Methemoglobinaemia with chronic phenazopyridine ingestion

http://bit.ly/2V2QXiQ

Neuroblastoma with an unusual ovarian metastasis in a 5-year-old girl

Neuroblastoma metastasizing to the ovary is rare. We report the 10th case and review the scarce literature. A 5-year-old girl with stage M neuroblastoma presented with an upper abdominal and a pelvic mass. Evaluation after induction showed very good tumour response with three remaining localisations: two abdominal and one pelvic. At gross total resection, the pelvic mass appeared to be the enlarged and abnormal right ovary and was removed completely. Pathology showed an ovarian metastasis. On completion of her postoperative treatment, she achieved complete remission. Literature review showed that underdiagnosing of ovarian metastasis in neuroblastoma is very likely.

http://bit.ly/2EbN6Kw

Spinal epidural lipomatosis following bilateral spinal decompression surgery

A 73-year-old man underwent bilateral spinal decompression of L4/5 for severe spinal canal stenosis, requiring minimal analgesia and providing immediate relief. Two days post-operatively, he presented with new onset bilateral leg pain and difficulty mobilising. MRI demonstrated spinal epidural lipomatosis (SEL), which was not present pre-operatively, at L5/S1. Further surgery was performed with decompression of L5/S1 through removal of epidural fat. At both 3 weeks and 5 months follow-up clinics, the patient was asymptomatic. To our knowledge, this is the first case of acute spinal epidural lipomatosis directly following spinal surgery. It is important to recognise SEL as a complication following spinal surgical intervention, due to the potential development of significant neurological consequences.

http://bit.ly/2V0fqFl

Liver transplant, toxoplasmosis and kidney stones: connecting the dots

http://bit.ly/2EfL6RB

MLL rearranged acute lymphoblastic leukaemia presenting as a maxillary sinus mass with a discordant immunophenotypic profile from the bone marrow

We describe an unusual case of pre-B lymphoblastic leukaemia presenting with a unilateral maxillary sinus mass in which biopsies of the primary mass and the bone marrow demonstrated conflicting immunophenotyping results. The extramedullary mass was consistent with a precursor B-cell malignancy, while the bone marrow was initially reported as a possible mature B-cell malignancy. The treatments for the two are fundamentally different, which necessitated a delay in the initiation of his chemotherapy until a clear diagnosis was made. Mixed lineage leukaemia gene rearrangement was confirmed by fluorescence in situ hybridisation in both the primary mass and bone marrow, which unified the diagnosis as pre-B acute lymphoblastic leukaemia given the common cytogenetic feature.

http://bit.ly/2V7LE1J

Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea.

Related Articles

Emergence of Cheyne-Stokes Breathing After Hypoglossal Nerve Stimulator Implant in a Patient With Mixed Sleep Apnea.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 14;:

Authors: Sarber KM, Ishman SL, Patil RD

PMID: 30763424 [PubMed - as supplied by publisher]

http://bit.ly/2GFIC0B

Reassessing the Safety of Bicycle Helmets-Finding Vulnerability in Strength.

Related Articles

Reassessing the Safety of Bicycle Helmets-Finding Vulnerability in Strength.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 14;:

Authors: Joseph B, Hanna K

PMID: 30763413 [PubMed - as supplied by publisher]

http://bit.ly/2IfwvcM

Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement.

Related Articles

Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 14;:

Authors: Bowe SN, Colaianni CA, Yamasaki A, Cummings BM, Hartnick CJ

Abstract
Importance: Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation.
Objective: Using principles of continuous QI, the objectives of this study were to (1) describe step-by-step methods to sustain QI efforts and (2) revisit a series of process, outcome, and balance measures for sedation weaning management following implementation of a new electronic health record (EHR).
Design, Setting, and Participants: A standardized sedation weaning protocol was previously developed and instituted in February 2013. To address healthcare system-wide changes, a 7-step, Institute for Healthcare Improvement methodology was used to reevaluate a series of measures comparing a previous postweaning group (2013-2014; 13 patients) and current post-EHR group (2016; 11 patients). We conducted a focus group review of these 24 patients.
Main Outcomes and Measures: The primary outcome measure was length of sedation weaning. Secondary outcome, process, and balance measures included total length of sedation, absence of standardized wean document, absence of specific recommendations on weaning regimen, length of stay, continued weaning at discharge, discharge location, absence of discharge instructions on weaning regimen or iatrogenic withdrawal syndrome (IWS), discharge within 72 hours of stopping weaning, and readmission.
Results: The postweaning and post-EHR groups were similar in age, (20.5 months [95% CI, 11.92-29.15] vs 26.5 months [95% CI, 17.68-35.40]), as well as male sex, 11 of 13 [85%] vs 10 of 11 [91%]), respectively. In the post-EHR group, the standardized sedation wean document was missing from 9 of 11 (82%) medical records. However, the primary outcome measure, length of sedation weaning, remained stable at 9.45 (95% CI, 7.62-11.29) days in the post-EHR group compared with 9.08 (95% CI, 7.00-11.18) days in the postweaning group. In addition, only 5 of 11 (46%) of discharges in the post-EHR group had specific guidance on weaning since the standardized template was no longer in use. As a result, in the post-EHR group, patients were 15.2 (95% CI, 0.46-242.34) times as likely to lack discharge instructions on weaning or IWS.
Conclusions and Relevance: Quality improvement is meant to be a continuous process in which reevaluation of care practices are regularly performed. System-wide redesign can be achieved using a formal methodological approach. Moving forward, notable QI opportunities for our institution included the development of a flexible sedation weaning template, as well as enhancements to discharge instructions to include IWS diagnosis and treatment.

PMID: 30763412 [PubMed - as supplied by publisher]

http://bit.ly/2tmFVsH

TBX1 Functions as a Tumor Suppressor in Thyroid Cancer Through Inhibiting the Activities of the PI3K/AKT and MAPK/ERK Pathways

Thyroid, Ahead of Print.


http://bit.ly/2Gr8JJj

Calcifying Epithelial Odontogenic (Pindborg) Tumor in a Child: A Case Report and Literature Review

Abstract

Calcifying epithelial odontogenic tumor (CEOT) is a rare neoplasm, which accounts for < 1% of all odontogenic tumors. CEOT occurs more frequently in adults with a peak incidence in the 5th decade of life and is extremely rare in the pediatric population. We present a case of a 13-year-old girl who was found to have a mandibular CEOT. We summarize the radiological features, pathological findings, clinical management and literature review focusing on this entity in children.

http://bit.ly/2SzYqJj

Human scalp hair: Modulation by various factors and hormones do estrogens inhibit or stimulate—A perplexing perspective

Summary

Several journal reports, reviews, and commentaries over the last 20‐25 years have pointed out the controversy attached to 17β‐estradiol's inhibitory or stimulatory influence on hair follicle growth/cycling citing rodent (murine) and human results. While 17β‐estradiol is the most potent sex steroid hormone in the body and has almost equal affinity for estrogen receptor (ER) alpha (α) and beta (β), there appears to be specific ER‐mediated effects on scalp hair follicles/growth, etc. Additionally, the newly discovered G protein‐coupled estrogen receptor (GPR30 or GPER) and the orphan receptor, estrogen‐related receptor (ERR) gamma (γ), in skin and other tissue sites have potential impacts of how estrogens via these receptors may alter scalp hair characteristics, but this remains to be elucidated. Conversely, the negative impact of the 5α‐reductase enzyme and its steroid product, 5α‐dihydrotestosterone, on scalp hair growth is clear. Less clear is how 17β‐estradiol is stimulatory in some scalp hair studies, but inhibitory in others. This brief summary examines the potential influences of steroidogenesis via aromatase (estrogen biosynthesis) and 5α‐reductase expression, their enzyme activities, and steroid products along with the concepts of how steroid acute regulatory protein (StAR) and estrone sulfate may be involved in the complex hormonal, cellular/molecular signaling cascade of the hair follicle in growth and cycling.

http://bit.ly/2tpUE6s

The stem cell markers expression CD44v6 and podoplanin in lip cancer: clinical significance

Abstract

This study aimed to analyze the immunoexpression of cancer stem cell markers, CD44v6, and podoplanin in 91 patients with lip squamous cell carcinomas (LSCC). The immunostaining of podoplanin and CD44v6 was evaluated in ten high-power fields (× 400 magnification) at the invasive front of LSCC, using a semi-quantitative score method. Chi-square test or Fisher's exact test was used to verify the association of podoplanin and CD44v6 expressions with clinicopathologic variables. Spearman's correlation test was used to analyze the correlation between the two antibodies in lip cancer. Disease-free survival probabilities in 5 and 10 years were estimated according to the Kaplan-Meier method and compared using the log-rank test. The independent effects of the significant variables were analyzed by Cox proportional hazards regression model. A strong podoplanin expression was observed in the membrane and cytoplasm of most lip tumor cells, and this was inversely associated with locoregional recurrence (p = 0.028) and with histopathological grade of malignancy (p = 0.026). Additionally, CD44v6 immunostaining was strongly expressed in the membrane of tumor cells in 95.4% of the LSCC. Patients with strong membranous (p = 0.016) or strong cytoplasmic (p = 0.030) podoplanin-positive tumors resulted in significantly better disease-free survival than those who had podoplanin weak/negative tumors, confirming podoplanin expression as a favorable independent prognostic factor. Podoplanin and CD44v6 were strongly expressed by tumor cells and podoplanin immunoexpression can help to determine lip cancer patients with lower risk for disease recurrence.

http://bit.ly/2Edcqjv

Human scalp hair: Modulation by various factors and hormones do estrogens inhibit or stimulate—A perplexing perspective

Summary

Several journal reports, reviews, and commentaries over the last 20‐25 years have pointed out the controversy attached to 17β‐estradiol's inhibitory or stimulatory influence on hair follicle growth/cycling citing rodent (murine) and human results. While 17β‐estradiol is the most potent sex steroid hormone in the body and has almost equal affinity for estrogen receptor (ER) alpha (α) and beta (β), there appears to be specific ER‐mediated effects on scalp hair follicles/growth, etc. Additionally, the newly discovered G protein‐coupled estrogen receptor (GPR30 or GPER) and the orphan receptor, estrogen‐related receptor (ERR) gamma (γ), in skin and other tissue sites have potential impacts of how estrogens via these receptors may alter scalp hair characteristics, but this remains to be elucidated. Conversely, the negative impact of the 5α‐reductase enzyme and its steroid product, 5α‐dihydrotestosterone, on scalp hair growth is clear. Less clear is how 17β‐estradiol is stimulatory in some scalp hair studies, but inhibitory in others. This brief summary examines the potential influences of steroidogenesis via aromatase (estrogen biosynthesis) and 5α‐reductase expression, their enzyme activities, and steroid products along with the concepts of how steroid acute regulatory protein (StAR) and estrone sulfate may be involved in the complex hormonal, cellular/molecular signaling cascade of the hair follicle in growth and cycling.

http://bit.ly/2tpUE6s

Lungensonografie für Anästhesie, Intensiv- und Notfallmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 108-127
DOI: 10.1055/a-0664-5700

Die Lungensonografie ist in der Intensiv- und Notfallmedizin ein unterschätztes Werkzeug: Bei bestimmten klinischen Fragestellungen ist ihre Sensitivität drastisch höher als die der Röntgen-Thoraxuntersuchung 1. Ein standardisierter Untersuchungsgang verbessert dabei die Untersuchungsqualität 2. Dieser Artikel vermittelt Grundlagenwissen der Lungensonografie und stellt die Überlegenheit des Ultraschalls gegenüber Röntgenverfahren heraus.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2UVObfc

Ultraschall in AINS

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 88-89
DOI: 10.1055/a-0805-2279

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2EcLiku

Extrakorporale kardiopulmonale Reanimation: Datenlage bis heute unklar

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 85-86
DOI: 10.1055/a-0823-5785

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2V1M5KJ

Kaffee, Kippe, Kaugummi – Mythen und Fakten zur präoperativen Nüchternheit

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 142-145
DOI: 10.1055/s-0043-124943

Zur Reduktion des Aspirationsrisikos gelten strikte Vorgaben für präoperative Nüchternzeiten. Für klare Flüssigkeiten (2 Stunden) und feste Nahrung (6 Stunden) sind diese eindeutig definiert; der Einfluss von Kaffee, Rauchen und Kaugummi wird dagegen kontrovers diskutiert. Dieser Beitrag zeigt, welche Mythen zur präoperativen Nüchternheit bestehen und durch welche Fakten sich das Risiko verlässlich einordnen lässt.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2Ef1Fxb

Driving Pressure – ein neuer/alter Parameter zur Beatmungsoptimierung?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 85-85
DOI: 10.1055/a-0823-5844

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2UZXSZV

Die fokussierte transthorakale Echokardiografie in der perioperativen Versorgung

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 90-106
DOI: 10.1055/a-0586-6146

Mithilfe der fokussierten transthorakalen Echokardiografie (TTE) erhalten wir rasch und nichtinvasiv aktuelle Informationen zum hämodynamischen Status eines Patienten. Diese können nachfolgend unsere aktuelle Therapie und dadurch unser Risikomanagement beeinflussen. Postoperativ hat sich die TTE als Untersuchungsmethode im Aufwachraum und auf der Intensivstation bewährt, um lebensbedrohliche Ursachen für eine Kreislaufdepression zeitnah zu diagnostizieren. Akutpathologika wie eine Perikardtamponade oder die fulminante Pulmonalarterienembolie können so schnell erfasst und evtl. auch zeitintensive Transporte in eine CT vermieden werden. Auch präoperativ kann der Einsatz der TTE sinnvoll sein zur Beurteilung des Volumenstatus, der Pumpfunktion oder hämodynamisch relevanter Vitien. Vor allem bei Operationen mit hohem perioperativem Komplikationsrisiko können diese Erkenntnisse mit in eine „goal-directed therapy" einfließen. Entsprechende Algorithmen für ein erweitertes hämodynamisches Monitoring und das Volumenmanagement existieren bereits in vielen Bereichen – sie werden aber häufig nicht konsequent umgesetzt und in die Abläufe der eigenen Klinik implementiert. Mit diesem Artikel legen wir Nutzen und Relevanz der hämodynamischen Evaluation mittels TTE in jeder Phase der Patientenversorgung dar. Darüber hinaus stellen wir einen möglichen Algorithmus für die Versorgung kritisch kranker Patienten vor, der auf den wichtigsten transthorakalen Untersuchungen und hämodynamischen Messverfahren basiert. Er soll im klinischen Alltag und insbesondere im Bereitschaftsdienst eine Hilfestellung für den sinnvollen Einsatz der TTE bieten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2EdNw38

Spinalanästhesie mit Chloroprocain 1% zeigt Vorteile bei ambulanten Arthroskopien

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 86-87
DOI: 10.1055/a-0823-5577

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2UZXM4v

Abdominelle Notfallsonografie in der Intensiv- und Akutmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 128-141
DOI: 10.1055/a-0585-5237

Die sonografischen Untersuchungstechniken unterstützen die Point-of-Care-Diagnostik (POC-Diagnostik) bei akutmedizinischen Fragestellungen. Für den Intensiv- und Notfallmediziner gilt: Kenntnisse und Fertigkeiten einer fokussierten Sonografie sind unabdingbar. Dieser Artikel beleuchtet die Optionen der abdominellen Notfallsonografie und gibt praktische Hilfestellung.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2Ed62sx

Gewalt in der Notfallmedizin – gegenwärtiger Stand in Deutschland

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 146-154
DOI: 10.1055/s-0043-112189

Hintergrund In den letzten Jahren werden Mitarbeiter von Rettungsdiensten und Notaufnahmen immer häufiger Opfer von gewalttätigen Übergriffen während ihres Dienstes. Jedoch wird die Erfassung von Häufigkeiten, Arten, Ursachen, Täterprofilen sowie möglichen Lösungsansätzen und Schutzmaßnahmen in Deutschland bisher – im Vergleich zum angloamerikanischen Sprachraum – eher stiefmütterlich behandelt. Ziel Das Ziel dieser Arbeit war eine weitgehende Erfassung der bisher vorliegenden aktuellen Daten der letzten Jahre, um einen zusammenfassenden Überblick über die Situation in Deutschland geben zu können. Ergebnisse Es liegen nur sehr wenige Arbeiten aus Deutschland zu diesem Thema vor. Die gefundenen Arbeiten zeigten, dass Gewalt im Rettungsdienst und in der Notaufnahme nicht nur ein Problem im angloamerikanischen Sprachraum ist. Bis zu 90% der Studienteilnehmer einer Befragung von Rettungsdienstmitarbeitern und 75% der teilnehmenden Mitarbeiter aus Notaufnahmen gaben an, in den letzten Monaten vor der Befragung Opfer von verbaler und/oder physischer Gewalt geworden zu sein. Die Mehrheit der Studienteilnehmer (je nach Studie zwischen 60 und 80%) fühlt sich gar nicht bis unzureichend auf aggressives und gewalttätiges Verhalten vorbereitet und wünscht sich professionelle regelmäßige Weiterbildung in Deeskalationstechniken und Selbstverteidigung. Auch die ständige Anwesenheit von Sicherheitsdiensten wurde zur Verminderung gewaltsamer Übergriffe auf Mitarbeiter durch Studienteilnehmer als sinnvoll erachtet. Um konkretere Aussagen treffen zu können, bedarf es weiterer prospektiver Multicenterstudien.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2UZXBWT

Massiver Informationsverlust bei Übergaben auf Intensivstation!

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 84-85
DOI: 10.1055/a-0823-5728

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2EdNtEu

Lungensonografie für Anästhesie, Intensiv- und Notfallmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 108-127
DOI: 10.1055/a-0664-5700

Die Lungensonografie ist in der Intensiv- und Notfallmedizin ein unterschätztes Werkzeug: Bei bestimmten klinischen Fragestellungen ist ihre Sensitivität drastisch höher als die der Röntgen-Thoraxuntersuchung 1. Ein standardisierter Untersuchungsgang verbessert dabei die Untersuchungsqualität 2. Dieser Artikel vermittelt Grundlagenwissen der Lungensonografie und stellt die Überlegenheit des Ultraschalls gegenüber Röntgenverfahren heraus.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2UVObfc

Ultraschall in AINS

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 88-89
DOI: 10.1055/a-0805-2279

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2EcLiku

Extrakorporale kardiopulmonale Reanimation: Datenlage bis heute unklar

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 85-86
DOI: 10.1055/a-0823-5785

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2V1M5KJ

Kaffee, Kippe, Kaugummi – Mythen und Fakten zur präoperativen Nüchternheit

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 142-145
DOI: 10.1055/s-0043-124943

Zur Reduktion des Aspirationsrisikos gelten strikte Vorgaben für präoperative Nüchternzeiten. Für klare Flüssigkeiten (2 Stunden) und feste Nahrung (6 Stunden) sind diese eindeutig definiert; der Einfluss von Kaffee, Rauchen und Kaugummi wird dagegen kontrovers diskutiert. Dieser Beitrag zeigt, welche Mythen zur präoperativen Nüchternheit bestehen und durch welche Fakten sich das Risiko verlässlich einordnen lässt.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2Ef1Fxb

Driving Pressure – ein neuer/alter Parameter zur Beatmungsoptimierung?

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 85-85
DOI: 10.1055/a-0823-5844

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2UZXSZV

Die fokussierte transthorakale Echokardiografie in der perioperativen Versorgung

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 90-106
DOI: 10.1055/a-0586-6146

Mithilfe der fokussierten transthorakalen Echokardiografie (TTE) erhalten wir rasch und nichtinvasiv aktuelle Informationen zum hämodynamischen Status eines Patienten. Diese können nachfolgend unsere aktuelle Therapie und dadurch unser Risikomanagement beeinflussen. Postoperativ hat sich die TTE als Untersuchungsmethode im Aufwachraum und auf der Intensivstation bewährt, um lebensbedrohliche Ursachen für eine Kreislaufdepression zeitnah zu diagnostizieren. Akutpathologika wie eine Perikardtamponade oder die fulminante Pulmonalarterienembolie können so schnell erfasst und evtl. auch zeitintensive Transporte in eine CT vermieden werden. Auch präoperativ kann der Einsatz der TTE sinnvoll sein zur Beurteilung des Volumenstatus, der Pumpfunktion oder hämodynamisch relevanter Vitien. Vor allem bei Operationen mit hohem perioperativem Komplikationsrisiko können diese Erkenntnisse mit in eine „goal-directed therapy" einfließen. Entsprechende Algorithmen für ein erweitertes hämodynamisches Monitoring und das Volumenmanagement existieren bereits in vielen Bereichen – sie werden aber häufig nicht konsequent umgesetzt und in die Abläufe der eigenen Klinik implementiert. Mit diesem Artikel legen wir Nutzen und Relevanz der hämodynamischen Evaluation mittels TTE in jeder Phase der Patientenversorgung dar. Darüber hinaus stellen wir einen möglichen Algorithmus für die Versorgung kritisch kranker Patienten vor, der auf den wichtigsten transthorakalen Untersuchungen und hämodynamischen Messverfahren basiert. Er soll im klinischen Alltag und insbesondere im Bereitschaftsdienst eine Hilfestellung für den sinnvollen Einsatz der TTE bieten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2EdNw38

Spinalanästhesie mit Chloroprocain 1% zeigt Vorteile bei ambulanten Arthroskopien

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 86-87
DOI: 10.1055/a-0823-5577

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2UZXM4v

Abdominelle Notfallsonografie in der Intensiv- und Akutmedizin

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 128-141
DOI: 10.1055/a-0585-5237

Die sonografischen Untersuchungstechniken unterstützen die Point-of-Care-Diagnostik (POC-Diagnostik) bei akutmedizinischen Fragestellungen. Für den Intensiv- und Notfallmediziner gilt: Kenntnisse und Fertigkeiten einer fokussierten Sonografie sind unabdingbar. Dieser Artikel beleuchtet die Optionen der abdominellen Notfallsonografie und gibt praktische Hilfestellung.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2Ed62sx

Gewalt in der Notfallmedizin – gegenwärtiger Stand in Deutschland

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 146-154
DOI: 10.1055/s-0043-112189

Hintergrund In den letzten Jahren werden Mitarbeiter von Rettungsdiensten und Notaufnahmen immer häufiger Opfer von gewalttätigen Übergriffen während ihres Dienstes. Jedoch wird die Erfassung von Häufigkeiten, Arten, Ursachen, Täterprofilen sowie möglichen Lösungsansätzen und Schutzmaßnahmen in Deutschland bisher – im Vergleich zum angloamerikanischen Sprachraum – eher stiefmütterlich behandelt. Ziel Das Ziel dieser Arbeit war eine weitgehende Erfassung der bisher vorliegenden aktuellen Daten der letzten Jahre, um einen zusammenfassenden Überblick über die Situation in Deutschland geben zu können. Ergebnisse Es liegen nur sehr wenige Arbeiten aus Deutschland zu diesem Thema vor. Die gefundenen Arbeiten zeigten, dass Gewalt im Rettungsdienst und in der Notaufnahme nicht nur ein Problem im angloamerikanischen Sprachraum ist. Bis zu 90% der Studienteilnehmer einer Befragung von Rettungsdienstmitarbeitern und 75% der teilnehmenden Mitarbeiter aus Notaufnahmen gaben an, in den letzten Monaten vor der Befragung Opfer von verbaler und/oder physischer Gewalt geworden zu sein. Die Mehrheit der Studienteilnehmer (je nach Studie zwischen 60 und 80%) fühlt sich gar nicht bis unzureichend auf aggressives und gewalttätiges Verhalten vorbereitet und wünscht sich professionelle regelmäßige Weiterbildung in Deeskalationstechniken und Selbstverteidigung. Auch die ständige Anwesenheit von Sicherheitsdiensten wurde zur Verminderung gewaltsamer Übergriffe auf Mitarbeiter durch Studienteilnehmer als sinnvoll erachtet. Um konkretere Aussagen treffen zu können, bedarf es weiterer prospektiver Multicenterstudien.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

http://bit.ly/2UZXBWT

Massiver Informationsverlust bei Übergaben auf Intensivstation!

Anästhesiol Intensivmed Notfallmed Schmerzther 2019; 54: 84-85
DOI: 10.1055/a-0823-5728

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2EdNtEu

Adenoid cystic carcinoma with high-grade transformation forming spindle cell component of the submandibular gland

Adenoid cystic carcinoma (AdCC) with high-grade transformation (AdCC-HGT) is rare, and AdCC-HGT with spindle cell component is particularly rare. The patient was a 65-year-old man with a 5 cm sized swelling of the right submandibular gland. Submandibular sialoadenectomy was performed. Histopathological findings mainly showed conventional AdCC, and minorly showed two other components: (1) the pleomorphic component, a proliferation of atypical pleomorphic epithelial cells forming solid or small clusters and accompanied by necrosis; (2) the spindle cell component, containing atypical spindle cells invading the stroma.

http://bit.ly/2DIFZI5

Point of care ultrasonography in the allergy and immunology clinic

Point of care (POC) clinical ultrasonography is used across multiple medical specialties to guide diagnosis and treatment, and to enhance the safety of invasive procedures. POC clinical ultrasonography is defined as a focused ultrasonographic examination, performed and interpreted by the treating clinician, to answer a specific question or to guide a procedure.1 Emergency department physicians were early adopters of POC ultrasonography in the late 1990's; since then, technological advances have resulted in enhanced portability, improved image quality, and user-friendly interfaces, expanding the use of POC ultrasonography at the bedside.

http://bit.ly/2GKbyVg

Clinicopathologic, misdiagnosis and survival differences between clinically amelanotic melanomas and pigmented melanomas

http://bit.ly/2V0FiAR

Comment re Dear Dr. Dermatoethicist: Exam of the Future or Exam of Future Cheating?

http://bit.ly/2BAGTWY

Tracking changes nailfold capillary abnormalities in Dermatomyositis on treatment

http://bit.ly/2TSwc98

Optimizing the Total Body Skin Exam: An Observational Cohort Study

Total body skin examinations (TBSE) are commonly performed in clinical practice. There is limited research on best practices for performing a TBSE.

http://bit.ly/2BDlnkd

Effects of channel morphology on nitrate retention in a headwater agricultural stream in Lake Chaohu Basin, China

Abstract

Five field tracer experiments and relevant detailed investigations of physical characterizations were conducted to investigate the effects of channel geomorphic settings on nitrate uptake efficiency on a 310-m long geomorphically distinct stream reach in a headwater agricultural stream in Hefei District, Lake Chaohu Basin. The model-fitted parameters from the one-dimensional transport with inflow and storage model were used to estimate the transient storage metric ( \( {F}_{\mathrm{med}}^{200} \) ) and determine the total nitrate uptake coefficient (k) for the study reach. And then, a nutrient spiraling approach was applied to reach-scale nitrate uptake estimates (S_w, V_f, and U). The results showed that the main channel was the major contributor to nitrate uptake retention, and the higher geomorphic complexity might result in better nitrate uptake efficiency. The partial least squares regression (PLSR) analysis showed strong correlations between the independent variables as geomorphic settings, Reynolds number and transient storage, and the dependent variables as nitrate uptake metrics, which further underscored the importance of stream physical characteristics on measurement of stream nitrate uptake.

http://bit.ly/2DJMieE

A novel nano zero-valent iron biomaterial for chromium (Cr 6+ to Cr 3+ ) reduction

Abstract

This research work aims to develop a biomaterial entrapped with iron nanoparticles by green synthesis method in which biomass act as both reducing and capping agent. Iron nanoparticles embedded in Citrus limetta peels were characterised using ICP-MS for determination of metal loading, XRD, XPS for crystallinity and oxidation states, TEM followed by FESEM-EDS for particle size and morphology. Sizes of nanoparticles were found to be in the range of 4–70 nm. Batch experiments were conducted to study the effect of different parameters such as contact time, amount of biomaterial and volume of chromium(VI) solution for 2500 mg L⁻¹ of Cr(VI). Complete reduction was attained for a contact time of 5 min with 1.5 g of biomaterial for initial concentration of 2500 mg L⁻¹. The experimental results inferred that 1 g of biomaterial completely reduced 33 mg of hexavalent Cr to trivalent Cr. XRD and XPS revealed that iron nanoparticles are in amorphous form while XPS confirms Fe⁰ state. The transition of Fe⁰ to Fe²⁺/Fe³⁺ during the treatment with chromium solution confirms the reduction of Cr⁶⁺ to Cr³⁺.

http://bit.ly/2SBHan1

Depression, anxiety-like behavior, and memory impairment in mice exposed to chitosan-coated zein nanoparticles

Abstract

The advent of biotechnology provided the synthesis of nanoproducts with diverse applications in the field of medicine, agriculture, food, among others. However, the toxicity of many nanoparticles (NP) currently used, which can penetrate natural systems and impact organisms, is not known. Thus, in this study, we evaluated whether the short exposure (5 days) to low concentrations of chitosan-coated zein nanoparticles (ZNP-CS) (0.2 ng/kg, 40 ng/kg, and 400.00 ng/kg) was capable of causing behavioral alterations compatible with cognitive deficit, as well as anxiety and depression-like behavior in Swiss mice. However, we observed an anxiogenic effect in the animals exposed to the highest ZNP-CS concentration (400.00 ng/kg), without locomotor alterations suggestive of sedation or hyperactivity in the elevated plus maze (EPM) test. We also observed that the ZNP-CS caused depressive-like behavior, indicated by the longer immobile time in the tail suspension test and the animals exposed to ZNP-CS presented deficit in recognition of the new object, not related to locomotor alteration in this test. To the best of our knowledge, this is the first report of the neurotoxicity of ZNP in a mammal animal model, contributing to the biological safety assessment of these nanocomposites.

http://bit.ly/2DGaezA

Preliminary report of microwave ablation for the primary papillary thyroid microcarcinoma: a large-cohort of 185 patients feasibility study

Abstract

Purpose

To assess the safety and efficacy of microwave ablation (MWA) for primary papillary thyroid microcarcinoma (PTMC) with a large sample of 185 patients.

Methods

A total of 185 patients underwent MWA for 206 primary PTMC nodules. They received ultrasound follow-up at 1, 3, 6, and 12 months after MWA and every 6 months thereafter. Nodule volumes were calculated at each follow-up and compared with those before MWA. Additionally, the volume reduction rate (VRR) of the nodules was calculated. Patients' thyroid functions were tested before and 1 month after MWA.

Results

The mean follow-up time of the 185 patients was 20.7 ± 8.8 months (range 12–36 months). During the follow-up period, the mean volume of the 206 nodules was 100.1 ± 92.9 mm³ (range 3.6–423.9) before MWA, which decreased to 2.2 ± 5.6 mm³ (range 0–20.3 mm³) after MWA (P = 0.000). The mean VRR of the nodules was 98.65 ± 3.60% after MWA (range 83.85–100%). One hundred and seventy four of 206 nodules (84.5%) were fully absorbed. Compared with the preoperative results, no significant variation in thyroid function was observed 1 month after MWA. Thirty-eight patients (20.5%) had different types of complications, ranging from minor to major. Five patients (2.7%) had hoarseness, 11 patients (5.9%) had bleeding, 21 patients (11.4%) had earache or toothache, and one patient had another lesion 1 month after MWA.

Conclusions

This preliminary study suggests that MWA is safe and effective in the treatment of primary PTMC and offers a new alternative for clinical treatment.

http://bit.ly/2X5CuV1

Preliminary report of microwave ablation for the primary papillary thyroid microcarcinoma: a large-cohort of 185 patients feasibility study

Abstract

Purpose

To assess the safety and efficacy of microwave ablation (MWA) for primary papillary thyroid microcarcinoma (PTMC) with a large sample of 185 patients.

Methods

A total of 185 patients underwent MWA for 206 primary PTMC nodules. They received ultrasound follow-up at 1, 3, 6, and 12 months after MWA and every 6 months thereafter. Nodule volumes were calculated at each follow-up and compared with those before MWA. Additionally, the volume reduction rate (VRR) of the nodules was calculated. Patients' thyroid functions were tested before and 1 month after MWA.

Results

The mean follow-up time of the 185 patients was 20.7 ± 8.8 months (range 12–36 months). During the follow-up period, the mean volume of the 206 nodules was 100.1 ± 92.9 mm³ (range 3.6–423.9) before MWA, which decreased to 2.2 ± 5.6 mm³ (range 0–20.3 mm³) after MWA (P = 0.000). The mean VRR of the nodules was 98.65 ± 3.60% after MWA (range 83.85–100%). One hundred and seventy four of 206 nodules (84.5%) were fully absorbed. Compared with the preoperative results, no significant variation in thyroid function was observed 1 month after MWA. Thirty-eight patients (20.5%) had different types of complications, ranging from minor to major. Five patients (2.7%) had hoarseness, 11 patients (5.9%) had bleeding, 21 patients (11.4%) had earache or toothache, and one patient had another lesion 1 month after MWA.

Conclusions

This preliminary study suggests that MWA is safe and effective in the treatment of primary PTMC and offers a new alternative for clinical treatment.

http://bit.ly/2X5CuV1

Detection of outliers in pollutant emissions from the Soto de Ribera coal-fired power plant using functional data analysis: a case study in northern Spain

Abstract

For more than a century, air pollution has been one of the most important environmental problems in cities. Pollution is a threat to human health and is responsible for many deaths every year all over the world. This paper deals with the topic of functional outlier detection. Functional analysis is a novel mathematical tool employed for the recognition of outliers. This methodology is applied here to the emissions of a coal-fired power plant. This research uses two different methods, called functional high-density region (HDR) boxplot and functional bagplot. Please note that functional bagplots were developed using bivariate bagplots as a starting point. Indeed, they are applied to the first two robust principal component scores. Both methodologies were applied for the detection of outliers in the time pollutant emission curves that were built using, as inputs, the discrete information available from an air quality monitoring data record station and the subsequent smoothing of this dataset for each pollutant. In this research, both new methodologies are tested to detect outliers in pollutant emissions performed over a long period of time in an urban area. These pollutant emissions have been treated in order to use them as vectors whose components are pollutant concentration values for each observation made. Note that although the recording of pollutant emissions is made in a discrete way, these methodologies use pollutants as curves, identifying the outliers by a comparison of curves rather than vectors. Then, the concept of outlier goes from being a point to a curve that employs the functional depth as the indicator of curve distance. In this study, it is applied to the detection of outliers in pollutant emissions from a coal-fired power plant located on the outskirts of the city of Oviedo, located in the north of Spain and capital of the Principality of Asturias. Also, strengths of the functional methods are explained.

http://bit.ly/2GLycwv

Management immunologischer Nebenwirkungen von Patienten, die mit Immun-Checkpoint-Inhibitoren behandelt werden: ASCO Clinical Practice Guideline Summary

http://bit.ly/2SHw6oE

Association and gene–gene interaction analyses for polymorphic variants in CTLA-4 and FOXP3 genes: role in susceptibility to autoimmune thyroid disease

Abstract

Purpose

Polymorphic variants of cytotoxic T-lymphocyte antigen-4 (CTLA-4) and forkhead box protein P3 (FOXP3) genes are implicated in dysregulated immune homeostasis and autoimmune disorders. We analyzed the association between CTLA-4 rs231775 and FOXP3 rs3761548, rs3761549 polymorphisms and predisposition to autoimmune thyroid disease (AITD), inclusive of Hashimoto's thyroiditis (HT) and Graves' disease (GD) in South-Indian population.

Methods

A total of 355 AITD subjects (comprising 275 HT and 80 GD) and 285 randomly selected age- and sex-matched control subjects were genotyped for the aforementioned polymorphisms by PCR-RFLP method.

Results

The rs231775 "G" allele was preponderant in HT and GD subjects when compared with controls and exerted a dominant influence on the susceptibility to HT (p = 0.009) and GD (p = 0.02), respectively. There was no allelic association of rs3761548 and rs3761549 polymorphisms with AITD susceptibility, albeit a significant difference in genotype distribution with respect to rs3761549. Haplotype analysis revealed an increased frequency of rs3761548 "C"–rs3761549 "T" in HT and GD subjects, thereby associating it with disease predisposition (p = 0.03). Epistatic interaction analysis by multifactor dimensionality reduction approach revealed redundancy between CTLA-4 and FOXP3 genes in influencing the susceptibility to AITD.

Conclusions

The genetic variation in CTLA-4 gene with reference to rs231775 polymorphism contributes to an increased predisposition to HT and GD. Also, in conjunction with FOXP3 gene variants it seems to influence the susceptibility to HT and GD respectively. The significance of these findings in combination with antithyroid antibody screening could plausibly contribute towards meticulous case-finding for effective treatment of HT and GD.

http://bit.ly/2SUEBM9

Adverse Events from Emollient Use in Eczema: A Restricted Review of Published Data

Abstract

Atopic dermatitis/eczema is a chronic inflammatory skin condition, and emollients are the first-line treatment. Despite their widespread use, there is uncertainty about the frequency and type of adverse events associated with different emollients. We conducted a restricted review of published data on adverse events associated with emollient use in eczema. Medline (Ovid) was searched from inception (1946) to June 2018. All types of studies, with the exception of reviews, were included. Eligibility was assessed using a two-stage screening process against inclusion and exclusion criteria. References of all included papers were screened for any additional eligible papers. Data were subsequently extracted from all eligible publications. A limited body of data were found in the published data: 24 papers reported on adverse events with 29 different emollients (3 containing urea, 5 containing ceramide, 4 containing glycerol, 4 were herbal and 13 contained "other" ingredients). Interpretation of the results and comparison of the emollients were difficult due to poor reporting and missing data. Many publications contained no data at all on adverse events, and no study reported serious treatment-related adverse events for any emollient. The proportion of participants in the studies experiencing treatment-related adverse events varied between 2 and 59%. The most common adverse events were skin related and often mild. The range of participants experiencing non-treatment-related adverse events varied between 4 and 43%. From this restricted review, clinicians and patients can be reassured that the emollients studied appear to be generally safe to use. Better studies and reporting of adverse events associated with emollients in common use are needed.

http://bit.ly/2TNyoi9

The Use of 124-I-PET/CT Whole Body and Lesional Dosimetry in Differentiated Thyroid Cancer

Condition:   Thyroid Cancer
Interventions:   Drug: Thyrogen;   Radiation: I-131;   Radiation: I-124
Sponsor:   National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Recruiting

http://bit.ly/2GvCloS

A Single Center Study in Healthy Volunteers to Assess the Pharmacokinetics of AZD9977 When Administered Alone and With Itraconazole

Condition:   Heart Failure With Preserved Ejection Fraction (HFpEF)
Interventions:   Drug: AZD9977;   Drug: Itraconazole
Sponsor:   AstraZeneca
Not yet recruiting

http://bit.ly/2Ij5YLQ

Protein and Exercise to Counteract Frailty in Older Adults

Condition:   Physical Frailty
Interventions:   Other: Resistance training;   Other: High-protein diet;   Other: Recommendations
Sponsors:   University of Southern Denmark;   Metropolitan University College;   The Municipality of Odense, Denmark;   Arla Foods
Not yet recruiting

http://bit.ly/2GoF3fK

GP vs PF as Induction Chemotherapy Combined With CCRT for Locoregionally Advanced Nasopharyngeal Carcinoma

Conditions:   Nasopharyngeal Carcinoma;   Nasopharyngeal Neoplasms;   Nasopharyngeal Diseases;   Head and Neck Neoplasm
Interventions:   Drug: gemcitabine and cisplatin;   Drug: cisplatin and fluorouracil;   Radiation: IMRT;   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/2IgyAoT

FT500 as Monotherapy and in Combination With Immune Checkpoint Inhibitors in Subjects With Advanced Solid Tumors

Conditions:   Advanced Solid Tumors;   Lymphoma;   HER2 Positive;   Gastric Cancer;   Colorectal Cancer;   Head and Neck Cancer;   Squamous Cell Carcinoma;   EGFR Positive Solid Tumor;   HER2-positive Breast Cancer;   Hepatocellular Carcinoma;   Small Cell Lung Cancer;   Renal Cell Carcinoma;   Pancreas Cancer;   Melanoma;   NSCLC;   Urothelial Carcinoma;   Cervical Cancer;   Microsatellite Instability;   Merkel Cell Carcinoma
Interventions:   Drug: FT500;   Drug: Nivolumab;   Drug: Pembrolizumab;   Drug: Atezolizumab
Sponsor:   Fate Therapeutics
Not yet recruiting

http://bit.ly/2Grdcvr

A Study Evaluating Safety and Efficacy of Niraparib in Patients With Previously Treated Metastatic Esophageal/Gastroesophageal Junction/Proximal Gastric Adenocarcinoma

Conditions:   Esophageal Cancer;   Gastric Cancer;   Adenocarcinoma
Intervention:   Drug: Niraparib
Sponsors:   Shadia Jalal, MD;   Tesaro, Inc.;   Indiana University School of Medicine
Not yet recruiting

http://bit.ly/2IgyddZ

Association and gene–gene interaction analyses for polymorphic variants in CTLA-4 and FOXP3 genes: role in susceptibility to autoimmune thyroid disease

Abstract

Purpose

Polymorphic variants of cytotoxic T-lymphocyte antigen-4 (CTLA-4) and forkhead box protein P3 (FOXP3) genes are implicated in dysregulated immune homeostasis and autoimmune disorders. We analyzed the association between CTLA-4 rs231775 and FOXP3 rs3761548, rs3761549 polymorphisms and predisposition to autoimmune thyroid disease (AITD), inclusive of Hashimoto's thyroiditis (HT) and Graves' disease (GD) in South-Indian population.

Methods

A total of 355 AITD subjects (comprising 275 HT and 80 GD) and 285 randomly selected age- and sex-matched control subjects were genotyped for the aforementioned polymorphisms by PCR-RFLP method.

Results

The rs231775 "G" allele was preponderant in HT and GD subjects when compared with controls and exerted a dominant influence on the susceptibility to HT (p = 0.009) and GD (p = 0.02), respectively. There was no allelic association of rs3761548 and rs3761549 polymorphisms with AITD susceptibility, albeit a significant difference in genotype distribution with respect to rs3761549. Haplotype analysis revealed an increased frequency of rs3761548 "C"–rs3761549 "T" in HT and GD subjects, thereby associating it with disease predisposition (p = 0.03). Epistatic interaction analysis by multifactor dimensionality reduction approach revealed redundancy between CTLA-4 and FOXP3 genes in influencing the susceptibility to AITD.

Conclusions

The genetic variation in CTLA-4 gene with reference to rs231775 polymorphism contributes to an increased predisposition to HT and GD. Also, in conjunction with FOXP3 gene variants it seems to influence the susceptibility to HT and GD respectively. The significance of these findings in combination with antithyroid antibody screening could plausibly contribute towards meticulous case-finding for effective treatment of HT and GD.

http://bit.ly/2SUEBM9

The Use of 124-I-PET/CT Whole Body and Lesional Dosimetry in Differentiated Thyroid Cancer

Condition:   Thyroid Cancer
Interventions:   Drug: Thyrogen;   Radiation: I-131;   Radiation: I-124
Sponsor:   National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Recruiting

http://bit.ly/2GvCloS

A Single Center Study in Healthy Volunteers to Assess the Pharmacokinetics of AZD9977 When Administered Alone and With Itraconazole

Condition:   Heart Failure With Preserved Ejection Fraction (HFpEF)
Interventions:   Drug: AZD9977;   Drug: Itraconazole
Sponsor:   AstraZeneca
Not yet recruiting

http://bit.ly/2Ij5YLQ

Protein and Exercise to Counteract Frailty in Older Adults

Condition:   Physical Frailty
Interventions:   Other: Resistance training;   Other: High-protein diet;   Other: Recommendations
Sponsors:   University of Southern Denmark;   Metropolitan University College;   The Municipality of Odense, Denmark;   Arla Foods
Not yet recruiting

http://bit.ly/2GoF3fK

GP vs PF as Induction Chemotherapy Combined With CCRT for Locoregionally Advanced Nasopharyngeal Carcinoma

Conditions:   Nasopharyngeal Carcinoma;   Nasopharyngeal Neoplasms;   Nasopharyngeal Diseases;   Head and Neck Neoplasm
Interventions:   Drug: gemcitabine and cisplatin;   Drug: cisplatin and fluorouracil;   Radiation: IMRT;   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/2IgyAoT

FT500 as Monotherapy and in Combination With Immune Checkpoint Inhibitors in Subjects With Advanced Solid Tumors

Conditions:   Advanced Solid Tumors;   Lymphoma;   HER2 Positive;   Gastric Cancer;   Colorectal Cancer;   Head and Neck Cancer;   Squamous Cell Carcinoma;   EGFR Positive Solid Tumor;   HER2-positive Breast Cancer;   Hepatocellular Carcinoma;   Small Cell Lung Cancer;   Renal Cell Carcinoma;   Pancreas Cancer;   Melanoma;   NSCLC;   Urothelial Carcinoma;   Cervical Cancer;   Microsatellite Instability;   Merkel Cell Carcinoma
Interventions:   Drug: FT500;   Drug: Nivolumab;   Drug: Pembrolizumab;   Drug: Atezolizumab
Sponsor:   Fate Therapeutics
Not yet recruiting

http://bit.ly/2Grdcvr

A Study Evaluating Safety and Efficacy of Niraparib in Patients With Previously Treated Metastatic Esophageal/Gastroesophageal Junction/Proximal Gastric Adenocarcinoma

Conditions:   Esophageal Cancer;   Gastric Cancer;   Adenocarcinoma
Intervention:   Drug: Niraparib
Sponsors:   Shadia Jalal, MD;   Tesaro, Inc.;   Indiana University School of Medicine
Not yet recruiting

http://bit.ly/2IgyddZ

The open access tsunami hits France

Publication date: Available online 15 February 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): H. Maisonneuve, O. Laccourreye

http://bit.ly/2X5JEsh

Successful treatment with trastuzumab in HER2-positive squamous cell carcinoma of the head and neck

Publication date: Available online 14 February 2019

Source: Oral Oncology

Author(s): Khalil Saleh, Esma Saada, Nathalie Auger, Lamia Mayache-Badis, Odile Casiraghi, Francois Bidault, Rastislav Bahleda, Caroline Even

http://bit.ly/2Ii2Tvt

Letter to the Editor regarding, “Total thyroidectomy versus lobectomy for intermediate-risk papillary thyroid carcinoma: A single-institution matched-pair analysis”

Publication date: Available online 14 February 2019

Source: Oral Oncology

Author(s): Shi-Tong Yu, Zi-Zheng Xiao

http://bit.ly/2Gt5FMQ

Juvenile polyautoimmunity in a rheumatology setting

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Clara Malagón, Maria del Pilar Gomez, Catalina Mosquera, Camilo Vargas, Tatiana Gonzalez, Cristine Arango, Lorena Martin, Pilar Perez, Laura Amaya-Uribe, Nicolas Molano-Gonzalez, Juan-Manuel Anaya

Abstract

Overt polyautoimmunity (PolyA) corresponds to the presence of more than one well-defined autoimmune disease (AD) manifested clinically in a single patient. The current study aimed to describe the main characteristics of juvenile PolyA in a pediatric rheumatology setting and analyze the chronological aspects, index cases, familial autoimmunity, and clustering pattern. This was a cross-sectional and multicenter study in which 313 children with overt PolyA were included. Patients were systematically interviewed and their medical records reviewed using a questionnaire that sought information about demographic, clinical, immunological, and familial characteristics. A hierarchical cluster analysis was done to determine similarities between autoimmune diseases based on PolyA. PolyA occurred simultaneously in 138 (44%) patients. Multiple autoimmune syndrome was observed in 62 (19.8%) patients. There were 25 index diseases of which, systemic lupus erythematosus (SLE, n = 134, 42.8%), juvenile idiopathic arthritis (JIA, n = 40, 12.7%), Hashimoto's thyroiditis (HT, n = 24, 7.66%), immune thrombocytopenic purpura (ITP n = 20, 6.39%), antiphospholipid syndrome (APS, n = 15, 4.79%), and vitiligo (VIT, n = 15, 4.79%) were the most frequent and represented 79.23% of the total number of patients. Familial autoimmunity influenced PolyA. A high aggregation of autoimmunity was observed (λ_r = 3.5). Three main clusters were identified, of which SLE and APS were the most similar pair of diseases (based on the Jaccard index) followed by HT and JIA, which were related to ITP and Sjögren's syndrome. The third cluster was composed of localized scleroderma and VIT. Our findings may assist physicians to make an early diagnosis of this frequent condition. Pediatric patients with ADs should be systematically assessed for PolyA.

http://bit.ly/2GMegcz

The European registry on obstetric Antiphospholipid syndrome (EUROAPS): A survey of 1000 consecutive cases

Publication date: Available online 15 February 2019

Source: Autoimmunity Reviews

Author(s): Jaume Alijotas-Reig, Enrique Esteve-Valverde, R. Ferrer-Oliveras, L. Sáez-Comet, E. Lefkou, A. Mekinian, C. Belizna, A. Ruffatti, A. Tincani, L. Marozio, G. Espinosa, R. Cervera, S. de Carolis, O. Latino, E. LLurba, P.L. Meroni, C.B. Chighizola, M. Gerosa, V. Pengo, K. Lundelin

Abstract

Aim

To analyse the clinical features, laboratory data and foetal-maternal outcomes, and follow them up on a cohort of 1000 women with obstetric antiphospholipid syndrome (OAPS).

Methods

The European Registry of OAPS became a registry within the framework of the European Forum on Antiphospholipid Antibody projects and was placed on a website in June 2010. Thirty hospitals throughout Europe have collaborated to carry out this registry. Cases with obstetric complaints related to antiphospholipid antibodies (aPL) who tested positive for aPL at least twice were included prospectively and retrospectively. The seven-year survey results are reported.

Results

1000 women with 3553 episodes were included of which 2553 were historical and 1000 were latest episodes. All cases fulfilled the Sydney classification criteria. According to the laboratory categories, 292 (29.2%) were in category I, 357 (35.7%) in IIa, 224 (22.4%) in IIb and 127 (12.7%) in IIc. Miscarriages were the most prevalent clinical manifestation in 386 cases (38.6%). Moreover, the presence of early preeclampsia (PE) and early foetal growth restriction (FGR) appeared in 181 (18.1%) and 161 (16.1%), respectively. In this series, 448 (44.8%) women received the recommended OAPS treatment. Patients with recommended treatment had a good live-birth rate (85%), but worse results (72.4%) were obtained in patients with any treatment (low-dose aspirin (LDA) or low-molecular-weight heparin (LMWH) not on recommended schedule, while patients with no treatment showed a poor birth rate (49.6%).

Conclusion

In this series, recurrent miscarriage is the most frequent poor outcome. To avoid false-negative diagnoses, all laboratory category subsets were needed. OAPS cases have very good foetal-maternal outcomes when treated. Results suggest that we were able to improve our clinical practice to offer better treatment and outcomes to OAPS patients.

http://bit.ly/2toQEmI

Enhanced type I interferon gene signature in primary antiphospholipid syndrome: Association with earlier disease onset and preeclampsia

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Michelle Remião Ugolini-Lopes, Giovana Tardin Torrezan, Ana Paula Rossi Gândara, Eloisa Helena Ribeiro Olivieri, Iana Souza Nascimento, Erika Okazaki, Eloisa Bonfá, Dirce Maria Carraro, Danieli Castro Oliveira de Andrade

Abstract

Objective

Recently, two studies demonstrated that a relevant percentage of primary antiphospholipid syndrome (PAPS) patients had an upregulation of interferon (IFN) genes. However, 20%–28% of these patients had anti-dsDNA, a highly specific systemic lupus erythematosus (SLE) autoantibody. This study aimed to determine the prevalence of the type I IFN signature in the peripheral blood mononuclear cells of PAPS patients without specific SLE autoantibodies and search for its clinical associations.

Methods

Fifty-three PAPS patients (Sydney's criteria) were consecutively selected and age-matched with 50 healthy controls. A third group of nonimmune-mediated thrombophilia patients was also included. The expression of 41 IFN-induced genes was analyzed using real time quantitative PCR. A principal component analysis determined which genes composed the IFN signature, and the z-score was calculated. An ROC curve defined the signature cut-off.

Results

Six genes remained in the IFN signature DNAJA1, IFIT5, IFI27, MX1, IFI6, and TYK2. The ROC cutoff was 3.9-fold (AUC = 0.706, S = 0.49, E = 0.86, PPV = 0.79, NPV = 0.61). The type I IFN signature was present in 49% of the patients with PAPS compared with 14.0% of the healthy controls and 17% of the nonimmune-mediated thrombophilia patients (p < .0001). The IFN signature was associated with a younger age at the first antiphospholipid syndrome event (p = .023) and with preeclampsia (p = .032).

Conclusion

Our results indicate that PAPS patients without lupus-specific antibodies have an enhanced type I IFN gene signature that is not observed in nonimmune-mediated thrombophilia. Also, this overexpression of type I IFN-regulated genes associated with an earlier onset of antiphospholipid syndrome event and preeclampsia.

http://bit.ly/2tosRmY

Lethal immunoglobulins: Autoantibodies and sudden cardiac death

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Varvara A. Ryabkova, Yuri V. Shubik, Mikhail V. Erman, Leonid P. Churilov, Darja Kanduc, Yehuda Shoenfeld

Abstract

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. Patients with cardiomyopathies, myocarditis, ischemic heart disease and cardiac channelopathies are at risk of SCD. However, a certain percentage of autopsy-negative cases of SCD in the young (<35 years) remain unexplained even after a post-mortem genetic testing. Autoantibodies against cardiac proteins may be potentially involved in the pathogenesis of different heart diseases and in the occurrence of unexplained SCD. In this review we analyze clinical and animal studies that elucidate the prevalence of these autoantibodies in patients with different cardiac diseases and their pathophysiological relevance. We propose a classification of the autoantibodies associated with heart diseases and focus on their molecular and cellular effects. Anti-beta adrenergic receptor antibodies and anti-muscarinic acetylcholine receptor antibodies affect myocardial electrophysiological properties and were reported to be the independent predictors of SCD in patients with different heart diseases. Autoimmune mechanism is proposed for cardiac-related adverse reactions following human papillomavirus (HPV) vaccination. The pentapeptid sharing between HPV's antigens, adrenergic receptors and muscarinic acetylcholine receptors supports this assumption. The dysregulating effects of the autoantibodies against calcium and potassium ion channels can be the basis for autoimmune phenocopies of genetic cardiac channelopathies, which are also associated with SCD.

http://bit.ly/2GKNt0m

The study of interactions between genome and exposome in the development of systemic lupus erythematosus

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Henrik Christian Bidstrup Leffers, Theis Lange, Christopher Collins, Constance Jensina Ulff-Møller, Søren Jacobsen

Abstract

Systemic lupus erythematosus (SLE) is a systemic inflammatory autoimmune disease characterized by a broad spectrum of clinical and serological manifestations. This may reflect a complex and multifactorial etiology involving several identified genetic and environmental factors, though not explaining the full risk of SLE. Established SLE risk genotypes are either very rare or with modest effect sizes and twin studies indicate that other factors besides genetics must be operative in SLE etiology. The exposome comprises the cumulative environmental influences on an individual and associated biological responses through the lifespan. It has been demonstrated that exposure to silica, smoking and exogenous hormones candidate as environmental risk factors in SLE, while alcohol consumption seems to be protective. Very few studies have investigated potential gene-environment interactions to determine if some of the unexplained SLE risk is attributable hereto. Even less have focused on interactions between specific risk genotypes and environmental exposures relevant to SLE pathogenesis. Cohort and case-control studies may provide data to suggest such biological interactions and various statistical measures of interaction can indicate the magnitude of such. However, such studies do often have very large sample-size requirements and we suggest that the rarity of SLE to some extent can be compensated by increasing the ratio of controls. This review summarizes the current body of knowledge on gene-environment interactions in SLE. We argue for the prioritization of studies that comprise the increasing details available of the genome and exposome relevant to SLE as they have the potential to disclose new aspects of SLE pathogenesis including phenotype heterogeneity.

http://bit.ly/2GKV5QH

The European registry on obstetric Antiphospholipid syndrome (EUROAPS): A survey of 1000 consecutive cases

Publication date: Available online 15 February 2019

Source: Autoimmunity Reviews

Author(s): Jaume Alijotas-Reig, Enrique Esteve-Valverde, R. Ferrer-Oliveras, L. Sáez-Comet, E. Lefkou, A. Mekinian, C. Belizna, A. Ruffatti, A. Tincani, L. Marozio, G. Espinosa, R. Cervera, S. de Carolis, O. Latino, E. LLurba, P.L. Meroni, C.B. Chighizola, M. Gerosa, V. Pengo, K. Lundelin

Abstract

Aim

To analyse the clinical features, laboratory data and foetal-maternal outcomes, and follow them up on a cohort of 1000 women with obstetric antiphospholipid syndrome (OAPS).

Methods

The European Registry of OAPS became a registry within the framework of the European Forum on Antiphospholipid Antibody projects and was placed on a website in June 2010. Thirty hospitals throughout Europe have collaborated to carry out this registry. Cases with obstetric complaints related to antiphospholipid antibodies (aPL) who tested positive for aPL at least twice were included prospectively and retrospectively. The seven-year survey results are reported.

Results

1000 women with 3553 episodes were included of which 2553 were historical and 1000 were latest episodes. All cases fulfilled the Sydney classification criteria. According to the laboratory categories, 292 (29.2%) were in category I, 357 (35.7%) in IIa, 224 (22.4%) in IIb and 127 (12.7%) in IIc. Miscarriages were the most prevalent clinical manifestation in 386 cases (38.6%). Moreover, the presence of early preeclampsia (PE) and early foetal growth restriction (FGR) appeared in 181 (18.1%) and 161 (16.1%), respectively. In this series, 448 (44.8%) women received the recommended OAPS treatment. Patients with recommended treatment had a good live-birth rate (85%), but worse results (72.4%) were obtained in patients with any treatment (low-dose aspirin (LDA) or low-molecular-weight heparin (LMWH) not on recommended schedule, while patients with no treatment showed a poor birth rate (49.6%).

Conclusion

In this series, recurrent miscarriage is the most frequent poor outcome. To avoid false-negative diagnoses, all laboratory category subsets were needed. OAPS cases have very good foetal-maternal outcomes when treated. Results suggest that we were able to improve our clinical practice to offer better treatment and outcomes to OAPS patients.

http://bit.ly/2toQEmI

Juvenile polyautoimmunity in a rheumatology setting

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Clara Malagón, Maria del Pilar Gomez, Catalina Mosquera, Camilo Vargas, Tatiana Gonzalez, Cristine Arango, Lorena Martin, Pilar Perez, Laura Amaya-Uribe, Nicolas Molano-Gonzalez, Juan-Manuel Anaya

Abstract

Overt polyautoimmunity (PolyA) corresponds to the presence of more than one well-defined autoimmune disease (AD) manifested clinically in a single patient. The current study aimed to describe the main characteristics of juvenile PolyA in a pediatric rheumatology setting and analyze the chronological aspects, index cases, familial autoimmunity, and clustering pattern. This was a cross-sectional and multicenter study in which 313 children with overt PolyA were included. Patients were systematically interviewed and their medical records reviewed using a questionnaire that sought information about demographic, clinical, immunological, and familial characteristics. A hierarchical cluster analysis was done to determine similarities between autoimmune diseases based on PolyA. PolyA occurred simultaneously in 138 (44%) patients. Multiple autoimmune syndrome was observed in 62 (19.8%) patients. There were 25 index diseases of which, systemic lupus erythematosus (SLE, n = 134, 42.8%), juvenile idiopathic arthritis (JIA, n = 40, 12.7%), Hashimoto's thyroiditis (HT, n = 24, 7.66%), immune thrombocytopenic purpura (ITP n = 20, 6.39%), antiphospholipid syndrome (APS, n = 15, 4.79%), and vitiligo (VIT, n = 15, 4.79%) were the most frequent and represented 79.23% of the total number of patients. Familial autoimmunity influenced PolyA. A high aggregation of autoimmunity was observed (λ_r = 3.5). Three main clusters were identified, of which SLE and APS were the most similar pair of diseases (based on the Jaccard index) followed by HT and JIA, which were related to ITP and Sjögren's syndrome. The third cluster was composed of localized scleroderma and VIT. Our findings may assist physicians to make an early diagnosis of this frequent condition. Pediatric patients with ADs should be systematically assessed for PolyA.

http://bit.ly/2GMegcz

Enhanced type I interferon gene signature in primary antiphospholipid syndrome: Association with earlier disease onset and preeclampsia

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Michelle Remião Ugolini-Lopes, Giovana Tardin Torrezan, Ana Paula Rossi Gândara, Eloisa Helena Ribeiro Olivieri, Iana Souza Nascimento, Erika Okazaki, Eloisa Bonfá, Dirce Maria Carraro, Danieli Castro Oliveira de Andrade

Abstract

Objective

Recently, two studies demonstrated that a relevant percentage of primary antiphospholipid syndrome (PAPS) patients had an upregulation of interferon (IFN) genes. However, 20%–28% of these patients had anti-dsDNA, a highly specific systemic lupus erythematosus (SLE) autoantibody. This study aimed to determine the prevalence of the type I IFN signature in the peripheral blood mononuclear cells of PAPS patients without specific SLE autoantibodies and search for its clinical associations.

Methods

Fifty-three PAPS patients (Sydney's criteria) were consecutively selected and age-matched with 50 healthy controls. A third group of nonimmune-mediated thrombophilia patients was also included. The expression of 41 IFN-induced genes was analyzed using real time quantitative PCR. A principal component analysis determined which genes composed the IFN signature, and the z-score was calculated. An ROC curve defined the signature cut-off.

Results

Six genes remained in the IFN signature DNAJA1, IFIT5, IFI27, MX1, IFI6, and TYK2. The ROC cutoff was 3.9-fold (AUC = 0.706, S = 0.49, E = 0.86, PPV = 0.79, NPV = 0.61). The type I IFN signature was present in 49% of the patients with PAPS compared with 14.0% of the healthy controls and 17% of the nonimmune-mediated thrombophilia patients (p < .0001). The IFN signature was associated with a younger age at the first antiphospholipid syndrome event (p = .023) and with preeclampsia (p = .032).

Conclusion

Our results indicate that PAPS patients without lupus-specific antibodies have an enhanced type I IFN gene signature that is not observed in nonimmune-mediated thrombophilia. Also, this overexpression of type I IFN-regulated genes associated with an earlier onset of antiphospholipid syndrome event and preeclampsia.

http://bit.ly/2tosRmY

Lethal immunoglobulins: Autoantibodies and sudden cardiac death

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Varvara A. Ryabkova, Yuri V. Shubik, Mikhail V. Erman, Leonid P. Churilov, Darja Kanduc, Yehuda Shoenfeld

Abstract

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease. Patients with cardiomyopathies, myocarditis, ischemic heart disease and cardiac channelopathies are at risk of SCD. However, a certain percentage of autopsy-negative cases of SCD in the young (<35 years) remain unexplained even after a post-mortem genetic testing. Autoantibodies against cardiac proteins may be potentially involved in the pathogenesis of different heart diseases and in the occurrence of unexplained SCD. In this review we analyze clinical and animal studies that elucidate the prevalence of these autoantibodies in patients with different cardiac diseases and their pathophysiological relevance. We propose a classification of the autoantibodies associated with heart diseases and focus on their molecular and cellular effects. Anti-beta adrenergic receptor antibodies and anti-muscarinic acetylcholine receptor antibodies affect myocardial electrophysiological properties and were reported to be the independent predictors of SCD in patients with different heart diseases. Autoimmune mechanism is proposed for cardiac-related adverse reactions following human papillomavirus (HPV) vaccination. The pentapeptid sharing between HPV's antigens, adrenergic receptors and muscarinic acetylcholine receptors supports this assumption. The dysregulating effects of the autoantibodies against calcium and potassium ion channels can be the basis for autoimmune phenocopies of genetic cardiac channelopathies, which are also associated with SCD.

http://bit.ly/2GKNt0m

The study of interactions between genome and exposome in the development of systemic lupus erythematosus

Publication date: Available online 14 February 2019

Source: Autoimmunity Reviews

Author(s): Henrik Christian Bidstrup Leffers, Theis Lange, Christopher Collins, Constance Jensina Ulff-Møller, Søren Jacobsen

Abstract

Systemic lupus erythematosus (SLE) is a systemic inflammatory autoimmune disease characterized by a broad spectrum of clinical and serological manifestations. This may reflect a complex and multifactorial etiology involving several identified genetic and environmental factors, though not explaining the full risk of SLE. Established SLE risk genotypes are either very rare or with modest effect sizes and twin studies indicate that other factors besides genetics must be operative in SLE etiology. The exposome comprises the cumulative environmental influences on an individual and associated biological responses through the lifespan. It has been demonstrated that exposure to silica, smoking and exogenous hormones candidate as environmental risk factors in SLE, while alcohol consumption seems to be protective. Very few studies have investigated potential gene-environment interactions to determine if some of the unexplained SLE risk is attributable hereto. Even less have focused on interactions between specific risk genotypes and environmental exposures relevant to SLE pathogenesis. Cohort and case-control studies may provide data to suggest such biological interactions and various statistical measures of interaction can indicate the magnitude of such. However, such studies do often have very large sample-size requirements and we suggest that the rarity of SLE to some extent can be compensated by increasing the ratio of controls. This review summarizes the current body of knowledge on gene-environment interactions in SLE. We argue for the prioritization of studies that comprise the increasing details available of the genome and exposome relevant to SLE as they have the potential to disclose new aspects of SLE pathogenesis including phenotype heterogeneity.

http://bit.ly/2GKV5QH

Clinical significance and immunobiology of IL-21 in autoimmunity

Publication date: Available online 14 February 2019

Source: Journal of Autoimmunity

Author(s): Di Long, Yongjian Chen, Haijing Wu, Ming Zhao, Qianjin Lu

Abstract

Interleukin-21 (IL-21), an autocrine cytokine predominantly produced by follicular helper T (Tfh) and T helper 17 (Th17) cells, has been proven to play an important role in the immune system, for example, by promoting proliferation and the development of Tfh and Th17 cells, balancing helper T cell subsets, inducing B cell generation and differentiation into plasma cells, and enhancing the production of immunoglobulin. These effects are mainly mediated by activation of the JAK/STAT, MAPK and PI3K pathways. Some IL-21 target genes, such as B lymphocyte induced maturation protein-1 (Blimp-1), suppressor of cytokine signaling (SOCS), CXCR5 and Bcl-6, play important roles in the immune response. Therefore, IL-21 has been linked to autoimmune diseases. Indeed, IL-21 levels are increased in the peripheral blood and tissues of patients with systematic lupus erythematosus (SLE), rheumatoid arthritis (RA), type 1 diabetes (T1D), immune thrombocytopenia (ITP), primary Sjogren's syndrome (pSS), autoimmune thyroid disease (AITD) and psoriasis. This increased IL-21 even positively associates with Tfh cells, plasma cells, autoantibodies and disease activity in SLE and RA. Additionally, IL-21 has been utilized as a therapeutic target in SLE, RA, T1D and psoriatic mouse models. Profoundly, clinical trials have shown safety and improvement in RA patients. However, tolerance and long-term pharmacodynamics effects with low bioavailability have been found in SLE patients. Therefore, this review aims to summarize the latest progress on IL-21 function and its signaling pathway and discuss the role of IL-21 in the pathogenesis of and therapy for autoimmune diseases, with the hope of providing potential therapeutic and diagnostic strategies for clinical use.

http://bit.ly/2EaNsB3

The functional neuroanatomy of musical memory in Alzheimer’s disease

Publication date: Available online 15 February 2019

Source: Cortex

Author(s): Catherine F. Slattery, Jennifer L. Agustus, Ross W. Paterson, Oliver McCallion, Alexander JM. Foulkes, Kirsty Macpherson, Amelia M. Carton, Emma Harding, Hannah L. Golden, Kankamol Jaisin, Catherine J. Mummery, Jonathan M. Schott, Jason D. Warren

Abstract

Background

Memory for music has attracted much recent interest in Alzheimer's disease but the underlying brain mechanisms have not been defined in patients directly. Here we addressed this issue in an Alzheimer's disease cohort using activation fMRI of two core musical memory systems.

Methods

We studied 34 patients with younger onset Alzheimer's disease led either by episodic memory decline (typical Alzheimer's disease) or by visuospatial impairment (posterior cortical atrophy) in relation to 19 age-matched healthy individuals. We designed a novel fMRI paradigm based on passive listening to melodies that were either previously familiar or unfamiliar (musical semantic memory) and either presented singly or repeated (incidental musical episodic memory).

Results

Both syndromic groups showed significant functional neuroanatomical alterations relative to the healthy control group. For musical semantic memory, disease-associated activation group differences were localised to right inferior frontal cortex (reduced activation in the group with memory-led Alzheimer's disease); while for incidental musical episodic memory, disease-associated activation group differences were localised to precuneus and posterior cingulate cortex (abnormally enhanced activation in the syndromic groups). In post-scan behavioural testing, both patient groups had a deficit of musical episodic memory relative to healthy controls whereas musical semantic memory was unimpaired.

Conclusions

Our findings define functional neuroanatomical substrates for the differential involvement of musical semantic and incidental episodic memory in major phenotypes of Alzheimer's disease. The complex dynamic profile of brain activation group differences observed suggests that musical memory may be an informative probe of neural network function in Alzheimer's disease. These findings may guide the development of future musical interventions in dementia.

http://bit.ly/2GtgluF

Terbinafine‐resistant strain of Trichophyton interdigitale strain isolated from a tinea pedis patient

Abstract

Trichophyton interdigitale is an anthropophilic species that is frequently isolated from tinea unguium and tinea pedis throughout the world. In the present study, antifungal susceptibility testing was performed on T. interdigitale isolates from Japanese patients (isolated in 2017–2018; 24 strains) to assess itraconazole (ITZ) and terbinafine (TRF) susceptibility of these strains. E‐test determinations revealed that the mean ITZ minimum inhibitory concentration (MIC) of the 24 strains was 0.023 mg/L (range, 0.064–1). Clinical Laboratory Standards Institute M38‐A2 determinations revealed that the mean TRF MIC of 23 of the 24 strains was less than 0.03125 mg/L. Among these strains, one (NUBS18016) had a TRF MIC of 2 mg/L, confirming its resistance to TRF. The predicted amino acid sequences of the squalene epoxidase (SQLE) gene from the TRF‐resistant strain (NUBS18016) was 100% identical to the SQLE gene sequence of the reference strain T. interdigitale, indicating that no gene mutations were present in NUBS18016. Therefore, the TRF‐resistance mechanism of our TRF‐resistant strain NUBS18016 has not been defined. Dermatologists should be cautious about the prevalence of foot dermatophytosis due to antifungal drug‐resistant strains.

http://bit.ly/2TV8iu0

Stratifying clinical complexity of dermatology outpatient visits: validation of a pilot instrument

Publication date: Available online 14 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Rajini K. Murthy, Benjamin J. Kahn, Chao Zhang, Suephy C. Chen

Abstract

The United States population is aging and increasing in comorbidity, and patient care is accordingly growing increasingly complex. Complexity impacts patterns of resource consumption, adverse event and medical error rates, health-related quality of life, physician burnout, and more. Tools capturing complexity can be of benefit in the modern value-based reimbursement landscape and have been well-studied in specialties other than dermatology. In this paper, we describe the validation of a tool specific to outpatient dermatologic care that captures the complexity of clinical visit medical decision-making. We performed a cross-sectional retrospective study to determine the inter-rater reliability and face validity of the tool. By objectively grading a clinical encounter based on clinical complexity, there is increased awareness of opportunities to improve clinical care and the allocation of healthcare costs and resources within the dermatologic community can be better assessed.

http://bit.ly/2Gx8FrF

Peristomal pyoderma gangrenosum: an exceedingly rare and overdiagnosed entity?

Publication date: Available online 14 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Stephanie T. Le, Jenny Z. Wang, Claire Alexanian, Samantha Ellis, Yocasta C. Martinez-Alvarado, Stephanie Johng, Apra Sood, Emanual Maverakis

http://bit.ly/2IgAgPv

Skin cancer risk factors and screening among sexual minority and heterosexual women

Publication date: Available online 14 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Howa Yeung, Marissa L.H. Baranowski, Suephy C. Chen

http://bit.ly/2GpYJ2Z

CD40LG duplications in patients with X-LAG syndrome commonly undergo random X-chromosome inactivation

Publication date: Available online 15 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Giampaolo Trivellin, Constantine A. Stratakis

http://bit.ly/2BD35zT

Reply

Publication date: Available online 15 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Carole Le Coz, Neil Romberg

http://bit.ly/2TO9S0s

Regulation of the pleiotropic effects of tissue resident mast cells

Publication date: Available online 15 February 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Michael Huber, Andrew C.B. Cato, George K. Ainooson, Marc Freichel, Volodymyr Tsvilovskyy, Rolf Jessberger, Eva Riedlinger, Christian P. Sommerhoff, Stephan C. Bischoff

Abstract

Mast cells, best known for their detrimental role in allergic diseases, act in a diverse array of physiological and pathological functions, made possible by the plurality of mast cell types. Their various developmental avenues and their distinct sensitivity to (micro-) environmental conditions convey extensive heterogeneity, resulting in diverse functions. We briefly summarize this heterogeneity, elaborate on molecular determinants that allow mast cells to communicate with their environment to fulfill their tasks, discuss their protease repertoire stored in secretory lysosomes, and consider different aspects of mast cell signaling. Further, we describe key mast cell governance mechanisms, i.e. the high-affinity receptor for IgE (FcεRI), the stem cell factor receptor KIT, the IL-4 system, and Ca²⁺-dependent as well as phosphatase-dependent mechanisms. Finally, we focus on distinct physiological functions such as chemotaxis, phagocytosis, host defense, and the regulation of mast cell functions at the mucosal barriers of the lung, the gastrointestinal tract, and the skin. A deeper knowledge of the pleiotropic functions of mast cell mediators as well as the molecular processes of mast cell regulation and communication should enable us to promote beneficial mast cell traits in physiology and suppress detrimental mast cell functions in disease.

http://bit.ly/2BD2Zbv

A Summary of 2018 and What Lies Ahead for Dermatology and Therapy in 2019

http://bit.ly/2TT9LRm

Pediatric ear foreign body retrieval: A comparison across specialties

Publication date: Available online 15 February 2019

Source: American Journal of Otolaryngology

Author(s): Katie Mingo, David Eleff, Samantha Anne, Kyra Osborne

Abstract

Objectives

To analyze what characteristics of patients and/or ear foreign bodies should prompt referral to otolaryngology with the goal to maximize successful removal and minimize complications.

Methods

This was a retrospective chart review of pediatric patients who presented for ear foreign body removal from January to December 2016 at a tertiary hospital center. Data collection included successful removal, major or minor complications, use of general or conscious sedation, use of otic or oral antibiotics, age of patient, comorbid behavioral disorders, and foreign body characteristics. Major complications included tympanic membrane perforation or ossicular damage. Minor complications included injury of the canal wall. Patients with retained or extruded tympanostomy tubes were excluded.

Results

Of 275 patients aged 1–18 years, 16% presented initially to otolaryngology (ENT), 48.4% presented to the emergency department (ED), 21.8% presented to a pediatrician, and 13.8% presented to ENT after prior attempts at removal. Rate of successful retrieval by ENT was significantly higher than by PCP (95.4% vs 75.0%) or by ENT after prior failed attempts (65.8%), but not when compared to removal in the ED (85.7%). Retrieval by ENT after prior failed attempts had the highest rate of minor complications (26.3% vs 2.3–6.0%). There were two tympanic membrane perforations that were noted by ENT after prior failed attempts. Rate of operative intervention was significantly higher in patients who presented to ENT after prior attempts compared to patients who presented initially to ENT (34.2 vs 4.6%, p = 0.001). Of the patients who presented to ENT after previous failed attempts, there was a higher rate of complications and operative intervention if the patient was age 5 or under or the foreign body was difficult to grasp.

Conclusions

Pediatric ear foreign body presentation is common. Repeated attempts at removal are associated with higher rates of minor complications and operative intervention. Early consultation to otolaryngology should be considered if the foreign body is deemed difficult to grasp such as a bead or stone, especially if the patient is age five or younger.

http://bit.ly/2GOVQs1

Stratum corneum interleukin-33 expressions correlate with the degree of lichenification and pruritus in atopic dermatitis lesions

Publication date: Available online 14 February 2019

Source: Clinical Immunology

Author(s): Naomi Nakamura, Risa Tamagawa-Mineoka, Risa Yasuike, Koji Masuda, Hiroshi Matsunaka, Yumi Murakami, Emiko Yokosawa, Norito Katoh

http://bit.ly/2GHJnpI

Cytokines, growth factors and proteases in medium and large vessel vasculitis

Publication date: Available online 14 February 2019

Source: Clinical Immunology

Author(s): Cornelia M. Weyand, Ryu Watanabe, Hui Zhang, Mitsuhiro Akiyama, Gerald J. Berry, Jörg J. Goronzy

Abstract

Giant cell arteritis and Takayasu arteritis are autoimmune vasculitides that cause aneurysm formation and tissue infarction. Extravascular inflammation consists of an intense acute phase response. Deeper understanding of pathogenic events in the vessel wall has highlighted the loss of tissue protective mechanisms, the intrusion of immune cells into "forbidden territory", and the autonomy of self-renewing vasculitic infiltrates. Adventitial vasa vasora critically control vessel wall access and drive differentiation of tissue-invasive T cells. Selected T cells establish tissue residency and build autonomous, self-sufficient inflammatory lesions. Pathogenic effector T cells intrude and survive due to failed immune checkpoint inhibition. Vasculitis-sustaining T cells and macrophages provide a broad portfolio of effector functions, involving heterogeneous populations of pro-inflammatory T cells and diverse macrophage subsets that ultimately induce wall capillarization and intimal hyperplasia. Redirecting diagnostic and therapeutic strategies from control of extravascular inflammatory markers to suppression of vascular inflammation will improve disease management.

http://bit.ly/2tmgnMt

Resultados de cirugía endoscópica nasal en el tratamiento de sinusitis fúngica invasiva en niños con cáncer e inmunosupresión

Publication date: Available online 14 February 2019

Source: Acta Otorrinolaringológica Española

Author(s): Jorge Javier Ramírez Argueta, Juan Pablo Díaz Molina, Ricardo Jose Ortiz Oliva, Roman Carlos Bregni, Yomara Bustamante

Resumen

Antecedentes y objetivo

El objetivo del estudio ha sido describir los resultados del tratamiento de sinusitis fúngica invasiva con cirugía endoscópica nasal en una población oncológica pediátrica con inmunosupresión e informar sobre la seguridad, la eficacia y las complicaciones del procedimiento

Métodos

Se realizó un estudio retrospectivo de la totalidad de los pacientes con diagnóstico de sinusitis fúngica invasiva operados en la Unidad Nacional de Oncología Pediátrica entre los años 2012 y 2016. Los datos tomados de su historial médico incluyeron: características epidemiológicas, diagnóstico oncológico, datos hematológicos, síntomas, estudios tomográficos, intervenciones quirúrgicas, resultados de enfermedad y cultivos, medicamentos recibidos, complicaciones, evolución y supervivencia. Los datos fueron analizados utilizando estadística descriptiva, las variables continuas con medidas de tendencia central y las variables categóricas de forma porcentual.

Resultados

Se identificó a 18 pacientes, 7 de sexo masculino y 11 de sexo femenino. El promedio de edad fue de 12 años, 13 tuvieron diagnóstico de leucemia linfoide aguda y 5 de leucemia mieloide aguda; 17 pacientes presentaron neutropenia severa en el momento del diagnóstico. El agente etiológico más frecuentemente identificado fue Aspergillus en 13 pacientes. En 16 pacientes (89%) se controló la enfermedad con cirugía endoscópica nasal. Diez pacientes fallecieron por causas no relacionadas a lo largo del estudio.

Discusión y conclusiones

La sinusitis fúngica invasiva es una enfermedad cuya incidencia va en aumento entre pacientes con inmunosupresión y debe de considerarse una urgencia médica debido a su alta mortalidad. El diagnóstico se basa en un alto índice de sospecha en pacientes con factores predisponentes (leucemia, neutropenia, fiebre persistente, sonda nasogástrica) y la evaluación endoscópica nasal. El tratamiento médico antifúngico y cirugía endoscópica nasal agresiva está indicado independientemente del estado del paciente para disminuir la carga fúngica y la alta mortalidad asociada. El tratamiento debe de ser suministrado por un equipo multidisciplinario que incluye pediatría, hemato-oncología, infectología y otorrinolaringología.

Abstract

Background and objective

to describe the results of the treatment of invasive fungal sinusitis with nasal endoscopic surgery in an immunocompromised paediatric oncological population.

Methods

retrospective study of all patients diagnosed with invasive fungal sinusitis operated in the National Paediatric Oncology Unit between 2012 and 2016. Data taken from their medical history included: epidemiological characteristics, oncological diagnosis, haematological data, symptoms, tomographic studies, surgical interventions, results of pathology and cultures, medications received, complications, evolution and survival.

Results

18 patients were identified, 7 male and 11 female. The average age was 12 years, 13 had a diagnosis of acute lymphocytic leukemia and 5 of acute myeloid leukemia. Seventeen patients presented severe neutropenia at the time of diagnosis. The most frequently identified aetiological agent was Aspergillus in 13 patients. In 16 patients (89%) the disease was controlled with nasal endoscopic surgery. Ten patients died due to unrelated causes throughout the study.

Discussion and conclusions

Invasive fungal sinusitis should be considered a medical emergency due to its high mortality. The diagnosis is based on a high index of suspicion in patients with predisposing factors (leukaemia, neutropenia, persistent fever, nasogastric tube) and endoscopic nasal evaluation. Antifungal medical treatment and aggressive nasal endoscopic surgery is indicated regardless of the patient's condition to reduce the fungal burden and associated high mortality. The treatment must be provided by a multidisciplinary team that includes paediatrics, haemato-oncology, infectology and otorhinolaryngology.

http://bit.ly/2TT7u8M

Quantitative Analysis of Free Amino Acids and Urea Derived from Isolated Corneocytes of Healthy Young, Healthy Aged, and Diseased Skin

Background/Aims: Free amino acids (FAAs) and urea, present inside the corneocytes, can be important indicators of skin condition. However, due to the lack of a standard extraction protocol for FAAs from corneocytes, conflicting research results have been reported. Therefore, the purpose of this study was (1) to standardize the extraction protocol and (2) to investigate FAA profiles in healthy young and healthy old volunteers, as well as in psoriasis and atopic dermatitis patients. Methods: Skin samples were collected from four groups (healthy young, healthy old, and psoriasis and atopic dermatitis patients) with 5 volunteers per group. Corneocytes were isolated and examined microscopically. FAAs and urea were extracted from the isolated corneocytes, and their amounts were quantified using LC-ESI/MS/MS (after derivatization with Fmoc-Cl) and colorimetric methods, respectively. Results: The micrographs of the corneocytes showed no morphological features attributable to age or disease conditions. The highest and lowest concentrations of total FAAs and urea were observed in the healthy old group and the healthy young group, respectively. Unlike the other FAAs and urea, citrulline was found at a higher level in the healthy young group than in the disease groups. Conclusion: This study suggests that the levels of FAAs and urea in the skin are affected by age and skin conditions (healthy/diseased). However, further studies are needed to show the effects of different skin conditions on the levels of FAAs and urea.
Skin Pharmacol Physiol 2019;32:94–100

http://bit.ly/2SRQgLF

Con: OIT is safe/better than food avoidance

Publication date: Available online 15 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Braun Camille, Caubet Jean-Christoph

http://bit.ly/2SRnV8d

Pro-Con Debate: Component resolved diagnostic testing is not useful for making food allergy diagnoses

Publication date: Available online 15 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Matthew Greenhawt.

http://bit.ly/2NcbS0g

Drug Hypersensitivity Reactions in the Americas: Similarities and Differences

Publication date: Available online 15 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Pedro Giavina-Bianchi, Edgardo Jares, Marcelo Vivolo Aun, Bernard Thong

http://bit.ly/2SUbCbp

African American Ancestry Contribution to Asthma and Atopic Dermatitis

Publication date: Available online 15 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Michelle Daya, Kathleen C. Barnes

http://bit.ly/2NcbMWs

From the pages of AllergyWatch May 2019

Publication date: Available online 14 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Stanley M. Fineman, David A. Khan, Chitra Dinakar

http://bit.ly/2SQKOc2