Head and Neck Diseases by Alexandros G.Sfakianakis: 02/03/19

Κυριακή 3 Φεβρουαρίου 2019

Hydrochars produced with by-products from the sucroenergetic industry: a study of extractor solutions on nutrient and organic carbon release

Abstract

Hydrothermal carbonization transforms biomass into value-added material called hydrochar. The release of nutrients (P, N, Ca, Mg, and K) and organic carbon (TOC) from hydrochar in different extractive solutions was investigated in this study. Two sets of hydrochar were produced: (i) hydrochar prepared from sugarcane bagasse and vinasse mixture (BV-HC) and (ii) hydrochar prepared by the addition of H₃PO₄ to this mixture (BVA-HC). Both hydrochar types released significative amounts of nutrient and organic carbon, mainly Ca (5.0 mg g⁻¹) in the mixture (KCl, K₂SO₄, NaOH, 1:1:1) extractive solution and TOC (72.6 mg g⁻¹) in the NaOH extractive solution, for BV-HC. Nutrient release was influenced by pH and ionic strength. The release of P, Ca, and Mg was affected by the presence of insoluble phosphate phases in BVA-HC. The release of nutrients P, N, Ca, Mg, and K and organic carbon demonstrated that hydrochar has potential for soil application purposes.

http://bit.ly/2RBu0Bh

Understanding spatial and temporal patterns of fish diversity and assemblage structure vis-a-vis environmental parameters in a tropical Indian reservoir

Abstract

Reservoirs have been given priority as an important resource for fisheries enhancement in inland open waters. This paper described the spatial and temporal pattern of fish diversity using GIS platform, assemblage structure, and studied the influence of environmental parameters in these variables in a large tropical reservoir, Chandil, located in the eastern India using multiple approaches. Altogether, 42 fish species belonging to 30 genera were recorded from the reservoir, including two exotic species: pangas, Pangasianodon hypophthalmus, and Nile tilapia, Oreochromis niloticus. The diversity indices indicated lowest fish diversity in the lacustrine zone, but without distinct seasonal variation. The taxonomic distinctness was lower in the lacustrine zone as compared to other zones, and the summer season exhibited higher taxonomic distinctness, though the number of species was lowest. Most of the physicochemical parameters recorded are within the favorable range for fisheries enhancement. Among the environmental parameters, pH and nitrate significantly influenced the fish abundance. The study recommends suitable measures and interventions for conservation of the native fish diversity and sustainable fisheries development: closed season, protected/conservation area, introduction of fish aggregating device (FAD), and regulated fish culture in enclosures.

http://bit.ly/2WHF6rV

Levels of phthalate acid esters and sex hormones and their possible sources in traffic-patrol policemen in Chongqing

Abstract

To investigate the correlation between the air phthalate acid ester (PAE) exposure and serum PAE concentration and the effects of PAE exposure on reproductive health among Chongqing traffic-patrol policemen. In 2013, 32 traffic-patrol policemen working in an area with poor air quality in Chongqing and 28 traffic-patrol policemen working in an area with good air quality were selected. Their blood levels of 14 PAEs and six reproductive hormones were determined. Air samples were collected from four traffic-patrol platforms. The concentrations of 14 PAEs in the air samples were evaluated. All 14 PAEs were detected in the blood samples. The concentrations of seven PAEs in the total suspended particulate, namely, dimethyl phthalate, diethyl phthalate, dibutyl phthalate, bis (2-ethox-yethyl) phthalate, dihexyl phthalate, benzyl butyl phthalate, and bis (2-n-butoxyethyl) phthalate, were positively and significantly associated with the blood levels of these PAEs in the participants. All the sex hormone levels measured here were significantly different between the participants from the two areas. The PAE concentrations in the blood samples were correlated with the reproductive hormone levels in the participants. Air PAE pollution may be a major source of PAE exposure in the traffic-patrol policemen of Chongqing.

http://bit.ly/2RBtPWD

Evaluation of the effect of teriparatide therapy on mandibular fracture healing in rats with medication-related osteonecrosis of the jaw

Abstract

Objective

The aim of this study was to evaluate the effect of teriparatide therapy on mandibular fracture healing in rats with medication-related osteonecrosis of the jaw (MRONJ).

Materials and methods

To induce MRONJ, a total of 120 rats received intravenous zoledronate 0.06 mg/kg once a week for 6 weeks and their right mandibular first molar was extracted. Eighty of 94 rats with MRONJ were randomly selected and underwent unilateral mandibular osteotomy to replicate a fracture. After surgery, the rats were randomly assigned to T (teriparatide-treated) and C (control) groups. Group T (n = 40) received subcutaneous injection of 2 μg/kg/day teriparatide and group C (n = 40) received the same volume of normal saline until sacrifice. Four and 8 weeks after surgery, 20 rats in each group were sacrificed. Fracture healing was scored using a histological grading system (1 to 10).

Results

In group C, at 4 weeks and 8 weeks post-fracture, fibrous and cartilaginous tissues and scant bone formation at the fracture site and lacunae without osteocyte in adjacent mandibular bone were seen. In group T, substantial amounts of new trabecular bone rimmed by osteoblasts and some areas of remodeled mature bone were seen. After 8 weeks, extensive replacement of trabecular bone with mature bone occurred. Except between C4 and C8 groups, the healing score was significantly different between all subgroups.

Conclusion

Teriparatide therapy successfully improved mandibular fracture healing in rats with MRONJ. However, this study was limited by the use of an animal model whose anatomy, physiology, and drug metabolism might be different from humans.

Clinical relevance

The present study showed that teriparatide therapy may be used adjunctive to surgery in the treatment of mandibular fractures in MRONJ patients.

http://bit.ly/2MN1sDU

Enhanced adsorption for Pb(II) and Cd(II) of magnetic rice husk biochar by KMnO 4 modification

Abstract

Novel KMnO₄-treated magnetic biochar (FMBC) was successfully synthesized by addition of Fe(NO₃)₃ during carbonization and KMnO₄ treatment following for Pb(II) and Cd(II) adsorption. SEM-EDS, XPS, and ICP-AES were used to evaluate the FMBC and magnetic biochar (FBC) on surface morphology, surface chemistry characteristics, surface functional groups, and Pb(II) and Cd(II) adsorption behavior. Results showed that the Langmuir maximum adsorption quantity of FMBC reached 148 mg/g for Pb(II) and 79 mg/g for Cd(II), nearly 7 times of that of FBC. The enhancement of FMBC for heavy metal adsorption was due to the successful load of manganese oxides and the increased oxygen functional groups consistent with XPS and FTIR results. The adsorption capacities of FMBC were maintained over 95% when the pH value was higher than 2.5 and 3.5 for Pb(II) and Cd(II), respectively. The adsorption performances of both heavy metals by FMBC were hardly influenced by ionic strength and humid acid. The adsorption capacities of FMBC could maintain over 50% and 87% after four cycles for Pb(II) and Cd(II), respectively. The saturation magnetization of FMBC was about 11.5 emu/g, which did not change after adsorption. This work proposed a new method to fabricate a magnetic biochar with high adsorption capacities of heavy metals Pb(II) and Cd(II).

http://bit.ly/2BgoxdG

Sediment phosphorus release in response to flood event across different land covers in a restored wetland

Abstract

The phosphorus (P) fraction and its release characteristics from sediment in response to flood events across different land covers (i.e., reclaimed land with dominant vegetation of Phragmites australis and/or Typha orientalis, grassland with dominant vegetation of annual and perennial forbs, and bare land) in the lakeshore of Chaohu Lake were investigated. The results indicated that the re-flooding of a restored wetland led to P release. IP (inorganic P) was the major P fraction in the soils pre-flood and post-flood. For all the soil samples, the rank order of P fractions was Ca-P (P associated with calcium) > OP (organic P) > Fe/Al-P (P bound to Al, Fe, and Mn oxides and hydroxides). During flooding, Fe/Al-P contributed the most as the P release source in the soils and to the P sources for the overlying water. In reclaimed land, Fe/Al-P release correlated significantly with soil pH. In grassland, Fe/Al-P release correlated significantly with soil pH and Al content. In bare land, Fe/Al-P release correlated significantly with Al and clay content. The max TP release rates were also significantly influenced by land cover, and the values in bare land, grassland, and reclaimed land were 9.91 mg P m⁻² day⁻¹, 8.10 mg P m⁻² day⁻¹, and 5.05 mg P m⁻² day⁻¹, respectively. The results showed that the P release processes might be regulated by different factors across different land covers, and that the re-introduction of vegetation during wetland restoration must be taken into account prior to flood events to avoid an undesirable degradation of water quality.

http://bit.ly/2TwnI7t

Evaluating giant panda as a surrogate species for conservation co-occurring species in the Baishuijiang National Nature Reserve

Abstract

The establishment of nature reserves is a key approach for biodiversity conservation worldwide. However, the effectiveness of nature reserves established by protecting the habitat needs of surrogate species is questioned. In this study, the Baishuijiang National Nature Reserve (Baishuijiang NNR), located in the Minshan Mountains, China, which is established mainly for the conservation of giant panda (a surrogate for the conservation of other endangered species) was selected. We quantitatively evaluated the conservation effectiveness of the reserve for giant panda and co-occurring species (here, seven protected species) using a maximum entropy model (Maxent), and analyzed spatial congruence between giant panda and other seven species. Results shown that the habitat of giant panda generally included the habitat of other seven protected species, suggesting that conservation of giant panda habitat also allows the conservation for the habitat of almost co-occurring species. Hence, the natural reserve established for giant panda as a surrogate species has a relatively high effectiveness. A high proportion of the suitable habitat for six species is inside the core zone, but a high proportion of the suitable habitat for two species is located in the experimental and buffer zones. Thus, the two species are affected by human activities. To improve the conservation effectiveness of the nature reserve, the management zones need to be amended. The result of the study will be beneficial for future conservation and management of the reserve. This study provides an effective method for evaluating the conservation effectiveness of nature reserves in other area of the worldwide.

http://bit.ly/2Bk1wGE

Impact of dietary nano-zinc oxide on immune response and antioxidant defense of broiler chickens

Abstract

This study aimed to elucidate the response of broiler chickens to the dietary nano-zinc supplementation in terms of immune response and antioxidant activity. Ninety-one-day-old chicks (Ross 308) were randomly assigned to one of three dietary treatments in three replicates, in a feeding trial that lasted for 5 weeks. Birds were fed a basal diet supplemented with inorganic zinc oxide at 40 mg/kg diet (control), zinc oxide nanoparticles (ZnONPs) at 40 mg/kg diet (ZN1), or ZnONPs at 80 mg/kg diet (ZN2). Birds were injected with DNP-KLH at the 7th and 21st days from the beginning of the experiment, and blood samples were collected on days 7, 14, 21, 28, and 35 to determine the levels of immunoglobulin Y (IgY) and malondialdehyde as well as the antioxidant enzyme activities. Cellular immunity was assayed by estimation of phagocytic percentage and index of peripheral monocytes of blood and estimation of the T lymphocyte activity using a lymphocyte transformation test. The results showed that feeding broiler chickens a diet supplemented with ZnONPs increased (p < 0.05) the activity of superoxide dismutase and catalase and decreased the concentration of malondialdehyde compared to the control diet, without significant differences between NZ1 and NZ2 diets. Moreover, the chicks fed diets supplemented with ZnONPs showed a significant increase (p < 0.05) in serum IgY, total lymphocyte count, and macrophages compared to the control. A higher significant response for antibodies IgY concentration was observed in birds fed the NZ2 vs NZ1 diet. Also, there was a significant increase in phagocytic activity and phagocytic index in ZnONP-fed groups with a higher significance in the group fed NZ1 than with NZ2 diet as compared with the control. In conclusion, ZnONP application up to 80 mg/kg in the diet is safe for broiler chickens and could improve their antioxidant defense and cellular immunity.

http://bit.ly/2Tv1bbo

Serum biotin and zinc in male androgenetic alopecia

Summary

Background

Male androgenetic alopecia (MAGA) is caused by the conversion of the terminal to vellus hair. Zinc is one of the most studied trace elements in hair disorders and biotin is one of the most prescribed supplement for its treatment.

Objectives

The study aimed to evaluate serum zinc and biotin levels in MAGA patients to answer the question if there is a value to add zinc or biotin as a supplements in the MAGA treatment.

Patients and Methods

Sixty MAGA patients and 60 age, sex, and body mass index‐matched healthy volunteers were included. We measured serum biotin and zinc in all participants.

Results

Zinc (µg/dL) was lower significantly in patients compared to controls (P = 0.01), suboptimal biotin (ng/L) levels were in patients, and within normal values in controls (P = 0.01). A positive significant correlation was found between serum zinc and serum biotin (r = 0.489, P = 0.001). Serum zinc and biotin showed a nonsignificant correlation with age and disease duration. A non‐significant relation was obtained between the MAGA grades, and zinc (P = 0.485) and biotin levels (P = 0.367).

Conclusions

Serum zinc showed subnormal value and adding zinc supplement in MAGA treatment is recommended. Serum biotin showed a suboptimal level in MAGA patients that is not correlated with patients' age or disease severity. Biotin supplement in MAGA treatment may add value to hair quality and texture. We recommend future biotin evaluation in serum combined with its metabolites in MAGA patients' urine.

http://bit.ly/2SksjfS

Serum biotin and zinc in male androgenetic alopecia

Summary

Background

Objectives

The study aimed to evaluate serum zinc and biotin levels in MAGA patients to answer the question if there is a value to add zinc or biotin as a supplements in the MAGA treatment.

Patients and Methods

Sixty MAGA patients and 60 age, sex, and body mass index‐matched healthy volunteers were included. We measured serum biotin and zinc in all participants.

Results

Conclusions

http://bit.ly/2SksjfS

Nanoanalytics: analytical methods for characterization of nano- and micro-objects

http://bit.ly/2HPqOCq

Technologies for deodorization of malodorous gases

Abstract

There is an increasing number of citizens' complaints about odor nuisance due to production or service activity. High social awareness imposes pressure on entrepreneurs and service providers forcing them to undertake effective steps aimed at minimization of the effects of their activity, also with respect to emission of malodorous substances. The article presents information about various technologies used for gas deodorization. Known solutions can be included into two groups: technologies offering prevention of emissions, and methodological solutions that enable removal of malodorous substances from the stream of emitted gases. It is obvious that the selection of deodorization technologies is conditioned by many factors, and it should be preceded by an in-depth analysis of possibilities and limitations offered by various solutions. The aim of the article is presentation of the available gas deodorization technologies as to facilitate the potential investors with selection of the method of malodorous gases emission limitation, suitable for particular conditions.

http://bit.ly/2t7gGKM

Huge rhinophyma in a complicated patient successfully treated with C02 laser

Abstract

Rhinophyma is a bothersome and disfiguring condition of the nose that is often cause of cosmetic embarrassment and social reclusion.

Nowadays the therapeutic possibilities are highly variable and have to be personalized case by case. These possibilities include pharmacological therapy, laser surgery, mechanical dermabrasion and surgical excision. For patients with cardiovascular comorbidies and anticoagulant therapy, the therapeutic choice is limited. We present a case of a giant rhinophyma in a patient with several comorbidities that we successfully treated with CO2 laser.

http://bit.ly/2MQ1D17

Huge rhinophyma in a complicated patient successfully treated with C02 laser

Abstract

Rhinophyma is a bothersome and disfiguring condition of the nose that is often cause of cosmetic embarrassment and social reclusion.

http://bit.ly/2MQ1D17

Small bowel obstruction with multiple perforations post chestnut ingestion

Phytobezoars are a rare cause of small bowel obstruction (SBO), which consists of vegetable matter such as seeds, skins, fibres of fruit and vegetables that have solidified. We present the case of a 61-year-old man with no previous surgery who presented with central abdominal pain, nausea and vomiting. An abdominal CT scan demonstrated SBO with a transition point in the left anterior abdomen. He proceeded to a laparoscopy, which revealed multiple perforations throughout the small bowel, from the proximal jejunum to the terminal ileum. Laparotomy was performed, and undigested chestnuts were milked out through the largest perforation and the perforations were oversewn. While obstruction due to phytobezoars is rare, this case demonstrates the importance of considering small bowel trauma and perforation due to phytobezoars and highlights the need for close inspection of the entire gastrointestinal tract for complications in the setting of phytobezoar-related bowel obstruction.

http://bit.ly/2D85FNX

Maculopathy from an accidental exposure to welding arc

Welding light can cause photic retinal injury. We report binocular maculopathy induced by a brief exposure to electric arc welding light in a patient who could not equipped with protective device because of narrow space. A 47-year-old man performed electric arc welding for approximately 10–15 min without wearing protective device because of narrow space and subsequently experienced eye discomfort and decreased visual acuity. At the initial visit, his best corrected visual acuity was 0.5. Fundus examination, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were performed. OCT showed disruption in the ellipsoid zone, and mfERG amplitudes in the central 10° were markedly reduced in both eyes. The decrease in visual acuity had been noted for at least 18 months. Using the proper protective device is essential in welding, despite short time periods of work. For patients with welding-induced photokeratitis, doctors should also consider the possibility of photic retinal injury.

http://bit.ly/2G9EFBS

Adalimumab-induced acute myeloid leukaemia in a patient with Crohns disease

We present a patient with Crohn's disease under treatment with adalimumab who developed acute myeloid leukaemia (AML) with core-binding factor beta gene rearrangement. This case report emphasises the importance of long-term close follow-up of patients receiving adalimumab because of the increased risk of developing AML and other malignancies.

http://bit.ly/2DbY1lI

Food avoidance strategies in eosinophilic oesophagitis

Abstract

EoE is a chronic disease associated with significant morbidity that can result in permanent fibrosis and stricture formation. Given the complexity a multidisciplinary approach is recommended to manage these patients. In the majority of children with EoE not responsive to proton pump inhibitors (PPI), inflammation is driven by sensitivity to foods and treatment with an elimination diet can be effective.

Foods most commonly identified to trigger EoE in children are milk and wheat, but egg, soy, meats and grains can also be triggers. Foods can be eliminated using a step‐down or step‐up approach. If the goal is to achieve quick remission elemental diet or six food elimination diets are the most effective. A step‐up approach starting from a 1‐2 food elimination diet and increasing the number of foods based on a personalised dietary approach is recommended if the goal is to achieve remission using the least number of endoscopies and with increased acceptability to the patient.

Children with EoE on elimination diets require frequent monitoring of growth and nutrition, as well as screening for symptoms of EoE, allergy, and mindfulness regarding psychosocial impact of chronic disease on the family and child. Current research focused on tools to select patients who mostly will benefit from dietary treatment, identify relevant food allergens, obtain oesophageal tissue non‐invasively and induce tolerance will greatly improve the treatment of EoE.

http://bit.ly/2DQqU8O

Stress and Obesity: The Ghrelin Connection

Abstract

Ghrelin is a hormone associated with feeding and energy balance. Not surprisingly, this hormone is secreted in response to acute stressors and it is chronically elevated after exposure to chronic stress in tandem with a number of metabolic changes aimed at attaining homeostatic balance. In this review we propose that ghrelin plays a key role in these stress‐induced homeostatic processes. Ghrelin targets the hypothalamus and brain stem nuclei that are part of the sympathetic nervous system to increase appetite and energy expenditure and promote the use of carbohydrates as a source of fuel while sparing fat. Ghrelin also targets mesolimbic brain regions like the ventral segmental area (VTA) and the hippocampus to modulate reward processes, to protect against damage associated with chronic stress, and to potentially increase resilience to stress. In all, these data support the notion that ghrelin, like corticosterone, is a critical metabolic hormone that is essential for the stress response.

http://bit.ly/2DQgF47

Biliary Complications Following Pediatric Living Donor Liver Transplantation: Risk Factors, Treatments and Prognosis

Background: We present retrospective analysis of our 15-year experience with pediatric living donor liver transplantation (LDLT), focusing on the risk factors, treatments and long-term prognosis for post-transplant biliary complications (BCs). Methods: Between May 2001 and December 2017, 290 LDLTs were performed. The median age was 1.4 years old. The median observation period was 8.4 years. Biliary strictures were classified as anastomotic stricture (AS) or non-anastomotic stricture (NAS). Results: Overall incidence of BCs was 18.6%, including AS in 46 cases, NAS in six, and other classifications in two. The mean period to diagnosis of the AS was 641 ± 810 post-operative days. The multivariate analysis showed that hepaticojejunostomy without external stent was an independent risk factor for AS (p=0.011). The first treatments for AS were percutaneous transhepatic biliary drainage (PTBD) in 25 cases, double-balloon enteroscopy (DBE) in 19, and surgical re-anastomosis in 2. The success and recurrence rates of PTBD treatments were 88.9% and 18.8%, respectively. The success and recurrence rates of endoscopic interventions under DBE were 76.8% and 69.9%, respectively. The 15-year graft survival rates in patients with and without AS were 95.7% and 89.1%, respectively (p=0.255), but 2 patients with cholangitis due to multiple NAS underwent re-transplantation. Conclusions: Post-transplant AS can be prevented by hepaticojejunostomy using external stent, and the long-term prognosis is good with early treatments using DBE or PTBD. However, the prognosis of multiple NAS is poor. Disclosures: We have no conflicts of interest to disclose as described by the Transplantation. Funding: We have no finding sources. This abstract of this manuscript was accepted for oral presentation at the 18th Congress of the European Society for Organ Transplantation held in Barcelona in September 2017. Correspondence information: Yukihiro Sanada M.D., Ph.D., Department of Transplant Surgery, Jichi Medical University Address: 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, JAPAN. Telephone and fax: +81-285-58-7069, E-mail: yuki371@jichi.ac.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G95Ix0

Intraoperative Hemodynamic Parameters and Acute Kidney Injury After Living Donor Liver Transplantation

Background: Acute kidney injury (AKI) after living donor liver transplantation (LDLT) is associated with increased mortality. We sought to identify associations between intraoperative hemodynamic variables and postoperative AKI. Methods: We retrospectively reviewed 734 cases of LDLT. Intraoperative hemodynamic variables of systemic and pulmonary arterial pressure, central venous pressure (CVP), and pulmonary artery catheter-derived parameters including mixed venous oxygen saturation (SvO2), right ventricular end-diastolic volume (RVEDV), stroke volume, systemic vascular resistance, right ventricular ejection fraction, and stroke work index were collected. Propensity score matching analysis was performed between patients with (n= 265) and without (n=265) postoperative AKI. Hemodynamic variables were compared between patients with acute kidney injury (AKI), defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria, and those without AKI in the matched sample. Results: The incidence of AKI was 36.1% (265/734). Baseline CVP, baseline RVEDV and SvO2 at 5 min before reperfusion were significantly different between patients with and without AKI in the matched sample of 265 pairs. Multivariable logistic regression analysis revealed that baseline CVP, baseline RVEDV, and SvO2 at 5 min before reperfusion were independent predictors of AKI (CVP per 5 cmH2O increase: odds ratio [OR] 1.20, 95% confidence interval [CI] 1.09-1.32; SvO2: OR 1.45, 95% CI 1.27-1.71; RVEDV: OR 1.48, 95% CI 1.24-1.78). Conclusion: Elevated baseline CVP, elevated baseline RVEDV after anesthesia induction and decreased SvO2 during anhepatic phase were associated with postoperative AKI. Prospective trials are required to evaluate whether optimization of these variables may decrease the risk of AKI after LDLT. Source of funding: No external fund received. Conflict of interest: The authors declared no conflict of interests. Corresponding Author: Won Ho Kim, MD, PhD, Mailing Address: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. E-mail: wonhokim.ane@gmail.com; Phone: 82-2-2072-2462; FAX: 82-2-747-5639 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D7WwVD

Donor characteristics, recipient outcomes, and histologic findings of kidney allografts with diffuse donor-derived glomerular fibrin thrombi

Background: Limited data is available regarding whether donor kidneys with diffuse glomerular fibrin thrombi (GFT) are safe to use. In this study, the clincopathologic characteristics of allografts with diffuse donor-derived GFT were examined. Methods: All deceased donor kidney transplant implantation biopsies from our institution between 07/2011 to 02/2018 with diffuse GFT were included. A control group for comparison consisted of all cases with implantation biopsies obtained during the study period without diffuse GFT. Clinical data were extracted from electronic medical records for all study patients, including donor information. Results: Twenty-four recipients received kidneys with diffuse GFT from 16 deceased donors. All donors died from severe head trauma. On average, 79% of glomeruli contained fibrin thrombi. Nineteen cases had subsequent biopsy; all revealed resolution of GFT. Compared to the control group, kidneys with diffuse GFT had longer cold ischemia time (34 versus 27 hours), were more frequently pumped using machine perfusion (100% versus 81%), and recipients experience a higher frequency of delayed graft function (58% versus 27%). Only two grafts with diffuse GFT failed within the first year. Overall graft survival was similar between the diffuse GFT group and control group. Conclusion: Deceased donor kidneys with diffuse GFT appear to be safe to use given that nearly 92% of recipients in this cohort who received such allografts experienced good clinical outcomes. Histologically, GFT demonstrated rapid resolution following transplantation. Interestingly, diffuse GFT only occurred in donors who suffered severe head trauma in this cohort, which may be a predisposing factor. Disclosure: The authors declare no conflicts of interest. Funding: None. Correspondence: Kuang-Yu Jen, MD, PhD, University of California Davis School of Medicine, Department of Pathology and Laboratory Medicine, 4400 V Street, Suite 1224, Sacramento, CA 95817, Phone: (916) 734-2579, Fax: (916) 734-2560, Email: kyjen@ucdavis.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D7WJIp

CONTINUOUS MONITORING OF TRANSPLANT CENTER PERFORMANCE: DIFFERENT OPTIONS FOR DIFFERENT GOALS

Background– In France, the need for continuous monitoring of transplant center performance has recently become apparent. CUSUM monitoring of transplantation is already been used to monitor transplant outcomes in the UK and in the US. Because CUSUM monitoring can be applied by different methods, the objective was to assess and compare the performance of different CUSUM methods for detecting higher than expected (that is, excessive) graft failure rates. Methods– Data come from the French transplant registry. Lung and kidney transplants in 2011-2013 constituted the control cohort, and those in 2014-2016 the observed cohort. The performance of CUSUM monitoring, according to center type and predefined control limits, was measured by simulation. The outcome monitored was 3-month graft failure. Results– In a low-volume center with a low failure rate, 3 different types of control limits produced successful detection rates (SDRs) of excessive graft failures of 15, 62, and 73% and false alarm rates (FARs) of 5, 40, and 52%, with 3, 1, and 1 excess failures necessary before a signal occurred. In a high-volume center with a high failure rate, SDRs were 83, 93, and 100%, and FARs were 5, 16, and 69%, with 6, 13, and 17 excess failures necessary before a signal occurred. Conclusions– CUSUM performances vary greatly depending on the type of control limit used. A new control limit set to maximize specificity and sensitivity of detection is an appropriate alternative to those commonly used. Continued attention is necessary for centers with characteristics making it difficult to obtain adequate sensitivity or sufficiently prompt response. Disclosure: The authors declare no conflicts of interest. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Corresponding author contact information: Camille Legeai, Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Pôle Evaluation, 1 avenue du Stade de France, 93212 Saint-Denis La Plaine cedex, France. Phone: +33 1 55 93 69 02. Fax: +33 1 55 93 69 30. Email: camille.legeai@biomedecine.fr Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D7WRYp

Conversion from calcineurin inhibitors to belatacept in HLA- sensitized kidney-transplant recipients with low-level donor specific antibodies.

Background. Belatacept could be the treatment of choice in renal-transplant recipients with renal dysfunction attributed to CNI nephrotoxicity. Few studies have described its use in patients with DSA. Methods. We retrospectively evaluated conversion from CNIs to belatacept in 29 HLA-immunized RTRs. Data regarding acute rejection, DSA and renal function were collected. These patients were compared to 42 non-immunized patients treated with belatacept. Results. Patients were converted from CNIs to belatacept a median of 444 days [IQR:85-1200] after transplantation and were followed-up after belatacept conversion, for a median of 308 days [IQR: 125-511]. At conversion, 16 patients had DSA. Nineteen DSA were observed in these 16 patients, of which 11/19 were less than 1000MFI, 7/19 were between 1000 and 3000 MFI , and one was more than 3000 MFI. At last follow-up, pre-existing DSA had decreased or stabilized. Seven patients still had DSA with a mean MFI of 1298 ± 930 at the last follow-up. No patient developed a de novo DSA in the DSA positive group. In the non-immunized group, one patient developed de novo DSA (A24- MFI 970; biopsy for cause did not show BPAR or microinflammation score). After belatacept conversion, one ABMR was diagnosed. The mean eGFR improved from 31.7 ± 14.2 mL/min/1.73 m2 to 40.7 ± 12.3 mL/min/1.73 m2 (p

http://bit.ly/2G9IOFH

Evaluation of Accepting Kidneys of Varying Quality for Transplantation or Expedited Placement with Decision Trees

Background: Underutilization of marginal-quality kidneys for transplantation produced ideas of expediting kidney placement for populations with decreased opportunities of receiving transplants. Such policies can be less efficacious for specific individuals and should be scrutinized until the decision-making for accepting marginal-quality organs, which has relied on experiential judgment, is better understood at the individual level. There exist rigorous tools promoting personalized decisions with useful and objective information. Methods: This article introduces a decision-tree methodology that analyzes a patient's dilemma: to accept a kidney offer now or reject it. The methodology calculates the survival benefit of accepting a kidney given a certain quality now and the survival benefit of rejecting it. Survival benefit calculation accounts for patients' and donors' characteristics and transplant centers' and organ procurement organizations' performances and incorporates patients' perceived transplant and dialysis utilities. Valuations of rejecting an offer are contingent on future opportunities and subject to uncertainty in the timing of successive kidney offers and their quality and donor characteristics. Results: The decision tree was applied to a realistic patient profile as a demonstration. The tool was tested on 1,000 deceased-donor kidney offers in 2016. Evaluating up to one year of future offers, the tool attains 61% accuracy with transplant utility 1.0 and dialysis utility 0.5. The accuracy reveals potential bias in kidney offer acceptance/rejection at transplant centers. Conclusions: The decision-tree tool presented could aid personalized transplant decision-making in the future by providing patients with calculated, individualized survival benefits between accepting and rejecting a kidney offer. *Corresponding Author: Vikram Kilambi, 20 Park Plaza Suite 920, Boston, MA 02116, E-mail: vkilambi@rand.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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A custom made clamp facilitating stabilization of cuffs in murine heterotopic cervical heart transplantation

No abstract available

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Developing CUSUM Charts for Monitoring Transplant Outcomes: Varied Goals and Many Possible Paths to Success

No abstract available

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Utilization of deceased donor kidneys to initiate living donor chains: practical, ethical and logistical issues

No abstract available

http://bit.ly/2D9eUO7

Can mycophenolic acid-based immunosuppression benefit liver transplant patients with HCC?

No abstract available

http://bit.ly/2G96YAj

Tolerance Biomarkers in Liver Transplantation: Independent External Validation of the Predictive Strength of SENP6 and FEM1C Gene Expression

Background: Numerous studies have emphasized the genetic and phenotypic profiles of tolerant transplant patients. Moreover, different groups have defined several biomarkers, trying to distinguish patients who are going to be tolerant from those who are going to reject. However, most of these biomarkers have not been validated by other groups or even established for clinical practice. Methods: We reanalyzed and stratified the predictive capacity of 20 previously described biomarkers for liver transplantation tolerance in a cohort of 17 liver transplant patients subjected to an independent, nonrandomized, prospective study of immunosuppression drug withdrawal. Results: Only 4 of the 20 studied biomarkers (expression of SENP6, FEM1C, miR31 and miR95) showed a strong predictive capacity in the present study. miR31 and FEM1C presented an area under the ROC curve (AUC) of 96.7 %, followed by SENP1 with 93.3 %. Finally, miR95 had an AUC value below 86.7 %. Conclusions: Even though this independent analysis seems to confirm the predictive strength of SENP6 and FEM1Cin liver transplantation tolerance, there are also risks in establishing biomarkers for clinical phenotypes without an understanding of how they are biologically relevant. Future collaborations between groups should be promoted so that the most promising biomarkers can be validated and implemented in daily clinical practice. † Equal senior authors. Disclosure: The authors of this manuscript have no conflicts of interest to disclose. Funding: This work was supported by a grant from Instituto de Salud Carlos III (PI12/02042 and PI17/00489) for J.A.P. and Fundación Mutua Madrileña (FMM13) for A.B.M. as Principal Investigators. Corresponding Author: Alberto Baroja-Mazo; Murcia's Biohealth Research Institute-Virgen de la Arrixaca; LAIB Building - Lab 4.20; Ctra. Buenavista s/n 30120 Murcia (SPAIN); +34 868885031; alberto.baroja@um.es Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2D7WzAN

Tandem Orthotopic Living Donor Liver Transplantation Followed by Same Donor Haploidentical Hematopoietic Stem Cell Transplantation for DOCK8 Deficiency: Tandem Liver and Bone Marrow Transplant in DOCK8 Deficiency

Background: An 11-year old girl with DOCK8 deficiency was proposed for potentially curative hematopoietic stem cell transplantation (HSCT), the donor being her haploidentical mother. However, end-stage liver disease, caused by chronic Cryptosporidium infection required liver transplantation before HSCT. Methods: Consequently, a staged approach of a sequential liver transplant followed by a HSCT was planned, with her mother as the donor for both liver and HSCT. Results: The patient successfully underwent a left lobe orthotopic liver transplant, however, she developed a biliary leak delaying the HSCT. Notably, the recipient demonstrated 3 percent donor lymphocyte chimerism in her peripheral blood immediately prior to HSCT. Haploidentical related donor HSCT performed two months after liver transplantation was complicated by the development of acyclovir-resistant HSV viremia, primary graft failure, and sinusoidal obstruction syndrome (SOS). The patient died from SOS associated multiorgan failure with Candida sepsis on day +40 following HSCT. Conclusions: We discuss the many considerations inherent to planning for HSCT preceded by liver transplant in patients with primary immunodeficiencies, including the role of prolonged immunosuppression and the risk of infection prior to immune reconstitution. We also discuss the implications of potential recipient sensitization against donor stem cells precipitated by exposure of the recipient to the donor lymphocytes from the transplanted organ. Acknowledgments: This work was supported by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases and National Cancer Institute, National Institutes of Health. This project has been funded in whole or in part with federal funds from the National Cancer Institute, National Institutes of Health, under Contract No. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. This trial is registered at Clinicaltrials.gov NCT01176006 Disclosure: The authors declare no conflicts of interest. Corresponding author: Nirali N. Shah , National Institutes of Health, Building 10/CRC, Room 1-5750, 10 Center Drive, Bethesda, MD 20892, USA. Phone 240-760-6199 , Email: shahnn@mail.nih.gov Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G9INS9

Lost in Translation: Converting Empirical Evidence to Organ Acceptance Decision-Making: Lost in Translation

No abstract available

http://bit.ly/2G9xxoP

Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States

Background: Since the Model for End-Stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. However, whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival remains understudied. Methods: A retrospective cohort of patients age ≥18 with renal dysfunction on the liver transplant (LT) waiting list was obtained from Organ Procurement and Transplantation Network. Renal dysfunction was defined as estimated glomerular filtration rate

http://bit.ly/2D7Wtcp

Comment on Dai R. et al.: The effect of milk consumption on acne: a meta‐analysis of observational studies

Abstract

We have read with interest the article on milk implication in acne pathogenesis and we would like to congratulate the authors for creating the first meta‐analysis on this subject (1). Acne is a cutaneous disease with major implications for both adolescent and adult patients and each step towards the establishment of a complete, complex and individually adapted management plan (including dietary interventions) is of most importance.

http://bit.ly/2Sn7Vux

ATA supports dialogue on emergency preparedness around nuclear power stations

Here's what could happen in a nuclear disaster in Washtenaw County

The American Thyroid Association has called for pre-distribution of potassium iodide, also known as KI, to households within a 10-mile radius of nuclear power plants such as Fermi 2, and stockpiling it in public facilities such as schools, hospitals, clinics, post offices and police and fire stations in up to a 50-mile radius.
Michigan Live (www.MLive.com)

ATA supports dialogue on emergency preparedness around nuclear power stations

Here's what could happen in a nuclear disaster in Washtenaw County

Short and long‐term responsiveness to low dose GH in adult Growth Hormone Deficiency (GHD): role of GH receptor (GHR) polymorphism

Abstract

Purpose

in patients with Growth Hormone Deficiency (GHD), low doses of recombinant human Growth Hormone (rhGH) have a similar or better long‐term clinical effect than higher doses. Pharmacogenetic studies suggest that GH receptor (GHR) polymorphism influences only some metabolic parameters. Nonetheless there is no clear scientific evidence proving the effects of lower rhGH dose regimens on metabolic parameters. The aim of our prospective study is to evaluate the effects of GHR polymorphism in adult GHD patients treated with low rhGH dose during short (6 and 12 months) and long‐term (5 years) follow‐up.

Methods

Sixty‐nine GHD adult patients were studied, before and during treatment with rhGH, using a standardized low‐dose protocol calculated on the basis of body weight (0.01‐0.03 mg/kg/week) and monitored by IGF‐I plasma assay, anthropometric and metabolic parameters. The GHR genotype (flfl, fld3, or d3d3) was determined from peripheral blood.

Results

d3‐GHR carriers showed a more effective short and long‐term response to low rhGH dose in LDL reduction, body composition and blood pressure (homozygous patients only); d3‐GHR homozygosity is related to a significant IGF‐I increase during short‐term follow‐up. Regression analysis demonstrated that rhGH dose, age at diagnosis and GHR genotype are the major determinants of IGF‐I increase at 6 and 12 months of replacement therapy.

Conclusions

the d3d3‐GHR genotype may influence some metabolic effects during short and long‐term follow‐up of low rhGH dose and could be an independent determinant of the increase of IGF‐ I during short‐term follow‐up.

http://bit.ly/2SblHBn

A role for taste receptors in (neuro)endocrinology?

Summary/Outline

The sense of taste is placed at the forefront when it comes to the interaction of our body with food‐borne chemicals. However, the role of our taste system and, in particular its associated taste receptors, is not limited to drive food preferences leading to ingestion or rejection before other organs take over responsibility for nutrient digestion, absorption, and metabolic regulation, taste sensory elements do much more. On the one hand extra‐oral taste receptors from brain to gut continue to sense nutrients and noxious substances after ingestion and, on the other hand, the nutritional state is acting backwards on the taste system. This intricate regulatory network is orchestrated by endocrine factors secreted in response to taste receptor signaling and, in turn regulating taste receptor cells themselves. This work summarizes current knowledge on the endocrine regulation of the taste perceptual system and the release of hunger/satiety regulating factors by gastrointestinal taste receptors. Furthermore, the regulation of blood glucose levels through the activation of pancreatic sweet taste receptors and subsequent insulin secretion as well as the influences of bitter compounds on thyroid hormone release will be addressed. Finally, central effects of tastants will be discussed briefly.

http://bit.ly/2UCgkYn

Issue Information

http://bit.ly/2RARW7R

Variable response to low‐dose naltrexone in patients with Darier disease: a case series

Abstract

Background

Darier disease is a rare autosomal‐dominant genodermatosis with a loss of function of a Ca²⁺‐ATPase pump (SERCA2‐pump). Clinically, the disease is characterized by red‐brown keratotic papules mainly in seborrheic areas and has only limited and unsatisfactory treatment options. Previously, low‐dose naltrexone was described as a successful treatment option in Hailey‐Hailey‐disease, a genodermatosis with a genetic mutation coding for a similar loss of function of a Ca²⁺‐ATPase pump (hSPCA1‐pump).

Objective

To assess the efficacy of low‐dose naltrexone as a treatment option in Darier disease.

Methods

Six patients with biopsy‐proven Darier disease (4 had severe, 1 had moderate and 1 mild clinical manifestations). The patients received off‐label therapy with naltrexone (5 mg per os [p.o.]) and magnesium (200 mg p.o.). Patients were followed up every 4 weeks for minimally 12 weeks. Upon clinical presentation, the disease severity and subjective pain and itch scores were assessed, and standardized photographs were obtained.

Results

The clinical response to naltrexone varied after 12 weeks. The 4 patients with severe Darier disease showed worsening after initial improvement during the first 4 weeks, whereas the 2 patients with a mild to moderate clinical manifestation clearly improved, showing almost full remission after 12 weeks with complete flattening of the keratotic papules.

Conclusion

Low‐dose naltrexone did not have an effect on severe Darier disease compared to Hailey‐Hailey disease, but it was beneficial in mild to moderate forms of the disease. Further studies are needed to confirm these observations of variable responses.

http://bit.ly/2WEYlSY

Stephen Ira Katz M.D., Ph.D., Director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), 1941–2018

http://bit.ly/2WETukX

Issue Information

http://bit.ly/2RzBzs8

Asthma Status and Risks among Lesbian, Gay, and Bisexual Adults in the United States: A Scoping Review

Publication date: Available online 2 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Cindy B. Veldhuis, Jean-Marie Bruzzese, Tonda L. Hughes, Maureen George

http://bit.ly/2MLEvAT

NDP‐MSH reduces oxidative damage induced by palmitic acid in primary astrocytes

Abstract

Recent findings relate obesity to inflammation in key hypothalamic areas for body weight control. Hypothalamic inflammation has also been related to oxidative stress. Palmitic acid (PA) is the most abundant free fatty acid found in food, and in vitro studies indicate that it triggers a pro‐inflammatory response in the brain. Melanocortins are neuropeptides with proven anti‐inflammatory and neuroprotective action mediated by melanocortin receptor 4 (MC4R), but little is known about the effect of melanocortins on oxidative stress. The aim of this study was to investigate whether melanocortins could alleviate oxidative stress induced by a high fat diet (HFD) model. We found that NDP‐MSH treatment decreased PA‐induced reactive oxygen species (ROS) production in astrocytes, an effect blocked by the MC4R inhibitor JKC363. NDP‐MSH abolished nuclear translocation of Nrf2 induced by PA and blocked the inhibitory effect of PA on superoxide dismutase (SOD) activity and glutathione (GSH) levels while it also per se increased activity of SOD and γ‐glutamate cysteine ligase (γ‐GCL) antioxidant enzymes. However, HFD reduced hypothalamic MC4R and BDNF mRNA levels, thereby preventing the neuroprotective mechanism induced by melanocortins.

http://bit.ly/2SooOF7

Dendritic pattern: Unique onychoscopic feature in endonyx

Publication date: Available online 2 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Deepak Jakhar, Chander Grover, Ishmeet Kaur

http://bit.ly/2HQ1hZP

Factors associated with the utilization of Mohs surgery in the treatment of microcystic adnexal carcinoma

Publication date: Available online 2 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Walter Liszewski, Derek R. Blanchette, Ian A. Maher

http://bit.ly/2t0xFyu

MdRDH1, a HSP67B2-like rhodanese homologue plays a positive role in maintaining redox balance in Musca domestica

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s): Ting Tang, Hehe Sun, Yongbao Li, Peiru Chen, Fengsong Liu

Abstract

Rhodanese homology domains (RHODs) are the structural modules of ubiquitous tertiary that occur in three major evolutionary phyla. Despite the versatile and important physiological functions of RHODs containing proteins, little is known about their invertebrate counterparts. A novel HSP67B2-like single-domain rhodanese homologue, MdRDH1 from Musca domestica, whose expression can be induced by bacterial infection or oxidative stress. Silencing MdRDH1 through RNAi causes important accumulations of reactive oxygen species (ROS) and malondialdehyde (MDA), and increases mortality in the larvae treated with bacterial invasion. The E. coli with MdRDH1 and the mutant MdRDH1^C135A are transformed, with significant rhodanese activity of the recombinant protein of MdRDH1 in vitro found, without no detection of enzyme activity of the mutant MdRDH1^C135A, revealing that catalytic Cys135 in the active-site loop is essential in the sulfurtransferase activity of MdRDH1. When oxidative stress is insulted by phenazine methosulfate (PMS), the MdRDH1 transformed E. coli shows enhanced survival rates compared with those bacteria transformed with MdRDH1^C135A. Our research indicates that MdRDH1 confers oxidative stress tolerance, thus rendering evidence for the idea that rhodanese family genes play a critical role in antioxidant defenses. This paper yields novel insights into the potential antioxidative and immune functions of HSP67B2-like rhodanese homologues in invertebrate.

http://bit.ly/2WA7VXv

Cockroach allergens – coping with challenging complexity

Publication date: Available online 2 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Jörg Kleine-Tebbe, Robert G. Hamilton, Richard E. Goodman

http://bit.ly/2Tt4hN5

Mining Social Media Data to Assess the Risk of Skin and Soft Tissue Infections from Allergen Immunotherapy

Publication date: Available online 2 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Kimberly G. Blumenthal, Maxim Topaz, Li Zhou, Tyler Harkness, Roee Sa'adon, Ofrit Bar-Bachar, Aidan A. Long

Abstract

Background

Allergen immunotherapy (AIT) treatment for allergic rhinitis and asthma is used by 2.6 million Americans annually. Clinical and sterility testing studies identify no risk of contamination or infection from extracts prepared using recommended aseptic techniques, but regulatory concerns persist. Social media can be used to investigate rare adverse effects not captured by traditional studies.

Objective

To investigate large social media databases for suggestion of AIT skin and soft tissue infection (SSTI) risk and compare this risk to a comparator procedure with a sterile pharmaceutical.

Methods

We analyzed USA-restricted data from over 10 common text-based social media platforms including Facebook, Twitter, and Reddit between 2012-2016. We employed natural language processing (NLP) to identify posts related to AIT and, separately, Influenza vaccination (comparator procedure). NLP was followed by manual review to identify posts suggesting a possible SSTI associated with either AIT or Influenza vaccination. SSTI frequencies with 95% confidence intervals (CI) were compared.

Results

We identified 25,126 AIT posts, which were matched by social media platform to 25,126 Influenza vaccination-related posts. NLP identified 4,088 (16.3%) AIT posts that required manual review, with 6 posts (0.02%, 95%CI 0.005% to 0.043%) indicative of possible AIT-related SSTI. NLP identified 2,689 (10.7%) Influenza posts that required manual review, with 7 posts (0.03%, 95%CI 0.007% to 0.048%) indicative of possible Influenza vaccination-related SSTI.

Conclusion

Social media data suggest that SSTI from AIT and Influenza vaccination are equally rare events. Given that AIT's SSTI risk appears comparable to the risk using a sterile pharmaceutical based on social media data, current aseptic technique procedures seem safe.

http://bit.ly/2BjMKjh

Regulation of Ectodomain Shedding of ADAM33 In Vitro and In Vivo

Publication date: Available online 2 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Elizabeth R. Davies, Laura Denney, Marieke Wandel, Clare M. Lloyd, Donna E. Davies, Hans Michael Haitchi

http://bit.ly/2TubjRs

Pediatric Anesthesia: A Problem-Based Learning Approach

No abstract available

http://bit.ly/2WDeE2N

Pediatric Anesthesia: A Problem-Based Learning Approach

No abstract available

http://bit.ly/2WDeE2N

Severe asthma in children: therapeutic considerations

Purpose of review Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma (PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinary team assessment to identify modifiable factors contributing to poor control is needed prior to considering therapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma (STRA) and the current array of add-on therapies will be discussed. Recent findings Adherence monitoring using electronic devices has shown that only 20–30% of children with PSA have STRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRA aged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, are available for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety data are available for mepolizumab, but efficacy data are unknown for those aged 6–11 years and minimal for those 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinical significance and contribution to disease severity remains uncertain. Summary Most children with PSA have steroid sensitive disease which improves with adherence to maintenance inhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacy data of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If we are to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accurately phenotyped children are needed. Correspondence to Sejal Saglani, MD, Imperial College London, London, UK. E-mail: s.saglani@imperial.ac.uk Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Bg2LH5

Sepsis - What's new in 2019?

Purpose of review Sepsis-3 guidelines have implications in a deeper understanding of the biopathology of the disease. Further, the review focuses on timely topics and new literature on fluid resuscitation, the value of steroids in sepsis, and new therapeutic options such as angiotensin II, vitamin C, and thiamine as well as the emerging role of procalcitonin (PCT) in managing antibiotics. Recent findings Traditional therapies such as type of crystalloid fluid administration and steroid therapy for sepsis are currently under re-evaluation. Angiotensin II is investigated for reversing vasodilatory shock. The role of capillary endothelium leak and cellular metabolism can be affected by vitamin C and thiamine levels. Biomarker level trends, specifically PCT, can aid clinical suspicion of infection. Summary Sepsis-3 shifts the focus from a noninfectious inflammatory process and an emphasis on a dysregulated host response to infection. Hyperchloremic crystalloid resuscitation is associated with poor clinical outcomes. Steroid administration can reverse shock physiology; however, mortality benefits remain uncertain. Angiotensin II, vitamin C, and thiamine are novel treatment options that need further validation. PCT assays can help discern between infectious and noninfectious inflammation. Correspondence to Mark E. Nunnally, MD, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, NYU Langone Medical Center, 550 1st Ave, New York, NY 10016, USA. Tel: +1 (212) 263 5072; e-mail: Mark.Nunnally@nyulangone.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2MLo7R6

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Κυριακή 3 Φεβρουαρίου 2019

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Here's what could happen in a nuclear disaster in Washtenaw County

Here's what could happen in a nuclear disaster in Washtenaw County

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