Entheseal changes in Ancient Egyptians from the Pyramid Builders of Giza‐Old Kingdom

Abstract

Entheseal changes are distinct skeletal markings that occur where a muscle, tendon, or ligament inserts into bone cortex, in response to many factors including physical activity. Therefore, entheseal changes have been frequently used to reconstruct habitual life activities of ancient populations. The present study examines a sample of 195 ancient Egyptians from Giza ‐ Old Kingdom (2700‐2190 BC), the period of pyramid builders. The material consists of two burials that were identified as belonging to individuals of different socioeconomic classes, Workers and High Officials. This distinction between the socioeconomic classes is based on evidence including location and design of cemeteries, contents of goods, and writings and drawings on tombs. Entheseal changes at 14 sites, representing the main articulations of the body, were examined to assess any association between entheseal expression and physical activities. The results of this study suggest that the frequency and severity of entheseal changes varied between Workers and High Officials, and between males and females. As expected, males exhibited higher levels of entheseal expression, suggesting sexual dimorphism in activity. No clear bilateral asymmetry was observed, except for in female High Officials, who exhibited higher levels of entheseal expression at the right hand. A direct comparison of frequencies of entheseal changes between the two social classes, by sex and age, revealed that male and female Workers had higher levels of entheseal expression than High Officials, suggesting a division in labor. Together, these data suggest that entheseal changes can be used, cautiously, to study activity patterns in ancient Egyptian populations.

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Unusual KRAS missense mutation (p.E63K) in patient with juvenile pilocytic astrocytoma of the tectum

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Stroke in a young man: a late complication of radiation therapy

This 37-year-old man presented with left sided facial warmth and numbness associated with new sudden-onset right hemiparesis. The patient first developed sudden numbness of his left lip and warmth in left ear which travelled to the rest of left face. His past medical history was significant for hypertension, Hodgkin lymphoma treated with radiation therapy at the age of 10, and sleeve gastrectomy for obesity 1 year ago complicated by bilateral ischaemic cerebral infarctions with residual left hemiparesis. No acute infarcts were found on MRI. Transesophageal echocardiography revealed a complex atheroma near the sinotubular junction in ascending aorta.

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Oesophageal atresia with tracheo-oesophageal fistula, ileal atresia and Hirschsprungs disease: outcome of a rare phenotype

Oesophageal atresia with or without tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease are surgical malformations of the gastrointestinal tract typically diagnosed early in the neonatal period and varying in severity and prognosis. This report describes a full-term male newborn presenting simultaneous oesophageal atresia with distal tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease. In addition to the complex types of gastrointestinal malformations involved, the combination of ileal atresia and Hirschsprung's disease, as well as ganglion cells distal to intestinal atresia, resulted in a challenging diagnosis. Despite a successful outcome, the patient presented increased morbidity and prolonged hospitalisation. We highlight some important findings that may aid the early diagnosis of Hirschsprung's disease in this clinical setting. To our knowledge, the association of oesophageal atresia/tracheo-oesophageal fistula, ileal atresia and Hirschsprung's disease has not been previously reported.

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Bouverets syndrome treated with endoscopic electrohydraulic lithotripsy

Bouveret's syndrome is a rare form of small bowel obstruction caused by a large biliary stone entering the lumen of the duodenum or the stomach through a bilioenteric fistula. Treatment options include various surgical techniques. However, recent advances in endoscopy also allow non-surgical endoscopic treatment options. We report a 68-year-old man, with a disseminated small intestinal neuroendocrine tumour, presenting with Bouveret's syndrome without any previously reported biliary disease. He experienced a number of symptoms 1 month prior to his admittance, which were difficult to differentiate from other infectious diseases and complications due to his neuroendocrine tumour. Abdominal CT showed a biliary stone impacted in the duodenal bulb, small bowel obstruction, pneumobilia and a bilioenteric fistula. The patient was treated with endoscopic electrohydraulic lithotripsy to fragment the large gallstone in smaller retractable pieces. The patient avoided major surgery and was discharged the following day.

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Post pulmonary embolism syndrome: a common, underdiagnosed complication that is not well recognised

A 56-year-old man developed chronic breathlessness which persisted for years after he suffered acute pulmonary embolism (PE) despite all investigations being subsequently normal. This case illustrates a very common complication which occurs in up to half of all patients after an acute PE which has been labelled 'post pulmonary embolism syndrome', yet it is not well recognised and at present there is not much research into the prevention or even possible treatment options for patients who develop these symptoms.

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Transient sinus arrest due to sinus node artery thrombus after revascularisation of the left circumflex artery

We present a case of sinus arrest and junctional escape rhythm from sinus node artery (SNA) thrombus in a 55-year-old man after revascularisation of right coronary and proximal circumflex arteries for infero-posterior wall ST-segement elevation myocardial infarction (STEMI). Sinus arrest from occlusion of the SNA is uncommon. The ensuing bradycardia may have haemodynamic consequences requiring temporary pacing but is almost always self-limited.

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Rare presentation of granulomatosis with polyangiitis

A 62-year-old man with no pertinent medical history presented with lower extremity weakness and worsening distal fingertips and toe cyanosis/gangrene. In the outpatient setting, he was initially being treated for Raynaud's phenomenon with a calcium channel blocker. On presentation, the patient had elevated inflammatory markers and white blood cell count. Serum vasculitis panel (proteinase-3 antibody) supported the diagnosis of granulomatosis with polyangiitis. His hospital course was complicated by ischaemic stroke and a diagnosis of mononeuritis multiplex in his lower extremities. After initiating therapy with intravenous steroid and rituximab, his symptoms overall improved including cyanotic fingertips/toes. His inflammatory markers and leucocytosis also improved. Outpatient follow-up consisted of further rituximab infusions and unrelated umbilical hernia incarceration which required surgery. He was found incidentally to have subsegmental pulmonary emboli which most likely occurred during the initial presentation prior to his diagnosis. The patient moved out of state and was lost to follow-up.

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Atrial myxoma presenting as abdominal pain: an unusual association

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Tuberculosis of the breast: an uncommon presentation of an old disease

Breast tuberculosis (TB) is considered an uncommon disease with an estimated incidence of 0.1% of all breast lesions reported in developed countries. A 53-year-old Caucasian woman, with a medical history of Crohn's disease, previously treated with infliximab for 3 months suspended due to a presumptive diagnosis of TB for which antitubercular regimen was started. Five months after, a painful lump in the left breast was identified by the patient. Mammary ultrasound confirmed left breast nodules and axillary adenopathies. Histology and microbiology of both lesions confirmed breast TB. Molecular drug susceptibility testing in both samples revealed no resistance to first line anti-TB drugs and the regimen was maintained for 1 year, with clinical and radiological improvement. Mammary gland involvement usually results from lymphatic extension and differential diagnosis frequently includes breast cancer or bacterial abscess.

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Liver haematoma as a presentation of peliosis hepatis

Peliosis hepatis (PH) is an uncommon, benign hepatic vascular condition involving liver lesions consisting of dilated sinusoidal spaces that ultimately lead to numerous blood-filled cavities within the liver parenchyma. We detail the case of a 62-year-old woman who presented with a large hepatic haematoma resulting from intracystic haemorrhage. She was subsequently diagnosed with PH via arteriogram. Her symptoms were successfully treated surgically with open fenestration. Patient's postoperative course was unremarkable, with no recurrence of symptoms to date.

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Transient iatrogenic Horners syndrome following carotid endarterectomy

We present a case of a 72-year-old man who developed a transient Horner's syndrome in the immediate postoperative period after right carotid endarterectomy which resolved within 3 months. Although Horner's syndrome has been reported with several disorders of the carotid artery, our case documents a rare iatrogenic oculosympathetic paresis after elective carotid endarterectomy.

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Peripheral ulcerative keratitis with corneal melt as the primary presentation in a case of human immunodeficiency virus

Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It is thought to be the result of immune complex deposition at the limbus, resulting in corneal inflammation and stromal melt. We present a case of a 43-year-old female patient of African origin, presenting with PUK and associated corneal perforation as the primary presentation of HIV infection. An urgent tectonic deep anterior lamellar keratoplasty was performed under general anaesthesia with excellent outcome. The patient was referred to the sexual health clinic and anti-retroviral treatment was initiated. This case is to the best of our knowledge the first report from the UK of PUK with corneal perforation as the primary presentation of HIV infection. As highlighted in this report, infection with HIV may initially be silent; therefore, it is vital to consider HIV infection when dealing with PUK of unknown aetiology.

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Pulmonary embolism with right ventricular thrombus: a management dilemma

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Voigt‐Futcher pigmentary demarcation lines

Abstract

Pigmentary demarcation lines (PDLs) are physiological abrupt transitions between hyperpigmented and lighter skin, a common and sometimes troubling feature of normal skin. They are seen in a majority of dark‐complexioned women and a substantial percentage of light‐complexioned ones too. We review this salient finding and approaches to its management.

https://ift.tt/2VgibCI

Voigt‐Futcher pigmentary demarcation lines

Abstract

Pigmentary demarcation lines (PDLs) are physiological abrupt transitions between hyperpigmented and lighter skin, a common and sometimes troubling feature of normal skin. They are seen in a majority of dark‐complexioned women and a substantial percentage of light‐complexioned ones too. We review this salient finding and approaches to its management.

https://ift.tt/2VgibCI

Additively Manufactured Reactive Material Architectures as a Programmable Heat Source

3D Printing and Additive Manufacturing, Ahead of Print.


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Cancer immunology, inflammation, and tolerance: an introduction

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Clinical Outcomes of Patients with Advanced Cancer and Pre‐Existing Autoimmune Diseases Treated with Anti‐Programmed Death‐1 Immunotherapy: A Real‐World Transverse Study

AbstractBackground.Patients with a history of autoimmune diseases (AIDs) have not usually been included in clinical trials with immune checkpoint inhibitors.Materials and Methods.Consecutive patients with advanced cancer, treated with anti‐programmed death‐1 (PD‐1) agents, were evaluated according to the presence of pre‐existing AIDs. The incidence of immune‐related adverse events (irAEs) and clinical outcomes were compared among subgroups.Results.A total of 751 patients were enrolled; median age was 69 years. Primary tumors were as follows: non‐small cell lung cancer, 492 (65.5%); melanoma, 159 (21.2%); kidney cancer, 94 (12.5%); and others, 6 (0.8%). Male/female ratio was 499/252. Eighty‐five patients (11.3%) had pre‐existing AIDs, further differentiated in clinically active (17.6%) and inactive (82.4%). Among patients with pre‐existing AIDs, incidence of irAEs of any grade was significantly higher when compared with patients without AIDs (65.9% vs. 39.9%). At multivariate analysis, both inactive (p = .0005) and active pre‐existing AIDs (p = .0162), female sex (p = .0004), and Eastern Cooperative Oncology Group Performance Status <2 (p = .0030) were significantly related to a higher incidence of irAEs of any grade. No significant differences were observed regarding grade 3/4 irAEs and objective response rate among subgroups. Pre‐existing AIDs were not significantly related with progression‐free survival and overall survival.Conclusion.This study quantifies the increased risk of developing irAEs in patients with pre‐existing AIDs who had to be treated with anti‐PD‐1 immunotherapy. Nevertheless, the incidence of grade 3/4 irAEs is not significantly higher when compared with control population. The finding of a greater incidence of irAEs among female patients ranks among the "hot topics" in gender‐related differences in immuno‐oncology.Implications for Practice.Patients with a history of autoimmune diseases (AIDs) have not usually been included in clinical trials with immune checkpoint inhibitors but are frequent in clinical practice. This study quantifies the increased risk of developing immune‐related adverse events (irAEs) in patients with pre‐existing AIDs who had to be treated with anti‐programmed death‐1 immunotherapy. Nevertheless, their toxicities are mild and the incidence of grade 3/4 irAEs is not significantly higher compared with those of controls. These results will help clinicians in everyday practice, improving their ability to offer a proper counselling to patients, in order to offer an immunotherapy treatment even to patients with pre‐existing autoimmune disease.

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Minimally Invasive Cordotomy for Refractory Cancer Pain: A Randomized Controlled Trial

AbstractBackground.Up to 30% of patients with cancer continue to suffer from pain despite aggressive supportive care. The present study aimed to determine whether cordotomy can improve cancer pain refractory to interdisciplinary palliative care.Materials and Methods.In this randomized controlled trial, we recruited patients with refractory unilateral somatic pain, defined as a pain intensity (PI) ≥4, after more than three palliative care evaluations. Patients were randomized to percutaneous computed tomography‐guided cordotomy or continued interdisciplinary palliative care. The primary outcome was 33% improvement in PI at 1 week after cordotomy or study enrollment as measured by the Edmonton Symptom Assessment Scale.Results.Sixteen patients were enrolled (nine female, median age 58 years). Six of seven patients (85.7%) randomized to cordotomy experienced >33% reduction in PI (median preprocedure PI = 7, range 6–10; 1 week after cordotomy median PI = 1, range 0–6; p = .022). Zero of nine patients randomized to palliative care achieved a 33% reduction in PI. Seven patients (77.8%) randomized to palliative care elected to undergo cordotomy after 1 week. All of these patients experienced >33% reduction in PI (median preprocedure PI = 8, range 4–10; 1 week after cordotomy median PI = 0, range 0–1; p = .022). No patients were withdrawn from the study because of adverse effects of the intervention.Conclusion.These data support the use of cordotomy for pain refractory to optimal palliative care. The findings of this study justify a large‐scale randomized controlled trial of percutaneous cordotomy.Implications for Practice.This prospective clinical trial was designed to determine the improvement in pain intensity in patients randomized to either undergo cordotomy or comprehensive palliative care for medically refractory cancer pain. This study shows that cordotomy is effective in reducing pain for medically refractory cancer pain, and these results can be used to design a large‐scale comparative randomized controlled trial that could provide the evidence needed to include cordotomy as a treatment modality in the guidelines for cancer pain management.

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Cost of Disease Progression in Patients with Metastatic Breast, Lung, and Colorectal Cancer

AbstractIntroduction.To reduce health care costs and improve care, payers and physician groups are piloting value‐based and episodic or bundled‐care payment models in oncology. Disease progression and associated costs may affect these models, particularly if such programs do not account for disease severity and progression risk across patient populations. This study estimated the incremental cost of disease progression in patients diagnosed with metastatic breast cancer (mBC), colorectal cancer (mCRC) and lung cancer (mLC) and compared costs among patients with and without progression.Methods.This was a retrospective study using U.S. administrative claims data from commercial and Medicare Advantage health care enrollees with evidence of mBC, mCRC, and mLC and systemic antineoplastic agent use from July 1, 2006, to August 31, 2014. Outcome measures included disease progression, 12‐month health care costs, and 3‐year cumulative predictive health care costs.Results.Of 5,709 patients with mBC, 3,707 patients with mCRC, and 5,201 patients with mLC, 56.8% of patients with mBC, 58.1% of those with mCRC, and 80.3% of those with mLC patients had evidence of disease progression over 12 months. Among patients with mBC and mCRC, adjusted and unadjusted health care costs were significantly higher among progressors versus nonprogressors. Per‐patient‐per‐month costs, which accounted for variable follow‐up time, were almost twice as high among progressors versus nonprogressors in patients with mBC, mCRC, and mLC. In each of the three cancer types, delays in progression were associated with lower health care costs.Conclusion.Progression of mLC, mBC, and mCRC was associated with higher health care costs over a 12‐month period. Delayed cancer progression was associated with substantial cost reductions in patients with each of the three cancer types.Implications for Practice.Data on the rates and incremental health care costs of disease progression in patients with solid tumor cancers are lacking. This study estimated the incremental costs of disease progression in patients diagnosed with lung cancer, breast cancer, and colorectal cancer and compared health care costs in patients with and without evidence of disease progression in a real‐world population. The data obtained in our study quantify the economic value of delaying or preventing disease progression and may inform payers and physician groups about value‐based payment programs.

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Comparison of the Clinicopathological Characteristics and Genetic Alterations Between Patients with Gastric Cancer with or Without Helicobacter pylori Infection

AbstractBackground.Helicobacter pylori (HP) can induce epithelial cells and intestinal metaplasia with genetic damage that makes them highly susceptible to the development of gastric cancer (GC).Materials and Methods.Between 2005 and 2010, 356 patients with gastric cancer who received curative surgery were enrolled. Analysis of HP, Epstein‐Barr virus (EBV) infection, PIK3CA amplification, and mutation analysis of 68 mutations in eight genes using a mass spectrometric single‐nucleotide polymorphism genotyping technology was conducted. The clinicopathological characteristics of patients with or without HP infection were compared.Results.Among the 356 patients, 185 (52.0%) had HP infection. For intestinal‐type GC, patients with HP infection were more likely to be younger and had fewer PI3K/AKT pathway genetic mutations than those without HP infection. For diffuse‐type GC, patients with HP infection were characterized by less male predominance, less lymphoid stroma, fewer microsatellite instability‐high tumors, and fewer PI3K/AKT pathway genetic mutations than those without HP infection. Patients with HP infection had less tumor recurrence and a better 5‐year overall survival (87.7% vs. 73.9%, p = .012) and disease‐free survival (64.1% vs. 51.3%, p = .013) than those without HP infection, especially for intestinal‐type GC. For EBV‐negative GC, patients with HP infection had fewer PI3K/AKT pathway mutations and a better 5‐year overall survival and disease‐free survival than those without HP infection. Multivariate analysis demonstrated that HP infection was an independent prognostic factor regarding overall survival and disease‐free survival.Conclusion.Patients with GC with HP infection were associated with fewer PI3K/AKT pathway genetic mutations and better survival than those without HP infection, especially for EBV‐negative and intestinal‐type GC.Implications for Practice.Patients with gastric cancer with Helicobacter pylori (HP) infection had fewer PI3K/AKT pathway genetic mutations, less tumor recurrence, and better survival than those without HP infection, especially for Epstein‐Barr virus (EBV)‐negative and intestinal‐type gastric cancer. HP infection is an independent prognostic factor regarding overall survival and disease‐free survival. Future in vivo and in vitro studies of the correlation among HP infection, PI3K/AKT pathway, and EBV infection in gastric cancer are required.

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A Phase II Study of Genexol‐PM and Cisplatin as Induction Chemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma

AbstractLessons Learned. Induction chemotherapy with Genexol‐PM and cisplatin demonstrated modest tumor response in locally advanced head and neck squamous cell carcinoma.Considering favorable toxicity profiles and promising survival data, further studies on this regimen are warranted in patients with head and neck squamous cell carcinoma.Background.Genexol‐PM is a polymeric micellar formulation of paclitaxel without Cremophor EL. We investigated the efficacy and safety of Genexol‐PM plus cisplatin as induction chemotherapy (IC) in patients with locally advanced head and neck squamous cell carcinoma (LA‐HNSCC).Methods.Patients received Genexol‐PM (230 mg/m2) and cisplatin (60 mg/m2) every 3 weeks as IC. After three cycles of IC, definitive treatment of either concurrent chemoradiotherapy (CCRT) with weekly cisplatin (30 mg/m2) or surgery was performed. The primary endpoint was overall response rate (ORR) after IC.Results.Of 52 patients enrolled, 47 completed three cycles of IC, and the ORR was 55.8% (95% confidence interval, 42.3–69.3). Although there was one treatment‐related death, toxicity profiles to Genexol‐PM and cisplatin were generally favorable, and the most common grade 3 or 4 toxicities were neutropenia (15.4%), anorexia (7.7%), and general weakness (7.7%). Fifty‐one patients received definitive treatment (CCRT [n = 44] or radical surgery [n = 7]). The rate of complete response following CCRT was 81.8% (36/44). After a median follow‐up of 39 months, estimates of progression‐free survival (PFS) and overall survival (OS) at 3 years were 54.3% and 71.3%, respectively.Conclusion.IC with Genexol‐PM and cisplatin demonstrated modest tumor response with well‐tolerated toxicity profiles for patients with LA‐HNSCC.

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Upfront Surgical Resection of Melanoma Brain Metastases Provides a Bridge Toward Immunotherapy‐Mediated Systemic Control

AbstractBackground.Immune checkpoint blockade has systemic efficacy in patients with metastatic melanoma, including those with brain metastases (MBMs). However, immunotherapy‐induced intracranial tumoral inflammation can lead to neurologic compromise, requiring steroids, which abrogate the systemic efficacy of this approach. We investigated whether upfront neurosurgical resection of MBM is associated with a therapeutic advantage when performed prior to initiation of immunotherapy.Material and Methods.An institutional review board‐approved, retrospective study identified 142 patients with MBM treated with immune checkpoint blockade between 2010 and 2016 at Massachusetts General Hospital, of whom 79 received surgery. Patients were classified based on the temporal relationship between immunotherapy, surgery, and development of central nervous system metastases. Overall survival (OS) was calculated from the date of diagnosis of MBM until death from any cause. Multivariate model building included a prognostic Cox model of OS, the effect of immunotherapy and surgical sequencing on OS, and the effect of immunotherapy and radiation sequencing on OS.Results.The 2‐year overall survival for patients treated with cytotoxic T‐lymphocyte antigen 4, programmed death 1, or combinatorial blockade was 19%, 54%, and 57%, respectively. Among immunotherapy‐naïve melanoma brain metastases, surgery followed by immunotherapy had a median survival of 22.7 months (95% confidence interval [CI], 12.6–39.2) compared with 10.8 months for patients treated with immunotherapy alone (95% CI, 7.8–16.3) and 9.4 months for patients treated with immunotherapy followed by surgery (95% CI, 4.1 to ∞; p = .12). On multivariate analysis, immunotherapy‐naïve brain metastases treated with immunotherapy alone were associated with increased risk of death (hazard ratio, 1.72; 95% CI, 1.00–2.99) compared with immunotherapy‐naïve brain metastases treated with surgery followed by immunotherapy.Conclusion.In treatment‐naïve patients, early surgical resection for local control should be considered prior to commencing immunotherapy. A prospective, randomized trial comparing the sequence of surgery and immunotherapy for treatment‐naïve melanoma brain metastases is warranted.Implications for Practice.In this retrospective study of 142 patients with melanoma brain metastases treated with immune checkpoint blockade, the development of melanoma brain metastases following immunotherapy was associated with decreased survival compared with diagnosis of immunotherapy‐naïve brain metastases. The benefit of surgical intervention was seen in immunotherapy‐naïve brain metastases in contrast to brain metastases that developed on immunotherapy. These results suggest that upfront local control with surgery for immunotherapy‐naïve melanoma brain metastasis may provide a bridge toward immunotherapy‐mediated systemic control.

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Anterolateral Thigh Flap in a Chicken Model: A Novel Perforator Training Model

J reconstr Microsurg
DOI: 10.1055/s-0039-1679882

Background Preclinical training in perforator flap harvesting is typically conducted on living animal models; however, repeated training is not possible with these models because of ethical and/or economical constraints. We describe an anterolateral thigh flap (ALT flap) training model using chicken thigh that seems to be an appropriate training model prior, for example, to raise a perforator flap in a living rat or swine model. Methods A total of 10 chicken legs were used in this study. Six chicken legs were anatomically dissected to confirm the presence of the perforator and to identify the main vascular tree. In four chicken legs, a skin flap was planned based on the perforator and intramuscular dissection was performed under magnification. Results The perforator was identified in all dissections and was consistently found 3 cm above the line extending from the patella to the head of the femur in its third proximal. Proximally, the mean diameter of the artery and vein was 0.56 (σ = 0.04) and 0.84 (σ = 0.06) mm, respectively. The mean dissection time to raise the flap was 88 (σ = 7) min. Conclusion This is the first description of a nonliving biological simulation model for training in perforator flap dissection that mimics an ALT flap. As an ex vivo chicken model, it is a cost effective and readily accessible model suitable for repeated practice.
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Article in Thieme eJournals:
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Concurrent Staged Cheek Random Pedicle Flap and Island Pedicle Advancement Flap for Reconstruction of Full Nasal Alar–Free Margin and Upper Cutaneous Lip Mohs Defect

No abstract available

https://ift.tt/2tHSxLv

Jowl Reduction With Deoxycholic Acid

BACKGROUND The study proposes a novel protocol for targeting the jowls using deoxycholic acid (DCA) injections, with emphasis on safety and feasibility of the procedure. METHODS This prospective study was conducted at a cosmetic practice between June 2016 and May 2017. Twelve consecutive patients seeking reduction/improvement in mild/moderate jowl fat were injected with DCA subcutaneously in a predefined circular area 1.0 cm above the mandibular border. Treatment response was assessed using physician-evaluated Global Aesthetic Improvement Scale (GAIS) and Subject GAIS. RESULTS Twelve patients (11 women and 1 man) with mild (n = 8) or moderate (n = 4) jowls were treated. After the first treatment, GAIS responses for 24 jowls showed 5 jowls with vast improvement, 15 with moderate improvement, and 4 with no change. After the second session for 5 jowls in 3 patients, GAIS responses showed vast improvement in 4 jowls and moderate improvement in 1. Adverse events included induration (n = 4), bruising (n = 6), numbness (n = 2), pain (n = 5), redness (n = 3), edema (n = 9), and dysphagia (n = 1). CONCLUSION Results of this early experience showed that DCA injections were safe and effective for nonsurgical jowl reduction. Address correspondence and reprint requests to: José Raúl Montes, MD, FACS, FACCS, José Raúl Montes Eyes & Facial Rejuvenation, 735 Ponce de León Avenue, Auxilio Mutuo Medical Tower, Suite 813 San Juan, Puerto Rico 00917, or e-mail: jrmontes@jrmontes.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2bw6lgr). Supported by a publication grant from Allergan Inc. A. Chillar is an employee of Cactus Communications, who was funded by Allergan for providing writing and editorial assistance. The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Physician-Centered Outcomes for Skin Cancer Treatment: A Single-Day Modified Delphi Process to Assess the Importance of Themes in Skin Cancer Management

BACKGROUND Success in skin cancer treatment is determined through outcome measurement. Patients and physicians may prioritize different outcomes of care, and identification of such may enhance patient-centered care. OBJECTIVE To identify gaps between patient and physician attitudes toward skin cancer outcomes. MATERIALS AND METHODS A single-day, 21-patient, modified, in-person Delphi process to solicit and rate the importance of skin cancer–related outcomes was conducted. Twelve masked dermatologic surgeons rated patient-generated outcomes in a 2-round modified Delphi process. Each item was rated on a 1 to 9 scale (1, least important; 9, most important) using the Qualtrics web platform (Qualtrics, Provo, UT). Results of the physician ratings were compared with the patient ratings. RESULTS A list of 53 skin cancer treatment–related themes and outcomes was generated. Eight items were ranked by physicians as "very high" (>80% importance), 5 as "high" (>70% importance), 19 as intermediate, and 21 as low. The physician and patient panels' ratings were concordant for 56% of items, whereas 7 outcome items showed a 2-category discordance. CONCLUSION Physicians and patients were concordant regarding skin cancer treatment on multiple spheres. Areas of discordance include patient fear of unknown future risk, recurrence, or empowering patients to make treatment choices, and may be areas of continued improvement for delivery of patient-centered care. Address correspondence and reprint requests to: Anthony M. Rossi, MD, Dermatology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, 16 East 60th Street, 4th Floor, New York, NY 10022, or e-mail: RossiA@mskcc.org Supported by an institutional research contract from the Patient-Centered Outcome Research Initiative. This research was funded in part through the PCORI ASDS Grant and the NIH/NCI Cancer Center Support Grant P30 CA008748. The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Microneedle Radiofrequency Treatment of Lymphangioma Circumscriptum

No abstract available

https://ift.tt/2tzqPR2

Treatment of Atrophic Facial Acne Scars With Microneedling Followed by Polymethylmethacrylate-Collagen Gel Dermal Filler

BACKGROUND Microneedling and soft-tissue filler injections have been used independently to improve acne scarring. The effectiveness of a combined approach using microneedling followed by polymethylmethacrylate (PMMA)-collagen gel has not been carefully studied. OBJECTIVE The goal of this study was to assess the effectiveness and safety of microneedling alone versus microneedling followed by injection of PMMA-collagen gel filler for correction of atrophic facial acne scars. METHODS We conducted a multicenter, open-label, randomized, prospective study on subjects with distensible atrophic acne scars in the face to determine whether microneedling with PMMA-collagen gel is a superior acne scar treatment over microneedling alone. Forty-four subjects received 3 microneedling treatments over a 12-week period followed by randomization to treatments with PMMA-collagen gel (treatment group) or no further treatment (control group). RESULTS At 24 weeks, the treatment group achieved a statistically significant improvement in acne scores over microneedling alone. The improvement continued at 36 weeks. At 24 weeks, the treatment group showed a strong trend in improvement on the Physician Global Aesthetic Improvement Scale compared with microneedling alone. Address correspondence and reprint requests to: Brian K. Pilcher, PhD, 1411 Rodessa Run, Rochester, NC 27607, or e-mail: brian.pilcher@criticalmassmd.com This study was funded by Suneva Medical, San Diego, CA. B.S. Biesman, M.H. Gold, G.D. Monheit, and T.E. Schlesinger are paid consultants for Suneva Medical and investigators on this study. B.S. Biesman received a stipend for manuscript development. J.L. Cohen, B.E. DiBernardo, J.J. Emer, R.G. Geronemus, and C.F. Teller were investigators for this study. B.K. Pilcher is a paid consultant, and A.S. Lehman is an employee of Suneva Medical. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2GYxKe8

Use of 5-Aminolevulinic Acid and Daylight Photodynamic Therapy for the Treatment of Actinic Keratoses

BACKGROUND Photodynamic therapy (PDT) is an effective modality for the treatment of actinic keratoses (AKs). The use of methyl aminolevulinate with daylight PDT (D-PDT) has quickly gained popularity internationally because of its tolerability and high levels of safety and efficacy. However, there is a paucity of studies on the use of D-PDT with 5-aminolevulinic acid (ALA). OBJECTIVE To study the safety and efficacy of D-PDT in treating AKs on the face and scalp using ALA. MATERIALS AND METHODS Thirty patients were recruited for this prospective, uncontrolled study. Patients were treated with topical ALA on either the scalp or face, incubated for 30 minutes, and then sat at home in a shady area for 2 hours. Weather conditions, lux measurements, and AK counts at 3 and 6 months were measured. RESULTS Daylight PDT led to a median of 75% reduction in AK count at 6 months, with no significant adverse effects. Ninety-six percentage of patients were either moderately or very satisfied with the treatment, and the median peak pain score during treatment was 1. There was no correlation between weather or average lux received during treatment and 6-month outcomes. CONCLUSION Daylight PDT with ALA is a safe and effective treatment modality for AKs on the head. Address correspondence and reprint requests to: Christopher Zachary, FRCP, Department of Dermatology, 118 Medical Surge I, Irvine, CA 92697-2400, or e-mail: czachary@uci.edu Supported by a Cutting Edge Research Grant from the American Society for Dermatologic Surgery. The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Safety of Laser-Assisted Delivery of Topical Poly-L-Lactic Acid in the Treatment of Upper Lip Rhytides: A Prospective, Rater-Blinded Study

BACKGROUND Perioral rhytides are a common complaint among dermatologic patients and can be notoriously stubborn and resistant to therapy. OBJECTIVE We aimed to assess the safety of fractional ablative laser-assisted delivery of topical poly-L-lactic acid (PLLA) suspension in the treatment of upper cutaneous lip rhytides. MATERIALS AND METHODS Prospective, single-arm, rater-blinded trial. Ten subjects with moderate to severe upper lip rhytides underwent 3 bimonthly treatments of low-density fractional carbon dioxide laser followed by topical application of PLLA suspension. Wrinkle severity before and after treatment was analyzed using computer-generated analyses. Blinded raters and subjects assessed improvement of wrinkles after treatment using the Global Aesthetic Improvement Scale (GAIS) (scores ranging from −3 to 3). Adverse events were recorded at each visit. RESULTS Treatments were well tolerated. Other than expected post–laser erythema, no unanticipated adverse events were noted. After 3 treatments, the severity of upper lip wrinkles decreased by an average of 47% (p

https://ift.tt/2GW8PrL

Use of Eflornithine Hydrochloride Cream to Reduce Facial Hair Growth in Flapped Skin

No abstract available

https://ift.tt/2tDlBU1

Management of Keratoacanthoma: 157 Tumors Managed With Surgery or Intralesional Methotrexate

BACKGROUND Keratoacanthomas (KAs) are common tumors of squamous cell origin that grow rapidly and may regress; however, differentiation from an aggressive squamous cell carcinoma is problematic. OBJECTIVE To report the authors' experience in managing KA with intralesional methotrexate (MTX) or surgical excision. MATERIALS AND METHODS The authors collected data on 157 tumors (136 patients) over 6 months from a single institution. RESULTS There were 73 tumors (54 patients) treated with intralesional MTX. There were 9 tumors that did not resolve with intralesional MTX (88% cure). Nonresolving tumors were excised with no recurrences or complications. In all 9 cases, the nonresolving tumors were of the same size or smaller after MTX. Of the 73 tumors treated with MTX, 29 tumors (11 patients) were multiple KAs. All 29 tumors resolved (100% tumor clearance). There were no complications in any of the MTX-treated patients. Tumor clearance was defined by clinical resolution for a minimum of 6 weeks without a recurrence. There were 84 tumors (83 patients) treated with surgical excision. There were no complications and no recurrences (100% cure) with surgery. CONCLUSION Intralesional MTX may be considered as the initial treatment for solitary KA, multiple KA, or in poor surgical candidates. Address correspondence and reprint requests to: Andrew D. Montemarano, DO, 6410 Rockledge Drive, Suite 300, Bethesda, MD 20814, or e-mail: andy.montemarano@gmail.com The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Optic Nerve Head Drusen: The Relationship Between Intraocular Pressure and Optic Nerve Structure and Function: Response

No abstract available

https://ift.tt/2EqKXLh

Actinomyces Orbital Osteomyelitis in the Setting of Multiple Myeloma and Bisphosphonate-Related Osteonecrosis

No abstract available

https://ift.tt/2V8v5ma

Unfavorable Structural and Functional Outcomes in Myelin Oligodendrocyte Glycoprotein Antibody–Associated Optic Neuritis

Background: Recurrent optic neuritis (rON) associated with myelin oligodendrocyte glycoprotein (MOG)-specific antibodies has been initially reported to show a better clinical outcome than aquaporin-4 (AQP4)-seropositive ON in neuromyelitis optica spectrum disorder (NMOSD). Here, we characterize clinical and neuroimaging findings in severe cases of MOG antibody–positive and AQP4 antibody–negative bilateral rON. Methods: Three male adults with rON (ages 18, 44, and 63 years) were evaluated with optical coherence tomography (OCT), MRI, cerebrospinal fluid (CSF), and serological studies. Results: All patients experienced >7 relapses of ON with severe reduction of visual acuity and partial response to steroid treatment. Optic nerves were affected bilaterally, although unilateral relapses were more frequent than simultaneous bilateral recurrences. Patients were MOG-seropositive but repeatedly tested negative for AQP4 antibodies. OCT showed severe thinning of the peripapillary retinal nerve fiber layer. On MRI, contrast-enhancing lesions extended over more than half the length of the optic nerve. CSF analyses during ON episodes were normal. Severe visual deficits accumulated over time in 2 of 3 patients, despite immunosuppressive therapy. Conclusions: MOG-seropositive and AQP4-seronegative rON may be associated with an aggressive disease course and poor functional and structural outcomes. In contrast to previous reports, the severity and pattern of retinal and optic nerve damage closely resembled phenotypes commonly observed in AQP4-seropositive rON without fulfilling current diagnostic criteria for NMOSD.

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Intracranial Hypertension Induced by Megestrol Acetate Withdrawal

No abstract available

https://ift.tt/2VfwreG

Retrospective, Multicenter Comparison of the Clinical Presentation of Patients Presenting With Diplopia From Giant Cell Arteritis vs Other Causes

Background: Although giant cell arteritis (GCA) is a well-known cause of transient and permanent vision loss, diplopia as a presenting symptom of this condition is uncommon. We compared symptoms and signs of patients presenting with diplopia from GCA to those from other causes. Methods: This was a multicenter, retrospective study comparing the clinical characteristics of patients presenting with diplopia from GCA with age-matched controls. Demographic information, review of symptoms, ophthalmic examination, and laboratory data of biopsy-proven patients with GCA were compared with those of age-matched controls presenting with diplopia. Results: A total of 27 patients presented with diplopia from GCA, 19 with constant diplopia, and 8 with transient diplopia. All patients with constant diplopia from GCA were matched with 67 control subjects who had diplopia from other etiologies. Patients with GCA were more likely to describe other accompanying visual symptoms (58% vs 25%, P = 0.008), a greater number of systemic GCA symptoms (3.5, GCA vs 0.6, controls, P

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A Tough NUT to Crack: A 47-Year-Old With Diplopia From a Rare Malignancy

No abstract available

https://ift.tt/2VgYpa9

Anterior Ischemic Optic Neuropathy After Dental Extraction

Background: While often idiopathic, anterior ischemic optic neuropathy occasionally may occur from an identifiable cause. Methods: Observational case report. Results: A 19-year-old woman with unremarkable medical and ophthalmic histories developed visual loss from nonarteritic anterior ischemic optic neuropathy in her right eye after otherwise uneventful dental extraction of the inferior third molars. Conclusions: Anterior ischemic optic neuropathy may rarely occur after dental extraction. Potential pathophysiologic mechanisms of this rare occurrence are discussed.

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Migraine: The Disease of the Year

No abstract available

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Retinal Neuronal Loss in Visually Asymptomatic Patients With Myoclonic Epilepsy With Ragged-Red Fibers

Background: Myoclonic epilepsy with ragged-red fibers (MERRF, OMIM, #545000) is a rare neurological condition mostly caused by the m.8344A>G mitochondrial DNA pathogenic variant, which can variably affect multiple tissues, including the retina and optic nerve. We report detection of visually asymptomatic neuroretinal loss in 3 patients with genetically confirmed MERRF, using spectral domain optical coherence tomography (SD-OCT). Methods: All patients underwent a complete ophthalmic examination including assessments of visual acuity, color vision, pupillary reactions, extraocular movements, applanation tonometry, slit-lamp, and dilated fundus examinations. Standard automated perimetry or Goldmann kinetic perimetry was performed, as well as fundus photographs and SD-OCT of the optic nerve head and macula. Results: Despite the absence of visual symptoms in all patients, and normal visual acuity and visual fields in 1 patient, the 3 genetically confirmed patients (point mutations m.8344A>G; age range: 18–62 years) with MERRF-related neurological manifestations, displayed thinning of the retinal nerve fiber layer and variable alterations of the macular ganglion cell complex. Conclusions: Visually asymptomatic patients with genetically confirmed MERRF can display features of structural neuroretinal loss, quantifiable with SD-OCT. Further investigations are needed to establish whether OCT can assess early neurodegeneration in MERRF.

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Finger Extension Weakness and Downbeat Nystagmus Motor Neuron Disease Syndrome: A Series of Two Cases

No abstract available

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The Influence of Volume and Anatomic Location of Optic Disc Drusen on the Sensitivity of Autofluorescence

Background: Optic disc drusen (ODD) are acellular deposits in the optic nerve head. ODD can be diagnosed using different imaging modalities, including enhanced depth imaging optical coherence tomography (EDI-OCT) and autofluorescence (AF). It is unknown which factors determine the sensitivity of AF. The aim of this study was to investigate the effect of volume and anatomic location of ODD on the sensitivity of AF. Methods: Cross-sectional study. Results: A total of 38 patients (75 eyes) with ODD were included. In 12 of 75 eyes (16%) and in 11 of 38 patients (29%), EDI-OCT detected ODD that were not detected by AF. In 24 distinctly solitary ODD, both increase in ODD volume (P = 0.0388) and a more superficial ODD location (P

https://ift.tt/2EpQdyw

Central Retinal Artery Occlusion Due to Intraorbital Ophthalmic Artery Aneurysm

Abstract: A 60-year-old woman experienced sudden onset of vision loss in her right eye. Neuroimaging studies initially were interpreted as tumorous compression of the right optic nerve. On referral to our institution, examination findings were that of a right central retinal artery occlusion (CRAO). Review of the previous imaging studies was consistent with an aneurysm of the intraorbital ophthalmic artery at the origin of the central retinal artery, which was believed to be the cause of the CRAO.

https://ift.tt/2Vd1MPl

Optic Nerve Head and Macular Optical Coherence Tomography Measurements in Papilledema Compared With Pseudopapilledema

Background: To compare macular and optic nerve head optical coherence tomography (OCT) measurements in mild to moderate papilledema and pseudopapilledema. Methods: One hundred nineteen eyes of 61 patients with mild to moderate papilledema, 84 eyes of 48 patients with pseudopapilledema, and 60 eyes of 60 healthy normal individuals were enrolled in this cross-sectional study. Using Spectralis SD-OCT, macular scans with macular ganglion cell–inner plexiform layer (GCIPL) and macular retinal nerve fiber layer (RNFL) segmentation were performed and divided into 2 regions (inner and outer, with a diameter of 3 and 6 mm, respectively); in addition, Bruch membrane opening (BMO) area and peripapillary RNFL thickness were obtained. Results: BMO area was similar in papilledema (1.83 ± 0.34 mm2), pseudopapilledema (1.85 ± 0.37 mm2), and controls (1.85 ± 0.32 mm2). Average inner region macular GCIPL thickness in the papilledema, pseudopapilledema, and control groups was 87.2 ± 14.4 μm, 90.8 ± 6.1 μm, and 91.2 ± 9.8 μm, respectively (P > 0.05). Outer temporal region macular GCIPL was significantly thinner in the papilledema group compared with control group (P = 0.01). By contrast, outer inferior and outer nasal macular RNFL sectors were significantly thicker in the papilledema group compared with control groups (P = 0.01 and P

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Leber Hereditary Optic Neuropathy in a Mother and Daughter Associated With m.10197G>A Mutation

No abstract available

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Cerebrospinal Fluid Pressure Reduction Results in Dynamic Changes in Optic Nerve Angle on Magnetic Resonance Imaging

Background: Optic nerve sheath tortuosity is a previously reported, but incompletely characterized, finding in idiopathic intracranial hypertension (IIH). We hypothesized that optic nerve angle (ONA), as a quantitative measure of tortuosity, would change dynamically with cerebrospinal fluid (CSF) pressure status of patients with IIH immediately before and after lumbar puncture (LP). Methods: Consecutive patients with suspected IIH referred for MRI and diagnostic LP were prospectively enrolled in this single institution, institutional review board–approved study. Each patient underwent a pre-LP MRI, diagnostic LP with opening pressure (OP) and closing pressure (CP), and then post-LP MRI all within 1 session. Sagittal and axial ONAs were measured on multiplanar T2 SPACE images by 2 neuroradiologists on pre- and post-LP MRI. Effects of measured pressure and CSF volume removal on changes in ONA were analyzed as was interrater reliability for ONA measurement. Results: Ten patients with IIH were included {all female, median age 29 (interquartile range [IQR] 25–32)}. All patients had elevated OP (median 37, IQR 34–41 cm H2O), and significantly reduced CP (median 18, IQR 16–19 cm H2O, P

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Neuro-Ophthalmology in Canada

No abstract available

https://ift.tt/2Vd1CYf

Traumatic Globe Luxation With Chiasmal Avulsion

Background: To describe an unusual case of traumatic globe luxation with optic chiasmal avulsion and review the existing literature on this rare condition for further discussion of mechanisms, diagnosis, and management. Methods: Case report and review of existing case reports and case series identified through literature search. Results: A 28-year-old woman, with no previous medical history, had left globe luxation and optic chiasm avulsion after being stabbed directly into the left orbit with the use of the stiletto high heel of a shoe. Automated visual field testing detected a temporal hemianopia in the unaffected eye despite normal central visual acuity. Chiasmal avulsion was demonstrated by MRI. Conclusions: This case suggests that perimetry and MRI should always be considered in traumatic globe luxation to localize the site of injury. Temporal hemianopia in the fellow eye indicates a concomitant chiasmal injury.

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Acute Retinal Necrosis Presenting With Optic Disc Edema

No abstract available

https://ift.tt/2Vd1ibZ

Neurofibromatosis Type 2–Related Eye Disease Correlated With Genetic Severity Type

Objective: Neurofibromatosis type 2 (NF2) is an uncommon but well-recognized disorder characterized by multiple schwannomas and meningiomas. Adults typically present with hearing loss and balance disturbance, and children with ocular, dermatological, and neurological signs. Clinical diagnosis is confirmed by neuroimaging and genetic testing. Although ophthalmic features are present in patients with NF2, there are no reports correlating genetic severity subtypes with ophthalmic involvement. Methods: We retrospectively reviewed longitudinal ophthalmological data of 83 patients with NF2, with known genetic severity subtype, to determine visual function over time. We created a scoring system (Oxford NF2 Ophthalmic Score [ONOS]) to quantify visually debilitating pathology. Results: The prevalence of optic atrophy, combined hamartomas, cataract, and epiretinal membranes significantly increased with genetic severity. Median age of survival to visual acuity worse than 1.0 logarithm of minimum angle of resolution in one eye significantly decreased with genetic severity and was 38 years in the genetically severe group, 49 years in moderate classics, 64 years in mild classics, and 84 years in the tissue mosaics. In the genetically severe, the visually damaging pathologies were largely untreatable. The ONOS correlated with genetic severity longitudinally and cross-sectionally. Conclusions: Mutations associated with severe systemic disease result in greater visual morbidity at an earlier age. Those with tissue mosaicism are unlikely to have visually debilitating pathology secondary to NF2. Potentially treatable sources of damage to vision, however, affect all groups and must be identified early and treated effectively to retain useful vision throughout life.

https://ift.tt/2EpIVeo

Radiation-Induced Multiphasic Demyelination

No abstract available

https://ift.tt/2Vd1eJh

Effects of Testosterone Undecanoate vs Placebo on Intrahepatic Fat Content in Obese Men With T2DM and Hypogonadism

Conditions:   Fatty Liver;   Obesity;   Type2 Diabetes Mellitus;   Hypogonadism, Male
Interventions:   Drug: Testosterone Undecanoate;   Drug: Placebo
Sponsors:   Alexandra Kautzky-Willer;   Bayer
Not yet recruiting

https://ift.tt/2GJfGpc

Effects of Testosterone Undecanoate vs Placebo on Intrahepatic Fat Content in Obese Men With T2DM and Hypogonadism

Conditions:   Fatty Liver;   Obesity;   Type2 Diabetes Mellitus;   Hypogonadism, Male
Interventions:   Drug: Testosterone Undecanoate;   Drug: Placebo
Sponsors:   Alexandra Kautzky-Willer;   Bayer
Not yet recruiting

https://ift.tt/2GJfGpc

Randomized Phase 3 Evaluation of Trifarotene 50 μG/G Cream Treatment Of Moderate Facial And Truncal ACNE

Acne vulgaris often affects the face, shoulders, chest, and back but treatment of non-facial acne has not been rigorously studied.

https://ift.tt/2IyElOX

Basal Cell Carcinoma: Additional Subtypes and Therapeutic Advances

https://ift.tt/2TebWlm

Refining Techniques in Eyebrow Transplantation

https://ift.tt/2IzjjzM

Management of Acute Radiation Dermatitis: A Review of the Literature and Proposal for Treatment Algorithm

Radiation dermatitis is a common sequela of radiation therapy; up to 95% of patients will develop moderate-to-severe skin reactions. No gold-standard currently exists for the treatment of acute radiation-induced skin toxicity. It is, therefore, imperative to develop a greater understanding of management options available to allow clinicians to make informed decisions when managing radiation oncology patients. This literature review discusses the topical agents studied for the treatment of acute radiation dermatitis, reviews their mechanisms of action, and presents a treatment algorithm for clinicians managing patients suffering from radiation dermatitis.

https://ift.tt/2TebSlC

Normalization of breathing with adenotonsillectomy in Japanese pediatric OSA

Since reports on surgical results for pediatric obstructive sleep apnea (OSA) in Japan are insufficient for debate, this study aimed to evaluate the feature of Japanese OSA children and surgical result and document whether is obesity and affecting factor similar to non-Asian countries.

https://ift.tt/2NnIYtV

Retrospective Review of Insurance Coverage for Patch Testing

Insurance coverage and prior authorization (PA) requirements imposed by insurance companies have resulted in widespread barriers to care for both dermatology and allergy patients.1–3 In a recent survey conducted by the American Academy of Dermatology (AAD), greater than two-thirds of 177 respondents from US-based AAD committee/task force members under the Council on Government Affairs, Health Policy, and Practice and Association of Dermatology Administrators/Managers members reported that PA requirements negatively affect at least 1 patient daily.

https://ift.tt/2SSOQS8

Utilization of high-fidelity simulation for medical student and resident education of allergic-immunologic emergencies

Anaphylaxis is an acute, systemic hypersensitivity reaction with an estimated lifetime prevalence of 0.05-2%.1 Epinephrine is the first line treatment while other therapies such as anti-histamines and systemic steroids have limited evidence for the acute management of anaphylaxis. Anaphylaxis is frequently under-diagnosed and not treated with epinephrine in health care settings.2-3 Delayed administration of epinephrine represents a significant risk factor for severe and fatal anaphylaxis.4-5 Furthermore, there are wide variations in epinephrine auto-injector (EAI) administration technique among patients, caregivers, and healthcare professionals alike.

https://ift.tt/2EarxJ4

Perspective Pro Debate: To introduce solids early or not to introduce, this is the question.

Early life nutrition has the potential to influence long-term health; what an infant consumes and when they consume it is an important and potentially contentious topic. Breast milk alone will not sustain adequate infant growth beyond 6 months of age, solid food introduction is therefore essential to ensure normal growth through childhood. In the following pro debate, we discuss the evidence for solid food introduction commencing early in an infant's life. The ages we refer to throughout reflect the ages of babies born at full term as prematurity was an exclusion criterion for most studies investigating timings of solid food introduction.

https://ift.tt/2STCaKD

Cockroach, Dust Mite, and Shrimp Sensitization Correlations in The National Health and Nutrition Examination Survey

Shellfish allergy is a common condition, affecting 1-2% of the U.S. population.1 Tropomyosin, the primary allergen in shrimp, is a muscle protein found in other arthropods, including cockroaches and dust mites (DM), and cross-sensitization to these allergens has been hypothesized to drive shrimp sensitization.2,3 In the National Health and Nutrition Examination Survey (NHANES), it was recently demonstrated that there was a marked decrease in the prevalence of shrimp sensitization between NHANES III (1988-1994) and NHANES 2005-2006.

https://ift.tt/2E48Qac

Intergenerational reproductive toxicity of chlordecone in male Caenorhabditis elegans

Abstract

Chlordecone (CLD), also named Kepone, is a synthetic organochlorine pesticide. As one of the common persistent organic pollutants (POPs) in nature, CLD has a profound impact on the environment and human health. The study aims to investigate the reproductive toxicity effects of CLD on male Caenorhabditis elegans and on progeny. L1-stage male nematodes were exposed to the control group (M9 solution) and four dose groups (0.02, 0.2, 2, and 20 μg/L). After exposure for 48 h, the male nematodes were picked to mating experiment and progeny experiment that the number of progeny and the time of observation in male parent and in F1 generation were counted; the number of germ cells and the number of sperm in the meiotic division of male nematodes were counted by staining with dimercaptophenyl hydrazine (DAPI), and the nematode gland area was observed under the bright field of the microscope. In male nematodes, the results showed that a number of progeny were 351.20 ± 31.40, 321.60 ± 24.70, 307.30 ± 19.30, 240.10 ± 27.60, and 227.90 ± 22.70 (P < 0.05); the generation times were 55.80 ± 1.95 h, 56.40 ± 1.60 h, 56.70 ± 0.92 h, 60.80 ± 0.95 h, and 69.60 ± 1.97 h (P < 0.05); relative areas of gonad were (99.80 ± 6.27)%, (93.00 ± 1.70)%, (85.00 ± 1.70)%, (70.70 ± 9.81)%, and (60.00 ± 5.23)% (P < 0.05); DAPI staining results showed the number of germ cells in meiosis area were 191.00 ± 10.97, 181.10 ± 15.56, 177.00 ± 9.20, 147.50 ± 10.56, and 139.30 ± 23.79 (P < 0.05); the sperm numbers were 335.60 ± 21.31, 308.60 ± 19.60, 306.00 ± 11.23, 260.10 ± 27.41, and 255.00 ± 3.72 (P < 0.05). In the F1 generation, the progeny numbers were 328.10 ± 22.28, 167.50 ± 15.30, 150.00 ± 13.65, 131.30 ± 18.40, and 130.20 ± 16.17 (P < 0.05); the generation times were 55.50 ± 2.36, 71.10 ± 0.97, 70.90 ± 0.52, 74.10 ± 2.07, and 73.90 ± 1.35 h (P < 0.05). The groups are grouped in order as M9 solution, 0.02, 0.2, 2, and 20 μg/L. The results revealed that CLD caused decrease in progeny number, relative area of gonad, number of germ cells, and sperm number and prolonged the generation time in the male nematode. In offspring grown up without CLD, the effect of CLD on generation time and sperm number can still be observed on offspring. In conclusion, CLD induces male nematode reproductive toxicity and causes defects in offspring.

https://ift.tt/2NqIKCw

Enhancement of phytoextraction by Taiwanese chenopod and Napier grass by soapnut saponin and EDDS additions

Abstract

Employment of biosurfactants and biodegradable chelants could further promote sustainability of soil and groundwater remediation tasks. Biosurfactant (soapnut saponin) and biodegrading chelants (ethylenediamine-N,N′-disuccinic acid (EDDS)) were employed to enhance the phytoextraction by native Taiwanese chenopod (Chenopodium formosanum Koidz.), Napier grass (Pennisetum purpureum) cultivar Taishi No. 4, and soapwort (Saponaria officinalis). Ethylene diamine tetraacetic acid (EDTA) was also employed as the control. Contaminated soils as silty clay loam texture was collected from a defunct rice paddy, containing chromium (Cr), cadium (Cd), and copper (Cu). Addition of both soapnut saponin and EDDS proportionally increased bioaccumulation factors (BCFs) of aboveground biomass for all three plants. Taiwanese chenopod demonstrated the best BCF values among three plants, with BCF increased from 0.76 to 2.6 and 1.3 for Cu under the presence of the highest dosages of EDDS and saponin. Plant aboveground biomass did exhibit negative correlation toward biomass metal concentrations. Presence of saponin did exhibit the least negative slopes among the correlations of all three additives for three plants. Taiwanese chenopod did exhibit the least negative slopes among the correlations of all three additives for three plants. Above observations suggested that saponin may have some protection for plants, especially for Napier grass. Taiwanese chenopod could possess more tolerance toward heavy metals than Napier grass does.

https://ift.tt/2GFTkoz

Idolization and ramification between globalization and ecological footprints: evidence from quantile-on-quantile approach

Abstract

Globalization persists the tendency to alter numerous aspects of today's world including religion, transport, language, living styles, and international relations; however, its potential to influence quality of environment is the prime concern for trade and environmental policies guidelines (Audi and Ali 2018). In response to the growing interest for identifying the dynamic relationship between globalization and environmental performance, the present study seeks to investigate the critical link between globalization and ecological footprints in top 15 globalized countries between 1970 and 2016. Applying the novel methods of quantile-on-quantile regression (QQ) and Granger causality in quantiles, the findings examine the manners in which quantiles of globalization affect the quantiles of ecological footprints and vice versa. The empirical results suggest that globalization has a long-term positive effect on ecological footprint and vice versa in case of Belgium, the Netherlands, Sweden, Switzerland, Denmark, Norway, Canada, and Portugal. On the other hand, the estimated results indicate a negative effect between globalization and ecological footprint in the case of France, Germany, the UK, and Hungary. These results extend the recent findings on the globalization–environment nexus implying that the magnitude of relationship among both variables varies with countries demanding individual focus and cautions for postulating environmental and trade policies.

https://ift.tt/2EqUOkd

Comparison of extraction techniques for polycyclic aromatic hydrocarbons from lichen biomonitors

Abstract

Lichens are useful biomonitors for atmospheric polycyclic aromatic hydrocarbons (PAHs). Different sample preparation techniques were explored in this regard, including ultrasound-assisted solvent extraction, microwave-assisted extraction, Soxhlet, and the quick, easy, cheap, effective, rugged, and safe (QuEChERS) technique. It was found that a QuEChERS technique using hexane:acetone (1:1, v/v), never reported before for application to lichens, provided the best recoveries of internal standards, the highest total peak area for all PAHs of interest, and %RSDs comparable with the other preparation techniques tested. The optimized sample preparation technique was found to be a comparatively fast method (45 min), with good recoveries (96%), using less solvents and minimal energy consumption. Strong matrix effects were found: both strong enhancement (for the lighter PAHs) and strong suppression (for the heavier PAHs). The use of matrix-matched standards is thus imperative for the accurate determination of PAH concentrations in the lichen samples.

Graphical abstract

"Note: This data is mandatory. Please provide."

https://ift.tt/2DZh1nS

Sodium dodecyl sulfate-coated-cationized agroforestry residue as adsorbent for benzene-adsorptive sequestration from aqueous solution

Abstract

The aim of this work is to convert agroforestry residue to a novel adsorbent (M-1CTA-SDS-BT) used for adsorptive benzene sequestration from aqueous solution. In this study, the anionic surfactant-coated-cationized banana trunk was synthesized and characterized for batch adsorption of benzene from aqueous solution. The surface morphology, surface chemistry, surface area, and pore properties of the synthesized adsorbents were examined. It was proven that surface cationization successfully increased the benzene adsorption capacity of sodium dodecyl sulfate-coated adsorbents. The Langmuir isotherm model satisfactorily described the equilibrium adsorption data. The maximum benzene adsorption capacity (q_max) of 468.19 μmol/g was attained. The kinetic data followed the pseudo-second-order kinetic model in which the rate-limiting step was proven to be the film diffusion. The batch-adsorbent regeneration results indicated that the M-1CTA-SDS-BT could withstand at least five adsorption/desorption cycles without drastic adsorption capacity reduction. The findings demonstrated the adsorptive potential of agroforestry-based adsorbent as a natural and cheap material for benzene removal from contaminated water.

https://ift.tt/2SRtswt

FDA Proposes Major Changes to Sunscreen Rules

The agency plans to update regulations that cover the safety of ingredients, sunscreen dosage forms, SPF, and requirements for testing and labeling.
WebMD Health News

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Detection and measurements of apical lesions in the upper jaw by cone beam computed tomography and panoramic radiography as a function of cortical bone thickness

Abstract

Objectives

In the current literature, cone beam computed tomography (CBCT) seems to be more accurate in detecting apical lesions (AL) than two-dimensional radiographs. Cortical bone thickness might have an influence on AL visibility. Therefore, the purpose of the study was to directly compare the diagnostic accuracy of panoramic radiography (PANO) and CBCT in detecting AL in the upper jaw and determine the influence of cortical bone thickness on AL visibility.

Materials and methods

Anonymised digital images of 351 patients who received a CBCT image and a panoramic radiograph within 90 days were examined for AL in the upper jaw. The analysis was conducted by a trained examiner and reviewed by an expert in dental radiology. Further, the dimensions of AL and cortical bone thickness in the region affected by AL were measured to determine their influence on visibility. Statistical analysis was carried out by means of statistical software (IBM SPSS 25; Armonk, NY, USA).

Results

The mean age of the patients was 58.9 years with an almost equal gender distribution. A total of 2223 teeth in the upper jaw were included in the final analysis. CBCT detected AL on 144 teeth (6.5%), of which only 23 were also visible on a PANO. The difference between both methods was significant (p < 0.001). The dimensions of AL measured within a PANO were approximately twice as high as those measured by CBCT. However, the difference was not significant (p ≥ 0.005). Cortical bone thickness had no influence on AL visibility.

Conclusions and clinical relevance

Panoramic radiographs are unsuitable for a reliable diagnosis of AL in the upper jaw, while CBCT leads to a better visualisation of AL. Bone thickness has no significant influence on AL visibility with either imaging method.

https://ift.tt/2Taozhm

Amino acid metabolism as drug target in autoimmune diseases

Publication date: Available online 22 February 2019

Source: Autoimmunity Reviews

Author(s): Giada Mondanelli, Alberta Iacono, Agostinho Carvalho, Ciriana Orabona, Claudia Volpi, Maria T. Pallotta, Davide Matino, Susanna Esposito, Ursula Grohmann

Abstract

In mammals, amino acid metabolism has evolved to control immune responses. Autoimmune diseases are heterogeneous conditions that involve the breakdown of tolerogenic circuitries and consequent activation of autoreactive immune cells. Therefore, critical enzymes along amino acid degradative pathways may be hijacked to keep in check autoimmunity. We examined here current knowledge of indoleamine 2,3-dioxygenase 1 (IDO1) and arginase 1 (ARG1), the main enzymes catabolizing tryptophan and arginine, respectively, in organ-specific and systemic autoimmune diseases as well as in the development of autoantibodies to therapeutic proteins. At variance with neoplastic contexts, in which it is known to act as a pure immunosuppressive molecule, ARG1 exhibited a protective or pathogenetic profile, depending on the disease. In contrast, in several autoimmune conditions, the bulk of data indicated that drugs capable of potentiating IDO1 expression and activity may represent valuable therapeutic tools and that IDO1-based immunotherapeutic protocols could be more effective if tailored to the genetic profile of individual patients.

https://ift.tt/2BHF7U3

Amino acid metabolism as drug target in autoimmune diseases

Publication date: Available online 22 February 2019

Source: Autoimmunity Reviews

Author(s): Giada Mondanelli, Alberta Iacono, Agostinho Carvalho, Ciriana Orabona, Claudia Volpi, Maria T. Pallotta, Davide Matino, Susanna Esposito, Ursula Grohmann

Abstract

In mammals, amino acid metabolism has evolved to control immune responses. Autoimmune diseases are heterogeneous conditions that involve the breakdown of tolerogenic circuitries and consequent activation of autoreactive immune cells. Therefore, critical enzymes along amino acid degradative pathways may be hijacked to keep in check autoimmunity. We examined here current knowledge of indoleamine 2,3-dioxygenase 1 (IDO1) and arginase 1 (ARG1), the main enzymes catabolizing tryptophan and arginine, respectively, in organ-specific and systemic autoimmune diseases as well as in the development of autoantibodies to therapeutic proteins. At variance with neoplastic contexts, in which it is known to act as a pure immunosuppressive molecule, ARG1 exhibited a protective or pathogenetic profile, depending on the disease. In contrast, in several autoimmune conditions, the bulk of data indicated that drugs capable of potentiating IDO1 expression and activity may represent valuable therapeutic tools and that IDO1-based immunotherapeutic protocols could be more effective if tailored to the genetic profile of individual patients.

https://ift.tt/2BHF7U3

Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists

Summary

Background

The increasing incidence of actinic keratosis (AK) is causing a large burden on health care systems. The current management of AK patients seems to vary within and between primary and secondary care; however, an in‐depth understanding of healthcare providers' management of AK is currently lacking.

Objective

To gain insight into the management of AK by exploring underlying motives of current practices among general practitioners (GPs) and dermatologists in The Netherlands.

Methods

A qualitative study was conducted consisting of semi‐structured individual interviews with 22 GPs and 18 dermatologists focusing on the underlying motives regarding AK management. A predefined topic list was used. All interviews were audiotaped, transcribed verbatim, and inductively analysed by two researchers drawing on elements of grounded theory.

Results

GPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK, mainly applying cryotherapy or referral to secondary care due to lack of experience, varying in their applications and providing mostly patient‐driven follow‐up care; they also reported a high need for guidelines due to a lack of knowledge of AK management. Dermatologists indicated to pursue proactive clinical assessments of cutaneous photodamage and the goal of providing guideline‐driven AK care. Patient preferences, though, still largely influence both treatment choices and follow‐up regimens. Furthermore, dermatologists reported the need for improving AK and skin cancer management in primary care.

Conclusions

For AK care to become more standardized and uniform in Dutch primary care, the implementation of guidelines and (continuing) education are needed to address the commonly reported barriers of lack of value, experience and knowledge among GPs. For efficient use of care among dermatologists, shared decision‐making tools along with adequate (framing of) patient information may be useful.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Nm5i7n

Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists

Summary

Background

The increasing incidence of actinic keratosis (AK) is causing a large burden on health care systems. The current management of AK patients seems to vary within and between primary and secondary care; however, an in‐depth understanding of healthcare providers' management of AK is currently lacking.

Objective

To gain insight into the management of AK by exploring underlying motives of current practices among general practitioners (GPs) and dermatologists in The Netherlands.

Methods

A qualitative study was conducted consisting of semi‐structured individual interviews with 22 GPs and 18 dermatologists focusing on the underlying motives regarding AK management. A predefined topic list was used. All interviews were audiotaped, transcribed verbatim, and inductively analysed by two researchers drawing on elements of grounded theory.

Results

GPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK, mainly applying cryotherapy or referral to secondary care due to lack of experience, varying in their applications and providing mostly patient‐driven follow‐up care; they also reported a high need for guidelines due to a lack of knowledge of AK management. Dermatologists indicated to pursue proactive clinical assessments of cutaneous photodamage and the goal of providing guideline‐driven AK care. Patient preferences, though, still largely influence both treatment choices and follow‐up regimens. Furthermore, dermatologists reported the need for improving AK and skin cancer management in primary care.

Conclusions

For AK care to become more standardized and uniform in Dutch primary care, the implementation of guidelines and (continuing) education are needed to address the commonly reported barriers of lack of value, experience and knowledge among GPs. For efficient use of care among dermatologists, shared decision‐making tools along with adequate (framing of) patient information may be useful.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Nm5i7n

Characterization of a subgroup of non-type 2 asthma with cow’s milk hypersensitivity in young subjects

Asthma with atopy is often characterized by type 2 inflammation but less progress has been made in defining non-type 2 asthma. We have previously identified a subgroup of young non-atopic asthmatics with perce...

https://ift.tt/2SkkFOC

Adjuvant radiochemotherapy vs. chemotherapy alone in gastric cancer: a meta-analysis

Abstract

Background

As an adjuvant therapeutic strategy in advanced gastric cancer, both adjuvant chemotherapy (CTx) and postoperative radiochemotherapy (RCTx) can be considered. Both approaches have been shown to improve overall survival compared to resection alone. Several prospective randomized trials have compared the two postoperative concepts.

Methods

We performed a literature search to identify prospective randomized trials which compared adjuvant chemotherapy to adjuvant radiochemotherapy in patients with advanced gastric cancer. As effect sizes, we extracted hazard ratios (HR) as well as event rates from the included trials for the endpoints overall survival, disease-free survival and locoregional control.

Results

We identified seven studies that enrolled 1807 patients overall. Combined radiochemotherapy showed no significant improvement of overall survival in comparison to chemotherapy alone (HR = 0.93; 95%CI: 0.82–1.06; p = 0.28). For disease-free survival (HR = 0.86; 95%CI: 0.76–0.98; p = 0.023) and locoregional control (odds ratio [OR] = 0.56; 95%CI: 0.42–0.75; p = <0.001) we detected significant advantages from the addition of radiation to chemotherapy. A subgroup analysis demonstrated an improvement in survival when the radiochemotherapy protocol was not de-intensified.

Conclusions

Adjuvant chemotherapy or radiochemotherapy demonstrate similar oncologic efficacy and therapy-associated toxicity. Individual patient characteristics should therefore determine the therapeutic approach in a multidisciplinary discussion. Irradiation added to standard-dose chemotherapy possibly results in a survival benefit.

https://ift.tt/2E4eOrt

Single-center long-term results from the randomized phase-3 TARGIT-A trial comparing intraoperative and whole-breast radiation therapy for early breast cancer

Abstract

Purpose

Partial breast irradiation using intraoperative radiotherapy (IORT) after breast-conserving surgery could be sufficient for a selected group of breast cancer patients. We report the results of a cohort of patients from a single center treated as part of the randomized phase-3 TARGIT-A trial.

Methods

Patients (≥50 years) with cT1 cN0 cM0 and invasive ductal histology on biopsy were randomized between IORT with 20 Gy (arm-A) or postoperative whole-breast RT (WBRT) up to 56 Gy in 2 Gy fractions (arm-B). Postoperatively, patients in arm-A with multifocality, lymphovascular invasion, nodal invasion, extensive intraductal component, invasive lobular carcinoma, or resection margins <1 cm received additional postoperative WBRT.

Results

Between 2002 and 2012, 184 patients were randomized, of whom 90 in arm-A and 90 in arm-B were evaluated. Median follow-up was 8.5 years. The 5‑year overall survival was 94.4% in arm-A and 93.3% in arm-B (p = 0.73). Two local recurrences were observed: one at 70.3 months in an arm-A patient who received IORT + WBRT and another at 4.5 months in an arm-B patient who refused all forms of adjuvant treatment, thus resulting in a 5-year local recurrence of 0% in arm-A and 1.1% in arm-B. The 5‑year in-breast recurrence (outside of the index quadrant) was 0% in arm-A and 1.2% in arm-B. Salvage mastectomy was performed successfully in all patients with relapse.

Conclusion

Long-term follow-up of this single-center cohort consolidates the earlier reports of low local recurrence rates after single-dose IORT. Our results are in line with non-inferiority of risk-adapted IORT for selected patients with early breast cancer.

https://ift.tt/2SRI7Yo

Two Mutations in Thyroid Hormone Receptor Beta Gene (P453A and C36Y) in a Family with Resistance to Thyroid Hormone with Comorbid Myotonic Dystrophy

Thyroid, Ahead of Print.


https://ift.tt/2GUVMXs

Thyroid Function Reference Values in Healthy Iodine-Sufficient Pregnant Women and Influence of Thyroid Nodules on Thyrotropin and Free Thyroxine Values

Thyroid, Ahead of Print.


https://ift.tt/2tBmcWg

A cure model survival analysis of patients affected by small intestinal neuroendocrine neoplasms: the Bologna ENETS center experience

Abstracts

Purpose

The primary end-point was to evaluate the cure fraction. Secondary end-points were to investigate the time to cure, the excess of death risk, the probability of cure and the factors related to these parameters.

Methods

Retrospective study of an ENETS database regarding patients affected by Si-NENs. For each patients, clinical, pathological and follow-up data were collected. The survival analysis was made using a novel approach: the cure model approach.

Results

The cure fraction was 92.1%. The death risk, time to cure and the probability of cure were 6/1000 person-years, 3.6 years and 98.2%, respectively. The independent factors influencing these parameters were the grading and the R status (P = 0.041 and P = 0.017, respectively). Patients affected by Si-NENs G2 increased the death risk and time to cure respect to Si-NENs G1 (51 versus 6 per 1000 person-years and 5.1 versus 3.6 years, respectively) as well as patients not operated respect to those radically resected (R0/1) (66 versus 1 per 1000 person-years and 4.8 versus 0.4 years, respectively). The probability of cure decreased (88.1 versus 97.8% and 80.4 versus 99.7%, respectively). R2 resection shows better results than no resection.

Conclusions

A large portion of patients affected by Si-NENs can be cured. The highest probability of cure regards patients with Si-NENs G1 who underwent to R0/R1 resection; the lower, those with Si-NENs G2 and no resection. R2 resection seems to be preferred respect to no resection.

https://ift.tt/2Iw0T2L

Nasal lavage cytology and mucosal histopathological alterations in patients with rhinitis

Publication date: Available online 22 February 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Loreni C.S. Kovalhuk, Ederaldo Queiroz Telles, Monica Nunes Lima, Nelson A. Rosario Filho

Abstract

Introduction

The extent of epithelial lesion in allergic and non-allergic rhinitis and its association with inflammatory changes in nasal lavage has not been clarified.

Objective

To verify the association between the inflammatory cells in the nasal lavage, epithelial lesion extent and basement membrane thickness, in the nasal mucosa of patients with rhinitis; to determine the cutoff point of the percentage of eosinophils in the nasal lavage associated with the atopic patients.

Methods

Patients with rhinitis and indication for septoplasty and (or) turbinectomy for turbinate hypertrophy were selected, and were submitted to allergy skin tests, nasal lavage with measurement of albumin and interleukin-8 levels, total and differential counting of cells, and mucosal histopathological analysis to determine the extent of epithelial lesion, and degree of basement membrane thickening.

Results

Fifty-six patients with a median age of 24.5 years and a diagnosis of allergic rhinitis (n = 36) and non-allergic rhinitis (n = 20) were studied. In atopic subjects, allergy skin tests were positive for Dermatophagoides pteronyssinus in 35 (97.0%) and Lolium perenne in 18 (50.0%). Atopic subjects showed a higher clinical score index of rhinitis compared to non-atopic ones. The total count of cells, neutrophils, and levels of albumin and IL-8 were not different in the nasal lavage of atopic and non-atopic subjects. The cutoff point for eosinophil count in nasal fluid for the distinction between allergic rhinitis and non-allergic rhinitis was 4%. Some degree of epithelial lesion was more frequent in allergic rhinitis (94%) than in non-allergic rhinitis (65%) patients. In the presence of basement membrane thickness, as a marker of remodeling, there was no difference in the nasal lavage of patients with allergic rhinitis and non-allergic rhinitis.

Conclusion

In this series, 4% was the cutoff point for the number of eosinophils in the nasal lavage, for atopy differentiation. Upper airway remodeling accessed by basement membrane thickness showed similar inflammatory cell infiltrate in the nasal lavage, regardless of the presence of atopy.

Resumo

Introdução

A extensão da lesão epitelial na rinite alérgica e não alérgica e sua associação com alterações inflamatórias no lavado nasal, ainda não estão esclarecidas.

Objetivo

Verificar a relação entre o processo inflamatório no lavado nasal, extensão da lesão epitelial e espessamento da membrana basal na mucosa nasal de pacientes com rinite; determinar o ponto de corte do percentual de eosinófilos no lavado nasal associado à presença de atopia.

Método

Foram selecionados pacientes com rinite e indicação de septoplastia e (ou) turbinectomia por hipertrofia de conchas nasais, os quais foram submetidos aos testes cutâneos alérgicos, lavado nasal com determinação das concentrações de albumina, interleucina-8 (IL-8), contagem total e diferencial de células, análise da extensão da lesão epitelial, e grau de espessamento da membrana basal por meio de histopatologia da mucosa.

Resultados

Foram estudados 56 pacientes, mediana de idade de 24,5 anos com diagnóstico de rinite alérgica (n = 36) e rinite não alérgica (n = 20). Nos atópicos os testes cutâneos alérgicos foram positivos para D. pteronyssinus em 35 (97,0%) e L. perenne em 18 (50,0%). Atópicos apresentaram maior índice de escore clínico para rinite em comparação a não atópicos. A contagem total de células, neutrófilos e níveis de albumina e IL-8, não foi diferente entre o lavado nasal de atópicos e não atópicos. O ponto de corte da contagem de eosinófilos no fluido nasal para a distinção de rinite alérgica e rinite não alérgica foi de 4%. Algum grau de lesão epitelial foi mais frequente em pacientes com rinite alérgica (94%) do que em pacientes com rinite não alérgica (65%). Na presença de espessamento da membrana basal, como marcador de remodelamento, não houve diferença no lavado nasal entre pacientes com rinite alérgica e não alérgica.

Conclusão

Nesta casuística, 4% foi o ponto de corte do número de eosinófilos no lavado nasal, para diferenciação de atopia. Remodelamento da via aérea superior pelo espessamento da membrana basal, revelou infiltrado semelhante de células inflamatórias no lavado nasal, independentemente da presença de atopia.

https://ift.tt/2Sk2g4a

Factors influencing the quality of life of children with cochlear implants

Publication date: Available online 22 February 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Joice de Moura Silva, Midori Otake Yamada, Elida Garbo Guedes, Adriane Lima Mortari Moret

Abstract

Introduction

The multidimensional impact of hearing loss on the various demands of life in children using cochlear implants is represented by variables that can influence the hearing, language and quality of life outcomes of this population.

Objective

To evaluate the factors influencing the quality of life of children with cochlear implantation, considering age, hearing age, age at evaluation, hearing skills, spoken language, family degree of receptiveness, schooling and socioeconomic status of the parents.

Methods

30 children using cochlear implants, aged 6–12 years and their respective parents participated. The children were evaluated by the "Categories of Auditory Performance", by "Language Category", and by the "Children with Cochlear Implants: Perspectives of Parents" questionnaire. Parents were assessed by the "Family Involvement Scale".

Results

The cochlear implant impacted the quality of life of the children, with more significant results on the increase of the social relations domain and the decrease of the family support domain. Overall, the increase of the age in the evaluation, better hearing and language skills, the mother's level of schooling and the family receptiveness correlated with the quality of life of children with cochlear implants.

Conclusion

The influencing factors that correlated with the quality of life of the implanted children were the child's older age at the evaluation, the better hearing and language skills, the mother's level of schooling and the family receptiveness.

Resumo

Introdução

O impacto multidimensional da deficiência auditiva nas várias demandas da vida das crianças usuárias de implante coclear é representado por variáveis que podem influenciar os resultados de audição, linguagem e qualidade de vida desta população.

Objetivo

Avaliar os fatores influenciadores na qualidade de vida de crianças com implante coclear, considerando a idade na cirurgia, a idade auditiva, a idade na avaliação, as habilidades auditivas, a linguagem falada, o grau de permeabilidade familiar, a escolaridade e o nível socioeconômico dos pais.

Método

Participaram 30 crianças usuárias de implante coclear com idade entre 6 a 12 anos e seus respectivos pais. As crianças foram avaliadas pela "Categorias de Audição", pela "Categoria de Linguagem, e pelo questionário "Crianças com Implante Coclear: Perspectivas dos Pais". Os pais foram avaliados pela "Escala de Envolvimento Familiar".

Resultados

O implante coclear impactou a qualidade de vida das crianças, com resultados mais significativos sobre o aumento do domínio relações sociais e a diminuição do domínio suporte da família. De maneira geral, maior idade na avaliação, as melhores habilidades auditivas e de linguagem, a escolaridade da mãe e a permeabilidade da família se correlacionaram com a qualidade de vida de crianças com implante coclear.

Conclusão

os fatores influenciadores que se correlacionaram com a qualidade de vida das crianças implantadas foram a maior idade na avaliação, as melhores habilidades auditivas e de linguagem, a escolaridade da mãe e a permeabilidade da família.

https://ift.tt/2GGpIY1

Surgical outcomes of sinonasal inverted papilloma: a 17 year review

Publication date: Available online 21 February 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Gil Coutinho, Joana Marques, Manuel Leal, Jorge Spratley, Margarida Sá Fernandes, Margarida Santos

Abstract

Introduction

Inverted papillomas represent one of the most common benign neoplasic lesions located in the sinonasal tract. Owing to the local erosive behavior, tendency to recur and the potential for malignant transformation, surgical management of inverted papillomas is often challenging.

Objective

This study aimed to analyze the surgical outcomes of patients with inverted papillomas, according to the Krouse staging and the different surgical approaches.

Methods

Retrospective study of patients diagnosed with sinonasal inverted papillomas who underwent surgical treatment between 2000 and 2016 at a tertiary referral hospital. Cases with follow-up less than 12 months were excluded. The rate and the time of recurrence were the main outcomes. Values of p < 0.05 were considered statistically significant.

Results

Thirty-six cases with mean age of 60 years, predominantly male (72%), were included. The follow-up period ranged from 1 to 17 years, with an average of 4.5 years. Krouse T1 Stage corresponded to 11.1%; T2 occurred in 50% of cases; while T3 and T4 Stages accounted for 30.6% and 8.3% of patients, respectively. Most cases were approached by an endoscopic technique alone (83.3%), with a recurrence rate of 13.3%. Patients treated via a combined or open approach revealed a recurrence of 16.7%. No differences in the recurrence rate were reported when comparing endoscopic surgery with the open or combined techniques. Krouse Stage T3 had a significant association with inverted papillomas recurrence (p = 0.023). All inverted papilloma relapses occurred up to 2 years post-operatively. One case of malignant transformation was recorded (2.7%).

Conclusion

Endoscopic surgery did not increase the recurrence rates and can be a safe and efficient alternative to open or combined techniques. The recurrence of inverted papillomas seem to be related to the persistence of the disease and tend to occur early after primary surgery. Krouse T3 Stages may be associated with a higher recurrence of inverted papillomas.

Resumo

Introdução

Os papilomas invertidos são uma das lesões neoplásicas benignas mais comuns no trato nasossinusal. Devido ao comportamento erosivo local, à tendência a recorrência e ao potencial de transformação maligna, o tratamento cirúrgico dos papilomas invertidos é muitas vezes desafiador.

Objetivo

Este estudo teve como objetivo analisar os resultados cirúrgicos dos papilomas invertidos segundo o estadiamento de Krouse, bem como avaliar as diferentes abordagens cirúrgicas.

Método

Este foi um estudo retrospectivo de pacientes com diagnóstico de papiloma invertido nasossinusal submetidos a tratamento cirúrgico entre 2000 e 2016 em hospital terciário de referência. Casos com acompanhamento inferior a 12 meses foram excluídos. A taxa e o tempo de recorrência foram os principais desfechos avaliados. Valores-p < 0,05 foram considerados estatisticamente significantes.

Resultados

O estudo incluiu 36 casos, com média de idade de 60 anos, predominantemente do sexo masculino (72%). O período de acompanhamento variou de 1 a 17 anos, em uma média de 4,5 anos. Quanto ao estadiamento, 11,1% dos pacientes foram classificados como estágio T1 de Krouse, 50% como T2, 30,6% como T3 e 8,3% como T4. A maioria dos casos foi tratada apenas por cirurgia endoscópica (83,3%), com taxa de recorrência de 13,3%. Pacientes tratados com uma técnica combinada ou aberta apresentaram recorrência de 16,7%. Não foram observadas diferenças quanto à taxa de recorrência quando a cirurgia endoscópica foi comparada com as técnicas abertas ou combinadas. Observou-se uma associação significante entre o estágio T3 de Krouse e recorrência de papilomas invertidos (p = 0,023). Todas as recidivas de papilomas invertidos foram observadas até dois anos após a operação. Um caso de transformação maligna foi registrado (2,7%).

Conclusão

A cirurgia endoscópica não aumentou as taxas de recidiva e pode ser uma alternativa segura e eficiente às técnicas abertas ou combinadas. Os casos de recorrência do papiloma invertido parecem estar relacionados à persistência da doença e tendem a ocorrer precocemente após a cirurgia primária. Os estágios T3 de Krouse podem estar associados a uma maior recorrência.

https://ift.tt/2Nt9BxT

A cure model survival analysis of patients affected by small intestinal neuroendocrine neoplasms: the Bologna ENETS center experience

Abstracts

Purpose

The primary end-point was to evaluate the cure fraction. Secondary end-points were to investigate the time to cure, the excess of death risk, the probability of cure and the factors related to these parameters.

Methods

Retrospective study of an ENETS database regarding patients affected by Si-NENs. For each patients, clinical, pathological and follow-up data were collected. The survival analysis was made using a novel approach: the cure model approach.

Results

The cure fraction was 92.1%. The death risk, time to cure and the probability of cure were 6/1000 person-years, 3.6 years and 98.2%, respectively. The independent factors influencing these parameters were the grading and the R status (P = 0.041 and P = 0.017, respectively). Patients affected by Si-NENs G2 increased the death risk and time to cure respect to Si-NENs G1 (51 versus 6 per 1000 person-years and 5.1 versus 3.6 years, respectively) as well as patients not operated respect to those radically resected (R0/1) (66 versus 1 per 1000 person-years and 4.8 versus 0.4 years, respectively). The probability of cure decreased (88.1 versus 97.8% and 80.4 versus 99.7%, respectively). R2 resection shows better results than no resection.

Conclusions

A large portion of patients affected by Si-NENs can be cured. The highest probability of cure regards patients with Si-NENs G1 who underwent to R0/R1 resection; the lower, those with Si-NENs G2 and no resection. R2 resection seems to be preferred respect to no resection.

https://ift.tt/2Iw0T2L