Head and Neck Diseases by Alexandros G.Sfakianakis: 02/05/19

Τρίτη 5 Φεβρουαρίου 2019

Variables that predict response of nevus of ota to lasers

Summary

Nevus of ota is a dermal melanocytosis common among Asian patients, mottled, blue‐gray macule that is usually located unilaterally within the distribution of the first and second branches of the trigeminal nerve and almost always responds well to treatment with Q‐switched lasers (eg, ruby, alexandrite, and Nd: YAG). In spite of the plethora of science behind laser‐tissue interactions, the objective evaluation of nevus of ota response to laser is not on firm footing and most studies report subjective percentile scoring improvement. A knowledge of the variations in morphology of nevus of ota can help predict an optimal dose response and help to counsel patients appropriately.

http://bit.ly/2DfEIYM

Variables that predict response of nevus of ota to lasers

Summary

http://bit.ly/2DfEIYM

Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology

AbstractBackground.Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown.Materials and Methods.We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013–2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)‐designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict‐of‐interest policies were associated with the strength of the payment‐prescribing association. We used modified Poisson regression to control confounding by other physician characteristics.Results.Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58–2.07), CML (RR 1.22, 95% CI 1.08–1.39), and lung (RR 1.69, 95% CI 1.58–1.82), but not prostate (RR 0.97, 95% CI 0.93–1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict‐of‐interest policies were not consistently associated with the direction of prescribing change.Conclusion.The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing.Implications for Practice.Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company's drug.

http://bit.ly/2DahkvU

Effects of cerium oxide nanoparticles on bacterial growth and behaviors: induction of biofilm formation and stress response

Abstract

In this paper, the effects of cerium oxide nanoparticles (CeO₂ NPs) on the group bacterial behaviors were elaborated. After 36-h cultivation, the biofilm biomass was enhanced by the sub-lethal concentrations of 0.5 and 2 mg/L CeO₂ NP exposure. Meanwhile, the promoted production of total amino acids in microbes further resulted in the increased surface hydrophobicity and percentage aggregation. To resist the CeO₂ NPs stress, the biofilm exhibited a double-layer microstructure, with the protein (PRO) and living cells occupying the bottom, the polysaccharide (PS), and dead cells dominating the top. The bacterial diversity was highly suppressed and Citrobacter and Pseudomonas from the phylum of γ-Proteobacteria strongly dominated the biofilm, indicating the selective and enriched effects of CeO₂ NPs on resistant bacteria. The stimulated inherent resistance of biofilm was reflected by the reduced adenosine triphosphate (ATP) content after 4 h exposure. The increased levels of reactive oxygen species (ROS) in the treatments of 8 h CeO₂ NP exposure led to the upregulated quorum sensing signals of acylated homoserine lactone (AHL) and autoinducer 2 (AI-2), beneficial to mitigating the environmental disturbance of CeO₂ NPs. These results provide evidences for the accelerating effects of CeO₂ NPs on biofilm formation through oxidative stress, which expand the understanding of the ecological effects of CeO₂ NPs.

http://bit.ly/2HThqNS

PTX3 and D‐dimer in children with asthma: a real‐world study‐Reply

Abstract

Licari and colleagues detected plasma pentraxin 3 (PTX3) and serum D‐dimer levels, and reported significant elevated concentrations for both biomarkers in asthmatic patients compared with healthy controls, but neither was observed to be associated with clinical parameters.

Elevated PTX3 expressions in asthmatic airways were firstly observed by Zhang et al,¹ and the same group reported that PTX3 deletion enhanced airway inflammation, mucus production, and airway hyperresponsiveness in an ovalbumin‐induced asthma model through a TH17‐dominant phenotype.²

http://bit.ly/2t4Kgkg

Clinical relevance of human papillomavirus outside of oropharynx

Purpose of review The role of HPV in oropharyngeal cancer is well recognized. HPV DNA is also found in a fraction of head and neck tumors outside of oropharynx but its clinical importance is unknown. The purpose of this review is to sum up the present knowledge about the prevalence and possible impact of HPV presence in head and neck tumors in nonoropharyngeal sites. Recent findings The data demonstrating prevalence of HPV presence in tumors outside of oropharynx are inconsistent. However, it can be stated that it is substantially lower than in oropharynx. Most articles report the HPV DNA presence only but very few prove also the transcriptionally active viral presence. The fraction of really HPV-induced tumors is probably very small. The majority of literature shows no impact of HPV on prognosis in nonoropharyngeal locations. Also the role of high-risk HPV in malignant transformation of lesions potentially linked to malignancy like inverted papillomas, recurrent respiratory papillomatosis or laryngeal dysplasia was up to date not demonstrated. Summary Despite of the unknown role of HPV and lack of evidence regarding any clinical use of HPV knowledge in other than oropharyngeal tumors, further research is warranted. Correspondence to Jan Klozar, MD, Department of Otolaryngology Head and Neck Surgery, First Faculty of Medicine, Charles University in Prague and University Hospital Motol Prague, V Úvalu 84, 150 06 Praha 5, Czech Republic. Tel: +420 727971911; e-mail: jan.klozar@fnmotol.cz Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RHfbwP

Photodynamic therapy in head and neck cancer: indications, outcomes, and future prospects

Purpose of review To identify and review the recent literature on clinical applications, outcome, and new developments in photodynamic therapy (PDT) for the treatment of head and neck cancer. Recent findings Although PDT and surgery have a similar local control and recurrence rate, the gold standard of treatment for early-stage oral cavity cancer remains local surgery with, on indication, concurrent treatment of the neck. PDT proves its value in treatment of patients with field cancerization and patients with superficial recurrence after previous surgery and/or radiation, in whom surgical salvage would entail important morbidity. PDT is also promising as an adjuvant treatment after surgery in the presence of macroscopic or microscopic involved margins, in patients where reresection or reirradiation would imply an unacceptable risk. Recent progress in the field of PDT focuses on development and clinical application of new photosensitizing agents, photochemical internalization, and photoimmunotherapy. Summary The value of PDT in specific well-selected head and neck cancer clinical scenarios is well established. The basic research field is rapidly evolving and experimental findings are promising, maybe eventually leading to optimized results, less side-effects, and more indications. Correspondence to Vincent Vander Poorten, MD, PhD, MSc, Department of Otorhinolaryngology–Head and Neck Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Tel: +32/16336340; e-mail: vincent.vanderpoorten@uzleuven.be Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2WJ9baQ

Medial femoral condyle free flap for head and neck reconstruction

Purpose of review The aim of this article is to review the literature on medial femoral condyle (MFC) free flap in head and neck reconstruction. Recent findings The MFC flap is a superb material for head and neck reconstruction, especially in smaller bony defects. As an alternative to fibular free flap, it presents many advantages. Combining the periosteal bone with skin and/or muscle paddle, the MFC flap is suitable for complex reconstructions with favorable healing process. Even though this flap has a longer history of orthopedic and traumatologic reconstructions, a number of cases in head and neck surgery have been recently reported. Summary The MFC flap has been successfully used to reconstruct various head and neck sites, from the orbit, maxilla, and mandible, to the laryngeal and tracheal scaffolds. Correspondence to Jacek Banaszewski, Department of Otolaryngology Head and Neck Surgery, Poznan University of Medical Sciences. Przybyszewskiego 49, 60355 Poznan, Poland. Tel: +48 61 8691387; e-mail: bananana@poczta.onet.pl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2RIpcKa

11C‐Metomidate PET/CT is a useful adjunct for lateralisation of primary aldosteronism in routine clinical practice

Abstract

Objective

To describe clinical practice experience of ¹¹C‐Metomidate PET/CT as an adjunct to adrenal vein sampling (AVS) in the lateralization of aldosterone producing adenomas (APA) in primary aldosteronism (PA).

Context

Accurate lateralisation of aldosterone producing adenomas in the setting of primary aldosteronism (PA) offers the potential for surgical cure and improved long‐term cardiovascular outcomes. Challenges associated with adrenal vein sampling, the current gold‐standard lateralization modality, mean that only a small proportion of potentially eligible patients currently make it through to surgery. This has prompted consideration of alternative strategies for lateralisation, including the application of novel molecular PET tracers such as ¹¹C‐Metomidate.

Design

Clinical Service Evaluation / Retrospective audit.

Patients

Fifteen individuals with a confirmed diagnosis of PA, undergoing lateralization with ¹¹C Metomidate PET/CT prior to final clinical decision on surgical versus medical management.

Measurements

All patients underwent screening aldosterone renin ratio (ARR), followed by confirmatory testing with the seated saline infusion test, according to Endocrine Society Clinical Practice Guidelines. Adrenal glands were imaged using dedicated adrenal CT. ¹¹C‐Metomidate PET/CT was undertaken due to equivocal or failed AVS. Management outcomes were assessed by longitudinal measurement of blood pressure, ARR, number of hypertensive medications following adrenalectomy or institution of medical therapy.

Results

We describe the individual lateralisation and clinical outcomes for 15 patients with PA.

Conclusion

¹¹C‐Metomidate PET/CT in conjunction with adrenal CT and AVS provided useful information which aided clinical decision making for PA within a multidisciplinary hypertension clinic.

http://bit.ly/2TwQcOv

Quality of life after microvascular mandibular reconstruction for osteoradionecrosis—A prospective study

Abstract

Background

Reconstructive surgery for mandibular osteoradionecrosis is increasing; however, evidence regarding the impact on health‐related quality of life is lacking. The current exploratory study prospectively investigates whether resection with reconstruction is associated with changes in HRQoL parameters for these patients.

Methods

Seventeen patients underwent microvascular reconstruction for mandibular osteoradionecrosis between 2012 and 2015, and 16 completed the EORTC quality of life questionnaires QLQ‐C30 and QLQ‐H&N35 1 month before and 1 year after surgery.

Results

Increases in emotional (P = 0.01) and social functioning (P = 0.004) were observed, together with improvements in the fatigue (P = 0.04), appetite loss (P = 0.02) and pain (P = 0.02) scores, as evaluated by the QLQ‐C30. Pain reduction was further confirmed by the QLQ‐H&N35 (P = 0.04), which also showed improved scores for feeling ill (P = 0.001) and sexual difficulties (P = 0.04).

Conclusion

This exploratory study suggests that microvascular reconstruction after mandibular osteoradionecrosis may improve HRQoL, with an emphasis on pain reduction; however, further studies are needed.

http://bit.ly/2Gr5wJ4

Evaluating the Predicted Impact of Changes to the AJCC/TMN Staging System for Differentiated Thyroid Cancer (DTC): A prospective observational study of patients in South East Scotland

Abstract

Objectives To assess the impact of the eighth edition AJCC/TMN staging system on patients with new diagnoses of differentiated thyroid cancers presenting to our regional multi‐disciplinary team meetings. Design We analysed Endocrine Cancer MDT meeting records from 2009‐2015 to identify all patients in the region presenting with a new diagnosis of differentiated thyroid cancer. We re‐staged patients according to the eighth edition AJCC/TNM staging classification and analysed the survival outcomes of patients in each stage under the seventh and eighth systems. Setting Tertiary referral centre in South East Scotland (NHS Lothian). Participants Three hundred and sixty one patients were newly diagnosed with DTC within South East Scotland during the study period and met our inclusion criteria. Main outcome measures Mortality at any time during follow‐up Results In total 119/361 (33%) patients were re‐staged when the eighth edition AJCC/TMN system was applied. The number of patients classified as having advanced stage (III/IV) disease fell from 76 (21%) to 8 (2%). The most common reason for down‐staging was re‐classification of tumour size, a factor in 96 (80.7%) down‐staged patients. The five‐year disease specific survival of the cohort overall was 98%. Overall 7 (1.9%) thyroid cancer –related deaths occurred during follow‐up, three of whom were down‐staged. Conclusions On implementation of the eighth edition of the AJCC/TMN staging system, we expect many patients who would previously have been considered to have advanced thyroid cancer will now be classified as early stage. This will accurately reflect their excellent survival outcomes.

http://bit.ly/2MPiW2w

Cost‐effectiveness of trans‐nasal endoscopic sphenopalatine artery ligation vs. arterial embolisation for intractable epistaxis: long‐term analyses

Summary

Objectives

Trans‐nasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolisation both provide excellent success rates for intractable epistaxis. Recent economic models suggest that TESPAL could be a cost‐saving strategy. Our main aim was to perform cost‐effectiveness analyses on TESPAL compared to embolisation to treat patients with epistaxis.

Design

We performed a retrospective, monocentric, comparative analyses on patients referred to our center and treated with embolisation or TESPAL.

Setting

This economic evaluation was carried out from a payer's perspective (i.e., French National Health Insurance) within a time horizon of 12 months.

Participants

Thirty‐seven TESPAL procedures and thirty‐nine embolisation procedures to treat intractable epistaxis were used in the analyses.

Main outcome measures

The primary outcome is presented as the cost per 1% of non‐recurrence. Effectiveness was defined as avoiding recurrence of epistaxis during the 1‐year follow‐up. Cost estimates were performed from the payer's perspective.

Results

Hospitalisation costs were higher for embolisation compared to TESPAL (5,972 vs. 3,769 euros). On average, hospitalization costs decreased by 41% when a patient was treated by TESPAL compared to an embolisation strategy (p= 0.06). The presence of comorbidities increased hospitalization costs by 79% (p=0.04). TESPAL enabled 1,867€ to be gained in intractable epistaxis.

Conclusions

The outcomes from our decision model confirm that TESPAL is more cost‐effective for patients with intractable epistaxis.

http://bit.ly/2DUWLFu

Acute iliac arterial thrombosis during laparoscopic abdominoperineal resection

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Abstract

Background

Acute iliac arterial thrombosis during surgery is very rare complication. There were few reports on this complication relative to gastroenterological surgery, and the risk has not been recognized.

Case presentation

A 70-year-old man, diagnosed with a rectal cancer (adenocarcinoma of rectum) with known history heavy cigarette smoking with no known history of peripheral vascular disease underwent a laparoscopic abdominoperineal resection. He presented severe pain in the left leg in the recovery room. A computed tomography (CT) scan revealed the complete obstruction of the left common iliac artery. A successful revasculization was achieved through a thrombotectomy and percutaneous transluminal angioplasty with a stent immediately after the diagnosis. The pain in the left leg disappeared immediately after the revasculization.

Conclusion

An acute arterial thrombosis is a potential complication of the laparoscopic colorectal surgery with the lithotomy position.

http://bit.ly/2Sft0rt

The Role of Glucagon-Like Peptide-1 in Energy Homeostasis

Metabolic Syndrome and Related Disorders, Ahead of Print.

http://bit.ly/2HRVgLW

Age, Sex, and Cardiovascular Risk Attributable to Lipoprotein Cholesterol Among Chinese Individuals with Coronary Artery Disease: A Case–Control Study

Metabolic Syndrome and Related Disorders, Ahead of Print.

http://bit.ly/2t5SxEx

The difference in nasal bacterial microbiome diversity between chronic rhinosinusitis patients with polyps and a control population

Background

Little is known regarding the role of the microbiome of the paranasal sinuses and its contribution to sinus mucosal health and disease. Consequently, we examined the microbiome of chronic rhinosinusitis patients with polyps (CRSwNP) and a control population to provide new insights into the microbiota associated with the pathogenesis of CRSwNP.

Methods

Fifty‐nine CRSwNP patients and 27 controls were enrolled in the study. The bacterial communities of the middle meatus were detected using 16S ribosomal RNA (rRNA)‒targeted Illumina MiSeq sequencing after microbial DNA was extracted from swabs.

Results

Although there was no difference in diversity between the 2 groups, richness was lower in the CRSwNP group than in the control group (p = 0.03). At the phylum level, Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes were predominant in both groups; however, the relative abundance was different, with the proportions of Actinobacteria (predominantly Corynebacterium) and Dolosigranulum being significantly higher in the control group than in the CRSwNP group.

Conclusion

These results support the theory of microbial dysbiosis as the pathogenesis of CRSwNP. The reduction in the proportions of potentially protective bacteria may decrease the overall stability of the sinonasal bacterial community.

http://bit.ly/2DVfYGU

An analysis of factors associated with compliance and dropout of sublingual immunotherapy on Japanese cedar pollinosis patients

Background

Sublingual immunotherapy (SLIT) is safe and effective but compliance is problematic. In this study we evaluated dropout and compliance among adults (≥20 years of age) and adolescents (<20 years of age) for Japanese cedar pollen extract (JCPE), an aqueous SLIT approved in 2014 in Japan.

Methods

Administrative claims data on 1236 Japanese patients, 846 adults (mean age, 43.0 years; 41.8% female) and 249 adolescents (mean age, 14.1 years; 36.6% female), with a JCPE prescription between October 2014 and June 2016 were reviewed. Adults and adolescents were divided according to the year they started SLIT (1‐ and 2‐year cohorts) to calculate dropout and compliance and identify associated factors using multivariate Cox and linear regression models.

Results

In 1‐ and 2‐year adult cohorts, dropout rates were 13.5% and 22.1% and compliance rates were 92.8% and 88.8%, respectively. Adolescents had higher dropout and lower compliance. Patients 40‐59 years of age had a lower dropout risk than patients 20‐29 years of age. Dropout hazard ratios (95% confidence interval) in 1‐ and 2‐year cohorts were 0.26 (0.12‐0.58) and 0.40 (0.17‐0.93) in patients 40‐49 years of age and 0.32 (0.14‐0.75) and 0.35 (0.13‐0.92) in patients 50‐59 years of age, respectively. Younger age contributed to lower compliance in 1‐ and 2‐year adult cohorts (p = 0.001 and p = 0.02, respectively). Systemic steroidal medication history and male gender were positively associated with compliance in adults but not in adolescents.

Conclusion

High dropout rate was associated with younger generations. Compliance in adults, but not in adolescents, was associated with age, systemic steroidal medication history, and gender.

http://bit.ly/2MQWfLh

Sensitivity, specificity, and predictive value of oral mucosal brush biopsy for the diagnosis of peanut allergy

Background

Current diagnostic testing methods for peanut allergy, including serum specific immunoglobulin E (sIgE) and skin‐prick testing (SPT), have low specificity, whereas oral food challenge (OFC) carries significant risk of provoking adverse events. Mucosal brush biopsy (MBB) from the oral cavity is currently being studied as a new diagnostic test for peanut allergy, but normative data is not yet available with which to begin measuring specificity and predictive value.

Methods

Twenty individuals with no history of adverse reactions from eating peanuts underwent oral MBB and serum testing for peanut sIgE. These data were then compared with previously published data from 10 individuals with a history of clinical peanut allergy, in order to generate receiver operating characteristic (ROC) curves and calculate the sensitivity, specificity, and positive and negative predictive values for both testing modalities.

Results

The optimal cutoff levels for oral MBB and sIgE testing were 0.12 kU/L and 1.0 kU/L, respectively. At 0.12 kU/L, the sensitivity of oral MBB testing was 80% and the specificity was 85%, whereas at 1.0 kU/L, the sensitivity of sIgE testing was 50% and the specificity was 100%. From the ROC curves, the areas under the ROC curve (AUC) for oral MBB and sIgE were 0.91 (p < 0.001) and 0.74 (p = 0.007), respectively. Combination testing further increased both sensitivity and accuracy over oral MBB alone.

Conclusion

In this pilot study, oral MBB demonstrated high sensitivity and specificity for screening individuals with and without oral cavity clinical reactivity to peanuts and may represent a potentially useful testing method for the diagnosis of peanut allergy in the future.

http://bit.ly/2DUyGP2

Can anatomical assessment of hypopharyngolarynx in awake patients predict obstructive sleep apnea?

Objectives/Hypothesis

To assess the relationships between laryngeal and hypopharyngeal morphology and obstructive sleep apnea‐hypopnea syndrome (OSAHS) in awake patients.

Study Design

Prospective study.

Methods

Awake flexible fiberoptic laryngoscopy and sleep studies were performed in 80 patients for snoring or OSAHS suspicion. Endoscopic videos were reviewed by two examiners to assess morphological characteristics of hypopharynx and larynx using a standardized examination of appearance, shape and position of epiglottis, shape of retropharyngeal‐epiglottic aerospace (RPEA), modified Cormack‐Lehane score, and length ratios of the hypopharynx and epiglottis. The multivariate logistic regression model was used to assess independent predictors of moderate/severe OSAHS.

Results

The interrater agreements were moderate for epiglottis appearance (κ = 0.52), epiglottis form (κ = 0.66), and epiglottis position (κ = 0.49), but fair for the shape of RPEA (κ = 0.26) and modified Cormack‐Lehane scoring (κ = 0.38). The presence of a mega‐epiglottis was significantly correlated with the severity of OSAHS (P < .05). By multivariate logistic regression analysis, independent predictors of moderate/severe obstructive sleep apnea were mega‐epiglottis (adjusted odds ratio [aOR]: = 4.78, 95% confidence interval [CI]: 1.23‐18.56, P = .024), modified Cormack‐Lehane score of 2 (aOR: 15.3, 95% CI: 1.8‐130.3, P = .012), or modified Cormack‐Lehane score of 3 (aOR: 10.03, 95% CI: 1.3‐78.2, P = .03) and aging (aOR = 1.07, 95% CI: 1.01‐1.14, P = .025).

Conclusions

Routine flexible fiberoptic laryngoscopy performed by otorhinolaryngologists in awake patients may help to detect some predictors of OSAHS such as presence of mega‐epiglottis, and modified Cormack‐Lehane score of 2 or more. Investigation of sleep disorders should be proposed in these patients.

Level of Evidence

2 Laryngoscope, 2019

http://bit.ly/2RIvlGc

Cost burden and resource utilization in patients with chronic rhinosinusitis and nasal polyps

Objectives/Hypothesis

Establish treatment patterns and economic burden in US patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) versus without chronic rhinosinusitis (CRS). Determine comparative costs of subgroups with high clinical burden.

Study Design

Observational, retrospective, case‐control study.

Methods

This study matched patients with CRSwNP to patients without CRS (1:1) using the Truven Health MarketScan US claims database. Categorical and continuous variables were compared using McNemar test and paired t test (normal distribution) or Wilcoxon signed rank tests (non‐normal distribution). Within subgroups, χ² and Wilcoxon or t tests were used (normal distribution).

Results

There were 10,841 patients with CRSwNP and 10,841 patients without CRS included. Mean age in the CRSwNP cohort was 45.8 years; 56.2% were male. During follow‐up, patients with CRSwNP had an increased diagnosis of asthma versus patients without CRS (20.8% vs. 8.1%, respectively; P < .001). Annual incremental costs were $11,507 higher for patients with CRSwNP versus those without CRS. Costs were higher in subgroups of patients with CRSwNP undergoing functional endoscopy sinus surgery (FESS), with a comorbid diagnosis of asthma, receiving oral corticosteroids, or macrolides versus the overall CRSwNP group. Patients with CRSwNP undergoing FESS had the highest costs of the four subgroups ($26,724, $22,456, $20,695, and $20,990, respectively).

Conclusions

Annual incremental costs were higher among patients with CRSwNP versus without CRS. Patients with CRSwNP with high clinical burden had higher overall costs than CRSwNP patients without.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2WK59Pb

Cost and efficiency of myringotomy procedures in minor procedure rooms compared to operating rooms

Objectives

Minor pediatric surgeries performed in the minor procedure room (MPR) may be more time efficient and less costly compared to those performed in the operating room (OR).

Study Design

Retrospective review.

Methods

This was a retrospective study on cost and efficiency differences of bilateral myringotomy with tube insertions performed in the MPR versus the OR. Charts were reviewed from June 2015 to May 2017. Cost data was based on supply cost and case costing of medical personnel including nurses, aides, and anesthesia assistants.

Results

Two hundred eighteen patients were included in the study. The median age was 2.7 years (range: 0.8–16.7), and there were no differences in gender between locations. One hundred twenty‐three patients had surgery in the MPR (56.4%), and 95 had surgery in the OR (43.6%). The median length of time in the procedure room was 11 minutes shorter for patients who underwent surgery in the MPR (12.0 minutes, range: 3.0–33.0) compared to patients in the OR (23.0 minutes, range: 11.0–52.0; P < .0001). Median hospital stay (2.0 hours vs. 4.3 hours; P < 0.0001) and median patient turnover time (6.0 minutes vs. 14.0 minutes; P < .0001) was shorter in the MPR compared to OR. The total overall cost of a myringotomy with tube insertion, including labor and supply cost, was $189.41 in the MPR compared to $468.56 in the OR, a difference of $279.15 per case.

Conclusion

Bilateral myringotomy with tube insertions are more time and cost‐efficient when performed in the MPR. This study supports the need for increased availability of MPR time for appropriate surgeries.

Level of Evidence

3. Laryngoscope, 2019

http://bit.ly/2RGn3yw

Building a Renewed ImaGe After Head & Neck Cancer Treatment (BRIGHT) 2.0

Condition: Head and Neck Cancer
Interventions: Behavioral: BRIGHT; Behavioral: Active Control
Sponsor: Medical University of South Carolina
Not yet recruiting

http://bit.ly/2SxFpX2

Diagnostic Significance of FDG PET/CT Dynamic Imaging in Detecting Metastatic Lymph Nodes With Papillary Thyroid Cancer.

Conditions: Positron-Emission Tomography; Lymph Node Metastases; Thyroid Cancer
Interventions: Diagnostic Test: ^{18^{F-FDG PET/CT dynamic scan; Diagnostic Test: B-ultrasonography
Sponsor: Fifth Affiliated Hospital, Sun Yat-Sen University
Recruiting}}

http://bit.ly/2Gr9wJl

Paclitaxel (Albumin Bound),Bleomycin And Cisplatin Or Carboplatin for Recurrent Or Metastatic Squamous Cell Carcinoma Of The Head And Neck

Condition: Squamous Cell Carcinoma Of The Head And Neck
Intervention: Drug: PaclitaxelPaclitaxel (Albumin Bound),Bleomycin combined with Cisplatin or Carboplatin
Sponsor: Sun Yat-sen University
Not yet recruiting

http://bit.ly/2SuYMQH

Weekly Plasma EBV DNA for Non-metastatic Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Carcinoma
Intervention:
Sponsor: The University of Hong Kong
Recruiting

http://bit.ly/2Gr9fGj

A Study to Assess the Safety, Tolerability and Pharmacokinetics of AZD9977 in Japanese Healthy Participants With Single and Multiple Ascending Dose Administration

Condition: Heart Failure
Interventions: Drug: AZD9977; Drug: Placebo
Sponsors: AstraZeneca; Parexel
Recruiting

http://bit.ly/2Sza1HE

Weekly Plasma EBV DNA for Non-metastatic Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Carcinoma
Intervention:
Sponsor: The University of Hong Kong
Recruiting

http://bit.ly/2Gr9fGj

Building a Renewed ImaGe After Head & Neck Cancer Treatment (BRIGHT) 2.0

Condition: Head and Neck Cancer
Interventions: Behavioral: BRIGHT; Behavioral: Active Control
Sponsor: Medical University of South Carolina
Not yet recruiting

http://bit.ly/2SxFpX2

Diagnostic Significance of FDG PET/CT Dynamic Imaging in Detecting Metastatic Lymph Nodes With Papillary Thyroid Cancer.

Paclitaxel (Albumin Bound),Bleomycin And Cisplatin Or Carboplatin for Recurrent Or Metastatic Squamous Cell Carcinoma Of The Head And Neck

A Study to Assess the Safety, Tolerability and Pharmacokinetics of AZD9977 in Japanese Healthy Participants With Single and Multiple Ascending Dose Administration

Condition: Heart Failure
Interventions: Drug: AZD9977; Drug: Placebo
Sponsors: AstraZeneca; Parexel
Recruiting

http://bit.ly/2Sza1HE

Gitelman Syndrome: A Rare Cause of Seizure Disorder and a Systematic Review

Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology of abnormal foci of seizure-related brain activity in GS cases. Interestingly, patients with GS are oftentimes diagnosed during pregnancy when the classic electrolyte pattern consistent with GS is noticed. Our case presents GS with normal serum magnesium in a patient, with seizures being the main clinical presentation. We also did a comprehensive literature review of 122 reported cases to show the prevalence of normal magnesium in GS cases and an overview of clinical and biochemical variability in GS. We suggest that further studies and in-depth analysis are required to understand the pathophysiology of seizures in GS patients with both normal and low magnesium levels.

http://bit.ly/2Ssvhih

Correction to: CD73 expression in normal and pathological human hepatobiliopancreatic tissues

The following information must be added to the published article:

http://bit.ly/2t2rPwG

Early objective response to avelumab treatment is associated with improved overall survival in patients with metastatic Merkel cell carcinoma

Abstract

Background

Response rates are primary endpoints in many oncology trials; however, correlation with overall survival (OS) is not uniform across cancer types, treatments, or lines of therapy. This study explored the association between objective response (OR) and OS in patients with chemotherapy-refractory metastatic Merkel cell carcinoma who received avelumab (anti-PD-L1).

Methods

Eighty-eight patients enrolled in JAVELIN Merkel 200 (part A; NCT02155647) received i.v. avelumab 10 mg/kg every 2 weeks until confirmed progression, unacceptable toxicity, or withdrawal. Using conditional landmark analyses, we compared OS in patients with and without confirmed OR (RECIST v1.1). We applied a Cox model that included OR as a time-varying covariate and adjusted for age, visceral disease, and number of previous therapies.

Results

Twenty-nine patients had confirmed OR; 20 by study week 7 and 7 more between study weeks 7 and 13. Survival probabilities 18 months after treatment initiation were 90% [95% confidence interval (CI) 65.6–97.4] in patients with OR at week 7 and 26.2% (95% CI 15.7–37.8) in patients without OR but who were alive at week 7. Median OS was not reached in patients with OR and was 8.8 months (95% CI 6.4–12.9) in patients without. Similar results were observed for the week 13 landmark. The adjusted Cox model showed OR was associated with a 95% risk reduction of death [hazard ratio 0.052 (95% CI 0.018–0.152)] compared with a nonresponse.

Conclusions

Patients with OR by 7 or 13 weeks had significantly longer OS than patients without, confirming that early OR is an endpoint of major importance.

http://bit.ly/2HRxUpP

Issue Information

http://bit.ly/2GaGdLY

Issue Information

http://bit.ly/2GaGdLY

Pembrolizumab for Unresectable or Metastatic Melanoma in Patients Older than 85 Years of Age

Background: Programmed cell death protein-1 (PD-1) inhibitors (pembrolizumab and nivolumab) have been approved for the treatment of advanced melanoma. Over the past decades, patients older than 85 years represent an expanding group of patients in developed countries. In France, 25% of melanomas are diagnosed in patients older than 75 years. Objective: To perform a monocentric retrospective study of patients older than 85 years and treated with pembrolizumab for unresectable or metastatic melanoma in order to evaluate tolerance and potential benefits of this immunotherapy. Methods: Medical records of patients treated with the PD-1 inhibitor pembrolizumab between January 2015 and January 2018 were reviewed. Results: Nine patients (6 women and 3 men) older than 85 years were included in the study. The mean age was 89.6 (85–97) years at inclusion. All patients were PS 0 or 1. The mean number of infusions was 4 (1–12). However, most patients were not able to tolerate the 4-infusion schedule. One patient refused the second infusion for personal reasons. Seven patients had grade 3 or 4 treatment-related adverse events. Conclusion: These results indicate that pembrolizumab treatment in patients older than 85 years may induce responses but is associated with a high risk of toxicity and impaired autonomy.
Dermatology

http://bit.ly/2GbJRoW

Removal efficiency of As(V) and Sb(III) in contaminated neutral drainage by Fe-loaded biochar

Abstract

Performance of raw and two Fe-loaded biochars, produced either by evaporation (E-product, 26.9% Fe) or precipitation (P-product, 12.6% Fe), was evaluated in batch and column testing for As(V) and Sb(III) removal from contaminated neutral drainage (CND). Batch testing results showed that sorption capacity of the E-product tripled for As(V) and quintupled for Sb(III), whereas for the P-product, it doubled for both contaminants, relative to the raw biochar. Moreover, As(V) removal by the E-product reached 90% in less than 8 h, for initial concentrations up to 50 mg/L. In column testing, the E-product efficiently treated the influent [pH 6; 1 mg/L As(V)] for more than 286 days. The pH of the final effluent was within the legally allowed limits (6–9.5) while less than 0.3 mg/L Fe leached out. Based on these findings, Fe-loaded biochar by evaporation (E-product) seems promising for As(V) treatment in CND.

http://bit.ly/2Gp0sEM

Association of Eu(III) and Cm(III) onto an extremely halophilic archaeon

Abstract

In addition to geological, geochemical, and geophysical aspects, also, microbial aspects have to be taken into account when considering the final storage of high-level radioactive waste in a deep geological repository. Rock salt is a potential host rock formation for such a repository. One indigenous microorganism, that is, common in rock salt, is the halophilic archaeon Halobacterium noricense DSM15987^T, which was used in our study to investigate its interactions with the trivalent actinide curium and its inactive analogue europium as a function of time and concentration. Time-resolved laser-induced fluorescence spectroscopy was applied to characterize formed species in the micromolar europium concentration range. An extended evaluation of the data with parallel factor analysis revealed the association of Eu(III) to a phosphate compound released by the cells (F₂/F₁ ratio, 2.50) and a solid phosphate species (F₂/F₁ ratio, 1.80). The association with an aqueous phosphate species and a solid phosphate species was proven with site-selective TRLFS. Experiments with Cm(III) in the nanomolar concentration range showed a time- and pC_H+-dependent species distribution. These species were characterized by red-shifted emission maxima, 600–602 nm, in comparison to the free Cm(III) aqueous ion, 593.8 nm. After 24 h, 40% of the luminescence intensity was measured on the cells corresponding to 0.18 μg Cm(III)/g_DBM. Our results demonstrate that Halobacterium noricense DSM15987^T interacts with Eu(III) by the formation of phosphate species, whereas for Cm(III), a complexation with carboxylic functional groups was also observed.

http://bit.ly/2SoZ4sn

In situ evaluation of the NO x removal efficiency of photocatalytic pavements: statistical analysis of the relevance of exposure time and environmental variables

Abstract

In the recent past, the NO_x removal efficiency of photocatalytic materials has been subject of many studies with promising results. However, many of these studies involve laboratory tests carried out under standardized climatic exposure conditions, often not representative of the real-world environment. With the aim to bridge this gap, selected photocatalytic materials have been applied to different substrates in outdoor demonstrator platforms at pilot scale as part of the project LIFE-PHOTOSCALING. The paper presents the results of in situ measurements of NO_x removal efficiency of the materials, performed during 17 months. Statistical models accounting for the influence of exposure time and relevant environmental variables are derived. They suggest that photocatalytic emulsions on the tested asphalt experience a significant loss of activity over time irrespective of climatic conditions. The efficiency of photocatalytic slurries on asphalt and of concrete tiles, with the photocatalyst applied on surface or in bulk, mainly depends on substrate humidity.

http://bit.ly/2Gp7PMH

Statin use associated with improved overall and cancer specific survival in patients with head and neck cancer

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Abhinav Gupta, William Stokes, Megan Eguchi, Mohammad Hararah, Arya Amini, Adam Mueller, Rustain Morgan, Cathy Bradley, David Raben, Jessica McDermott, Sana D Karam

Abstract

Objectives

Studies have shown the utility of lipid-lowering agents in improving outcomes in various cancers. We aim to explore how statins affect overall survival and cancer specific survival in head and neck cancer patients using population-based datasets.

Patients and methods

Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset, we separated HNC patients into three groups: those with no hyperlipidemia (nH), those with hyperlipidemia and not taking a statin (HnS), and those with hyperlipidemia and taking a statin (H + S). Overall survival (OS) and cancer specific survival (CSS) were compared between the three groups based on disease subsite (oral cavity, oropharynx, and other) using Kaplan-Meier and multivariate Cox regression analysis (MVA), controlling for demographic, socioeconomic, staging, treatment, and comorbidity covariates. Using Pearson chi-square analysis, we also compared the incidence of cancer-related toxicity events.

Results

There were 495 nH, 567 HnS, and 530 H + S patients. H + S patients had superior OS and CSS (73.0, 81.2%) relative to nH (58.6, 69.1%) and HnS groups (61.7, 69.2%) (p < 0.01). On MVA, H + S patients showed improved OS (p < 0.01) and CSS (p = 0.04) compared to nH (HR = 1.64, 1.56) and HnS (HR = 1.40, 1.37). MVA stratified by subsite yielded similar results for oral cavity and oropharyngeal disease. Toxicity-related events did not differ significantly between the groups.

Conclusion

HNC patients with hyperlipidemia and taking a statin demonstrated improved outcomes compared to nH and HnS patients, further supporting statins' role as a potential adjuvant anti-neoplastic agent in HNC. Further prospective studies to investigate the impact of statins on HNC outcomes are warranted.

http://bit.ly/2G9DHW9

Editorial Board/Aims & Scope

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s):

http://bit.ly/2DavPzI

Mast cells within cellular networks

Publication date: Available online 5 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Michael Stassen, Ann-Kathrin Hartmann, Sharon Jiménez Delgado, Susann Dehmel, Armin Braun

Abstract

Mast cells are highly versatile in terms of their mode of activation by a host of stimuli and their ability to flexibly release a plethora of biologically highly active mediators. Within the immune system, mast cells can best be designated as an active nexus interlinking innate and adaptive immunity. Herein, we try to draw an arc from the initiation of acute inflammatory reactions to microbial pathogens to the development of adaptive immunity and allergies. This multifaceted nature of mast cells is made possible by the interaction with multiple cell types of immunological and non-immunological origin. Examples for the former include neutrophils, eosinophils, T cells and professional antigen presenting cells. These interactions allow mast cells to orchestrate inflammatory innate reactions and complex adaptive immunity, including the pathogenesis of allergies.

Important partners of non-immunological origin include cells of the sensory neuronal system. The intimate association between mast cells and sensory nerve fibers allows bidirectional communication leading to neurogenic inflammation. Evidence is accumulating that this mast cell / nerve crosstalk is of pathophysiological relevance in allergic diseases like asthma.

http://bit.ly/2MOLGZe

Meta-Analysis of the Efficacy of Pharmacotherapies and Allergen Immunotherapy for Adult Perennial Allergic Rhinitis

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Eli O. Meltzer, Dana V. Wallace, Howard S. Friedman, Prakash Navaratnam, Christopher M. Burton, Erin P. Scott, Hendrik Nolte

http://bit.ly/2DSPSnL

Pollen Food Allergy Syndrome (PFAS) Among Young Armenian Adults

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Mariam R. Movsisyan, Armine V. Hakobyan, Spartak S. Gambarov

http://bit.ly/2DVeQTH

Innate Immune Memory in Paediatric Food Allergy

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Melanie Neeland, Boris Novakovic, Jennifer Koplin, Thanh D. Dang, Richard Saffery, Katrina Allen

http://bit.ly/2DVeA7b

Omalizumab Treatment Patterns in Chronic Idiopathic Urticaria (CIU): Evidence from a Large Allergy Practice in the United States (US)

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Brian D. Stone, Abhishek Kavati, Maryia Zhdanava, Benjamin Ortiz, Jason Lecocq, Bradd Schiffman, Hoi Ching Cheung, Patrick Lefebvre

http://bit.ly/2DVerAF

NK cells in treated HIV-infected children display altered phenotype and function

Publication date: Available online 5 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Sanjana Mahapatra, William T. Shearer, Charles G. Minard, Emily Mace, Mary Paul, Jordan S. Orange

Abstract

Background

Chronic human immunodeficiency virus (HIV) infection is known to trigger a population redistribution and alteration in the functional capacity of NK cells. Due to improved anti-retroviral treatments, there are rising numbers of adolescents and young adults worldwide that are living with HIV infection since birth.

Objective

We sought to determine how NK cell phenotypic and functional subsets are altered in treated pediatric patients.

Methods

NK cells were contrasted among 29 HIV-unexposed and uninfected controls (5-19 years), 23 HIV-exposed but uninfected patients (HEU) (3-19 years) and 25 HIV-infected patients (3-19 years) using multi-parametric flow cytometry.

Results

While majority of the NK cell markers did not differ, activating receptors like NKp46, DNAM-1, NKG2C and stimulatory receptors like CD2 and CD11c were expressed by a higher frequency of NK cells in HIV-infected patients than controls. Interestingly, there were less differences between HIV-infected and HEU children. There was an inverse relationship between CD4/CD8 T cell ratio (as a marker of disease progression) and CD11c and NKG2C frequency and CD69 upregulation on stimulation among HIV-infected patients.

Conclusions

A chronic NK cell activation phenotype persists in HIV-infected children receiving anti-retroviral therapy and is associated with declining CD4/CD8 T cell ratios. A lower CD4/CD8 T cell ratio was associated with higher baseline granzyme B (p=0.0068, R²=0.29) and degranulation potential (p=0.022, R²=0.22) in stimulated NK cells. Thus, NK cells in HIV-infected children receiving treatment have reduced functional potential and an activated phenotype that distinguishes them from uninfected children.

Graphical abstract

Graphical abstract for this article

http://bit.ly/2DVeYTb

Mind the gaps: clinical trial concepts to address unanswered questions in aeroallergen immunotherapy. An NIAID/AHRQ Workshop

Publication date: Available online 5 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Lisa M. Wheatley, Robert Wood, Kari Nadeau, Andrew Liu, Edward Zoratti, Leonard Bacharier, Erica Brittain, Moises Calderon, Thomas Casale, Bradley Chipps, Linda Cox, Peter S. Creticos, Manisha Desai, Sten Dreborg, Stephen Durham, Peter J. Gergen, Rebecca Gruchalla, Harold Nelson, Robyn E. O'Hehir, Marshall Plaut

Abstract

The Agency for Healthcare Research and Quality and the National Institute of Allergy and Infectious Diseases organized a workshop to develop trial concepts that could improve the usage and effectiveness of aeroallergen immunotherapy (AAIT). Expert groups were formed to accomplish the following tasks: 1) Propose a study design to compare effectiveness and safety of subcutaneous versus sublingual AAIT; 2) Propose a study design to compare effectiveness and safety of AAIT using one or a few allergens vs all or most allergens to which a patient is sensitized; 3) Propose a study design to determine whether AAIT can alter the progression of childhood allergic airways disease; 4) Propose a study design to determine the optimal dose and duration of AAIT to achieve maximal effectiveness with acceptable safety. Study designs were presented by the workgroups, extensively discussed at the workshop and revised for this report. The proposed trials would be of long duration, and require large, highly characterized patient populations. Scientific caveats and feasibility matters are discussed. These concepts are intended to help the development of clinical trials that can address some of the major questions related to the practice of AAIT for the management and prevention of allergic airways disease.

http://bit.ly/2DVeSLj

New graft manipulation strategies improved outcome of mismatched stem cell transplantation in children with primary immunodeficiencies

Publication date: Available online 4 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Reem Elfeky, Ravi M. Shah, Mohamed NM. Unni, Giorgio Ottaviano, Kanchan Rao, Robert Chiesa, Persis Amrolia, Austen Worth, Terry Flood, Mario Abinun, Sophie Hambleton, Andrew J. Cant, Kimberly Gilmour, Stuart Adams, Gul Ahsan, Dawn Barge, Andrew R. Gennery, Waseem Qasim, Mary Slatter, Paul Veys

Abstract

Background

Mismatched stem cell transplantation is associated with high risk of graft loss, graft versus host disease (GvHD) and transplant related mortality (TRM). Alternative graft manipulation strategies have been employed over the last 11 years to reduce these risks.

Objective

We investigated the outcome of using different graft manipulation strategies among children with primary immunodeficiency (PID).

Methods

Between 2006-2017, 147 PID patients received 155 mismatched grafts; 30 TCRαβ/CD19 depleted, 43 cords (72% with no serotherapy), 17 CD34+ selection with T cell add-back and 65 unmanipulated grafts.

Results

The estimated 8-year survival of the entire cohort was 79%, TRM was 21.7% and graft failure rate was 6.7%. Post-transplant viral reactivation, aGvHD grades II-IV and chronic GvHD complicated 49.6%, 35% and 15% transplants, respectively. The use of TCR αβ/CD19 depletion was associated with a significantly lower incidence of grade II-IV aGvHD (11.5%) and cGvHD (0%) however with a higher incidence of viral reactivation (70%) in comparison to other grafts. T cell immune reconstitution was robust among cord transplants however with a high incidence of aGvHD grade II-IV 56.7%. Stable full donor engraftment was significantly higher at 80% among TCRαβ⁺/CD19⁺depleted and cord transplants versus 40-60% among the other groups.

Conclusions

Rapidly accessible cord and haploidentical grafts are suitable alternatives for patients with no HLA matched donor. Cord transplantation without serotherapy and TCRαβ⁺/CD19⁺depleted grafts produced comparable survival rates of around 80% albeit with a high rate of aGvHD with the former and high risk of viral reactivation with the latter that need to be addressed.

http://bit.ly/2MOLZTS

A Randomized Phase 3 Study, Sinus-52, Evaluating the Efficacy and Safety of Dupilumab in Patients with Severe Chronic Rhinosinusitis with Nasal Polyps

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Claus Bachert, Martin Desrosiers, Joaquim Mullol, Peter W. Hellings, Anders Cervin, Lawrence Sher, John V. Bosso, Stella E. Lee, Jorge F. Maspero, Shigeharu Fujieda, Shoji Matsune, Xin Lu, Chunpeng Fan, Steven Draikiwicz, Nikhil Amin, Siddhesh Kamat, Asif Khan, Gianluca Pirozzi, Neil M.H. Graham, Marcella Ruddy

http://bit.ly/2MOLUzy

Field Study of a Novel Synthetic Peptide Immunotherapy in Cat Allergic Patients

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Geoff Down, Kirsten L. Evans, Mark Larché, Paul Laidler

http://bit.ly/2DVeNY1

Safety and Tolerability of Shortened Updosing with 7 Injections of Subcutaneous Allergen Immunotherapy

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Eike G. Wuestenberg, Andreas Horn, Hendrik Wolf, Santiago Martin Hurtado, Katerina Koutromanou, Nadia Ghaussy, Montserrat Fernandez-Rivas

http://bit.ly/2MRcYhq

Time Trends in Adrenaline Auto-Injector Dispensing Patterns Using Australian Pharmaceutical Benefits Scheme Data

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Yichao Wang, Jennifer Koplin, Shaoke Lei, Rachel Peters, Simon Horne, Harriet Hiscock, Katrina Allen

http://bit.ly/2MOLhGc

Safety and Tolerability of a Novel Peptide-Based Immunotherapy for Peanut Allergy

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Sara R. Prickett, Pascal LC. Hickey, Judy Bingham, Tracy Phan, Jodie Abramovitch, Jennifer M. Rolland, William B. Smith, Mark Hew, Robyn E.O. Hehir

http://bit.ly/2DVevQV

Double-Blind, Placebo-Controlled Randomized Trial of Epicutaneous Immunotherapy in Children of Milk-Induced Eosinophilic Esophagitis

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Jonathan M. Spergel, Okan Elci, Amanda Muir, Chris A. Liacouras, Benjamin Wilkins, Deirdre D. Burke, Megan Ott Lewis, Terri F. Brown-Whitehorn, Antonella Cianferoni

http://bit.ly/2MOLdWY

Long-Term Outcomes of Omalizumab in Chronic Idiopathic Urticaria (CIU): Evidence from a Large Allergy Practice in the United States (US)

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Jason Lecocq, Abhishek Kavati, Maryia Zhdanava, Benjamin Ortiz, Bradd Schiffman, Hoi Ching Cheung, Patrick Lefebvre, Brian D. Stone

http://bit.ly/2MOLaug

Demographic Characteristics, Comorbidities, and Exacerbation Frequency Among Patients Enrolled in the Chronicle Study: A Real-World, Prospective, Observational Study of US, Subspecialist-Treated Adults with Severe Asthma

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Weily Soong, Warner Carr, Bradley E. Chipps, Dennis K. Ledford, Njira Lugogo, Wendy C. Moore, Reynold A. Panettieri, Jennifer Trevor, Laura Belton, Frank Trudo, Christopher S. Ambrose

http://bit.ly/2DSCHDF

Withdrawn

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s):

http://bit.ly/2MP1lYu

DNA Methylation Predicts BMI Status Change from Pre-Adolescence to Post-Adolescence

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Jiajing WANG, Hongmei Zhang, Syed H. Arshad, John W. Holloway

http://bit.ly/2MRcJTJ

The Influence of Patient Anxiety and Perception on the Effectiveness of Drug Allergy Testing

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): Christine Rukasin, Cosby A. Stone, David G. Schlundt, Kemberlee Bonnet, Elizabeth J. Phillips

http://bit.ly/2DTxwmT

Diversity Among Allergic March Trajectories

Publication date: February 2019

Source: Journal of Allergy and Clinical Immunology, Volume 143, Issue 2, Supplement

Author(s): David A. Hill, Robert Grundmeier, Jonathan M. Spergel

http://bit.ly/2MO4Aj3

Using Anxiolytics in a Pediatric Otolaryngology Clinic to Avoid the Operating Room

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Quinn Orb, Aida Rezaie, Sheldon Furst, Jeremy D. Meier, Albert H. Park

Abstract

Introduction

There is increasing concern regarding the risks associated with the use of general anesthesia in pediatric patients. Many otolaryngologic procedures performed under general anesthesia can also be performed in clinic. We hypothesize that anxiolytics can aid in performing common procedures in clinic thus avoiding the need to undergo general anesthesia in the OR.

Methods

We performed a retrospective review of patients undergoing inoffice procedures with anxiolytics in our pediatric otolaryngology outpatient clinic between February 2013 and January 2017. Charts were reviewed for age, past medical history, procedure type/duration, and outcome. These results were then compared to a cohort undergoing similar procedures in the OR.

Results

A total of 34 patients underwent an in-office procedure with an anxiolytic. The success rate was 97% (33/34). The average age was 6.2 years. Six children (17%) had a known history of chromosomal abnormalities and 2 children (6%) had autism. The four most common procedures performed were cerumen impaction removal (8), flexible laryngoscopy (6), ear canal foreign body removal (5), and septal cautery (4). Performing similar procedures in the OR resulted in an average additional cost of $822.

Conclusions

Performing procedures with anxiolytics in a pediatric otolaryngology clinic is safe, expeditious, and cost-effective. Anxiolytics can provide an effective alternative to general anesthesia.

http://bit.ly/2G9YGIs

The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: a randomized clinical trial

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Hadiseh Ghomi, Fariba Yadegari, Farin Soleimani, Brenda Lessen Knoll, Mahdi Noroozi, Ali Mazouri

Abstract

Objective

Given the increase in the birth and survival rate of the premature infants, a need for supportive health care services becomes more evident. The goal of the present study was to examine the effectiveness of the Premature Infant Oral Motor Intervention (PIOMI) in the feeding progression and early intervention. This study was a double-blind randomized clinical trial.

Methods

This clinical trial included premature infants in the neonatal intensive care units (NICUs) of two hospitals in Tehran, who were randomly assigned into intervention and control group, each containing 15 infants. The PIOMI was administered to the intervention group in the course of 10 days. The infants in the control group received routine nursing services. Repeated measures ANOVA (RMA) were analyzed. The postmenstrual age and weight of the participants were examined at the time points of accomplishing one, four, and eight oral feedings a day and at the time of hospital discharge.

Results

The intervention group reached the first oral feeding (with a mean of 7.2 days) and eight oral feeding (with a mean of 13.47 days) earlier than the control group. The length of hospital stay in intervention group was significantly shorter (P=0.03). RMA wasn't statistically significant between groups for weight (F: 0.76, P: 0.39, ŋ: 0.03); but within-subjects test showed that change of the weight over time and for interaction of time and group was significant (F: 74.437, P <0.001, ŋ: 0.727). The effect size of infants' age in the measurement times was 91%.

Conclusion

the results revealed that PIOMI is a fruitful method for premature infants. We suggest that PIOMI can be integrated in feeding rehabilitation programs of the premature infants born with gestational age of as young as 26-29 weeks, and applied at 29 weeks postmenstrual age (PMA).

The clinical trial registration number

IRCT20180410039260N1.

http://bit.ly/2DdkUFq

Acknowledgements to referees 2018

http://bit.ly/2SoTXbC

Neonatal Vocal Fold Motion Impairment After Complex Aortic Arch Reconstruction: What Should Parents Expect After Diagnosis?

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jennifer Rodney, Jess Thompson, Michael Anderson, Harold Burkhart

Abstract

Objectives

To study the incidence, sequelae, follow up, and recovery rate of vocal fold motion impairment (VFMI) after complex aortic arch reconstruction in neonates.

Study design

Retrospective case control study.

Methods

We retrospectively evaluated 105 neonates who underwent complex aortic arch reconstruction from 2014-2016. We compared patients that did have VFMI compared to a control group of patients with normal vocal fold movement. Descriptive statistics were computed for all demographic and clinical variables by treatment group.

Results

36% of patients were evaluated for VFMI (n=38) by an otolaryngologist. The incidence of VFMI was 22% (n= 23). Females were more likely to have VFMI (p= 0.02). Aspiration was more common in patients with VFMI (p=0.006). The difference in age, weight, incidence of pneumonia, nasogastric tube, gastrostomy, total length of stay, genetic anomaly, and reintubation was not significant between the VFMI group and control group (p> 0.05). Tracheostomy was not performed in any patients with unilateral paralysis. Only 61% of patients followed up in clinic (n=14). 64% of patients showed improvement or resolution (n=9). Average time to improvement was 4.8 months. Average time to complete resolution was 10.5 months.

Conclusions

VFMI after complex aortic arch reconstruction is relatively common. Despite increased aspiration in patients with VFMI, pneumonia did not occur at all in either group. Tracheostomy was not necessary in any patients with a unilateral paralysis. Most patients showed an improvement in the VFMI within 5 months of surgery. Our data support the need for otolaryngology follow-up.

http://bit.ly/2G9Am9v

Regulatory T Lymphocytes are Associated with Increased Nasopharyngeal Colonization in Children

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jessica Jane Browne, Evan Howard Matthews, Andrew William Taylor-Robinson, Jennelle Maree Kyd

Abstract

Objectives

Regulatory T lymphocytes (T_reg) have been linked to survival of commensal bacteria at mucosal sites, but their presence and role in chronic otitis media (COM) and their response to otopathogens has not been evaluated previously. We investigated the association between T_reg lymphocytes and otopathogens in COM prone and non-COM prone children.

Methods

Forty children, 2 to 7 years of age, scheduled for adenoidectomy were enrolled into COM (n = 20) or non-COM (n = 20) groups. Adenoid biopsy and nasopharyngeal aspirate bacteriology were assessed by conventional culture techniques. Peripheral blood and adenoid lymphocytes were stained with viability stain, monoclonal anti-CD19, anti-CD3, anti-CD4, anti-CD8, anti-CD25 and anti-CD127. Cells were stained intracellularly with monoclonal anti-FoxP3 and then quantified by flow cytometry.

Results

Children with nasopharyngeal otopathogen-positive culture had significantly more circulating CD3⁺CD4⁺FoxP3⁺CD25^hi+CD127^lo+ lymphocytes (M = 4.4%) compared to culture-negative children (M = 3.1%, p = 0.005). Circulating CD19⁺ lymphocytes were significantly increased in children with positive Moraxella catarrhalis nasopharyngeal culture (M = 12.4%) compared to culture-negative children (M = 8.6%, p = 0.006). Adenoid-derived lymphocytes were not significantly different in children with any positive nasopharyngeal culture compared to negative culture. Lymphocyte subsets were not significantly different between COM and non-COM prone children.

Conclusion

Clinically-detectable otopathogen nasopharyngeal culture is positively associated with T_reg lymphocytes, potentially inducing suppressive effector responses to promote colonization and infection chronicity. This finding supports further investigation of T_reg lymphocyte activity and influence on upper airway colonization of young children.

http://bit.ly/2GchK90

Sleep disordered breathing in children – diagnostic questionnaires, comparative analysis

Publication date: Available online 5 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Marcin Burghard, Eliza Brożek-Mądry, Antoni Krzeski

Abstract

Study Objectives

The purpose of this work is to present available questionnaires enabling diagnostic screening when obstructive sleep disordered breathing (SDB) in a child is suspected or its effects are observed and polysomnography is unavailable. These questionnaires are designed to facilitate further diagnostic process or even therapeutic decisions, aid in selecting the optimal one for the specified conditions of clinical practice, with the caveat that none of these represents a diagnostic equivalent to PSG.

Methods

The questionnaires subjected to analysis: Pediatric Sleep Questionnaire (PSQ), Sleep Clinical Record (SCR), OSA-18 score (OSA-18), Brouilette score (BS), "I'm Sleepy" questionnaire (I'M SLEEPY), and "Sleeping Sleepless Sleepy Disturbed Rest" questionnaire (SSSDR).

The comparative analysis of questionnaires included the following parameters: simplicity and time of administer; necessity to engage a physician or other trained individual; taking into account examination of the patient; type and scope of considered symptoms and consequences of obstructive SDB, sensitivity, specificity, recommendations of the guidelines.

Results

Seven questionnaires were subjected to analysis with presentation of their similarities and differences. Six out of seven were evaluated as simple in administration. Time required to fulfill the questionnaires ranged between 1 and 60 minutes. Three of them involved a physician or a trained personnel. Physical examination was necessary in two out of seven questionnaires. Sensitivity was estimated in 5 of them and ranged between 59 and 96%. Specificity ranged between 46 and 72%.

Conclusions

Several questionnaires enabling quick, simple, and inexpensive screening for OSAS have been created. Four (of the seven analyzed) questionnaires may be useful in diagnosis of obstructive SDB in children – two follow current (2015) recommendations. However, there is a need for further work on optimizing such tools, particularly on improving their specificity.

http://bit.ly/2DdkNtu

Genetic susceptibility to aminoglycoside ototoxicity

Publication date: Available online 4 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Tien Nguyen, Anita Jeyakumar

Abstract

Introduction

Aminoglycosides are a well-known clinically relevant antibiotic family used to treat bacterial infections in humans and animals and can produce toxic side effects. Aminoglycoside-induced hearing loss (HL) has been shown to have a genetic susceptibility. Mitochondrial DNA mutations have been implicated in inherited and acquired hearing impairment.

Objective

Literature review of genetic mutations associated with aminoglycoside-induced ototoxicity.

Methods

PubMed was accessed from 1993 to 2017 using the search terms "aminoglycoside, genetic, ototoxicity, hearing loss". Exclusion criteria consisted of a literature in a language other than English, uncompleted or ongoing studies, literature with non-hearing related diseases, literature on ototoxicity due to cisplatin/carboplatin based chemotherapy, literature on ototoxicity from loop diuretics, animal studies, literature studying oto-protective agents, and literature without documented aminoglycoside exposure.

Results

108 articles were originally identified, and 25 articles were included in our review. Mitochondrial 12S rRNA mutations were identified in all 25 studies in a total of 220 patients. Eight studies identified A1555G mutation as primary genetic factor underlying HL in cases of aminoglycoside-induced ototoxicity. The next most common mutation identified was C1494T.

Discussion

Mitochondrial 12s rRNA mutation A1555G was present in American, Chinese, Arab-Israeli, Spanish and Mongolian ethnicities. All mutations leading to aminoglycoside ototoxicity were mitochondrial mutations.

Conclusions

Consideration of preexisting genetic defects may be valuable in treatments involving aminoglycosides. In particular populations such as those of Chinese origin, clinicians should continue to consider the increased susceptibility to aminoglycosides.

http://bit.ly/2Ddl9jO

Caspse-11-GSDMD pathway is required for serum ferritin secretion in sepsis

Publication date: Available online 5 February 2019

Source: Clinical Immunology

Author(s): Dan Wang, Songlin Yu, Yening Zhang, Lingmin Huang, Yiting Tang, Kai Zhao, Ben Lu

Abstract

Ferritin is the major iron storage molecule of vertebrates, which can be detected in serum under numerous conditions, including inflammatory, neurodegenerative, and malignant diseases. Given this character, serum ferritin is frequently used as a biomarker in clinical settings. How the ferritin secreted to the serum has attracted much attention. Although some studies have found ferritin was mediated via the endoplasmic reticulum (ER)-Golgi secretion pathway or secretory lysosomes trafficking pathway under normal conditions, the secretion pathway of ferritin under pathological conditions, especially in sepsis is not very clear. In this report, we adopt a murine sepsis model to study the secretion pathway of ferritin in sepsis. We demonstrated caspase-11-GSDMD pathway and associated pyroptosis are required for secretion of ferritin in vitro and in vivo in sepsis. Moreover, our work connects pyroptosis to serum ferritin secretion and suggests a passive release process of ferritin, enhancing our understanding of the mechanism of ferritin secretion.

http://bit.ly/2BkRKnD

Estimating CDKN2A mutation carrier probability among global familial melanoma cases using GenoMELPREDICT

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Nicholas J. Taylor, Nandita Mitra, Lu Qian, Marie-Françoise Avril, D. Timothy Bishop, Brigitte Bressac-de Paillerets, William Bruno, Donato Calista, Francisco Cuellar, Anne E. Cust, Florence Demenais, David E. Elder, Anne-Marie Gerdes, Paola Ghiorzo, Alisa M. Goldstein, Thais C. Grazziotin, Nelleke A. Gruis, Johan Hansson, Mark Harland, Nicholas K. Hayward

Abstract

Background

Although rare in the general population, highly penetrant germline mutations in CDKN2A are responsible for 5-40% of melanoma cases reported in melanoma-prone families. We sought to determine whether MELPREDICT was generalizable to a global series of melanoma families and whether performance improvements can be achieved.

Methods

2,116 familial melanoma cases were ascertained by the international GenoMEL Consortium. We recapitulated the MELPREDICT model within our data (GenoMELPREDICT) to assess performance improvements by adding phenotypic risk factors and history of pancreatic cancer. We report areas under the curve (AUC) with 95% confidence intervals (CI) along with net reclassification indices (NRI) as performance metrics.

Results

MELPREDICT performed well (AUC=0.752; 95%CI: 0.730, 0.775), and GenoMELPREDICT performance was similar (AUC=0.748; 95% CI: 0.726, 0.771). Adding a reported history of pancreatic cancer yielded discriminatory improvement (p<0.0001) in GenoMELPREDICT (AUC=0.772; 95%CI: 0.750, 0.793; NRI=0.40). Including phenotypic risk factors did not improve performance.

Conclusion

The MELPREDICT model functioned well in a global dataset of familial melanoma cases. Adding pancreatic cancer history improved model prediction. GenoMELPREDICT is a simple tool for predicting CDKN2A mutational status among melanoma patients from melanoma-prone families and can aid in counselling these patients towards genetic testing or cancer risk counselling.

http://bit.ly/2BmJbc3

Coffee, tea, caffeine, and risk of non-melanoma skin cancer in a Chinese population: The Singapore Chinese Health Study

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Choon Chiat Oh, Aizhen Jin, Jian-Min Yuan, Woon-Puay Koh

Abstract

Background

While epidemiological studies in populations of European-descent suggest possible chemo-protective effect of caffeine against non-melanoma skin cancer (NMSC), data in Asian populations are lacking.

Objectives

We examined the relations between coffee, tea and caffeine consumption, and NMSC risk among Chinese in Singapore.

Methods

We used data from the Singapore Chinese Health Study, a prospective cohort of 63,257 men and women aged 45–74 years at recruitment from 1993 to 1998. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazard models.

Results

Coffee drinking was associated with reduced NMSC risk in a dose-dependent manner (P trend<0.0001); compared with those who drank coffee less than weekly, in those who drank ≥3 cups/day, HRs (95% CIs) were 0.54 (0.31-0.93) for risk of basal cell carcinoma, and 0.33 (0.13-0.84) for risk of squamous cell carcinoma. Compared with non-drinkers, daily drinkers of black tea also had reduced NMSC risk (HR=0.70; 95% CI=0.52-0.94). Caffeine intake reduced NMSC risk in a stepwise manner (P trend=0.0025); subjects with caffeine intake ≥400 mg/day had the lowest risk (HR=0.59; 95% CI=0.34-1.04).

Conclusion

Consumption of caffeinated drinks such as coffee and black tea may reduce the risk of NMSC among Chinese.

http://bit.ly/2TwUPIB

Incidence and Risk of Photosensitivity with Targeted Anticancer Therapies

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): K.T. Ciccolini, J. Kim, S.P. Chaudhari, A.Skripnik Lucas, B. Benhuri, J. Duran, S. Wu, M. Lacouture

http://bit.ly/2Bjnolw

Determining patient preferences and willingness to pay related to scar length and appearance following skin cancer treatment on the face and trunk: A multi-center discrete choice experiment

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Nicholas Golda, William Black, Vishal Patel, Donald Neal, Jeremy Etzkorn

http://bit.ly/2TsINzW

The Hydroxychloroquine–Interferon Gamma Release Assay Question: TB or not TB?

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Warren R. Heymann

http://bit.ly/2BlnlFX

Recommendations for the definition, evaluation, and treatment of nail psoriasis in adult patients with no or mild skin psoriasis: a dermatologist and nail expert group consensus

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Dimitrios Rigopoulos, Robert Baran, Soumiya Chiheb, Carlton Ralph Daniel, Nilton Di Chiacchio, Stamatis Gregoriou, Chander Grover, Eckart Haneke, Matilde Iorizzo, Marcel Pasch, Bianca Maria Piraccini, Phoebe Rich, Bertrand Richert, Natalia Rompoti, Adam I. Rubin, Archana Singal, Michela Starace, Antonella Tosti, Ioanna Triantafyllopoulou, Martin Zaiac

Abstract

Nail involvement in psoriasis is common, and the severity of it does not always parallel the intensity of cutaneous disease.

We created a consensus group, of which the aim was to provide practical recommendations for the treatment of nail psoriasis in patients without skin psoriasis, or with mild skin lesions with no indication for a systemic treatment. This collaborative process was conducted by an international panel of dermatologists with special expertise in nail disorders, using a formal consensus methodology.

During this process, the panel strived to establish an agreement regarding the definition of nail psoriasis, the severity of nail psoriasis, and treatment response. Treatment recommendations are provided regarding nail psoriasis severity and matrix or bed involvement. "Few-nail" disease was considered as nail psoriasis affecting 3 or less nails. In the case of matrix involvement only, intralesional steroid injections were considered the treatment of choice. Topical steroids alone or in combination with topical vitamin D analogues were suggested for nail psoriasis limited to the nail bed. For the systemic treatment of nail psoriasis acitretin, methotrexate, cyclosporine, small molecules, and biologics can be employed.

http://bit.ly/2TsJkBW

Pigments in American Tattoo Inks and their Propensity to Elicit Allergic Contact Dermatitis

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Walter Liszewski, Erin M. Warshaw

Abstract

Background

Tattoos have become increasingly common in the United States. Historically, tattoo inks were comprised of metallic pigments which had the potential to cause allergic contact dermatitis. Data have been lacking on the current use of these pigments in tattoo ink.

Objective

Identify pigments currently used in tattoo inks manufactured in or sold by wholesalers in the United States and investigate cases of allergic contact dermatitis to these pigments.

Methods

Using specific keywords, an internet search was performed. Pigment information listed in tattoo product inserts was collated and evaluated.

Results

1,416 unique inks were surveyed. The average bottle of ink contained 3.0 pigments. A total of 44 distinct pigments were identified, of which 10 contained metallic pigments including iron, barium, zinc, copper, molybdenum, and titanium. The remaining 34 pigments contained carbon, azo, diketopyrrolopyrrole, quinacridone, anthraquinone, dioxazine, or quinophthalone dyes. A literature search revealed that 11 of the 44 (25%) pigments had been suspected to cause contact dermatitis. Five were confirmed by patch testing.

Conclusions

These findings highlight the diversity of pigments currently used in tattoos. Relatively few inks contained metallic pigments to which allergic contact dermatitis has historically been attributed. Patch test clinicians should be aware of these new pigments.

http://bit.ly/2BkRSDD

Early Detection of Acral Melanoma: A Review of Clinical, Dermoscopic, Histopathologic, and Molecular Characteristics

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Claudia C. Darmawan, Gwanghyun Jo, Sara E. Montenegro, Yoonjin Kwak, Lee Cheol, Kwang Hyun Cho, Je-Ho Mun

Abstract

Acral lentiginous melanoma is a distinct subtype of melanoma on acral skin. Patient presentation at later stages as well as delayed diagnosis by physicians contribute to a worse associated prognosis and survival rate. Despite our progress on understanding the key features of this disease, the diagnosis of early stage acral melanoma is still challenging. It is essential to integrate clinical, dermoscopic, and histological findings in the diagnosis of acral lentiginous melanoma. In addition, molecular studies can be helpful. In this review, we summarized our current understanding of this disease entity from articles that have been published between 1969 and 2018. We outline clinical and dermoscopic features as well as pathologic and molecular findings of acral melanoma and present an algorithm for diagnosis. Understanding and integrating these characteristics may assist clinicians in the early detection of acral melanomas.

http://bit.ly/2TsIAg8

Intralesional sodium stibogluconate under inhaled anesthesia for the treatment of cutaneous leishmaniasis in children: A retrospective cohort

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Yael Renert-Yuval, Claes D. Enk, Sari Murad, Valerie Yofe, David Gozal, Vered Molho-Pessach

http://bit.ly/2BmZe9R

Liposuction-like Sclerotherapy Technique: a Deep Approach to Superficial Lymphatic Malformation

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Huaijie Wang, Xinkui Guo, Qiang Liu, Na Liu, Xin He, Yuping Peng, Hongfen Lv, Xiaoqian Zhou, Ya Gao

http://bit.ly/2TspeHQ

L-α-Phosphatidylcholine attenuates mercury-induced hepato-renal damage through suppressing oxidative stress and inflammation

Abstract

The potential ameliorative effects of L-α-phosphatidylcholine (PC) against mercuric chloride (HgCl₂)-induced hematological and hepato-renal damage were investigated. Rats were randomly allocated into four groups (n = 12): control, PC (100 mg/kg bwt, intragastrically every other day for 30 consecutive days), HgCl₂ (5 mg/kg bwt, intragastrically daily), and PC plus HgCl₂. Hematological and hepato-renal dysfunctions were evaluated biochemically and histopathologically. Hepatic and renal oxidative/antioxidative indices were evaluated. The expression of proinflammatory cytokines (tumor necrosis factor-α and interleukin-6) was also detected by ELISA. HgCl₂ significantly increased serum aminotransferases (ALT, AST), urea, and creatinine levels that are indicative of hepato-renal damage. HgCl₂ also induced a significant accumulation of malondialdehyde (+ 195%) with depletion of glutathione (− 43%) levels in the liver and renal tissues. The apparent hepato-renal oxidative damage was associated with obvious organ dysfunction that was confirmed by impairments in the liver and kidney histoarchitecture. Furthermore, HgCl₂ significantly attenuated the expression of proinflammatory cytokines named tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Conversely, PC treatment attenuated these effects, which improved the hematological and serum biochemical alternations, reduced the oxidative stress and proinflammatory cytokine levels, and ameliorated the intensity of the histopathological alterations in livers and kidneys of HgCl₂-treated rats. It could be concluded that PC displayed potential anti-inflammatory and antioxidant activities against HgCl₂-induced hepato-renal damage via suppression of proinflammatory cytokines and declining oxidative stress.

http://bit.ly/2Gtz1to

Corrigendum to “Using single cell analysis for translational studies in immune mediated diseases: Opportunities and challenges” [Mol. Immunol. 103 (2018) 191–199]

Publication date: Available online 4 February 2019

Source: Molecular Immunology

Author(s): Siddhartha Sharma, Louis Gioia, Brian Abe, Marie Holt, Anne Costanzo, Lisa Kain, Andrew Su, Luc Teyton

http://bit.ly/2SbGVin

Bite force measurements for objective evaluations of orthodontic tooth movement-induced pain in rats

Publication date: Available online 4 February 2019

Source: Archives of Oral Biology

Author(s): Hu Long, Di Shan, Renhuan Huang, He Liu, Yang Zhou, Muyun Gao, Fan Jian, Yan Wang, Wenli Lai

Abstract

Objective

To examine the reliability of bite force for evaluating orthodontic tooth movement-induced pain in rats.

Design

Orthodontic tooth movement-induced pain was induced by mounting springs (40 g) between incisors and ipsilateral molars in male Sprague-Dawley rats. Five group sets of animals were used: for the first group set, 20 rats were randomly divided into a force group (n = 10) and a sham group (n = 10); for the second group set, 20 rats were divided into a 20-g group and a 80-g group; for the third group set, 20 rats were randomly divided into either a CFA group (complete freund's adjuvant) (n = 10) receiving periodontal injections of CFA at baseline or a control group (n = 10) receiving periodontal injections of saline at baseline; for the forth group set, 24 rats were randomly divided into the following four groups: force + saline, control + saline, force + antiNGF and control + NGF (NGF: nerve growth factor). Rats in the fifth group set were used for immunostaining against CGRP. Bite force and bite frequency were measured at baseline (day 0) and following interventions (day 1, day 3, day 5, day 7 and day 14). Two-way ANOVA with repeated measures was used for statistical analysis and a p value less than 0.05 was considered statistical significance.

Results

Our results revealed that bite force was significantly smaller in the force group than in the sham group at all time points (p < .001). As compared to the control group, periodontal injections of CFA significantly decreased bite force on the 3^rd day (p < .01). Moreover, bite force was significantly higher in the force + antiNGF group than in the force + saline group (p = .01 < .05) while significantly smaller in the control + NGF group than in the control + saline group (p < .05). Bite force was similar between the force + antiNGF group and the control + saline group (p = .71 > .05) and between the control + NGF group and the force + saline group (p = .58 > .05). Similar results were found for bite frequency.

Conclusion

Bite force, an indicator of mechanical hyperalgesia, is a viable and reliable index for evaluating orthodontic tooth movement-induced pain.

http://bit.ly/2Bl7pmS

Heterogeneous localization of muscarinic cholinoceptor M1 in the salivary ducts of adult mice

Publication date: Available online 4 February 2019

Source: Archives of Oral Biology

Author(s): Atsara Rawangwong, Suthankamon Khrongyut, Surang Chomphoo, Kohtaro Konno, Miwako Yamasaki, Masahiko Watanabe, Hisatake Kondo, Wiphawi Hipkaeo

Abstract

We hypothesize variation in expression and localization, along the course of the glandular tubule, of muscarinic cholinergic receptor M₁ which plays as a distinct contribution, though minor in comparison with M₃ receptor, in saliva secretion. Localization of the M₁ receptor was examined using immunohistochemistry in three major salivary glands. Although all glandular cells were more or less M₁-immunoreactive, acinar cells were weakly immunoreactive, while ductal cells exhibited substantial M₁-immunoreactivity. Many ductal cells exhibited clear polarity with higher immunoreactivity in their apical/supra-nuclear domain. However, some exhibited indistinct polarity because of additional higher immunoreactivity in their basal/infra-nuclear domain. A small group of cells with intense immunoreactivity was found, mostly located in the intercalated ducts or in portions of the striated ducts close to the intercalated ducts. In immuno-electron microscopy, the immunoreactive materials were mainly in the cytoplasm including various vesicles and vacuoles. Unexpectedly, distinct immunoreactivity on apical and basal plasma membranes was infrequent in most ductal cells. The heterogeneous localization of M₁-immunoreactivity along the gland tubular system is discussed in view of possible modulatory roles of the M₁ receptor in saliva secretion.

http://bit.ly/2TyKDPQ

Electron microscopy and tomography reveal that sodium 2‐naphthalene sulfonate incorporated into perming solutions swells and tilts trichocyte intermediate filaments causing straightening of curly Japanese human hair

Abstract

Objective

A new hair‐care process has been specifically developed for the straightening of curved Japanese woman's hair [1]. The process included sodium 2‐naphthalene sulfonate (SNS) in the reduction and oxidation steps of a conventional perming process. Our objective was to develop an understanding of how this process caused hair straightening by measuring the changes to morphology and ultrastructure between, untreated, conventionally permed and SNS permed hair. Untreated and SNS permed Merino wool fibres were used to confirm structural changes.

Methods

Japanese hair samples were measured for single fibre curvature before and after perming treatments. A silver staining method was developed to stain hair fibres without changing fibre curvature so that transmission electron microscopy could be used to measure changes in the lateral dimensions of all structural components from the cellular to protein filament level. Electron tomography determined intermediate filament slopes and slope changes after SNS perming relative to the central longitudinal axis of the fibre.

Results

SNS perming was found to cause greater lateral swelling than conventional perming of: the paracortical cells of wool; the cuticle, the cuticular cell membrane complex and the macrofibrillar centre‐to‐centre distance of hair; and of the intermediate filaments in wool and hair. In curved hair, SNS perming caused the intermediate filaments of the helical macrofibrils to simultaneously swell and to tilt further, resulting in the slight longitudinal contraction of the macrofibrils. The overall swelling and tilting was greatest in the helical macrofibrils of Type B cortical cells predominately located in the convex fibre half. The presence of a higher percentage of helical macrofibrils in the convex fibre half than in the concave fibre half caused a contraction differential between the two halves leading to straighten of the curved fibre. A mechanical model was proposed to explain how SNS perming straightened curly hair.

Conclusion

The effects of conventional and SNS perming on the morphological and ultrastructural components of curved Japanese hair and high‐curl Merino wool fibres has given clear insights into understanding the mechanism of fibre curvature change.

http://bit.ly/2RCz5sN

Validation of a predictive method for sunscreen formula evaluation using gene expression analysis in a Chinese reconstructed full‐thickness skin model

Abstract

Objective

The present study aimed to establish a predictive in vitro method for assessing the photoprotective properties of sunscreens using a reconstructed full‐thickness skin model.

Materials And Methods

A full‐thickness skin model reconstructed with human fibroblasts and keratinocytes isolated from Chinese skin was exposed to daily UV radiation (DUVR). We examined the transcriptomic response, identifying genes for which expression was modulated by DUVR in a dose‐dependent manner. We then validated the methodology for efficacy evaluation of different sunscreens formulas.

Results

The reconstructed skin model was histologically consistent with human skin, and upon DUVR exposure, the constituent fibroblasts and keratinocytes exhibited transcriptomic alterations in pathways associated with oxidative stress, inflammation and extracellular matrix remodeling. When used to evaluate sunscreen protection on the model, the observed level of protection from UV‐induced gene expression was consistent with the corresponding protection factors determined clinically and allowed for statistical ranking of sunscreen efficacy.

Conclusions

Within the present study we show that quantification of gene modulation within the reconstructed skin model is a biologically‐relevant approach with sensitivity and predictability to evaluate photoprotection products.

http://bit.ly/2WJCUA8

Could Isotretinoin flare Hidradentis suppurativa? A Case Series

Summary

We report eight cases of patients with severe acne who were treated with Isotretinoin and developed painful nodules in their axillae and groin consistent with Hidradenitis Suppurativa (HS). The pathogenesis of HS is still not completely understood; recent research from a study in 2011 of biopsies from HS lesions showed a reduction or absence of sebaceous glands compared to normal skin in HS patients and the author suggested this contributes to the pathogenesis of the disease^. Interestingly the main effect of Isotretinoin is to decrease the size and action of sebaceous glands; so hypothetically, as Isotretinoin acts by reducing the sebaceous glands further it could potentially aggravate the condition. Our experience has instilled caution in our prescribing of Isotretinoin; patients are questioned about symptoms of HS prior to and during treatment, particularly patients with acne conglobata.

http://bit.ly/2UFJy8L

Could Isotretinoin flare Hidradentis suppurativa? A Case Series

Summary

http://bit.ly/2UFJy8L

The addition of chemotherapy to radiotherapy did not reduce the rate of distant metastases in low‐risk HPV‐related oropharyngeal cancer in a real‐world setting

Abstract

Background

Distant metastases (DM) are a leading cause of death for patients with oropharyngeal cancer (OPSCC). The objective of this study was to compare the rates of DM after chemoradiotherapy (CRT) and radiotherapy alone (RT) in patients with human papillomavirus (HPV)‐positive and HPV‐negative OPSCC.

Method

In a retrospective population‐based study of 525 patients across Ontario, Canada, in 1998/99/03/04, we compared treatment effectiveness using cumulative incidence function curves and cause‐specific Cox regression models.

Results

Sixty of 525 patients developed DM. There was no difference in rates (overall 10%‐15%) between HPV‐positive and HPV‐negative patients or between CRT‐ and RT‐treated patients. CRT reduced the risk of DM for the 15% of all HPV‐positive patients with higher risk (T4 and/or N3) and not for HPV‐negative patients (hazard ratio, 1.82 [0.65‐5.07]).

Conclusion

The addition of platin‐based chemotherapy to conventional RT did not decrease the rates of DM in the majority of patients with HPV‐positive or in HPV‐negative OPSSC.

http://bit.ly/2MPJalF

Sudden elevation of plasma D‐dimer levels induced by the combination therapy of dabrafenib and trametinib: Report of two cases

Abstract

The combination therapy of dabrafenib and trametinib revolutionized the treatment for BRAF V600‐mutated melanoma. Various adverse events have been reported for this treatment, most notably fever. Herein, we report two cases of novel an adverse event, namely sudden and significant elevation of plasma D‐dimer level induced by this therapy. In the first case, the remarkable elevation of plasma D‐dimer level up to 87.4 mg/dL was noted on day 11, and in the second case, the plasma D‐dimer level reached 125.5 mg/dL on day 25. In both cases, D‐dimer levels gradually decreased after the cessation of this therapy. Although the exact cause is not clear, we assume two possible hypotheses: the first is that the combination therapy may induce disseminated intravascular coagulation, and the second is that the therapy induced pathological condition of secondary thrombotic microangiopathies. Our cases suggest that this thrombotic adverse event should not be overlooked, and coagulation parameters need to be monitored during the course of this treatment.

http://bit.ly/2DbZoki

B‐cell lymphoblastic leukemia/lymphoma in infants: Report of two cases on the face

http://bit.ly/2GbX2pN

Varied responses to and efficacies of hydroxychloroquine treatment according to cutaneous lupus erythematosus subtypes in Japanese patients

Abstract

Hydroxychloroquine is recommended as the first‐line systemic treatment for cutaneous lupus erythematosus (CLE) in Western countries, and it was approved in Japan in 2016. However, the efficacy of hydroxychloroquine in various cutaneous lupus erythematosus subtypes in Japanese patients has not been elucidated to date. Therefore, we investigated the efficacy of hydroxychloroquine for the treatment of cutaneous manifestations according to CLE subtypes in Japanese patients. We enrolled 35 patients (29 diagnosed with systemic lupus erythematosus and six with CLE) in this retrospective study. We analyzed the efficacy of hydroxychloroquine for the treatment of cutaneous manifestations according to cutaneous lupus erythematosus subtypes, time to the first skin improvement, as well as effects on laboratory data and reduction of concomitant immunosuppressive drug administration at 16 and 32 weeks of therapy. Complete improvement was observed at high rates for acute CLE (ACLE); however, partial or non‐improvement rates were higher for chronic CLE (CCLE) at 16 weeks. Several patients with alopecia without scarring achieved complete improvement at 32 weeks. CCLE tended to take more time to improve than ACLE. Overall, hydroxychloroquine was highly effective for skin: 87% of patients had at least some beneficial response at 16 weeks. Nevertheless, there were wide variations in complete improvement rates and duration for improvement among CLE subtypes. Our findings suggest that a therapeutic approach considering the subtypes of CLE will improve its management.

http://bit.ly/2D8Aja9

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 5 Φεβρουαρίου 2019

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