Head and Neck Diseases by Alexandros G.Sfakianakis: 02/12/19

Τρίτη 12 Φεβρουαρίου 2019

Primary Osteosarcoma of Sphenoid and Ethmoid Sinus in a 17 Year Female: Case Report

Abstract

Primary osteosarcoma of sphenoid and ethmoid sinus present as a challenge in head neck cancer. A 17 year female presented with left sided hemifacial pain, headache with nasal discharge. Clinico-radiological finding showed mass in sphenoethmoid recess spreading to adjacent structures. Endoscopic resection was done. Histopathological diagnosis was osteosarcoma of sphenoid and ethmoid sinus. Adjuvant chemotherapy administered. Osteosarcomas of sphenoid and ethmoid sinus are aggressive tumors with variable clinical features warranting high clinical suspicion.

http://bit.ly/2ByXs5E

Removal of fecal indicator bacteria and antibiotic resistant genes in constructed wetlands

Abstract

Wastewater discharge evidently increased bacterial diversity in the receiving waterbodies. The objective of this study was to evaluate the effectiveness of a constructed wetland in reducing fecal indicator bacteria (FIB) and antibiotic resistant genes (ARGs). We determined the prevalence and attenuation of fecal indicator bacteria including Escherichia coli and enterococci, along with ARGs, and human-associated Bacteroidales (HF183) markers by quantitative polymerase chain reaction (qPCR) method. Three types of water samples (inlet, intermediate, and outlet) from a constructed wetland were collected once a month from May to December in 2013. The overall reduction of E. coli was 50.0% based on culture method. According to the qPCR result, the overall removal rate of E. coli was only 6.7%. Enterococci were found in 62.5% of the wetland samples. HF183 genetic marker was detected in all final effluent samples with concentration ranging from 1.8 to 4.22 log₁₀ gene copies (GC)/100 ml. Of the ARGs tested, erythromycin resistance genes (ermF) were detected in 79.2% of the wetland samples. The class 1 integrase (intI1) was detected in all water samples with concentration ranging from 0.83 to 5.54 log₁₀ GC/100 ml. The overall removal rates of enterococci, HF183, intI1, and ermF were 84.0%, 66.6%, 67.2%, and 13.1%, respectively.

http://bit.ly/2DBe9gK

Inferior pole breast reconstruction by TDAP flap in post-burn breast contracture

Abstract

Background

Post-burn breast deformities are not an uncommon condition after severe second-degree or third-degree burn and present as severe asymmetry of the breast as compared to the opposite side, displacement of nipple-areola complex, obliteration of inframammary fold, and reduced breast projection. Based on deformities especially for lower pole breast contracture, we propose a new classification to describe breast contracture. There is no tailor-made approach described to deal such deformities. Various options are available ranging from skin graft to different flaps. We present reconstruction by TDAP flap after the release of breast contracture grades I and II. This study aimed to classify the lower pole breast contracture according to its severity and to evaluate the outcome of TDAP flap reconstruction and augmentation of the lower pole of the breast in terms of symmetry and aesthesis.

Methods

This is a descriptive retrospective study of 10 patients with 15 post-burn contracted breast affecting the inferior pole of the breast and inframammary fold within a period of January 2012 to March 2016 in Kasralainy hospital, Cairo. All cases were evaluated according to flap vascularity, donor site morbidity, symmetry, and esthetic outcome.

Results

All flaps survived completely. Flap dimension ranged from 18 × 10 to 22 × 12 cm. The muscle sparing design had been used in three patients due to lack of reliable perforators. Patients were evaluated for their satisfaction, and all of them were satisfied.

Conclusions

It is essential to classify the grade of post-burn lower pole breast contracture according to the proposed classification. TDAP is a valuable option in case of grade I and II deformities only. For severe grade III breast contracture, more volume restoring procedure is advisable.

Level of Evidence: Level IV, therapeutic study.

http://bit.ly/2TMi7dA

Randomized, single‐blinded, crossover study of a novel wound dressing vs current clinical practice after percutaneous collagen induction therapy

Summary

Introduction

Skin rejuvenation procedures have become common with sophisticated technologies with reduced downtime and related risks. Recently, microneedling has been paired with radiofrequency to create Fractional Radiofrequency Microneedling (FRFM) to induce neocollagenesis. Frequently, topical products are applied immediately after the needling. This procedure is known as percutaneous collagen induction therapy (PCIT). Postoperative topical wound care is critical for prompt rapid and safe healing, with moist wound healing deemed of primary importance for fast and correct scarring process. An ideal dressing enables a moist environment while reducing postprocedural inflammatory responses in the first stages of wound healing.

Objective

To evaluate whether an innovative silicone‐based wound dressing is superior than standard of care therapy in decreasing severity and duration of treatment‐site acute inflammatory reactions post PCIT.

Materials and Methods

Endymed PRO Intensif Handpiece (Endymed, Israel) was used for the full‐face FRFM procedure. Subjects (n = 20) applied treatment (Stratacel^®—Stratpharma SG, Switzerland) and control (Aquaphor^®—Beiersdorf Inc, USA) immediately after the procedure and daily; they were evaluated immediately postprocedure (baseline assessment), at 2, 3 and 7 days postprocedure. Digital and 3D pictures (Antera 3D Camera for Skin Analysis—Miravex, Ireland) were taken at each assessment.

Results

All patients healed properly without reporting adverse reactions to any of the studied products. Erythema at each study visit was significantly reduced with the use of the novel wound dressing (P < 0.001). A statistically significant difference in favor of the innovative wound dressing also emerged with respect to the patient‐rated product properties (P = 0.008), such as feel on skin, drying time and stickiness.

Conclusions

The novel wound dressing reduced signs of acute inflammation following PCIT when compared to standard of care, without reporting adverse events and resulting in a more favorable outcome from a patient perspective.

http://bit.ly/2N28jJS

Randomized, single‐blinded, crossover study of a novel wound dressing vs current clinical practice after percutaneous collagen induction therapy

Summary

Introduction

Objective

Materials and Methods

Results

Conclusions

http://bit.ly/2N28jJS

Primary Tonsillar Epithelioid Follicular Dendritic Cell Sarcoma: Report of a Rare Case Mimicking Undifferentiated Carcinoma and a Brief Review of the Literature

Abstract

We present a 52 years old male with a left tonsillar follicular dendritic cell sarcoma with prominent epithelioid features that on light microscopical examination bore a striking resemblance to a lymphoepithelial or undifferentiated carcinoma. The tumor was immunohistochemically positive for CD21 and CD35 and negative for cytokeratins. Two distinct histopathological features (both present in our case) that may serve as clues to the correct diagnosis on light microscopical examination were formation of ectatic pseudovascular spaces lined by malignant cells and the presence of non-neoplastic multinucleated giant cells. Familiarity with the above-mentioned morphological clues, and awareness that this tumour may occur in anatomical sites outside the lymph node, are essential for accurate diagnosis.

http://bit.ly/2N1Pjeo

Primary Osteosarcoma of Sphenoid and Ethmoid Sinus in a 17 Year Female: Case Report

Abstract

http://bit.ly/2ByXs5E

Contribution of Nitric oxide synthase 3 genetic variants to nasopharyngeal carcinoma risk and progression in a Tunisian population

Abstract

Purpose

We conduct this study to evaluate the clinical and functional impact of Nitric Oxide Synthase 3 (NOS3) T-786C and G894T genetic variants on nasopharyngeal carcinoma (NPC) risk and progression in a Tunisian population.

Methods

259 NPC patients and 169 healthy controls were enrolled into our case–control study. Blood samples were genotyped by the RFLP-PCR analysis. The levels of Nitric oxide (NO) were measured by a colorimetric assay kit in the plasma of NPC patients, healthy controls and according to NOS3 genotypes. The correlation between the NOS3 variants and the clinicopathological parameters was examined.

Results

We found no linkage disequilibrium between NOS3 T-786C and G894T variants. These results showed that NOS3 variants were genetically independent. In contrast to NOS3 T-786C, a significant association was found between NOS3 G894T polymorphism and NPC risk. The 894T allele decreased significantly in NPC patients and appeared as protective factor (OR = 0.65, CI 95%= 0.48–0.88, p = 0.006). NPC patients had significantly higher levels of plasma NO as compared to healthy controls (p = 0.0011). The T-786C mutation reduced the levels of plasma NO and decreased risk of lymph node metastasis in NPC patients (OR = 0.64, 95% CI = 0.43–0.96; p = 0.03). In contrast, NOS3 G894T polymorphism had no effects neither on NO plasma levels nor clinical parameters.

Conclusions

This is the first study to associate NPC with significantly higher levels of plasma NO. NOS3-derived NO could play key roles in NPC pathogenesis. NOS3 variants differently contribute to NPC risk and progression in a Tunisian population. NOS3 G894T was associated with NPC risk. NOS3 T-786C decreased the levels of plasma NO and reduced the development of regional lymph node metastasis.

http://bit.ly/2GnioAv

Botulinumtoxin A für eine schönere Halskurve

Ein verkürzter Hals wird von vielen als unästhetisch angesehen. Er kann unter anderem durch eine Hypertrophie des Trapeziusmuskels entstehen. Die Injektion von Botulinumtoxin A kann das Erscheinungsbild maßgeblich verbessern und die Patientenzufriedenheit erhöhen.

http://bit.ly/2BykrOa

Upload nur mit Einverständniserklärung!

Wenn Patienten die neue E-Gesundheitsakte Vivy mit ihren Daten gefüllt sehen wollen, gibt es einige Aspekte zu beachten. Die Kassenärztliche Bundesvereinigung hat nun Informationen zusammengestellt.

http://bit.ly/2X861O2

Ärztliche Sorgfaltspflicht wahren

Der Deutsche Ärztetag hat das Fernbehandlungsverbot gelockert und damit einen wichtigen Grundstein für die Patientenbehandlung per Video, Telefon oder E-Mail gelegt. Ein Rechtsanwalt erklärt, für welche Patienten eine Fernbehandlung infrage kommt.

http://bit.ly/2TO0qdI

Wenn es beim Einlesen der E-Card hakt

Immer wieder kommt es in Arztpraxen beim Einlesen von Gesundheitskarten zu technischen Problemen. Die Kassenärztliche Vereinigung Nordrhein gibt einen Überblick über die gängigsten Fehlermeldungen und hat Tipps, was dann zu tun ist.

http://bit.ly/2TO0j1M

Strahlende Haut durch Nahrungsergänzungsmittel

http://bit.ly/2Bxepxp

Dauerhafte Hautstraffung bei Cellulite

http://bit.ly/2TO0eLw

Kein automatischer Urlaubsverfall zum Jahreswechsel

Mit zwei Urteilen hat der Europäische Gerichtshof (EuGH) wiederholt die Arbeitnehmerrechte im Hinblick auf Urlaubsansprüche gestärkt. Der EuGH hat mit seinen Entscheidungen den lange geltenden Grundsatz über Bord geworfen, dass Urlaubsansprüche zum Jahresende automatisch verfallen. Dies kann für jeden Praxisinhaber erhebliche Mehrkosten und -belastungen mit sich bringen. Es lohnt also ein Blick auf die Auswirkungen der Urteile für die tägliche Praxis und darauf, wie man sich vor nachteiligen Folgen schützen kann.

http://bit.ly/2BxejG3

Atrophe Aknenarben: gelen statt nadeln?

Der Schweregrad atropher Aknenarben war sechs Monate nach der Behandlung mit topischem Tazaroten-Gel bei guter Verträglichkeit in gleichem Maß verbessert wie nach Microneedling, so eine Studie.

http://bit.ly/2TTETQw

Ein Schritt in die richtige Richtung!

http://bit.ly/2BxegtR

Mit Laserlipolyse Körperfett entfernen und Bindegewebe straffen

http://bit.ly/2RZ6LkC

Methotrexat bei Alopecia areata/totalis?

Die Therapie von Alopecia areata/totalis mit Methotrexat (MTX) ist bisher nur unzureichend untersucht worden. In einer neuen Literatursuche fanden die Autoren Hinweise auf ein erneutes Haarwachstum nach MTX-Therapie.

http://bit.ly/2RYxY6Y

Betriebsausfall durch Unwetter einkalkulieren

Ist die Praxis aufgrund eines Hochwassers nicht zugänglich, drohen massive Betriebsausfälle — selbst im zweiten Stock. Praxen sollten sich deswegen gut gegen die möglichen Folgen versichern.

http://bit.ly/2WZwygf

Neue Befunde bestätigen: Dexpanthenol forciert die Wundheilung

http://bit.ly/2RZ6Dl8

Mit körpereigenen Ressourcen zu einem besseren Hautbild

Viele Patienten finden es besonders verlockend, ihr autologes Regenerationspotenzial zu nutzen. So erfreut sich die Anwendung einer aus dem eigenen Blut gewonnenen Thrombozytenfraktion wachsender Beliebtheit — auch in der ästhetischen Dermatologie.

http://bit.ly/2X1VFin

Wirksamkeit von OTC-Produkten bei Hyperpigmentierungen

Dank Over-the-counter-Produkten benötigen Menschen mit Hyperpigmentierungen nicht unbedingt ein Rezept vom Arzt, wenn sie ihr Hautbild verschönern möchten. Aber welche Cremes sind bei Patienten am beliebtesten, welche wirken am besten, wie lange werden sie eingesetzt — und sind verschreibungspflichtige Produkte vielleicht nicht doch besser? Das wurde jetzt in einer neuen Studie in den USA untersucht.

http://bit.ly/2RZ77Yu

„Ästhetik für Einsteiger“

http://bit.ly/2WWF93f

Hybrid-Plattform zur Körper- und Gesichtskonturierung

http://bit.ly/2RZ72Ea

DSGVO — wann droht eine Abmahnung?

Mit der Datenschutzgrundverordnung (DSGVO) wurden zahlreiche neue Verpflichtungen für die ärztliche Praxis eingeführt, die bereits viel diskutiert und aufbereitet sind. Unbeleuchtet bleibt dabei häufig die Frage, welche Rechtsfolgen ein Verstoß gegen die DSGVO überhaupt nach sich ziehen kann. Gerade die Sorge vor Sanktionen ist aber wesentlicher Anlass, sich mit der DSGVO intensiv zu beschäftigen.

http://bit.ly/2X031TK

Ist Body-Contouring nach bariatrischer Operation absolut notwendig?

http://bit.ly/2RZ6mi6

Medical Needling bei Verbrennungsnarben im Kindesalter

Verbrennungen im Kindesalter gehören zu den psychisch und physisch am stärksten traumatisierenden Verletzungen. Sie können eine lebenslange Stigmatisierung durch Narbenbildung hinterlassen. Die konservative Narbentherapie schließt direkt an die Akutbehandlung an, kann jedoch die Ausbildung von hypertrophen oder kontrakten und damit bewegungseinschränkenden Narben nicht immer verhindern. Besonders am kindlichen wachsenden Organismus müssen die Narben jahrelang behandelt und beobachtet werden, um die Entwicklung des Kindes nicht zu beeinträchtigen.

http://bit.ly/2X02WiU

Outcome of a giant coronary artery mycotic pseudoaneurysm secondary to non-typhoid Salmonella managed without surgical intervention

A 48-year-old woman with a history of AIDS, a recent coronary artery bypass graft operation and prior bacteraemia with non-typhoid Salmonella presented with non-exertional chest pain and elevated troponins. The cardiac catheterisation and coronary CT angiography revealed a 9 cm pseudoaneurysm arising from the proximal left anterior descending artery. The blood cultures confirmed non-typhoid Salmonella. Emergent surgery was initially deferred due to her complex anatomy. Moreover, the hospital course was complicated by Epstein-Barr virus meningitis and an associated decline in the patient's mentation. Consequently, the mycotic pseudoaneurysm was medically managed with antibiotics and strict blood pressure goals. The natural history of giant mycotic coronary artery pseudoaneurysm formation and progression is appreciated through this first reported medically managed case. The follow-up coronary CT angiography at 3 months showed evidence of pseudoaneurysm leakage into surrounding tissue. The patient expired at 5 months from an unknown cause.

http://bit.ly/2N1iNJk

Atypical presentation of IgG4 sclerosing cholangitis

IgG₄ sclerosing cholangitis (ISC) is a rare disease which usually presents in patients in their 60's or above. Patients often present with obstructive jaundice as the first symptom, especially when associated with autoimmune pancreatitis. We report the case of a 20-year-old man who presented with acute abdominal pain, which was subsequently diagnosed as ISC in addition to autoimmune pancreatitis following magnetic resonance cholangiopancreatography (MRCP). The patient was thus treated with steroids.

http://bit.ly/2SNUJ26

Child with unusual combination of sickle cell disease and autosomal recessive agammaglobulinemia associated with a novel CD79a gene mutation

This article describes a novel mutation in CD79a gene identified in a child with sickle cell disease (SCD), who was diagnosed with autosomal recessive agammaglobulinaemia in the context of prolonged febrile syndrome. The association of a primary immunodeficiency with SCD in the same child was unexpected.

http://bit.ly/2N42BHh

Bilateral maxillary palatal talon cusps in deciduous central incisors

'Talon cusp' is a developmental dental disturbance characterised by a cuspal projection in the cingulum area or cementoenamel junction, with normal enamel and dentin containing varying degrees of pulp tissue. The prevalence of talon cusp varies with race, age and the criteria used for diagnosis. It has been reported in the maxillary and mandibular arches of both the deciduous and permanent dentitions. The prevalence of the talon cusp in the deciduous dentition is reported to be 2.1% in Saudi Arabian subjects. The purpose of this paper is to report the rare bilateral presence of talon cusps on the deciduous maxillary central incisors of a 4-year-old female patient with a family history of consanguineous marriage.

http://bit.ly/2SNjoUi

Intermediate uveitis in a child with phosphatase and tensin homolog gene mutation and Bannayan-Riley-Ruvalcaba syndrome

Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a congenital disorder characterised by macrocephaly, multiple hamartomas, lipomas, and pigmented macules of the glans penis. Intermediate uveitis is characterised by chronic inflammatory cells aggregates on the pars plana (snowbanks) and within the vitreous cavity (snowballs). We describe what we believe to be the first case of intermediate uveitis associated with BRRS. Early examination under anaesthesia should be considered in the management of young children diagnosed with this syndrome in order to provide appropriate ocular evaluation, treatment and follow-up. Further research is needed to establish a better understanding of the ophthalmic manifestations of this syndrome.

http://bit.ly/2N20Eew

Cutaneous angiosarcoma with lymphoedema: the Stewart-Treves syndrome

http://bit.ly/2SNUAM6

Isolated superior petrosal sinus dural arteriovenous fistula treated with selective sinus packing using a quadriaxial catheter system

A 67-year-old patient presented with a headache, vertigo and nausea, followed by a disturbance of consciousness. CT and MRI showed venous ectasia at the left cerebellopontine angle and extensive oedema in the left cerebellum. Angiography demonstrated a dural arteriovenous fistula that appeared at the left superior petrosal sinus–cavernous sinus) junction. After the evaluation of the shunt point, occluded areas were recanalised via the femoral vein with a quadriaxial catheter system using a 6-Fr guiding sheath, 6-Fr guiding catheter, 4.2-Fr catheter and microcatheter. Selective coil embolisation was performed, resulting in shunt removal.

http://bit.ly/2SL56Ub

Inhalation cancer risk estimation of source-specific personal exposure for particulate matter–bound polycyclic aromatic hydrocarbons based on positive matrix factorization

Abstract

In previous studies, inhalation cancer risk was estimated using conventional risk assessment method, which was normally based on compound-specific analysis, and cannot provide substantial data for source-specific particulate matter concentrations and pollution control. In the present study, we applied an integrated risk analysis method, which was a synthetic combination of source apportionment receptor model and risk assessment method, to estimate cancer risks associated to individual PAHs coming from specific sources. Personal exposure particulate matter samples referring to an elderly panel were collected in a community of Tianjin, Northern China, in 2009, and 12 PAH compounds were measured using GC-MS. Positive matrix factorization (PMF) was used to extract the potential sources and quantify the source contributions to the PAH mixture. Then, the lung cancer risk of each modeled source was estimated by summing up the cancer risks of all measured PAH species according to the extracted source profile. The final results indicated that the overall cancer risk was 1.12 × 10⁻⁵, with the largest contribution from gasoline vehicle emission (44.1%). Unlike other risk estimation studies, this study was successful in combining risk analysis and source apportionment approaches, which allow estimating the potential risk of all source types and provided suitable information to select prior control strategies and mitigate the main air pollution sources that contributing to health risks.

http://bit.ly/2SPVnfi

The Devil Is in the Details

Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors' commentary follows. Stage. A 75-year-old woman…

http://bit.ly/2Gml3dV

β-Catenin nuclear expression discriminates deep penetrating nevi from other cutaneous melanocytic tumors

Abstract

Recent advances in genomics have improved the molecular classification of cutaneous melanocytic tumors. Among them, deep penetrating nevi (DPN) and plexiform nevi have been linked to joint activation of the MAP kinase and dysregulation of the β-catenin pathways. Immunohistochemical studies have confirmed cytoplasmic and nuclear expression of β-catenin and its downstream effector cyclin D1 in these tumors. We assessed nuclear β-catenin immunohistochemical expression in a large group of DPN as well as in the four most frequent differential diagnoses of DPN: "blue" melanocytic tumors, Spitz tumors, nevoid and SSM melanomas, and pigmented epithelioid melanocytomas (PEM). Nuclear β-catenin expression was positive in 98/100 DPN and 2/16 of melanomas (one SSM and one nevoid melanoma with a plexiform clone) and was negative in all 30 Spitz, 26 blue, and 6 PEM lesions. In 41% DPN, β-catenin expression was positive in more than 30% nuclei. No differences were observed in cytoplasmic and nuclear cyclin D1 expression between these tumor groups, suggesting alternate, β-catenin-independent, activation pathways. We have subsequently studied nuclear β-catenin expression in a set of 13 tumors with an ambiguous diagnosis, for which DPN was part of the differential diagnosis. The three out of four patients showing canonical DPN mutation profiles were the only β-catenin-positive cases. We conclude that nuclear β-catenin expression, independently from CCND1 expression, in a dermal melanocytic tumor is an argument for its classification as DPN. In ambiguous cases and in early combined DPN lesions, this antibody can be helpful as a screening tool. β-Catenin is also potentially expressed in a subset of malignant melanomas with CTNNB1 mutations.

http://bit.ly/2N0SP8M

Recent success and limitations of immune checkpoint inhibitors for cancer: a lesson from melanoma

Abstract

Several researches have been carried over the last few decades to understand of how cancer evades the immune system and thus to identify therapies that could directly act on patient's immune system in the way of restore or induce a response to cancer. As a consequence, "cancer immunotherapy" is conquering predominantly the modern scenario of the fight against cancer. The recent clinical success of immune checkpoint inhibitors (ICIs) has created an entire new class of anti-cancer drugs and restored interest in the field of immuno-oncology, leading to regulatory approvals of several agents for the treatment of a variety of malignancies. The first to be approved in 2011 was the anti-CTLA-4 antibody ipilimumab for the treatment of unresectable or metastatic melanoma. Subsequently, the anti-PD-1s, nivolumab and pembrolizumab, received regulatory approvals for the treatment of melanoma and several other cancers. More recently, three anti-PD-L1 antibodies have received approval: atezolizumab and durvalumab for locally advanced or metastatic urothelial carcinoma and metastatic non-small cell lung cancer (NSCLC) and avelumab for the treatment of locally advanced or metastatic urothelial carcinoma and metastatic Merkel cell carcinoma. This review, starting from the results of melanoma trials, highlights in turn different ICIs and data for different indications in several malignancies are included under each drug class.

http://bit.ly/2SKodO7

Two rare cases of endosalpingiosis in the axillary sentinel lymph nodes: evaluation of immunohistochemical staining and one-step nucleic acid amplification (OSNA) assay in patients with breast cancer

Abstract

Benign inclusions, such as endosalpingiosis, in an axillary sentinel lymph node (SLN) can be misdiagnosed as metastatic breast carcinoma. However, endosalpingiosis is rare in lymph nodes above the diaphragm. Among 792 patients with breast carcinoma who underwent sentinel lymph node biopsy at our center, 2 patients have experienced benign glandular inclusions in 3 SLNs, and all of these glandular inclusions were lined with columnar and ciliated epithelial cells. Immunohistochemistry revealed that the epithelial cells were positive for Müllerian markers (e.g., PAX8 and WT-1) and negative for mammary markers (e.g., mammaglobin, GCDFP-15, and GATA3), which confirm the diagnosis of endosalpingiosis. The epithelial cells were positive for CK19 but the one-step nucleic acid amplification assay revealed negative results for the axillary SLNs. Although endosalpingiosis is rare in axillary SLNs, care is needed to identify these rare cases and avoid unnecessary axillary lymph node dissection, overstaging, and overtreatment.

http://bit.ly/2N3kPbT

Outcome measures to be considered on asthma in elderly

Purpose of review Asthma is a chronic heterogeneous respiratory disease which is characterized by airflow limitation and variable respiratory symptoms. Asthma in patients more than 65 years of age has an important negative impact on quality of life. The pathophysiology and treatment of asthma in older patients are not as well identified as in younger groups of ages. In this review we intend to outline characteristics found in elderly adults which distinguish them from other age groups of patients with asthma. Recent findings With increasing age, there are alterations in the innate and adaptive immune responses, known as 'immunosenescence.' These age-associated modifications include an altered response after a pathogenic exposure or tissue injury, moderately mediated through an irreversible loss of cellular replication and defective tissue repair. Summary Asthma is a consequence of complex gene–environment interactions, with diversity in clinical presentation and the type and intensity of airway inflammation and remodeling. Age-associated changes in lung physiology and morphology may occur and contribute to asthma. Aging is correlated with a notable decrease in elastic recoil, greater chest wall rigidity, and poor respiratory muscle strength. Underreporting of symptoms by elderly patients is common because of multiple underlying causes. Video abstract http://bit.ly/2I7ztAi. Correspondence to Sandra Nora Gonzalez-Diaz, MD, PhD, Monterrey, Nuevo León, Mexico. Tel: +52 (818) 348 2459; e-mail: sgonzalezdiaz@yahoo.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-allergy.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2Gl9Qu7

Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter‐Days

AbstractBackground.Peripherally inserted central catheters (PICCs) are central venous catheters (CVCs) that are commonly used in onco‐hematologic settings for chemotherapy administration. As there is insufficient evidence to recommend a specific CVC for chemotherapy administration, we aimed to ascertain PICC‐related adverse events (AEs) and identify independent predictors of PICC removal in patients with cancer receiving chemotherapy.Materials and Methods.Information on adult patients with cancer with a PICC inserted for chemotherapy administration between September 2007 and December 2014 was extracted from six hospital databases. The primary outcome was PICC removal due to PICC‐related AEs (occlusion, infection, or symptomatic thrombosis). Independent predictors of PICC removal were identified using a multivariate Cox regression model.Results.Among the 2,477 included patients, 419 PICC‐related AEs (16.9%; 1.09 AEs per 1,000 PICC‐days) were reported. AEs increased when PICC was inserted at the brachial site (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.02–1.84) and with open systems (HR, 1.89; 95% CI, 1.24–2.88) and decreased in older men (HR, 0.63; 95% CI, 0.49–0.81).Conclusion.Use of PICC for chemotherapy administration was associated with a low all‐AEs rate. The basilic vein was the safer site, and valved systems had fewer AEs than open systems. More research is needed to explore the interaction between AEs, sex, and age.Implications for Practice.These findings provide clinicians with evidence that peripherally inserted central catheters (PICCs) are safe for chemotherapy administration. They also suggest that clinicians should limit the use of open systems when long chemotherapy regimens are scheduled. Moreover, alternatives to PICCs should be considered when administering chemotherapy to young men.

http://bit.ly/2I8xjA8

Sidedness Matters: Surrogate Biomarkers Prognosticate Colorectal Cancer upon Anatomic Location

AbstractBackground.Anatomic location of primary tumors across the colon correlate with survival in the metastatic setting, whereas left‐sided tumors may exhibit superior survival compared with right‐sided tumors. The Oncotype Recurrence Score (RS) assay is a clinically validated predictor of recurrence risk in patients with stage II colorectal cancer (CRC). Previous studies had indicated that without adjuvant chemotherapy, CDX2‐negative stage II CRC tumors are associated with a lower rate of disease‐free survival than CDX2‐positive stage II CRC tumors. We aimed to evaluate whether these two validated prognostic biomarkers may correlate with primary tumor location, and whether tumor location may reflect differential prognosis in stage II CRC.Materials and Methods.We retrospectively analyzed patients with T3 mismatch repair‐proficient (MMR‐P) stage II CRC for whom RS assay was performed. Pathological report was reviewed for exact primary tumor location and CDX2 immunostaining. RS and CDX2 expression were correlated with primary tumor location.Results.The analysis included 1,147 patients with MMR‐P stage II CRC (median age 69 years [range 29–93]). Tumor distribution across the colon was as follows: 46% (n = 551) were right‐sided and 54% (n = 596) were left‐sided. RS was higher in right‐sided tumors (p = .01). The RS results gradually decreased across the colon (cecum, highest score; sigmoid, lowest score; p = .04). Right‐sided tumors exhibited more CDX2‐negative tumors (p = .07).Conclusion.Our study indicates that right‐sided colorectal tumors may display worse prognosis compared with left‐sided tumors in MMR‐P stage II CRC. Primary tumor location may serve as a prognostic factor that should be taken into account for recurrence risk assessment and consideration of adjuvant treatment.Implications for Practice.Sidedness matters, even in stage II colorectal cancer (CRC). Using two previously established prognostic tools, the Oncotype DX assay and CDX2 expression, this study found that right‐sided tumors may display worse prognosis compared with left‐sided tumors in mismatch repair‐proficient stage II CRC. Therefore, primary tumor location should be taken into account for recurrence risk assessment and consideration of adjuvant treatment.

http://bit.ly/2E7Ed4H

A Case of Donor‐Transmitted Non‐Small Cell Lung Cancer After Liver Transplantation: An Unwelcome Guest

AbstractCancer transmission with organ donation has been previously reported with a variety of malignancies and organ transplants. The risk of transmission through organ transplantation from donors with a history of previously treated malignancies has been addressed by guidelines from transplant societies. Herein, we report a case of a patient who developed lung cancer confined to the liver after liver transplantation with no known history of malignancy in the donor. The suspicion of donor origin arose after positron emission tomography‐computerized tomography scan showed metastatic lung cancer only involving the transplanted liver without a primary focus. Genetic analysis of the malignant cells confirmed donor origin of the cancer.

http://bit.ly/2I6XYgV

High IDO1 Expression Is Associated with Poor Outcome in Patients with Anal Cancer Treated with Definitive Chemoradiotherapy

AbstractBackground.This study characterizes the tumor‐immune microenvironment in pretreatment, localized anal squamous cell carcinoma (ASCC), including two markers that have not previously been studied in ASCC: indoleamine 2,3 dioxygenase 1 (IDO1) and human leukocyte antigen (HLA) class I.Materials and Methods.Retrospective review identified 63 patients with ASCC receiving definitive chemoradiation between 2005 and 2016 with pretreatment tissue available. Immunohistochemistry was used to quantify cluster of differentiation 8 (CD8), programmed cell death protein 1, programmed death‐ligand 1, HLA class I, and IDO1. Cox proportional hazards models evaluated associations between outcomes and immune markers, controlling for clinical characteristics.Results.With a median follow‐up of 35 months, 3‐year overall survival was 78%. The only marker found to have a robust association with outcome was tumor IDO1. In general, the percentage of tumor cells expressing IDO1 was low (median 1%, interquartile range 0%–20%); however, patients with >50% of tumor cells expressing IDO1 had significantly worse overall survival (hazard ratio [HR] 4.7, p = .007) as well as higher local recurrence (HR 8.6, p = .0005) and distant metastasis (HR 12.7, p = .0002). Tumors with >50% IDO1 were also more likely to have the lowest quartile of CD8 infiltrate (<40 per high‐power field, p = .024).Conclusion.ASCC has a diverse immune milieu. Although patients generally do well with standard therapy, IDO1 may serve as a prognostic indicator of poor outcome and could help identify a patient population that might benefit from IDO‐targeted therapies.Implications for Practice.After definitive chemoradiation, patients with locally advanced anal cancer may experience significant treatment morbidity and high risk of recurrence. The goal of the current study is to identify novel prognostic factors in the tumor‐immune microenvironment that predict for poor outcomes after definitive chemoradiation. This study characterizes the tumor‐immune microenvironment in pre‐treatment, localized anal squamous cell carcinoma (ASCC), including two markers which have not previously been studied in ASCC: indoleamine 2,3 dioxygenase 1 (IDO1) and HLA class I. With a median follow‐up of 3 years, this study demonstrated that high IDO1 expression is correlated with significantly worse 3‐year overall survival (88% vs. 25%). Whereas recent studies of IDO1 inhibitors have shown mixed results, this study suggests that patients with anal cancer with high IDO1 expression have dismal prognosis and may represent a patient population primed for response to targeted IDO1 inhibition.

http://bit.ly/2E73TP3

STEP as a Useful Tool to Screen for Diabetes-Specific Health-Related Problems in Community-Based Geriatric Patients- An Exploratory Secondary Analysis of Cross-Sectional Data

07-2018-0310-dia_10-1055-a-0803-0362-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0803-0362

Background and Aims Comprehensive geriatric assessments are established tools for the identification of health problems in the elderly. So far, little is known about tailoring and targeting to facilitate their application. As a starting point for a tailored assessment of patients with diabetes, a highly prevalent health condition, we aimed to assess if the Standardized Assessment of Elderly People (STEP) is able to identify relevant differences in self-reported health problems between diabetic and non-diabetic patients. Patients and Methods We performed a secondary analysis of a cross-sectional study including 1007 adults (aged 65 and older) from 28 German general practices, evaluating the feasibility and usefulness of the self-administered STEP version. For this exploratory study we re-analysed the data and compared patients with and without diabetes. Results Out of 940 patients included in the secondary analysis, 248 (26.4%) had diabetes. Compared to non-diabetic patients, geriatric diabetic patients reported more often problems in activities of daily living, physical problems typically associated with diabetes such as urinary incontinence, visual impairment, mood disturbances, as well as the use of medical or social services. Most of our results were stable after adjusting for age, sex and body mass index. Conclusion We conclude that the self-administered version of the STEP tool may be used to screen for health problems typically associated with diabetes. Our results may guide the development of a tailored STEP-version specifically for diabetic patients. Further research might evaluate the adoption and usefulness of such a tool in every-day general practice.
[...]

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

http://bit.ly/2WTR561

Association of the PNPLA2, SCD1 and Leptin Expression with Fat Distribution in Liver and Adipose Tissue From Obese Subjects

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0829-6324

The expansion of adipose tissue is regulated by insulin and leptin through SREBP-1c, up-regulating lipogenesis in tissues by SCD1 enzyme, while ATGL enzyme is key in lipolysis. The research objective was to evaluate the expression of SREBF1, SCD1, PNPLA2, and LEP genes in hepatic-adipose tissue, and related them with the increment and distribution of fat depots of individuals without insulin resistance. Thirty-eight subjects undergoing elective cholecystectomy with liver and adipose tissue biopsies (subcutaneous-omental) are included. Tissue gene expression was assessed by qPCR and biochemical parameters determined. Individuals are classified according to the body mass index, classified as lean (control group, n=12), overweight (n=11) and obesity (n=15). Abdominal adiposity was determined by anthropometric and histopathological study of the liver. Increased SCD1 expression in omental adipose tissue (p=0.005) and PNPLA2 in liver (p=0.01) were found in the obesity group. PNPLA2 decreased expression in subcutaneous adipose tissue was significant in individuals with abdominal adiposity (p=0.017). Anthropometric parameters positively correlated with liver PNPLA2 and the expression of liver PNPLA2 with serum leptin. SCD1 increased levels may represent lipid storage activity in omental adipose tissue. Liver PNPLA2 increased expression could function as a primary compensatory event of visceral fat deposits associated to the leptin hormone related to the increase of adipose tissue.
[...]

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

http://bit.ly/2RYNWOu

Trends in hospitalizations related to anaphylaxis, angioedema and urticaria in the United States

Allergic disorders are a common clinical disorders with high rates of health care usage.1 Studies from developed countries have suggested an increasing prevalence of allergic diseases. 2–4 However, the data on the epidemiology of anaphylaxis, angioedema and urticaria are limited, with only small cohort studies available. 1,4 Recent studies from the United Kingdom (UK) and Australia have noted marked increase in hospitalizations related to urticaria, angioedema and anaphylaxis.1,4 Epidemiological study and incidence data of these conditions, however, depend on several factors, including diagnostic criteria used, variation in patient surveys, disease incidence in the general population and also diagnostic awareness among physicians.

http://bit.ly/2E6vcc9

Does angioedema influence the quality of life in chronic spontaneous urticaria patients?

Chronic spontaneous urticaria (CSU) symptoms are wheals in a number of cases accompanied by recurrent angioedema. The proportion of CSU patients manifesting both wheals and angioedema and those reporting only one type of symptoms is different - a similar number of patients experience both symptoms or wheals only, whereas 1–13% experience angioedema only1,2. Symptoms of CSU have a detrimental influence on patients' quality of life. Additionally, the coexistence between angioedema symptoms and wheals is related to prolonged disease duration2.

http://bit.ly/2UTwooX

Phytoremediatory efficiency of Chrysopogon zizanioides in the treatment of landfill leachate: a case study

Abstract

A common approach for waste management is their disposal in landfills, which is usually associated with the production of dangerous gases and of liquid leachate. Due to its toxicity, polluted liquid negatively impacts on the environment with the possible contamination of large volumes of soil, groundwater, and surface water. Leachate remediation is therefore subject of intensive research, and phytoremediation has been achieving increasing interest in recent decades. We describe here the suitability of vetiver grass for the remediation of two leachates collected in urban landfills of northern Italy, characterized by different composition. Our objective was measuring the accumulation/tolerance potential of this species and the evapotranspiration ability in a pot experiment, to evaluate applicability of vetiver plants for the reduction and decontamination of landfill leachate. Plants were grown for 4 months in pots with a zeolite growth bed and watered with either tap water (control) or undiluted landfill leachate. Plant growth and fitness and elemental content in shoots and roots were evaluated at the end of the experiment. In these experimental conditions, the high bioaccumulation of metals highlights the suitability of this species for its employment in phytoremediation; however, vetiver growth under leachate treatment was strongly dependent on leachate composition, making a case-to-case evaluation of plant tolerance necessary before large-scale application.

http://bit.ly/2RY7Zwm

“We don’t really know what else we can do”: Parent experiences when adolescent distress persists after the Maudsley and family-based therapies for anorexia nervosa

Abstract

Background

Maudsley Family Therapy (MFT), and its manualised version, Family-Based Therapy (FBT), are the only well-established treatment interventions for adolescent anorexia nervosa (AN), with treatment efficacy primarily measured by improvements in eating behaviours and weight restoration. A crucial component of this therapy is an intensive home-based refeeding intervention that requires a substantial commitment from parents for up to one year. While this treatment works to restore weight in a proportion of adolescents, very little is known about its impacts on family distress, relationships and identity, including in the 40% of families where the adolescent experiences ongoing eating disorder (ED) symptomatology and/or psychological distress during and post-treatment. Specifically, few studies have investigated the impacts of MFT/FBT treatment on family functioning or on how parents negotiate their identities, or who they understand themselves to be, in the context of this treatment intervention. This is a significant omission, given the substantive role assigned to parents to take responsibility for their child's eating restoration in the first treatment phase. This study seeks to address this gap through a qualitative exploration of parents' experiences of MFT/FBT, in cases where treatment was discontinued and/or their child continued to experience psychological distress post-treatment.

Methods

13 parents participated in in-depth semi-structured interviews that scaffolded between their experiences and ways they negotiated and sustained their identities as parents within the context of MFT/FBT for their child. Interview data was analysed through a framework of critical discursive analysis to generate themes centred on these parents' experiences and identity negotiation.

Results

Key findings are that MFT/FBT: (1) provided a map for therapy that initially relieved parents' anxieties for their child and facilitated improvements in family functioning; (2) inadequately addressed parental guilt and blame with a form of externalisation of the illness; (3) perpetuated parental guilt by raising anxiety about AN and allocating responsibility for refeeding their child in phase 1 of the treatment; and (4) when ceased, left these parents struggling with an uncertain future, and fears for the wellbeing of their children.

Conclusions

The structure of MFT/FBT provided initial relief with some improvements in family communication patterns, however, when the adolescent experienced protracted ED symptoms and/or ongoing psychological distress post-treatment, these parents were left with uncertainty as to how to navigate their shifting roles and their child's ongoing struggles. This research highlights the need for treatments for adolescent AN that more comprehensively address both the adolescent and parents' psychological distress and also (re)build their senses of identity that have been challenged by AN and its effects.

http://bit.ly/2GCOc3Q

Different surface modifications combined with universal adhesives: the impact on the bonding properties of zirconia to composite resin cement

Abstract

Objective

The purpose of this study was to analyze the impact of plasma treatment and (universal adhesives) UAs on the bonding properties of zirconia.

Material and methods

Zirconia specimens (N = 744; n = 186/pretreatment) were prepared, highly polished, and pretreated: (i) plasma (oxygen plasma, 10s, 5 mm), (ii) airborne-particle abrasion (alumina, 50 μm, 0.05 MPa, 5 s, 10 mm), (iii) airborne-particle abrasion + plasma, and (iv) without pretreatment (highly polished surface). Surface roughness (R_a) and surface free energy (SFE) were measured (n = 6/pretreatment). Tensile bond strength (TBS) specimens (n = 180/pretreatment) were further divided (n = 18/conditioning): Clearfil Ceramic Primer (PCG), All-Bond Universal (ABU), Adhese Universal (AU), Clearfil Universal Bond (CUB), G-Premio Bond (GPB), Futurabond U (FBU), iBond Universal (IBU), One Coat 7 Universal (OCU), Scotchbond Universal (SBU), and no conditioning. PCG was luted with Panavia F2.0 and the remaining groups with DuoCem. After storage in distilled water (24 h; 37 °C) and thermocycling (5000×; 5 °C/55 °C), TBS was measured and fracture types (FTs) were determined. Data were analyzed using univariate ANOVA with a partial eta square (ƞ_P²), the Kruskal–Wallis H, the Mann–Whitney U, and the Chi² test (P < .05).

Results

Plasma treatment resulted in an increase of SFE but had no impact on R_a. Airborne-particle abrasion resulted in the highest R_a and a higher TBS when compared with plasma and non-treatment. SBU and AU obtained a higher TBS when compared with PCG. OCU, FBU, ABU, IBU, and GPB indicated comparable TBS to PCG. CUB revealed the lowest TBS.

Conclusions

Plasma treatment cannot substitute airborne-particle abrasion when bonding zirconia but MDP-containing adhesives are essential for successful clinical outcomes.

Clinical relevance

Airborne-particle abrasion with a low pressure (0.05 MPa) in combination with UAs promotes the clinical success of adhesively bonded zirconia restorations.

http://bit.ly/2SOhC5m

Szent-Györgyi Prize to honor NCI’s Steven A. Rosenberg

steven-rosenberg-article.__v30078920.jpg

The 2019 Szent-Györgyi Prize for Progress in Cancer Research will be awarded to NCI's Steven A. Rosenberg, M.D., Ph.D., for his pioneering role in the development of immunotherapy.

http://bit.ly/2TNMHU4

Non Familial Cherubism: A Case Report

Abstract

Cherubism might occur in solitary cases or in several members of the family, often in many generations. Treatment depends on the clinical course of the disease. The reported case is an example of solitary sporadic occurrence within a family, which is a less documented condition in the literature.

http://bit.ly/2N0BFIs

Safety of outpatient admission and comparison of different surgical techniques in adult tonsillectomy

Abstract

Purpose

To investigate the safety of outpatient admission and the effects of surgical technique in tonsillectomy operations of adult patients.

Methods

The digital database was scanned for patients aged ≥ 15 years that underwent tonsillectomy in our institution between years 2014 and 2018. Demographic and clinical characteristics, the surgical technique, length of stay (LOS) in hospital, re-admissions after discharge, complications and interventions performed were recorded.

Results

A total of 276 patients met the inclusion criteria, comprising 139 (50.4%) females and 137 (49.6%) males with a mean age of 27.17 ± 9.41 years. The most common indication was recurrent tonsillitis (n = 223, 80.8%), and surgical techniques used were bipolar scissors (CURIS^®, Sutter Medizintechnik, Germany) (n = 137, 49.6%), cold dissection (n = 75, 27.2%) and/or plasma blade (PEAK Surgical, Medtronic, USA) (n = 64, 23.2%). A total of 43 (15.5%) re-admissions from 37 (13.4%) patients were recorded because of bleeding (n = 33, 70.2%) and/or odynodysphagia (n = 13, 27.7%). Non-surgical interventions were sufficient in 32 (74.4%) cases, while surgical interventions were required in 11 (25.6%) patients. In patients where "hot" techniques (bipolar scissors, plasma blade) were used and in patients with complaints in the first 24 h postoperatively, significantly increased rates of elongated LOS values for more than 1 day were determined (p < 0.01, p < 0.001).

Conclusions

Adult tonsillectomy is a safe surgical procedure with low complication, re-operation and mortality rates. Significantly increased rates of elongated LOS values for more than 1 day and re-admissions after discharge were determined in those patients having complications in the first 24 h postoperatively. Cold dissection seems to be more advisable than hot techniques for outpatient tonsillectomy among adult patients.

http://bit.ly/2BrR687

Non Familial Cherubism: A Case Report

Abstract

http://bit.ly/2N0BFIs

Development of an Experimental System “Computer-Aided Diagnosis in Neurotology (CADINO)” for Vertigo

Abstract

Computer-based medical diagnosis expert systems, when used by clinicians, familiar with the limitations of the system, were found both accurate and educationally helpful. Vertigo is one of the most common complaints of the patients and the specialists who manage these patients are not easily available. Diagnostic expert system can help clinicians including general practitioners in providing reasonable diagnostic suggestions while dealing with patients with vertigo/dizziness when the specialist doctors are not available. To provide an understanding about the method of making an expert system "Computer-Aided Diagnosis in Neurotology (CADINO)" for dizzy patients and highlight its potential uses. CADINO, developed during this original research project, is an expert computer program which is capable of making diagnoses in patients with vertigo. CADINO includes more than 100 causes of vertigo. It was developed in Microsoft Office using hyperlinks. CADINO has the potential of making diagnoses in patients with vertigo. It differs from most other programs for computer-assisted diagnosis in the generality of its approach and knowledge base. Specific deficiencies of CADINO include its inability to explain its thinking. CADINO can broaden the clinicians' scope and awareness regarding the findings which are important for making the differential diagnoses in patients with vertigo/dizziness. Though the CADINO on its face value seems to improve patient safety and quality of care by enhancing knowledge and cognitive skills of the clinicians, yet it remains a research tool and will need clinical evaluation in terms of diagnostic accuracy.

http://bit.ly/2TKQEsK

Roles of Ki-67 and p16 as biomarkers for unknown primary head and neck squamous cell carcinoma

Abstract

Purpose

Treatment guidelines have not been established for unknown primary head and neck squamous cell carcinoma (SCC). For these patients, chemoradiotherapy (CRT) can provide a better prognosis than that for patients with other head and neck cancers. The presence of HPV in the tumor is associated with a better outcome. However, not all patients with HPV-positive unknown primary head and neck SCC experience good treatment outcomes in actual clinical settings.

Methods

We thus retrospectively determined the Ki-67 proliferation index and p16 expression status to assess the associations of these parameters with treatment outcomes of patients with unknown primary head and neck SCC.

Results

The subjects were 13 patients who underwent CRT after surgery or excision biopsy between 1999 and 2016. The 2- and 5-year overall survival (OS) rate was 76.9% and 68.4%, respectively. The prognostic factor was age. There was no significant difference in survival between patients with a high Ki-67 vs. low Ki-67 or between patients with p16-positive vs. p16-negative metastases OS. However, all p16-positive patients with low Ki-67 showed good locoregional control.

Conclusions

The combination of ki67 expression and p16 expression status may allow prediction of local control more accurately than p16 expression status alone.

http://bit.ly/2TM1Bdl

Effects of azathioprine and its metabolites on inflammatory cytokines in human nasal polyp organ cultures

Background

Oral steroids are recommended for the treatment of nasal polyps (NPs), but prolonged use is avoided because of side effects. Topical steroids can also control NPs without significant complications; however, the response to this is partially successful, and additional therapies are needed to treat glucocorticoid‐resistant NPs. Azathioprine (AZA) and its first metabolite 6‐mercaptopurine (6‐MP) are important immunosuppressants used for the therapy of various diseases. The aim of this study was to investigate the effects of AZA and 6‐MP on inflammatory cytokines in organ‐cultured NPs.

Methods

NP explants were cultured using an air‐liquid interface method. Cultures were maintained in the absence and presence of steroid, AZA, and 6‐MP for 72 hours. Elaboration of cytokines tumor necrosis factor alpha (TNF‐α), interleukin (IL)‐2, IL‐4, IL‐5, and IL‐13 into the supernatant was quantitated using the enzyme‐linked immunosorbent assay (ELISA). The messenger RNA (mRNA) expression levels of TNF‐α, IL‐2, IL‐4, IL‐5, and IL‐13 in cultured mucosa were measured using real‐time polymerase chain reaction. Hematoxylin and eosin staining of cultured mucosa was performed to observe inflammatory cells. Immunohistochemistry was done to evaluate the distribution pattern of inflammatory cytokines in NP explants.

Results

On histologic examination, less inflammatory cell infiltration was found in NPs treated by steroid, AZA, and 6‐MP than in control, but there was no statistical significance (p = 0.218). On immunohistochemistry, IL‐13 showed a steady falling tendency in submucosal glands by steroid, AZA, and 6‐MP. Expression of TNF‐α, IL‐2, IL‐4, IL‐5, and IL‐13 mRNA in the NPs treated by steroid, AZA, and 6‐MP were significantly lower than those of the control (p < 0.001 for all). By ELISA, IL‐2 and IL‐13 were significantly lower with topical steroid, AZA, and 6‐MP treatment (p = 0.012 and p < 0.001).

Conclusion

Topical AZT decreases inflammatory cytokines on human NP explants and this could have future therapeutic implications for NPs.

http://bit.ly/2Gqy99U

Effect of commercial nasal steroid preparation on bacterial growth

Background

Topical budesonide (Pulmicort; AstraZeneca AB, Sodertalje, Sweden) is commonly used in the management of chronic rhinosinusitis (CRS). Although its use is due to its perceived anti‐inflammatory effect, studies have suggested that it may also have antibacterial properties. To make the hydrophobic steroid molecule suitable for topical administration, pharmaceutical excipients are used in commercial steroid formulations. Herein we investigated the antibacterial action of commercial budesonide and its excipients.

Methods

Planktonic and biofilm forms of Staphylococcus aureus and methicillin‐resistant Staphylococcus aureus (MRSA) were treated with Pulmicort or its excipients at clinically relevant concentrations. Bacterial growth was determined by optical density, resazurin assays, colony‐forming unit counts, and Giemsa staining. Minimum inhibitory concentration (MIC) studies assessed excipients' potentiation of antibiotics. Experiments were conducted in triplicate and results analyzed using one‐way analysis of variance.

Results

There was significant reduction in planktonic and biofilm growth of S aureus and MRSA on exposure to budesonide (p < 0.0001) and its excipients (p < 0.0001). Excipient ethylene diamine‐tetraactic acid (EDTA) demonstrated an antibacterial property even at the low concentrations used in topical preparations (p < 0.0001). With amoxicillin, excipients exhibited a potential additive/synergistic effect on MIC, whereas erythromycin and aminoglycosides showed an antagonistic action.

Conclusion

The commercial product Pulmicort has a direct antibacterial effect on the planktonic and biofilm forms of S aureus and MRSA. This effect is at least in part mediated through the excipient EDTA in the product. Excipients also influenced the antimicrobial activity of antibiotics depending on the bacterial strain and antibiotic tested.

http://bit.ly/2Im2jx1

Ein 7‑jähriger Junge mit leicht juckenden, weißlichen, stecknadelkopfgroßen Papeln

http://bit.ly/2IhG5MC

HPV as a marker for molecular characterization in head and neck oncology: Looking for a standardization of clinical use and of detection method(s) in clinical practice

Abstract

Background

A consensus about the most appropriate diagnostic method(s) for head and neck human papillomavirus (HPV)‐induced carcinogenesis is still lacking because most of the commercially available assays have been designed for the cervix.

Methods

This article summarizes current data and trends concerning HPV diagnostic strategies in oropharyngeal squamous cell carcinoma (OPSCC). Six main approaches are described.

Results

The diagnostic gold standard for HPV‐related OPSCC, focusing on E6/E7 mRNA detection, requires fresh samples. Because most frequently available samples are formalin‐fixed paraffin‐embedded (FFPE), the pros and cons of the different approaches were analyzed.

Conclusions

In the FFPE samples, the immunohistochemistry of p16, which is considered appropriate to assess HPV‐driven carcinogenesis in OPSCC according to the 8th American Joint Committee on Cancer TNM classification, may not be specific enough to become the diagnostic standard in the perspective of treatment deintensification. p16 may play a safer role in combination with another highly sensible assay. Other promising approaches are based on DNA detection through real‐time polymerase chain reaction and RNAscope.

http://bit.ly/2GFdCxO

Development of an Experimental System “Computer-Aided Diagnosis in Neurotology (CADINO)” for Vertigo

Abstract

http://bit.ly/2TKQEsK

Feasibility and Tolerance of Nivolumab Neoadjuvant Immunotherapy in High Risk HPV Driven Oropharynx Cancer

Condition: Oropharynx Cancer
Interventions: Drug: Nivolumab; Radiation: Chemoradiation
Sponsor: UNICANCER
Not yet recruiting

http://bit.ly/2Ia764e

Ponatinib in Advanced or Metastatic Medullary Thyroid Cancer

Condition: Medullary Thyroid Cancer
Intervention: Drug: Ponatinib
Sponsors: Antonio Fojo; Millennium Pharmaceuticals, Inc.
Not yet recruiting

http://bit.ly/2Ia7foi

Radiotherapy Plus Concurrent Nimotuzumab or Cisplatin in Stage II-III Nasopharyngeal Carcinoma

Conditions: Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharyngeal Diseases; Head and Neck Neoplasm
Interventions: Drug: Nimotuzumab; Drug: Cisplatin
Sponsors: Sun Yat-sen University; Affiliated Cancer Hospital & Institute of Guangzhou Medical University; Guangdong General Hospital; First Affiliated Hospital, Sun Yat-Sen University
Recruiting

http://bit.ly/2Go1ge2

Role of Microbiome as a Biomarkers in Locoregionally-Advanced Oropharyngeal Squamous Cell Carcinoma 2

Condition: Head and Neck Squamous Cell Carcinoma
Intervention: Drug: MET-4
Sponsors: University Health Network, Toronto; NuBiyota
Not yet recruiting

http://bit.ly/2GpiFTq

A Single Dry Needling Session of the Obliquus Capitis Inferior for the Altered Sensorimotor Function in People With Neck Pain

Conditions: Whiplash Syndrome; Neck Pain
Interventions: Other: dry needling; Other: Sham needling
Sponsor: University of Valencia
Recruiting

http://bit.ly/2Ia6XxI

Ponatinib in Advanced or Metastatic Medullary Thyroid Cancer

Condition: Medullary Thyroid Cancer
Intervention: Drug: Ponatinib
Sponsors: Antonio Fojo; Millennium Pharmaceuticals, Inc.
Not yet recruiting

http://bit.ly/2Ia7foi

Radiotherapy Plus Concurrent Nimotuzumab or Cisplatin in Stage II-III Nasopharyngeal Carcinoma

Feasibility and Tolerance of Nivolumab Neoadjuvant Immunotherapy in High Risk HPV Driven Oropharynx Cancer

Condition: Oropharynx Cancer
Interventions: Drug: Nivolumab; Radiation: Chemoradiation
Sponsor: UNICANCER
Not yet recruiting

http://bit.ly/2Ia764e

Role of Microbiome as a Biomarkers in Locoregionally-Advanced Oropharyngeal Squamous Cell Carcinoma 2

Condition: Head and Neck Squamous Cell Carcinoma
Intervention: Drug: MET-4
Sponsors: University Health Network, Toronto; NuBiyota
Not yet recruiting

http://bit.ly/2GpiFTq

A Single Dry Needling Session of the Obliquus Capitis Inferior for the Altered Sensorimotor Function in People With Neck Pain

Conditions: Whiplash Syndrome; Neck Pain
Interventions: Other: dry needling; Other: Sham needling
Sponsor: University of Valencia
Recruiting

http://bit.ly/2Ia6XxI

Radikale Prostatektomie beim lokal fortgeschrittenen und metastasierten Prostatakarzinom

Zusammenfassung

Hintergrund

Der Anteil der Patienten mit lokal fortgeschrittenem oder (oligo)metastasiertem Prostatakarzinom (PCa) hat in den letzten Jahren zugenommen. Im Vergleich zu Patienten mit lokalisiertem PCa ist ohne eine Lokaltherapie das Risiko lokaler Komplikationen höher und die onkologischen Ergebnisse schlechter.

Ziel

Der Stellenwert der radikalen Prostatektomie (RP) bei klinisch lokal fortgeschrittenem oder metastasiertem Prostatakarzinom wird erörtert.

Material und Methoden

Es erfolgten eine systematische Literaturrecherche und Zusammenstellung relevanter Artikel aus PubMed und Medline.

Ergebnisse

Aktuelle Leitlinien empfehlen die RP als eine der Behandlungsoptionen bei Patienten mit lokal fortgeschrittenem PCa. Die Durchführung einer RP bei Patienten mit metastasiertem PCa hingegen sollte nur innerhalb klinischer Studien durchgeführt werden. Im Vergleich zu Patienten ohne eine lokale Behandlung verringert die RP das Risiko lokaler Komplikationen deutlich. Während beim lokal fortgeschrittenen PCa ein klarer onkologischer Nutzen für die RP gezeigt werden konnte, ist der Nutzen bei Patienten mit metastasierten Erkrankungen immer noch umstritten. Aufgrund schwierigerer Operationsbedingungen und einer erhöhten Wahrscheinlichkeit für ein multimodales Therapiekonzept werden in der Literatur eine höhere perioperative Morbidität und schlechtere funktionelle Ergebnisse im Vergleich zu Patienten mit lokalisiertem PCa berichtet.

Schlussfolgerung

Während die RP für Patienten mit lokal fortgeschrittenem PCa genauso wie im lokalisierten Stadium durchgeführt werden kann, muss der Nutzen bei Vorliegen einer metastasierten Erkrankung weiter geklärt werden. Alle Patienten, die sich einer RP unterziehen, müssen besonders im Hinblick auf das mögliche schlechtere funktionelle Ergebnis beraten werden.

http://bit.ly/2GnCxXh

Estimating the spatial distribution of environmental suitability for female lung cancer mortality in China based on a novel statistical method

Abstract

Lung cancer as one of the major causes of cancer mortality has been demonstrated to be closely related to the ambient atmospheric environment, but little has been done in the synthetic evaluation of the linkage between cancer mortality and combined impact of ambient air pollution and meteorological conditions. The present study determined the environmental suitability for female lung cancer mortality associated with air contaminants and meteorological variables. A novel fuzzy matter–element method was applied to identify the spatial distribution and regions for the environmental suitability for the female lung cancer mortality across China in 2013. The membership functions between the cancer mortality and 6 environmental factors, including PM_2.5, NO₂, SO₂, PM₁₀, the annual mean wind speed, and mean temperature, were generated and the weights of each of the environmental factors were established by the maximum entropy (MaxEnt) model. We categorized the environmental suitability combined with GIS spatial analysis into three zones, including low-suitable, medium-suitable, and high-suitable region where the cancer mortality ranging from low to high rate was identified. These three zones were quantified by the MaxEnt model taking different air pollutants and meteorological variables into consideration. We identified that NO₂ was a most significant factor among the 6 environmental factors with the weight of 24.88%, followed by the annual mean wind speed, SO₂, and PM_2.5. The high-suitable area, mainly in the North China Plain which is a most heavily contaminated region by air pollution in China, covers 1.6195 million square kilometers, accounting for 17.85% of the total area investigated in this study. Identification of the impact of various environmental factors on cancer mortality in the different suitable area provides a scientific basis for the environmental management, risk assessment, and lung cancer control.

http://bit.ly/2GE8N7D

Spatial variation of heavy metals and uptake potential by Typha domingensis in a tropical reservoir in the midlands region, Zimbabwe

Abstract

Pollution of aquatic ecosystems with heavy metals is now of global concern due to their dangers to human health and persistence in the environment. An investigation on the spatial distribution of heavy metals in water and sediments and the bioaccumulation potential of heavy metals by plant parts (i.e. roots, stems and leaves) of aquatic macrophyte Typha domingensis (Pers.) Steud in a tropical reservoir was carried out. The results showed no difference in spatial distribution of heavy metals (Fe, Cu, Cd, Cr, Pb, Zn, Mn) in water and sediments from the riverine to the dam wall. The concentration of heavy metals Fe, Cu, Cr and Zn in T. domingensis was of the order root > stem > leaves, but for Pb, Cd and Mn, it followed the order root > leaf > stem. The metal transfer between roots and shoots of T. domingensis followed the order Zn > Pb > Fe > Cu > Cd > Cr. The bio-concentration factor (BCF) was low (BCF < 1) for all the selected metals while the transfer factor (TF) varied among metals suggesting that T. domingensis is not an accumulator of the studied metals. The high concentration of heavy metals found in the water (0.7–16.14 mg L⁻¹) and sediments (43.6–569.18 mg kg⁻¹) present a potential risk to both ecological health and human health for the population living in the area. The results of metal concentration in water and sediments from this study are important as a baseline for future monitoring studies. Further studies on bioavailability of metals to other macrophytes and aquatic organisms are recommended.

http://bit.ly/2titH4v

Gastrointestinal stromal tumor of the lesser omentum: a case report and review of the literature

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Abstract

A 72-year-old woman visited our hospital for a routine health examination and underwent abdominal ultrasonography, which revealed an intra-abdominal tumor. Abdominal computed tomography and magnetic resonance imaging showed a well-defined solid mass of ~3 cm in diameter lying adjacent to the stomach. The mass was preoperatively diagnosed as gastrointestinal stromal tumor of the stomach. At laparotomy, a well-encapsulated tumor was found in the lesser omentum. It was slightly adherent to the stomach wall but was removed without difficulty. Therefore, only enucleation of the tumor was performed. The excised tumor, which was 35 × 30 × 25 mm³ in size, had a white cut surface without necrosis or hemorrhage. According to the pathological findings, the tumor was classified as a very low-risk gastrointestinal stromal tumor originating in the lesser omentum. Gastrointestinal stromal tumor of the lesser omentum is very rare, and surgical resection is the only effective treatment modality.

http://bit.ly/2GoeDdY

Perforation of Heterotopic Gastric Mucosa in ileal duplication in an adult: A case report

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Abstract

Bowel duplication with heterotopic gastric mucosa (HGM) is a known but uncommon pathology. It usually presents with intussusception or melena in the early years of life. We present a case of ileal duplication with HGM with a rare presentation of bowel perforation and peritonitis in an adult male.

http://bit.ly/2IhvPE6

Massive adult cystic lymphangioma of the breast

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Abstract

Adult cystic lymphangiomas are exceedingly rare tumors resulting from malformation of the lymphatic vessels. Like their pediatric counterparts, these lesions almost exclusively involve the head and neck. However, adult cystic lymphangiomas have been reported in several organs. Those involving the breast are exceptionally rare, with only a few reported instances. Here, we present the case of a 27-year-old woman who attended a surgical breast clinic with a 2-year history of a large, disfiguring left breast mass. Pathology was consistent with adult cystic lymphangioma of the breast. Measuring 21.0 × 20.0 × 6.0 cm³, this represents the second largest of its kind and the largest reported case in an African American patient.

http://bit.ly/2GmoZeG

Approach to a large rare diaphragmatic hernia in a patient undergoing cardiac surgery

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Abstract

Hernia of Morgagni is an unusual congenital defect of the sternal portion of the diaphragm. Its concurrence with cardiac surgical pathology is rarely described in the literature. Notwithstanding, huge hernia of Morgagni have been noted to cause serious peri-operative impediment and complications. We report the case of a 50-year-old gentleman with a massive Morgagni hernia that threatened strangulation during cardiopulmonary bypass. We describe the combined surgical approach undertaken to repair this hernia, with an accompanying review of the literature relating to misadventure and management of similar large hernia coinciding with cardiac surgery.

http://bit.ly/2I9NSvM

Recurrent acute pancreatitis in a patient with both gallbladder and cystic duct agenesis and polycystic liver disease

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Abstract

Agenesis of the gallbladder and cystic duct is a rare congenital anomaly occurring in <0.1% of the population. However, combined gallbladder and cystic duct agenesis (CDA) with polycystic liver disease associated with recurrent acute pancreatitis (RAP) has not been reported earlier. Herein we report a case of a 36-year-old female patient who was admitted to the hospital and successfully treated for acute pancreatitis most probably caused in the background of gallbladder and CDA with polycystic liver disease. In case of non-visualization of gallbladder with the presence of biliary symptoms after repeated ultrasonographic examinations, advanced techniques like MRCP, computed tomography, EUS and even endoscopic retrograde cholangiopancreatography (ERCP) to visualize biliary anatomy must be conducted before any surgical intervention. We present a case of gallbladder and CDA causing RAP by the formation of microlithiasis treated successfully with ERCP and without any unnecessary surgery, its management and review of the literature is assessed.

http://bit.ly/2GkWNsx

Spontaneous regression of a sporadic intra-abdominal located desmoid-type fibromatosis

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Abstract

Background

Desmoid-type fibromatosis (DTF) is a rare benign proliferation of myofibroblasts with an unpredictable disease course. Treatment of intra-abdominal located DTF is difficult because of the close relationship with vital organs.

Case presentation

A healthy young male presents with an asymptomatic palpable mass in the lower right abdominal quadrant. A computed tomography shows a 10 × 7 cm² pear-shaped mass, and pathological examination revealed DTF. A watchful waiting approach was initiated, as the patient was asymptomatic and surgery would imply a significant amount of intestinal resection. After a follow-up of 2 years, the tumor has regressed spontaneously and the patient is still without symptoms.

Conclusions

DTF is a difficult to treat condition where individualized management is appropriate. An asymptomatic patient could be treated with a watchful waiting approach, even with intra-abdominal location. Thereby sparing unnecessary morbidity as the tumor can be stable for many years or even regress spontaneously.

http://bit.ly/2I8Ge4M

Ionomic profile and arsenic speciation in Semisulcospira cancellata , a freshwater shellfish from a mine-impacted river in China

Abstract

Freshwater aquatic environment close to cities and industrial areas is more sensitive than marine environment. The freshwater shellfish Semisulcospira cancellate was introduced as a bioindicator to monitor the heavy metal contamination in the river through ionomic profiles and arsenic speciation. The shellfish samples were collected near four cities along the Xiang River in China. The concentrations of elements including Mg, Al, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, Ga, As, Sr, Cd, Sn, Sb, Ba, and Pb were determined using ICP-MS. Multivariate statistical analyses such as Pearson's correlation analysis and principle component analysis (PCA) were employed to identify the possible sources of the elements in the shellfish samples. Three principle components were extracted from the ionomic matrix and were associated with natural existence, biological pathways, and mining and smelting activities, respectively. The ionomic profiles of the shellfish samples were evaluated through hierarchical cluster analysis (HCA) which was exhibited in the form of heatmap. The shellfish samples were categorized according to the sampling sites with different contamination levels. Six As species including arsenite [As(III)], arsenate [As(V)], monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), arsenobetaine (AsB), and arsenocholine (AsC) were separated and quantified using HPLC-ICP-MS. The concentrations of As(III) and As(V) were linearly increased with total As concentration increasing. However, the proportion of AsB was decreased with total As while the AsB concentration was irrelevant to total As.

http://bit.ly/2MZhYkr

Characterizations and mechanisms for synthesis of chitosan-coated Na–X zeolite from fly ash and As(V) adsorption study

Abstract

Solid waste fly ash with low aluminum of Yunnan Province in China was used as pristine material to prepared chitosan-coated Na–X zeolite, and the obtained composite material was employed as As(V) adsorbent. Then, the prepared materials were characterized by XRD, FT-IR, and XPS. And the results suggested that the low aluminum fly ash was successfully convert into Na–X zeolite, and the mineralization between Si–OH of the obtained Na–X zeolite and C–OH of chitosan was the dominated mechanism for coated chitosan over the surface of Na–X zeolite. From the batch experiments of As(V) removal, it has been found that the coated chitosan could significantly improve As(V) performance of Na–X zeolite. The optimal working pH for removal As(V) by chitosan-coated Na–X zeolite was attained at pH 2.1 ± 0.1, and the maximum adsorption capacity was 63.23 mg/g. And the adsorption data at different interval time was excellent fitted by pseudo-second-order kinetic model. From the analyze of XPS, the results suggested that As(V) uptake over adsorbent by the bond of As–N and As–O and the surface hydroxyl group of Al–OH and –NH₂ were involved in uptake As(V) from acid wastewater.

http://bit.ly/2SIQwwE

The impact of particulate matter on allergy risk among adults: integrated exposure assessment

Abstract

Exposure assessment is an important part in environmental epidemiology for determining the associations of environmental factors with health effects. One of the greatest challenges for personal exposure assessment is associated with peoples' mobility during the day and spatial and temporal dynamics of air pollution. In this study, the impact of PM₁₀ (particulate matter less than 10 μm) on allergy risk among adults was assessed using objective methods of exposure assessment. The primary objective of the present study was to estimate personal exposure to PM₁₀ based on individual daily movement patterns. Significant differences between the concentration of PM₁₀ in different microenvironments (MEs) and personal exposure to PM₁₀ were determined. Home exposure accounted for the largest part of PM₁₀ exposure. Thirty-five percent of PM₁₀ exposure was received in other non-home MEs. Allergy risk increased significantly with increasing exposure to PM₁₀. Adults exposed to the highest levels of PM₁₀ exposure had a twice-higher risk of allergies than adults exposed to the lowest levels of PM₁₀ exposure. The study results have practical relevance for exposure assessment to environmental factors and its impact on health effects.

http://bit.ly/2N2lIBE

Electro-transformation of mefenamic acid drug: a case study of kinetics, transformation products, and toxicity

Abstract

Poor removal of many pharmaceuticals and personal care products in sewage treatment plants leads to their discharge into the receiving waters, where they may cause negative effects for aquatic environment and organisms. In this study, electrochemical removal process has been used as alternative method for removal of mefenamic acid (MEF). For our knowledge, removal of MEF using electrochemical process has not been reported yet. Effects of initial concentration of mefenamic acid, sodium chloride (NaCl), and applied voltage were evaluated for improvement of the efficiency of electrochemical treatment process and to understand how much electric energy was consumed in this process. Removal percentage (R%) was ranged between 44 and 97%, depending on the operating parameters except for 0.1 g NaCl which was 9.1%. Consumption energy was 0.224 Wh/mg after 50 min at 2 mg/L of mefenamic acid, 0.5 g NaCl, and 5 V. High consumption energy (0.433 Wh/mg) was observed using high applied voltage of 7 V. Investigation and elucidation of the transformation products were provided by Bruker software dataAnalysis using liquid chromatography-time of flight mass spectrometry. Seven chlorinated and two non-chlorinated transformation products were investigated after 20 min of electrochemical treatment. However, all transformation products (TPs) were eliminated after 140 min. For the assessment of the toxicity, it was impacted by the formation of transformation products especially between 20 and 60 min then the inhibition percentage of E. coli bacteria was decreased after 80 min to be the lowest value.

http://bit.ly/2SIQtRu

Madurella mycetomatis infection of the buttock in an Eritrean refugee in Switzerland: a case report

Mycetoma is a neglected infectious disease caused by a fungus (eumycetoma) or bacteria (actinomycetoma); it is characterized by chronic local inflammation with sinus formation and purulent discharge. Its cours...

http://bit.ly/2GEeO4v

Factors of success of low‐dose macrolides in chronic sinusitis: Systematic review and meta‐analysis

Objective

To assess the prognostic factors that predict favorable outcomes of low‐dose macrolides (LDMs) in treating chronic rhinosinusitis (CRS).

Methods

Randomized controlled trials studying the effects of LDMs in treating CRS were included. Data were pooled for meta‐analysis. Primary outcome was Sino‐Nasal Outcome Test (SNOT). Six prognostic factors: CRS subtypes, serum immunoglobulin (Ig)E level, membered lactone ring of macrolides, concurrent endoscopic sinus surgery (ESS), and dosage and duration of the LDMs were assessed by subgroup analyses.

Results

Ten studies (608 patients) met the inclusion criteria. LDMs and placebo were not different in SNOT improvement (standardized mean difference [SMD] = −0.23, 95% confidence interval [CI]: −0.69 to 0.24). Subgroup analyses showed that the effects favored LDMs in the patients with CRS without polyps (SMD = −0.64, 95% CI: −1.01 to −0.27) compared to CRS with polyps, and the patients receiving a half dose (SMD = −0.64, 95% CI: −1.01 to −0.27) compared to a very low dose. There was no difference in SNOT improvement between LDMs plus standard treatment compared to standard treatment (SMD = −0.52, 95% CI: −1.57 to 0.53). Subgroup analyses showed that the effects favored LDMs in the patients receiving LDMs for a duration of 24 weeks (SMD = −1.68, 95% CI: −2.40 to −0.95) compared to 8 and 12 weeks. There was no difference between the 14‐membered and 15‐membered ring LDMs. Assessment of concurrent ESS found mixed results. Serum IgE level could not be assessed.

Conclusions

LDMs provided favorable outcomes in patients with CRS without polyps. A half dose of macrolides should be given for a duration of 24 weeks.

Level of Evidence

1a Laryngoscope, 2019

http://bit.ly/2Sq8YL3

In reference to pH‐neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury

http://bit.ly/2DumByC

Therapieoptionen des lokal begrenzten Prostatakarzinoms

Zusammenfassung

Etablierte Therapieoptionen des lokalisierten Prostatakarzinoms (T1–2N0M0 [T: Tumorgrad, N: Lymphknotenstatus, M: Metastasen]), welche aufgrund des üblicherweise langsamen Krankheitsverlaufs bei Patienten mit einer Lebenserwartung von mindestens 10 Jahren empfohlen werden, sind die aktive Überwachung, die radikale Prostatektomie, die Brachytherapie und die perkutane Bestrahlung. Die Wahl der Therapieform orientiert sich am Tumorstadium bzw. der Risikogruppe, den Komorbiditäten sowie der Patientenpräferenz. Neben dem onkologischen Ergebnis sind die potenziellen Nebenwirkungen der jeweiligen Lokaltherapie mit dem Betroffenen zu diskutieren, wobei insbesondere Einschränkungen der Harnkontinenz und Erektionsfähigkeit möglich sind.

http://bit.ly/2RVHQOT

Langzeitlebensqualität bei Patienten mit Kopf-Hals-Tumoren

Zusammenfassung

Hintergrund

Die Diagnose eines Kopf-Hals-Tumors geht zwar nicht mit einer vielversprechenden Langzeitprognose einher, aber je nach Art des Tumors überleben annähernd 50 % der Patienten wenigsten 5 Jahre. Es gibt nur wenige wissenschaftliche Belege für die Lebensqualität dieser Langzeitüberlebenden.

Methoden

In der Datenbank PubMed wurde eine Suche nach Artikeln durchgeführt, die Ergebnisse zur Lebensqualität für Patienten mit einem Kopf-Hals-Tumor und einem Überleben von mindestens 5 Jahren enthalten.

Ergebnisse

Dabei wurden 8 Studien aus verschiedenen Ländern gefunden, in denen 4 verschiedene Messinstrumente verwendet wurden. Die Ergebnisse zeigen, dass die Überlebenden vor allem Schwierigkeiten mit dem Schlafen, Schmerzen, Fatigue, Dyspnoe, Schlucken und Kauen haben; die funktionellen Werte waren manchmal niedriger (schlechter) als die Ergebnisse in der Allgemeinbevölkerung, in einem Fall aber auch gleich.

Schlussfolgerung

Weiterhin fehlt ein klares Bild über die Lebensqualität in dieser speziellen Patientengruppe. Es gibt wissenschaftliche Belege dafür, dass einige Patienten Schwierigkeiten mit dem Schlucken und einen trockenen Mund haben sowie Probleme mit dem Schlafen, Fatigue, Schmerzen und Dyspnoe. Eine Studie mit einer großen Stichprobe aus dieser speziellen Patientengruppe ist erforderlich.

http://bit.ly/2SLo8dd

Phase II clinical trial of adoptive cell therapy for patients with metastatic melanoma with autologous tumor-infiltrating lymphocytes and low-dose interleukin-2

Abstract

Adoptive cell therapy using autologous tumor-infiltrating lymphocytes (TIL) has shown significant clinical benefit, but is limited by toxicities due to a requirement for post-infusion interleukin-2 (IL-2), for which high dose is standard. To assess a modified TIL protocol using lower dose IL-2, we performed a single institution phase II protocol in unresectable, metastatic melanoma. The primary endpoint was response rate. Secondary endpoints were safety and assessment of immune correlates following TIL infusion. Twelve metastatic melanoma patients were treated with non-myeloablative lymphodepleting chemotherapy, TIL, and low-dose subcutaneous IL-2 (125,000 IU/kg/day, maximum 9–10 doses over 2 weeks). All but one patient had previously progressed after treatment with immune checkpoint inhibitors. No unexpected adverse events were observed, and patients received an average of 6.8 doses of IL-2. By RECIST v1.1, two patients experienced a partial response, one patient had an unconfirmed partial response, and six had stable disease. Biomarker assessment confirmed an increase in IL-15 levels following lymphodepleting chemotherapy as expected and a lack of peripheral regulatory T-cell expansion following protocol treatment. Interrogation of the TIL infusion product and monitoring of the peripheral blood following infusion suggested engraftment of TIL. In one responding patient, a population of T cells expressing a T-cell receptor Vβ chain that was dominant in the infusion product was present at a high percentage in peripheral blood more than 2 years after TIL infusion. This study shows that this protocol of low-dose IL-2 following adoptive cell transfer of TIL is feasible and clinically active. (ClinicalTrials.gov identifier NCT01883323.)

http://bit.ly/2RX8p6u

Metronomic cyclophosphamide attenuates mTOR-mediated expansion of regulatory T cells, but does not impact clinical outcome in patients with metastatic renal cell cancer treated with everolimus

Abstract

Introduction

Metastatic renal cell cancer (mRCC) patients have a median overall survival (mOS) of approximately 28 months. Until recently, mammalian target of rapamycin (mTOR) inhibition with everolimus was the standard second-line treatment regimen for mRCC patients, improving median progression-free survival (mPFS). Treatment with everolimus supports the expansion of immunosuppressive regulatory T cells (Tregs), which exert a negative effect on antitumor immune responses. In a phase 1 dose-escalation study, we have recently demonstrated that a low dose of 50 mg oral cyclophosphamide once daily can be safely combined with everolimus in mRCC patients and prevents the everolimus-induced increase in Tregs.

Materials and methods

In a multicenter phase 2 study, performed in patients with mRCC not amenable to or progressive on a vascular endothelial growth factor (VEGF)-receptor tyrosine kinase inhibitor (TKI) containing treatment regimen, we assessed whether the addition of this metronomic dosing schedule of cyclophosphamide to therapy with everolimus could result in an improvement of progression-free survival (PFS) after 4 months of treatment.

Results

Though results from this study confirmed that combination treatment effectively lowered circulating levels of Tregs, addition of cyclophosphamide did not improve the PFS rate at 4 months. For this reason, the study was abrogated at the predefined interim analysis.

Conclusion

Although the comprehensive immunomonitoring analysis performed in this study provides relevant information for the design of future immunotherapeutic approaches, the addition of metronomic cyclophosphamide to mRCC patients receiving everolimus cannot be recommended.

http://bit.ly/2WYr7yf

Editorial Board

Publication date: March 2019

Source: Molecular Immunology, Volume 107

Author(s):

http://bit.ly/2IbBzPw

Prostate cancer treated with irreversible electroporation: MRI-based volumetric analysis and oncological outcome

Publication date: Available online 12 February 2019

Source: Magnetic Resonance Imaging

Author(s): Francesco Giganti, Armando Stabile, Simone Giona, José Marenco, Clement Orczyk, Caroline M. Moore, Clare Allen, Alex Kirkham, Mark Emberton, Shonit Punwani

Abstract

Background

To assess multiparametric magnetic resonance imaging (mpMRI) characteristics in prostate cancer (PCa) before and after irreversible electroporation (IRE) and to investigate their correlation with the presence of post-operative recurrence of PCa.

Methods

MpMRI was performed in 30 men with PCa prior to treatment, after 10 days and at 6 months. An additional scan at 1 year was available for 18 men. Two radiologists assessed retrospectively the following parameters by planimetry: tumour volume, necrotic volume (early post-treatment scan) and residual fibrosis. Residual tumour/recurrence were defined as a suspicious area within the treatment field scored ≥ 4 on a 1-to-5 scale. Oncological outcome was also assessed.

Results

The median follow-up of the entire study was 16 months. Six men were undertreated and showed mpMRI recurrence after 6 months. At 1-year, three additional men had recurrence. Overall, four of these 9 men (44%) were retreated. The other five men did not receive any further treatment. Median time to re-treatment was 15 months. Median pre-treatment lesion volume was 0.65 cc, 0.66 cc and 0.43 cc on the different mpMRI sequences (T2, DWI and DCE). Median necrotic volume was 10.77 cc. Median overall residual fibrosis volume were 0.84 cc and 0.95 cc at 6-month and 1-year mpMRI. Pre-treatment, necrotic and residual fibrosis volumes were significantly different (p < 0.001). Pre-treatment tumour volumes on diffusion-weighted imaging and necrotic volumes were correlated (r = 0.18; p = 0.02).

Conclusions

MpMRI is able to visualise the IRE ablation effects in men with PCa. MpMRI-derived parameters - such as tumour, necrotic and fibrosis volumes - can be measured and are potentially useful for assessing efficacy in the medium term, as with other ablative techniques.

http://bit.ly/2Bxl5eS

Autophagy promotes aortic adventitial fibrosis via the IL-6/Jak1 signaling pathway in Takayasu's arteritis

Publication date: Available online 11 February 2019

Source: Journal of Autoimmunity

Author(s): Rongyi Chen, Ying Sun, Xiaomeng Cui, Zongfei Ji, Xiufang Kong, Sifan Wu, Qingrong Huang, Xiaoming Dai, Si Zhang, Lili Ma, Lindi Jiang

Abstract

Background

Autophagy is a ubiquitous and evolutionarily conserved self-rescue process. Studies have shown that autophagy is involved in the pathogenesis of multiple diseases; however, whether autophagy is associated with the pathogenesis of Takayasu's arteritis (TA), a large vessel idiopathic inflammatory disease characterized by vascular fibrosis, remains unclear. Moreover, although IL-6 is believed to be a direct target for TA treatment, anti-IL-6 treatment could not block TA-associated fibrosis in some cases, which impairs the aortic function of patients and can result in death. Thus, identify the mechanisms associated with TA is extremely important. Based on the relationship between autophagy and IL-6, we investigated the role of autophagy in the vascular fibrosis of TA induced by IL-6.

Methods

Autophagy proteins (LC3 and Atg3), IL-6, and markers of fibrosis (collagen 1 and α-SMA) were detected in tissues with TA lesions via immunochemistry, immunofluorescence, and Western blot, respectively. Different stages of autophagy were analyzed by the specific inhibitors, 3-methyladenosine (early stage), hydroxychloroquine sulfate (late stage), and bafilomycin A1 (late stage). Autophagosomes were detected using electron microscopy and a viral-vector transfection assay. The fibrosis profiles induced by IL-6-dependent autophagy was assessed with an ELISA.

Results

The expression of autophagy, IL-6, and fibrosis markers were elevated and correlated with each other in the adventitia tissues of TA patients. Furthermore, exogenous IL-6/IL-6Rα could significantly increase autophagy and fibrosis in vitro. An autophagy inhibitor was found to significantly block both autophagy and fibrosis induced by IL-6. Finally, IL-6 was found to significantly promote autophagy-induced fibrosis through the activation of the Jak1 pathway.

Conclusions

IL-6-induced autophagy plays an important role in vascular fibrosis of TA. Targeting autophagy pathways might represent a novel therapeutic option for the treatment of TA.

http://bit.ly/2ByEoEs

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 12 Φεβρουαρίου 2019

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