Background: Induction of anesthesia and the knee-chest position are associated with hemodynamic changes that may impact patient outcomes. The aim of this study was to assess whether planned reductions in target-controlled infusion propofol concentrations attenuate the hemodynamic changes associated with anesthesia induction and knee-chest position. Materilas and Methods: A total of 20 patients scheduled for elective lumbar spinal surgery in the knee-chest position were included. In addition to standard anesthesia monitoring, bispectral index and noninvasive cardiac output (CO) monitoring were undertaken. The study was carried out in 2 parts. In phase 1, target-controlled infusion propofol anesthesia was adjusted to maintain BIS 40 to 60. In phase 2, there were 2 planned reductions in propofol target concentration: (1) immediately after loss of consciousness—reduction calculated using a predefined formula, and (2) before positioning—reduction equal to the average percentage decrease in CO after knee-chest position in phase 1. Changes from baseline in CO and other hemodynamic variables following induction of anesthesia and knee-chest positioning were compared. Results: Induction of anesthesia led to decreases of 25.6% and 19.8% in CO from baseline in phases 1 and 2, respectively (P
http://bit.ly/2FJY0Za
Παρασκευή 18 Ιανουαρίου 2019
Role of Frailty and Comorbidity in Determination of Operability for Patients With Oral and Oropharyngeal Squamous Cell Carcinoma
Abstract
Purpose of Review
To review the role of frailty and comorbidities in determining operability and associated outcomes in patients with oral and oropharyngeal squamous cell carcinoma.
Recent Findings
Frailty and comorbidity have been linked to multiple adverse outcome measures including risk of mortality, surgical complications, length of stay, intensity of care needs, discharge disposition, risk of readmission, and cost of healthcare delivery. There are diverse objective and validated measures of comorbidity and frailty. Addition of comorbidity and objective frailty measurements has been demonstrated to improve predictive power of nomograms and clinical staging systems for patients with oral and oropharyngeal squamous cell carcinoma. The use of predictive tools that assess frailty may contribute to shared decision making, realistic expectations, and facilitation of appropriate level of care. While emerging literature supports the role of prehabilitation, there is paucity of data in support of such interventions for patients afflicted by oral and oropharyngeal cancer.
Summary
Frailty assesses operability beyond anatomic resectability and incorporates key determinants of physical, nutritional, and cognitive well-being. Objective measurements of frailty predict meaningful outcomes following surgery for cancers of the oral cavity and oropharynx. This paper suggests that clinicians should objectively and routinely assess frailty, which may facilitate patient counseling, improved risk stratification, informed decision making, and further research to elucidate relationship of frailty with outcomes in head and neck specific populations.
http://bit.ly/2HleOID
Modified Transverse-Vertical Gross Examination: a Better Method for the Detection of Definite Capsular Invasion in Encapsulated Follicular-Patterned Thyroid Neoplasms
Abstract
The diagnosis of encapsulated follicular-patterned thyroid carcinoma (EFPTC) is challenging, and the detection of capsular invasion and/or vascular invasion is essential in distinguishing benign lesions from malignant lesions. In this study, we present a modified transverse-vertical gross examination method with additional vertical cuts at the upper and lower ends of thyroid nodules. In addition, we compared the clinicopathological characteristics of patients with EFPTC between conventional and modified methods. The diagnostic rate of follicular thyroid carcinoma and invasive encapsulated follicular variant of papillary thyroid carcinoma was higher with the modified method (p = 0.003 and p = 0.028, respectively). Furthermore, the paraffin block number and the number of capsular invasion per centimeter were significantly higher with the modified method (p < 0.001 and p = 0.007, respectively). However, vascular invasion was not significantly different between the two methods (p = 0.771). The possibility of identifying capsular invasion was around two times higher with the modified method (odds ratio = 1.91, 95% confidence interval = 1.20–3.07, p = 0.007). A total of 38 samples (23%) in the modified transverse-vertical group had capsular and/or vascular invasion in the additional vertical cuts of the upper/lower ends of the tumor. Our modified transverse-vertical gross examination method was more effective than the conventional transverse examination method for the detection of capsular invasion in EFPTC. This modified gross examination method might allow a better differential diagnosis among various encapsulated micro-follicular proliferative lesions.
http://bit.ly/2RyQDuI
Oncocytic cyst of the larynx: a rare finding
A 75-year-old woman presented with an 18-month history of severe, slowly worsening dysphonia. She was a smoker and known to have multiple benign cystic thyroid lesions. She reported no associated symptoms and other medical and social history was unremarkable. Fibreoptic nasendoscopy revealed a right-sided supraglottic cyst appearing to arise from the right false vocal cord. Further bedside examination was unremarkable. She underwent microlaryngoscopy and biopsy which showed a cyst originating from the right anterior ventricle, successfully removed without rupture using cold steel. Formal histopathology revealed a 14x10x7 mm unilocular, completely excised cyst lined by oncocytic epithelium and composed of columnar cells with darkly stained nuclei and abundant granular, eosinophilic cytoplasm. Three weeks postoperatively the patient's voice had returned to normal. To date, 11 months postoperatively, there is no evidence of recurrence, and she will continue long-term follow-up.
http://bit.ly/2FJkoSt
Inguinal hernia containing a native orthotopic kidney
We report a rare case of an inguinal hernia containing part of a native kidney and present a review of the literature with regard to urological findings in patients with inguinal hernias. This case involves an elderly man with known bilateral inguinal hernias with an incidental radiographic finding of a large right inguinal hernia containing the inferior pole of the right kidney. The patient was not symptomatic from the hernia and given his overall frailty, no surgical intervention was offered.
http://bit.ly/2FA9wqR
Hypokalaemic metabolic alkalosis, hypertension and diabetes: what is the link
Two years after diagnosis of a metastatic neuroendocrine gastrin-secreting tumour and after several cycles of chemotherapy and peptide receptor radionuclide therapy, a 56-year-old woman presented with hypokalaemic metabolic alkalosis, hypertension, leg oedema and new-onset diabetes mellitus. Further investigations revealed renal potassium loss confirmed by a transtubular potassium gradient of 16, fully suppressed serum aldosterone, but instead highly elevated blood levels of morning cortisol and adrenocorticotropic hormone as well as increased urinary excretion of glucocorticoid and mineralocorticoid metabolites. Ruling out other causes, paraneoplastic hypercortisolism was diagnosed. Pharmacological inhibition of the steroid 11β-hydroxylase with metyrapone resulted in complete resolution of metabolic alkalosis, hypokalaemia, hypertension, hyperglycaemia and leg oedema within 1 week.
http://bit.ly/2FJNe5a
Monocytopenia in clozapine-induced agranulocytosis: insights into pathophysiology and treatment
A 26-year-old man with history of schizophrenia was admitted for neutropaenia. He was started on clozapine 3 months prior to admission. As a result he had weekly monitoring of his blood counts and on day of admission was noted to have an absolute neutrophil count (ANC) of 450 cells/μL. He was admitted for clozapine-induced agranulocytosis. Clozapine was held and the patient was started on granulocyte colony-stimulating factor (G-CSF) filgrastim and received two doses without any signs of ANC recovery. On further review, it was noted that the absolute monocyte count (AMC) was also low and tracked with the trend of ANC. We then theorised that the impact of clozapine was on a haematopoietic precursor (colony-forming unit granulocyte-macrophage, CFU-GM) which gives rise to both monocytic and myeloid lineages. Therefore, sargramostim GM-CSF was started. After two doses, the ANC and AMC started trending up and by the third dose, both counts had fully recovered. He was discharged from the hospital and there are no plans to rechallenge with clozapine. Thus, we demonstrate a case of monocytopenia accompanying clozapine-induced agranulocytosis with successful use of GM-CSF. At least in this case, the target of the clozapine injury appears to be the CFU-GM, explaining the rapid and full response to GM-CSF after lack of response to G-CSF.
http://bit.ly/2FHyfJ8
Focal myositis and contracture secondary to amiodarone extravasation from a peripheral cannula
A 63-year-old man underwent cardioversion of atrial fibrillation with intravenous amiodarone through an antecubital fossa cannula. Mid-infusion, the cannula tissued. He developed immediate pain and swelling. At 3 weeks, he continued to have significant pain and had developed a fixed flexion deformity. MRI demonstrated focal myositis of the biceps and brachialis muscles. Treatment included physiotherapy and plastic surgery but sadly in spite of this, the patient has had minimal symptomatic improvement at 1 year. Amiodarone extravasation is well recognised to cause local injection site reactions. Involvement of deeper tissues is rare. To our knowledge, this is only the second description of a consequent focal myositis in the literature.
http://bit.ly/2FAkxsm
Rare case of bladder chondroma causing lower urinary tract symptoms
An extraosseous or soft tissue chondroma is a rare, benign cartilaginous tumour characterised by the formation of mature hyaline cartilage. The majority of osseous chondromas are located within the medullary cavity of long bones. Soft tissue chondromas are extremely rare with only five cases affecting the bladder being reported in the literature. Soft tissue chondroma of the bladder is a rare cause of lower urinary tract symptoms and abdominopelvic pain. All reported cases of soft tissue chondromas of the bladder have occurred in women in their fifth to seventh decades of life. We describe the case of a 65-year-old woman diagnosed with a soft tissue chondroma of her bladder while being investigated for lower urinary tract symptoms.
http://bit.ly/2FJAgEy
Urothelial carcinoma with villoglandular differentiation (UCVGD) with small cell neuroendocrine carcinoma of urinary bladder
Urothelial carcinoma with villoglandular differentiation (UCVGD) is a rare aggressive variant of urothelial carcinoma. It is usually associated with high-grade urothelial carcinoma or rarely adenocarcinoma. There is only one other previous report of UCVGD associated with small cell neuroendocrine carcinoma of urinary bladder. We report the second case of UCVGD with small cell neuroendocrine carcinoma of urinary bladder in a 74-year-old non-smoker male patient. The mass was muscle invasive and also invaded the prostate. This entity needs to be confidently diagnosed due to its prognostic and therapeutic implications.
http://bit.ly/2FA9mQh
Spontaneous anterior dislocation of lens in a case of ectopia lentis et pupillae: a rare entity treated by a novel technique of microscope integrated optical coherence tomography (MIOCT) guided intralenticular lens aspiration
A 7-year-old girl presented with watering and redness in the left eye for 2 months. Her parents reported poor vision in both eyes for 4 years. Visual acuity was finger counting at 1 m and finger counting close to face in the right and left eyes, respectively. Slit lamp examination of the right eye revealed corectopia, aphakia in the pupillary area, temporally subluxated clear crystalline lens, persistent pupillary membrane, irido-hyaloidal adhesion and poorly dilating pupil. Left eye revealed central corneal oedema with descemet scarring, anteriorly dislocated clear crystalline lens with lenticulo-corneal touch. Ultrasound examination of the left eye was normal. Hence a diagnosis of ectopia lentis et pupillae with left eye spontaneous anterior dislocation of the lens along with corneal decompensation was made. The child underwent microscope integrated intraoperative optical coherence tomography guided intralenticular lens aspiration with optical iridectomy in the left eye. Postoperative visual rehabilitation was done with aphakic glasses.
http://bit.ly/2FKEps3
Effects of Oral Morphine on Dyspnea in Patients with Cancer: Response Rate, Predictive Factors, and Clinically Meaningful Change (CJLSG1101)
AbstractBackground.Although the efficacy of parenteral morphine for alleviating dyspnea has been previously demonstrated in several studies, little is known regarding the efficacy of oral morphine for dyspnea among patients with cancer, including its response rate and predictive factors of effectiveness. Therefore, the aim of this study was to clarify the effectiveness of oral morphine on dyspnea in patients with cancer and elucidate the predictive factors of its effectiveness.Subjects, Materials, and Methods.In this multicenter prospective observational study, we investigated the change in dyspnea intensity in patients with cancer before and after the administration of oral morphine by using a visual analog scale (VAS). We also administered a self‐assessment questionnaire to determine whether the patients believed oral morphine was effective.Results.Eighty patients were enrolled in the study, and 71 of these patients were eligible. The least square mean of the VAS scores for dyspnea intensity was 53.5 at baseline, which decreased significantly to 44.7, 40.8, and 35.0 at 30, 60, and 120 minutes after morphine administration, respectively. Fifty‐four patients (76.1%) reported that oral morphine was effective on the self‐assessment questionnaire. Among the background factors, a high score for "sense of discomfort" on the Cancer Dyspnea Scale (CDS) and a smoking history of fewer pack‐years were associated with greater effectiveness.Conclusion.Oral morphine was effective and feasible for treating cancer‐related dyspnea. A higher score for "sense of discomfort" on the CDS and a smaller cumulative amount of smoking may be predictive factors of the effectiveness of oral morphine.Implications for Practice.This study demonstrated that oral morphine was effective in alleviating cancer‐related dyspnea due to multiple factors including primary lung lesions, airway narrowing, and pleural effusion. Approximately 76% of patients reported that oral morphine was effective. A higher score for "sense of discomfort" on the Cancer Dyspnea Scale and a lower cumulative amount of smoking may be predictive factors for the effectiveness of oral morphine. Interestingly, respiratory rates in patients who reported the morphine to be effective decreased significantly after oral morphine administration, unlike the respiratory rates in "morphine‐ineffective" patients.
http://bit.ly/2RDZ8F2
Genomic Features for Therapeutic Insights of Chemotherapy‐Resistant, Primary Mediastinal Nonseminomatous Germ Cell Tumors and Comparison with Gonadal Counterpart
AbstractPrimary mediastinal nonseminomatous germ cell tumors (PMNSGCT) frequently become refractory to chemotherapy, and no effective salvage therapy exists. We performed genomic profiling on a series of 44 PMNSGCT and compared the results with those from chemorefractory, metastatic pure seminomatous (Sem, n = 22) and nonseminomatous (NS, n = 86) testicular germ cell tumors. Archival tissues were sequenced by a hybrid capture‐based technology (FoundationONE; Foundation Medicine, Inc., Cambridge, MA). Microsatellite instability (MSI) and tumor mutational burden (TMB, mutations [mut]/Mb) were determined.Statistically significant differences in genomic alterations (GA) of PMNSGCT versus NS included higher TP53 pathway GA (p < .0001), PIK3CA pathway GA (p < .0001), and lower cell‐cycle pathway GA (p = .0004). There were no MSI‐high PMNSGCT cases. Mean TMB was similar between the groups, but there were more ≥10 mut/Mb in the PMNSGCT group versus NS (11.4% vs. 4.6%).The GA identified in PMNSGCT were similar to the findings from NS, with differential opportunities for targeted therapies and immunotherapies. Further study of precision treatments appears warranted.
http://bit.ly/2CxHUyR
Frontal Fibrosing Alopecia: An Update on Pathogenesis, Diagnosis, and Treatment
Abstract
Frontal fibrosing alopecia (FFA), first described by Kossard in the early 1990s, is a form of primary lymphocytic cicatricial alopecia characterized by selective involvement of the frontotemporal hairline and eyebrows. Since the original description, an increasing number of cases have been reported worldwide and the clinical aspects of the disease have been better characterized. However, the pathogenesis is still unknown and several hypotheses have been made about possible triggering factors, including hormones, neurogenic inflammation, smoking, UV filters, and ingredients in leave-on facial products. A genetic basis has also been hypothesized as the disease can occur in siblings and members of the same family. Besides its pathogenesis, research is also focused on treatment; FFA is a chronic condition and at present there is no validated or approved treatment for this disorder. Commonly prescribed topical treatments include corticosteroids, minoxidil, and calcineurin inhibitors. Systemic treatments include 5α-reductase inhibitors, hydroxychloroquine, and retinoids. Intralesional triamcinolone acetonide is also utilized, especially for the eyebrows. Other possible treatments include pioglitazone, naltrexone, tofacitinib, and lasers.
http://bit.ly/2AVEwgW
Spatiotemporal distribution of organotin compounds in the coastal water of the Bahía Blanca estuary (Argentina)
Abstract
Several areas within the Bahía Blanca estuary (BBE), with different maritime traffic intensity, were studied in order to confirm the presence and assess the distribution of tributyltin (TBT), dibutyltin (DBT), and monobutyltin (MBT) in the water column. The organotin compounds (OTCs) were determined in the water samples—taken in summer, autumn, winter, and spring of 2014—by gas chromatography coupled to mass spectrometry after liquid-liquid extraction with hexane. The incidence of TBT throughout the whole sampling period indicated a continuous presence of this compound to the study area. However, in accordance with the butyltin degradation index (BDI), TBT was not recently introduced in the BBE. Furthermore, the average TBT levels exceeded the international guideline established by the Oslo-Paris commission (0.62 ng Sn L−1). As a result, certain biological effects could be expected to occur in sensitive species such as mussels. While DBT were below the detection limit in the 75% of the samples analyzed, MBT was detected in all the samples and no significant differences were found among the concentrations measured in the different seasons (Kruskal–Wallis test, p > 0.05). In addition, no correlations were found among the OTCs levels and the evaluated physiochemical parameters (Spearman coefficient, p > 0.05).
http://bit.ly/2QVo3Pa
Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: A prospective randomised crossover controlled study in healthy volunteers
BACKGROUND High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S) To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING Operating room in a primary university hospital. DESIGN A prospective, randomised crossover study. PARTICIPANTS Fifty healthy volunteers. INTERVENTIONS Participants were randomly pre-oxygenated through spontaneous breathing 100% oxygen in a face mask and with HFNO (mouth closed, heated and humidified gas flow at 60 l min–1). In the face mask group, the ETO2 was measured continuously. In the HFNO group, the nasal cannula was quickly exchanged with a face mask while the subject held their breath at end inspiration and the ETO2 was measured after a deep expiration. The protocol ended when ETO2 reached 90% or otherwise at 6 min. MAIN OUTCOME MEASURES The primary endpoint was the ETO2 after 3 min of pre-oxygenation. Secondary endpoints were the proportion of participants with an ETO2 at least 90% and the time until the ETO2 at least 90%. RESULTS The ETO2 after 3 min of pre-oxygenation was 89 (2) % and 77 (12) % in the face mask and HFNO groups [difference 12% (95% confidence interval, 95% CI: 8 to 15]; P
http://bit.ly/2FEaz9t
http://bit.ly/2FEaz9t
Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study
BACKGROUND Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting. OBJECTIVES We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC. DESIGN A prospective, observational cohort study. SETTING Single-centre, academic hospital cardiovascular ICU. PATIENTS We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h. MAIN OUTCOME MEASURES The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC. RESULTS MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P
http://bit.ly/2FI7Hr6
http://bit.ly/2FI7Hr6
Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial
BACKGROUND The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. OBJECTIVE The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. DESIGN A randomised controlled study. SETTING A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. INTERVENTION(S) Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h−1, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. MAIN OUTCOME MEASURES The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. RESULTS There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg−1 versus 6 [3.5 to 9] μg kg−1 respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. CONCLUSION Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378). Correspondence to Dr. Yasuko Taketa, Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama-City, Ehime 790-0024, Japan. E-mail: suko1231@yahoo.co.jp © 2019 European Society of Anaesthesiology
http://bit.ly/2Fzh4Kw
http://bit.ly/2Fzh4Kw
Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study
BACKGROUND Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors. OBJECTIVES The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH). DESIGN Prospective observational blinded study. SETTING Operating room from June 2017 to February 2018. PATIENTS One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study. INTERVENTIONS Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min. MAIN OUTCOME MEASURES The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis. RESULTS Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%. CONCLUSION Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI. TRIAL REGISTRATION This study evaluate accuracy of two diagnostic methods for the occurrence of postspinal anaesthesia hypotension, so not a clinical trial as no intervention is present and no outcome of intervention is measured. Correspondence to Dr Eman Ramadan Salama, MD, Anaesthesia and Surgical ICU, Tanta University Hospital, Tanta, Egypt Tel: +20 1277886405; fax: +20 402231671; e-mail: dr.ers1975@yahoo.com © 2019 European Society of Anaesthesiology
http://bit.ly/2FHgTvX
http://bit.ly/2FHgTvX
Influence of nutrient formulations on growth, lipid yield, carbon partitioning and biodiesel quality potential of Botryococcus sp. and Chlorella sp.
Abstract
The study was conducted to analyse the influence of three nutrient formulations, namely BG-11 medium, BBM and TAP medium, on growth potential and lipid yield of two microalgal genera (Botryococcus sp. and Chlorella sp.) and to study the roles of N, P and other major nutrients. The study focussed on the general patterns of starch and lipid synthesis and storage and to further assess how photosynthetic carbon partitioning into starch and lipid is altered by conditions in growth media such as N and C presence as seen in BG11 medium which are known to induce neutral lipid production and the lack of it in BBM and TAP medium. BG-11 medium performed better as compared to BBM and TAP medium in terms of biomass productivity and lipid yield. The lipid yield was highest in Botryococcus sp. (63.03% dry wt.) and Chlorella sp. (50.27% dry wt.) at 30th day of incubation. Mean biomass productivity was highest for Botryococcus in BBM medium (6.14 mg/L/day) and for Chlorella in BG-11 medium (4.97 mg/L/day). Mean lipid productivity (50.78% and 39.36%) was highest in BG11 medium for both Botryococcus and Chlorella species, respectively. A sharp decline in sugar content was observed in the late stationary phase of growth from 30th day to 45th day. Fatty acid methyl ester (FAME) profile of the extracted lipids showed predominantly oleic acid, followed by palmitic acid and stearic acid in both the strains when grown in BG-11 medium. The other biodiesel quality parameters were in accordance with the international standards. A complex relationship was found between chemical composition and biodiesel properties. Proximity analysis indicated that the fuel properties of biodiesels are determined by a number of parameters and by the combination of different chemical compositions. The results provide an insight into organic carbon partitioning into lipid compounds and how the organism's lipid metabolism changes due to N-deplete culturing in TAP medium and inorganic carbon source availability as seen in BG-11 and BBM medium.
http://bit.ly/2FxbacI
Comparison of Outcomes in Oncoplastic Pelvic Reconstruction with VRAM versus Omental Flaps: A Large Cohort Analysis
J reconstr Microsurg
DOI: 10.1055/s-0038-1677524
Background The purpose of this study is to describe our experience and outcomes in oncoplastic pelvic reconstruction for patients who underwent either vertical rectus abdominis musculocutaneous (VRAM) or omental flap following abdominoperineal resection (APR) at a single tertiary care institution. Methods All patients who underwent pelvic reconstruction following APR with either VRAM or omental flaps from January 1992 to January 2017 were retrospectively reviewed. Patient demographics and relevant comorbidities including chemotherapy and radiation therapy data were collected and analyzed. In addition, margin status at the time of oncologic resection was analyzed. Flap-specific data were collected for each approach. Oncologic data collected included cancer type, stage at time of APR, and rate of tumor recurrence within the flap. Results A total of 562 patients were identified who underwent pelvic reconstruction with either VRAM or omental pedicle flaps. Of these, 274 (48.8%) underwent VRAM reconstruction and 288 (51.2%) underwent omental flap reconstruction. All margins were negative at time of cancer ablation surgery. Complications data included: seroma (VRAM = 2 [0.36%]; omentum = 32 [5.69%], p < 0.0001), wound dehiscence (VRAM = 31 [5.52%]; omentum = 17 [3.02%], p = 0.022), abscess (VRAM = 4 [0.71%]; omentum = 27 [4.8%], p < 0.0001), cellulitis (VRAM = 2 [0.36%]; omentum = 10 [1.78%], p = 0.025). Statistical comparison of tumor recurrence between these two reconstructive approaches showed a significantly higher recurrence rate in omental flaps compared with VRAM flaps (p = 0.000127). Conclusions The results of this study suggest a significantly higher tumor recurrence rate in omental flap pelvic reconstruction compared with VRAM flaps. This knowledge has the potential to influence surgical planning and flap selection in pelvic reconstruction.
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Table of contents | Abstract | Full text
http://bit.ly/2W39KvH
Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: A prospective randomised crossover controlled study in healthy volunteers
BACKGROUND High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown. OBJECTIVE(S) To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask. SETTING Operating room in a primary university hospital. DESIGN A prospective, randomised crossover study. PARTICIPANTS Fifty healthy volunteers. INTERVENTIONS Participants were randomly pre-oxygenated through spontaneous breathing 100% oxygen in a face mask and with HFNO (mouth closed, heated and humidified gas flow at 60 l min–1). In the face mask group, the ETO2 was measured continuously. In the HFNO group, the nasal cannula was quickly exchanged with a face mask while the subject held their breath at end inspiration and the ETO2 was measured after a deep expiration. The protocol ended when ETO2 reached 90% or otherwise at 6 min. MAIN OUTCOME MEASURES The primary endpoint was the ETO2 after 3 min of pre-oxygenation. Secondary endpoints were the proportion of participants with an ETO2 at least 90% and the time until the ETO2 at least 90%. RESULTS The ETO2 after 3 min of pre-oxygenation was 89 (2) % and 77 (12) % in the face mask and HFNO groups [difference 12% (95% confidence interval, 95% CI: 8 to 15]; P
http://bit.ly/2FEaz9t
http://bit.ly/2FEaz9t
Central venous-to-arterial PCO2 difference, arteriovenous oxygen content and outcome after adult cardiac surgery with cardiopulmonary bypass: A prospective observational study
BACKGROUND Rapid identification and treatment of tissue hypoxia reaching anaerobiosis (dysoxia) may reduce organ failure and the occurrence of major postoperative complications (MPC) after cardiac surgery. The predictive ability of PCO2-based dysoxia biomarkers, central venous-to-arterial PCO2 difference (ΔPCO2) and ΔPCO2 to arteriovenous oxygen content difference ratio, is poorly studied in this setting. OBJECTIVES We evaluated the ability of PCO2-based tissue dysoxia biomarkers, blood lactate concentration and central venous oxygen saturation measured 2 h after admission to the ICU as predictors of MPC. DESIGN A prospective, observational cohort study. SETTING Single-centre, academic hospital cardiovascular ICU. PATIENTS We included adult patients undergoing cardiac surgery with cardiopulmonary bypass and measured dysoxia biomarkers at ICU admission, and after 2, 6 and 24 h. MAIN OUTCOME MEASURES The primary endpoint was MPC, a composite of cardiac and noncardiac MPC evaluated in the 48 h following surgery. After univariate analysis of MPC covariates including dysoxia biomarkers measured at 2 h, multivariate logistic regression analyses were performed to identify the association of these biomarkers with MPC for confounders. Areas under the receiver operating characteristic curves were determined for biomarkers which remained independently associated with MPC. RESULTS MPC occurred in 56.5% of the 308 patients analysed. ΔPCO2, blood lactate concentration and central venous oxygen saturation measured at 2 h, but not ΔPCO2 to arteriovenous oxygen content difference ratio, were significantly associated with MPC. However, only ΔPCO2 was independently associated with MPC after multivariate analysis. The areas under the receiver operating characteristic curves of ΔPCO2 measured at 2 h for MPC prediction was 0.64 (95% CI 0.57 to 0.70, P
http://bit.ly/2FI7Hr6
http://bit.ly/2FI7Hr6
Programmed intermittent bolus infusion versus continuous infusion of 0.2% levobupivacaine after ultrasound-guided thoracic paravertebral block for video-assisted thoracoscopic surgery: A randomised controlled trial
BACKGROUND The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown. OBJECTIVE The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block. DESIGN A randomised controlled study. SETTING A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study. INTERVENTION(S) Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h−1, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine. MAIN OUTCOME MEASURES The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised. RESULTS There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg−1 versus 6 [3.5 to 9] μg kg−1 respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group. CONCLUSION Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378). Correspondence to Dr. Yasuko Taketa, Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama-City, Ehime 790-0024, Japan. E-mail: suko1231@yahoo.co.jp © 2019 European Society of Anaesthesiology
http://bit.ly/2Fzh4Kw
http://bit.ly/2Fzh4Kw
Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study
BACKGROUND Hypotension after spinal anaesthesia is a common side effect that may be harmful. Patients' susceptibility to intra-operative hypotension can be affected by many pre-operative factors. OBJECTIVES The current study aimed to evaluate the efficacy of both pre-operative inferior vena cava collapsibility index (IVCCI) and inferior vena cava to aorta diameter (IVC : Ao) index for predicting postspinal anaesthesia hypotension (PSAH). DESIGN Prospective observational blinded study. SETTING Operating room from June 2017 to February 2018. PATIENTS One hundred adult patients of both sexes, American Society of Anesthesiologists' physical status 1 or 2 scheduled for elective surgery under spinal anaesthesia were included in this study. INTERVENTIONS Patients received spinal anaesthesia performed at the level of L3 to 4 or L4 to 5 intervertebral space with the patient in the sitting position then placed in the supine position immediately after neuraxial block and kept supine throughout the study period (30 min). IVCCI and IVC : Ao index were assessed pre-operatively. Baseline noninvasive blood pressure was recorded before administration of spinal anaesthesia then every minute after spinal blockade for 30 min. MAIN OUTCOME MEASURES The primary outcome was to evaluate the predictive values of both IVCCI and IVC : Ao index for detecting PSAH and the secondary outcomes were to compare the predictive values of both IVCCI and IVC : Ao index and to detect other clinical predictors for PSAH using logistic regression analysis. RESULTS Forty-five patients developed PSAH (45%). IVCCI was significantly higher in patients who developed PSAH than in patients who did not, while IVC : Ao index was significantly lower in patients who developed PSAH than in patients who did not. Hypotension after induction of spinal anaesthesia was defined as an absolute value of SBP less than 90 mmHg, a decrease in SBP more than 30% of the baseline value or an absolute value of arterial blood pressure less than 60 mmHg. Logistic regression analysis revealed that IVCCI and IVC : Ao index were good predictors of the occurrence of PSAH. Receiver operating characteristic curve analysis showed that IVC : Ao index had a sensitivity of 96%, a specificity of 88%, and an accuracy of 95% to predict PSAH at a cut-off point less than 1.2. IVCCI had a sensitivity of 84%, a specificity of 77%, and an accuracy of 84% to predict PSAH at a cut-off point more than 44.7%. CONCLUSION Pre-operative IVCCI and IVC : Ao index are good predictors of the occurrence of PSAH. However, IVC : Ao index is a more powerful predictor than IVCCI. TRIAL REGISTRATION This study evaluate accuracy of two diagnostic methods for the occurrence of postspinal anaesthesia hypotension, so not a clinical trial as no intervention is present and no outcome of intervention is measured. Correspondence to Dr Eman Ramadan Salama, MD, Anaesthesia and Surgical ICU, Tanta University Hospital, Tanta, Egypt Tel: +20 1277886405; fax: +20 402231671; e-mail: dr.ers1975@yahoo.com © 2019 European Society of Anaesthesiology
http://bit.ly/2FHgTvX
http://bit.ly/2FHgTvX
Pressure Ulcers: Pathophysiology, Epidemiology, Risk Factors, and Presentation
Though preventable in the vast majority of cases, pressure ulcers continue to pose a major burden to the individual and society, affecting up to 3 million adults annually in the United States alone. Despite increased national attention over the past 20 years, the prevalence of pressure ulcers has largely remained unchanged, while associated costs of care continue to increase. Dermatologists can play a significant role in pressure ulcer prevention by becoming aware of at-risk populations and implementing suitable preventive strategies.
http://bit.ly/2FEa5Ab
Pressure Ulcers: Prevention and Management
Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure ulcers remain common in hospitals and the community. Moreover, pressure ulcers often become chronic wounds that are difficult to treat and tend to recur after healing. Especially given these challenges, dermatologists should have the knowledge and skills to implement pressure ulcer prevention strategies and to effectively treat pressure ulcers in their patients. This continuing medical education article will focus on pressure ulcer prevention and management, with a particular emphasis on the evidence for commonly accepted practices.
http://bit.ly/2Fzizbv
Tonsillectomy plus steroid pulse therapy is the most effective treatment in adult patients with C-Grade I IgA nephropathy, and the weight of the extracted palatine tonsils and Yamamoto scale have no significant correlation with the effects of this treatment
We studied patients who underwent tonsillectomy plus steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN), in order to investigate the clinical factors associated with a positive response to this treatment.
http://bit.ly/2RQFFAg
Comparison among TIRADS (ACR TI-RADS and KWAK- TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules
Abstract
Purpose
To compare the value of Thyroid Imaging Reporting and Data Systems proposed by Kwak (KWAK-TIRADS) and ACR (ACR TI-RADS) and 2015 American Thyroid Association (ATA) guidelines in the diagnosis of surgically resected thyroid nodules.
Methods
From January 2015 to December 2015, 2544 thyroid nodules in 1758 patients who underwent thyroidectomy at our center were included. The KWAK-TIRADS category, ACR TI-RADS and ultrasound (US) pattern based on ATA guidelines were assigned to each thyroid nodule. Nodules were divided into groups according to their maximal diameter further.
Results
Of all the nodules, 863 (33.9%) were benign, whereas 1681 (66.1%) were malignant. The malignancy percentage of ACR TI-RADS category 1, 2, 3, 4, and 5 were 0%, 1.3%, 9.1%, 52.5%, and 88.8%, respectively. KWAK-TIRADS and ATA guidelines showed a better diagnostic efficiency than ACR TI-RADS (P < 0.01). ACR TI-RADS demonstrated a higher specificity (79.7%, P < 0.05), whereas the ATA US pattern had a higher sensitivity (95.5%, P < 0.01). The TIRADS (KWAK-TIRADS and ACR TI-RADS) category and ATA guidelines performed better in differentiating nodules >1 cm. KWAK-TIRADS showed better diagnostic efficiency than the other methods in differentiating nodules >1 cm (AUC: 0.92, P < 0.01).
Conclusions
KWAK-TIRADS and ATA guidelines provide a better diagnostic efficiency than ACR TI-RADS. The TIRADS (KWAK-TIRADS and ACR TI-RADS) category and ATA guidelines perform better in differentiating nodules >1 cm than nodules ≤1 cm. KWAK-TIRADS perform better in differentiating nodules >1 cm than other methods.
http://bit.ly/2T23nHb
Comparison among TIRADS (ACR TI-RADS and KWAK- TI-RADS) and 2015 ATA Guidelines in the diagnostic efficiency of thyroid nodules
Abstract
Purpose
To compare the value of Thyroid Imaging Reporting and Data Systems proposed by Kwak (KWAK-TIRADS) and ACR (ACR TI-RADS) and 2015 American Thyroid Association (ATA) guidelines in the diagnosis of surgically resected thyroid nodules.
Methods
From January 2015 to December 2015, 2544 thyroid nodules in 1758 patients who underwent thyroidectomy at our center were included. The KWAK-TIRADS category, ACR TI-RADS and ultrasound (US) pattern based on ATA guidelines were assigned to each thyroid nodule. Nodules were divided into groups according to their maximal diameter further.
Results
Of all the nodules, 863 (33.9%) were benign, whereas 1681 (66.1%) were malignant. The malignancy percentage of ACR TI-RADS category 1, 2, 3, 4, and 5 were 0%, 1.3%, 9.1%, 52.5%, and 88.8%, respectively. KWAK-TIRADS and ATA guidelines showed a better diagnostic efficiency than ACR TI-RADS (P < 0.01). ACR TI-RADS demonstrated a higher specificity (79.7%, P < 0.05), whereas the ATA US pattern had a higher sensitivity (95.5%, P < 0.01). The TIRADS (KWAK-TIRADS and ACR TI-RADS) category and ATA guidelines performed better in differentiating nodules >1 cm. KWAK-TIRADS showed better diagnostic efficiency than the other methods in differentiating nodules >1 cm (AUC: 0.92, P < 0.01).
Conclusions
KWAK-TIRADS and ATA guidelines provide a better diagnostic efficiency than ACR TI-RADS. The TIRADS (KWAK-TIRADS and ACR TI-RADS) category and ATA guidelines perform better in differentiating nodules >1 cm than nodules ≤1 cm. KWAK-TIRADS perform better in differentiating nodules >1 cm than other methods.
http://bit.ly/2T23nHb
Subcostal approach to anterior quadratus lumborum block for pain control following open urological procedures
Abstract
In the case of open urological surgeries, analgesic coverage at mid thoracic dermatomal levels is required. As shown in cadaveric studies, the site of QL block injection is an important determinant of the extent of dye spread and presumably local anesthetic dermatomal coverage. In this case series, we evaluated dermatomal blockade and analgesic efficacy of a subcostal approach to anterior QL block following open urological surgeries. Twenty-two adult patients undergoing renal transplant surgery (60%) and open nephrectomy (40%) received unilateral ultrasound-guided subcostal anterior QL block with catheter insertion. Sensory level, pain score (numeric rating scale, NRS), local anesthetic consumption, and opioid consumption (morphine equivalent dose, MED) were assessed daily for 3 days. The block achieved sensory blockade between T6-7 and L1-2. The most frequently affected dermatomes were T8 -T12 and the number of blocked segments was 3 (mean 2.8). The median (interquartile range Q1, Q3) of NRS pain score was 3.7 (2.8–5.5), 3.3 (2.4–4.7), 2.9 (1.9–3.6), and 2.3 (1.0–4.2) on POD0, POD1, POD2, and POD3, respectively. Our preliminary data showed that the subcostal approach to anterior QL block provides appropriate thoracic dermatome level needed for analgesia following open urological surgical procedures between T6-7 and L1-2.
http://bit.ly/2CrDaKW
Comparison between Radioiodine therapy and single‐session Radiofrequency ablation of autonomously functioning thyroid nodules: a retrospective study
Abstract
Objective
To compare the efficacy of Radioiodine (RI) and Radiofrequency ablation (RFA) in the treatment of autonomously functioning thyroid nodules (AFTNs). End points: nodule volume reduction (NVR) and thyroid function normalization.
Design, patients and measurements
Twenty‐two patients (2:20 M:F; 51.9±13.9 years) affected by 25 AFTNs, treated by RFA were retrospectively compared with 25 patients (8:17 M:F; 57.2±12.8 years) affected by a single AFTN treated by RI. Both group showed analogous characteristics as to age, gender, toxic/pretoxic phase, and pre‐treatment nodule volume (calculated by the ellipsoid formula). Thyroid hormone levels and autoimmune thyroid profile were assessed before treatment. A fixed RI activity of 555MGb (15mCi) was administered. RFA was performed with an 18G, single‐tipped electrode, by the 'modified moving shot technique'. Thyroid hormones were assessed and the nodule post‐treatment volume calculated 12 months after treatment.
Results
No statistical difference was found between the post‐treatment NVR by comparing RI and RFA (p=0.69). The volume reduction rates were 68.4±28.9% and 76.4±16.9% after RI and RFA, respectively. As to the thyroid function, 5/25 patients developed clinical hypothyroidism after RI. After RFA, all the 22 patients silenced their AFTN and normalized the thyroid hormones. Subclinical hypothyroidism was recorded in 2 patients after both RI and RFA. Thus, the functional therapeutic success, defined as the restoration of euthyroidism, was achieved in 18/25 (72%) patients treated by RI and in 20/22 (90.9%) treated by RFA.
Conclusions
No statistical difference in NVR was found between RI and RFA. All patients responded to RI but 5/25 were 'over‐treated' developing hypothyroidism. RFA was effective in all patients with no case of post‐treatment clinical hypothyroidism. No radiation exposure and lower risk of post‐treatment hypothyroidism might make RFA the favorite option especially for young patients.
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http://bit.ly/2DjXijJ
Hyponatraemia in patients with community acquired pneumonia; prevalence and etiology, and natural history of siad
Abstract
Objective
Hyponatraemia is common in community acquired pneumonia (CAP) and is associated with increased mortality. The mechanism of hyponatraemia in CAP is not completely understood and treatment is therefore ill‐defined. We aimed to define the causation of hyponatraemia in CAP.
Design
Prospective, single‐centre, observational study of all patients with CAP and hyponatremia (≤ 130 mmol/L) during a 9‐month period.
Patients
The prevalence of each subtype of hyponatraemia, and the associated mortality, was determined in 143 admissions with CAP (Study 1). A sub‐cohort of patients with SIAD(n=10) was prospectively followed, to document the natural history of SIAD associated with CAP (Study 2).
Measurements
In Study 2, blood and urine were collected on day 1, 3, 5 and 7 following admission for measurement of plasma vasopressin, sodium, osmolality and urine osmolality.
Results
In study 1, 143/1723(8.3%) of CAP‐patients had hyponatraemia (≤130 mmol/L). 66 had SIAD (46%), 60(42%) had hypovolaemic hyponatraemia (HON), 13(9%) had hypervolaemic hyponatraemia (HEN) and 4(3%) patients had hyponatraemia due to glucocorticoid hormone deficiency. Mortality was higher in the HEN than in the HON, SIAD or normonatraemic groups (p < 0.01). In Study 2, plasma sodium concentration normalised in 8/10 (80%) by day 7. Two patients with persistent hyponatraemia were discovered to have underlying bronchiectasis.
Conclusions
Hyponatraemia in CAP is most commonly secondary to SIAD or hypovolaemia. HEN is less common, but has worse prognosis. Prospective observation demonstrates that in SIAD, plasma AVP and sodium concentrations normalise with antimicrobials; failure of reversal of suggests underlying lung disease, such as bronchiectasis.
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http://bit.ly/2sC10ze
Insulin resistance is associated with hirsutism in unselected reproductive‐aged women
Summary
Objective
Hirsutism affects 5‐10% of reproductive‐aged women worldwide and exhibits clinical importance as a cutaneous manifestation of underlying hyperandrogenism. Racial and genetic factors play roles in manifestation of hirsutism, and the prevalence of hirsutism seems to be low in East Asians. However, the reference value of the modified Ferriman‐Gallway (mFG) score to diagnose hirsutism and the prevalence of hirsutism have not been determined in Korean populations to date. We aimed to investigate the distribution of the mFG score and establish its reference value for defining hirsutism and to examine its relationship with metabolic and reproductive traits in reproductive‐aged Korean women.
Design, Patients and Measurements
We enrolled 2,139 female volunteers of reproductive age (15 ‐ 39 years). We recorded mFG scores from 0 to 4 on 9 different body locations (upper lip, chin, chest, arm, upper abdomen, lower abdomen, upper back, lower back, and thighs). Hirsutism was defined as > 95th percentile of mFG score. In addition, a 75‐g oral glucose tolerance test was performed, and the homeostasis model assessment of insulin resistance (HOMA‐IR) was calculated.
Results
The mFG values of the 50th, 75th, 90th, and 95th percentiles were 0, 1, 4, and 6, respectively. Therefore, the mFG score was indicative of hirsutism when the score was 6 or greater, which represents the 95th percentile. In the correlation analysis, total testosterone, free testosterone, fasting plasma insulin, and HOMA‐IR were positively correlated with mFG score (all Ps < 0.05). Multiple linear regression analysis revealed that HOMA‐IR (β = 0.081) was positively associated with mFG score after adjustments for age, body mass index, total testosterone, and the number of menses per year (P < 0.001).
Conclusions
In conclusion, setting the 95th percentile of the mFG score as normal, the reference value to define hirsutism was 6 in reproductive‐aged Korean women. HOMA‐IR was positively associated with the mFG score even after adjustment for biochemical hyperandrogenism.
This article is protected by copyright. All rights reserved.
http://bit.ly/2Mjva3l
Diagnostic Cutaneous Pathology: Clinical‐Pathological Correlation of Inflammatory and Other Non‐Neoplastic Skin Diseases, 2 Vols. Kerl H, Cerroni L, Kokol R, Requena L, Kutzner H, Metze D, Fried I, Stieber W, Wolf IH, ed. Graz: Vhj Verlagshaus Jakomini, 2017; 1488 pp. ISBN: 978‐3‐902920‐24‐9. Price EUR 660,00
http://bit.ly/2FyZ0Aj
A Randomized Pilot Trial of a School‐Based Psychoeducational Intervention for Children with Asthma
Abstract
Background
Asthma is a common childhood illness with high morbidity and mortality among minority and socioeconomically disadvantaged children. Disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. One such factor is psychological stress.
Objective
Here, we examine the feasibility and acceptability of "I Can Cope (ICC)," a school‐based stress management and coping intervention for children with asthma.
Methods
A parallel randomized pilot trial was conducted. One hundred and four low income children (mean age 10 years; 54% male; 70% African American) with persistent asthma were recruited from 12 urban schools and randomized to: (1) ICC or one of two control conditions: (2) "Open Airways for Schools (OAS)" – an asthma education intervention or (3) no treatment.
Results
71% of eligible children participated in the study, with a dropout rate of 12%. ICC was rated as highly acceptable by participating children and parents. Preliminary efficacy data suggest that when compared with no treatment, ICC resulted in decreased symptoms of depression, perceived stress, and child‐reported symptoms of asthma, and improvements in sleep quality and child‐reported asthma control. There were no intervention‐related changes in objective measures of asthma morbidity. The magnitude of intervention effects on psychological function did not differ between the ICC and OAS groups.
Conclusions
Results support the feasibility and acceptability of utilizing school‐based interventions to access hard to reach children with asthma. Preliminary findings offer support for future, large‐scale efficacy studies of school‐based interventions designed to target multiple factors that contribute to asthma disparities.
This article is protected by copyright. All rights reserved.
http://bit.ly/2W2K8iA
Longitudinal analysis to better characterize Asthma‐COPD Overlap Syndrome (ACOS): Findings from an adult asthma cohort in Korea (COREA)
Abstract
Background
Asthma‐chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS), which has received much attention, has not been unanimously defined.
Objective
In this study, we tried to demonstrate that longitudinally defined ACOS is more useful in the real‐world than blending patients with asthma and COPD.
Methods
The study patients had undergone two consecutive pulmonary function tests measured at least 3 months apart (n = 1,889). We selected the patients who had positive bronchodilator response or methacholine provocation tests (n = 959). Next, we defined ACOS as a patient with a persistent airflow obstruction [forced expiratory volume in 1 sec (FEV1)/forced vital capacity < 0.7] that was identified twice consecutively by an interval of at least 3 months (n = 228).
Results
The proportions of patients who were older, male, and smokers were significantly higher, and baseline lung function was lower in patients with ACOS. In the longitudinal analysis, the mean change in lung function was high, and a greater decline in FEV1 was observed in patients with ACOS. In addition, we compared ACOS and severe asthma, and we also performed a cluster analysis and compared the results with our definition of ACOS. According to our definition, ACOS is an independent subtype with distinctive characteristics. Finally, a genome‐wide association study (GWAS) was performed to identify genetic variations associated with ACOS, but no significant single nucleotide polymorphisms were identified.
Conclusion
Our findings suggest that ACOS should be defined longitudinally and considered as an independent subgroup distinguished by inherited environmental factors rather than as a genetically distinct independent group.
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http://bit.ly/2QWwJow
Identification and characterization of a naïve CD8+ T‐cell repertoire for benzylpenicillin
Abstract
Background
Beta‐lactams allergy is the most commonly reported drug allergy and constitutes an important health problem. We previously showed the pre‐existence of a naïve CD4+ T‐cell repertoire for benzylpenicillin (BP) coupled to human serum albumin (HSA) but little is known about the naïve CD8+ T‐cell repertoire specific for BP.
Objective
The purpose of this work was to identify naïve CD8+ T cells specific for BP and to explore mechanisms dictating their activation.
Methods
Co‐cultures were established with naïve CD8+ T cells and autologous dendritic cells (DCs) loaded with HSA‐BP or free BP. T cells were restimulated once a week with autologous DCs loaded with HSA‐BP or BP. The specific CD8+ T cell response was measured using an IFN‐γ ELISpot assay.
Results
When using free BP, we were able to detect a naïve CD8+ T‐cell repertoire for BP in the 6 out of 7 tested healthy donors. However, our results showed that HSA‐BP was recognized by naïve CD8+ T cells in only one donor out of five tested healthy donors. Using free BP, we evidenced its binding to cellular proteins in DCs that was concentration dependent and was correlated with BP‐specific CD8+ T‐cell activation. Moreover, the BP‐specific CD8+ T‐cell response was MHC class I dependent and required intracellular processing and proteasome activity.
Conclusion and clinical relevance
This work showed the existence of a naïve CD8+ T‐cell repertoire for BP when DCs were treated with free BP suggesting that patients could be immunized by haptenated peptides from cellular proteins generated in antigen‐presenting cells.
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http://bit.ly/2W4HV6m
Validation of childhood asthma predictive tools: a systematic review
Abstract
Background
There is uncertainty about the clinical usefulness of currently available asthma predictive tools. Validation of predictive tools in different populations and clinical settings is an essential requirement for the assessment of their predictive performance, reproducibility and generalizability. We aimed to critically appraise asthma predictive tools which have been validated in external studies.
Methods
We searched MEDLINE and EMBASE (1946‐2017) for all available childhood asthma prediction models and focused on externally validated predictive tools alongside the studies in which they were originally developed. We excluded non‐English and non‐original studies. PROSPERO registration number is CRD42016035727.
Results
From 946 screened papers, 8 were included in the review. Statistical approaches for creation of prediction tools included chisquare tests, logistic regression models and the least absolute shrinkage and selection operator. Predictive models were developed and validated in general and high‐risk populations. Only three prediction tools were externally validated: the Asthma Predictive Index, the PIAMA, and the Leicester asthma prediction tool. A variety of predictors has been tested, but no studies examined the same combination. There was heterogeneity in definition of the primary outcome among development and validation studies, and no objective measurements were used for asthma diagnosis. The performance of tools varied at different ages of outcome assessment. We observed a discrepancy between the development and validation studies in the tools' predictive performance in terms of sensitivity and positive predictive values.
Conclusions
Validated asthma predictive tools, reviewed in this paper, provided poor predictive accuracy with performance variation in sensitivity and positive predictive value.
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Air Methods’ airway management tool published in leading trauma textbook
http://bit.ly/2FH0VSw
Altered NOX expression does not seem to account for epidermal NLRP3 inflammasome activation in Hidradenitis Suppurativa
Abstract
Hidradenitis Suppurativa (HS)/ acne inversa is defined as a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep‐seated, inflamed lesions in the apocrine gland‐bearing areas of the body, most commonly the axillae, inguinal and anogenital regions (Dessau definition). It is associated with systemic comorbidities and influenced by genetic predisposition while triggering of the disease occurs by environmental factors. Consecutively, innate immune events appear to play a role. Recently, van der Zee et al. reported increased production of the proinflammatory cytokine IL‐1β in HS.
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http://bit.ly/2ASg9Rj
A retrospective cohort study evaluating the accuracy of clinical diagnosis compared to immunofluorescence and electron microscopy in children with inherited epidermolysis bullosa
Abstract
Traditionally, the diagnosis of epidermolysis bullosa (EB) was made using electron microscopy (EM), and immunofluorescence mapping (IFM). Increasingly, genomics plays a role in the diagnosis of EB, and other genetic conditions, with a result turn‐around‐time as little as 1‐3 weeks. The rapid turn around time and accuracy of genetic testing mandates a rethink on the way that we currently assess infants and children with EB. A biopsy is invasive and can be distressing for caregivers. Given the limitations of skin biopsy in some situations, the future should see genetic testing as a first‐line investigation. However, it is important to note that currently, in severe neonates and infants with EB, a biopsy remains a first line investigation since clinical diagnosis is not accurate using current scoring systems and even when assessed by experts in EB.
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http://bit.ly/2T1A6w5
A qualitative examination of the experience of skin camouflage by people living with visible skin conditions
Abstract
Background
People with a visible skin conditions can experience anxiety and intrusive reactions from others when in social situations. The use of products to conceal marks on the skin is provided in a number of different hospital services and by charities. However, little is known about the experience of people using camouflage as a tool for enhancing quality of life.
Aim
This study aimed to examine the experience of using skin camouflage to cover a visible mark on the skin. It sought to gain a detailed account of the issues associated with camouflage use and the needs of people using it.
Methods
Interpretative Phenomenological Analysis (IPA) was used to gain a detailed understanding of the meaning of camouflage use for participants. Six skin camouflage service‐users completed semi‐structured interviews.
Results
The IPA analysis revealed that the experience of using camouflage was influenced by socio‐cultural factors and the views of others. The use of camouflage was linked to investment in appearance maintenance and functioned to give a sense of control over social interactions, increase social confidence and manage concern about the responses of others.
Conclusions
This study provides an in‐depth insight into the experience of using skin camouflage and suggests that camouflage can play a valuable role in maintaining wellbeing in those living with a visible skin condition.
This article is protected by copyright. All rights reserved.
http://bit.ly/2AS47au
Severe disseminated Nocardia infection associated with ustekinumab treatment for psoriasis
Abstract
Ustekinumab is one of the newer biologic agents on the market, and most clinical experience associated with this agent has been accumulated with the treatment of psoriasis. It exerts its effect through IL‐12/IL‐23p40 antagonism. This immune signaling pathway is associated with Mendelian Susceptibility to Mycobacterial Disease, a genetic condition predisposing to opportunistic infections with mycobacteria and other select organisms. Nonetheless, clinical trial safety data for this agent has suggested its safety, with very few case reports of severe opportunistic infections. It is sometimes considered to be associated with a lesser infectious risk compared to some other biologic agents such as tumor necrosis factor inhibitors. We report a 56‐year‐old patient presenting with an unusually severe disseminated Nocardia farcinica infection associated with ustekinumab treatment: sustained bacteremia, disseminated skin lesions, large renal abscess, septic renal vein thrombosis and pulmonary and cerebral lesions . To our knowledge, this is the first report of disseminated nocardiosis associated with this monoclonal antibody.
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http://bit.ly/2SXcw3D
The anti‐inflammatory potency of biologics targeting TNF‐α, IL‐17A, IL‐12/23 and CD20 in hidradenitis suppurativa: an ex vivo study
Abstract
Background
Biologics targeting inflammatory mediators are able to clinically improve hidradenitis suppurativa (HS). However, their clinical efficacy shows great inter‐patient variability in daily practice.
Objective
To investigate the anti‐inflammatory potency of a selection of currently available biologics for the treatment of HS in an ex vivo skin culture system using lesional HS biopsies.
Methods
Lesional skin samples of ten HS patients and skin samples of five healthy controls were cultured ex vivo and exposed to prednisolone or biologics targeting TNF‐α, IL‐17A, IL‐12/23p40, or CD20, respectively adalimumab, infliximab, secukinumab, ustekinumab and rituximab. Real‐Time quantitative PCR and cytokine bead arrays were used to measure the inhibitory effect of the biologics on cytokines and antimicrobial peptides (AMPs).
Results
The relative mRNA expression of all tested cytokines and AMPs was significantly downregulated by all anti‐inflammatory agents (p<0·0001). The protein production of the pro‐inflammatory cytokines TNF‐α, IFN‐ɣ, IL‐1ß, IL‐6, and IL‐17A was significantly inhibited by adalimumab, infliximab, ustekinumab, prednisolone (all p<0·0001) and rituximab (p=0·0071), but not by secukinumab (p=0·0663). On both mRNA and protein level, adalimumab, infliximab and prednisolone reduced the levels of a broader mix of individual cytokines than secukinumab, ustekinumab and rituximab. Moreover, a significant inhibitory effect on the mRNA expression levels of inflammatory markers in healthy control skin was observed only for prednisolone (p=0·0015) and the TNF‐α inhibitors (p<0·0001).
Conclusions
This ex vivo study suggests that TNF‐α inhibitors and prednisolone are the most powerful inhibitors of pro‐inflammatory cytokines and AMPs in HS lesional skin, which is in accordance with our clinical experience in patients with HS.
This article is protected by copyright. All rights reserved.
http://bit.ly/2ARS2SJ
Altered NOX expression does not seem to account for epidermal NLRP3 inflammasome activation in Hidradenitis Suppurativa
Abstract
Hidradenitis Suppurativa (HS)/ acne inversa is defined as a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep‐seated, inflamed lesions in the apocrine gland‐bearing areas of the body, most commonly the axillae, inguinal and anogenital regions (Dessau definition). It is associated with systemic comorbidities and influenced by genetic predisposition while triggering of the disease occurs by environmental factors. Consecutively, innate immune events appear to play a role. Recently, van der Zee et al. reported increased production of the proinflammatory cytokine IL‐1β in HS.
This article is protected by copyright. All rights reserved.
http://bit.ly/2ASg9Rj
A qualitative examination of the experience of skin camouflage by people living with visible skin conditions
Abstract
Background
People with a visible skin conditions can experience anxiety and intrusive reactions from others when in social situations. The use of products to conceal marks on the skin is provided in a number of different hospital services and by charities. However, little is known about the experience of people using camouflage as a tool for enhancing quality of life.
Aim
This study aimed to examine the experience of using skin camouflage to cover a visible mark on the skin. It sought to gain a detailed account of the issues associated with camouflage use and the needs of people using it.
Methods
Interpretative Phenomenological Analysis (IPA) was used to gain a detailed understanding of the meaning of camouflage use for participants. Six skin camouflage service‐users completed semi‐structured interviews.
Results
The IPA analysis revealed that the experience of using camouflage was influenced by socio‐cultural factors and the views of others. The use of camouflage was linked to investment in appearance maintenance and functioned to give a sense of control over social interactions, increase social confidence and manage concern about the responses of others.
Conclusions
This study provides an in‐depth insight into the experience of using skin camouflage and suggests that camouflage can play a valuable role in maintaining wellbeing in those living with a visible skin condition.
This article is protected by copyright. All rights reserved.
http://bit.ly/2AS47au
A retrospective cohort study evaluating the accuracy of clinical diagnosis compared to immunofluorescence and electron microscopy in children with inherited epidermolysis bullosa
Abstract
Traditionally, the diagnosis of epidermolysis bullosa (EB) was made using electron microscopy (EM), and immunofluorescence mapping (IFM). Increasingly, genomics plays a role in the diagnosis of EB, and other genetic conditions, with a result turn‐around‐time as little as 1‐3 weeks. The rapid turn around time and accuracy of genetic testing mandates a rethink on the way that we currently assess infants and children with EB. A biopsy is invasive and can be distressing for caregivers. Given the limitations of skin biopsy in some situations, the future should see genetic testing as a first‐line investigation. However, it is important to note that currently, in severe neonates and infants with EB, a biopsy remains a first line investigation since clinical diagnosis is not accurate using current scoring systems and even when assessed by experts in EB.
This article is protected by copyright. All rights reserved.
http://bit.ly/2T1A6w5
Severe disseminated Nocardia infection associated with ustekinumab treatment for psoriasis
Abstract
Ustekinumab is one of the newer biologic agents on the market, and most clinical experience associated with this agent has been accumulated with the treatment of psoriasis. It exerts its effect through IL‐12/IL‐23p40 antagonism. This immune signaling pathway is associated with Mendelian Susceptibility to Mycobacterial Disease, a genetic condition predisposing to opportunistic infections with mycobacteria and other select organisms. Nonetheless, clinical trial safety data for this agent has suggested its safety, with very few case reports of severe opportunistic infections. It is sometimes considered to be associated with a lesser infectious risk compared to some other biologic agents such as tumor necrosis factor inhibitors. We report a 56‐year‐old patient presenting with an unusually severe disseminated Nocardia farcinica infection associated with ustekinumab treatment: sustained bacteremia, disseminated skin lesions, large renal abscess, septic renal vein thrombosis and pulmonary and cerebral lesions . To our knowledge, this is the first report of disseminated nocardiosis associated with this monoclonal antibody.
This article is protected by copyright. All rights reserved.
http://bit.ly/2SXcw3D
The anti‐inflammatory potency of biologics targeting TNF‐α, IL‐17A, IL‐12/23 and CD20 in hidradenitis suppurativa: an ex vivo study
Abstract
Background
Biologics targeting inflammatory mediators are able to clinically improve hidradenitis suppurativa (HS). However, their clinical efficacy shows great inter‐patient variability in daily practice.
Objective
To investigate the anti‐inflammatory potency of a selection of currently available biologics for the treatment of HS in an ex vivo skin culture system using lesional HS biopsies.
Methods
Lesional skin samples of ten HS patients and skin samples of five healthy controls were cultured ex vivo and exposed to prednisolone or biologics targeting TNF‐α, IL‐17A, IL‐12/23p40, or CD20, respectively adalimumab, infliximab, secukinumab, ustekinumab and rituximab. Real‐Time quantitative PCR and cytokine bead arrays were used to measure the inhibitory effect of the biologics on cytokines and antimicrobial peptides (AMPs).
Results
The relative mRNA expression of all tested cytokines and AMPs was significantly downregulated by all anti‐inflammatory agents (p<0·0001). The protein production of the pro‐inflammatory cytokines TNF‐α, IFN‐ɣ, IL‐1ß, IL‐6, and IL‐17A was significantly inhibited by adalimumab, infliximab, ustekinumab, prednisolone (all p<0·0001) and rituximab (p=0·0071), but not by secukinumab (p=0·0663). On both mRNA and protein level, adalimumab, infliximab and prednisolone reduced the levels of a broader mix of individual cytokines than secukinumab, ustekinumab and rituximab. Moreover, a significant inhibitory effect on the mRNA expression levels of inflammatory markers in healthy control skin was observed only for prednisolone (p=0·0015) and the TNF‐α inhibitors (p<0·0001).
Conclusions
This ex vivo study suggests that TNF‐α inhibitors and prednisolone are the most powerful inhibitors of pro‐inflammatory cytokines and AMPs in HS lesional skin, which is in accordance with our clinical experience in patients with HS.
This article is protected by copyright. All rights reserved.
http://bit.ly/2ARS2SJ
Competence of final year otolaryngology residents with the bedside head impulse test
Abstract
Background
The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex (VOR). It is a critical component of the bedside assessment of dizzy patients, and can help differentiate acute stroke from vestibular neuritis. However, there is evidence showing the bHIT is often not performed in appropriate clinical settings or is performed poorly. To date, there have been no studies evaluating the bHIT competence of graduating physicians.
Methods
23 final year Otolaryngology –Head &Neck Surgery (OTL-HNS) residents in Canada were evaluated on the use of bHIT using a written multiple-choice examination, interpretation of bHIT videos, and performance of a bHIT. Ratings of subject bHIT performance were completed by two expert examiners (DT, DL) using the previously published Ottawa Clinic Assessment Tool (OCAT).
Results
Using a cut-off of an OCAT score of 4 or greater, only 22% (rater DT) and 39% (rater DL) of residents were found able to perform the bHIT independently. Inter-rater reliability was fair (0.51, interclass correlation). The mean scores were 65% (14.1% standard deviation) on the video interpretation and 71% (20.2% standard deviation) on the multiple-choice questions. The scores on multiple choice examination did not correlate with bHIT ratings (Pearson r = 0.07) but there was fair correlation between video interpretation and bHIT ratings (Pearson r = 0.45).
Conclusion
Final year OTL-HNS residents in Canada are not adequately trained in performing the bHIT, though low interrater reliability may limit the evaluation of this bedside skill. Multiple choice examinations do not reflect bHIT skill. These findings have implications for development of competency-based curricula and evaluations in Canada in critical physical exam skills.
http://bit.ly/2Cxe0dO
Pediatric Laryngeal Electromyography Technique for Vocal Fold Immobility Using Bipolar Double Hookwire Electrodes
Publication date: Available online 18 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Sarah N. Bowe, Carissa J. Wentland, Christopher J. Hartnick
Abstract
Vocal fold immobility (VFI) is a common cause of dysphonia and dysphagia in children. Laryngeal electromyography (LEMG) is an important adjunctive test in its diagnosis and treatment. In this study, we present an alternative technique in which bipolar double hookwire electrodes allow simultaneous placement and recordings from the bilateral thyroarytenoid and posterior cricoarytenoid muscles. Details of the technique are shown for a 5 y/o F with history of Neurofibromatosis Type 2 with left VFI and aspiration and dysphonia. This modified technique for pediatric LEMG has the potential to be a useful tool in predicting return of laryngeal function.
http://bit.ly/2FMuv90
Caregiver perception of speech quality in patients with ankyloglossia: comparison between surgery and non-treatment
Publication date: Available online 18 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Srihari Daggumati, Jason E. Cohn, Matthew J. Brennan, Marissa Evarts, Brian J. McKinnon, Alyssa R. Terk
Abstract
Objectives
Our objective was to determine if there are differences in caregiver perception of speech for patients that undergo frenulectomy compared to patients that were not surgically treated.
Introduction
Ankyloglossia is a controversial topic without standardized treatment guidelines. Although there have been several studies suggesting that breastfeeding does improve after frenulectomy, there is a paucity of literature that investigates the relationship between ankyloglossia and speech.
Methods
A retrospective chart review was conducted to identify patients with ankyloglossia. Patients were categorized into surgical treatment (frenulectomy) and non-treatment groups. Caregivers of both groups were contacted by phone and surveyed on speech quality and tongue mobility using Likert scores. Mann Whitney-U testing was used to determine if there were significant differences in perceived speech quality between the surgical and non-surgical groups.
Results
The caregivers of seventy-seven patients participated in the phone survey: 46 (60%) children in the surgical group and 31 (40%) children in the non-surgical group who participated in the phone survey. There were no differences in difficulty with speech (p=0.484) and tongue mobility (p=0.064) between the two groups. However, patients that underwent surgical intervention for ankyloglossia reported less difficulty with tongue tasks (p<0.001) compared to those who were not surgically treated. Additionally, 50% of patients that underwent surgery had a documented family history of ankyloglossia which was significantly higher than 16.1% in the non-surgical group (p=0.002).
Conclusions
It appears that children with ankyloglossia might have similar speech quality following frenulectomy in comparison to speech quality without treatment. Children who undergo frenulectomy may experience improvements in tongue tasks. This data should encourage further research on the management of speech concerns in children with ankyloglossia.
http://bit.ly/2Fzbyro
Editorial Board
Publication date: February 2019
Source: Archives of Oral Biology, Volume 98
Author(s):
http://bit.ly/2CwfOnD
Effect of Er,Cr:YSGG Laser Associated with Fluoride on the Control of Enamel Erosion Progression
Publication date: Available online 17 January 2019
Source: Archives of Oral Biology
Author(s): Vilmara Rocha Mendes da Silva, Ítallo Emídio Lira Viana, Raquel Marianna Lopes, Denise Maria Zezell, Taís Scaramucci, Ana Cecília Corrêa Aranha
Abstract
Objective
To evaluate the effect of Er,Cr:YSGG laser associated or not with acidulated phosphate fluoride (APF) on the control of enamel erosion progression. Design: Enamel slabs (4 mm × 4 mm×2 mm) from bovine incisors were flattened, polished, and received a tape on their test surfaces, leaving a 4 mm x 1 mm area exposed. Specimens were eroded (10 min in 1% citric acid solution) and randomly assigned into 8 experimental groups (n = 10): Control (no treatment); F (APF gel, 1.23% F, pH 3.6-3.9); Er,Cr:YSGG laser irradiation (P1: 0.25 W, 20 Hz, 2.8 J/cm2, 56 W/cm2); Er,Cr:YSGG laser irradiation (P2: 0.50 W, 20 Hz, 5.7 J/cm2, 113,6 W/cm2); Er,Cr:YSGG laser irradiation (P3: 0.75 W, 20 Hz, 8.5 J/cm2, 170,4 W/cm2); F + Laser P1; F + Laser P2; F + Laser P3. Specimens were then subjected to erosive cycling (5 min immersion in 0.3% citric acid solution, followed by immersion in artificial saliva for 60 min; 4×/day for 5 days). At the end of cycling, surface loss (SL, in μm) was determined with optical profilometry. Selected specimens were further evaluated by environmental scanning electron microscopy (n = 3). Data were analyzed using Kruskal-Wallis and Tukey tests (α = 0.05). Results: Group F + Laser P2 had the lowest SL value, differing significantly from the control; however, with no significant difference from the other groups. All groups, except F + Laser P2, showed no significant difference in SL when compared with the control. An irregular and rough surface, suggestive of a melting action of laser, was observed on enamel in Laser P2 and F + Laser P2 groups. Conclusions: Association of the Er,Cr:YSGG laser in parameter 2 with fluoride was the only treatment capable of controlling the progression of enamel erosion.
http://bit.ly/2RAaGcu
Cellular senescence in dental pulp stem cells
Publication date: Available online 17 January 2019
Source: Archives of Oral Biology
Author(s): Christian Morsczeck
Abstract
Objective
This short review summarizes our current knowledge about dental stem cell aging and about possible targets for the regulation of cellular senescence.
Design
A literature search was performed using a combination of keywords, e.g., stem cells, replicative senescence, differentiation potential, dental pulp, dental follicle and periodontal ligament
Results
Previous studies have shown that cellular senescence occurs while the proliferation of dental stem cells. Moreover, the differentiation potential was significantly decreased in senescent stem cells and senescent cells secrete also factors that are harmful to the adjacent tissue cells. Moreover, many targets for the regulation of cellular senescence are considered; for example pathways related to the nutrient sensing such as the 5' adenosine monophosphate-activated protein kinase (AMPK) pathway.
Conclusions
The regulation of cellular senescence will play a crucial role in the clinical use of stem cells. However, there is no cell culture protocol available that prevents dental stem cell senescence. Therefore, more knowledge about molecular processes in stem cells is needed before and after the induction of senescence.
http://bit.ly/2CxT3iP
Psychoonkologie in dermatologischen Praxen
Zusammenfassung
Hintergrund
Im nationalen Krebsplan ist eine psychoonkologische Betreuung fester Bestandteil einer umfassenden Betreuung von Krebspatienten. Dieses Ziel ist auch im Strategiepapier der Nationalen Versorgungskonferenz Hautkrebs enthalten. In zertifizierten Hautkrebszentren konnten die wesentlichen Voraussetzungen für eine psychoonkologische Versorgung geschaffen werden. Ein großer Anteil von Hautkrebspatienten wird jedoch in dermatologischen Praxen versorgt. Für dieses Versorgungssegment liegen bisher keine Daten zur psychoonkologischen Versorgung vor.
Material und Methoden
In einer deskriptiven Querschnittstudie in Form eines schriftlichen Surveys wurden niedergelassene Dermatologen zur psychoonkologischen Versorgung von Hautkrebspatienten im Erhebungszeitraum Oktober 2016 bis Februar 2017 befragt.
Ergebnisse
Den psychoonkologischen Fragebogen haben 171 Praxen beantwortet; 19,4 % der Praxen gaben einen onkologischen Schwerpunkt an. Die mittlere Anzahl jährlich betreuter Hautkrebspatienten wurde mit 554,3 ± 659,1 und die der Melanompatienten mit 62,4 ± 73,6 angegeben. Ein Großteil der Praxiskollegen schätzt den Anteil psychoonkologisch betreuungsbedürftiger Patienten gering ein (≤5 %). In 21,9 % der Praxen wird über psychoonkologische Unterstützungsangebote aktiv informiert; 26,1 % der Praxen kooperieren bezüglich psychoonkologischer Unterstützungsangebote mit anderen Einrichtungen; 29,3 % der Praxen haben Interesse an einem psychoonkologischen Versorgungskonzept.
Diskussion
In dermatologischen Praxen ist nur von gelegentlicher und teils defizitärer psychoonkologischer Versorgung und einer Zuweisung zu psychoonkologischen Einrichtungen auszugehen. Dies zeigt die Notwendigkeit einer Sensibilisierung für das Thema, um eine Integration der psychoonkologischen Beratung auch in der dermatologischen Routineversorgung zu ermöglichen.
http://bit.ly/2FyObOv
Luftverschmutzung und atopisches Ekzem
Zusammenfassung
Hintergrund
Unter zahlreichen Risikofaktoren für die Entstehung eines atopischen Ekzems (AE) wird neuerdings der Einfluss von Luftverschmutzung vermehrt diskutiert. Ein systematisches Review hierzu liegt aber bisher nicht vor.
Fragestellung
Welche Effekte von Außenluftverschmutzung (Partikel, Stickstoffoxide, Schwefeldioxid, Ozon oder allgemeine Straßenverkehrsemissionen) auf AE zeigen sich in einer systematischen Analyse verfügbarer umweltepidemiologischer Studien?
Methodik
Alle umweltepidemiologischen Studien zu AE und Luftverschmutzung aus der Literaturdatenbank PubMed wurden identifiziert, ihre wichtigsten Kenngrößen tabellarisch zusammengefasst, qualitativ nach Evidenzgraden beurteilt und beschrieben.
Ergebnisse
Es wurden 57 entsprechende Studien identifiziert. Nur in einer der 15 Querschnittstudien, bei denen die Exposition großräumig erfasst wurde, zeigte sich ein signifikanter Zusammenhang zwischen AE und Luftverschmutzung. Dagegen fanden sich signifikante positive Assoziationen von AE mit straßenverkehrsbedingten Emissionen – insbesondere aus LKWs – in 23 von 30 Studien mit kleinräumiger Expositionserfassung. Von diesen 30 Studien waren 14 Kohortenstudien (1-mal Erwachsene, 13-mal Geburtskohorten). Die einzige Kohortenstudie bei Erwachsenen zeigte eine Assoziation insbesondere mit einem intrinsischen AE. In ostasiatischen Geburtskohorten (alle in den letzten 3 Jahren veröffentlicht) war eine Verkehrsbelastung der Mutter während der Schwangerschaft mit einer erhöhten Inzidenz von AE beim Kind assoziiert. In den älteren Kohortenstudien aus Europa/USA war dies nicht so klar oder wurde nicht untersucht. In 5/5 Panelstudien (alle aus Korea) fand sich ein positiver Zusammenhang zwischen dem Schweregrad von Ekzem und der Außenluftbelastung.
Schlussfolgerung
In der systematischen Analyse umweltepidemiologischer Studien zeigte sich eine eher gute Evidenz dafür, dass Belastungen mit Straßenverkehrsemissionen, die kleinräumig variieren, die Prävalenz von AE erhöhen, während großräumige Belastung mit groben Partikeln (PM10) oder SO2 keinen Einfluss zeigte. Unter pathophysiologischen Aspekten scheinen Verkehrsemissionen sowohl über Einflüsse auf die Hautbarriere als auch auf die Aktivierung von Immunreaktionen zu wirken.
http://bit.ly/2FJ5UlO
Ewing’s Sarcoma of the Sinonasal Tract: A Report of Two Challenging Cases
Abstract
Ewing's sarcoma (ES) is a malignant small round cell tumor that belongs to the primitive neuroectodermal tumor class. ES generally arises in the long bones of the extremities (skeletal form) and less frequently in the soft tissue of the trunk and extremities (extra-skeletal form). Sinonasal localization of ES is an extremely rare event. About 80% of the patients are less than 20 years old with the highest incidence in the second decade of life. The combination of histopathological examination and ancillary methods (such as immunohistochemistry and molecular genetics) is extremely important to establish the diagnosis of ES. The most effective treatment plan for ES includes a multidisciplinary approach with surgery, radiotherapy and chemotherapy. This is a report of two challenging cases of sinonasal ES in two different age groups. The first case is a 13-years old female patient who presented with right nasal obstruction, anosmia, intermittent epistaxis and hearing loss. The second case is a 24-years old male patient who presented with a history of right nasal obstruction, right eye pain and periorbital edema. We present these cases due to the rarity of the disease and the difficulty of diagnosis.
http://bit.ly/2ARXrcJ
Management des lokal fortgeschrittenen Zervixkarzinoms
Zusammenfassung
Das lokal fortgeschrittene Zervixkarzinom erfordert eine besonders intensive interdisziplinäre Absprache. In der Definition des Stadiums spielen neben der klassischen FIGO-Einteilung (FIGO: „Fédération Internationale de Gynécologie et d'Obstétrique") Risikofaktoren eine wichtige Rolle. Dabei ist der Lymphknotenstatus entscheidend. In frühen Stadien wird operativ vorgegangen, bei weiter fortgeschrittener Erkrankung bis hin zum Stadium IVA wird die Radiochemotherapie präferiert. In jedem Fall ist eine frühzeitige Besprechung innerhalb eines Tumorboards erforderlich. Kontroversen betreffen z. B. den Einsatz moderner bildgebender Verfahren, die Therapie bei befallenen paraaortalen Lymphknoten, den Stellenwert einer neoadjuvanten Chemotherapie und die Versuche, die klassische Radiochemotherapie mit Cisplatin zu intensivieren. Der Artikel gibt dazu einen Überblick, unter besonderer Berücksichtigung aktueller Studiendaten und unter Bezugnahme auf die derzeit gültigen Leitlinien.
http://bit.ly/2QXptZf
Possible long-term sequelae in hand, foot, and mouth disease caused by Coxsackievirus A6
Publication date: Available online 17 January 2019
Source: Journal of the American Academy of Dermatology
Author(s): Francesco Broccolo, Francesco Drago, Giulia Ciccarese, Angelo Genoni, Alice Porro, Aurora Parodi, Konstantin Chumakov, Antonio Toniolo
http://bit.ly/2W0mbsa
Ebi3 promotes T- and B-cell division and differentiation via STAT3
Publication date: March 2019
Source: Molecular Immunology, Volume 107
Author(s): Ning Ma, Ying Fang, Ruonan Xu, Bing Zhai, Chunmei Hou, Xiaoqian Wang, Zhenyu Jiang, Liang Wang, Qilin Liu, Gencheng Han, Renxi Wang
Abstract
Although sharing the same subunit Ebi3, IL-27 (p28/Ebi3) and IL-35 (p35/Ebi3) have different biological functions, suggesting that Ebi3 subunit may functions as a carrier. Our data demonstrated that activated T cells and B cells effectively up-regulated Ebi3 expression. In addition, Ebi3 effectively promoted T-cell activation and the differentiation of helper T 1 (Th1), Th17, and Foxp3+ regulatory T (Treg) cells induced by Th1, Th17, and Treg polarizing condition, respectively. Naturally, Ebi3 could promote B-cell activation and the production of CD138+ plasma cells (PC) induced by LPS. Conversely, neutralizing anti-Ebi3 antibody could significantly suppress T/B-cell activation and production of Th1, Th17, Tregs, and PC induced by Th1, Th17, Treg polarizing condition, and LPS, respectively. Furthermore, we found that Ebi3 time-dependently induced STAT3 activation in CD4+T cells and B cells. Conversely, STAT3−/− effectively reduced Ebi3 expression and the production of Th1, Th17, Tregs, and plasma cells. Finally, we showed that gp130 but not IL-27Rα mediates Ebi3-induced STAT3 activation. These results suggest that Ebi3 promotes Th- and B-cell differentiation via gp130-STAT3 signaling pathway. Thus, autocrine Ebi3 may play an important role in the differentiation of Th and B cells and thus in infection, inflammation, and autoimmune disorders.
http://bit.ly/2FFFilo
Anagliptin ameliorates high glucose- induced endothelial dysfunction via suppression of NLRP3 inflammasome activation mediated by SIRT1
Publication date: March 2019
Source: Molecular Immunology, Volume 107
Author(s): Tiechao Jiang, Dongli Jiang, Lirong Zhang, Mei Ding, Hui Zhou
Abstract
High glucose- induced endothelial dysregulation has been recognized as an initiation of vascular complications in Type 2 diabetes mellitus (T2DM). Anagliptin is a novel licensed dipeptidyl peptidase-4 (DPP-4) inhibitor for the treatment of T2DM. The effects of anagliptin in high glucose- induced endothelial dysfunction are less reported. In the current study, we found that treatment with anagliptin prevented high glucose- induced reduction of cell viability and increase in LDH release in human umbilical vein endothelial cells (HUVECs). Our results indicate that anagliptin- reduced high glucose- induced increase in mitochondrial ROS and NOX-4 expression. Additionally, anagliptin treatment inhibited high glucose- induced expressions of TXNIP in HUVECs. Importantly, anagliptin treatment downregulated high glucose- induced NLRP3 inflammasome activation, as evidenced by reducing the expressions of NLRP3, ASC, and cleaved caspase-1 (P10). Also, ELISA results demonstrate that anagliptin treatment significantly abolished high glucose- induced maturation of IL-1β and IL-18. Mechanistically, we found that anagliptin treatment restored high glucose- induced reduction of SIRT1 expression. Silencing of SIRT1 by transfection with SIRT1 siRNA abolished the inhibitory effects of anagliptin in NLRP3 inflammasome activation. These results display that anagliptin may confer protection against high glucose- induced endothelial injury via SIRT1-dependent inhibition of NLRP3 infammasome activation.
http://bit.ly/2FzHgEH
Apport de la microscopie confocale par réflectance et de l’OCT dans le diagnostic d’un carcinome basocellulaire nodulaire kystique
Publication date: Available online 17 January 2019
Source: Annales de Dermatologie et de Vénéréologie
Author(s): L. Huppert, E. Cinotti, C. Habougit, D. Grivet, L. Tognetti, A. Gâillot, F. Cambazard, P. Rubegni, J.L. Perrot
http://bit.ly/2sxQOYn
Perioperative Teaching and Feedback: How are we doing in Canadian OTL-HNS programs?
Discrepancies between resident and faculty perceptions regarding optimal teaching and feedback during surgery are well known but these differences have not yet been described in Otolaryngology - Head and Neck ...
http://bit.ly/2TWAmN2
Double-strand break repair through homologous recombination in autosomal recessive BCL10 deficiency
Publication date: Available online 18 January 2019
Source: Journal of Allergy and Clinical Immunology
Author(s): Sonia García-Gómez, Rebeca Chaparro, Amin Safa, Ana Van Den Rym, Rubén Martinez-Barricarte, Lazaro Lorenzo, Silvia Sánchez-Ramón, Victor Toledano, Carolina Cubillos-Zapata, Eduardo López-Collazo, Maria Dolores Martín-Arranz, Eduardo Martín-Arranz, Maria Vela, Pablo Gonzalez-Navarro, Antonio Pérez-Martínez, Jean-Laurent Casanova, Maria José Recio, Rebeca Pérez de Diego
http://bit.ly/2RT7HuZ
Challenges in Assessing the Efficacy of Systemic Corticosteroids for Severe Wheezing Episodes in Preschool Children
Publication date: Available online 17 January 2019
Source: Journal of Allergy and Clinical Immunology
Author(s): Theresa W. Guilbert, Leonard B. Bacharier, David T. Mauger, Wanda Phipatanakul, Stanley J. Szefler, Susan Boehmer, Avraham Beigelman, Anne M. Fitzpatrick, Daniel J. Jackson, Sachin N. Baxi, Mindy Benson, Carey-Ann D. Burnham, Michael D. Cabana, Mario Castro, James F. Chmiel, Ronina Covar, Michael Daines, Jonathan M. Gaffin, Deborah A. Gentile, Fernando Holguin
Summary
This letter addresses the controversial issue of the use of oral corticosteroids during wheezing exacerbations in preschool-aged children by demonstrating findings of a prematurely terminated multi-center clinical trial, discussing lessons learned, and suggesting future directions.
http://bit.ly/2HgvT6p
Allergen challenge increases capsaicin evoked cough responses in allergic asthma
Publication date: Available online 17 January 2019
Source: Journal of Allergy and Clinical Immunology
Author(s): Imran Satia, Richard Watson, Tara Scime, Rachel J. Dockry, Shilpi Sen, James W. Ford, Patrick D. Mitchell, Stephen J. Fowler, Gail M. Gauvreau, Paul M. O'Byrne, Jaclyn A. Smith
Abstract
Background
Cough is a common and troublesome symptom in asthma but little is known about the neuronal pathways that trigger cough. The mechanisms by which airway inflammation, airway hyper-responsiveness and variable airflow obstruction cause cough are unclear.
Objective
To investigate the effects of allergen exposure on cough reflex sensitivity.
Methods
We performed a nine visit, randomised, single-blind, placebo-controlled, two-way cross-over study comparing cough responses to inhaled capsaicin in mild atopic asthmatics after allergen challenge compared with diluent control. Full dose capsaicin challenge was performed at screening to determine the excitatory dose evoking half the maximum cough response (ED50), which was subsequently administered at 30mins and 24-hours after inhaled allergen/diluent challenge. Spontaneous coughing was measured for 24-hours after allergen/diluent. Methacholine challenge and induced sputum was performed before and after allergen/diluent challenge.
Results
Twelve steroid naïve subjects completed the study (6 female, mean age 34.8yrs) Allergen inhalation caused both an early (mean 38.2±S.D.13.0%) and late (23.7±13.2%) fall in FEV1 and an increase in sputum eosinophils 24-hours later [median 1.9(IQR 0.8-5.8) % post-diluent to 14.9(8.9-37.3) % post-allergen, p=0.005]. There was also an increase in capsaicin evoked coughs after allergen exposure compared to diluent at both 30 mins [geometric mean coughs 21.9(95% C.I 16.5-29.20) versus 12.1(8.3-17.7), p<0.001], and at 24hrs [geometric mean coughs 16.1(95% C.I 11.3-23.0) versus 9.8(6.1-15.8), p=0.001]. Allergen exposure was also associated with an increase in spontaneous coughs over 24-hours.
Conclusion
Allergen induced bronchoconstriction and airway eosinophilia results in increased cough reflex sensitivity to capsaicin associated with an increase in 24-hour spontaneous coughing.
Graphical abstract
http://bit.ly/2RYBAda
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