Αρχειοθήκη ιστολογίου

Κυριακή 25 Μαρτίου 2018

Perceptual attention as the locus of transfer to nonnative speech perception

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Publication date: May 2018
Source:Journal of Phonetics, Volume 68
Author(s): Charles B. Chang
One's native language (L1) is known to influence the development of a nonnative language (L2) at multiple levels, but the nature of L1 transfer to L2 perception remains unclear. This study explored the hypothesis that transfer effects in perception come from L1-specific processing strategies, which direct attention to phonetic cues according to their estimated relative functional load (RFL). Using target languages that were either familiar (English) or unfamiliar (Korean), perception of unreleased final stops was tested in L1 English listeners and four groups of L2 English learners whose L1s differ in stop phonotactics and the estimated RFL of a crucial cue to unreleased stops (i.e., vowel-to-consonant formant transitions). Results were, overall, consistent with the hypothesis, with L1 Japanese listeners showing the poorest perception, followed by L1 Mandarin, Russian, English, and Korean listeners. Two exceptions occurred with Russian listeners, who underperformed Mandarin listeners in identification of English stops and outperformed English listeners in identification of Korean stops. Taken together, these findings support a cue-centric view of transfer based on perceptual attention over a direct phonotactic view based on structural conformity. However, transfer interacts with prior L2 knowledge, which may result in significantly different perceptual consequences for a familiar and an unfamiliar L2.



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The roles of toll like receptor 3, 7 and 8 in allergic rhinitis pathogenesis

Publication date: Available online 3 February 2018
Source:Allergologia et Immunopathologia
Author(s): A. Golshiri-Isfahani, M. Amizadeh, M.K. Arababadi
Allergic rhinitis, as an allergic and nasal hypersensitivity disease, is associated with the inflammation of nasal mucosa. It appears that innate immune receptors are the important risk factors in the pathogenesis of the inflammatory disease. Toll-like receptors (TLRs) are the most important receptors of innate immunity; their crucial roles in the recognition of allergens and subsequently pathogenesis of allergic diseases have been evaluated recently. TLR3, 7 and 8 are the intracellular members of the innate immune receptors and recognize intracellular single and double strand RNAs. This review article collected the investigations regarding the roles of TLR3, 7 and 8 in the allergic rhinitis pathogenesis.



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Assessment of IL-31 levels and disease severity in children with atopic dermatitis

Publication date: Available online 17 March 2018
Source:Allergologia et Immunopathologia
Author(s): D. Ozceker, M. Bulut, A. Celik Ozbay, F. Dilek, M. Koser, Z. Tamay, N. Guler
Introduction and objectivesAtopic dermatitis is a chronic, relapsing, highly pruritic, inflammatory skin disease characterized by typical localization with increasing prevalence of 10–20% in children. Pruritus is one of the major diagnostic criteria of atopic dermatitis and also the main complaint altering quality-of-life of affected patients, inducing and aggravating inflammation. Although pruritus is the absolute symptom of AD, the etiology has not been fully explained yet and current antihistamine therapies are ineffective.The aim of the study was to assess the correlation between IL-31 level and disease severity in patients with atopic dermatitis through Severity SCORing of Atopic Dermatitis (SCORAD) index and the degree of itching assessed subjectively.Material and methodsOne hundred thirty-five children were enrolled in the study in total, 70 children with diagnosis of atopic dermatitis and 65 healthy children in control group. Data on demographic features (age, gender, family history of atopy) and laboratory values of serum eosinophil, total IgE, IgM, IgA, IgG levels and skin prick test results were collected through patient files. The disease severity was assessed by SCORAD index. IL-31 levels were measured with human IL-31 ELISA kit.ResultsThe statistical analysis showed that IL-31 level was significantly higher in AD patients than in the control group (AD vs CG, p 0.0001). There was no significant difference in IL-31 levels between the three subgroups divided according to the SCORAD severity score (p:0.27).ConclusionIL-31 levels were significantly higher in AD patients compared to control group but irrelevant to the disease severity.



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Knowledge on asthma, food allergies, and anaphylaxis: Assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil

Publication date: Available online 12 January 2018
Source:Allergologia et Immunopathologia
Author(s): M. Urrutia-Pereira, L.P. Mocellin, R.B. de Oliveira, L. Simon, L. Lessa, D. Solé
IntroductionAllergic diseases have become an increasingly common reality in the last years, extending beyond the family context.ObjectiveAssessing the level of knowledge on asthma, food allergies and anaphylaxis of asthmatic children's parents/caregivers (PC), elementary school teachers (EST) and university students (US) in Uruguaiana, RS, Brazil.Method577 individuals (PC – N=111; EST – N=177; US – N=299) took part in the study, answering the Newcastle Asthma Knowledge Questionnaire (validated for Portuguese) and another questionnaire on Food Allergy (FA) and anaphylaxis.ResultsAlthough PC have asthmatic children, their asthma knowledge level was average, slightly above that of EST and EU. The lack of knowledge on passive smoking, use of medications and their side effects should be highlighted. US have shown to be better informed about FA and anaphylaxis. However, even though a significant proportion of respondents know the most common symptoms of FA and anaphylaxis, few named subcutaneous adrenaline as the drug of choice for treating anaphylaxis. Although a significant number of respondents know about the possibility of anaphylactic reactions happening at school or in activities outside the school, we were surprised by the absence of conditions in schools to provide emergency care to such students.ConclusionDespite the high prevalence of allergic diseases in childhood, asthmatic children's parents/caregivers, elementary school teachers and university students have inadequate levels of knowledge to monitor these patients.



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Is vitamin D level associated with the natural course of atopic dermatitis?

Publication date: Available online 17 March 2018
Source:Allergologia et Immunopathologia
Author(s): M. Dogru
Introduction and objectivesAtopic dermatitis (AD) is a chronic inflammatory disease of the skin. Apart from its well-known role on calcium metabolism, vitamin D is reported to affect skin functions. The study aims were to: compare the vitamin D levels of children with AD and healthy children; investigate the relationship between the severity of AD and vitamin D levels; and investigate the effect of vitamin D on the natural course of AD.Patients or materials and methodsSixty-nine patients with AD were enrolled. Seventy healthy children were assigned as control group. Clinical and demographic features of groups were recorded. The skin prick test, eosinophil counts, immunoglobulin (Ig) E levels and serum 25 OH cholecalciferol (25OHD3) levels were measured. After at least 4 years of follow-up, patients were re-evaluated for natural course of AD.ResultsMean 25OHD3 level was lower in patient group vs. control group; 19.86±6.7ng/mL (min–max: 6.8–40) vs. 24.07±9.08ng/mL, respectively, (p=0.002). Mean 25OHD3 levels, and vitamin D status were significantly different between AD severity groups. (p<0.05). In terms of vitamin D status in the pairwise comparison, vitamin D deficiency was greater in children with severe and moderate AD groups (respectively, p=0.005, p=0.018). In Tukey's post hoc analysis for 25OHD3 level, the 25OHD3 levels of severe AD are significantly lower than mild or moderate AD (respectively, p=0.001, p=0.026). There was a negative correlation between 25OHD3 levels and severity of AD (r=−0.480; p=0.001). In patients reassessed after 4 years: age, the age of AD onset, vitamin D deficiency, SCORAD level and severe AD were higher in the persistent group vs. remission group, 25OHD3 levels were higher in the remission group vs. persistent group (p<0.05).ConclusionsMean vitamin D levels were lower in patients with AD. A negative correlation between vitamin D levels and disease severity was documented. Vitamin D may affect the natural course of atopic dermatitis. There is a need for more comprehensive studies in this regard.



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Evaluation of an intervention to improve the management of allergens in school food services in the city of Barcelona

Publication date: Available online 15 February 2018
Source:Allergologia et Immunopathologia
Author(s): M. Fontcuberta-Famadas, G. Serral, M.J. López, P. Balfagón, E. García-Cid, L. Caballé-Gavaldà
BackgroundAn intervention to promote the development of an allergen control plan (ACP) and preventive measures for the management of allergens in school food services was implemented in all schools of Barcelona city over a three-year period (2013–2015) by the public health services. The present study aimed to assess changes regarding the management of food allergens in school food services in Barcelona after an intervention conducted by the public health services of the city.MethodsSchool meal operators of a random sample of 117 schools were assessed before and after the intervention using a structured questionnaire. The questionnaire collected general information on the students and their demand for special menus, and included 17 closed questions regarding the implementation of specific preventive measures for the management of allergens. Based on these 17 questions, a food safety score was calculated for each school. The improvement in these scores was evaluated.ResultsThe results showed positive increments in the percentage of implementation of 12 of the 17 preventive measures assessed. The percentage of school food services with an implemented ACP increased by 49%. Schools with external and internal food supplies increased their scores by 16.5% and 19.6%, respectively. The greatest improvements were observed in smaller food services and in schools located in districts with low gross household incomes.ConclusionsThe intervention was effective in improving school food services' management of allergens and in reducing the differences found among food services in the pre-intervention survey. We must also focus efforts on reducing socio-economic inequalities linked to the management of allergens.



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Adherence to pharmacotherapy improves school performance in children with rhinitis and asthma

Publication date: Available online 17 March 2018
Source:Allergologia et Immunopathologia
Author(s): J. Sánchez, A. Sánchez, R. Cardona
BackgroundAdherence to pharmacotherapy reduces symptoms of asthma and rhinitis, however, little is known of its impact on school performance.ObjectiveTo evaluate the impact of pharmacotherapy in absenteeism and school performance in a child population.MethodsA cross-sectional study, carried out in eight schools. All participants and their parents were given a questionnaire assessing parameters related to respiratory diseases and pharmacotherapy. Data on school performance was obtained from the academic history of each child who participated in the study. Adherence to pharmacotherapy was classified as a correct use of therapy for more than five days per week.Results1109 children agreed to participate. Students were divided into two groups: symptomatic (36%) and asymptomatic (63%). The symptomatic group had a higher frequency of school absenteeism (1 vs. 3.1days/year/patient p<0.01) and lower academic performance (failed: 20% vs. 33% p<0.01). After dividing the symptomatic group between adherents and non-adherents to the pharmacotherapy, the group of adherents had a similar school performance to the asymptomatic group and it was significantly different from the no-adherent group.ConclusionRespiratory symptoms are associated with poor school performance and with an increase in school absenteeism, but adherence to pharmacotherapy can reduce these negative impacts in children.



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Development and characterization of an allergoid of cat dander for immunotherapy

Publication date: Available online 17 January 2018
Source:Allergologia et Immunopathologia
Author(s): J.P. Sola, Y. Pedreño, A. Cerezo, M. Peñalver-Mellado
BackgroundAllergy to cats is a frequent cause of sensitization to indoor allergens and currently there are few alternatives to specific immunotherapy with cat native extracts. The objective is to develop and characterize a new allergoid to increase the tools available for use in clinical practice.MethodsThe allergoid cat dander extract (ACD) was developed from a native cat dander extract (NCD) by modification with glutaraldehyde, and the optimal process control was determined by SDS-PAGE, DOT BLOT and determination of free amine groups. The ACD was characterized in protein profile by SDS-PAGE, size exclusion chromatography (SEC) and peptide footprint. The allergenic profile of ACD was determined by immunoblot, IgE CAP inhibition and IgG competition ELISA. The major allergen content in NCD was obtained by the ELISA sandwich protocol and was extrapolated to ACD.ResultsThe control process determined the optimal development of the allergoid. The ACD obtained contains 182.28μg/mg of protein and 11.90μg/mg of Fel d 1. SDS-PAGE and SEC confirmed the presence of high molecular weight proteins in ACD, and the peptide footprint showed the presence of Fel d 1 and Fel d 7. The high degree of polymerization was evidenced with the determination of the reduction of lysine residues in the allergoid, resulting 91.96%. The ACD showed a significant loss of allergenicity respect to NCD, while the IgG-binding capacity was maintained.ConclusionsThe ACD obtained presents a good safety profile, so would be a good alternative for treatment of cat allergy.



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Acknowledgment to reviewers

Publication date: March–April 2018
Source:Allergologia et Immunopathologia, Volume 46, Issue 2





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Sublingual immunotherapy in children

Publication date: March–April 2018
Source:Allergologia et Immunopathologia, Volume 46, Issue 2
Author(s): M. Tortajada-Girbés, C. Rivas-Juesas




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An international comparison of risk factors between two regions with distinct differences in asthma prevalence

Publication date: Available online 24 March 2018
Source:Allergologia et Immunopathologia
Author(s): K. Madani, E. Vlaski, D.C. Rennie, M. Sears, J.A. Lawson
Background and purposeInvestigation of the geographic variation in asthma prevalence can improve our understanding of asthma etiology and management. The purpose of our investigation was to compare the prevalence of asthma and wheeze among adolescents living in two distinct international regions and to investigate reasons for observed differences.MethodsA cross-sectional survey of 13–14 year olds was completed in Saskatoon, Canada (n=1200) and Skopje, Republic of Macedonia (n=3026), as part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3 study. Surveys were self-completed by students following the ISAAC protocol. Multiple logistic regression models were used to investigate associations with reports of asthma and current wheeze. A mediation analysis was then completed.ResultsAsthma prevalence was much higher in Saskatoon than Skopje (21.3% vs. 1.7%) as was the prevalence of current wheeze (28.2% vs. 8.8%). Higher paracetamol (acetaminophen) use was a consistent risk factor for asthma and wheeze in both locations and showed dose-response relationships. In both countries, paracetamol use and physical activity mediated some of the association for both asthma and wheeze. In Saskatoon, among those with current wheeze, 42.6% reported ever having a diagnosis of asthma compared to 10.2% among Skopje adolescents.ConclusionsThe results suggest that the variation in risk factors between the two locations may explain some of the differences in the prevalence of asthma and wheeze between these two study sites. However, diagnostic labeling patterns should not be ruled out as another potential explanatory factor.



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Efficacy and safety of sublingual immunotherapy with Dermatophagoides farinae drops in pre-school and school-age children with allergic rhinitis

Publication date: March–April 2018
Source:Allergologia et Immunopathologia, Volume 46, Issue 2
Author(s): L.-X. Tang, X.-J. Yang, P.-P. Wang, W.-T. Ge, J. Zhang, Y.-L. Guo, J. Lu, J. Tai, Y.-M. Zhang, X. Ni
BackgroundThe safety and efficacy of sublingual immunotherapy (SLIT) have been confirmed by many studies. However, in China, the research on efficacy and safety in young and older children with allergic rhinitis (AR) is still rare.ObjectiveThe aim of this retrospective study is to evaluate the efficacy and safety of SLIT with Dermatophagoides farinae drops in pre-school and school-age children with AR.MethodsA total of 282 subjects aged 2–13 years with AR received a two-year course of sublingual immunotherapy along with pharmacotherapy. According to the age, patients were defined as the pre-school group (2–6 years old, n=116) and school-age group (7–13 years old, n=166). Total nasal rhinitis symptom scores (TNSS), visual analogue score (VAS) and total medication scores (TMS) were evaluated at four time points: baseline, after SLIT for half a year, one year and two years. The adverse events (AEs) were evaluated at each visit.ResultsAfter two-year SLIT, the four rhinitis symptom scores, TNSS, VAS and TMS scores were significantly lower than baseline (all P<0.05). The comparison of efficacy between one and two-year duration showed no significant difference in global clinical outcomes (all P>0.05). In addition, there were no significant differences between the pre-school and school-age group in TNSS (all P>0.05), VAS (all P>0.05) and TMS scores (P>0.05) after SLIT for half a year, one year and two years. No severe systemic AEs were reported.ConclusionSLIT with D. farinae drops is clinically effective and safe in pre-school and school-age patients with house dust mites (HDMs)-induced AR.



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Diagnostic criteria for acute food protein-induced enterocolitis syndrome. Is the work in progress?

Publication date: Available online 15 February 2018
Source:Allergologia et Immunopathologia
Author(s): S. Miceli Sopo, G. Bersani, C. Fantacci, A. Romano, S. Monaco
Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES.



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Haploidentical stem cell transplantation in a boy with chronic granulomatous disease

Publication date: Available online 17 January 2018
Source:Allergologia et Immunopathologia
Author(s): A. Regueiro-García, S. Fariña-Nogueira, J.Á. Porto-Arceo, J.M. Couselo-Sánchez
Chronic granulomatous disease is a primary immunodeficiency caused by mutations in any one of the five components of the NADPH oxidase in phagocytic leucocytes. This causes impaired microbial killing, which leads to severe life-threatening bacterial and fungal infections. Currently, allogenic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for chronic granulomatous disease, although gene therapy may provide a new therapeutic option for the treatment of patients with CGD. Haploidentical HSCT provides a potentially curative treatment option for patients who lack a suitably HLA-matched donor, but only a few cases have been reported in the literature. Herein, we report a boy with X-linked chronic granulomatous disease treated successfully by haploidentical HSCT with post-transplant cyclophosphamide using a treosulfan-based conditioning regimen.



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Small-airway dysfunction precedes the development of asthma in children with allergic rhinitis

Publication date: Available online 12 January 2018
Source:Allergologia et Immunopathologia
Author(s): E. Skylogianni, M. Triga, K. Douros, K. Bolis, K.N. Priftis, S. Fouzas, M.B. Anthracopoulos
BackgroundEpidemiological evidence suggests the existence of a direct link between allergic rhinitis (AR) and asthma. Several studies also support the presence of small-airway dysfunction (SAD) in non-asthmatic children with AR. However, it remains unknown whether SAD can predict the progression of AR to asthma. Our objective was to explore the existence of SAD in non-asthmatic children with AR and to assessed its ability to predict the development of asthma.MethodsSeventy-three 6-year-old children with intermittent moderate-severe AR but without asthma symptoms/medication within the last two years, underwent spirometry and measurement of respiratory resistance (Rrs) and reactance (Xrs) before and after bronchodilation (BD) (300mcg salbutamol). Lung function measurements were performed in the absence of nasal symptoms and repeated at AR exacerbation. SAD was defined as >30% decrease in Rrs or >50% increase in Xrs at 6 or 8Hz post-BD. Participants were followed for five years.ResultsTwenty-three children (31.5%) developed asthma; this group presented significant post-BD changes in Rrs and Xrs, but only at AR exacerbation. The ability of these changes to predict the development of asthma was exceptional and superior to that of the spirometric parameters. SAD (22 children, 30.1%), emerged as the single most efficient predictor of asthma, independently of other risk factors such as parental asthma, personal history of eczema and type of allergic sensitisation.ConclusionSAD precedes the development of asthma in children with AR. Changes in respiratory impedance at AR exacerbation may assist in identifying those at risk to progress to asthma.



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Increase of natural killer cells in children with liver transplantation-acquired food allergy

Publication date: Available online 16 February 2018
Source:Allergologia et Immunopathologia
Author(s): F. Mori, C. Angelucci, A. Cianferoni, S. Barni, G. Indolfi, A. Casini, G. Mangone, M. Materassi, N. Pucci, C. Azzari, E. Novembre
BackgroundTransplantation-acquired food allergies (TAFA) are frequently reported and considered to be caused by immunosuppressive therapy.The aim of this study was to investigate the allergic and immunologic responses in children who had liver or kidney transplantations.MethodsTwelve children receiving liver transplantations and 10 children receiving kidney transplantations were investigated. All children underwent the allergy work-up and in most of them, lymphocyte screening and serum cytokine measurements were also performed.ResultsTAFA were found in 7/12 (58%) children with liver transplantations and in none of the 10 children with kidney transplantations. The mean age at transplantation was significantly lower in children who underwent liver transplantations (p<0.001). The immunosuppressive therapy administered to children with liver transplantation was tacrolimus in 11 patients and cyclosporine in one patient, while all 10 children with kidney transplantation received tacrolimus plus mycophenolate. The most common antigenic food was egg. The natural killer (NK) cell numbers were significantly higher in liver-transplant children than in kidney-transplant children. No significant differences were found in the serum cytokine levels.ConclusionsThis study confirms that liver-transplant children treated with tacrolimus alone have a higher risk of developing TAFA than kidney-transplant children treated with tacrolimus plus mycophenolate. NK cells might be involved in this difference.



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Exposure to dogs but not cats is associated to a decrease in the prevalence in atopic dermatitis amongst school-children

Publication date: Available online 15 February 2018
Source:Allergologia et Immunopathologia
Author(s): M. Bedolla-Barajas, J. Morales-Romero, T.I. Bedolla-Pulido, T.R. Bedolla-Pulido, C. Meza-López, N.A. Pulido-Guillén
IntroductionThe association regarding the exposure to pets, especially cats and dogs, and the prevalence of allergic diseases is inconsistent.ObjectiveWe analyzed the role played by early exposure to dogs or cats in the prevalence of allergic diseases amongst school-aged children.MethodThrough a cross-sectional study, we examined 756 children, aged 6–7; these candidates were selected through cluster sampling. We inquired about the exposure that these children had had to dogs and cats, and whether these pets spent most of their time indoors or outdoors during the first year of the child's life. In order to identify the prevalence of allergic diseases and their symptoms, each child's parent completed the International Study of Asthma and Allergies in Childhood questionnaire.ResultsExposure to outdoor dogs was associated to nocturnal coughing, odds ratio (OR) 0.64, with a confidence interval of 95% (95% CI) 0.43–0.95 and with atopic dermatitis (OR: 0.39; 95% CI: 0.20–0.76). Interestingly, exposure to outdoor cats was associated to nocturnal coughing (OR: 0.51; 95% CI: 0.32–0.83) and current rhinitis symptoms (OR: 0.59; 95% CI 0.36–0.97). After carrying out the multivariate analyses, only exposure to dogs, both indoor and outdoor, was significantly associated to a decrease in the prevalence of atopic dermatitis OR 0.40 (95% CI: 0.20–0.79) and OR 0.38 (95% CI: 0.18–0.83), respectively.ConclusionOur findings suggest that exposure to dogs, whether they be indoor or outdoor pets, is associated to a decreased prevalence in atopic dermatitis.



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Pine nut allergy in Korean children: Clinical characteristics and diagnostic values of specific IgE against pine nuts

Publication date: Available online 12 February 2018
Source:Allergologia et Immunopathologia
Author(s): E. Lee, K. Jeong, J. Lee, S. Lee
BackgroundHypersensitivity reactions to pine nuts in children have been occasionally encountered recently, although reports on pine nut allergy cases are rare worldwide. The study aimed to feature clinical and laboratory findings pertaining to pine nut allergy in Korean children.MethodsForty-two subjects were enrolled through a retrospective review of medical records, from September 2010 to December 2015, at the Department of Pediatrics in Ajou University Hospital. The demographic profiles, clinical characteristics, and laboratory findings were evaluated.ResultsTwenty-four patients showed immediate-type reactions after exposure to pine nuts (the allergic group), while the remaining 18 were atopic controls, who exhibited no allergic symptoms (the tolerant group). The median age of the subjects in the allergic group was three years. More than half of the subjects in this group experienced allergic symptoms within 5min, and seven of them experienced anaphylaxis. The median level of pine nut-specific immunoglobulin E (sIgE) in the allergic group (1.62kUA/L) was significantly higher (p=0.014) than that in the tolerant group (0.11kUA/L), with an optimal cut-off level of 0.40kUA/L (sensitivity, 66.7% and specificity, 77.8%). The positive decision point of pine nut-sIgE (specificity, 100%) to distinguish the allergic and tolerant groups was 2.84kUA/L. However, there was no difference in pine nut-sIgE levels between the anaphylaxis and non-anaphylaxis cases.ConclusionAbout 30% of children with pine nut allergy experienced anaphylaxis. The optimal cut-off level of pine nut-sIgE to distinguish the allergic and tolerant groups was 0.40kUA/L and the positive decision point was 2.84kUA/L.



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Immunomodulation of allergic response in children and adolescents: What we can learn from lymphatic filarial infection

Publication date: March–April 2018
Source:Allergologia et Immunopathologia, Volume 46, Issue 2
Author(s): A.M. Aguiar-Santos, S. Montenegro, Z. Medeiros, A. Rocha, C.N.L. Morais, A.R. Silva, C. Bonfim, T.R. Costa, E.S.C. Sarinho
BackgroundAlthough it is well known that allergic diseases involve a strong Th2 immune response, with production of high levels of specific IgE allergen, knowledge on the association between filarial infection and allergies, among paediatric patients is scarce.ObjectiveTo evaluate the allergic response patterns in cases of filarial infection by comparing peripheral eosinophils, total IgE levels, immediate hypersensitivity and cytokine levels in children and adolescents in Brazil.MethodsThis was an exploratory study with three groups: (I) with filarial infection and without allergic diseases; (II) without filarial infection and with allergic diseases; and (III) without filarial infection and without allergic diseases. The prick test and specific IgE tests for aeroallergens were performed using five antigens. Peripheral eosinophils and total IgE were also evaluated. IL-4 and IL-5 were determined using whole-blood culture stimulated by three antigens.ResultsEosinophilia and elevated levels of total IgE (≥400IU/dl) were observed in all groups. The prick test was positive in 56.6% of the cases. Group I presented hypersensitive responses similar to the allergic disease groups. In the whole-blood culture stimulated by Dermatophagoides pteronyssinus, average IL-4 production did not differ significantly among the groups, but IL5 production resulting from stimulation was greater in the allergic disease groups (p<0.05).ConclusionsThe allergic response pattern in group with filarial infection was similar to that of the groups with and without allergic diseases, but the response to IL-5 in the culture stimulated by D. pteronyssinus was an exclusive characteristic of the allergic group.



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Fluticasone in mild to moderate atopic dermatitis relapse: A randomized controlled trial

Publication date: Available online 17 January 2018
Source:Allergologia et Immunopathologia
Author(s): E. Rubio-Gomis, I. Martinez-Mir, F.J. Morales-Olivas, A. Martorell-Aragones, V. Palop-Larrea, A. Bernalte-Sesé, J.C. Cerda-Mir, P. Polo-Martín, I. Febrer, L. Aranda-Grau, I. Llosa-Cortes, Mª.J. Tejedor-Sanz, J.C. Julia-Benito, T. Alvarez-de-Laviada-Mulero, Mª.V. Planelles-Cantarino, E. Apolinar-Valiente, M. Loriente-Tur, A.M. Abella-Bazataqui, I. Alvarez-Gonzalez, C. Morales-Carpi, Mª.E. Burches-Greus, A.B. Ferrer-Bautista, R. Felix-Toledo, D. Marmaneu-Laguia, V.E. Garcia-Martinez, Mª.A. Beltran-Marques, B. Rodriguez-Gracia
BackgroundThe long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD.MethodsA randomized controlled, multicentric, double-blind trial was conducted. Children (2–10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan–Meier estimates were calculated.ResultsFifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated.ConclusionThis long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.



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Loss of tolerance for fishes previously tolerated in children with fish food protein induced enterocolitis syndrome

Publication date: Available online 17 January 2018
Source:Allergologia et Immunopathologia
Author(s): S. Miceli Sopo, C. Fantacci, G. Bersani, A. Romano, S. Monaco
We describe two case reports presenting some novel information on fish FPIES. Fish FPIES to one fish does not always start at the same time to other fish. Additionally, development of tolerance to the index fish do not necessarily imply tolerance to other reactive fish. This reflects on the best management of children with FPIES fish.



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Hematopoietic Stem Cell Transplantation for Adult Philadelphia-Negative Acute Lymphoblastic Leukemia in the First Complete Remission in the Era of Minimal Residual Disease

Abstract

Purpose of Review

The purpose of this review is to discuss the potential role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for Philadelphia-negative (Ph) adult acute lymphoblastic leukemia (ALL) in first complete remission (CR1) in the era of minimal residual disease (MRD).

Recent Findings

Allo-HSCT continues to have a role in the therapy of a selected group of high-risk adult patients with ALL in CR1. Although the clinical significance of MRD has been studied less extensively in adults with ALL than in children, recent studies support its role as the strongest prognostic factor that can identify patients that are unlikely to be cured by standard chemotherapy and benefit from undergoing allo-HSCT. In addition, MRD status both pre- and post-HSCT has been found to correlate directly with the risk of relapse.

Summary

Currently, the clinical challenge consists on applying MRD and molecular failure to integrate novel agents and immunotherapy to lower MRD before allo-HSCT and to modulate the graft versus leukemia (GVL) effect after transplant.



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Recurrent Adult Intraabdominal Undifferentiated High-Grade Pleomorphic Sarcoma Infiltrated the Descending Colon: a Case Report and Review of the Literature



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Novel Variants and Copy Number Variation in CDH1 Gene in Iranian Patients with Sporadic Diffuse Gastric Cancer

Abstract

Introduction

The aim of this study was to survey the nucleotide changes and copy number variations (CNV) in the CDH1 gene in Iranian patients with sporadic diffuse gastric cancer (SDGC).

Materials and Methods

In this study, 28 patients were examined who upon gastrectomy had been diagnosed with SDGC according to the familial history and histopathological criteria which was confirmed by the pathologist. DNA extraction was performed from formalin-fixed paraffin-embedded tissues using a phenol-chloroform method following xylene deparaffinization. Determination of DNA sequence by Sanger was performed using PCR amplification of 16 exons and boundaries of intron/exon of CDH1 gene. Multiplex ligation-dependent probe amplification (MLPA) was performed on patients with pathogenic disorders in the sequence.

Results

In total, patients included 20 males and 8 females. Of all patients, 12 patients were under 45 years old (early onset gastric cancer, EODC) and 16 patients were older. The tumor was diagnosed in the early TNM stage (I, II) in six patients and in late stages (III, IV) in 19 cases. Altogether, 16 variants (three exonic with one new variant and 13 intronic with nine new variants) were found in DNA sequencing of the CDH1 gene in five samples. Also, using MLPA, a new duplication in exon 9 and one deletion in exon 2 were detected in two other patients. Altogether, CDH1 variants were identified in seven out of 28 patients (25%).

Conclusion

Our study revealed several novel somatic variants in the CDH1 gene in Iranian patients with sporadic diffuse GC. Our data supports the hypothesis that mutations in CDH1 gene, and particularly the mutations we describe, should be considered, even in sporadic cases of gastric cancer. The presence of these mutations in patients raises important issues regarding genetic counseling and diagnostic test in DGC patients.



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Gastroesophageal Cancer During Pregnancy: a Case Report and Review of the Literature



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Alan F. Weissman: Top score for the Radiology Boards Q&A for the Core and Certifying Exams



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Alan F. Weissman: Top score for the Radiology Boards Q&A for the Core and Certifying Exams



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Toward eradicating misconceptions on matching in etiological studies



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Local and remote black carbon sources in the Metropolitan Area of Buenos Aires

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Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Melisa Diaz Resquin, Daniela Santágata, Laura Gallardo, Darío Gómez, Cristina Rössler, Laura Dawidowski
Equivalent black carbon (EBC) mass concentrations in the fine inhalable fraction of airborne particles (PM2.5) were determined using a 7-wavelength Aethalometer for 17 months, between November 2014 and March 2016, for a suburban location of the Metropolitan Area of Buenos Aires (MABA), Argentina. In addition to describing seasonal and diurnal black carbon (BC) cycles for the first time in this region, the relative contributions of fossil fuel and remote and local biomass burning were determined by distinguishing different carbonaceous components based on their effect on light attenuation for different wavelengths. Trajectory analyses and satellite-based fire products were used to illustrate the impact of long-range transport of particles emitted by non-local sources. EBC data showed a marked diurnal cycle, largely modulated by traffic variations and the height of the boundary layer, and a seasonal cycle with monthly median EBC concentrations (in μg/m3) ranging from 1.5 (February) to 3.4 (June). Maximum values were found during winter due to the combination of prevailingly stable atmospheric conditions and the increase of fossil fuel emissions, derived primarily from traffic and biomass burning from the domestic use of wood for heating. The use of charcoal grills was also detected and concentrated during weekends. The average contribution of fossil fuel combustion sources to EBC concentrations was 96%, with the remaining 4% corresponding to local and regional biomass burning. During the entire study period, only two events were identified during which EBC concentrations attributed to regional biomass burning accounted for over 50% of total EBC; these events demonstrate the relevance of agricultural and forestry activities that take place far from the city yet whose emissions can affect the urban atmosphere of the MABA.



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Emission characteristics and chemical components of size-segregated particulate matter in iron and steel industry

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Publication date: June 2018
Source:Atmospheric Environment, Volume 182
Author(s): Jia Jia, Shuiyuan Cheng, Sen Yao, Tiebing Xu, Tingting Zhang, Yuetao Ma, Hongliang Wang, Wenjiao Duan
As one of the highest energy consumption and pollution industries, the iron and steel industry is regarded as a most important source of particulate matter emission. In this study, chemical components of size-segregated particulate matters (PM) emitted from different manufacturing units in iron and steel industry were sampled by a comprehensive sampling system. Results showed that the average particle mass concentration was highest in sintering process, followed by puddling, steelmaking and then rolling processes. PM samples were divided into eight size fractions for testing the chemical components, SO42− and NH4+ distributed more into fine particles while most of the Ca2+ was concentrated in coarse particles, the size distribution of mineral elements depended on the raw materials applied. Moreover, local database with PM chemical source profiles of iron and steel industry were built and applied in CMAQ modeling for simulating SO42− and NO3 concentration, results showed that the accuracy of model simulation improved with local chemical source profiles compared to the SPECIATE database. The results gained from this study are expected to be helpful to understand the components of PM in iron and steel industry and contribute to the source apportionment researches.



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Toward eradicating misconceptions on matching in etiological studies



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Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center.

Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center.

Neuroradiology. 2018 Mar 23;:

Authors: Nacar Dogan S, Kizilkilic O, Kocak B, Isler C, Islak C, Kocer N

Abstract
PURPOSE: Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients.
METHODS: We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up.
RESULTS: The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24 h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1 months. Three (3%) patients complained about severe headache 3-4 weeks after the procedure.
CONCLUSIONS: IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.

PMID: 29572604 [PubMed - as supplied by publisher]



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The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin, Published online: 26 March 2018; doi:10.1038/s41416-018-0043-8

The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin

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Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry, Published online: 26 March 2018; doi:10.1038/s41416-018-0033-x

Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry

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Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma, Published online: 26 March 2018; doi:10.1038/s41416-018-0061-6

Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma

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Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study, Published online: 26 March 2018; doi:10.1038/s41416-018-0037-6

Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study

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Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

Targeting glutaminolysis in chondrosarcoma in context of the <i>IDH1/2</i> mutation, Published online: 26 March 2018; doi:10.1038/s41416-018-0050-9

Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation

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Targeting glutaminolysis in chondrosarcoma in context of the IDH1/2 mutation



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Long-term follow-up of overall survival for cabozantinib versus everolimus in advanced renal cell carcinoma



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Predicting cumulative incidence of adverse events in older patients with cancer undergoing first-line palliative chemotherapy: Korean Cancer Study Group (KCSG) multicentre prospective study



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The mechanism study of lentiviral vector carrying methioninase enhances the sensitivity of drug-resistant gastric cancer cells to Cisplatin



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Optoacoustics delineates murine breast cancer models displaying angiogenesis and vascular mimicry



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Visual Performance and Perception as a Target of Saccadic Strategies in Patients With Unilateral Vestibular Loss

Objectives: To evaluate the ability of saccadic strategies developed during vestibular compensation to reduce the effect of an impaired vestibulo-ocular reflex (VOR) on a retinal smear and image motion sensation. Design: Twenty patients with unilateral vestibular loss were examined with a video head impulse test before and after vestibular rehabilitation (VR) with the use of gaze stabilization and refixation saccades training. Head and eye velocity functions were processed to infer the retinal eccentricity, and through its correlation with visual acuity (VA), several measurements are proposed to evaluate the influence of VR on saccades behavior and visual performance. To isolate the effect of saccades on the findings and avoid bias because of gain differences, only patients whose VOR gain values remained unchanged after VR were included. Results: Improved contribution of covert saccades and reduction of overt saccades latency were measured after VR. We found significant differences when assessing both the interval less than 70% VA (50.25 ms), which is considered the limit of a moderate low vision, and less than 50% VA (39.515 ms), which is the limit for severe low vision. Time to recover a VA of 75% (near normal) was reduced in all the patients (median: 56.472 ms). Conclusion: Despite the absence of VOR gain improvement, patients with unilateral vestibular loss are able to develop saccadic strategies that allow the shortening of the interval of retinal smear and image motion. The proposed measurements might be of use to evaluate VR outcomes and visually induced impairment. ACKNOWLEDGMENTS: All authors contributed to this work, discussed the results and implications, and commented on the article at all stages. G. T. performed explorations, designed and performed measurements, analyzed data, and wrote the article; J. R. designed the RV protocol, performed explorations, and reviewed the article; A. B. performed explorations and reviewed the article; E. M. performed explorations and reviewed the article; N. P. participated in the study design, performed explorations, and reviewed the article. The authors have no conflicts of interest to disclose. Address for correspondence: Gabriel Trinidad-Ruiz, Neurotology Unit, Department of Otorhinolaryngology, University hospital of Badajoz, Spain. E-mail: gtrinidad@gmail.com Received November 17, 2017; accepted February 1, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Development of a Novel Bone Conduction Verification Tool Using a Surface Microphone: Validation With Percutaneous Bone Conduction Users

Objectives: To determine if a newly-designed, forehead-mounted surface microphone would yield equivalent estimates of audibility when compared to audibility measured with a skull simulator for adult bone conduction users. Design: Data was analyzed using a within subjects, repeated measures design. There were two different sensors (skull simulator and surface microphone) measuring the same hearing aid programmed to the same settings for all subjects. We were looking for equivalent results. Patients: Twenty-one adult percutaneous bone conduction users (12 females and 9 males) were recruited for this study. Mean age was 54.32 years with a standard deviation of 14.51 years. Nineteen of the subjects had conductive/mixed hearing loss and two had single-sided deafness. Methods: To define audibility, we needed to establish two things: (1) in situ–level thresholds at each audiometric frequency in force (skull simulator) and in sound pressure level (SPL; surface microphone). Next, we measured the responses of the preprogrammed test device in force on the skull simulator and in SPL on the surface mic in response to pink noise at three input levels: 55, 65, and 75 dB SPL. The skull simulator responses were converted to real head force responses by means of an individual real head to coupler difference transform. Subtracting the real head force level thresholds from the real head force output of the test aid yielded the audibility for each audiometric frequency for the skull simulator. Subtracting the SPL thresholds from the surface microphone from the SPL output of the test aid yielded the audibility for each audiometric frequency for the surface microphone. The surface microphone was removed and retested to establish the test–retest reliability of the tool. Results: We ran a 2 (sensor) × 3 (input level) × 10 (frequency) mixed analysis of variance to determine if there were any significant main effects and interactions. There was a significant three-way interaction, so we proceeded to explore our planned comparisons. There were 90 planned comparisons of interest, three at each frequency (3 × 10) for the three input levels (30 × 3). Therefore, to minimize a type 1 error associated with multiple comparisons, we adjusted alpha using the Holm–Bonferroni method. There were five comparisons that yielded significant differences between the skull simulator and surface microphone (test and retest) in the estimation of audibility. However, the mean difference in these effects was small at 3.3 dB. Both sensors yielded equivalent results for the majority of comparisons. Conclusions: Models of bone conduction devices that have intact skin cannot be measured with the skull simulator. This study is the first to present and evaluate a new tool for bone conduction verification. The surface microphone is capable of yielding equivalent audibility measurements as the skull simulator for percutaneous bone conduction users at multiple input levels. This device holds potential for measuring other bone conduction devices (Sentio, BoneBridge, Attract, Soft headband devices) that do not have a percutaneous implant. ACKNOWLEDGMENTS: Portions of this work were paid for from a grant to W. Hodgetts from the Oticon Foundation. P. M. works for Oticon Medical. The other authors have no competing interests to declare. Received August 22, 2017; accepted January 26, 2018. Address for correspondence: William Hodgetts, Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada. E-mail: bill.hodgetts@ualberta.ca Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Histologic and Outcome Study Supports Reclassifying Appendiceal Goblet Cell Carcinoids as Goblet Cell Adenocarcinomas, and Grading and Staging Similarly to Colonic Adenocarcinomas

Goblet cell carcinoid tumors are amphicrine tumors whose biological behavior ranges from indolent to highly aggressive, depending on tumor grade. Current grading systems for these tumors are based on identifying an adenocarcinoma arising in the setting of a goblet cell carcinoid tumor, which distinguishes this tumor from other gastrointestinal tract adenocarcinomas. Because goblet cell tumors are predominantly tumors of mucin secreting cells, we propose that they be classified as goblet cell adenocarcinomas, and graded using a methodology that has parallels in colorectal adenocarcinoma grading. We graded a large series of goblet cell adenocarcinomas by assessing the proportion of the tumor that demonstrates tubular or clustered growth. Histologic grade correlated with overall survival independent of stage, with median overall survival of 204, 86, and 29 months for low-grade, intermediate-grade, and high-grade goblet cell adenocarcinomas, respectively. Tumor stage also correlated with overall survival. We also graded the tumors according to previously proposed grading systems, and found that these systems are valid, in that they segregate patients according to prognosis. This work was conducted with support from Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, and its affiliated academic health care centers, or the National Institutes of Health. Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Joseph Misdraji, MD, Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 (e-mail: jmisdraji@partners.org). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Intraoperative Consultation and Macroscopic Handling: The International Society of Urological Pathology (ISUP) Testicular Cancer Consultation Conference Recommendations

The International Society of Urological Pathology held a conference on issues in testicular and penile pathology in Boston in March 2015, which included a presentation by the testis macroscopic features working group. The presentation focused on current published guidance for macroscopic handling of testicular tumors and retroperitoneal lymph node dissections with a summary of results from an online survey of members preceding the conference. The survey results were used to initiate discussions, but decisions on practice were made by expert consensus rather than voting. The importance of comprehensive assessment at the time of gross dissection with confirmation of findings by microscopic assessment was underscored. For example, the anatomic landmarks denoting the distinction of hilar soft tissue invasion (pT2) from spermatic cord invasion (pT3 category) can only be determined by careful macroscopic assessment in many cases. Other recommendations were to routinely sample epididymis, rete testis, hilar soft tissue, and tunica vaginalis in order to confirm macroscopic invasion of these structures or if not macroscopically evident, to exclude subtle microscopic invasion. Tumors 2 cm or less in greatest dimension should be completely embedded. If the tumor is >2 cm in greatest dimension, 10 blocks or a minimum of 1 to 2 additional blocks per centimeter should be taken (whichever is greater). Members of the ISUP testicular tumor panel: Amin MB, Delahunt B, Magi-Galluzzi C, Algaba F, Montironi R, Young RH, Idrees MT, Williamson SR, Yilmaz A. C.V. and J.P.-K. contributed equally to the manuscript. Conflicts of Interest and Source of Funding: The International Society of Urological Pathology (ISUP) 2015 consultation on testis and penile cancer was generously supported by Orchid. Clare Verrill's research time is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) (Molecular Diagnostics Theme/Multimodal Pathology Subtheme). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: Clare Verrill, FRCPath, Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK (e-mail: Clare.Verrill@OUH.nhs.uk). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Microsurgery, Ahead of Print.

Microsurgery, Ahead of Print.


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Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle

Publication date: Available online 24 March 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Selçuk Güneş, Kadir Serkan Orhan, Bora Başaran, Mehmet Çelik, Erkan Kıyak
IntroductionLaryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities.ObjectiveThe aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid suscle.MethodsIn total, 29 male patients (average years 58.20±9.00 years; range 41–79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared.ResultsThe mean maximum phonation time was 8.68±4.21s in Group A and 15.24±6.16s in Group B (p>0.05). The S/Z (s/s) ratio was 1.23±0.35 in Group A and 1.08±0.26 in Group B (p>0.05); the voice handicap index averages were 9.86±4.77 in Group A and 12.42±12.54 in Group B (p>0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73±3.08 in Group A and 13.64±1.49 in Group B (p>0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21±4.11, 32.21±6.85, and 20.14±2.17 in the Group B, and 29.20±2.54, 32.4±4.79, and 19±1.92 in Group A, respectively.ConclusionAlthough there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.



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Preservation of residual hearing after cochlear implant surgery: an exploration of residual hearing function in a group of recipients at cochlear implant units

Publication date: Available online 24 March 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Katherine Gautschi, Katijah Khoza-Shangase, Dhanashree Pillay
IntroductionThe preservation of residual hearing is becoming increasingly important in cochlear implant surgery. Conserving residual hearing is a positive prognostic indicator for improved hearing abilities.ObjectiveThe primary aim of the study was to explore the preservation of residual hearing following cochlear implantation in a group of recipients at two major cochlear implant centers.MethodsA quantitative paradigm was adopted and exploratory research conducted within a retrospective data review design. The sample consisted of 50 surgical records and 53 audiological records from 60 observations (53 patients, seven of whom were implanted bilaterally). The records were selected using purposive sampling and consisted of records from participants ranging from six to 59 years of age. The average time of when the postoperative audiograms were performed in the current study was 24.7 months (s.d.=±9.0). Data were analyzed through both qualitative and inferential statistics and a comparative analysis of unaided pre- and postoperative audiological test results was conducted.ResultsResults indicated a high success rate of 92% preservation of residual hearing with half of the sample exhibiting complete preservation in cochlear implant recipients across all frequencies postoperatively. A total postoperative hearing loss was found in only 8% of cochlear implantees across all frequencies. There was no relationship between preoperative hearing thresholds and preservation of hearing postoperatively. The two main surgical techniques used in the current study were the contour on stylet and the advance off-stylet techniques, with the majority of surgeons utilizing a cochleostomy approach. From the findings, it became apparent that the majority of cases did not have any reported intraoperative complications. This is a positive prognostic indicator for the preservation of residual hearing.ConclusionFindings suggest improved cochlear implant surgical outcomes when compared to previous studies implying progress in surgical techniques. The surgical skill and experience of the surgeon are evidenced by the minimal intraoperative complications and the high success rate of hearing preservation. This is a positive prognostic indicator for individuals with preoperative residual hearing as the preserved residual hearing allows for the potential of electro-acoustic stimulation, which in turn has its own hearing benefits.



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"Long-Term Outcomes of Smile Reconstruction in Möbius Syndrome.”

No abstract available

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“Quality of Life in Adults with Non-Syndromic Craniosynostosis”

Background: While studies have analyzed quality of life (QOL) in children with non-syndromic craniosynostosis (NSC), to date nobody has investigated long-term QOL in adults with NSC. The purpose of this study is to compare QOL in adult NSC patients with a cohort of unaffected controls. Methods: We queried our institution's prospectively maintained craniofacial registry for NSC patients 18 years and older, and administered the validated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Responses were compared, using a two-sample t-test, to an age-matched, United States, normative database provided by the World Health Organization (WHO). Results: 151 adults met inclusion criteria: 52 were successfully contacted and 32 completed the WHOQOL-BREF. Average age of respondents was 23.0±6.1 years old (range, 18.1 to 42.1). 12 subjects had metopic synostosis, 15 had unicoronal, and 5 had sagittal. NSC patients had a superior quality of life compared to comparative norms in all domains: physical health (17.8±2.7 vs. 15.5±3.2, p0.05), while all individual subtypes maintained superior or equivalent QOL relative to controls. Demographic variables, Whitaker score, and number of surgical interventions did not correlate with differences in QOL. Conclusion: Adult patients previously treated for NSC perceive their quality of life to be high, superior to that of a normative United States sample. Future work will seek to analyze additional patients and better understand the reasons behind these findings. Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Conflicts of Interest: None of the authors listed have any conflicts of interest to report. Funding source: This study did not have any funding sources. IRB: This study was granted approval by the Institutional Review Board for research at the Children's Hospital of Philadelphia. Corresponding author: Scott P. Bartlett, MD, Chief of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Colket Translational Research Building, 3501 Civic Center Blvd, 9th floor, Philadelphia, PA 19104, Email: bartletts@email.chop.edu, Telephone: 215-590-2214, Fax: 215-590-2496 ©2018American Society of Plastic Surgeons

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Genetics of non-syndromic craniosynostosis

SUMMARY: Occurring once in every 2,000 live births, craniosynostosis is one of the most frequent congenital anomalies encountered by the craniofacial surgeon. Syndromic craniosynostoses account for ~15% of cases and demonstrate Mendelian patterns of inheritance with well-established genetic etiologies1,2, however non-syndromic craniosynostoses (NSC), which account for ~85% of cases2, are genetically heterogeneous and largely unexplored. NSC is sporadic in >95% of affected families3, thus surgeons have suggested for decades that NSC is likely a fluke occurrence. Contrary to this, recent studies have established that genetics underlie a substantial fraction of NSC risk. Given the predominantly sporadic occurrence of disease, parents are often bewildered by the primary occurrence of NSC or even recurrence in their own families and request genetic testing. Existing genetic testing panels are useful when the phenotype strongly resembles a known syndrome, wherein the risk of disease recurrence can be accurately predicted for future offspring of the parents as well as the future offspring of the affected child. The diagnostic utility of existing panels for NSC, however, is extremely low, while these tests are quite costly. Recent genetic studies have identified several novel genes and pathways that cause NSC, providing genetic evidence linking the pathoetiology of syndromic and non-syndromic craniosynostoses, and allowing for genotype-based prediction of risk of recurrence in some non-syndromic families. Based on analysis of exome sequence data from 384 families, we provide recommendations for a new genetic testing protocol for children with NSC, which include testing non-syndromic cases of sagittal, metopic, and coronal craniosynostosis. Financial Disclosure Statement: No authors have any disclosures. Presented at: N/A Correspondence should be addressed to: Andrew T. Timberlake PhD, John A. Persing MD, Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, 3rd Floor Boardman Building, New Haven, CT 06520, Andrew.timberlake@yale.edu, John.persing@yale.edu ©2018American Society of Plastic Surgeons

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New Developments Are Improving Flexor Tendon Repair

Summary: New developments in primary tendon repair over the past decades include stronger core tendon repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During repair, core sutures over the tendon should have sufficient suture purchase (no shorter than 0.7 to 1 cm) in each tendon end and must be sufficiently tensioned to resist loosening, forming gaps. Slight or even modest bulkiness in the tendon substance at the repair site is not harmful, though marked bulkiness should always be avoided. To expose the tendon ends and reduce restriction to tendon gliding, the longest annular pulley in the fingers, i.e., the A2 pulley, can be vented partially with an incision over its distal or proximal sheath no longer than 1.5 to 2 cm; the annular pulley over the middle phalanx, i.e., the A4 pulley, can be vented entirely. Surgeons have not observed adverse effects on hand function after judicious and limited venting. The digital extension-flexion test to check the quality of the repair during surgery has become increasingly routine. A wide-awake surgical setting allows patient to actively move the digits. After surgery, surgeons and therapists protect patients in with a short splint, flexible wrist positioning, and are now moving towards out-of-splint freer early active motion. Improved outcomes have been reported over the last decade with minimal or no rupture during postoperative active motion and lower rates of tenolysis. Financial disclosure: None Corresponding author: Jin Bo Tang, MD, Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China; email: jinbotang@yahoo.com., Fax: 513-85110966, Phone: 86-513-85052524 ©2018American Society of Plastic Surgeons

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Requirements for successful trachea transplantation; a study in the rabbit model

Background: Although creating a tracheal tube de novo might appear straightforward, the first clinical applications have shown that reconstruction of long-segment tracheal defects remains challenging. In this study, we aimed to refine the baseline requirements of successful trachea transplantation by means of three proof-of-concept models in the rabbit. Methods: In each model, one characteristic of a perfect tracheal transplant was eliminated. The first model was developed to map out the immunological response of vascularized allogenic trachea, transplanted without immunosuppression (n = 6). The second model studied the need for wrapping the transplant with a highly-vascularized flap, and the source of angiogenesis after autologous trachea-transplantation (n = 18). In the third model, we examined the importance of an inner epithelial covering (n = 12). All models were compared to a control group of heterotopically transplanted vascularized autologous tracheae (n = 6). Results: Embedded in an avascular matrix, allogenic chondrocytes were protected from an overt immune response. Orthotopic transplantation without additional external vascular wrap was successful in a well-vascularized environment. Nonetheless, an external vascular source was essential to maintain viability of the construct. Epithelial covering was necessary to prevent secondary healing. Epithelial migration from the anastomoses or graft was not sufficient to cover long-segment defects. Conclusions: These experiments provided ample evidence of the importance of baseline requirements when designing a tracheal-transplant study. This study confirmed that different tracheal cell-types possess different immunological sensitivities. External revascularization, preferably in a two-stage procedure, and fast reepithelialization were both paramount to successful transplantation. Financial disclosure: The authors of this manuscript have no conflicts to disclose as described by Plastic and Reconstructive Surgery. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Acknowledgements: This work was supported by the predoctoral fellowship of the Research Foundation Flanders (FWO; 11I0413N) of Margot Den Hondt. Corresponding Author: Margot Den Hondt, margot.denhondt@uzleuven.be, +32 494 18 64 83 ©2018American Society of Plastic Surgeons

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Assessing technical performance and determining the learning curve in cleft palate surgery using a high fidelity cleft palate simulator

Introduction: Technical skills assessment can provide objective measures of surgical performance. This study assessed technical performance in cleft palate repair using a newly developed assessment tool and high fidelity cleft palate simulator through a longitudinal simulation training exercise. Methods: Three residents performed five and one resident performed nine consecutive endoscopically recorded cleft palate repairs using a cleft palate simulator. Two fellows in pediatric plastic surgery and two expert cleft surgeons also performed recorded simulated repairs. A cleft palate objective structured assessment of technical skill (CLOSATS) scoring scale and end-product score were developed to assess performance. Two blinded cleft surgeons assessed the recordings and the final repairs using the CLOSATS, end-product scores and a previously developed global rating scale. Results: The average procedure specific (CLOSATS), global and end-product scores increased logarithmically after each successive simulation session for the residents. Reliability of the CLOSATS (average item ICC=0.85±0.093) and global ratings (average item ICC=0.91±0.02) amongst the raters was high. Reliability of the end-product assessments was lower (average item ICC=0.66±0.15). Standard setting linear regression using an overall cutoff score of 7 out of 10 corresponded to a pass score for the CLOSATS, and global rating score of 44 (maximum 60) and 23 (maximum 30) respectfully. Using logarithmic best fit curves, 6.3 simulation sessions are required to reach the minimum standard. Conclusions: A high fidelity cleft palate simulator has been developed that improves technical performance in cleft palate repair. The simulator and technical assessment scores can be used to determine performance before operating on patients. Financial disclosure: The cleft palate simulator is available commercially and sold by Simulare Medical Corp. (Toronto, Ontario, Canada). Drs. Podolsky, Fisher, Wong, Drake and Forrest are each shareholders of Simulare Medical Corp. Corresponding author: Dale J Podolsky, Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, 5430-555 University Avenue, Toronto, Ontario, M5G 1X8. E-mail: dale.podolsky@mail.utoronto.ca. ©2018American Society of Plastic Surgeons

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A novel small animal model of irradiated, implant based breast reconstruction

PURPOSE: There is currently a need for a clinically relevant small animal model for irradiated, implant based breast reconstruction. Present models are inadequate in terms of suboptimal location of expander placement and mode of radiation delivery, correlating poorly with the human clinical scenario. We hypothesized that by delivering fractionated radiation and placing an expander under the scalp of the animal, we would achieve histologically analogous soft tissue changes seen in human irradiated, implant based breast reconstruction. METHODS: This study consisted of eleven immunocompetent, hairless rats divided into three groups: an untreated control (n=3), tissue expanded scalps (n=4) and fractionated radiation plus tissue expansion of the scalp (n=4). At the completion of the experiment for each group, skin tissue samples were analyzed histologically for vascularity, epidermal and dermal thickness, and collagen fiber alignment or scar formation. RESULTS: Expanded rat epidermis was significantly thicker and dermis was more vascular than non-expanded skin. We observed a greater degree of collagen fiber alignment in the expanded group compared with non-expanded skin. The combination of radiation and expansion resulted in significant dermal thinning, vascular depletion and increased scar formation compared with expanded skin alone. CONCLUSIONS: We describe a novel small animal model for irradiated, implant based breast reconstruction where histologic analysis shows structural changes in the skin consistent with known effects of radiation and expansion in human skin. This model represents a significant improvement from previous ones and as such, holds the potential to be used to test new therapeutic agents to improve clinical outcomes. Financial Disclosure Statement: The authors have no disclosures. Internal funding from the University of Virginia School of Medicine Research and Development Grant was used for this research. This article has been approved by the Institutional Animal Care and Use Committee at the University of Virginia Acknowledgements: We would like to thank Quan Chen, PhD and Brian Neal, PhD for their participation in this work. Corresponding Author/Reprints: Kant Y. Lin, MD, FACS, Department of Plastic and Reconstructive Surgery, University of Virginia Health System, P.O Box 800376, Charlottesville VA, 22908, Kyl5s@hscmail.mcc.virginia.edu, Phone: 434-924-2528, Fax: 434-924-1333 ©2018American Society of Plastic Surgeons

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Targeted muscle reinnervation: considerations for future implementation in adolescents and younger children

Summary: Prosthetic options for patients with proximal upper limb absence are limited. Current above elbow prostheses may restore basic motor functions for crucial activities, but they are cumbersome to operate, lack sensory feedback, and are often abandoned. Targeted muscle reinnervation (TMR) is a novel surgical procedure that enhances the ability of patients with above elbow amputations to intuitively control a myoelectric prosthesis. By transferring multiple severed peripheral nerves to a robust target muscle, TMR restores physiologic continuity and enables more intuitive prosthetic control. Although reports have been limited to adults, TMR has great potential for application in a pediatric population with congenital or acquired proximal upper limb absence. In this review, we describe the rehabilitative challenges of proximal upper limb amputees and outline the objectives, techniques, and outcomes of TMR. We then discuss important considerations for adapting TMR to pediatric patients, including etiology of upper limb absence, central plasticity, timing of prosthesis fitting, role of the family, surgical feasibility, and bioethical aspects. We believe that carefully screened school-aged children and adolescents with bilateral proximal upper limb absence, as well as adolescents with unilateral proximal upper limb absence, should be seriously considered for TMR by an experienced surgical and rehabilitation team. Financial Disclosure Statement: The authors have nothing to disclose. Corresponding Author: Dr. Gregory Borschel, MD, FACS, FAAP , Associate Professor, Division of Plastic & Reconstructive Surgery, Assistant Professor, Institute of Biomaterials and Biomedical Engineering, University of Toronto, The Hospital for Sick Children, 555 University Avenue, Room 5547, Hill Wing, Toronto, ON M5G 1X8, Tel: (416) 813-7654, ext. 228197, Fax: (416) 813-6637, Email: gregory.borschel@sickkids.ca ©2018American Society of Plastic Surgeons

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Response Re: Five Step to Internal Mammary Vessel Preparation in Less than Fifteen Minutes

No abstract available

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Acellular Human Dermal Allograft as a Graft for Nasal Septal Perforation Reconstruction

Objective: Nasal septal perforations pose a troubling source of morbidity for patients and a difficult problem for the Otolaryngologist. Multiple surgical techniques have been tried with inconsistent success. Prosthetic nasal buttons also have limitations, including patient intolerance and dissatisfaction. Acellular human dermal allograft, AlloDerm™ (LifeCell Branchburg, NJ) has been previously described as an alternative material for septal perforation repair. We aim to demonstrate objective and subjective outcomes, including quantification of patient's symptoms in septal perforation repair with AlloDerm. Methods: A prospective cohort study of twelve patients with 1-2cm anterior septal perforations that were recruited from a tertiary care practice. Patients with admitted smoking or cocaine use in the previous three months, vascular or granulomatous diseases were excluded. Subjective SNOT-22 scores along with objective nasal endoscopy and acoustic rhinometry measures were collected at baseline and 2, 4, and 12 weeks postoperatively, patients were followed for re-perforation 9-20 months post operatively. Data was normalized to baseline values and analyzed using ANOVA and Bonferroni correction. Results: Successful closure of the septal perforation was obtained in 10/12 patients and confirmed with rigid nasal endoscopy. Nasal symptom scores (SNOT-22) were significantly reduced to 52.8% (95%CI[35.1%-70.5.%];p

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Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success?

No abstract available

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RE: Macro textured breast implants with defined steps to minimize bacterial contamination around the device.

No abstract available

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Re: Five Steps to Internal Mammary Vessel Preparation in Less than 15 Minutes

No abstract available

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Vertical growth phase as a prognostic factor for sentinel lymph node positivity in thin melanomas: a systematic review and meta-analysis

Background: The 2010 AJCC guidelines recommended consideration of sentinel lymph node (SLN) biopsy for thin melanoma (Breslow thickness IV. Seven studies reported on VGP, which was strongly associated with SLN positivity (odds ratio 4.3; 95% CI, 2.5- 7.7). Conclusion: To date, this is the largest meta-analysis to examine predictors of SLN biopsy positivity in thin melanoma. VGP had a strong association with SLN biopsy positivity, providing support for its inclusion in standardized pathological reporting. The authors have no conflicts of interest to declare ACKNOWLEDGEMENTS: This work was supported in part by a Capital Health Trainee Research Award. The study sponsor had no role in design, collection, analysis or interpretation of the data, and writing the manuscript. The authors thank Kara Thompson and the Research Methods Unit at Dalhousie University for assistance in the meta-analysis and statistics, and Penny Logan from the Capital Health Halifax Infirmary Library for help with the literature search. The authors also wish to thank Dr. Noreen Walsh of the Division of Clinical Dermatology & Cutaneous Science, Department of Pathology, Dalhousie University, for her insightful comments and critique of this manuscript. Corresponding author: Michael Bezuhly, Division of Plastic and Reconstructive Surgery, Dalhousie University, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, Nova Scotia, Canada, B3K 6R8; Tel: +1-902-470-8168, Fax: +1-902-470-7939; E-mail: mbezuhly@dal.ca ©2018American Society of Plastic Surgeons

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Prophylactic Nipple-Sparing Mastectomy and Direct-to-Implant Reconstruction of the Large and Ptotic Breast: Is Preshaping of the Challenging Breast a Key to Success? – Reply to Dr. Bonomi

No abstract available

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Utilizing “Black Bone” MRI in Craniofacial Virtual Surgical Planning: A Comparative Cadaver Study

Background: The use of MRI for virtual surgical planning has not yet been described. In the US, over 600,000 CT scans are performed on children annually, who are at higher risk for developing cancer caused by ionizing radiation compared to adults. The aim of this study is to demonstrate that 3D printed craniofacial surgical guides created from Black Bone MRI are comparable in accuracy to those created from CT scans. Methods: A mock craniosynostosis surgery translocating four calvarial segments was virtually planned and performed in ten cadavers. For five specimens, this planning was performed and 3D-printed guides created using Black Bone MRI scans. Five other specimens underwent standard planning using CT scans. The reconstructed skulls underwent CT scans and 3D-reconstruction. Surgical accuracy was then compared to the virtually-planned surgery. Results: The pre-op Black Bone MRI scan had an average deviation from the pre-op CT scan of 1.37mm. There was no statistically significant difference in the accuracy of guide fit between MRI versus CT-created guides. Average deviation of post-operative anatomy from pre-operative plan was within 1.5mm for both MRI and CT-created guides, with no statistically significant difference in accuracy between the two methods. Planned versus postoperative skull volume was not statistically significant different when MRI versus CT was used. Conclusion: This study demonstrates that virtual surgical planning and 3D surgical guide creation for craniofacial surgery can be performed using Black Bone MRI with comparable accuracy to CT scans. This could dramatically reduce radiation exposure for pediatric and adult craniofacial reconstruction patients. Financial Disclosure Statement: There are no financial disclosures to report. Presented at: Mayo Clinic Chang Gung Symposium in Reconstructive Surgery, Munich, Germany, October 21, 2016 Acknowledgments: This work supported by a generous gift from the Tribuno Family. We would like to thank Kyle Iverson from Mayo Clinic for help with MRI scanning, and Shelby Marks, Cyndi Hoffmeister, and Katie Weimer from 3D Systems for their support and help with scan analysis, segmentation, guide design, and postoperative analysis. We would like to acknowledge the Mayo Clinic Anatomy Department, especially Shaun Heath, Karen Mills, Andy Wilhorn, and Terry Regnier, as well as the noble generosity of the Mayo Clinic's whole body donors whose altruistic gift made this study possible. Corresponding author: Samir Mardini, MD, Professor of Surgery, Mayo Clinic College of Medicine, Program Director, Plastic Surgery, Mayo Clinic, Rochester, MN, Email: mardini.samir@mayo.edu ©2018American Society of Plastic Surgeons

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Metastasis to Paranasal Sinuses from Carcinoma of Prostate: Report of a Case and Review of the Literature

Metastasis from distant primary tumors is extremely rare in the paranasal sinuses with few hundred cases in the literature. Metastatic carcinoma of the prostate is even rarer, despite being one of the most common tumors, with only 24 cases published. In this article, we report a case of a 58-year-old male presenting with epistaxis and nasal obstruction as initial symptoms of a metastatic prostate carcinoma in the ethmoid cells and maxillary sinus.

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The aVOR App Increases Medical Students’ Competence in Treating Benign Paroxysmal Positional Vertigo (BPPV)

Hypothesis: Implementation of the "aVOR app" into teaching courses at medical school enhances students' satisfaction with the course and increases their competence in treating benign paroxysmal positional vertigo (BPPV). Background: BPPV is often underdiagnosed and left untreated. One problem in teaching the management of BPPV to health care professionals is the lack of simulation-based training tools. The aVOR app (aVOR = angular vestibulo-ocular reflex) works as a bionic labyrinth that simulates the activation of the semicircular canals by rotational acceleration and the resulting vestibular evoked eye movements. Methods: In this prospective, randomized, controlled study, medical students at a university hospital were randomly assigned to two kinds of small instructional groups. Students of the control group (n = 67) practiced diagnostic and therapeutic maneuvers for BPPV on each other, while the participants of the study group (n = 46) used the aVOR app as a virtual patient in addition. At the end of the term, students were asked to arrange the steps of the canalith repositioning procedure in the correct order in a written test. Results: Quality of the teaching media was rated significantly better in the aVOR group (two-sided Mann–Whitney test: P 

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Metastasis to Paranasal Sinuses from Carcinoma of Prostate: Report of a Case and Review of the Literature

Metastasis from distant primary tumors is extremely rare in the paranasal sinuses with few hundred cases in the literature. Metastatic carcinoma of the prostate is even rarer, despite being one of the most common tumors, with only 24 cases published. In this article, we report a case of a 58-year-old male presenting with epistaxis and nasal obstruction as initial symptoms of a metastatic prostate carcinoma in the ethmoid cells and maxillary sinus.

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[Benign aggressive vascular anomalies in children].

[Benign aggressive vascular anomalies in children].

Bull Cancer. 2018 Mar 20;:

Authors: Boccara O, Maruani A, Léauté-Labrèze C

Abstract
Superficial vascular anomalies constitute a large group of malformative and tumoral conditions developed from all types of vessels. Vascular tumors are the result of cellular hyperplasia, whereas vascular malformations (VMs) are constituted of dysplastic vessels. The classification from International Society for the Study of Vascular Anomalies (ISSVA) is based on this pathogenic difference. The most common vascular tumor is infantile hemangioma, which treatment, when necessary, is propranolol. Congenital hemangiomas and tumors that might be complicated with Kasabach-Merritt phenomenon, i.e. deep thrombocytopenia, are much rarer. Management of Kasabach-Merritt phenomenon is now largely based on sirolimus. Low-flow VMs include capillary, venous and lymphatic malformations; arteriovenous malformations are high-flow malformations. These different types of VMs might be combined. Currently, there is an increasing work in delineating the different entities based on molecular findings. Treatment of VMs depends on the impairment linked to them, and is decided case by case, in pluridisciplinary consultations. Interventional treatments, especially surgery and sclerotherapy, are usually partially efficient, and management of patients with VMs increasingly involves medical drugs. First-line treatment of coagulation disorders associated with venous malformations is based on low molecular weight heparin; sirolimus seems efficient in hemorrhagic complications refractory to usual treatment. Sirolimus is about to become the standard treatment in painful inflammatory manifestations of mixed and/or complicated lymphatic malformations.

PMID: 29571951 [PubMed - as supplied by publisher]



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Lasers in Surgery and Medicine, Ahead of Print.

Lasers in Surgery and Medicine, Ahead of Print.


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Epilepsia, Ahead of Print.

Epilepsia, Ahead of Print.


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Protective Effects of Micronized Purified Flavonoid Fraction (MPFF) on a Novel Experimental Model of Chronic Venous Hypertension

Publication date: Available online 24 March 2018
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Maria das Graças C de Souza, Fatima ZGA Cyrino, Jorge J de Carvalho, Vanessa Blanc-Guillemaud, Eliete Bouskela
ObjectivesTo assess protective effects of micronized purified flavonoid fraction (MPFF) on microcirculation in an original chronic model of hind limb venous hypertension with low blood flow in small animals.MethodsVein ligatures were performed on male hamsters, as follows: A-right femoral vein; A + B-right femoral vein and its right branch; A + C-right femoral vein and its left branch; A + B + C-right femoral and its right and left branches; D-external right iliac vein. In sham operated groups, similar vascular dissections were performed without ligatures. Superficial (epigastric) and central (jugular) venous pressure evaluations were made during a 10 week period. Hamsters subjected to A + B + C and D ligatures were selected for leukocyte rolling and sticking, functional capillary density (FCD), and venular and arteriolar diameter observations. D ligature was selected to evaluate pharmacological treatment efficacy. MPFF (100 mg/kg), concomitant active flavonoids of MPFF (diosmetin, hesperidin, linarin, and isorhoifolin) (10 mg/kg), diosmin (100 mg/kg) or drug vehicle were administered orally during 2 weeks before vein ligature and 6 weeks thereafter.ResultsA, A + B and A + C models maintained venous return through collaterals. From the 2nd to the 10th weeks after vein ligatures, A + B + C and D models elicited a progressive increase of superficial venous pressure (3.83 ± 0.65 vs. 8.56 ± 0.72 mmHg, p < .001 and 4.13 ± 0.65 vs. 9.35 ± 0.65 mmHg, p < .001, respectively) with significant changes to the microcirculation. As D model significantly increased superficial venous pressure without affecting central venous pressure, it was used to evaluate the long-term effects of treatment. Compared with vehicle, MPFF, concomitant active flavonoids of MPFF, and diosmin, significantly decreased leukocyte-endothelium interaction and prevented FCD reduction. Only MPFF significantly prevented venular enlargement as observed in the vehicle treated group.ConclusionMPFF was more effective than diosmin in improving all microvascular variables. The superiority of MPFF over diosmin alone can be explained by the synergistic beneficial effects of the association between diosmin and active flavonoids of MPFF.



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A rare case of drug-induced hypersensitivity syndrome by pirfenidone for idiopathic pulmonary fibrosis

Publication date: Available online 24 March 2018
Source:Allergology International
Author(s): Kumiko Suda, Koji Kamiya, Binluen Chiang, Hirofumi Okada, Naoko Mato, Takeo Maekawa, Mayumi Komine, Satoru Murata, Mamitaro Ohtsuki




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Non-invasive quantification of human swallowing using a simple motion tracking system.

Non-invasive quantification of human swallowing using a simple motion tracking system.

Sci Rep. 2018 Mar 23;8(1):5095

Authors: Hashimoto H, Hirata M, Takahashi K, Kameda S, Katsuta Y, Yoshida F, Hattori N, Yanagisawa T, Palmer J, Oshino S, Yoshimine T, Kishima H

Abstract
The number of patients with dysphagia is rapidly increasing due to the ageing of the population. Therefore, the importance of objectively assessing swallowing function has received increasing attention. Videofluoroscopy and videoendoscopy are the standard clinical examinations for dysphagia, but these techniques are not suitable for daily use because of their invasiveness. Here, we aimed to develop a novel, non-invasive method for measuring swallowing function using a motion tracking system, the Kinect v2 sensor. Five males and five females with normal swallowing function participated in this study. We defined three mouth-related parameters and two larynx-related parameters and recorded data from 2.5 seconds before to 2.5 seconds after swallowing onset. Changes in mouth-related parameters were observed before swallowing and reached peak values at the time of swallowing. In contrast, larynx-related parameters showed little change before swallowing and reached peak values immediately after swallowing. This simple swallow tracking system (SSTS) successfully quantified the swallowing process from the oral phase to the laryngeal phase. This SSTS is non-invasive, wireless, easy to set up, and simultaneously measures the dynamics of swallowing from the mouth to the larynx. We propose the SSTS for use as a novel and non-invasive swallowing assessment tool in the clinic.

PMID: 29572522 [PubMed - in process]



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