Impact of an Urban Environment on Trace Element Concentrations in Domestically Produced Lettuce ( Lactuca sativa L. )

Abstract

Urban horticulture is gaining more and more attention in the context of sustainable food supply. Yet, cities are exposed to (former) industrial activities and traffic, responsible for emission of contaminants. Trace elements were monitored in soils located in the urban environment of Ghent (Belgium) and 84 samples of Lactuca satica L. lettuce grown on it. The effects of cultivation in soil versus trays, neighbouring traffic and washing of the lettuce before consumption were studied. The 0–30 cm top layer of soils appeared heterogenic in composition and enriched in Co, Cd, Ni and Pb within 10 m from the nearest road. Yet, no similar elevated concentrations could be found in the crops, except for As. Besides uptake from the roots, the presence of trace elements in the plants is also caused by the atmospheric deposition of airborne particulate matter on the leaf surface. Correlation analysis and principal component analysis (PCA) revealed that this latter transport pathway might particularly be the case for Pt, Pd and Rh. Concentrations of Cd did not exceed the 0.2 mg kg⁻¹ (fresh weight) threshold for Cd in leafy vegetables set by the European Commission. Measurements to reduce the health risks include the washing of lettuce, which effectively reduced the number of samples trespassing the maximum Pb level of 0.3 mg kg⁻¹ (fresh weight). Also, cultivation in trays resulted in a lower As content in the plants. Taking into account a vigilance on crop selection, cultivation substrate and proper washing before consumption are considered essential steps for safe domestic horticulture in urban environments.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zeOafL

Restless legs syndrome and sleep quality among adult sickle cell disease patients

Abstract

Objective

The purpose of this study is to determine and compare the prevalence of restless legs syndrome (RLS) between adult patients with sickle cell disease (SCD) and non-SCD anemia.

Methods

This cross-sectional study was conducted from December 2013 to July 2014. Patients with SCD and non-SCD anemia were recruited from a hematology clinic at a large university hospital. Patients with secondary RLS were excluded. Data were collected on demographic features, clinical evaluations, laboratory tests, sleep quality using the Pittsburgh Sleep Quality Index, RLS symptoms using the International Restless Legs Syndrome Study Group Criteria, severity of RLS using the International Restless Leg Syndrome Rating Scale, and daytime sleepiness using the Epworth Sleepiness Scale.

Results

The study sample consisted of 44 patients with SCD and 45 with non-SCD anemia. The two groups were comparable in age, gender, body mass index, smoking habit, and comorbidities. Poor sleep quality was found in 63% of the SCD group compared to 53% of the non-SCD group. The prevalence of RLS among SCD group and non-SCD group was 13.6% (6/44) and 8.8% (4/45), respectively. These differences, however, were not statistically significant, p > 0.05. Excessive daytime sleepiness was also similar in both groups, with the rate being 20.5 and 17.8% in the SCD and non-SCD groups, respectively.

Conclusion

Our study revealed that poor sleep quality and RLS were both common among adult patients with SCD; however, they did not differ significantly from patients with non-SCD anemia.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zPK7WY

Revisits after pediatric tracheotomy: Airway concerns result in returns

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Sophie Shay, Nina L. Shapiro, Neil Bhattacharyya
ObjectivesChildren undergoing tracheotomy represent a medically vulnerable patient population, and understanding the reasons for revisiting the hospital setting following tracheotomy is critical for improving the quality of care for these patients. This study aims to investigate the incidence and characteristics of revisits following pediatric tracheotomy.MethodsCross-sectional, population-based study using state databases. The State Inpatient Databases and State Emergency Department Databases for California, Florida, Iowa and New York 2010–11 were linked and examined for cases of pediatric tracheotomy (patients < 18.0 years) and corresponding subsequent 30-day post-discharge revisits. Demographic and descriptive data were analyzed determining the revisit rate, revisit diagnoses, procedures, and discharge dispositions.Results2,248 pediatric tracheotomy cases were extracted (60.8% male, mean age 8.3 years). There were 373 inpatient or emergency department revisits (30-day revisit rate, 16.6%), of which 34.3% occurred within 48 h after discharge. Of these, 59.2% were inpatient readmissions. There were ≤10 deaths during these revisits (30-day revisit mortality rate, ≤2.7%). The most common primary revisit diagnoses were "fitting of prosthesis and adjustment of devices" (25.7%, likely representing adjustment/replacement of the tracheotomy tube), respiratory failure (11.0%), intracranial injury (5.4%), pneumonia (4.0%), "other upper respiratory disease" (3.8%), and "complications of surgical procedures or medical care" (3.8%). The most common revisit procedures were endotracheal intubation (11.4%), mechanical ventilation (8.8%), and replacement of tracheostomy tube (≤2.7%). Children discharged to a skilled care facility (47.1%) were more likely than those discharged to home (52.9%) to have a revisit (23.3% versus 12.0%, respectively; p < 0.001).ConclusionsChildren undergoing tracheotomy have a substantial 30-day revisit rate, most notably during the first 48 h after discharge, often involving tracheotomy tube or pulmonary complications. Improvements in discharge planning should target prevention of these complications.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j54tB3

Branchial anomalies in children: A report of 105 surgical cases

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Wanpeng Li, Hongming Xu, Liming Zhao, Xiaoyan Li
BackgroundBranchial anomalies (BAs) account for 20% of all congenital masses in children. We sought to review the incidence of involvement of individual anomalies, diagnostic methods, surgical treatment, and complications of BAs in children. In addition, we also classified our study and analyzed a congenital lower neck cutaneous fistula near the sternoclavicular joint that was thought to be the skin-side remnant of the fourth BAs.MethodsWe conducted a retrospective analysis of 105 children who were referred to our hospital from June 2009 to December 2016 for the treatment of BAs.ResultsIn this series, there were 51 males and 54 females. The age at the time of operation varied from 19 days to 13 years, and the mean age was 4.5 years. A total of 33 (31.4%) cases presented with first BAs, 13 (12.4%) presented with second BAs, and 59 (56.2%) presented with third and fourth BAs, including 6 cases of congenital lower neck cutaneous fistula. Fistulectomy under general anesthesia was performed on all of them. For postoperative complications, 2 cases had temporary facial paralysis, 1 case had permanent facial paralysis, 4 cases had temporary recurrent laryngeal nerve injury. Recurrence occurred in 2 patients with first BAs after medium follow-up time of 3.6 years (6 months–8 years).ConclusionsBAs are common congenital head and neck lesions in children, and there are four distinct types (first, second, third and fourth anomalies). The incidence of third and fourth BAs in Asia maybe higher when compared with literature reports, second BAs seem rare in this population, but more research is needed to confirm this perspective. Diagnosis is not difficult with a proper knowledge of the anatomy of the BAs. The surgical procedures should be tailored depending on the various types, and complete excision of the fistula is the key to prevent recurrence.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j4QyLs

Adaptation and validation of Mandarin Chinese version of the pediatric Voice Handicap Index (pVHI)

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Dan Lu, Mengjie Huang, Zhen Li, Edwin M.-L. Yiu, Ivy K.-Y. Cheng, Hui Yang, Estella P.-M. Ma
ObjectiveThe aim of this study was to adapt and validate the English version of pediatric voice handicap index (pVHI) into Mandarin Chinese.
MethodsA cross-sectional study was performed from May 2016 to April 2017. A total of 367 parents participated in this study, and 338 parents completed the translated questionnaire without missing data, including 213 parents of children with voice disorders (patients group), and 125 parents of children without voice disorders (control group). The internal consistency, test-retest reliability, contents validity, construct validity, clinical validity, and cutoff point were calculated.ResultsThe most common voice disorder in the patients group was vocal fold nodules (77.9%), followed by chronic laryngitis (18.8%), and vocal fold polyps (3.3%). The prevalence for voice disorders was higher in boys (67.1%) than girls (32.9%). The most common vocal misuse and abuse habit was shouting loudly (n = 186, 87.3%), followed by speaking for a long time (n = 158, 74.2%), and crying loudly (n = 99, 46.5%). The internal consistency for the Mandarin Chinese version of pVHI was excellent in patients group (Cronbach α = 0.95). The inter-class correlation coefficient indicated strong test-retest reliability (ICC = 0.99). The principal-component analysis demonstrated three-factor eigenvalues greater than 1, and the cumulative proportion was 66.23%. The mean total scores and mean subscales scores were significantly higher in the patients group than the control group (p < 0.05). The physical domain had the highest mean score among the three subscales (functional, physical and emotional) in the patients group. The optimal cutoff point of the Mandarin Chinese version of pVHI was 9.5 points with a sensitivity of 80.3% and a specificity of 84.8%.ConclusionThe Mandarin Chinese version of pVHI was a reliable and valid tool to assess the parents' perception about their children's voice disorders. It is recommended that it can be used as a screening tool for discriminating between children with and without dysphonia.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zT9OmZ

Coblation versus microdebrider in pediatric adenoidectomy

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Chris Mularczyk, David L. Walner, Katherine K. Hamming
ObjectiveTo compare and contrast coblation and microdebrider with touch-up electrocautery (ME) for adenoidectomy in children.MethodsPatients <18 years old undergoing adenoidectomy without tonsillectomy were selected for this prospective, single-blinded, randomized controlled trial. Participants were enrolled into one of two groups based on birth date: coblation or ME. The surgeons completed a standard survey about intraoperative factors for each method. Recovery nurses filled out a standardized survey postoperatively. A third standardized survey was completed via a phone interview with the parent or patient caregiver on postoperative day 3 to assess procedure outcomes. The survey results were then compared using ANOVA statistical analysis.Results50 patients were enrolled in the coblation group and 51 were enrolled in the ME group. There was no significant difference in mean age between the coblation (4.96 years) and ME groups (4.58 years) (p = 0.525). The mean time (in minutes) for coblation (5.50) was significantly lower than ME (9.47) when controlling for the confounder: surgical site exposure (p < 0.001). The surgical time was significantly influenced by the quality of exposure/visualization (p = 0.037). The coblator method had significantly less intraoperative blood loss compared to ME (p < 0.001). There was a statistically significant difference between coblation (1.53) and ME (2.05) for days of pain (p = 0.045) when controlling for the confounder adenoid size.ConclusionIn our study we found that coblation demonstrated significantly less intraoperative time and less blood loss, as well as a shorter duration of postoperative pain, when compared to ME for adenoidectomy.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j6gMNq

Congenital respiratory tract disorders in 22q11.2 deletion syndrome

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Emmy Verheij, Lucienne Speleman, Aebele B. Mink van der Molen, Henricus G.X.M. Thomeer
ObjectiveRespiratory tract disorders have been reported in patients with 22q11.2 deletion syndrome, however infrequently. This study describes the respiratory tract disorders encountered in a cohort of 278 patients with 22q11.2 deletion syndrome.MethodsWe conducted a retrospective, cross-sectional, study at a single tertiary referral center. We identified the patients with 22q11.2 deletion syndrome and with an upper and/or lower respiratory tract disorder at our otorhinolaryngologic department. The different disorders were described.ResultsOut of 278 patients referred to the otorhinolaryngologic department, we identified 14 patients with a laryngeal and/or tracheal disorder. Nine patients had more than one congenital disorder in this anatomical area. Disorders included a choanal stenosis (n = 1), laryngeal web (n = 5), laryngeal cleft (n = 2), subglottic stenosis (n = 3), pharyngo-, laryngo-, tracheo- and/or bronchomalacia (n = 11) and tracheal stenosis (n = 1).ConclusionDifferent types of respiratory tract disorders can be present in patients with 22q11.2 deletion syndrome. Clinicians should be aware of this clinical association for timely and accurate diagnosis and treatment. In addition, the diagnosis 22q11.2 deletion syndrome should be considered in patients presenting with a congenital respiratory tract disorder.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zT9KDL

Effect of preoperative visiting operation room on emergence agitation in preschool children under sevoflurane anesthesia

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Qiaosheng Zhong, Xianfeng Qu, Chuanhua Xu
BackgroundEmergence agitation (EA) is a common complication in children during recovery from sevoflurane anesthesia with an high incidence. The main objective of this study was to compare the effects of preoperative visiting operation room (PVOR) to administration of propofol at the end of anesthesia on EA in preschool children under sevoflurane anesthesia.MethodsSixty-nine preschool children aged from 3 to 6 years scheduled for tonsillectomy under sevoflurane anesthesia were randomly allocated to one of the three groups to receive either PVOR (Group PV), routine preoperative visit (Group RV) or routine preoperative visit plus propofol (Group RP), 23 patients were included in each group. General anesthesia was induced and maintained with sevoflurane. Parental separation status score, mask acceptance score, Aono's four point score and pediatric anesthesia emergence delirium (PAED) score and incidence of EA were recorded. PAED score >10 were regarded as EA. Recovery profile and adverse events were also recorded.ResultParental separation status score and mask acceptance score in group PV was significantly lower than that in group RV and group RP (P < 0.05); Aono's four point score, PAED score and incidence of EA in group PV and group RP was significantly lower than that in group RV (P < 0.05); Time to extubation and time to interaction in group PV and group RV was significantly shorter than that in group RP (P < 0.05); POV and rescue by fentanyl in group PV and group RP was significantly lower than that in group RV(P < 0.05).ConclusionPVOR can effectively reduce the incidence of EA as well as administration of propofol without additional medical expenses and other adverse effects.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j506Ga

Evaluation and remediation of central auditory processing disorders in children with autism spectrum disorders

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Hesham Kozou, Hanan Galal Azouz, Rania M. Abdou, Alyaa Shaltout
ObjectivesThis study was carried out to assess various skills of central auditory processing (CAP) in children with autism spectrum disorders (ASD) and to evaluate the efficacy of auditory training in these children.MethodsThis study is a non-randomized clinical experiment. 30 high functioning ASD children aged from 7 to 12 years were included in the study. They underwent behavioral assessments of CAP skills with subsequent remediation by dichotic training therapy for the children who revealed dichotic deficits.ResultsScores of CAP skills in ASD children are wide-ranging from completely normal to substantially defective and generally lower than those of typically developing children. By auditory training, ASD children improved their dichotic deficits as well as other untrained areas of auditory and language processing skills.ConclusionsA group of ASD children showed different degrees of abnormalities in CAP that could be measured behaviorally and achieved benefits from auditory training in improving their dichotic listening, auditory and language processing skills.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zTgqle

Closure of fistula of the hard palate with two layers of mucoperiosteum

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Mosaad Abdel-Aziz, Ahmed Kamel, Mohamed Fawaz, Ibrahim Rezk, Mohamed Kamel
ObjectiveOronasal fistula represents a functional problem, as it may result in nasal regurgitation of food and fluids and it also leads to hypernasal speech. Many methods have been proposed for its closure with a high recurrence rate. The aim of this study was to assess the efficacy of closure of hard palate fistula by two layers of mucoperiosteal flaps.MethodsEighteen patients with fistula of the hard palate were included. The fistula was repaired by two layers of mucoperiosteal flaps; the first layer was created from the mucoperiosteum surrounding the fistula as bilateral hinge flaps and the second layer was formed of a rotational flap based on the greater palatine artery. Pre- and postoperative clinical assessment was performed.ResultsThe etiology of fistulas was previous cleft palate repair in 13 patients, previous nasal septal surgery in 3 patients, and untreated sharp accidental trauma to the palate in 2 patients. All patients presented with nasal regurgitation and hypernasal speech. Complete closure of all fistulas was achieved at first attempt, with no recurrence through the follow up period.ConclusionsClosure of oronasal fistula by two layers of mucoperiosteal flaps is an effective method and it has neither complications nor recurrence.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j5Azg7

A novel splicing mutation in SMPX is linked to nonsyndromic progressive hearing loss

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Zhijie Niu, Denise Yan, Sara Bressler, Lingyun Mei, Yong Feng, Xuezhong Liu
ObjectiveX-linked nonsyndromic hearing impairment is the rarest form of genetic hearing loss and represents only a minor fraction of all cases. The aim of this study was to investigate the cause of X-linked nonsyndromic sensorineural hearing loss in a three-generation American family.MethodsWhole-exome sequencing and co-segregation analysis were used to identify disease-causing genes.ResultsIn this study, we described in detail the clinical characteristics of the family and identified a novel frameshift mutation creating a premature stop codon (c.133-1 G > A, p.(Gly45fs*36)) of SMPX. The loss-of-function mutation was co-segregated with the progressive hearing loss phenotype and was absent in 200 normal controls.ConclusionsWe report the first SMPX (DFNX4) mutation in a North American family. Our findings contribute to the existing genotypic and phenotypic spectrum of SMPX associated hearing loss. Furthermore, our data suggest that exome sequencing is promising in the genetic diagnosis of hearing loss.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zSdgOH

Incidence and factors associated with revision adenoidectomy: A retrospective study

Publication date: December 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 103
Author(s): James Johnston, Murali Mahadevan, Richard G. Douglas
IntroductionAdenoidectomy is one of the most commonly performed pediatric operations worldwide. There are a proportion of children who require revision adenoidectomy. Yet there is little in the literature about the incidence, associated factors and etiology of adenoidal regrowth. The aim of this retrospective cohort study was to determine incidence and factors associated with revision adenoidectomy.MethodsAn extraction of all hospital morbidity records belonging to patients under the age of 18 years who underwent one or more adenoidectomy procedures (with or without tonsillectomy) between January 1, 2000 and June 2016 at a tertiary care children's hospital was performed. Demographic, diagnostic, and procedural data were included in the analysis. Community prescribing information was examined for the number of courses of antibiotics prescribed to each patient prior to initial adenoidectomy.ResultsThere were 8260 patients under the age of 18 years who underwent primary adenoidectomy from 2000 to 2016 at a tertiary pediatric hospital. 2.5% (n = 212) of patients underwent revision adenoidectomy in our cohort during the same time period. A higher proportion of females underwent revision adenoidectomy when compared to male counterparts (p = 0.007). Patients who were prescribed more than five courses of antibiotics prior to initial adenoidectomy were more likely to undergo revision adenoidectomy (p = 0.003). Patients with a diagnosis of otitis media with effusion were more likely to undergo revision adenoidectomy (p=<0.001). A diagnosis of asthma (p=<0.001), gastroesophageal reflux disease (GERD) (p=<0.001), and allergic rhinitis (p=<0.001) was associated with revision adenoidectomy. An age of over 4 years at the time of initial adenoidectomy was associated with revision adenoidectomy (p=<0.001). Adenoids that obstructed over 75% of the nasal choanae were associated with revision adenoidectomy in this cohort (p=<0.001).ConclusionThis study has identified several factors associated with revision adenoidectomy.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zTyHij

Microarray analysis of lncRNA and mRNA expression profiles in mice with allergic rhinitis

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Yue Ma, Le Shi, Chunquan Zheng
ObjectivesWe aimed to identify the effect of lncRNAs in CD4⁺ T cells on Allergic rhinitis (AR).MethodsThe present study conducted a microarray to identify the expression profiles of lncRNA and mRNA in CD4⁺ T cells in both AR murine models and normal controls. And qRT-PCR was used to confirm the results. GO and KEGG enrichment analysis were used to show all related pathways and a co-expression network was conducted to find lncRNAs which have high correlation with these pathways.ResultsThe results showed that the two groups contained a total of 158 deregulated lncRNAs, of which 110 were upregulated and 48 were downregulated. And positive regulation of calcium ion transport, B cell activation, chemokine-signaling pathways and calcium-signaling pathways may be involved in the development of T cells in AR pathology. Finally, we can find the differentially expressed mRNA in the pathways related to T cell differentiation correlated with many deregulated lncRNAs.ConclusionsThe present study was the first to show the differential expression profiles of lncRNAs in the CD4⁺ T cells of an AR murine model, which may provide significant insights into AR pathogenesis and offer new treatment targets to alleviate it.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zTgl0U

Effects of transient auditory deprivation during critical periods on the development of auditory temporal processing

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Bong Jik Kim, Jungyoon Kim, Il-Yong Park, Jae Yun Jung, Myung-Whan Suh, Seung-ha Oh
ObjectivesThe central auditory pathway matures through sensory experiences and it is known that sensory experiences during periods called critical periods exert an important influence on brain development. The present study aimed to investigate whether temporary auditory deprivation during critical periods (CPs) could have a detrimental effect on the development of auditory temporal processing.Materials and methodsTwelve neonatal rats were randomly assigned to control and study groups; Study group experienced temporary (18–20 days) auditory deprivation during CPs (Early deprivation study group). Outcome measures included changes in auditory brainstem response (ABR), gap prepulse inhibition of the acoustic startle reflex (GPIAS), and gap detection threshold (GDT). To further delineate the specific role of CPs in the outcome measures above, the same paradigm was applied in adult rats (Late deprivation group) and the findings were compared with those of the neonatal rats.ResultsSoon after the restoration of hearing, early deprivation study animals showed a significantly lower GPIAS at intermediate gap durations and a larger GDT than early deprivation controls, but these differences became insignificant after subsequent auditory inputs. Additionally, the ABR results showed significantly delayed latencies of waves IV, V, and interpeak latencies of wave I-III and wave I-V in study group. Late deprivation group didn't exhibit any deterioration in temporal processing following sensory deprivation.ConclusionTaken together, the present results suggest that transient auditory deprivation during CPs might cause reversible disruptions in the development of temporal processing.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j5LEO6

Low rate of positive bronchoscopy for suspected foreign body aspiration in infants

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Cameron C. Sheehan, Joseph Lopez, Charles A. Elmaraghy
ObjectivesTo describe our institution's low rate of positive bronchoscopy in infants suspected of inhaling a foreign body.Study DesignRetrospective chart review.MethodsA retrospective review was performed of patients at a tertiary children's hospital with suspected inhalation of a foreign body. Charts were reviewed for demographic information, radiologic findings, operative reports, and respiratory viral panels were reviewed.ResultsSixteen pediatric patients under 12 months of age were identified from 2008 to 2016 with a diagnosis of possible airway foreign body inhalation who underwent emergent bronchoscopy. Of these patients, only one was positive for a foreign body present in the airway. The remaining 15 children were found to have a negative direct laryngoscopy and bronchoscopy evaluation for a foreign body. Of these fifteen patients, 14 were found to have structural airway abnormalities and 7 tested positive for a respiratory viral infection.ConclusionsOur institution has a low rate of positive bronchoscopy for highly suspected foreign body inhalation in a group of patients less than 12 months of age. Patients presenting with respiratory distress, stridor, or other airway symptoms were often found to have an underlying airway abnormality or viral infection, which coupled with an unclear history, would increase the suspicion for an airway foreign body and subsequent decision to perform bronchoscopy. In stable patients, diagnostic evaluation for an underlying respiratory infection should be performed in these cases.Level of EvidenceCase Series.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zTgjWQ

Cardiac complications in diphtheria and predictors of outcomes

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Sunil Samdani, Avani Jain, Vinod Meena, C.B. Meena
ObjectiveTo study the cardiac complications in diphtheria patients and to study the predictors of outcomes.Study DesignSingle centre prospective analysis of cardiac complications in diphtheria patients.ResultsIn this study, there were 60 patients diagnosed with diphtheria with ECG changes. The ECG changes seen were sinus tachycardia (68.3%), T wave inversion (20%), ST segment depression (13.3%), right bundle branch block (5%), multiple atrial ectopics (3.3%). The case fatality rate in our study was 25% (15 patients). High CPK-MB, myoglobulin and cardiac troponin levels were associated with cardiac mortality. In our study, cardiac troponin T had the highest sensitivity (80%) and CK-MB had the highest specificity (95.56%).ConclusionCardiac involvement is a common complication of infection with C. diphtheria and is associated with high mortality. As diphtheria can be prevented by adequate vaccination, efforts should be maximized for high vaccine coverage with booster doses.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j6ggis

Management trends of infantile hemangioma: A national perspective

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Mana Espahbodi, Ke Yan, Robert H. Chun, Michael E. McCormick
IntroductionThe primary management of infantile hemangioma (IH) has changed since 2008, with the initiation of propranolol. The change that propranolol has affected on resource utilization is unknown.Materials and methodsThe Kids' Inpatient Database (KID) in 2003, 2006, 2009, and 2012 was queried for ICD-9 codes for IH in children under age three. The number of patients undergoing the following procedures of interest: tracheostomy, tracheoscopy and laryngoscopy with biopsy, and excision of skin lesion were evaluated. Data was analyzed for demographics and details on the admission. Trends were identified. Weighted statistical analyses were performed with SAS 9.4.ResultsThe number of qualified admissions significantly increased over the years (9271 in 2003–12029 in 2012, OR 1.042 per year increase, p < 0.001). The mean age at admission ranged from 26 to 28 days but did not vary over time (p = 0.54). The percentage undergoing tracheostomy significantly decreased from 1.05% in 2003 to 0.27% in 2012 (p = 0.0055), and the percentage undergoing tracheoscopy and laryngoscopy with biopsy significantly decreased from 7.29% in 2003 to 4.20% in 2012 (p = 0.011) among those with IH of unspecified or other sites. The percentage undergoing skin lesion excision also significantly decreased from 1.87% in 2003 to 1.03%, in 2012 (p = 0.0038) among those with IH of skin and subcutaneous tissue. These findings suggest a potential impact of propranolol. After adjusting for inflation, the total hospital charges increased from a mean of $17,838 in 2003 to an adjusted mean of $41,306 in 2012 (p < 0.0001).ConclusionsTotal admissions and hospital charges in children with IH has increased from 2003 to 2012. The percentage of patients undergoing tracheostomy, tracheoscopy and laryngoscopy with biopsy, and skin lesion excision significantly decreased in 2012 compared to 2003, suggesting a potential impact of propranolol. Further studies are needed to examine these changes more closely.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zUe0De

A novel mutation of the EYA4 gene associated with post-lingual hearing loss in a proband is co-segregating with a novel PAX3 mutation in two congenitally deaf family members

Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Federica Cesca, Elisa Bettella, Roberta Polli, Elona Cama, Pietro Scimemi, Rosamaria Santarelli, Alessandra Murgia
ObjectivesThis work was aimed at establishing the molecular etiology of hearing loss in a 9-year old girl with post-lingual non-syndromic mild sensorineural hearing loss with a complex family history of clinically heterogeneous deafness.MethodsThe proband's DNA was subjected to NGS analysis of a 59-targeted gene panel, with the use of the Ion Torrent PGM platform. Conventional Sanger sequencing was used for segregation analysis in all the affected relatives. The proband and all the other hearing impaired members of the family underwent a thorough clinical and audiological evaluation.ResultsA new likely pathogenic mutation in the EYA4 gene (c.1154C > T; p.Ser385Leu) was identified in the proband and in her 42-year-old father with post-lingual non-syndromic profound sensorineural hearing loss. The EYA4 mutation was also found in the proband's grandfather and uncle, both showing clinical features of Waardenburg syndrome type 1. A novel pathogenic splice-site mutation (c.321+1G > A) of the PAX3 gene was found to co-segregate with the EYA4 mutation in these two subjects.ConclusionThe identified novel EYA4 mutation can be considered responsible of the hearing loss observed in the proband and her father, while a dual molecular diagnosis was reached in the relatives co-segregating the EYA4 and the PAX3 mutations. In these two subjects the DFNA10 phenotype was masked by Waardenburg syndrome.The use of NGS targeted gene-panel, in combination with an extensive clinical and audiological examination led us to identify the genetic cause of the hearing loss in members of a family in which different forms of autosomal dominant deafness segregate. These results provide precise and especially important prognostic and follow-up information for the future audiologic management in the youngest affected member.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j6TCGR

Fertility management for malignant ovarian germ cell tumors patients

Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120
Author(s): Chiara Di Tucci, Assunta Casorelli, Elisa Morrocchi, Innocenza Palaia, Ludovico Muzii, Pierluigi Benedetti Panici
Malignant Germ Cell Tumors have primarily affecting adolescents and young adults. In advanced disease, greater than 70% of patients can be cured with standard chemotherapy regimens and fertility-sparing surgery appears to be safe with excellent survival after long-term follow-up.Due to their rarity, follow up and fertility management is largely based on trials of epithelial ovarian cancer or on few small studies.We report a review of the literature studies about the assessment, the monitoring and the treatment of fertility for Malignant Germ Cell Tumors as pratical guidelines for management of fertility in these patients.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2mEjDlN

The effects of enzalutamide and abiraterone on skeletal related events and bone radiological progression free survival in castration resistant prostate cancer patients: An indirect comparison of randomized controlled trials

Publication date: Available online 16 October 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Sergio Rizzo, Antonio Galvano, Francesco Pantano, Michele Iuliani, Bruno Vincenzi, Francesco Passiglia, Silvia Spoto, Giuseppe Tonini, Viviana Bazan, Antonio Russo, Daniele Santini
Two new drugs, the CYP17 inhibitor abiraterone acetate and the androgen receptor (AR) antagonist enzalutamide, have recently shown to prolong OS prior chemotherapy or in docetaxel treated mCRPC patients, using steroidal therapy or placebo as control group. Updated analyses underlined the role of these new agents on two prostate-specific endpoints as radiographic progression-free survival (rPFS) and time to first skeletal-related event (tSRE). On the basis of these reports, we made an indirect comparison between abiraterone and enzalutamide. We obtained a clinically but not significant difference favouring enzalutamide over abiraterone in terms of rPFS (HR 0.48, 95% CI 0.22–1.02). No significant difference was shown in term of tSRE (HR 0.99, 95% CI 0.83–1.17). In conclusion, abiraterone and enzalutamide have both demonstrated to significantly delay the bone progression resulting in similar improvements in bone-related endpoints in patients with mCRPC.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zgyCYU

Developing chemotherapy for diffuse pontine intrinsic gliomas (DIPG)

Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120
Author(s): Ho-Shin Gwak, Hyeon Jin Park
Prognosis of diffuse intrinsic pontine glioma (DIPG) is poor, with a median survival of 10 months after radiation. At present, chemotherapy has failed to show benefits over radiation.Advances in biotechnology have enabled the use of autopsy specimens for genomic analyses and molecular profiling of DIPG, which are quite different from those of supratentorial high grade glioma. Recently, combined treatments of cytotoxic agents with target inhibitors, based on biopsied tissue, are being examined in on-going trials. Spontaneous DIPG mice models have been recently developed that is useful for preclinical studies. Finally, the convection-enhanced delivery could be used to infuse drugs directly into the brainstem parenchyma, to which conventional systemic administration fails to achieve effective concentration.The WHO glioma classification defines a diffuse midline glioma with a H3-K27M-mutation, and we expect increase of tissue confirmation of DIPG, which will give us the biological information helping the development of a targeted therapy.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2xKST4c

ERCC1 as a prognostic factor for survival in patients with advanced urothelial cancer treated with platinum based chemotherapy: A systematic review and meta-analysis

Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120
Author(s): Yuksel Urun, Jeffrey J. Leow, Andre P. Fay, Laurence Albiges, Toni K. Choueiri, Joaquim Bellmunt
BackgroundThe predictive role of excision repair cross-complementing group 1 (ERCC1) as a predictive factor in patients with advanced urothelial cancer (AUC) treated with platinum-based treatment is not well defined. Here, we evaluate the role of ERCC1 in patients with AUC treated with platinum-based treatment.MethodsWe performed comprehensive, systematic computerized search to identify relevant studies through Medline, Embase, Cochrane Controlled Trials Register (CCTR) databases and abstracts from American Society of Clinical Oncology (ASCO) and ASCO Genitourinary Cancers Symposium, European Society For Medical Oncology (ESMO) and European Association of Urology (EAU) meeting up to July 2015. A systematic review and meta-analysis were performed.ResultsWe included a total of 1475 patients from 13 studies. We found that ERCC1 positivity was significantly associated with worse progression-free survival (pooled HR: 1.54, 95% CI: 1.13–2.11, p=0.006). There was no significant association with overall survival (pooled HR1.63, 95% CI: 0.93–2.88, p=0.09) and disease-free survival (pooled HR: 1.092, 95% CI: 0.63–1.90, p=0.75).ConclusionERCC1 positivity might be a prognostic indicator for poorer survival outcomes among patients with AUC. ERCC1 positivity was trending to poorer OS but was statistically worse for PFS. Further large prospective studies are warranted as ERCC1 could be used as a predictive marker to direct treatment of patients with AUC.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zfFd66

The role of Nuclear Factor-kappa B signaling in human cervical cancer

Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120
Author(s): Sam Tilborghs, Jerome Corthouts, Yannick Verhoeven, David Arias, Christian Rolfo, Xuan Bich Trinh, Peter A. van Dam
Background The Nuclear Factor kappaB (NF-kB) family consists of transcription factors that play a complex and essential role in the regulation of immune responses and inflammation. NF-kB has recently generated considerable interest as it has been implicated in human cancer initiation, progression and resistance to treatment. In the present comprehensive review the different aspects of NF-kB signaling in the carcinogenesis of cancer of the uterine cervix are discussed. NF-kB functions as part of a network, which determines the pattern of its effects on the expression of several other genes (such as crosstalks with reactive oxygen species, p53, STAT3 and miRNAS) and thus its function. Activation of NF-kB triggered by a HPV infection is playing an important role in the innate and adaptive immune response of the host. The virus induces down regulation of NF-kB to liquidate the inhibitory activity for its replication triggered by the immune system leading a status of persistant HPV infection. During the progression to high grade intraepithelial neoplasia and cervical cancer NF-KB becomes constitutionally activated again. Mutations in NF-kB genes are rare in solid tumors but mutations of upstream signaling molecules such as RAS, EGFR, PGF, HER2 have been implicated in elevated NF-kB signaling. NF-kB can stimulate transcription of proliferation regulating genes (eg. cyclin D1 and c-myc), genes involved in metastasis, VEGF dependent angiogenesis and cell immortality by telomerase. NF-kB activation can also induce the expression of activation-induced cytodine deaminase (AID) and the APOBEC proteins, providing a mechanistic link between the NF-kB pathway and mutagenic characteristic of cervical cancer. Inhibition of NF-kB has the potential to be used to reverse resistance to radiotherapy and systemic anti-cancer medication, but currently no clinicaly active NF-kB targeting strategies are available.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2mFKyxv

Impact of chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN) on cancer treatment outcomes: An overview about well-established and recently emerging clinical data

Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120
Author(s): Yassine Lalami, Jean Klastersky
Despite the overwhelming evidence for the role of granulocyte colony stimulating factors (G-CSF) in managing febrile neutropenia (FN) risk, chemotherapy-induced neutropenia (CIN) and/or FN still remain the most common reasons for reducing relative dose intensity (RDI) and/or delaying chemotherapy schedule. The need to maintain RDI to ensure optimal clinical outcomes is one of the key rationales for utilizing G-CSF. There is a high incidence of reduced RDI in both curative and palliative settings, and this observation is especially evidenced in retrospective analyses. Reduced RDI leads to significantly decreased survival outcomes and quality of life in various malignancies at various clinical settings and stages.Beyond its role as a surrogate prognostic marker, high-grade CIN may have an unexpected predictive role in clinical practice, as illustrated by several data relating CIN occurrence with favorable survival outcomes; this may be due to the fact that body surface area (BSA) – based calculation of dose may not fully account for the pharmacokinetics (PK) of cytotoxic drugs and the fact that there may be variability in drug metabolism between patients treated with same chemotherapy regimens.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AvwYyU

Biomarkers in Prostate Cancer – Current Clinical Utility and Future Perspectives

Publication date: Available online 13 November 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Alexander Kretschmer, Derya Tilki
Current tendencies in the treatment course of prostate cancer patients increase the need for reliable biomarkers that help in decision-making in a challenging clinical setting. Within the last decade, several novel biomarkers have been introduced. In the following comprehensive review article, we focus on diagnostic (PHI^®, 4K score, SelectMDx^®, ConfirmMDx^®, PCA3, MiPS, ExosomeDX, mpMRI) and prognostic (OncotypeDX GPS^®, Prolaris^®, ProMark^®, DNA-ploidy, Decipher^®) biomarkers that are in widespread clinical use and are supported by evidence. Hereby, we focus on multiple clinical situations in which innovative biomarkers may guide decision-making in prostate cancer therapy. In addition, we describe novel liquid biopsy approaches (circulating tumour cells, cell-free DNA) that have been described as predictive biomarkers in metastatic castration-resistant prostate cancer and might support an individual patient-centred oncological approach in the nearer future.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hBP8Yc

Optimization and purification of l-asparaginase from fungi: A systematic review

Publication date: Available online 13 November 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Paula Monteiro Souza, Marcela Medeiros de Freitas, Samuel Leite Cardoso, Adalberto Pessoa, Eliete Neves Silva Guerra, Pérola Oliveira Magalhães
The purpose of this systematic review was to identify the available literature of the l-asparaginase producing fungi. This study followed the Preferred Reporting Items for Systematic Reviews. The search was conducted on five databases: LILACS, PubMed, Science Direct, Scopus and Web of Science up until July 20th, 2016, with no time or language restrictions. The reference list of the included studies was crosschecked and a partial gray literature search was undertaken. The methodology of the selected studies was evaluated using GRADE. Asparaginase production, optimization using statistical design, purification and characterization were the main evaluated outcomes. Of the 1,686 initially gathered studies, 19 met the inclusion criteria after a two-step selection process. Nine species of fungi were reported in the selected studies, out of which 13 studies optimized the medium composition using statistical design for enhanced asparaginase production and six reported purification and characterization of the enzyme. The genera Aspergillus were identified as producers of asparaginase in both solid and submerged fermentation and l-asparagine was the amino acid most used as nitrogen source. This systematic review demonstrated that different fungi produce l-asparaginase, which possesses a potential in leukemia treatment. However, further investigations are required to confirm the promising effect of these fungal enzymes.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zPdgBa

Concomitant Use Of Corticosteroids And Immune Checkpoint Inhibitors In Patients With Hematologic Or Solid Neoplasms: A Systematic Review

Publication date: Available online 27 October 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): A. Garant, C. Guilbault, T. Ekmekjian, Z. Greenwald, P. Murgoi, T. Vuong
PurposeClinical trials studying immune checkpoint inhibitors exclude patients on corticosteroids, due to the hypothesis that corticosteroids may antagonize immunotherapy. We performed a systematic review of the literature looking at the clinical outcomes of cancer patients treated with immune checkpoint inhibitors and concomitant corticosteroids.MethodsThe following databases were searched for relevant studies: MEDLINE, Embase Classic+Embase, BIOSIS Previews, the Cochrane Database of Systematic Reviews, the CENTRAL Registry of Controlled Trials, Web of Science and Scopus. Abstracts from the meetings of the European Cancer Congress/European Society for Medical Oncology, the American Society of Clinical Oncology, the American Society of Hematology, the European Society for Radiotherapy & Oncology, the American Society for Radiation Oncology and the European Society for Radiotherapy & Oncology were manually searched. Two independent reviewers screened the references: case reports and articles with a low risk of bias were retained.ResultsFollowing a retrieval of 14603 unique references, 140 abstracts were retained for review; 27 articles are in the final analysis. Although limited, the reviewed data suggests that the concomitant administration of corticosteroids and immune checkpoint inhibitors may not necessarily lead to poorer clinical outcomes.ConclusionIn our systematic review, there was no objective data on the exact types of corticosteroids and the dose threshold above which an interaction could be measured clinically. Consideration of stratified randomization and treatment sequence evaluations in prospective trials may clarify this challenging topic and perhaps improve patient access to immune checkpoint therapies.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zP8XG4

The predictive value of primary tumor location in patients with metastatic colorectal cancer: A systematic review

Publication date: Available online 7 November 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Nele Boeckx, Katleen Janssens, Guy Van Camp, Marika Rasschaert, Konstantinos Papadimitriou, Marc Peeters, Ken Op de Beeck
Colorectal cancer (CRC) is one of the most frequently diagnosed cancers worldwide. It has been reported that left- and right-sided CRC harbor varying disease characteristics, which leads to a difference in prognosis and response to therapy. Recently, there have been retrospective studies about tumor location in metastatic CRC (mCRC) and its potential to predict the effect of anti-vascular endothelial growth factor and anti-epidermal growth factor receptor (anti-EGFR) therapies. In this review, we provide a comprehensive overview of the latest trials studying the predictive value of primary tumor location in mCRC and discuss biomarkers that might be associated with the differences in treatment response. Although data need to be interpreted with caution due to the absence of randomized trials stratified based on tumor location, patients with left-sided CRC seem to benefit more from anti-EGFR therapy than patients with right-sided CRC. Further clinical trials, stratified for tumor location, are warranted.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hBOWbq

Ovarian sex-cord stromal tumours and small cell tumours: pathological, genetic and management aspects

Publication date: Available online 16 October 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Stergios Boussios, Michelle Moschetta, George Zarkavelis, Alexandra Papadaki, Aristides Kefas, Konstantina Tatsi
Non-epithelial ovarian cancers (NEOC) constitute a group of uncommon malignancies and their treatment is still a challenging task. Collectively, these tumours account for about 10% of all ovarian cancers and occur in all age groups from childhood to old-age. They include malignancies of germ cell origin, sex cord-stromal cell origin, and a variety of extremely rare ovarian cancers, such as small-cell carcinomas and sarcomas. Each of these classifications encompasses multiple histologic subtypes. It is imperative that these rare tumours are managed with accurate diagnosis, staging, and treatment, to optimise the outcome. The aetiology and molecular origins of each sub-group of NEOC remain largely unresolved, and international cooperation to promote high quality translational research is crucial. Much effort has been made into researching the molecular mechanisms underlying epithelial ovarian cancers, but far less is known about the genetic changes in NEOC. In this article, it is provided an overview of the current knowledge on the incidence, clinical presentation, pathology, genetics, therapeutic interventions, survival and prognostic factors of adult and juvenile granulosa cell tumours (GrCT), Sertoli-Leydig Cell tumours (SLCT) and small cell carcinoma of the ovary. We also consider future potential therapeutic targets in these rare cancers.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yNCccu

Editorial Board

Publication date: November 2017
Source:Critical Reviews in Oncology/Hematology, Volume 119





from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zQFdsi

Sulfites: No Longer a Zebra?

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yVhJiy

Piercing and Metal Sensitivity: Extended Analysis of the North American Contact Dermatitis Group Data, 2007–2014

Background Body piercing provides a unique route of metal exposure. Objective The aim of this study was to update previous analyses using the North American Contact Dermatitis Group data comparing pierced and unpierced individuals. Methods This was a retrospective cross-sectional analysis of 17,912 patients patch tested by the North American Contact Dermatitis Group from 2007 to 2014 for demographics, positive reactions to metals (nickel, cobalt, chromium), and detailed analysis of nickel reactions by age, sex, and source of exposure. Results Piercing was significantly associated with female sex, being older than 18 years, and atopy (P

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yYR2Jx

Patch Testing with Decyl and Lauryl Glucoside: How Well Does One Screen for Contact Allergic Reactions to the Other?

Background Alkyl glucoside surfactants, present in many cosmetic products, can cause allergic contact dermatitis. Decyl glucoside has been part of the North American Contact Dermatitis Group standard allergen panel since 2009. Objectives This study aimed to identify rates and relevance of positive patch test reactions to decyl and lauryl glucosides and to determine how well one of these glucosides screens for contact allergic reactions to the other. Methods A retrospective analysis was performed on 897 patients suspected of having a cosmetic-related dermatitis and patch tested with both decyl and lauryl glucosides between 2009 and 2016. Results Forty-eight patients (5%) had positive reactions to decyl glucoside and/or lauryl glucoside. Among the alkyl glucoside–allergic patients, 65% had positive reactions to both decyl and lauryl glucosides. In 41% of cases, reactions were of definite or probable relevance. In approximately 55% of cases, reactions were of possible relevance. Conclusions Sixty-five percent of glucoside-allergic patients exhibited co-reactions to decyl and lauryl glucosides. Thus, neither glucoside is an adequate screen for allergy to the other. Given that these reactions are often relevant, clinicians should patch test with decyl, lauryl, and other alkyl glucosides in cases of suspected cosmetic allergy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yYR04n

CrossFit-Associated Allergic Contact Dermatitis

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yYQYth

Benzalkonium Chloride: An Irritant and Sensitizer

Background Benzalkonium chloride (BAK) is a known irritant, and potentially cross-reacting quaternary ammonium compounds are commonly used as preservatives in personal care products. Objective The aim of the study was to review positive reactions to BAK in 615 patients patch tested for suspected allergic contact dermatitis. Methods A retrospective chart review was performed in 615 patients patch tested from June 2015 to October 2016. All patients were tested to a Modified American Contact Dermatitis Society core series of 70 allergens including BAK (0.1% aqueous). Initial readings were performed at 48 hours with final readings performed between 72 and 168 hours. Results were graded as + (weak: papules and erythema), ++ (strong: papules and edema or vesicles), or +++ (extreme: coalescing vesicles, spreading or bullous reactions). Results A total of 141 men (23%) and 475 women (77%) were tested (mean age, 49 years). Four hundred thirty-two (70%) were atopic. Of 615 patients, 198 (32%) tested positive to BAK, and 64 (10%) had ++ or +++ reactions at their final reading. On average, BAK-positive patients were using at least 1 product containing BAK or possible cross-reactors. Conclusions Widespread exposure to irritants in dermatitis patients can predispose to sensitization. Products containing BAK or potential cross-reactors should be used carefully in patients with compromised skin barriers.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yXeNC3

SELF-ASSESSMENT

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AZm3P3

Allergenic Ingredients in Facial Wet Wipes

Background Allergic contact dermatitis commonly occurs on the face. Facial cleansing wipes may be an underrecognized source of allergens. Objective The aim of this study was to determine the frequency of potentially allergenic ingredients in facial wet wipes. Methods Ingredient lists from name brand and generic facial wipes from 4 large retailers were analyzed. Results In the 178 facial wipes examined, a total of 485 ingredients were identified (average, 16.7 ingredients per wipe). Excluding botanicals, the top 15 potentially allergenic ingredients were glycerin (64.0%), fragrance (63.5%), phenoxyethanol (53.9%), citric acid (51.1%), disodium EDTA (44.4%), sorbic acid derivatives (39.3%), tocopherol derivatives (38.8%), polyethylene glycol derivatives (32.6%), glyceryl stearate (31.5%), sodium citrate (29.8%), glucosides (27.5%), cetearyl alcohol (25.8%), propylene glycol (25.3%), sodium benzoate (24.2%), and ceteareth-20 (23.6%)/parabens (23.6%). Of note, methylisothiazolinone (2.2%) and methylchloroisothiazolinone (1.1%) were uncommon. The top potential allergens of botanical origin included Aloe barbadensis (41.0%), chamomile extracts (27.0%), tea extracts (21.3%), Cucumis sativus (20.2%), and Hamamelis virginiana (10.7%). Conclusions Many potential allergens are present in facial wet wipes, including fragrances, preservatives, botanicals, glucosides, and propylene glycol.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AZm2KZ

Dermoscopic Findings of Irritant “Poral” Reactions to Cobalt During Patch Testing

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AYVIk6

Contact Allergy to Neem Oil

A case of allergic contact dermatitis from neem oil is presented. Neem oil (synonyms: Melia azadirachta seed oil [INCI name], nim oil, margosa oil) is a vegetable (fixed) oil obtained from the seed of the neem tree Azadirachta indica by cold pressing. Contact allergy to neem oil has been described previously in only 3 patients. The allergen(s) is/are unknown.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AYVGZw

Occupationally Induced Allergic Contact Dermatitis to Aerosolized Quaternary Ammonium Compounds

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yYmKqF

Tan in a Can: Proceed With Patch Testing

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yXeGq7

Defining Gaps in Dermatitis Care

No abstract available

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yYBwO1

Increased serum 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF) levels are associated with glucose metabolism in Chinese pregnant women

Abstract

Purpose

Previous studies have found that 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF) was associated with diabetes. This study aimed to investigate the relationship between abnormal increased CMPF levels and gestational diabetes mellitus (GDM).

Methods

We recruited 828 pregnant women, and all of them underwent an oral glucose tolerance test (OGTT). We screened out 141 GDM patients and 230 pregnant women with normal glucose tolerance as controls. The serum CMPF concentration in participants was measured, and the relationship between the serum CMPF concentration and various parameters and biochemical indices was analyzed.

Results

Compared with the serum levels in pregnant women with normal glucose tolerance, GDM patients exhibited markedly higher serum CMPF levels. The serum CMPF concentration showed an independent positive correlation with the blood glucose levels, glycated hemoglobin A1c(HbA1c), and the area under the glucose–time curve from the 2-h OGTT (AUC for glucose). Moreover, the CMPF concentration was independently negatively correlated with insulin secretion. However, CMPF was not significantly associated with lipid metabolism.

Conclusions

Elevated serum CMPF levels are detrimental to the development of hyperglycemia and islet β-cell functional failure in patients with GDM, which may promote the development of GDM.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zTQiqI

Tracheocutaneous Fistula Closure with Turnover Flap and Polydioxanone Plate

Summary: An alternative surgical treatment is proposed for closure of tracheocutaneous fistulas. The authors present a new technique for reconstruction of persistent tracheocutaneous fistula resultant from temporary tracheostomy. The single-stage closure under local anesthesia involves a fistulous tract turnover flap with a perforated 0.15 mm polydioxanone plate between the flap and the subcutaneous closure. This article presents 3 cases of persistent tracheocutaneous fistula treated by this method. At follow-up examination after follow-up, no recurrent fistula formation had occurred, and no respiratory deformity was present.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yVul93

Radiological Anatomy of Inner Ear Malformation in Hearing Impaired Children and it’s Correlation with Hearing Loss: A Hospital Based Observational Study

Abstract

To see the radiological anatomy of inner ear malformations in hearing impaired children. This study was a prospective observational study done at a tertiary care teaching hospital in north India. The included were children of 1–7 years with first time detected severe to profound SNHL. The evaluation of hearing was done by brainstem evoked response audiometry. Those with history of chronic suppurative otitis media and conductive hearing loss were excluded. The all included were undergone high resolution computed tomography of the tympano-mastoid region. A written informed consent was taken. The institutional ethics committee approved the study protocol. We screened 130 children of 1–7 years of age with complaints of severe to profound hearing impairment (SNHL) by BERA. We excluded 38 and 14 children who had conductive hearing loss with or without CSOM and did not give consent, respectively. Among recruited 78 children, 47 (60.3%) had severe (71–90 dB) and 31 (39.7%) had profound (> 90 dB) SNHL. The majority of children (60/78, 76.9%) had a bilateral hearing impairment, only 18 (23.1%) had unilateral hearing impairment. The mean ± SD of age was 3.9 ± 1.3 years (95% CI = 3.6–4.2). The incidence of severe to profound SNHL was higher, though not statistically significant among the girls. Only 7.7% children with severe to profound SNHL were detected within first 2 years of life. Most of the children (92.3%) with severe to profound SNHL were detected after 2 years of age. Among 78 with severe to profound SNHL, 16 (20.5%) children had structural anomalies in their internal ears. Only 2 (6.9%) ears had single anomaly, others (27, 93.1%) had multiple anomalies. A maximum number of anomalies found in one ear were 5. The most common anomalies were found in the vestibule. The total number of anomalies were 115. Five children (6.4%) with severe to profound SNHL had craniofacial dysmorphism. Approximately 20% of children with severe to profound SNHL have congenital anomalies in their internal ears. It is crucial to know these anomalies before planning of CI. HRCT of tympano-mastoid is the first modality to know these anomalies. MRI should also be included to know the details of vestibulocochlear nerve. Since, the neurocognitive outcome would be the best if CI will be done as early as possible preferably around 1 year of age. Therefore, children must be screened at the appropriate age, firstly by OAE followed by BERA.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j4JXjX

Radiological Anatomy of Inner Ear Malformation in Hearing Impaired Children and it’s Correlation with Hearing Loss: A Hospital Based Observational Study

Abstract

To see the radiological anatomy of inner ear malformations in hearing impaired children. This study was a prospective observational study done at a tertiary care teaching hospital in north India. The included were children of 1–7 years with first time detected severe to profound SNHL. The evaluation of hearing was done by brainstem evoked response audiometry. Those with history of chronic suppurative otitis media and conductive hearing loss were excluded. The all included were undergone high resolution computed tomography of the tympano-mastoid region. A written informed consent was taken. The institutional ethics committee approved the study protocol. We screened 130 children of 1–7 years of age with complaints of severe to profound hearing impairment (SNHL) by BERA. We excluded 38 and 14 children who had conductive hearing loss with or without CSOM and did not give consent, respectively. Among recruited 78 children, 47 (60.3%) had severe (71–90 dB) and 31 (39.7%) had profound (> 90 dB) SNHL. The majority of children (60/78, 76.9%) had a bilateral hearing impairment, only 18 (23.1%) had unilateral hearing impairment. The mean ± SD of age was 3.9 ± 1.3 years (95% CI = 3.6–4.2). The incidence of severe to profound SNHL was higher, though not statistically significant among the girls. Only 7.7% children with severe to profound SNHL were detected within first 2 years of life. Most of the children (92.3%) with severe to profound SNHL were detected after 2 years of age. Among 78 with severe to profound SNHL, 16 (20.5%) children had structural anomalies in their internal ears. Only 2 (6.9%) ears had single anomaly, others (27, 93.1%) had multiple anomalies. A maximum number of anomalies found in one ear were 5. The most common anomalies were found in the vestibule. The total number of anomalies were 115. Five children (6.4%) with severe to profound SNHL had craniofacial dysmorphism. Approximately 20% of children with severe to profound SNHL have congenital anomalies in their internal ears. It is crucial to know these anomalies before planning of CI. HRCT of tympano-mastoid is the first modality to know these anomalies. MRI should also be included to know the details of vestibulocochlear nerve. Since, the neurocognitive outcome would be the best if CI will be done as early as possible preferably around 1 year of age. Therefore, children must be screened at the appropriate age, firstly by OAE followed by BERA.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2j4JXjX

Increased serum 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF) levels are associated with glucose metabolism in Chinese pregnant women

Abstract

Purpose

Previous studies have found that 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF) was associated with diabetes. This study aimed to investigate the relationship between abnormal increased CMPF levels and gestational diabetes mellitus (GDM).

Methods

We recruited 828 pregnant women, and all of them underwent an oral glucose tolerance test (OGTT). We screened out 141 GDM patients and 230 pregnant women with normal glucose tolerance as controls. The serum CMPF concentration in participants was measured, and the relationship between the serum CMPF concentration and various parameters and biochemical indices was analyzed.

Results

Compared with the serum levels in pregnant women with normal glucose tolerance, GDM patients exhibited markedly higher serum CMPF levels. The serum CMPF concentration showed an independent positive correlation with the blood glucose levels, glycated hemoglobin A1c(HbA1c), and the area under the glucose–time curve from the 2-h OGTT (AUC for glucose). Moreover, the CMPF concentration was independently negatively correlated with insulin secretion. However, CMPF was not significantly associated with lipid metabolism.

Conclusions

Elevated serum CMPF levels are detrimental to the development of hyperglycemia and islet β-cell functional failure in patients with GDM, which may promote the development of GDM.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zTQiqI

Metam Sodium (MS) in Water and Cane Juice at Different Processing Conditions According to the Industrial Case. Part 1. Effects of Matrix, pH, Temperature, Processing Time, and Photolysis

Abstract

The process for extracting sugarcane juice (Saccharum officinarum) represents the point of greatest contamination in sugarcane mills. Sodium dithiocarbamate also known as metam-sodium or MS is added to inhibit the growth of microorganisms especially Leuconostoc mesenteroides which is responsible for forming polysaccharides. Metam-sodium, upon decomposition, produces highly toxic byproducts. According to literature, under acidic conditions, MS is hydrolyzed resulting in methylamine (MA), CH₃NH₂, and carbon disulfide (CS₂), and in dilute alkaline solutions, MS produces an oxidation reaction characterized by the formation of elemental sulfur (S) and methyl isothiocyanate (MITC). In this paper, it was studied how MS decomposes to MITC and/or MA considering the effects of the matrix (methanol and water); of temperature (4 and 25 °C); of processing time (0, 1, 2, 3, 4 days); and of pH (4.0, 4.5, 7.0). A second experimental design considering the effects of the matrix (water and sugarcane juice); of temperature (4, 25, 35, 45 °C); of processing time (30, 300 min); and of pH (4.0, 4.5, 7.0) was derived from the results obtained considering MITC and/or MA formation. According to the statistical analysis of these results (p < 0.05), the order of the influential factors was as follows: time > matrix > pH > temperature. Results also indicated that the water matrix at pH = 4.5 and 45 °C had the lowest degradation rate (k), with a value of 8.82 day⁻¹, while for the sugarcane juice matrix at the same pH and temperature conditions was larger, with a k value of 30.07 day⁻¹. These results show that the matrix is also important for the degradation of dithiocarbamate to MITC and to MA.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zRffon

Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism

Abstract

Objective

To evaluate if the parameters of hypothalamic–pituitary–adrenal (HPA) axis activity could predict the occurrence and duration of post-surgical hypocortisolism (PSH) in patients with Cushing's syndrome (CS) and with adrenal incidentaloma (AI).

Methods

We studied 80 patients (54 females, age 53.3 ± 11 years), who underwent adrenalectomy for CS (17 patients) or for AI (53 patients). Before surgery, we measured adrenocorticotroph hormone (ACTH), urinary free cortisol (UFC) and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST) levels. After surgery, all patients were given a steroid replacement therapy, and PSH was searched after 2 months by a low-dose (1 µg, iv) corticotropin stimulation test, that was repeated every 6 months in PSH patients for at least 4 years.

Results

The PSH occurred in 82.4 and 46% of CS and AI patients, respectively. In the whole sample and in AI patients separately considered, the PSH was independently predicted by the preoperative cortisol levels after 1 mg-DST, however, with a low (< 70%) accuracy. In AI patients the PSH occurrence was not ruled out even by the cortisol levels after 1 mg-DST lower than 1.8 μg/dL (50 nmol/L). In the 50% of CS patients and in 31% of AI patients the PSH lasted more than 18 months and in 35.7% of CS patients it persisted for more than 36 months. In AI patients, the PSH duration was not predictable by any parameter. However, a PSH duration of at least 12 months was significantly predicted before adrenalectomy (sensitivity 91.7%, specificity 41.2%, positive predictive value 52.4%, negative predictive value 87.5%, p = 0.05) by the presence of at least 2 out of low ACTH levels, increased UFC levels and cortisol levels after 1 mg-DST ≥ 3.0 µg/dL (83 nmol/L).

Conclusion

The PSH occurrence and its duration are hardly predictable before surgery. All patients undergoing unilateral adrenalectomy should receive a steroid substitutive therapy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zdRloe

Safety of intrathecal route: focus to methylprednisolone acetate (Depo-Medrol) use

Abstract

Purpose

Complications of the intrathecal route may cause potential toxicity related to the medical device and properties of the administered drug and/or excipient. A description of clinical and histological effects of polyethylene glycol and miripirium after Depo-Medrol injection, and the adverse reactions of particulate methylprednisolone acetate was conducted. The safety of the intrathecal route with excipients, label and off-label drugs is discussed.

Methods

A bibliographic search in Medline, Google, and Cochrane database from 1940 to June 2016 was performed. The keywords included 'intrathecal methylprednisolone acetate', 'miripirium', 'myristyl-gamma-picolinium', 'side effects', 'intrathecal Depo-Medrol', 'polyethylene glycol', and 'intrathecal devices' used individually or in combination.

Results

Adverse reactions have been reported with this intrathecal administration route such as arachnoiditis, bladder dysfunction, headache, meningitis. Some pharmaceutical excipients have been associated with specific toxicity issues and with allergic and anaphylaxis reactions. Additives of methylprednisolone acetate formulations such as polyethylene glycol and miripirium chloride can be neurotoxic when injected intrathecally. Polyethylene glycol—an antimicrobial agent widely used in pharmaceutical drugs—has been associated with cardiovascular, hepatic, respiratory, and CNS toxicity.

Conclusions

Intrathecal methylprednisolone acetate (Depo-Medrol) therapy seems not fully safe due to reported adverse events. The use of other forms of corticosteroid therapy free from excipients should be emphasized such as soluble methylprednisolone sodium succinate.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2B1tG7B

Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism

Abstract

Objective

To evaluate if the parameters of hypothalamic–pituitary–adrenal (HPA) axis activity could predict the occurrence and duration of post-surgical hypocortisolism (PSH) in patients with Cushing's syndrome (CS) and with adrenal incidentaloma (AI).

Methods

We studied 80 patients (54 females, age 53.3 ± 11 years), who underwent adrenalectomy for CS (17 patients) or for AI (53 patients). Before surgery, we measured adrenocorticotroph hormone (ACTH), urinary free cortisol (UFC) and serum cortisol after 1 mg dexamethasone suppression test (1 mg-DST) levels. After surgery, all patients were given a steroid replacement therapy, and PSH was searched after 2 months by a low-dose (1 µg, iv) corticotropin stimulation test, that was repeated every 6 months in PSH patients for at least 4 years.

Results

The PSH occurred in 82.4 and 46% of CS and AI patients, respectively. In the whole sample and in AI patients separately considered, the PSH was independently predicted by the preoperative cortisol levels after 1 mg-DST, however, with a low (< 70%) accuracy. In AI patients the PSH occurrence was not ruled out even by the cortisol levels after 1 mg-DST lower than 1.8 μg/dL (50 nmol/L). In the 50% of CS patients and in 31% of AI patients the PSH lasted more than 18 months and in 35.7% of CS patients it persisted for more than 36 months. In AI patients, the PSH duration was not predictable by any parameter. However, a PSH duration of at least 12 months was significantly predicted before adrenalectomy (sensitivity 91.7%, specificity 41.2%, positive predictive value 52.4%, negative predictive value 87.5%, p = 0.05) by the presence of at least 2 out of low ACTH levels, increased UFC levels and cortisol levels after 1 mg-DST ≥ 3.0 µg/dL (83 nmol/L).

Conclusion

The PSH occurrence and its duration are hardly predictable before surgery. All patients undergoing unilateral adrenalectomy should receive a steroid substitutive therapy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zdRloe

Prise en charge des cicatrices hypopigmentées post-brûlure

Publication date: Available online 16 November 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): M. Schmidt, K. Serror, M. Chaouat, M. Mimoun, D. Boccara
ObjectifL'hypopigmentation définitive des cicatrices est une complication fréquente après les brûlures profondes traitées par cicatrisation dirigée, et peut entraîner des séquelles esthétiques importantes. Le traitement chirurgical a pour but d'enlever les tissus cicatriciels puis d'apporter des mélanocytes sains, en limitant la surface des zones donneuses. Cette revue détaille les différents traitements proposés pour prendre en charge les cicatrices hypopigmentées post-brûlures, et en précise les indications.MéthodesLes articles publiés entre 1985 et 2016 ont été recherchés sur Pubmed. Les études sur le traitement des cicatrices hypopigmentées étaient incluses uniquement si elles étaient secondaires à des brûlures. Les traitements ont été évalués en fonction de la région et la surface de la cicatrice, la couleur de la peau et l'efficacité de la repigmentation.RésultatsSeize études ont été incluses. Les traitements non chirurgicaux comme le maquillage et le tatouage, et les traitements chirurgicaux comme la greffe de peau mince pleine, les microgreffes, les greffes enfouies, la suspension cellulaire de mélanocytes et kératinocytes autologues, et la culture de cellules épithéliales, ont été comparés.ConclusionLa greffe de peau mince pleine est un traitement fiable, particulièrement pour les petites lésions hypopigmentées car cette méthode nécessite une zone donneuse de la même taille que la zone traitée. La suspension cellulaire peut être une alternative pour les lésions plus étendues. De plus une démarcation entre la greffe et la peau normale peut exister, et quand une couleur précise est attendue en particulier sur la face, le tatouage et la microgreffe sont efficaces.ObjectivePermanent hypopigmentation of burn scars is a common consequence after partial and full thickness burns that heal by secondary intent, and they can cause severe aesthetic issues. The surgical goals for effective treatment of postburn hypopigmentation are to remove scar tissues, and to produce healthy melanocytes, with minimal donor site morbidity. This article reviews the current literature about the different ways to treat hypopigmentation following burn injuries and discusses the indications.MethodsThe PubMed database was searched for articles published from 1985 and up to 2016. Papers with regards to the management of hypopigmented lesions were included only if scars were following burn injuries. The treatments were assessed according to body region treated, surface involved, skin color, effectiveness on restoring skin pigmentation.ResultsSixteen studies were included in this review. Non-surgical treatments like makeup and tattooing, and surgical treatments including thin skin grafting, chip skin grafting, punch grafting, non-cultured keratinocyte-melanocyte cell suspension, and cultured epidermal cells were all compared.ConclusionThin skin grafting is a reliable treatment especially for patient who suffer from small hypopigmented lesions as this method requires a donor skin of the same size. The cell suspension procedure may be beneficial for larger scars. Moreover demarcation between skin graft and normal skin may exist and when a precise color match is required, particularly in the head, tattooing and chip skin grafting produce a good pigmentation outcome.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AaNaJJ

Cone-beam computed tomography and anatomical observations of normal variants in the mandible: variant dentists should recognize

Abstract

Many types of cone-beam computed tomography (CBCT) have recently been developed and are being used in many dental clinics. CBCT has significantly changed imaging diagnosis in dentistry by showing detailed structures in multiple dimensions with high spatial resolution. This allows dentists to confirm what cannot be recognized with conventional two-dimensional images, such as small neurovascular canals, the buccolingual location of structures/lesions, and the three-dimensional shapes of hard tissue structures. The aim of this study was to review the normal variants of detailed anatomical structures in relation with the mandibular canal by comparing the previous reports and anatomical evaluations. These structures are likely to be observed on CBCT images by dental practitioners prior to dental procedures involving the mandibular teeth and bone. Understanding the relationship of these structures is useful for dental practitioners and oral surgeons to reduce the possibility of causing damage and patient discomfort during dental procedures.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2yVMDao

Impaired cerebrovascular reactivity in obstructive sleep apnea: A case-control study

Publication date: Available online 15 November 2017
Source:Sleep Medicine
Author(s): Laura B. Ponsaing, Ulrich Lindberg, Egill Rostrup, Helle K. Iversen, Henrik B.W. Larsson, Poul Jennum
ObjectiveObstructive sleep apnea (OSA) is an independent risk factor for stroke. Little is known about the cerebrovascular hemodynamic changes during apnea. Hypercapnia occurs in apneas and hypopneas, and a reduced cerebral vasodilatory response to CO2 could compromise the cerebral blood flow (CBF). Therefore, we aimed to evaluate whether the apnea−hypopnea index (AHI) affected the cerebrovascular response to CO2.MethodsA total of 11 patients with OSA were compared to 16 controls. We assessed the cerebrovascular responses with arterial spin labeling (ASL) and blood oxygen level−dependent (BOLD) magnetic resonance imaging during hypercapnia or breath-holding tasks.ResultsThe CBF response to CO2 was impaired with increasing AHI (average CBF: p = 0.018; gray matter: p = 0.038; white matter: p = 0.045), that is, increased OSA severity. When comparing the OSA patients to the control subjects, the OSA patients had a significantly reduced CO2 response of the white matter CBF (p = 0.04). However, the BOLD response to CO2 and the breath-holding task did not show any significant differences between OSA patients and control subjects.ConclusionThe cerebrovascular CO2 reactivity, measured by the CBF, was impaired with increasing AHI, that is, OSA severity. These findings may add to the understanding of the increased stroke risk found in OSA patients.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zNKBg6

Editorial Board

Publication date: November 2017
Source:Sleep Medicine, Volume 39





from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2AaKhsm

Two Scientific Awards for papers published in Sleep Medicine

Publication date: November 2017
Source:Sleep Medicine, Volume 39





from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zOukaF

Downregulation of DUSP4 enhances cell proliferation and invasiveness in colorectal carcinomas

Abstract

It is widely accepted that aberrant activation of the Wnt signaling pathway is responsible for the development of precursor lesions of colorectal cancer (CRC). However, the molecular mechanisms involved in the process of progression from these precursor lesions to invasive lesions of CRC are not fully understood. Recently, we reported that constitutive activation of MAPK accompanied by downregulation of dual-specificity phosphatase 4 (DUSP4), a MAPK phosphatase, contributes to the progression of precursor lesions in the pancreas. In this study, we found that downregulation of DUSP4 was related to constitutive activation of extracellular signal-regulated kinases (ERKs) in CRC cells. Restoration of DUSP4 resulted in inactivation of ERKs, leading to suppression of both proliferation and invasiveness, as shown by treatment with a MEK inhibitor. Furthermore, immunohistochemistry revealed that DUSP4 expression was upregulated in the superficial region of CRC tissue, whereas it was significantly downregulated in the deep region. On the other hand, ERKs in the deep region were markedly hyper-activated compared to those in the superficial region. These results suggest that activation of the MAPK signaling pathway caused by downregulation of DUSP4 is responsible for progression of CRCs and would be a promising therapeutic target.

This article is protected by copyright. All rights reserved.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2Aan21E

The Prevalence of Biopsy-Proven Eosinophilic Esophagitis in Hispanics Undergoing Endoscopy Is Infrequent Compared to Caucasians: A Cross-Sectional Study

Abstract

Introduction

The prevalence of eosinophilic esophagitis (EoE), a chronic, immune-mediated, clinicopathologic, inflammatory disorder, has been well described in the pediatric and adult Caucasian population but not as well studied in the Hispanic population. The major aims of this study are to determine the prevalence and gene expression profile of EoE in these populations.

Methods

This is a retrospective cohort study of patients from two institutions predominantly serving a Hispanic population. Patients included at Los Angeles County Hospital (LACH) had an esophagogastroduodenoscopy (EGD) and esophageal biopsies performed for evaluation of dysphagia and/or food impaction, while patients included from the University Hospital Medical Center of El Paso (UHMCEP) had an EGD and esophageal biopsies performed for any appropriate clinical indication. Gene expression analysis which has been shown to accurately diagnose EOE in Caucasians was performed for 9 patients at UHMCEP to determine its accuracy in Hispanics.

Results

At LACH, 234 patients were included in the study of whom 155 (66.3%) were Hispanic and 22 (9.4%) were Caucasian. 3.2% of the Hispanic patients and 9.1% of the Caucasian patients were diagnosed with EOE with threefold difference. At UHMCEP 1700 patients were included of whom 1350 (79.4%) were Hispanic and 179 (10.5%) were Caucasian. 0.96% of the Hispanic patients and 7.26% of the Caucasian patients were diagnosed with EOE with a sevenfold difference. Gene expression accurately diagnosed EOE in a small number of both Hispanics and Caucasians who underwent analysis.

Conclusions

Hispanic patients at LAC and UMHCEP had a significantly lower prevalence of EOE as compared to Caucasians at these two institutions and a lower prevalence as compared to Caucasians with EOE previously reported in the literature. Gene expression analysis, which has previously been shown to accurately diagnose EOE in Caucasian patients, accurately diagnosed EOE in a small sample of this Hispanic population. Based on this similar gene expression, other factors such as environmental, ethnic, and cultural causes should be investigated to explain the markedly lower prevalence of EOE in Hispanics.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zPBET7

Out-of-Pocket Cost Is a Barrier to Therapeutic Drug Monitoring in Inflammatory Bowel Disease

Abstract

Background

Therapeutic drug monitoring (TDM) is increasingly performed to optimize biologic therapy in inflammatory bowel disease (IBD). However, patients and physicians may be reluctant to perform TDM due to concerns related to potential out-of-pocket costs.

Aims

The aim of this study was to evaluate patient understanding and attitudes toward TDM in different clinical scenarios with and without potential out-of-pocket costs.

Methods

Adult IBD patients at a tertiary gastroenterology clinic were anonymously surveyed from March to September 2016 to assess their understanding of and willingness to undergo TDM in a variety of clinical scenarios, both with and without a potential out-of-pocket cost. Responses were analyzed for associations with changes in attitudes if out-of-pocket costs were involved.

Results

Of 118 completed surveys, 68.2% of patients were aware of or had previously undergone TDM. Patient willingness to undergo TDM was high both with and without potential out-of-pocket costs (70 and 98%, respectively); however, patients were significantly less willing with out-of-pocket cost (p < 0.01). Higher disease-related quality of life scores, as measured by the short inflammatory bowel disease questionnaire (SIBDQ), was significantly associated with an increased willingness to assume a potential out-of-pocket cost (p = 0.007).

Conclusions

Overall, patients understand and are willing to undergo TDM in certain potentially beneficial clinical scenarios, however, are significantly less willing if paying out-of-pocket. A higher SIBDQ score was associated with an increase in willingness to undergo TDM when out-of-pocket cost was involved. Physicians should discuss TDM with their patients in order to make an informed and personalized treatment decision.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hAZojF

Hydrogen-Rich Saline Ameliorates Hepatic Ischemia-Reperfusion Injury Through Regulation of Endoplasmic Reticulum Stress and Apoptosis

Abstract

Objective

To evaluate the effect of hydrogen-rich saline (HS) on hepatic ischemia-reperfusion (I/R) injury.

Methods

Forty rats were randomly allocated into five groups: one sham group (control group), one group treated with 20 min of ischemia and normal saline (NS; I/R1 + NS group), one group treated with 20 min of ischemia and HS (I/R1 + HS group), one group treated with 60 min of ischemia and NS (I/R2 + NS group), and one group treated with 60 min of ischemia and HS (I/R2 + HS group). After reperfusion for 6 h, hepatic function, oxidative stress, pathological changes, and apoptosis of hepatic cells were evaluated. Furthermore, the expression levels of endoplasmic reticulum (ER) stress-associated proteins were identified.

Results

Serum ALT and AST levels and tissue MDA content in the I/R + HS groups were significantly lower than those in the I/R + NS groups. Pathological changes were also significantly ameliorated in the HS groups compared with those in the NS groups. Moreover, HS appeared to significantly attenuate hepatic I/R-induced ER stress responses, as indicated by the decreased expression of C/EBP homologous protein, protein-kinase-RNA-like ER kinase, and inositol-requiring protein-1α, as well as the increased expression of GRP78 proteins. Finally, the levels of apoptotic markers such as caspase-3 and TUNEL-positive cells were significantly lower in the HS groups than in the NS control groups, whereas the level of Bcl2 protein increased in the HS groups.

Conclusion

The protective effect of HS can be attributed to ER stress and apoptosis inhibition.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zOwaIe

Clinical Features and Outcomes of Gastric Ischemia

Abstract

Background and Aims

Gastric ischemia is a rare condition associated with poor prognosis. Our study aim was to highlight the clinical features and outcomes of patients with gastric ischemia.

Methods

A retrospective review of patients diagnosed with isolated gastric ischemia at our institution from January 1, 2000, to May 5, 2016, was performed. Demographic, clinical, endoscopic, radiologic, and outcome variables were abstracted for analysis.

Results

Seventeen patients (65% men) with mean age of 69.3 ± 11.3 years and body mass index of 28.8 ± 11.1 were identified. The etiologies for gastric ischemia included local vascular causes (n = 8), systemic hypoperfusion (n = 4), and mechanical obstruction (n = 5). The most common presenting symptoms were abdominal pain (65%), gastrointestinal bleeding (47%), and altered mental status (23%). The typical endoscopic appearance was mucosal congestion and erythema with or without ulceration. Gastric pneumatosis and portal venous air were more commonly seen on CT imaging. Radiologic and/or surgical intervention was needed in 9 patients, while the remaining 8 patients were managed conservatively with acid suppression, antibiotics, and nasogastric tube decompression. The median duration of hospital stay was 15 days (range 1–36 days). There were no cases of rebleeding and the mortality rate as a direct result of gastric ischemia was 24% within 6 months of diagnosis.

Conclusion

Although uncommon, gastric ischemia is associated with significant mortality. Endoscopy and CT imaging play an important role in its diagnosis. The management of gastric ischemia is dictated by its severity and associated comorbidities.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hCwQ9u

The Role and Regulation of the 11 Beta-Hydroxysteroid Dehydrogenase Enzyme System in Patients with Inflammatory Bowel Disease

Abstract

Introduction

Glucocorticoids are known to modulate a number of immunological responses including counteracting inflammation. Within tissues expressing the glucocorticoid and mineralocorticoid receptors including the colon, glucocorticoid metabolism is regulated by the isoenzymes of 11ß-hydroxysteroid dehydrogenase (11β-HSD). 11β-HSD1 acts as an oxidoreductase converting inactive cortisone into active cortisol, while 11β-HSD2 acts as a dehydrogenase converting active cortisol to inactive cortisone. Hexose-6 phosphate dehydrogenase (H6PDH) is a key regulator of 11β-HSD1 activity via its generation of NADPH. Variations in the 11β-HSD enzyme system in relation to levels of expression and regulation may have a role in IBD. The aim of this study was to investigate possible abnormalities of 11β-HSD enzyme system in the colon of patients with IBD.

Methods

By using quantitative real-time PCR, we investigated the transcription levels of 11β-HSD1 and 2 in colonic tissue from IBD patients and healthy controls undergoing a colonoscopy for disease assessment. Disease activity was recorded using clinical (Mayo Score/Harvey–Bradshaw Index), Biochemical (C-reactive protein), histological, and endoscopic parameters. In addition, transcription levels of H6PDH and the glucocorticoid receptor alpha (GR-α) as well as key pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, Rela (subunit for NF Kappa B)) were later examined among this group, and results were correlated with 11β-HSD2 gene expression. Results and patient demographics were expressed as a mean (and SD), and differences between IBD patients and control groups were analyzed using a Student's t test or Mann–Whitney U test as appropriate, with a p value of ≤0.05 considered significant. Results were controlled for disease activity as outlined above.

Results

Results have demonstrated a significant downregulation in 11β-HSD2 expression in IBD patients compared with controls (13.8 ± 17.1 au vs. 318.4 ± 521.1 au, p = 0.01), whereas levels of 11β-HSD1 did not appear to vary across the two groups. Among IBD patients, there was a trend toward higher 11β-HSD1 expression in inflamed tissue compared with matched non-inflamed tissue (422.1 ± 944 au vs. 102.2 ± 103.9, P = 0.09). Levels of H6PDH and the GR-α expression did not appear to vary among active inflamed IBD tissue and controls. As a result, we examined the association between pro-inflammatory cytokines and levels of 11β-HSD2 expression. Results showed an upregulation of key pro-inflammatory cytokine mRNA expression (TNF-α, IL-1β, IL-6) during inflammation with an associated downregulation of 11β-HSD2 mRNA expression when compared to controls. Dysregulation in this pathway could have a potential role in IBD pathogenesis and may account for exogenous glucocorticoid resistance in IBD. Further work assessing the role of the 11β-HSD enzyme system in steroid-resistant subjects is warranted.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2zOkHZo

A Statistically Significant Association Between Esophageal Granular Cell Tumors and Eosinophilic Esophagitis: A 16-year Analysis at Two Large Hospitals of 167,434 EGDs

Abstract

Background

Esophageal granular cell tumor (eGCT) is a rare, usually benign, neoplasm of neuroectodermic origin. Eosinophilic esophagitis (EoE) is a relatively uncommon, immune-mediated, chronic disease. Both diseases commonly present with dysphagia. One case has been reported of simultaneous occurrence of both diseases.

Aims

To determine the association between diseases.

Methods

The present study was an IRB-approved, retrospective review of esophagogastroduodenoscopies (EGDs) with esophageal biopsies from two large hospitals, 1999–2014.

Results

Among 29,235 EGDs with esophageal biopsies for 16 years (167,434 total EGDs), 16 patients had pathologically diagnosed eGCT, and 1225 patients had pathologically diagnosed EoE. Five (31%) of 16 patients with eGCT had concomitant EoE (p = 0.001, OR 10.43, 95% ORCI 3.16–32.44, Fisher's exact test). Patients with simultaneous eGCT and EoE were young (mean age = 33.6 ± 12.9 years). Three were female. Dysphagia was presenting symptom in 4 (80%) of patients. Three had asthma. All five patients had > 20 eosinophils/hpf in esophageal biopsy specimens. Three patients had endoscopic esophageal abnormalities suggesting EoE. Four patients were treated with a PPI (before and after diagnosis of EoE), and 2 patients underwent six-food-elimination diet with partial symptomatic improvement. The eGCTs averaged 13.4 ± 4.2 mm in maximal diameter and were located in upper-2, middle-2, and lower esophagus-2 (1 patient had 2 eGCTs). eGCTs were endoscopically resected-3 patients, and monitored-2 patients. Surveillance endoscopies revealed no recurrence or growth of eGCTs after resection (mean follow-up = 4.6 years).

Conclusions

This novel report of 5 patients with simultaneous EoE and eGCT adds to one, previously published case and suggests these two diseases are associated, and have a common pathophysiologic link, despite apparently different pathogenesis. Large, prospective, endoscopic and pathologic studies are warranted to further investigate this association.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2hAZlV1