findings directly associated with the endoscopic sinus surgery procedure. However, relatively little work has been published on interventions to relieve task-related pain and body discomfort in rhinology. Summary Surgeon fatigue and bodily injury is a surprisingly frequent occurrence and is more likely to occur in procedures that are mentally challenging, prolonged, and require the surgeon to operate in a fixed position. Endoscopic sinus and skull base surgeons appear particularly susceptible to task-related physical discomfort, and incorporation of ergonomic principles should be a priority. Correspondence to Vijay R. Ramakrishnan, MD, Department of Otolaryngology, University of Colorado School of Medicine, 12631 E 17th Ave, B205, Aurora, CO 80045, USA. Tel: +1 303 724 1950; fax: +1 303 724 1961; e-mail: Vijay.ramakrishnan@ucdenver.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2G5tzhV

The relation between androgenetic thin hair diagnosed by trichoscope and benign prostatic hyperplasia

Summary

Background

Androgenetic alopecia carries a major cosmetic disfigurement and benign prostatic hyperplasia is associated with many urinary tract symptoms and both diseases are mediated by dihydrotestosterone.

Objectives

The study aimed to determine the relationship between hair diameter in androgenetic alopecia diagnosed, by trichoscope, to benign prostatic hyperplasia symptoms and signs.

Methods

Fifty androgenetic alopecia males and 50 normal males as control were included. We used trichoscope for hair examination, transrectal ultrasound for prostate volume, and urodynamic inspectoscope for urinary symptoms, serum total testosterone, dihydrotestosterone, and total prostatic specific antigen were measured in blood samples. All participants answered the International prostate symptom score questionnaire and the International Index of Erectile Function score questionnaire.

Results

A significant difference between patient and control groups was detected as regards hair thickness (P = 0.001), prostatic volume (P = 0.013), urinary symptoms, prostatic specific antigen level (P = 0.015). A significant difference was detected between thin (<0.03 mm, n = 26) and medium to thick hair (>0.03, n = 24) subgroups of patients as regards age (P = 0.001), dihydrotestosterone level (P = 0.001), testosterone level (P = 0.001), and urinary symptoms (P = 0.001).

Conclusion

Androgenetic alopecia patients with thin hair diagnosed by trichoscopy are more prone to prostatic enlargement and its related symptoms. Androgenetic alopecia severity can be diagnosed by trichoscopy in addition to Hamilton‐Norwood scale.

https://ift.tt/2StVzgz

Dermoscopic follow‐up of therapeutic response in mantle cell lymphoma with secondary involvement of the scalp

Summary

The scalp is a potential location for both benign and malignant tumors. Lymphoproliferative diseases can involve the skin as a primary or secondary manifestation. Dermoscopy is a noninvasive diagnostic tool for rapid diagnosis, screening, and follow‐up of the majority of skin tumors. Mantle cell lymphoma (MCL), a rare type of aggressive systemic lymphoma, usually occurs as a generalized lymphadenopathy, commonly with infiltration of the bone marrow, spleen, gastrointestinal tract, and Waldeyer's ring. In rare cases, it can also involve other structures, such as the lungs, central nervous system, liver, or skin. We report the case of a 74‐year‐old male patient suffering from MCL since 2015. Complete remission was obtained after R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) treatment. During maintenance therapy with rituximab, a solitary tumor occurred on the scalp. Dermoscopy of the lesion suggested relapse because of the presence of multiple chaotically distributed short linear vessels with multiple red dots within the hair follicles. Histological examination confirmed the diagnosis of MCL. After second‐line therapy with rituximab and bendamustine (R‐B), the tumor of the scalp completely disappeared and dermoscopy showed no abnormalities.

https://ift.tt/2EfX2Ei

Improvements in the perception of facial attractiveness following surgical aesthetic treatment; study based on online before and after photos

Summary

Background

Aesthetic surgery procedures such as lip augmentation, eyelid correction, face‐lifting, or Botox treatment for lines and wrinkles are an important part of cosmetic surgery.

Objectives

The aim of the study was to estimate improvement in appearance following plastic surgery using modern collective intelligence methods of validation.

Methods

A total of 108 photographs showing 54 patients prior to and following cosmetic surgery were downloaded from Internet web presentations of several unnamed plastic surgeons. The same number of photographs depicted each of the four investigated areas of treatment—26 lip enhancement, 26 blepharoplasty, 26 face‐lift, 26 botulinum toxin injection. Attractiveness of depicted individuals was assessed by 167 observers. Each photograph was judged separately.

Results

Blepharoplasty produced the most remarkable improvement in attractiveness amounting to 32.79 (SD ± 26.35). Improvement following Botox treatment stood at 30.29 (SD ± 24.55), whereas face‐lifting produces improvement of 28.70 (SD ± 22.76). Improvement following lip augmentation was estimated at 12.70 (SD ± 29.8). Highest Spearman's rank correlation coefficient was obtained for face‐lift and Botox (0.24 and 0.22, respectively).

Conclusions

Blepharoplasty, face‐lifting, and Botox deliver a significant improvement in facial attractiveness. Additionally, face‐lifting and Botox are distinguished by a high level of reproducibility. Our results indicate that lip augmentation is a treatment with a statistically significant, but less marked improvement in attractiveness.

https://ift.tt/2Su2iXK

A new approach to lower eyelid‐cheek junction rejuvenation

Summary

Background

Anti‐aging in lower eyelid‐cheek junction area has always been the upmost widely sought of cosmetic surgery. Removal of orbital fat from inside or outside, removal of part of the skin or even the orbicularis muscle, superficial pull and deep fill and a series of surgical procedures like these have been or are becoming the mainstream of clinical practice. However, aging involves a variety of tissues and causes, which is a dynamic and continuous process. Conventional or a single method cannot fundamentally solve all of the problems of the aging in lower eyelid‐cheek junction area. Therefore, we propose a better‐organized surgical approach based on the whole anatomy of lower eyelid‐cheek junction area.

Methods

A total of 103 patients received lower eyelid‐cheek junction rejuvenation surgery from September 2014 to September 2017 in our department. Efficacy of surgeries was delineated and scored by both patients and surgeons.

Results

All patients of different ages, genders were relatively satisfied with the lower eyelid‐cheek junction rejuvenation surgery in our department. Patients with different past histories of cosmetic surgeries could all benefit from the lower eyelid‐cheek junction rejuvenation surgery.

Conclusion

Rejuvenation of lower eyelid‐cheek junction area should be based on a thorough understanding of periorbital anatomy, age‐related changes of the lid‐cheek junction, and the variables controlling lower lid tone and position. The surgical strategies are best used in a graded fashion.

https://ift.tt/2EeXJh3

Dermoscopic follow‐up of therapeutic response in mantle cell lymphoma with secondary involvement of the scalp

Summary

The scalp is a potential location for both benign and malignant tumors. Lymphoproliferative diseases can involve the skin as a primary or secondary manifestation. Dermoscopy is a noninvasive diagnostic tool for rapid diagnosis, screening, and follow‐up of the majority of skin tumors. Mantle cell lymphoma (MCL), a rare type of aggressive systemic lymphoma, usually occurs as a generalized lymphadenopathy, commonly with infiltration of the bone marrow, spleen, gastrointestinal tract, and Waldeyer's ring. In rare cases, it can also involve other structures, such as the lungs, central nervous system, liver, or skin. We report the case of a 74‐year‐old male patient suffering from MCL since 2015. Complete remission was obtained after R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) treatment. During maintenance therapy with rituximab, a solitary tumor occurred on the scalp. Dermoscopy of the lesion suggested relapse because of the presence of multiple chaotically distributed short linear vessels with multiple red dots within the hair follicles. Histological examination confirmed the diagnosis of MCL. After second‐line therapy with rituximab and bendamustine (R‐B), the tumor of the scalp completely disappeared and dermoscopy showed no abnormalities.

https://ift.tt/2EfX2Ei

Improvements in the perception of facial attractiveness following surgical aesthetic treatment; study based on online before and after photos

Summary

Background

Aesthetic surgery procedures such as lip augmentation, eyelid correction, face‐lifting, or Botox treatment for lines and wrinkles are an important part of cosmetic surgery.

Objectives

The aim of the study was to estimate improvement in appearance following plastic surgery using modern collective intelligence methods of validation.

Methods

A total of 108 photographs showing 54 patients prior to and following cosmetic surgery were downloaded from Internet web presentations of several unnamed plastic surgeons. The same number of photographs depicted each of the four investigated areas of treatment—26 lip enhancement, 26 blepharoplasty, 26 face‐lift, 26 botulinum toxin injection. Attractiveness of depicted individuals was assessed by 167 observers. Each photograph was judged separately.

Results

Blepharoplasty produced the most remarkable improvement in attractiveness amounting to 32.79 (SD ± 26.35). Improvement following Botox treatment stood at 30.29 (SD ± 24.55), whereas face‐lifting produces improvement of 28.70 (SD ± 22.76). Improvement following lip augmentation was estimated at 12.70 (SD ± 29.8). Highest Spearman's rank correlation coefficient was obtained for face‐lift and Botox (0.24 and 0.22, respectively).

Conclusions

Blepharoplasty, face‐lifting, and Botox deliver a significant improvement in facial attractiveness. Additionally, face‐lifting and Botox are distinguished by a high level of reproducibility. Our results indicate that lip augmentation is a treatment with a statistically significant, but less marked improvement in attractiveness.

https://ift.tt/2Su2iXK

A new approach to lower eyelid‐cheek junction rejuvenation

Summary

Background

Anti‐aging in lower eyelid‐cheek junction area has always been the upmost widely sought of cosmetic surgery. Removal of orbital fat from inside or outside, removal of part of the skin or even the orbicularis muscle, superficial pull and deep fill and a series of surgical procedures like these have been or are becoming the mainstream of clinical practice. However, aging involves a variety of tissues and causes, which is a dynamic and continuous process. Conventional or a single method cannot fundamentally solve all of the problems of the aging in lower eyelid‐cheek junction area. Therefore, we propose a better‐organized surgical approach based on the whole anatomy of lower eyelid‐cheek junction area.

Methods

A total of 103 patients received lower eyelid‐cheek junction rejuvenation surgery from September 2014 to September 2017 in our department. Efficacy of surgeries was delineated and scored by both patients and surgeons.

Results

All patients of different ages, genders were relatively satisfied with the lower eyelid‐cheek junction rejuvenation surgery in our department. Patients with different past histories of cosmetic surgeries could all benefit from the lower eyelid‐cheek junction rejuvenation surgery.

Conclusion

Rejuvenation of lower eyelid‐cheek junction area should be based on a thorough understanding of periorbital anatomy, age‐related changes of the lid‐cheek junction, and the variables controlling lower lid tone and position. The surgical strategies are best used in a graded fashion.

https://ift.tt/2EeXJh3

The relation between androgenetic thin hair diagnosed by trichoscope and benign prostatic hyperplasia

Summary

Background

Androgenetic alopecia carries a major cosmetic disfigurement and benign prostatic hyperplasia is associated with many urinary tract symptoms and both diseases are mediated by dihydrotestosterone.

Objectives

The study aimed to determine the relationship between hair diameter in androgenetic alopecia diagnosed, by trichoscope, to benign prostatic hyperplasia symptoms and signs.

Methods

Fifty androgenetic alopecia males and 50 normal males as control were included. We used trichoscope for hair examination, transrectal ultrasound for prostate volume, and urodynamic inspectoscope for urinary symptoms, serum total testosterone, dihydrotestosterone, and total prostatic specific antigen were measured in blood samples. All participants answered the International prostate symptom score questionnaire and the International Index of Erectile Function score questionnaire.

Results

A significant difference between patient and control groups was detected as regards hair thickness (P = 0.001), prostatic volume (P = 0.013), urinary symptoms, prostatic specific antigen level (P = 0.015). A significant difference was detected between thin (<0.03 mm, n = 26) and medium to thick hair (>0.03, n = 24) subgroups of patients as regards age (P = 0.001), dihydrotestosterone level (P = 0.001), testosterone level (P = 0.001), and urinary symptoms (P = 0.001).

Conclusion

Androgenetic alopecia patients with thin hair diagnosed by trichoscopy are more prone to prostatic enlargement and its related symptoms. Androgenetic alopecia severity can be diagnosed by trichoscopy in addition to Hamilton‐Norwood scale.

https://ift.tt/2StVzgz

Mutilating genital aphthous ulceration causing perforation in two women

https://ift.tt/2rlQtHF

Zosteriform lymphangitis carcinomatosis in the cervical area arising from pyriform fossa adenocarcinoma

https://ift.tt/2GeseFR

Mutilating genital aphthous ulceration causing perforation in two women

https://ift.tt/2rlQtHF

Zosteriform lymphangitis carcinomatosis in the cervical area arising from pyriform fossa adenocarcinoma

https://ift.tt/2GeseFR

Chronic mercury exposure and blood pressure in children and adolescents: a systematic review

Abstract

The aim of this paper is to systematically review the scientific literature on the possible relation of chronic mercury exposure and blood pressure among children and adolescents. We searched for observational studies in 6 electronic databases and grey literature for English, French or Spanish language studies published up to 30^th November 2017. We performed a quality assessment of primary studies. We identified 8 articles involving 5 cohorts, 1 cross-sectional study and 1 case-control study. The participants had mean ages of between 3 and 17 years. Mercury was analysed in different matrices and periods of exposure. Four articles evaluated prenatal exposure, 2 evaluated both prenatal and postnatal exposures and 2 postnatal exposure. Blood pressure was measured according to different protocols. The association between mercury and blood pressure was adjusted by different covariates in each study. Four articles found a positive significant association between chronic mercury exposure and blood pressure in children or adolescents. Among these 4 articles, three of them evaluated prenatal exposure. There are still few studies assessing chronic mercury exposure and blood pressure in children and adolescents with inconsistency in results. Designs are very heterogeneous, which hampers their comparability. Evidence of this association is scarce and further research is needed.

https://ift.tt/2E7SpLJ

Spatial identification of environmental health hazards potentially associated with adverse birth outcomes

Abstract

Reduced birth weight (RBW) and reduced head circumference (RHC) are adverse birth outcomes (ABOs), often linked to environmental exposures. However, spatial identification of specific health hazards, associated with these ABOs, is not always straightforward due to presence of multiple health hazards and sources of air pollution in urban areas. In this study, we test a novel empirical approach to the spatial identification of environmental health hazards potentially associated with the observed RHC and RBW patterns. The proposed approach is implemented as a systematic search, according to which alternative candidate locations are ranked based on the strength of association with the observed birth outcome patterns. For empirical validation, we apply this approach to the Haifa Bay Area (HBA) in Israel, which is characterized by multiple health hazards and numerous sources of air pollution. We identified a spot in the local industrial zone as the main risk source associated with the observed RHC and RBW patterns. Multivariate regressions, controlling for personal, neighborhood, and geographic factors, revealed that the relative risks of RHC and RBW tend to decline, other things being equal, as a function of distance from the identified industrial spot. We recommend the proposed identification approach as a preliminary risk assessment tool for environmental health studies, in which detailed information on specific sources of air pollution and air pollution dispersion patterns is unavailable due to limited reporting or insufficient monitoring.

https://ift.tt/2QBzFdT

Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes

Objectives/Hypothesis

Currently, due to the rarity of pathology, there are limited data surrounding outcomes of pediatric skull base surgery. Traditionally, surgeons have proceeded with caution when electing endonasal endoscopic transsellar/transplanum approaches to the skull base in pediatric patients due to poor sphenoid pneumatization. In this study, we review outcomes of endoscopic pediatric skull base surgery based on sphenoid pneumatization patterns.

Study Design

Retrospective chart review.

Methods

A review of all cases of pediatric (age < 18 years) craniopharyngioma managed via an endoscopic endonasal approach at a tertiary academic medical center.

Results

A total of 27 patients were included in the analysis. The median age was 8 years. Nineteen (70%) patients were male. Presellar, sellar/postsellar, and conchal sphenoid pneumatizations were found in 6, 11, and 10 patients, respectively. There was no significant association between sphenoid pneumatization pattern and extent of resection (gross vs. subtotal, P = .414), postoperative cerebrospinal fluid (CSF) leak (P = .450), intraoperative estimated blood loss (P = .098), total operative time (P = .540), and length of stay (P = .336). On multivariate analysis, after accounting for age, sex, preoperative cranial nerve involvement, and cavernous sinus invasion, there remained no significant association between sphenoid pneumatization pattern and extent of resection (P = .999) and postoperative CSF leak (P = .959).

Conclusions

Sphenoid pneumatization pattern does not appear to affect outcomes in endoscopic skull base surgery in the pediatric population. Importantly, lack of sphenoid pneumatization does not impede gross total resection or increase complications. Thorough knowledge of the anatomy during the endoscopic approach is critical to optimize outcomes.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2E3QdET

Treatment Outcomes and Sensitivity to Hormone Therapy of Aggressive Angiomyxoma: A Multicenter, International, Retrospective Study

AbstractBackground.Aggressive angiomyxoma (AA) is a rare, locally aggressive tumor usually arising from pelvis or perineum, with a high local‐recurrence rate after complete surgery. Anecdotal responses to hormone therapy have been reported. In the present study we aimed at studying surgical treatment outcomes and sensitivity to hormone therapy of AA.Materials and Methods.We conducted a multicenter, international retrospective effort including patients with AA treated at three European referral centers (Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy and the Italian Rare Cancer Network; Centre Léon Bérard, Lyon, France; and Hospital Universitario Virgen del Rocio, Seville, Spain).Results.A total of 36 patients were included. Median follow‐up was 51.3 months. Thirty‐three patients (92%) underwent complete (R0 + R1) surgery, with a local relapse rate of 50% and a median relapse‐free survival of 39 months (95% confidence interval [CI], 27–68.1). Thirteen patients received a first‐line systemic treatment with hormone therapy for locally advanced disease, with an overall response rate of 62% and a median progression‐free survival of 24.6 months (95% CI, 11.0–39.7). In two patients, adding an aromatase inhibitor (AI) on progression to first‐line GnRH agonist (GnRHa) resulted in a new tumor response.Conclusion.Our findings confirm that in AA, surgical local control may be challenging, with a significant rate of local relapse despite complete surgery. Hormone therapy is an active treatment option, with a potential of disease control and of being combined with surgery. The addition of an AI to first‐line GnRHa could be an effective second‐line systemic therapy in premenopausal female patients with AA.Implications for Practice.In this retrospective effort including 36 patients with aggressive angiomyxoma, local relapse rate after complete surgery was 50%, with a median relapse‐free survival of 39 months, confirming that local control is challenging. Overall response rate to first‐line hormone therapy was 62%, with a median progression‐free survival of 24.6 months. Thus, hormone therapy has a potential of disease control and of being combined with surgery.

https://ift.tt/2zM4aV7

Mixed Invasive Ductal and Lobular Carcinoma of the Breast: Prognosis and the Importance of Histologic Grade

AbstractBackground.The diagnosis of mixed invasive ductal and lobular carcinoma (IDC‐L) in clinical practice is often associated with uncertainty related to its prognosis and response to systemic therapies. With the increasing recognition of invasive lobular carcinoma (ILC) as a distinct disease subtype, questions surrounding IDC‐L become even more relevant. In this study, we took advantage of a detailed clinical database to compare IDC‐L and ILC regarding clinicopathologic and treatment characteristics, prognostic power of histologic grade, and survival outcomes.Materials and Methods.In this retrospective cohort study, we identified 811 patients diagnosed with early‐stage breast cancer with IDC‐L or ILC. Descriptive statistics were performed to compare baseline clinicopathologic characteristics and treatments. Survival rates were subsequently analyzed using the Kaplan–Meier method and compared using the Cox proportional hazards model.Results.Patients with ILC had more commonly multifocal disease, low to intermediate histologic grade, and HER2‐negative disease. Histologic grade was prognostic for patients with IDC‐L but had no significant discriminatory power in patients with ILC. Among postmenopausal women, those with IDC‐L had significantly better outcomes when compared with those with ILC: disease‐free survival (DFS) and overall survival (OS; adjusted hazard ratio [HR], 0.54; 95% confidence interval [CI] 0.31–0.95). Finally, postmenopausal women treated with an aromatase inhibitor had more favorable DFS and OS than those treated with tamoxifen only (OS adjusted HR, 0.50; 95% CI, 0.29–0.87), which was similar for both histologic types (p = .212).Conclusion.IDC‐L tumors have a better prognosis than ILC tumors, particularly among postmenopausal women. Histologic grade is an important prognostic factor in IDC‐L but not in ILC.Implications for Practice.This study compared mixed invasive ductal and lobular carcinoma (IDC‐L) with invasive lobular carcinomas (ILCs) to assess the overall prognosis, the prognostic role of histologic grade, and response to systemic therapy. It was found that patients with IDC‐L tumors have a better prognosis than ILC, particularly among postmenopausal women, which may impact follow‐up strategies. Moreover, although histologic grade failed to stratify the risk of ILC, it showed an important prognostic power in IDC‐L, thus highlighting its clinical utility to guide treatment decisions of IDC‐L. Finally, the disease‐free survival advantage of adjuvant aromatase inhibitors over tamoxifen in ILC was consistent in IDC‐L.

https://ift.tt/2Pkx3wl

Neoadjuvant Chemotherapy Use for Nonmetastatic Breast Cancer at Five Public South African Hospitals and Impact on Time to Initial Cancer Therapy

AbstractBackground.In the U.S., neoadjuvant chemotherapy (NAC) for nonmetastatic breast cancer (BC) is used with extensive disease and aggressive molecular subtypes. Little is known about the influence of demographic characteristics, clinical factors, and resource constraints on NAC use in Africa.Materials and Methods.We studied NAC use in a cohort of women with stage I–III BC enrolled in the South African Breast Cancer and HIV Outcomes study at five hospitals. We analyzed associations between NAC receipt and sociodemographic and clinical factors, and we developed Cox regression models for predictors of time to first treatment with NAC versus surgery.Results.Of 810 patients, 505 (62.3%) received NAC. Multivariate analysis found associations between NAC use and black race (odds ratio [OR] 0.49; 95% confidence limit [CI], 0.25–0.96), younger age (OR 0.95; 95% CI, 0.92–0.97 for each year), T‐stage (T4 versus T1: OR 136.29; 95% CI, 41.80–444.44), N‐stage (N2 versus N0: OR 35.64; 95% CI, 16.56–76.73), and subtype (triple‐negative versus luminal A: OR 5.16; 95% CI, 1.88–14.12). Sites differed in NAC use (Site D versus Site A: OR 5.73; 95% CI, 2.72–12.08; Site B versus Site A: OR 0.37; 95% CI, 0.16–0.86) and time to first treatment: Site A, 50 days to NAC versus 30 days to primary surgery (hazard ratio [HR] 1.84; 95% CI, 1.25–2.71); Site D, 101 days to NAC versus 126 days to primary surgery (HR 0.49; 95% CI, 0.27–0.89).Conclusion.NAC use for BC at these South African hospitals was associated with both tumor characteristics and heterogenous resource constraints.Implications for Practice.Using data from a large breast cancer cohort treated in South Africa's public healthcare system, the authors looked at determinants of neoadjuvant chemotherapy use and time to initiate treatment. It was found that neoadjuvant chemotherapy was associated with increasing tumor burden and aggressive molecular subtypes, demonstrating clinically appropriate care in a lower resource setting. Results of this study also showed that time to treatment differences between chemotherapy and surgery varied by hospital, suggesting that differences in resource limitations were influencing clinical decision making. Practice guidelines and care quality metrics designed for low‐ and middle‐income countries should accommodate heterogeneity of available resources.

https://ift.tt/2zKrNgF

Predictors of Survival in Patients with Advanced Gastrointestinal Malignancies Admitted to the Intensive Care Unit

AbstractBackground.Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). We sought to evaluate the predictors for outcome in patients with gastrointestinal (GI) cancer admitted to the ICU for nonsurgical conditions.Patients and Methods.The primary objective was to determine the predictors of hospital mortality. Secondary objectives included investigating the predictors of ICU mortality and hospital overall survival (OS). All patients with GI cancer admitted to the ICU at the University of Texas MD Anderson Cancer Center between November 2012 and February 2015 were retrospectively analyzed. Cancer characteristics, treatment characteristics, and Sequential Organ Failure Assessment (SOFA) scores were analyzed for their effects on survival.Results.The characteristics of the 200 patients were as follows: 64.5% male, mean age of 60 years, median SOFA score of 6.7, and tumor types of intestinal (37.5%), hepatobiliary/pancreatic (36%), and gastroesophageal (24%). The hospital mortality was 41%, and overall 6‐month mortality was 75%. In multivariate analysis, high admission SOFA score > 5, poor tumor differentiation, and duration of metastatic disease ≤7 months were associated with increased hospital mortality. For OS, high admission SOFA score > 5, poor tumor differentiation, and patients who were not on active chemotherapy because of poor performance had worse outcome. In multivariate analysis, SOFA score remained significant for OS even after excluding patients who died in the ICU.Conclusion.For patients with metastatic GI cancer admitted to the ICU, SOFA score was predictive for both acute and long‐term survival. A patient's chemotherapy treatment status was not predictive for hospital mortality but was for OS. The SOFA score should be utilized in all patients with GI cancer upon ICU admission for prognostication.Implications for Practice.Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). Although there have been substantial increases in duration of survival for patients with advanced metastatic cancer, their mortality after an ICU admission remains high. GI malignancy is considered one of the top three lethal cancers estimated in 2017. Survival of critically ill patients with advanced GI cancer should be evaluated to help guide treatment planning.

https://ift.tt/2PnoaSE

Der Mini-Audio-Test (MAT) – eine Screeningmethode auf Schwerhörigkeit für Haus- und Fachärzte

Laryngo-Rhino-Otol
DOI: 10.1055/a-0805-5741

Hintergrund In Deutschland leiden etwa 15 Millionen Menschen an einer Schwerhörigkeit (SH), doch nur 16 % tragen Hörgeräte. Diese Unterversorgung kann für die Betroffenen zu schwerwiegenden Folgen (soziale Isolation, Depression, Förderung einer Demenz etc.) führen. Ein frühzeitiges und flächendeckendes Hörscreening ab dem 50. Lebensjahr kann dies verbessern. In dieser Studie wurde der Mini-Audio-Test (MAT), ein sechs Fragen zum subjektiven Hörverlust (HV) umfassender Test mit dreistufiger Antwortskala, an einem Normalkollektiv überprüft (Sensitivität (Se), Spezifität (Sp), positiver prädiktiver Wert (PPW)). Methode Es wurden 943 Patienten (älter als 50 Jahre) ohne bekannte Ohrenerkrankungen mittels MAT befragt, zum Vergleich die Hörschwellen tonaudiometrisch ermittelt und die Se, Sp und der PPW zur Detektion eines relevanten HV durch den MAT für die Altersklassen < 60 Jahre (AG1) und ≥ 60 Jahre (AG2) mittels binomialer Proportionen ermittelt. Ergebnisse Die Se lag für AG1 bei 0,66, die Sp bei 0,61, der PW bei 0,60, für die AG2 lag die Se bei 0,47, die Sp bei 0,80, der PPW bei 0,89. Schlussfolgerung Entsprechend der vorliegenden Ergebnisse wird der Einsatz des MAT als Screeningmethode für Nicht-HNO-Ärzte zur Detektion von schwerhörenden Patienten ab dem 50. Lebensjahr vorgeschlagen. Hierdurch ließen sich auch schwerwiegende Begleiterkrankungen wie Minderung der kognitiven Leistungsfähigkeit, Sturzrisiko, Depression und Demenz positiv beeinflussen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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

https://ift.tt/2rm7uBw

Risk factors and distribution features of level IB lymph nodes metastasis in nasopharyngeal carcinoma

The objective of this study is to investigate the risk factors and distribution features for level IB metastasis in nasopharyngeal carcinoma (NPC) and provide clinical evidence for defining the indications and clinical target volume (CTV) of prophylactic level IB irradiation.

https://ift.tt/2SwcZJj

Increased risk of incident thyroid diseases in people with psoriatic disease: A cohort study

●Patients with psoriasis are associated with an increase in incident thyroid diseases including hyperthyroidism, Grave's disease, hypothyroidism, and Hashimoto's thyroiditis. This risk is further increased in those with psoriatic arthritis.●Our findings may serve as a guide for risk stratification for thyroid disease among patients with psoriatic disease.

https://ift.tt/2Str7TR

Segmental phenol-Croton oil chemical peels for treatment of periorbital or perioral rhytides

https://ift.tt/2KZX9En

Correction

https://ift.tt/2BTw5nw

Correction

https://ift.tt/2KYWy5H

Correction

https://ift.tt/2BTvYZ8

REPLY to JAAD-D-18-01922: ‘‘Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up’’

https://ift.tt/2KWfZMN

Correction

https://ift.tt/2BSETdi

Eosinophilic dermatosis of hematologic malignancy: a retrospective cohort of 37 patients from an Italian center

https://ift.tt/2KWfYZf

Comment on ‘‘Folliculitis decalvans: Effectiveness of therapies and prognostic factors in a multicenter series of 60 patients with long-term follow-up’’

https://ift.tt/2BSojKD

Patient Comfort and Expectations for Total Body Skin Exams: A Cross-Sectional Study

https://ift.tt/2KZKBNk

“Vitiligo and major depressive disorder: a bidirectional population-based cohort study”

•It is known that patients with vitiligo are at risk for depression; however this study demonstrated an increased risk of vitiligo in patients with depression, which may be due to immune dysregulation.•Clinicians treating vitiligo patients should be aware of this bidirectional relationship and refer for mental health services accordingly.

https://ift.tt/2BTvGBw

The enhanced lipid productivity of Chlorella minutissima and Chlorella pyrenoidosa by carbon coupling nitrogen manipulation for biodiesel production

Abstract

Biodiesel production from microalgae has been researched extensively and attempted to commercialize on a large scale, but there are major hurdles in the production process like harvesting and low lipid content, which should be studied to enhance the process and make it economical. Present study aimed to improve the lipid productivity of Chlorella minutissima and Chlorella pyrenoidosa by modifying the carbon and nitrogen content of the medium. Both organisms were grown in BG11 medium for the first 6 days and thereafter grown in a modified BG11 medium completely deprived of nitrogen for 2 to 10 days. Nitrogen deprivation increased the lipid productivity of Chlorella minutissima to 20% and that of Chlorella pyrenoidosa to 17.6% by day 6. This was further coupled with carbon addition in the form of citric acid (5 g/L), sodium acetate (5 g/L), sodium carbonate (5 g/L), and sodium potassium tartarate (5 g/L), which increased the total lipid productivity of Chlorella minutissima up to 24% and that of Chlorella pyrenoidosa up to 23%. The highest lipid productivity of up to 24% for Chlorella minutissima and up to 23% for Chlorella pyrenoidosa was observed with nitrogen deprivation coupled with sodium acetate. Acidic transesterification revealed the presence of fatty acid methyl esters, majority of which consisted of hexadecanoic acid methyl ester and octadecanoic acid methyl ester. Maximum of 3% fatty acid methyl esters for Chlorella minutissima and 4% for Chlorella pyrenoidosa were obtained under nitrogen deprivation and sodium acetate as a carbon source. Thus, nitrogen deprivation coupled with sodium acetate as an increased carbon source in BG11 medium helps to increase the lipid productivity of Chlorella minutissima and Chlorella pyrenoidosa, and produces long-chain fatty acid methyl esters of C17 and C19 along with C21, C25, and C29.

https://ift.tt/2E2PIL5

A Case of Thyrotoxicosis due to Simultaneous Occurrence of Subacute Thyroiditis and Graves' Disease.

A Case of Thyrotoxicosis due to Simultaneous Occurrence of Subacute Thyroiditis and Graves' Disease.

Case Rep Endocrinol. 2018;2018:3210317

Authors: Kageyama K, Kinoshita N, Daimon M

Abstract
Subacute thyroiditis is an inflammatory disorder of the thyroid. Graves' disease is an autoimmune thyroid disease in which thyroid hormones are overproduced. Here we present a rare case of thyrotoxicosis due to the simultaneous occurrence of both diseases. Prompt diagnosis and therapy are required to prevent complications in patients with thyrotoxicosis.

PMID: 30510812 [PubMed]

https://ift.tt/2zHJMUK

Three‐dimensional structure of the wheat β‐amylase Tri a 17, a clinically relevant food allergen

https://ift.tt/2EfTYI2

The relationship of habitual diet with oesophageal inflammation and integrity in Eosinophilic Esophagitis

https://ift.tt/2Sty5rS

Smoking habits among adolescents with asthma – data from a population based birth cohort

https://ift.tt/2EeGjB7

Long‐term outcomes in chronic hypersensitivity pneumonitis

Abstract

Introduction

The objective of this study was to analyze mortality, possible predictors of long‐term survival and health‐related quality of life of a large chronic hypersensitivity pneumonitis (CHP) patient sample.

Methods

Longitudinal study in patients diagnosed with CHP during 2004‐2013, followed for at least one year. Patients remaining alive and consenting to participate had a follow‐up visit during 2015, including a complete pulmonary function study and the EuroQol‐5D and Beck Depression and Anxiety Inventories.

Results

Out of the 160 patients finally included, 87 remained alive. Seventy‐three had died or underwent lung transplantation at the time of the study with a median survival of 7.0 (4.4‐14.5) years. A Cox proportional risk model showed that factors associated with lower survival were: increased age, a low percentage of lymphocytes in bronchoalveolar lavage (BAL), a decreased transfer factor of the lung for carbon monoxide (DLCO), presence of honeycomb in the high resolution chest scan (HRCT) and the usual interstitial pneumonia (UIP) histologic pattern. At follow‐up all patients presented an EuroQol‐5D score < 0.8 and 21(50%) and 9(28.6%) subjects presented a probable anxiety and depressive syndrome, respectively.

Conclusion

CHP is a severe disease with a bad mid‐term prognosis. Lymphocyte values in BAL and DLCO values at baseline, presence of honeycomb in HRCT and UIP histologic pattern were found to be predictors of survival. Early accurate diagnosis of the disease is fundamental for prompt initiation of antigen avoidance.

This article is protected by copyright. All rights reserved.

https://ift.tt/2StxZR2

The WHO/IUIS Allergen Nomenclature

Summary

The WHO/IUIS Allergen Nomenclature Sub‐Committee (http://www.allergen.org/), an international body of experts, has developed an allergen nomenclature system to provide a common language for unambiguous communications between researchers, clinicians, pharmaceutical companies and regulatory authorities regarding specific allergenic proteins. Official allergen names are only assigned by the WHO/IUIS Nomenclature Sub‐Committee once a new allergen has successfully undergone the submission and evaluation process. This article highlights the necessary steps to obtain an official allergen name and the high importance of having an official allergen nomenclature.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Eii5pu

Does isotretinoin cause depression and anxiety in acne patients?

Background

Acne is the most common skin disease, and isotretinoin is the most powerful drug amongst the various drugs used for its treatment. A causal relationship has not yet been established between isotretinoin use and depression.

Objectives

The aim of this study is to research the effect of isotretinoin treatment on depression in a group of patients undergoing isotretinoin therapy.

Methods

Behavioral tests measuring anxiety and depression, and the measures assessing acne severity and quality of life were applied to 112 acne patients consulted at Dermatology Clinic of Beyazit Medico Social Center of Istanbul University.

Results

In this study, 72 acne patients (61 female and 11 male) were evaluated. A significant decrease was observed in HAD‐D, GAGS and CADI scores at the end of the therapy. There was no significant relationship between patients' depression history and HAD‐D scores at the end of first month of therapy and at the end of treatment.

Conclusion

Although the psychiatrists are concerned about the potential psychiatric side effects of isotretinoin, our data support no causal relationship between isotretinoin use and depression in acne patients.

This article is protected by copyright. All rights reserved.

https://ift.tt/2GbgnrI

Alitretinoin for palmoplantar keratodermas: a novel case and review of the literature

Papillon‐Lefèvre syndrome (PLS) is a rare, autosomal recessive disorder of keratinization, characterized by palmoplantar keratoderma (PPK) and severe chronic periodontitis which leads to an early loss of primary and permanent teeth. Oral retinoids, such as etretinate, isotretinoin and acitretin, represent the most important therapeutic options for keratoderma of PLS, with varying results in terms of efficacy. We report here the first case of 55‐year‐old woman diagnosed with PLS treated with alitretinoin.

This article is protected by copyright. All rights reserved.

https://ift.tt/2rnoXcJ

When IL‐17 inhibitors fail: real‐life evidence to switch from secukinumab to adalimumab or ustekinumab

Psoriasis is a chronic, systemic inflammatory disease that in the moderate to severe forms may benefit of biologics, namely TNF and IL‐12/23 and IL‐17 inhibitors. Loss of response, lack of response or discontinuation due to adverse events represent a concrete therapeutic challenge for dermatologists that have to switch patients to other treatments. Although some evidences already exist toward the switch from IL‐12/23 and TNF inhibitors to IL‐17 inhibitors, conversely nothing is present toward the switch from IL‐17 inhibitors to IL‐12/23 and TNF inhibitors. We performed a real‐life study enrolling 50 patients randomly switched to adalimuamb, a TNF inhibitor, or ustekinumab, an IL‐12/23 inhibitor. Our observational study suggests that switching from IL‐17i to TNFi and IL‐12/23i is a safe and effective therapeutic strategy.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Gdy0rh

Clindamycin as Unique Antibiotic Choice in Hidradenitis Suppurativa

Background and Objective

The Rifampicin (RF) ‐ Clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy.

The aim of this study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS.

Methods

In the period January 2017 ‐ May 2018 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by J.E. Revuz, Hidradenitis Suppurativa Physician Global Assessment/HS‐PGA and International Hidradenitis Suppurativa Severity Score System/IHS4) before (W0) and after (W12) CL oral therapy.

Results

CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12‐week period (p≤0.01). There was also a statistically significant change in the mean VAS for pain.

Conclusions

This study demonstrates the efficacy of oral CL monotherapy as RF‐sparing regimen alternative to RF‐CL combination in a selected group of patients.

This article is protected by copyright. All rights reserved.

https://ift.tt/2rnoQOl

Does isotretinoin cause depression and anxiety in acne patients?

Background

Acne is the most common skin disease, and isotretinoin is the most powerful drug amongst the various drugs used for its treatment. A causal relationship has not yet been established between isotretinoin use and depression.

Objectives

The aim of this study is to research the effect of isotretinoin treatment on depression in a group of patients undergoing isotretinoin therapy.

Methods

Behavioral tests measuring anxiety and depression, and the measures assessing acne severity and quality of life were applied to 112 acne patients consulted at Dermatology Clinic of Beyazit Medico Social Center of Istanbul University.

Results

In this study, 72 acne patients (61 female and 11 male) were evaluated. A significant decrease was observed in HAD‐D, GAGS and CADI scores at the end of the therapy. There was no significant relationship between patients' depression history and HAD‐D scores at the end of first month of therapy and at the end of treatment.

Conclusion

Although the psychiatrists are concerned about the potential psychiatric side effects of isotretinoin, our data support no causal relationship between isotretinoin use and depression in acne patients.

This article is protected by copyright. All rights reserved.

https://ift.tt/2GbgnrI

Alitretinoin for palmoplantar keratodermas: a novel case and review of the literature

Papillon‐Lefèvre syndrome (PLS) is a rare, autosomal recessive disorder of keratinization, characterized by palmoplantar keratoderma (PPK) and severe chronic periodontitis which leads to an early loss of primary and permanent teeth. Oral retinoids, such as etretinate, isotretinoin and acitretin, represent the most important therapeutic options for keratoderma of PLS, with varying results in terms of efficacy. We report here the first case of 55‐year‐old woman diagnosed with PLS treated with alitretinoin.

This article is protected by copyright. All rights reserved.

https://ift.tt/2rnoXcJ

When IL‐17 inhibitors fail: real‐life evidence to switch from secukinumab to adalimumab or ustekinumab

Psoriasis is a chronic, systemic inflammatory disease that in the moderate to severe forms may benefit of biologics, namely TNF and IL‐12/23 and IL‐17 inhibitors. Loss of response, lack of response or discontinuation due to adverse events represent a concrete therapeutic challenge for dermatologists that have to switch patients to other treatments. Although some evidences already exist toward the switch from IL‐12/23 and TNF inhibitors to IL‐17 inhibitors, conversely nothing is present toward the switch from IL‐17 inhibitors to IL‐12/23 and TNF inhibitors. We performed a real‐life study enrolling 50 patients randomly switched to adalimuamb, a TNF inhibitor, or ustekinumab, an IL‐12/23 inhibitor. Our observational study suggests that switching from IL‐17i to TNFi and IL‐12/23i is a safe and effective therapeutic strategy.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Gdy0rh

Clindamycin as Unique Antibiotic Choice in Hidradenitis Suppurativa

Background and Objective

The Rifampicin (RF) ‐ Clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy.

The aim of this study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS.

Methods

In the period January 2017 ‐ May 2018 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by J.E. Revuz, Hidradenitis Suppurativa Physician Global Assessment/HS‐PGA and International Hidradenitis Suppurativa Severity Score System/IHS4) before (W0) and after (W12) CL oral therapy.

Results

CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12‐week period (p≤0.01). There was also a statistically significant change in the mean VAS for pain.

Conclusions

This study demonstrates the efficacy of oral CL monotherapy as RF‐sparing regimen alternative to RF‐CL combination in a selected group of patients.

This article is protected by copyright. All rights reserved.

https://ift.tt/2rnoQOl

Dysphagia diagnosis with questionnaire, tongue strength measurement, and FEES in patients with childhood-onset muscular dystrophy

Publication date: Available online 5 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Athanasia Printza, Charalambos Goutsikas, Stefanos Triaridis, Athanasios Kyrgidis, Katerina Haidopoulou, Jannis Constantinidis, Evagelos Pavlou

https://ift.tt/2EhIzYz

Does suturing tonsil pillars post-tonsillectomy reduce postoperative hemorrhage?: A Literature Review

Publication date: Available online 4 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jacqueline A. Wulu, Melissa Chua, Jessica R. Levi

Abstract

Objective

Literature review comparing post-tonsillectomy hemorrhage in pediatric and adult patients with and without suturing tonsil pillars to investigate whether suturing tonsil pillars reduces the risk of post-tonsillectomy hemorrhage.

Review

methods; Online journal databases were searched using the key phrases "post tonsillectomy hemorrhage", "post tonsillectomy bleed", and "tonsil pillar suture". 10 published studies were found regarding tonsil pillar suturing, four directly related to postoperative bleeding and five focusing on postoperative pain reduction. There was one study that evaluated both pain and bleeding. The pain reduction studies were comprised of 225 patients while the postoperative bleeding studies included 3987 patients.

Conclusions

Suturing tonsil pillars after tonsillectomy may be beneficial after cold tonsillectomy.

Implications for practice; Post-operative bleeding is one of the most common complications that can result in increased patient distress and hospitalization. In this article, we provide literature review of tonsil pillar suturing and post-tonsillectomy hemorrhage. Our study suggests suturing the tonsil pillars immediately post-tonsillectomy may reduce the risk of severe post-operative bleeding requiring return to the operating room for certain patients.

https://ift.tt/2SwSFaH

Uncertain diagnosis and prognosis in advanced melanoma: A qualitative study of the experiences of bereaved carers in a time of immune and targeted therapies

Abstract

Background

Recent advances in advanced melanoma therapies are associated with improved survival for some patients. How patients with diagnoses of advanced disease and their carers experience this expanding treatment paradigm, however, is not well understood.

Objectives

We explored bereaved carers' accounts of the trajectory of advanced melanoma involving treatment by immune or targeted therapies to build an understanding of their experiences of care relating to diagnosis and prognosis.

Methods

A qualitative exploratory design, using methods drawn from grounded theory was adopted. Analyses drew on in‐depth interviews with 20 bereaved carers from three metropolitan melanoma treatment centres in Australia. A flexible interview guide and a structured approach of concurrent data collection and analysis were applied.

Results

Carers described qualities of the experience including the shock of diagnosis after a sometimes‐innocuous presentation with vague symptoms. They reported an unclear prognosis with complexity arising from interplay between an uncertain disease trajectory and often ambiguous expectations of outcomes of emerging immune and targeted therapies. Uncertainty dominated carers' experiences, increasing the complexity of care planning.

Conclusions

Effective communication of an advanced melanoma diagnosis and prognosis is critical. Recognition of the uncertainty inherent in the benefit of immune and targeted therapies in a constructive manner may facilitate more timely and effective care planning conversations between patients, carers and medical specialists.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BSguUZ

Notch dysregulation and HS: let's talk about Numb

Abstract

We read with great interest the article by J. W. Frew regarding Notch Dysregulation as an Epiphenomenon in Inflammatory Skin Diseases.¹ The paper pointed out some controversies among Notch activity and keratinocyte proliferation as well as maturation in Hidradenitis Suppurativa (HS), Psoriasis, Atopic Dermatitis and Lichen Planus. Because of a recognized involvement of Notch in HS, but at the same time still not clear, we also explored other components of the same signalling.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KVyYaf

The illusion of conventional histological resection margin control

Abstract

An advantage of surgical treatment for basal cell carcinoma (BCC) over other therapeutic options is the possibility of histological margin control. The general understanding is that only 1‐2% of the actual margins are checked histologically using the 'bread loaf' or step sectioning technique for conventional excision specimens, but the percentage of resection margins that are microscopically evaluated have not actually been quantified to date. [1, 2] This study's objective was to calculate the mean percentage of resection margins of BCC excision specimens that is histologically evaluated.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BRkTYf

Diagnostic accuracy of ex vivo fluorescence confocal microscopy for Mohs surgery of basal cell carcinomas: a prospective study on 753 margins

Abstract

Background

Frozen histological sections are currently used for intra‐operative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool, which offers a promising and faster alternative to frozen histology.

Objective

The aim of the present study is to prospectively evaluate in a clinical setting, the accuracy of FCM as compared to frozen sections in BCC's margin assessment.

Methods

Patients with BCC, scheduled for Mohs surgery were prospectively enrolled. Freshly‐excised surgical specimens were first examined through FCM and then frozen sections were evaluated. Permanent sections were finally obtained, in order to validate our sample technique.

A blind re‐evaluation was also performed for discordant cases between FCM and frozen sections.

Sensitivity and specificity levels, as well as positive and negative predicting values were calculated and ROC curves were generated.

Results

We enrolled 127 BCCs in as many patients (40.2% females). A total number of 753 sections were examined. All BCCs were located on the head and neck area. When evaluating the performance of FCM as compared to frozen sections 79.8% sensitivity, 95.8% specificity, 80.5% positive predicting and 95.7% negative predicting values were found (Area Under the Curve: .88, 95%CI .84‐.92; P<.001). A total of 49 discordant cases between FCM and frozen sections evaluations were blindly re‐evaluated, of which 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment.

Conclusions

We found high levels of accuracy for FCM as compared to frozen sections evaluation, in intra‐operative BCC's margin assessment during Mohs surgery. Some technical issues still prevent a wide use of this technique, but new upcoming devices promise to overcome these limitations.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KVyVez

Correlation of the Refined Hurley Classification for Hidradenitis suppurativa with Patient Reported Quality of Life and Objective Disease Severity Assessment

Abstract

Background

Hidradenitis suppurativa (HS) is a chronic, debilitating, heterogeneous disease requiring different treatment approaches. Recently, we refined the classic Hurley classification into a seven‐stage classification in order to guide these treatment choices. This new classification subdivides Hurley stage I and II into three sub‐stages namely mild (A), moderate (B), and severe (C) HS disease. Hurley stage III is not sub‐categorised and always severe.

Aim

To investigate the correlation between the given severity grades of Hurley I and Hurley II in the refined Hurley classification, and the patient reported quality of life and physician‐assessed objective severity score.

Methods

In this cross‐sectional study, HS patients participating in the observational cohorts of two Dutch tertiary referral centres were included before June 2017. The patient reported Dermatology Life Quality Index (DLQI) and physician‐assessed International HS Severity Score System (IHS4) scores were compared between the refined Hurley stages.

Results

In total, 433 patients were analysed. DLQI and IHS4 scores increased within Hurley stage I and II from A through C. There was a significant positive correlation of DLQI and IHS4 with increasing refined Hurley sub‐stages (refined Hurley stage I (A, B, and C) to DLQI: r_s=0.259, p<0.001 and refined Hurley stage II (A, B, and C) to DLQI r_s=0.185, p=0.010; refined Hurley stage I (A, B, and C) to IHS4 r_s=0.603, p<0.001 and refined Hurley stage II (A, B, and C) to IHS4 r_s=0.532, p<0.001).

Conclusion

The refined Hurley classification accurately correlates with HS severity assessed by both patients and clinicians. Therefore, the refined Hurley classification is a useful tool for the quick assessment of severity in HS.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BSiQU4

Uncertain diagnosis and prognosis in advanced melanoma: A qualitative study of the experiences of bereaved carers in a time of immune and targeted therapies

Abstract

Background

Recent advances in advanced melanoma therapies are associated with improved survival for some patients. How patients with diagnoses of advanced disease and their carers experience this expanding treatment paradigm, however, is not well understood.

Objectives

We explored bereaved carers' accounts of the trajectory of advanced melanoma involving treatment by immune or targeted therapies to build an understanding of their experiences of care relating to diagnosis and prognosis.

Methods

A qualitative exploratory design, using methods drawn from grounded theory was adopted. Analyses drew on in‐depth interviews with 20 bereaved carers from three metropolitan melanoma treatment centres in Australia. A flexible interview guide and a structured approach of concurrent data collection and analysis were applied.

Results

Carers described qualities of the experience including the shock of diagnosis after a sometimes‐innocuous presentation with vague symptoms. They reported an unclear prognosis with complexity arising from interplay between an uncertain disease trajectory and often ambiguous expectations of outcomes of emerging immune and targeted therapies. Uncertainty dominated carers' experiences, increasing the complexity of care planning.

Conclusions

Effective communication of an advanced melanoma diagnosis and prognosis is critical. Recognition of the uncertainty inherent in the benefit of immune and targeted therapies in a constructive manner may facilitate more timely and effective care planning conversations between patients, carers and medical specialists.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BSguUZ

Notch dysregulation and HS: let's talk about Numb

Abstract

We read with great interest the article by J. W. Frew regarding Notch Dysregulation as an Epiphenomenon in Inflammatory Skin Diseases.¹ The paper pointed out some controversies among Notch activity and keratinocyte proliferation as well as maturation in Hidradenitis Suppurativa (HS), Psoriasis, Atopic Dermatitis and Lichen Planus. Because of a recognized involvement of Notch in HS, but at the same time still not clear, we also explored other components of the same signalling.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KVyYaf

The illusion of conventional histological resection margin control

Abstract

An advantage of surgical treatment for basal cell carcinoma (BCC) over other therapeutic options is the possibility of histological margin control. The general understanding is that only 1‐2% of the actual margins are checked histologically using the 'bread loaf' or step sectioning technique for conventional excision specimens, but the percentage of resection margins that are microscopically evaluated have not actually been quantified to date. [1, 2] This study's objective was to calculate the mean percentage of resection margins of BCC excision specimens that is histologically evaluated.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BRkTYf

Diagnostic accuracy of ex vivo fluorescence confocal microscopy for Mohs surgery of basal cell carcinomas: a prospective study on 753 margins

Abstract

Background

Frozen histological sections are currently used for intra‐operative margin assessment during Mohs surgery. Fluorescence confocal microscopy (FCM) is a new tool, which offers a promising and faster alternative to frozen histology.

Objective

The aim of the present study is to prospectively evaluate in a clinical setting, the accuracy of FCM as compared to frozen sections in BCC's margin assessment.

Methods

Patients with BCC, scheduled for Mohs surgery were prospectively enrolled. Freshly‐excised surgical specimens were first examined through FCM and then frozen sections were evaluated. Permanent sections were finally obtained, in order to validate our sample technique.

A blind re‐evaluation was also performed for discordant cases between FCM and frozen sections.

Sensitivity and specificity levels, as well as positive and negative predicting values were calculated and ROC curves were generated.

Results

We enrolled 127 BCCs in as many patients (40.2% females). A total number of 753 sections were examined. All BCCs were located on the head and neck area. When evaluating the performance of FCM as compared to frozen sections 79.8% sensitivity, 95.8% specificity, 80.5% positive predicting and 95.7% negative predicting values were found (Area Under the Curve: .88, 95%CI .84‐.92; P<.001). A total of 49 discordant cases between FCM and frozen sections evaluations were blindly re‐evaluated, of which 24 were false positive and 25 false negative. The performance of FCM and frozen sections was also evaluated according to the final histopathological assessment.

Conclusions

We found high levels of accuracy for FCM as compared to frozen sections evaluation, in intra‐operative BCC's margin assessment during Mohs surgery. Some technical issues still prevent a wide use of this technique, but new upcoming devices promise to overcome these limitations.

This article is protected by copyright. All rights reserved.

https://ift.tt/2KVyVez

Correlation of the Refined Hurley Classification for Hidradenitis suppurativa with Patient Reported Quality of Life and Objective Disease Severity Assessment

Abstract

Background

Hidradenitis suppurativa (HS) is a chronic, debilitating, heterogeneous disease requiring different treatment approaches. Recently, we refined the classic Hurley classification into a seven‐stage classification in order to guide these treatment choices. This new classification subdivides Hurley stage I and II into three sub‐stages namely mild (A), moderate (B), and severe (C) HS disease. Hurley stage III is not sub‐categorised and always severe.

Aim

To investigate the correlation between the given severity grades of Hurley I and Hurley II in the refined Hurley classification, and the patient reported quality of life and physician‐assessed objective severity score.

Methods

In this cross‐sectional study, HS patients participating in the observational cohorts of two Dutch tertiary referral centres were included before June 2017. The patient reported Dermatology Life Quality Index (DLQI) and physician‐assessed International HS Severity Score System (IHS4) scores were compared between the refined Hurley stages.

Results

In total, 433 patients were analysed. DLQI and IHS4 scores increased within Hurley stage I and II from A through C. There was a significant positive correlation of DLQI and IHS4 with increasing refined Hurley sub‐stages (refined Hurley stage I (A, B, and C) to DLQI: r_s=0.259, p<0.001 and refined Hurley stage II (A, B, and C) to DLQI r_s=0.185, p=0.010; refined Hurley stage I (A, B, and C) to IHS4 r_s=0.603, p<0.001 and refined Hurley stage II (A, B, and C) to IHS4 r_s=0.532, p<0.001).

Conclusion

The refined Hurley classification accurately correlates with HS severity assessed by both patients and clinicians. Therefore, the refined Hurley classification is a useful tool for the quick assessment of severity in HS.

This article is protected by copyright. All rights reserved.

https://ift.tt/2BSiQU4

Bone turnover markers, BMD and TBS after short-term, high-dose glucocorticoid therapy in patients with Graves’ orbitopathy: a small prospective pilot study

Abstract

Purpose

Chronic GC administration has numerous side effects, but little is known about the side effects of their short-term use (< 3 months)—particularly, when high doses are involved, as in the treatment of Graves' orbitopathy (GO). We investigated the effects of short-term, high-dose GC on bone turnover markers, bone mineral density (BMD), and trabecular bone scores (TBS).

Methods

Eleven patients (10 females and 1 male; median age 56 years) with active GO who were candidates for treatment with intravenous (iv) methylprednisone were consecutively enrolled. All patients were pretreated with a loading dose of 300,000 units of cholecalciferol, then given a median cumulative dose of 4.5 g (range 1.5–5.25 g) iv methylprednisone. Biochemical parameters of bone metabolism (25OHD3, PTH, P1NP, CTX and bALP) were measured at the baseline, and then 1 week and 1, 3, 6 and 12 months. BMD and TBS were obtained by X-ray absorptiometry (DXA) at the baseline and at 6 and 12 months. On DXA image, morphometric vertebral fracture assessment (VFA) was done.

Results

There were no significant changes in PTH, bALP or P1NP. A significant drop in CTX was seen at 1 month (down Δ49.31% from the baseline, p = 0.02), with a return to the baseline at the 3-month measurement. There was a moderate (not significant), but persistent reduction in P1NP. No changes in BMD or TBS came to light. No vertebral fractures were documented.

Conclusions

Short-term, high-dose GC treatment caused a rapid, transient suppression of bone resorption, with no effects on BMD or bone micro-architecture (TBS).

https://ift.tt/2Qid72N

Dermoscopy of angioleiomyoma: A case report

https://ift.tt/2zLnbXL

A rare association of paraneoplastic pemphigus with gastric signet cell ring carcinoma

https://ift.tt/2PlIeF4

Dermoscopy of angioleiomyoma: A case report

https://ift.tt/2zLnbXL

A rare association of paraneoplastic pemphigus with gastric signet cell ring carcinoma

https://ift.tt/2PlIeF4

Generalized pustular psoriasis complicated with bullous pemphigoid

https://ift.tt/2ASQJCn

Aggressive Squamous Cell Carcinoma in Organ Transplant Recipients

This case series describes the clinicopathologic features of and identifies factors associated with aggressive squamous cell carcinoma in solid organ transplant recipients.

https://ift.tt/2UcyZe9

Comparison of Injuries From Sharps Among Residents Within Dermatology and Other Medical Specialties

This study assesses whether the nature of injuries from sharps among dermatology residents is demonstrably different compared with injuries from sharps among residents in other medical and surgical specialties.

https://ift.tt/2AS4f9t

Use of Big Data to Estimate Defective DNA Repair Variants in the US Population

This molecular epidemiologic study examinsd 3 large exome sequence databases totaling more than 200 000 alleles to correlate disease-associated allele frequencies with the expected and reported prevalence of clinical disease.

https://ift.tt/2UhA4Bh

Cyclosporine-Induced Gingival Hypertrophy

This case report describes cyclosporine-induced gingival hypertrophy in a child with aplastic anemia.

https://ift.tt/2AVhq9H

In reply: Use of low-molecular weight dextran as an LA adjuvant to extend LA action

https://ift.tt/2RyGme0

Deep Brain Stimulation Surgery without Sedation

Background: Sedatives and opioids used during deep brain stimulation (DBS) surgery interfere with optimal target localization and add to side effects and risks, and thus should be minimized. Objective: To retrospectively test the actual need for sedatives and opioids when cranial nerve blocks and specific therapeutic communication are applied. Methods: In a case series, 64 consecutive patients treated with a strong rapport, constant contact, non-verbal communication and hypnotic suggestions, such as dissociation to a "safe place," reframing of disturbing noises and self-confirmation, were compared to 22 preceding patients under standard general anaesthesia or conscious sedation. Results: With introduction of the protocol the need for sedation dropped from 100% in the control group to 5%, and from a mean dose of 444 mg to 40 mg in 3 patients. Remifentanil originally used in 100% of the patients in an average dose of 813 µg was reduced in the study group to 104 µg in 31% of patients. There were no haemodynamic reactions indicative of stress during incision, trepanation, electrode insertion and closure. Conclusion: With adequate therapeutic communication, patients do not require sedation and no or only low-dose opioid treatment during DBS surgery, leaving patients fully awake and competent during surgery and testing.
Stereotact Funct Neurosurg

https://ift.tt/2Qv2lp9

Die adaptive Messung des Freiburger Einsilbertests im Störschall

Zusammenfassung

Hintergrund

Während sich die adaptive Messweise unter den Satztests etabliert hat, ist sie bei dem Freiburger Einsilbertest (FBE) als wichtigstem Vertreter der Worttests noch nicht angewendet worden. Da sich die Ergebnisse von Wort- und Satztests wegen der unterschiedlichen Messweise nicht vergleichen lassen, haben wir in dieser Studie einen adaptiven Messalgorithmus auf den FBE im Störschall übertragen, der sich bei Satztests bewährt hat. Die Ergebnisse des neuen Messverfahrens haben wir mit denen des Standards unter den Satztests, dem Oldenburger Satztest (OLSA), verglichen.

Methoden

An 40 otologisch gesunden Probanden wurde in randomisierter Reihenfolge sowohl der adaptiv gemessene FBE als auch der OLSA durchgeführt. Die Ergebnisse wurden bezüglich ihres Zeitbedarfs, möglicher geschlechtsspezifischer Unterschiede und der Reihenfolge der Sprachverstehenstests ausgewertet und hinsichtlich der Korrelation mit dem neuen Test untersucht.

Ergebnisse

Der Zeitbedarf für den adaptiven FBE war signifikant größer als für den OLSA. Bezüglich möglicher geschlechtsspezifischer Unterschiede oder der Präsentationsreihenfolge ließen sich keine signifikanten Unterschiede der Testergebnisse nachweisen. Der mittlere Signal-Rausch-Abstand für das 50 %-Sprachverstehen des OLSA war signifikant kleiner als der des FBE. Zwischen den Ergebnissen beider Tests konnte keine Korrelation nachgewiesen werden.

Schlussfolgerungen

Der FBE kann nicht nur den Diskriminationsverlust als Hörverlust in Prozent, sondern mit einem adaptiven Algorithmus auch die 50 %-Sprachverstehensschwelle messen. Der adaptive FBE ist zeitaufwendiger als der OLSA. Hinsichtlich einer möglichen fehlenden Korrelation der Ergebnisse für das 50 %-Sprachverstehen beider Tests sollten weitere Studien mit Schwerhörenden durchgeführt werden.

https://ift.tt/2PlHAYm

Comparison of microbiota and allergen profile in house dust from homes of allergic and non-allergic subjects- results from the GUSTO study

The prevalence of allergic diseases, such as asthma, allergic rhinitis, eczema and food allergy, has been increasing worldwide, as shown in a large number of studies, including the International Study of Asthm...

https://ift.tt/2Uhcpkz

Targeted disruption of PI3K/Akt/mTOR signaling pathway, via PI3K inhibitors, promotes growth inhibitory effects in oral cancer cells

Abstract

Purpose

The phosphoinositide-3-kinase (PI3K) pathway is the frequently altered in human cancer. This has led to the development and study of novel PI3K inhibitors for targeted therapy and also to overcome resistance to radiotherapy.

Method

The anti-tumour effects of PI3K inhibitors (PI-828, PI-103 and PX-866) in terms of cell proliferation, colony formation, induction of apoptosis, cell cycle arrest, invasion, autophagy, and pNF-κB/p65 translocation in SCC-4, SCC-9 and SCC-25 cells were studied by performing MTT, clonogenic, DAPI staining, propidium iodide staining, annexin-V binding, matrigel invasion, acridine orange staining and immuno-fluorescence assay. Western blot assay was performed to assess the alteration in the expression of various proteins.

Result

PI-828 and PI-103 treatment exhibited dose-dependent inhibition of growth and proliferation of OSCC cells with a concomitant induction of apoptosis, altered cell cycle regulation and decreased invasiveness (p < 0.01). PX-866 induced apoptosis, cell cycle arrest, autophagy and a significant decrease in the invasiveness of oral cancer cells as compared to untreated cells (p < 0.01). These compounds significantly reduced expression of COX-2, cyclin-D1 and VEGF in the treated cells besides cytoplasmic accumulation of pNF-κB/p65 protein. In addition to PI3Kα, inactivation of downstream components, i.e. Akt and mTOR was seen.

Conclusion

PI3K inhibitors such as PI-103, PI-828 and PX-866 may be developed as potential therapeutic agents for effective treatment of oral squamous cell carcinoma (OSCC) patients, associated with activated PI3K/Akt pathway.

https://ift.tt/2BSrWjK

Italian consensus for the classification and reporting of thyroid cytology: the risk of malignancy between indeterminate lesions at low or high risk. A systematic review and meta-analysis

Abstract

Background

Italian consensus for the classification and reporting of thyroid cytology has proposed to discriminate the cancer prevalence of high (Tir 3B) vs. low (Tir 3A) risk indeterminate nodules. To obtain more robust evidence on this topic, we performed a meta-analysis of the Odds Ratio (OR) of malignancy of Tir 3B vs. Tir 3A nodules.

Methods

A comprehensive literature exploration of online databases was conducted until May 2018. Original articles reporting histology of nodules cytologically classified as Tir 3A and Tir 3B were eligible. Pooled cancer prevalence in Tir 3A and Tir 3B, and OR of Tir 3B vs. Tir 3A were calculated.

Results

The search revealed 95 articles, and 10 were included for the meta-analysis. Overall, 1168 indeterminate lesions were reported (441 Tir 3A and 727 Tir 3B), of which 391 were cancers. The pooled cancer prevalence was 17% in Tir 3A and 47% in Tir 3B. The OR of Tir 3B vs. Tir 3A was 4.24 (95% CI 2.75 to 6.53) with mild heterogeneity and without publication bias. When we considered non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as non-malignant, cancer rate was lower, and OR of Tir 3B against Tir 3A was 2.93 (95% CI 1.60 to 5.37), with no heterogeneity but with publication bias.

Conclusions

The Italian system for thyroid cytology is reliable to assess indeterminate lesions at low and high risk, being Tir 3B associated with a cancer risk significantly higher than Tir 3A, also when considering NIFTP as non-malignant entity.

https://ift.tt/2rlEoCh

Italian consensus for the classification and reporting of thyroid cytology: the risk of malignancy between indeterminate lesions at low or high risk. A systematic review and meta-analysis

Abstract

Background

Italian consensus for the classification and reporting of thyroid cytology has proposed to discriminate the cancer prevalence of high (Tir 3B) vs. low (Tir 3A) risk indeterminate nodules. To obtain more robust evidence on this topic, we performed a meta-analysis of the Odds Ratio (OR) of malignancy of Tir 3B vs. Tir 3A nodules.

Methods

A comprehensive literature exploration of online databases was conducted until May 2018. Original articles reporting histology of nodules cytologically classified as Tir 3A and Tir 3B were eligible. Pooled cancer prevalence in Tir 3A and Tir 3B, and OR of Tir 3B vs. Tir 3A were calculated.

Results

The search revealed 95 articles, and 10 were included for the meta-analysis. Overall, 1168 indeterminate lesions were reported (441 Tir 3A and 727 Tir 3B), of which 391 were cancers. The pooled cancer prevalence was 17% in Tir 3A and 47% in Tir 3B. The OR of Tir 3B vs. Tir 3A was 4.24 (95% CI 2.75 to 6.53) with mild heterogeneity and without publication bias. When we considered non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as non-malignant, cancer rate was lower, and OR of Tir 3B against Tir 3A was 2.93 (95% CI 1.60 to 5.37), with no heterogeneity but with publication bias.

Conclusions

The Italian system for thyroid cytology is reliable to assess indeterminate lesions at low and high risk, being Tir 3B associated with a cancer risk significantly higher than Tir 3A, also when considering NIFTP as non-malignant entity.

https://ift.tt/2rlEoCh

Urticaria control test might misevaluate disease control in particular patients treated with omalizumab

Publication date: Available online 4 December 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Murat Türk, İnsu Yılmaz

https://ift.tt/2G0ZPTu

Immunadsorption in der Dermatologie

Zusammenfassung

Den blasenbildenden Autoimmundermatosen liegen pathogenetisch relevante Autoantikörper gegen Bestandteile der Epidermis und/oder oberflächennahen Schleimhäute (beim Pemphigus) bzw. gegen Strukturproteine der dermoepidermalen Junktionszone (bei den Pemphigoiderkrankungen) zugrunde. Mittels Immunadsorption (IA) können Antikörper aus dem Plasma entfernt werden. Daten zum adjuvanten Einsatz dieser Therapie in der Dermatologie liegen insbesondere für Patienten mit einem therapierefraktären oder schweren Pemphigus vulgaris und Pemphigus foliaceus, aber auch mit Pemphigoiderkrankungen vor. In den letzten Jahren wurden zudem verschiedene Therapieprotokolle für den Einsatz der IA bei Patienten mit schwerem atopischem Ekzem und erhöhten IgE-Spiegeln publiziert. Während hauptsächlich Panimmunglobulinadsorber bzw. bei der atopischen Dermatitis auch ein spezifischer Ig(Immunglobulin)E-Adsorber eingesetzt wurden, sind in Zukunft antigenspezifische Adsorber zu erwarten, die eine gezielte Reduktion der Autoantikörper ermöglichen.

https://ift.tt/2EftFSw

Liposomal iRInotecan, Carboplatin or oXaliplatin for Esophagogastric Cancer

Condition:   Esophageal Cancer
Interventions:   Drug: Liposomal Irinotecan;   Drug: Carboplatin;   Drug: Capecitabine;   Drug: Oxaliplatin;   Drug: 5-fluorouracil;   Drug: Leucovorin
Sponsors:   Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA);   Servier
Not yet recruiting

https://ift.tt/2RCIykD

Study on the Effect of Sound Therapy on Chronic Primary Tinnitus

Condition:   Tinnitus
Interventions:   Device: CAABT;   Device: TMT
Sponsor:   Beijing Friendship Hospital
Recruiting

https://ift.tt/2QdkpVi

Study of Pembrolizumab Given Prior to Surgery and in Combination With Radiotherapy Given Post-surgery for Advanced Head and Neck Squamous Cell Carcinoma (MK-3475-689)

Condition:   Head and Neck Neoplasms
Interventions:   Biological: Pembrolizumab 200 mg;   Radiation: Radiotherapy 60 Gray/day;   Radiation: Radiotherapy 66 Gray/day;   Radiation: Radiotherapy 70 Gray/day;   Drug: Cisplatin 100 mg/m^2
Sponsor:   Merck Sharp & Dohme Corp.
Not yet recruiting

https://ift.tt/2RAjVoN

GETNE Registration of Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   Grupo Espanol de Tumores Neuroendocrinos
Not yet recruiting

https://ift.tt/2QcaAXD

Study on the Effect of Sound Therapy on Chronic Primary Tinnitus

Condition:   Tinnitus
Interventions:   Device: CAABT;   Device: TMT
Sponsor:   Beijing Friendship Hospital
Recruiting

https://ift.tt/2QdkpVi

Liposomal iRInotecan, Carboplatin or oXaliplatin for Esophagogastric Cancer

Condition:   Esophageal Cancer
Interventions:   Drug: Liposomal Irinotecan;   Drug: Carboplatin;   Drug: Capecitabine;   Drug: Oxaliplatin;   Drug: 5-fluorouracil;   Drug: Leucovorin
Sponsors:   Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA);   Servier
Not yet recruiting

https://ift.tt/2RCIykD

Study of Pembrolizumab Given Prior to Surgery and in Combination With Radiotherapy Given Post-surgery for Advanced Head and Neck Squamous Cell Carcinoma (MK-3475-689)

Condition:   Head and Neck Neoplasms
Interventions:   Biological: Pembrolizumab 200 mg;   Radiation: Radiotherapy 60 Gray/day;   Radiation: Radiotherapy 66 Gray/day;   Radiation: Radiotherapy 70 Gray/day;   Drug: Cisplatin 100 mg/m^2
Sponsor:   Merck Sharp & Dohme Corp.
Not yet recruiting

https://ift.tt/2RAjVoN

GETNE Registration of Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:  
Sponsor:   Grupo Espanol de Tumores Neuroendocrinos
Not yet recruiting

https://ift.tt/2QcaAXD

Perindopril-induced angioedema of the lips and tongue: a case report

Ace inhibitor-induced angioedema, characterized by sudden-onset swelling of the mucous membrane, skin, or both, is a rare occurrence in the Kingdom of Saudi Arabia. Because of its safety and efficacy, perindop...

https://ift.tt/2SvPyQu

The fate of root canals obturated with Thermafil: 10-year data for patients treated in a master’s program

Abstract

Objectives

Retrospective description of the 10-year success rate of endodontic treatments with Thermafil (TF).

Materials and methods

Patients treated by postgraduate students in an Endodontics Master's Program (2006–2008) were enrolled. All treated root canals were filled with TF and AH Plus. Teeth satisfying the inclusion criteria (206 teeth in 89 patients) were reexamined clinically and radiographically to estimate a 10-year survival and periapical health. Demographic and medical data were registered; collected information included pre-, intra-, and postoperative variables. Teeth were classified as "healthy" (PAI ≤ 2 in absence of signs/symptoms), "endodontically diseased" (presenting at least one of the following: PAI ≥ 3, signs/symptoms, retreated in the course of the follow-up, or extracted for endodontic reasons), or "non-endodontically diseased" (extracted for non-restorable fractures or periodontal disease). For teeth lost during the 10-year follow-up, details and reason of extraction were analyzed. Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed (α level set at 0.05).

Results

At 10 years, 179 (87%) teeth survived and 27 were extracted: 20 for non-endodontic reasons (excluded from success analysis) and 7 for endodontic reasons (considered "endodontically diseased"). Multilevel analysis revealed that the probability of extraction was increased by the presence of preoperative pain (odds ratio = 6.720; 95% confidence interval, 1.483–30.448) and by maxillary location (odds ratio = 2.950; 95% confidence interval, 1.043–8.347). Concerning periapical status, 159/186 teeth (85%) were assessed as "healthy." Multilevel analysis confirmed that maxillary location (odds ratio = 3.908; 95% confidence interval, 1.370–11.146), presence of flare up (odds ratio = 9.914; 95% confidence interval, 2.388–41.163), and fracture occurrence (odds ratio = 35.412; 95% confidence interval, 3.366–372.555) decreased the odds of healing, respectively.

Conclusions

After 10 years, teeth filled with Thermafil in a specialist master's program presented a survival and a periapical health comparable to cohorts where root canals were filled with other obturation techniques.

Clinical relevance

Carrier-based techniques provide time savings for clinicians while satisfying clinical quality criteria for the root filling and consequently the clinical outcome.

https://ift.tt/2rnLar8

Environmental exposure to agrochemicals and allergic diseases in preschool children in high grown tea plantations of Sri Lanka

Exposure to agrochemicals is one of the many aetiological agents, postulated to cause allergic diseases. In this study, we have compared the prevalence of allergic diseases among preschool children growing in ...

https://ift.tt/2PkdXq1

Episodic Recognition Memory and the Hippocampus in Parkinson’s disease: A Review

Publication date: Available online 4 December 2018

Source: Cortex

Author(s): Tanusree Das, Jaclyn Joyce Hwang, Kathleen L. Poston

Abstract

Parkinson's disease is a progressive neurodegenerative disorder of aging. The hallmark pathophysiology includes the development of neuronal Lewy bodies in the substantia nigra of the midbrain with subsequent loss of dopaminergic neurons. These neuronal losses lead to the characteristic motor symptoms of bradykinesia, rigidity, and rest tremor. In addition to these cardinal motor symptoms patients with PD experience a wide range of non-motor symptoms, the most important being cognitive impairments that in many circumstances lead to dementia. People with PD experience a wide range of cognitive impairments; in this review we will focus on memory impairment in PD and specifically episodic memory, which are memories of day-to-day events of life. Importantly, these memory impairments severely impact the lives of patients and caregivers alike.

Traditionally episodic memory is considered to be markedly dependent on the hippocampus; therefore, it is important to understand the exact nature of PD episodic memory deficits in relation to hippocampal function and dysfunction. In this review, we discuss an aspect of episodic memory called recognition memory and its subcomponents called recollection and familiarity. Recognition memory is believed to be impaired in PD; thus, we discuss what aspects of the hippocampus are expected to be deficient in function as they relate to these recognition memory impairments. In addition to the hippocampus as a whole, we will discuss the role of hippocampal subfields in recognition memory impairments.

https://ift.tt/2AP0uS2

L’acne conglobata existe-t-elle ?

Publication date: Available online 5 December 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): J. Revuz, F. Poli

https://ift.tt/2E19kzm

A New Technique for Reconstruction of Medium-Sized Eyelid Defects (A Modification of Tessier Nasojugal Flap)

Facial plast Surg
DOI: 10.1055/s-0038-1676050

Eyelid reconstructions are considered challenging surgical procedures, which are mostly performed due to trauma, tumor resections, and congenital defects. Several techniques can be used to reconstruct the lower eyelid defects. In this study, the authors aimed to introduce a new single-step technique for the reconstruction of medium-sized lower eyelid defects while preventing ectropion. A modified nasojugal flap was designed and harvested after making a complete incision. A dermal extension from the nasolabial area was added to the end of the nasojugal flap. A tunnel was created under the orbicularis oculi muscle, and the dermal tail was passed through this tunnel toward the lateral canthus. The flap was fixed in its new position by suturing. The defect in the nasojugal area was repaired by bilateral advancement of the surrounding tissue. The recovery of the patients was followed up for 6 months, which included assessment of the eyelid position and donor site morbidity. A total of four patients with an age range of 64 ± 8 years who suffered from basal cell carcinoma were treated using the technique introduced in this study. No ectropion or abnormal eyelid position nor donor site morbidity was observed during the follow-up period. Reconstruction of a medium-sized lower eyelid defect using nasolabial flap with local modification combined with orbital canthus fixation resulted in appropriate functional and cosmetic outcomes and limited the risk of complications and morbidity.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

https://ift.tt/2PlQDIw

Deep Plane Facelift: An Evaluation of the High-SMAS versus Standard Incision Points

Facial plast Surg
DOI: 10.1055/s-0038-1675634

In surgery of the aging face, operative adjustments of the superficial musculoaponeurotic system (SMAS) enhance facial contours. The senior author has observed that the standard deep plane face lift entry points on the SMAS do not provide as much tissue movement in a vertical direction as high-SMAS deep plane face lift entry points. In this study, tissue movement was measured comparing the conventional SMAS entry point with a high-SMAS entry point for deep plane face lifts. Institutional review board approval was obtained. Fourteen facelift patients were enrolled, 10 female and 4 male. Average age was 63.4 (50–81) years. Tissue movement at three points along the jaw line was measured intraoperatively. Standard SMAS entry point suspension resulted in average vertical movements of 6.4, 10.3, and 13.8 mm and average horizontal movements of 3.5, 5.7, and 6.5 mm. High-SMAS entry point resulted in average vertical movements of 11.8, 17.9, and 24.1 mm and average horizontal movements of 5.8, 9.8, and 9.9 mm. This resulted in a 77.3% increase (p = 0.03) in vertical movement and a 61.4% increase (p = 0.02) in horizontal movement with a high-SMAS entry compared with standard SMAS entry. The high-SMAS entry point for a deep plane facelift resulted in a significant increase in lift for both the horizontal and vertical vector on the facial skin flap when compared with the conventional entry.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

https://ift.tt/2zM2VoJ

Effects of Topical Mandelic Acid Treatment on Facial Skin Viscoelasticity

Facial plast Surg
DOI: 10.1055/s-0038-1676048

Mandelic acid is an α-hydroxy acid with reported benefit in treating acne and hyperpigmentation. The authors have developed a topical mandelic acid formulation that subjectively improves the quality of aged skin. Although the gold standard for assessing outcomes, photographic documentation is limited by subjective interpretation. Tools for measuring physical skin properties allow for an objective assessment of changes in skin quality. The authors sought to objectively study the viscoelastic changes to the skin following treatment with topical mandelic acid, using the Cutometer MPA 580. Twenty-four patients, twenty females and four males, aged 42 to 68 years, were studied over a four-week period. Mandelic acid was applied topically to the face twice a day for four weeks. The lower eyelid skin viscoelastic properties were assessed weekly using the Cutometer. After four weeks of topical mandelic acid treatment, the elasticity of lower eyelid skin increased 25.4% (P = .003). Skin firmness increased 23.8% (P = .029). Improvement in photographic appearance correlated with these findings. Mandelic acid is another topical treatment option for improving skin quality, and is well tolerated by patients. The authors feel that the Cutometer or similar device should be used routinely in facial plastic surgery to objectively assess outcomes of various treatment modalities.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

https://ift.tt/2PkYaHH

Impairment of Lipophagy by PNPLA1 Mutations Cause Lipid Droplet Accumulation in Primary Fibroblasts of Autosomal Recessive Congenital Ichthyosis Patients

Publication date: Available online 4 December 2018

Source: Journal of Dermatological Science

Author(s): Gizem Onal, Ozlem Kutlu, Ebru Ozer, Devrim Gozuacik, Aysen Karaduman, Serap Dokmeci (Emre)

Abstract

Background

Autosomal Recessive Congenital Ichthyosis (ARCI) is a group of epidermal keratinization disorders. One of the disease-associated proteins, patatin-like phospholipase domain-containing protein-1 (PNPLA1), plays a key role in the epidermal omega-O-acylceramide synthesis and localizes on the surface of lipid droplets (LDs).

Objective

Previously, routine clinical test results showed abnormal LD accumulation in blood smear samples of our ARCI patients with PNPLA1 mutations. To investigate abnormal accumulation of LDs, we analyzed primary fibroblast cells of ARCI patients with PNPLA1 mutations (p.Y245del and p.D172 N). We hypothesized that PNPLA1 mutations might affect lipophagy-mediated regulation of LDs and cause intracellular lipid accumulation in ARCI patients.

Methods

LD accumulation was analyzed by fluorescence stainingwith BODIPY®493/503 in fibroblasts of patient cells and PNPLA1 siRNA transfected control fibroblast cells. The expression of PNPLA1 and its effects on the lipophagy-mediated degradation of LDs were analyzed by immunocytochemistry and immunoblotting.

Results

Our results showed that mutant or downregulated PNPLA1 protein cause abnormal intracellular LD accumulation. We found that PNPLA1 mutations affect neither the cellular localization nor expression levels of the protein in fibroblast cells. When we analyzed lipophagic degradation process, LC3 expression and the number of autophagosomes were significantly decreased in fibroblast cells of the patients. In addition, co-localization of LDs with autophagosomes and lysosomes were markedly less than that of the control group.

Conclusion

PNPLA1 mutations caused disturbances in both autophagosome formation and fusion of autophagosomes with lysosomes. Our results indicate a possible role for PNPLA1 protein in LD regulation via lipophagy-mediated degradation.

https://ift.tt/2EdaIjp

A Turkish girl with H syndrome: stunted growth and development of autoimmune insulin dependent diabetes mellitus in the 6th year of diagnosis

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


https://ift.tt/2QbrBRQ

Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control: comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus

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


https://ift.tt/2RBkoqK

Epiglottopexy by external puncture for epiglottic prolapse in severe laryngomalacia. A novel technique

Publication date: Available online 5 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): H. Álvarez-Neri, P. Villamor, E. Ortiz Hernandez, J. Penchyna Grub

Abstract

Introduction

Laryngomalacia (LM) is the first cause of stridor in infants. 10 to 20% of patients with LM may require surgery due to the development of severe symptoms. Supraglottoplasty is the most commonly performed surgery for severe LM. However, it is insufficient for the rostrocaudal displacement of the epiglottis against the posterior pharyngeal wall.

Case summary

We report a case of a 2-month-old infant with severe laryngomalacia with a remarkable collapse of the epiglottis towards the glottis with secondary obstruction of the airway, alteration in swallowing and failure to thrive. The patient was treated satisfactorily through epiglottopexy by an external puncture. During a follow-up of 2 years, the patient has been asymptomatic, without any adverse event.

Discussion

Glottic obstruction from posterior epiglottic collapse is the most severe type of laryngomalacia, generating severe respiratory symptoms and failure to thrive. Epiglottopexy by external puncture is a new technique, certainly affordable since it does not require special instruments and it can be performed in medical centers through suspension laryngoscopy. It can be achieved alone or in combination with traditional supraglottoplasty.

https://ift.tt/2PjZgn5

A vicious enemy in head and neck oncology: Delay!

Publication date: Available online 5 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): O. Laccourreye, G. Marret, P. Giraud

https://ift.tt/2zFRBu7

Scedosporium apiospermum invasive sinusitis presenting as extradural abscess

Publication date: Available online 4 December 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): N. Khoueir, B. Verillaud, P. Herman

Abstract

Introduction

Chronic invasive fungal rhinosinusitis (CIFR) is a rare entity generally observed in immunodepressed subjects. The pathogen most frequently identified is Aspergillus spp. Imaging generally reveals invasive pseudoneoplastic features. We report a case of Scedosporium apiospermum (S. apiospermum) CIFR with an atypical clinical and radiological presentation.

Case report

A 72-year-old immunocompetent man presented with chronic headache, neck pain and bilateral limitation of lateral gaze. Imaging revealed an isolated left sphenoidal lesion with marked bone changes and an extradural abscess over the clivus. Large endoscopic sphenoidotomy with type II rhinopharyngectomy was performed and the diagnosis of S. apiospermum CIFR was based on histological examination and fungal culture. The patient refused all medical treatment and did not present any signs of recurrence after 1 year of follow-up.

Discussion

S. apiospermum is a fungal species rarely isolated in CIFR. The present case was revealed by an atypical clinical presentation including isolated sphenoidal infection complicated by bilateral abducens nerve paralysis and extradural abscess. Imaging was also unusual, revealing features of fibrous dysplasia or bacterial osteomyelitis rather than the typical pseudoneoplastic appearance. The patient was successfully treated by surgery alone, which may therefore be sufficient treatment in immunocompetent subjects.

https://ift.tt/2PmMQea