Right ventricular (RV) hypoplasia may develop secondary to pulmonary or tricuspid valve atresia. These patients are usually symptomatic early in life and need prompt intervention. Isolated RV hypoplasia is a rare congenital heart disease. We report a case of 23-year-old twins who have been monitored for the last 14 years for isolated right ventricular hypoplasia. ECHO and MRI studies showed a small, heavily trabeculated, nonapex-forming RV and mild tricuspid valve insufficiency. The girl has a patent foramen ovale (PFO). Otherwise, the cardiac anatomy and function was normal. They have both been completely asymptomatic from the cardiac standpoint. The family history is remarkable for death of father at the age of 30 years with autopsy suggestive of a hypoplastic RV. The paternal uncle also died at the age of 46 years, and his son has an unidentified congenital heart disease. The family history appears to suggest an autosomal dominant pattern of inheritance with variable expressivity. However, the chromosome microarray analysis of the twins did not identify any variations of clinical significance.
http://bit.ly/2W6wg6X
Κυριακή 20 Ιανουαρίου 2019
Asymptomatic Right Ventricular Hypoplasia in Twin Siblings: A Normal Variant or Cause of Early Mortality?
Potential life-threatening complication of tonsillectomy: cervicofacial surgical emphysema
A 30-year-old woman presented to the accident and emergency department 3 days post-tonsillectomy with bleeding from the tonsillar fossa and left-sided facial swelling. The patient denied any dysphagia or breathing difficulties but experienced pain on neck movement. On examination, although the bleeding had stopped on reaching the emergency department, a small clot was noted in her left tonsillar fossa. A left facial/submandibular swelling was seen, which had been present since her operation and was slowly enlarging. Flexible nasendoscopy showed a mild left sided oropharyngeal swelling but was otherwise normal. She was treated initially with antibiotics and hydrogen peroxide gargles. After 24 hours of observation and a slight worsening of the swelling she underwent a CT of the neck. This showed widespread indurated subcutaneous surgical emphysema, originating from the left tonsillar bed. Following a period of observation and improvement in her symptoms, she was discharged home with safety netting.
http://bit.ly/2RVSE3M
Novel intronic DICER1 variation associated with pleuropulmonary blastoma in two siblings
Pleuropulmonary blastomas (PPB) are rare aggressive paediatric lung malignancies associated with DICER1 variants. We present two cases, a 2-year-old girl with upper respiratory tract symptoms as well as a 6-month-old girl sibling undergoing screening due to family history of malignancy. Imaging of the 2-year-old girl revealed a large mass filling the right hemithorax which was determined to be a type II PPB after pathological examination. Imaging of the 6-month-old sibling demonstrated a small cystic lesion in the posterior basal segment of the right lower lobe which was determined to be a type 1r PPB after pathological examination. The 2-year-old girl received adjuvant chemotherapy while the baby sister underwent resection alone and both are alive and well at 12 months and 7 months, respectively. Sequence analysis in both cases confirmed the same DICER1 variation, c.2437-2A>G (likely pathogenic), which has not been previously described in the literature.
http://bit.ly/2RXzlH1
Recurrent vulvar melanoma in a patient with neurofibromatosis and gastrointestinal stromal tumour
We report a case of a 51-year-old woman with neurofibromatosis who presented in 2012 with postmenopausal bleeding. Excision biopsy of a pigmented lesion of the labia minora was consistent with an ulcerated vulvar BRAF wild type malignant melanoma (MM). Initial excision was followed by radical vulvectomy and adjuvant interferon. Local recurrence in January 2017 was further resected. Positron emission tomography (PET)-CT in May 2017 identified an FDG avid omental deposit; consistent histologically with MM when resected. Postoperative PET-CT in August 2017 demonstrated local recurrence. In the setting of resected stage IV disease and a third local recurrence, the decision was made to instigate immunotherapy. Vulvar melanoma is rare accounting for 0.2% of all melanoma. Presentation is typically a decade later than cutaneous melanoma with a tendency to late metastases and poorer prognosis. Given their rarity the treatment paradigm is less clearly defined and largely extrapolated from that of cutaneous melanomas.
http://bit.ly/2HpsIcB
Clear cell, giant myoepithelioma of tongue base: a diagnostic and surgical challenge
Clear cell variant is a rare histological type of myoepithelioma seen in parotid and soft palate. This article describes clear cell variant of myoepithelioma in the tongue base, which has not been reported in the literature so far. A 34-year-old man presented with dysphagia and foreign body sensation of throat. Video laryngostroboscopy using a 70° rigid telescope showed a smooth globular mass in the oropharynx arising from the tongue base. Based on clinical and radiological findings, the lesion was considered as benign. Fine needle aspiration cytology was not attempted fearing risk of bleeding, aspiration and airway compromise. Hence, an excisional biopsy followed by definitive histopathological examination without frozen section was planned. The patient underwent coblator-assisted excision and subsequently sent for histopathological analysis. There were cuboidal cell nests with abundant clear cytoplasm which stained positive for p63 by immunohistochemistry. This helped in establishing the diagnosis of clear cell myoepithelioma.
http://bit.ly/2sBpuIC
Successful treatment of stage III hidradenitis suppurativa with botulinum toxin A
A 41-year-old obese Native American woman presented with hidradenitis suppurativa (HS) after failing all available treatment options. Her HS was more pronounced in the axillary and groin regions (Hurley stage III) and was a major source of her pain and a barrier for home exercise and aquatic therapy. She received a botulinum toxin A injection every 3 months (four times thus far), which has significantly helped alleviate her pain and curb the progress of her HS by resolving abscesses and healing draining sinuses.
http://bit.ly/2sA7uOZ
Managing psychotic depression and diagnostic uncertainty in liaison psychiatry
A middle-aged woman presented with a history of symptoms of depression with psychotic features severely affecting her physical health. Neuroimaging of her brain suggested pathological changes out of keeping with her age, leading to further investigations including genetic testing for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis was also considered as a differential diagnosis as an initial serum test for anti-NMDAR autoantibodies was positive. Her symptoms resolved following treatment with electroconvulsive therapy. Despite her initial neuroimaging, her genetic test for CADASIL was negative and her subsequent test for anti-NMDAR autoantibodies was negative, suggesting that the initial test may have been a false positive.
http://bit.ly/2MmzLSe
Long‐term outcomes of imiquimod‐treated lentigo maligna
Summary
Background
Lentigo maligna (LM) may be disfiguring and can progress to LM melanoma. Surgical excision remains the mainstay of treatment, but may result in disfigurement when used for large facial lesions. Topical imiquimod is a nonsurgical alternative although data on its long‐term efficacy remain limited.
Aim
To assess long‐term outcomes of LM treated with imiquimod cream.
Methods
We collected data retrospectively for 33 patients treated with imiquimod cream for biopsy‐proven LM from 2001 to 2016. Patients initially applied imiquimod once daily, 5 days/week for 6 weeks, aiming to produce a brisk local inflammatory response. If there was no response, the dose was increased to twice daily 7 days/week for 6 weeks and if again there was no response, to twice daily for 10 weeks.
Results
An inflammatory response developed in 29 (88%) of the 33 patients, and of these, 4 patients stopped treatment earlier than planned because they could not tolerate the inflammatory reaction, while 3 patients reported systemic side effects. There was lesion clearance in 21 (72%) of the 29 patients, and they remained clear after a mean follow‐up of 4.1 years. Eight failed to clear; in five the lesion was excised, while the remaining three were managed expectantly.
Conclusions
Our results support the use of imiquimod as an alternative to surgery for the treatment of LM in selected cases. With adequate patient preparation, imiquimod is generally tolerated and can achieve excellent cosmetic results. A clinical response is more likely if there is a brisk inflammatory response, and LM will not resolve if there is no inflammatory response.
http://bit.ly/2MlGBYd
Long‐term outcomes of imiquimod‐treated lentigo maligna
Summary
Background
Lentigo maligna (LM) may be disfiguring and can progress to LM melanoma. Surgical excision remains the mainstay of treatment, but may result in disfigurement when used for large facial lesions. Topical imiquimod is a nonsurgical alternative although data on its long‐term efficacy remain limited.
Aim
To assess long‐term outcomes of LM treated with imiquimod cream.
Methods
We collected data retrospectively for 33 patients treated with imiquimod cream for biopsy‐proven LM from 2001 to 2016. Patients initially applied imiquimod once daily, 5 days/week for 6 weeks, aiming to produce a brisk local inflammatory response. If there was no response, the dose was increased to twice daily 7 days/week for 6 weeks and if again there was no response, to twice daily for 10 weeks.
Results
An inflammatory response developed in 29 (88%) of the 33 patients, and of these, 4 patients stopped treatment earlier than planned because they could not tolerate the inflammatory reaction, while 3 patients reported systemic side effects. There was lesion clearance in 21 (72%) of the 29 patients, and they remained clear after a mean follow‐up of 4.1 years. Eight failed to clear; in five the lesion was excised, while the remaining three were managed expectantly.
Conclusions
Our results support the use of imiquimod as an alternative to surgery for the treatment of LM in selected cases. With adequate patient preparation, imiquimod is generally tolerated and can achieve excellent cosmetic results. A clinical response is more likely if there is a brisk inflammatory response, and LM will not resolve if there is no inflammatory response.
http://bit.ly/2MlGBYd
Dravet Syndrome in Lebanon: First Report on Cases with SCN1A Mutations
Dravet syndrome, also known as severe myoclonic epilepsy in infancy, is a rare disease characterized by the appearance of different types of seizures in a healthy baby, triggered by various factors and stressful events. We report 8 Lebanese cases referred for molecular analysis of the SCN1A gene. Results were positive in 7 cases and revealed de novo variants at the heterozygous state in different exons of the gene for all except one, where the variant was intronic. Four variants were novel. Confirmation of Dravet syndrome is important for a better follow-up and treatment, preventing the occurrence of status epilepticus and severe neurological deterioration.
http://bit.ly/2W7QBIQ
Modified phenol peels for treatment‐refractory hyperpigmentation of lichen planus pigmentosus: A retrospective clinico‐dermoscopic analysis
Abstract
Background
Lichen Planus Pigmentosus (LPP), a disorder with stubborn treatment‐refractory hyperpigmentation predominantly affects the darker skin. Deep dermal pigmentary incontinence of LPP renders the condition treatment‐refractory.
Objectives
Lack of a consistently effective depigmenting treatment protocol of inactive LPP mandates exploration of novel approaches. We analyzed the effect of six sessions of modified phenol peel on reduction of pigmentation of LPP in Indian patients.
Methods
The results of a retrospective analysis of the efficacy and safety of six sessions of Croton oil free phenol combination (CFPC) peel done every 3 weeks, for inactive LPP‐associated hyperpigmentation in 17 patients are presented. Efficacy evaluation was done with patient‐reported improvement, physician‐evaluated improvement (photographic comparison of baseline and post‐treatment clinical images), and pre‐ and posttreatment comparison of dermoscopic images using a simple scale.
Results
Out of 17, 5 (29%) patients sustained excellent improvement with >75% reduction of pigmentation. Overall 13 (76%) patients had moderate to excellent improvement, that is, at least 25% or more reduction in pigmentation. The patient‐reported improvement, physician‐graded improvement, and dermoscopic changes—all three measures showed harmonious overlap. Lightening of the background color and reduction in density and color intensity of pigmented structures was observed on dermoscopy in majority of patients. The treatment was well tolerated with no serious local/systemic adverse effects.
Conclusions
Modified phenol peels seem effective in reduction of hyperpigmentation of LPP. They are safe and well tolerated. Thorough priming, stringent sun protection and use of post‐peel adjuvant topicals boost the peel effect and aid in maintaining the effect for up to a year.
http://bit.ly/2U5wUzL
A comparison of infection rates during skin cancer excisions using nonsterile vs sterile gloves: A prospective randomized pilot study
Summary
Background
Standard surgical skin excision is a routine outpatient procedure commonly performed in Dermatology practice to treat nonmelanoma and melanoma skin cancer. Use of sterile gloves during this procedure has been the standard of care in most Dermatology offices.
Objective
To determine whether the incidence of infection rates was affected when using nonsterile gloves (NSG) instead of sterile gloves (SG) during standard skin excisions in an outpatient Dermatology clinic setting.
Methods
This prospective, subject‐blinded, single‐center trial randomized 93 patients presenting for routine skin cancer excisions into two groups. In the first group, 53 excisions were performed with NSG and in the second group 53 excisions were performed with sterile gloves. Degree of wound inflammation and wound infection at 48‐72 hours postprocedure was measured.
Results
One hundred and six total wounds were included. Zero of 53 were infected in the NSG group, and 0/53 were infected in the SG at the initial screening 48‐72 hours postexcision procedure (P = 0.99). The average wound inflammation score was 0.321 for the NSG group and 0.245 for the SG group.
Conclusions
Our study suggests that NSG are safe to use for simple excisions of cutaneous skin cancers in an outpatient dermatology clinic setting.
http://bit.ly/2DnHj4c
Modified phenol peels for treatment‐refractory hyperpigmentation of lichen planus pigmentosus: A retrospective clinico‐dermoscopic analysis
Abstract
Background
Lichen Planus Pigmentosus (LPP), a disorder with stubborn treatment‐refractory hyperpigmentation predominantly affects the darker skin. Deep dermal pigmentary incontinence of LPP renders the condition treatment‐refractory.
Objectives
Lack of a consistently effective depigmenting treatment protocol of inactive LPP mandates exploration of novel approaches. We analyzed the effect of six sessions of modified phenol peel on reduction of pigmentation of LPP in Indian patients.
Methods
The results of a retrospective analysis of the efficacy and safety of six sessions of Croton oil free phenol combination (CFPC) peel done every 3 weeks, for inactive LPP‐associated hyperpigmentation in 17 patients are presented. Efficacy evaluation was done with patient‐reported improvement, physician‐evaluated improvement (photographic comparison of baseline and post‐treatment clinical images), and pre‐ and posttreatment comparison of dermoscopic images using a simple scale.
Results
Out of 17, 5 (29%) patients sustained excellent improvement with >75% reduction of pigmentation. Overall 13 (76%) patients had moderate to excellent improvement, that is, at least 25% or more reduction in pigmentation. The patient‐reported improvement, physician‐graded improvement, and dermoscopic changes—all three measures showed harmonious overlap. Lightening of the background color and reduction in density and color intensity of pigmented structures was observed on dermoscopy in majority of patients. The treatment was well tolerated with no serious local/systemic adverse effects.
Conclusions
Modified phenol peels seem effective in reduction of hyperpigmentation of LPP. They are safe and well tolerated. Thorough priming, stringent sun protection and use of post‐peel adjuvant topicals boost the peel effect and aid in maintaining the effect for up to a year.
http://bit.ly/2U5wUzL
A comparison of infection rates during skin cancer excisions using nonsterile vs sterile gloves: A prospective randomized pilot study
Summary
Background
Standard surgical skin excision is a routine outpatient procedure commonly performed in Dermatology practice to treat nonmelanoma and melanoma skin cancer. Use of sterile gloves during this procedure has been the standard of care in most Dermatology offices.
Objective
To determine whether the incidence of infection rates was affected when using nonsterile gloves (NSG) instead of sterile gloves (SG) during standard skin excisions in an outpatient Dermatology clinic setting.
Methods
This prospective, subject‐blinded, single‐center trial randomized 93 patients presenting for routine skin cancer excisions into two groups. In the first group, 53 excisions were performed with NSG and in the second group 53 excisions were performed with sterile gloves. Degree of wound inflammation and wound infection at 48‐72 hours postprocedure was measured.
Results
One hundred and six total wounds were included. Zero of 53 were infected in the NSG group, and 0/53 were infected in the SG at the initial screening 48‐72 hours postexcision procedure (P = 0.99). The average wound inflammation score was 0.321 for the NSG group and 0.245 for the SG group.
Conclusions
Our study suggests that NSG are safe to use for simple excisions of cutaneous skin cancers in an outpatient dermatology clinic setting.
http://bit.ly/2DnHj4c
MP‐AzeFlu provides rapid and effective allergic rhinitis control: results of a non‐interventional study in Denmark
Background
Allergic rhinitis (AR) control is a priority in the European Union (EU), and Allergic Rhinitis and its Impact on Asthma (ARIA) has endorsed a visual analogue scale (VAS) as the new language of AR control. This study evaluated the effectiveness of MP‐AzeFlu (Dymista®, antihistamine [azelastine], and intranasal corticosteroid [fluticasone propionate]) using a VAS in real‐life clinical practice in Denmark.
Methods
The multicenter, prospective, non‐interventional study included 170 patients (≥12 years) with ARIA‐defined moderate‐to‐severe AR prescribed MP‐AzeFlu. Patients assessed symptom severity using a VAS (0 to 100 mm) on days 0, 1, 3, and 7 and after ∼14 days of MP‐AzeFlu use. On day 3, patients assessed their disease as well controlled, partly controlled, or uncontrolled. Proportions of patients achieving VAS score cutoffs (well‐controlled, partly controlled) were also calculated.
Results
MP‐AzeFlu reduced mean ± standard deviation VAS score from 67.1 ± 19.3 mm at baseline to 28.4 ± 23.7 mm on the last day, a reduction of 38.8 ± 27.3 mm. At day 3, 85.6% of patients considered their symptoms to be partly or well controlled. Effectiveness was consistent across disease severity, phenotype (seasonal, perennial, or combined AR), and patient age. Respectively, 28.2%, 44.2%, 61.6%, and 71.4% of patients achieved ≤38 mm well‐controlled VAS score cutoff on days 1, 3, and 7, and the last day.
Conclusion
MP‐AzeFlu provided effective, rapid, and sustained symptom control in a real‐life setting among patients from Denmark. These results align with EU and ARIA objectives and support the effectiveness of MP‐AzeFlu for the treatment of AR in real life.
http://bit.ly/2CwURc0
Fueling Ketone Metabolism Quenches Salt-Induced Hypertension
Publication date: Available online 19 January 2019
Source: Trends in Endocrinology & Metabolism
Author(s): David E. Place, Thirumala-Devi Kanneganti
Understanding the molecular mechanisms by which diet and exercise regulate disease has the potential to help identify new treatments. In their recent study, Chakraborty et al. (Cell Reports 2018;25:677–689) discovered that supplementation with a metabolic precursor produced β-hydroxybutyrate (BHB), counteracting the pathological effects of high-salt diet-induced hypertension, suggesting a new treatment modality.
http://bit.ly/2TbMI3G
Pressure Ulcers: Prevention and Management
Publication date: Available online 18 January 2019
Source: Journal of the American Academy of Dermatology
Author(s): Joshua S. Mervis, Tania J. Phillips
Abstract
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/2FL68st
Pressure Ulcers: Pathophysiology, Epidemiology, Risk Factors, and Presentation
Publication date: Available online 18 January 2019
Source: Journal of the American Academy of Dermatology
Author(s): Joshua S. Mervis, Tania J. Phillips
Abstract
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. Moreover, dermatologists should be able to recognize early changes that occur prior to skin breakdown and to properly identify and stage pressure ulcers so as to prevent delay of appropriate care. The aim of the first part of this continuing medical education article is to discuss the pathophysiology, risk factors, epidemiology, social and economic burden, and clinical presentation of pressure ulcers.
http://bit.ly/2FCeof5
A novel technique to safely maximize botulinum toxin extraction from 50 unit vials
Publication date: Available online 18 January 2019
Source: Journal of the American Academy of Dermatology
Author(s): Isadore S. Tarantino, Brett C. Neill, Melanie N. Wolf, Anand Rajpara, Daniel J. Aires
http://bit.ly/2FJMEV0
Oxytocin facilitates the proliferation, migration and osteogenic differentiation of human periodontal stem cells in vitro
Publication date: Available online 19 January 2019
Source: Archives of Oral Biology
Author(s): Bin Ge, Hongrui Liu, Qianyu Liang, Lingling Shang, Ting Wang, Shaohua Ge
Abstract
Objective
To explore the effect of oxytocin (OT) on the proliferation, migration, and osteogenic differentiation of periodontal ligament stem cells (PDLSCs) in vitro.
Design
PDLSCs were obtained by limiting dilution method. Immunofluorescence (IF), cell-counting kit-8 (CCK8), cell migration assay, Alizarin Red S staining, cetylpyridinium chloride (CPC) colorimetry, quantitative real-time polymerase chain reaction (qRT-PCR), and western blot analysis were used to examine the effect of OT on oxytocin receptor (OTR) expression, cell proliferation, migration and osteogenic differentiation of PDLSCs.
Results
Our study showed that PDLSCs expressed OTR. One hundred nanomolar OT exhibited the maximal effect on migration, while only 50 nM OT significantly promoted proliferation of PDLSCs, as well as mineralized nodule formation and calcium deposition (p < 0.05). Furthermore, 50 nM OT significantly up-regulated expression of osteogenesis-related genes—alkaline phosphatase (ALP), Collagen I (Col I), runt related transcription factor 2 (Runx 2), osteopontin (OPN) and osteocalcin (OCN)—at specific time points compared with osteogenic inductive medium (p < 0.05). In addition, western blot analysis demonstrated that 50 nM OT enhanced protein levels of ALP, Col I, and Runx 2 at day 7 and day 14 (p < 0.01), as well as activating the phosphorylation of extracellular-signal-regulated kinase (ERK) and protein kinase B (AKT) pathway; notably, 50 nM OT inhibited phosphorylation of the phosphatidylinositol 3-kinase (PI3K) pathway (p < 0.05).
Conclusions
OT promoted proliferation, migration, and osteogenic differentiation of PDLSCsin vitro. Furthermore, the effect of OT on osteogenic differentiation was mediated through ERK and AKT pathway. Thus, OT may have potential for use in periodontal regeneration.
http://bit.ly/2Mpcuze
Jagged1 promotes mineralization in human bone-derived cells
Publication date: Available online 18 January 2019
Source: Archives of Oral Biology
Author(s): Thanaphum Osathanon, Jeeranan Manokawinchoke, Noppadol Sa-Ard-Iam, Rangsini Mahanonda, Prasit Pavasant, Jaijam Suwanwela
Abstract
Objectives
The present study aimed to investigate the expression of Notch signaling components during osteogenic differentiation in vitro and bone healing in vivo. In addition, the influence of Notch signaling on osteogenic differentiation of human bone-derived cells was examined.
Methods
Gene expression profiling of osteogenic differentiation of human bone marrow-derived mesenchymal stromal cells in vitro (GSE80614) and bone healing period of murine tibial fracture in vivo (GSE99388) was downloaded from Gene Expression Omnibus database. The expression of Notch signaling components was obtained from bioinformatic tools. Human bone-derived cells were isolated from alveolar and iliac bone. Cells were seeded on Jagged1 immobilized surface. Osteogenic marker gene expression and mineralization were examined using real-time polymerase chain reaction and alizarin red s staining, respectively.
Results
From bioinformatic analysis of gene expression profiling, various Notch signaling components were differentially expressed during osteogenic differentiation of human bone marrow-derived mesenchymal stromal cells in vitro and bone healing period of murine tibial fracture in vivo. The common genes differentially regulated of these two datasets were Hes1, Aph1a, Nsctn, Furin, Adam17, Hey1, Pcsk5, Nedd4, Jag1, Heyl, Notch3, Dlk1, and Hey2. For an in vitro analysis, the mineral deposition markedly increased after seeding human bone-derived cells on Jagged1 immobilized surface, correspondingly with the increase of ALP mRNA expression. Jagged1 treatment downregulated TWIST2 mRNA expression in both human alveolar and iliac bone-derived cells.
Conclusion
Notch signaling is regulated during osteogenic differentiation and bone healing. In addition, the activation of Notch signaling promotes osteogenic differentiation in human alveolar and iliac bone-derived cells. Therefore, Notch signaling manipulation could be a useful approach for enhancing bone regeneration.
http://bit.ly/2sFjqyN
Food allergy is linked to season of birth, sun exposure, and vitamin D deficiency
Publication date: Available online 19 January 2019
Source: Allergology International
Author(s): Teruaki Matsui, Kajiyo Tanaka, Hirotaka Yamashita, Ken-ichi Saneyasu, Hiroyuki Tanaka, Yoshihiro Takasato, Shiro Sugiura, Naoki Inagaki, Komei Ito
Abstract
The season of birth and ultraviolet B exposure have been related to the occurrence of food allergy. The levels of vitamin D produced from skin by ultraviolet B exposure might reflect this relationship. Vitamin D is known to induce antimicrobial peptides, protect intestinal flora, enhance the gut epithelial barrier, suppress mast cell activation and IgE synthesis from B cells, and increase the number of tolerogenic dendritic cells and IL-10-producing regulatory T cells. Vitamin D deficiency has been shown to exacerbate sensitization and allergic symptoms in a murine model of food allergy. However, in clinical situations, contradictory observations have been reported regarding the relationship between food allergy and vitamin D deficiency/supplementation. In this review, we have explored the links between food allergy and vitamin D levels. One explanation for the discrepant findings is confounding factors such as race, age, residency, skin color, and epigenetic changes that contribute to vitamin D levels. In addition, the season of birth influences the development of atopic dermatitis, which could lead to food sensitization. Finally, ultraviolet radiation could lead to regulatory T cell expansion and immunosuppression, irrespective of vitamin D status. Based on our current understanding, we believe that correction of vitamin D deficiency by supplementation, appropriate skin care, and sufficient ultraviolet radiation exposure could alter the prognosis of food allergy. To identify potential treatment strategies for food allergy, it is essential to gain a better understanding of the appropriate levels of vitamin D and ultraviolet radiation exposure.
http://bit.ly/2S0SUOE
Allergic bronchopulmonary aspergillosis in succession to chronic eosinophilic pneumonia
Publication date: Available online 19 January 2019
Source: Allergology International
Author(s): Takao Mochimaru, Koichi Fukunaga, Soichiro Ueda, Aoi Kuroda, Risa Watanabe, Shotaro Chubachi, Tomoko Betsuyaku
http://bit.ly/2HvjDiG
The effects of different packing materials on healing and hearing after trauma to middle ear mucosa, an experimental study in rats
Publication date: Available online 20 January 2019
Source: American Journal of Otolaryngology
Author(s): Baklaci Deniz, Kum Rauf Oguzhan, Ozdemir Erdem, Sahin Hasan, Yilmaz Yavuz Fuat, Ozcan Muge
http://bit.ly/2R42P1L
Frequency characteristics and speech recognition in cartilage conduction
Publication date: Available online 19 January 2019
Source: Auris Nasus Larynx
Author(s): Tadashi Nishimura, Ryosuke Miyamae, Hiroshi Hosoi, Osamu Saito, Ryota Shimokura, Toshiaki Yamanaka, Tadashi Kitahara
Abstract
Objective
Cartilage conduction (CC) is a new transduction form, and hearing devices that utilize CC present a new option for patients with aural atresia. However, in occluded ears, low-tone sounds are transmitted very effectively, resulting in excessive low-tone sound emphasis and speech recognition reduction. This study aimed to clarify low-tone speech recognition for CC in occluded ears, and determine if excessive low-tone sound emphasis decreases maximum speech recognition scores.
Methods
Eight volunteers with normal hearing participated. The performance-intensity function and maximum speech recognition scores for CC with an earplug (i.e., occluded) and air conduction (AC) were measured under high- and low-pass filter (HPF and LPF) conditions, respectively.
Results
An HPF improved the maximum speech recognition scores for CC in occluded ears. The scores for CC (occluded) under the conditions of the first- and second-order HPF did not differ from that for AC under the no-filter condition. Conversely, an LPF reduced the scores for AC. The scores and confusion matrices under the second-order LPF condition were similar to those for CC (occluded).
Conclusion
The conditions under the second-order LPF resembled those of CC in occluded ears. An HPF can compensate excessive low-tone emphasis and improve speech recognition.
http://bit.ly/2W8sx8G
Are melanocortin peptides future therapeutics for cutaneous wound healing?
Abstract
Cutaneous wound healing is a complex process divided into different phases, i. e. an inflammatory, proliferative and remodelling phase. During these phases a variety of resident skin cell types but also cells of the immune system orchestrate the healing process. In the last year it has been shown that the majority of cutaneous cell types express the melanocortin 1 receptor (MC1R) that binds α‐melanocyte‐stimulating hormone (α‐MSH) with high affinity and elicits pleiotropic biological effects, e. g. modulation of inflammation and immune responses, cytoprotection, antioxidative defence, and collagen turnover. Truncated α‐MSH peptides such as Lys‐Pro‐Val (KPV) as well as derivatives like Lys‐d‐Pro‐Thr (KdPT), the latter containing the amino acid sequence 193‐195 of interleukin‐1β, have been found to possess anti‐inflammatory effects but to lack the pigment‐inducing activity of α‐MSH. We propose here that such peptides are promising future candidates for the treatment of cutaneous wounds and skin ulcers. Experimental approaches in silico, in vitro, ex vivo and in animal models are outlined. This is followed by an unbiased discussion of the pro and contra arguments of such peptides as future candidates for the therapeutic management of cutaneous wounds and a review of the so‐far available data on melanocortin peptides and derivatives in wound healing.
This article is protected by copyright. All rights reserved.
http://bit.ly/2CwZRxl
Laryngopharyngeal reflux concept: what is known and what should we focus on?
Publication date: Available online 19 January 2019
Source: Brazilian Journal of Otorhinolaryngology
Author(s): Seher Sirin, Ferhan Öz
http://bit.ly/2CuJjpH
Detection of increased intracerebral lactate in a mouse model of Leigh syndrome using proton MR spectroscopy
Publication date: Available online 19 January 2019
Source: Magnetic Resonance Imaging
Author(s): Yusuke Takahashi, Hidetaka Kioka, Yasunori Shintani, Akiko Ohki, Seiji Takashima, Yasushi Sakata, Takahiro Higuchi, Shigeyoshi Saito
Abstract
Purpose
To establish a brain proton magnetic resonance spectroscopy (1H MRS) experimental system using a mouse model of Leigh syndrome for monitoring intracerebral lactate levels as a biomarker of mitochondrial disease progression.
Materials and methods
Brain 1H MRS was performed in the Ndufs4 homozygous knockout (KO) mice, a mouse model of Leigh syndrome, and control mice on a horizontal 7.0-T magnetic resonance imaging system at age 5–9 weeks. In a subset of KO mice, survival analysis was performed according to the median of the intracerebral lactate levels. In addition, in KO mice alive until 9 weeks of age, both 1H MRS and T2-weighted imaging (T2WI) were longitudinally performed in the same individuals at 5, 7, and 9 weeks of age.
Results
Brain 1H MRS demonstrated increased lactate levels in KO mice compared with control mice (6.4 ± 1.2 mM vs. 3.3 ± 0.8 mM, p < 0.0001). The increased intracerebral lactate levels were already observed at 5 weeks of age, while no obvious abnormal findings were detected in T2WI. Notably, an increased lactate level of >5.94 mM at week 5 was associated with a poor prognosis (median survival days: 24.5 vs. 42 days, log-rank p = 0.03). Longitudinal 1H MRS experiments revealed temporal increase of intracerebral lactate levels, peaking at week 7 (mean change: 2.6 ± 0.7 mM, p = 0.001), followed by decrease at week 9 (mean change: −3.8 ± 2.5 mM, p = 0.03), along with further disease progression, with brain lesions being detected on T2WI.
Conclusion
Using brain 1H MRS, we demonstrated significant increase in intracerebral lactate levels in a mouse model of Leigh syndrome. Additionally, we demonstrated that intracerebral lactate is a useful biomarker of mitochondrial disease progression at stages preceding the development of brain lesions.
http://bit.ly/2TXc7ya
How far can regulating TRIM16 help reduce malignant transformation of OPMD’s to OSCC?
Publication date: Available online 18 January 2019
Source: Oral Oncology
Author(s): Samapika Routray
http://bit.ly/2R13r84
Beta human papillomaviruses in middle ear squamous cell carcinoma
Publication date: Available online 18 January 2019
Source: Oral Oncology
Author(s): Francesca Paolini, Claudia Bonomo, Irene Terrenato, Annarita Pennetti, Renato Covello, Giovanni Cristalli, Aldo Venuti
http://bit.ly/2W8miSi
National Impact of 13-Valent Pneumococcal Conjugate Vaccine on Ambulatory Care Visits for Otitis Media in Children under 5 Years in the United States
Publication date: Available online 19 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Xiaofeng Zhou, Cynthia de Luise, Michael Gaffney, Catharine W. Burt, Daniel A. Scott, Nicolle Gatto, Kimberly J. Center
Abstract
Objective
The 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) were approved in the US in 2000 and 2010, respectively, for active immunization against invasive disease caused by all vaccine serotypes and otitis media (OM) caused by 7 serotypes common to both vaccines, starting at ∼6 weeks of age. This study assessed the impact of PCV13 on OM by evaluating changes in US ambulatory care visit rates between the period before PCV7 (1997-1999), during PCV7 (2001–2009), and after the introduction of PCV13 (2011-2013) among US children <5 years old.
Methods
This ecological study used US National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data. Trend analyses using weighted least-squares regression and mean visit rates were calculated for OM and two control endpoints not likely to be related to either vaccine (skin rash and trauma).
Results
Among children <5 and <2 years old, the observed reduction in OM visit rates was 22% (95%CI: 12%-32%) and 24% (95%CI: 13%-35%) when comparing PCV13 to PCV7 periods, and 41% (95%CI: 30%-52%) and 48% (95%CI: 37%-59%) when comparing PCV13 to pre-PCV7 periods. Visit rates for skin rash and trauma remained stable.
Conclusion
Significant reductions in US ambulatory care visit rates for OM were observed among children aged <5 years after introduction of PCV13 compared to the periods before and during PCV7; reductions were greatest among children <2 years old. The reductions beyond the PCV7 period support the effectiveness of the vaccine's 6 additional serotypes in preventing OM.
http://bit.ly/2FKRlhr
Effectiveness and Safety of Chinese Herbal Medicine for Pediatric Adenoid Hypertrophy: a meta-analysis
Publication date: Available online 19 January 2019
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Ya-Lei Sun, Hai-Tao Zheng, Jia-Lei Tao, Ming-Chen Jiang, Chan-Chan Hu, Xin-Min Li, Bin Yuan
Abstract
Objective
Chinese herbal medicine has been gradually used to treat pediatric adenoid hypertrophy. This meta-analysis were conducted to evaluate the clinical efficacy and safety of Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy.
Methods
Randomized controlled trials involving Chinese herbal medicine in the treatment of pediatric adenoid hypertrophy were identified from Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Wanfang Database and VIP Information Database. The methodological quality of trials was evaluated with Cochrane Handbook criteria, and the Cochrane Collaboration's Review Manager 5.3 software was used for Meta-analysis.
Results
A total of 13 valid articles involving 1038 patients were included.The meta-analysis showed that: Compared with western medicine treatment, Chinese herbal medicine significantly improved clinical efficacy (RR=1.33, 95% CI [1.24,1.43]), and significantly decreased A/N ratio (MD=-0.04,95%CI[-0.05,-0.03]). Chinese herbal medicine also prominently improved the quality of life (MD=-4.77,95%CI[-8.35,-1.20]). Meanwhile, it dramatically improved snoring (MD=-0.46,95%CI[-0.62,-0.30]); mouth breathing (MD=-0.52,95%CI[-0.66,-0.39]); nasal obstruction (MD= -0.56,95%CI[-0.68,-0.45]).
Conclusion
Chinese herbal medicine has good clinical efficacy and safety on pediatric adenoid hypertrophy, which need to be confirmed by high quality, multiple-center, large sample randomized controlled trials.
http://bit.ly/2FBVC7N
Mass spectrometry‐based proteomics reveals the distinct nature of the skin proteomes of photoaged compared to intrinsically aged skin
Abstract
Objective
With increasing age skin is subject to alterations in its organisation, which impacts on its function as well as having clinical consequences. Proteomics is a useful tool for non‐targeted, semi‐quantitative simultaneous investigation of high numbers of proteins. In the current study we utilise proteomics to characterise and contrast age‐associated differences in photoexposed and photoprotected skin, with a focus on the epidermis, dermal‐epidermal junction and papillary dermis.
Methods
Skin biopsies from buttock (photoprotected) and forearm (photoexposed) of healthy volunteers (aged 18‐30 or ≥65 years) were transversely sectioned from the stratum corneum to a depth of 250 μm. Following SDS‐PAGE, each sample lane was segmented prior to analysis by liquid chromatography‐mass spectrometry/mass spectrometry. Pathways analysis was carried out using Ingenuity IPA.
Results
Comparison of skin proteomes at buttock and forearm sites revealed differences in relative protein abundance. Ageing in skin on the photoexposed forearm resulted in 80% of the altered proteins being increased with age, in contrast to the photoprotected buttock where 74% of altered proteins with age were reduced. Functionally, age‐altered proteins in the photoexposed forearm were associated with conferring structure, energy and metabolism. In the photoprotected buttock proteins associated with gene expression, free‐radical scavenging, protein synthesis and protein degradation were most frequently altered.
Conclusion
This study highlights the necessity of not considering photoageing as an accelerated intrinsic ageing, but as a distinct physiological process.
This article is protected by copyright. All rights reserved.
http://bit.ly/2DmIQHW
Novel Proteasome Assembly Chaperone mutations in PSMG2/PAC2, cause the autoinflammatory interferonopathy, CANDLE/PRAAS4
Publication date: Available online 18 January 2019
Source: Journal of Allergy and Clinical Immunology
Author(s): Adriana A. de Jesus, Anja Brehm, Rachel VanTries, Pascal Pillet, Anne-Sophie Parentelli, Gina A. Montealegre Sanchez, Zuoming Deng, Isabelle Koné Paut, Raphaela Goldbach-Mansky, Elke Krüger
Summary
Chronic Atypical Neutrophilic Dermatosis with Lipodystrophy and Elevated temperature (CANDLE) is a rare autoinflammatory interferonopathy caused by additive loss-of-function mutations in proteasome genes. Mutations in the proteasome chaperone, PSMG2/PAC2 are a novel cause of CANDLE.
http://bit.ly/2DmOxp5
Regulatory cells in the skin: pathophysiological role and potential targets for anti-inflammatory therapies
Publication date: Available online 18 January 2019
Source: Journal of Allergy and Clinical Immunology
Author(s): Sagar Uttarkar, Nicolo Costantino Brembilla, Wolf-Henning Boehncke
Abstract
Inflammation is a fundamental defence mechanism to protect the body from danger, which becomes potentially harmful if it turns chronic. Therapeutic strategies aimed at specifically blocking pro-inflammatory signals - particularly cytokines such as interleukin-4, interleukin-6, interleukin-13, interleukin-17A or tumour necrosis factor α - have substantially improved our ability to effectively and safely treat chronic inflammatory diseases. Much less efforts have been made to better understand the role of potential anti-inflammatory mechanisms. Here, we summarize the current understanding of regulatory cell populations in the context of chronic inflammation, namely macrophages, Langerhans cells, myeloid-derived suppressor cells, regulatory T and B lymphocytes. Emphasis is given to the skin as many different immune related diseases occur in the skin. Development, phenotype, function, and evidence for their role in animal models of inflammation as well as in the corresponding human diseases are described. Finally, the feasibility of using regulatory cells as targets for potentially disease-modifying therapeutic strategies is discussed.
http://bit.ly/2U1BTBm
Systemic Antibody Responses to Gut Commensal Bacteria: How and Why Do I Know You?
Publication date: Available online 18 January 2019
Source: Journal of Allergy and Clinical Immunology
Author(s): Peter J. Mannon
http://bit.ly/2DmOrOf
Teaching Ear Examination Skill to Undergraduate Students Using Check List
Abstract
For examination of ear, proper illumination is a pre requisite. Diseases related to ear may lead to altered sense of hearing and may affect normal balance system. If students are taught to examine ear using a check list, they may perform better. To teach ear examination to undergraduate students using a check list. Total 50 undergraduate students of M.B.B.S. attending E.N.T. clinic in Chirayu Medical College and Hospital were included in the study. They were given enrolment no. 1 to 50 and were divided into two groups. Group 1, enroll. no. 1 to 25 and group 2, enroll. no. 26 to 50. Group 1 was taught using check list and the Group 2 was taught without use of checklist. Both the groups were evaluated using check list. The group B students were again taught, using check list and were again evaluated using check list. Use of check list showed that there was statistically significant improvement in learning by students using check list in group 1 students compared to group 2 students who were taught without use of check list. The group 2 students also had improvement on evaluation, after they were taught using check list. Study suggests that use of check list for ear examination skill to undergraduate students has significant role and students learn better than when taught without use of checklist. Inclusion of checklist for teaching ear examination to undergraduate students may be considered.
http://bit.ly/2FLzHKp
Epidemiologic studies about food allergy and food sensitization in tropical countries. Results and limitations
Publication date: Available online 19 January 2019
Source: Allergologia et Immunopathologia
Author(s): Jorge Sánchez, Andres Sánchez
Abstract
The variety of foods and methods of preparation are part of the cultural identity of each population, and thus the main foods that cause symptoms vary among different regions. Due to their increasing frequency, Adverse Reactions to Food (AFR) have been the subject of extensive study, especially in North America and Europe but few studies have been conducted in other areas, especially in populations located in the tropics and subtropics. In this article, we review available information on the epidemiology of food sensitization and food allergies in tropical regions and explore the different epidemiological data considering the major food involved, the underlying immune mechanism and clinical symptoms partners. In addition, we identify the possible limitations and questions that arise from studies conducted in tropical countries, which helps to generate objectives for future research.
http://bit.ly/2R2ZQq2
A Rare Case of Spontaneous Hemorrhage in a Giant Accessory Spleen in a Child
Accessory spleen (AS) is a condition found in about 20% of patients and is most commonly located in the hilar region of the spleen. It is more often asymptomatic, single, and smaller than 2 cm. In the present study, we report the rare case of a 13-year-old boy with giant accessory spleen underwent spontaneous intrasplenic hemorrhage who presented with recurrent abdominal pain. Contrast-enhanced MRI was mandatory for the diagnosis before surgical procedure.
http://bit.ly/2DoMzof
Status epilepticus induced by treatment with dopamine agonist therapy for giant prolactinoma: a case report
Dopamine agonists are the standard first-line medical therapy for prolactinoma. We report a rare case of giant prolactinoma with a first epileptic seizure due to rapid reduction of the tumor as a complication ...
http://bit.ly/2FFBf9E
A Rare Occurrence of Isolated Brain Metastases from Gastric Cancer
Background. Gastric cancer is the fourth most common cancer worldwide and the second most common cause of cancer-related death. The majority of newly diagnosed gastric cancer cases present either as locally advanced tumor growth or with distant metastases. Case Report. Here, we describe a case of isolated brain metastases in a male patient with gastric cancer. Initially, our patient presented with dysphagia and was diagnosed with gastric cancer after a thorough evaluation. One year after chemotherapy and surgical resection of his gastric cancer, he presented with headaches, nausea, dizziness, and photophobia. Further evaluation of these symptoms led to the discovery of three metastatic brain lesions without evidence of extracranial metastases. Conclusions. Our review of the literature has found that such cases are rare. Additionally, our review of the literature demonstrates the poor outcomes associated with metastatic brain lesions from gastric cancer and highlights the importance of surgical resection in increasing overall survival time.
http://bit.ly/2Dn4LP2
45,X/46,XY Mosaicism and Normozoospermia in a Patient with Male Phenotype
The phenotypic spectrum of 45,X/46,XY mosaic males varies greatly. Previous reports have only described cases with either oligozoospermia, growth retardation, or elevated gonadotropins. However, the present case presented with normozoospermia, and normal height, sperm DNA fragmentation index (DFI), and gonadotropins. The male and his spouse were referred to The Fertility Clinic, Skive Regional Hospital, due to 2 years of infertility. After failure of several attempts of assisted reproductive treatment (ART), the male underwent genetic analysis. Conventional karyotyping in peripheral lymphocytes yielded a low-grade 45,X/46,XY mosaicism, confirmed by fluorescence in situ hybridization (FISH) showing 6% 45,X cells. A FISH test performed on interphase nuclei from buccal mucosal cells yielded one cell with only one X-signal (0.6%), explaining the normal phenotype of the patient, but not the infertility. FISH test for sperm aneuploidy showed normal range parameters, except for a 10-fold elevated gonosomal nullisomy rate (2.1%). Hence, germinal mosaicism may be an explanation of the infertility of the case. Increased sex nullisomy levels may reflect an aberrant testicular environment compromising fertility even though sperm euploidy rates and other sperm parameters do not preclude a successful treatment with ART. Based on these results, the couple decided to use donor semen for their subsequent intrauterine insemination treatment and obtained a successful pregnancy.
http://bit.ly/2FGqBQb
Early Intratympanic Methylprednisolone in Sudden SNHL: A Frequency-wise Analysis
Abstract
Sudden sensorineural hearing loss is a dire medical emergency which must be treated at the earliest to get better long term hearing results. Our study aims to determine the efficacy of intratympanic steroid (Methylprednisolone) on auditory outcomes in patients of sudden sensorineural hearing loss and study the relation between time of onset of hearing loss to start of therapy and frequency-wise recovery of hearing loss. A prospective cohort clinical study with 33 patients with sudden hearing loss of 30 dB or more were treated with the intratympanic injection of methylprednisolone and the effect of the drug was observed. In this study, 33 patients with sudden onset (unilateral or bilateral) of hearing loss were treated with intratympanic methylprednisolone. The duration at which the drug was administered and the age of the participants was taken into consideration. Main outcome measures included audiometry results at low, medium and high hearing loss frequencies. The specific frequency at which the hearing improvement took place was tabulated. It was observed that hearing improved significantly if the steroid is injected within the first 4 days of onset (p < 0.05) at all the frequencies. A gain of 15 dB or more was achieved in more than 78% patients after injecting methylprednisolone intratympanically. A statistically significant association was found between recovery rate and frequency of hearing loss with patients showing greater improvement at low hearing loss frequency in comparison to mid and high frequencies (p < 0.05). The drug efficacy does not change with the age of the patient.
http://bit.ly/2RVKxnH
ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ,ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ,ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ
Εφαρμόζονται πίσω από το αυτί και συνδέονται με το κατάλληλο εκμαγείο
Ενδοκαναλικά
Αθέατα,Είναι μικρότερα σε μέγεθος και εφαρμόζονται μέσα στον ακουστικό πόρο.
Καθαρή και διαυγή μετάδοση της φωνής των συνομιλούντων
Έξυπνη φραγή των θορύβων
Άριστη ποιοτική ενίσχυση και απόδοση του ήχου,εύκολα στη χρήση,άνετα στην εφαρμογή,όμορφα για καλύτερη αισθητική όσο αφορά το μέγεθος και την εξωτερική εμφάνιση,χωρίς καμμία ιδιαίτερη συντήρηση.
Ενδοωτιαίο Ακουστικό Βοήθημα με ελεγχόμενη ένταση,
Ενδοωτιαίο Ακουστικό Βοήθημα Υψηλής Πιστότητας,
Ενδοωτιαίο Ακουστικό Βοήθημα Δώρο Χαράς Σε Όσους Αγαπάτε και Φροντίζετε,
Ενδοωτιαίο Ακουστικό Βοήθημα με πιστοποίηση γνησιότητας και ποιότητας,
Ενδοωτιαίο Ακουστικό Βοήθημα υποαλλεργικά άριστης εφαρμογής,
Ενδοωτιαίο Ακουστικό Βοήθημα όμορφα μικρά αόρατα με άριστες αποδόσεις,
Ενδοωτιαίο Ακουστικό Βοήθημα όμορφα μικρά αόρατα με άριστες αποδόσεις για μεσαίες εως υψηλές βαρηκοΐες,
Ενδοωτιαίο Ακουστικό Βοήθημα Οδηγίες Χρήσης,
https://akoustika-ellas.blogspot.com/,
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Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με μπαταρία μακράς διάρκειας,
https://akoustika-ellas-2.blogspot.com/,
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Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με μπαταρία μακράς διάρκειας,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC sound processing technology,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise με μπαταρία μακράς διάρκειας και γρήγορης φόρτισης,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με μπαταρία μακράς διάρκειας 12 εως 18 ωρών φόρτιση σε θύρα USB,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise με μπαταρία μακράς διάρκειας και γρήγορης φόρτισης 5γρ εύκολη χρήση,
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