Effects of continuous positive airway pressure on cardiovascular biomarkers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

Abstract

Purpose

Obstructive sleep apnea (OSA) is associated with increased levels of systemic inflammatory markers, increased arterial stiffness, and endothelial dysfunction, which may lead to increased cardiovascular risk. We aimed to quantify the effects of continuous positive airway pressure (CPAP) on cardiovascular biomarkers and to establish predictors of response to CPAP.

Methods

We searched PubMed and the Cochrane Library from inception to May 31, 2017. Randomized controlled trials (RCTs) assessing the efficacy of CPAP on high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumor necrosis factor- alpha (TNF-α), augmentation index (AIx), pulse wave velocity (PWV), and flow-mediated dilatation (FMD) in patients with OSA were selected by consensus.

Results

We included 15 RCTs comprising 1090 patients in the meta-analysis. The pooled standard mean difference (SMD) of effect of CPAP on hs-CRP was − 0.64 (95% confidence interval (CI) − 1.19 to − 0.09; P = 0.02). CPAP was associated with a reduction in AIx of 1.53% (95% CI, 0.80 to 2.26%; P < 0.001) and a significant increase in FMD of 3.96% (95% CI 1.34 to 6.59%; P = 0.003). Subgroup analyses found CPAP was likely to be more effective in improving FMD levels in severe OSA patients or patients with effective CPAP use ≥ 4 h/night.

Conclusions

Among patients with OSA, CPAP improves inflammatory marker hs-CRP, arterial stiffness marker AIx, and endothelial function marker FMD. These biomarkers may provide information related to response to treatment. Future studies will need to clarify the efficacy of these biomarkers in assessing cardiovascular risk reduction among OSA treated with CPAP.

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Validation of Bahasa Malaysia STOP-BANG questionnaire for identification of obstructive sleep apnea

Abstract

Purpose

The diagnosis of obstructive sleep apnea (OSA) by polysomnography (PSG) is time-consuming and expensive. The STOP-BANG questionnaire (SBQ) is an adequate screening tool and easily applied. We aimed to validate the Bahasa Malaysia version for use in sleep clinic.

Methods

A cross-sectional study was carried out in the sleep clinic. Standard forward–backward method was used for translation. Patients were required to answer a translated version of the questionnaire in Bahasa Malaysia and underwent a PSG study. Apnea–hypopnea index (AHI) of five and more was considered diagnostic. SBQ score was divided into two groups, less than 3 and 3 or more to determine its correlation with mild, moderate, or severe OSA. The reliability of the questionnaire was compared against that of the PSG result.

Results

We recruited 134 patients with mean age of 41.22 ± 12.66 years old. 9.7% patients have low risk, 48.5% moderate risk, and 41.8% high risk of OSA by SBQ scoring. 28.4% of patients had mild, 33.6% had moderate, and 38.0% had severe OSA by PSG. The Bahasa Malaysia version had sensitivity, specificity, and positive and negative predictive value of 61.42, 71.05, and 84.06 and 41.54% respectively. When the score is higher, the probability increases for patients to have moderate or severe OSA. SBQ score showed moderate value of agreement to AHI.

Conclusions

The Bahasa Malaysia version of SBQ is a valid tool for the identification of OSA. It is useful to detect patients at risk for further investigation and management.

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The American Society of Hematology (ASH) Medical Educators Institute: a Pilot Faculty Development Project for Hematology Educators

Abstract

Clinician educators at academic medical centers often lack the community, mentorship, and faculty development to support their missions around education scholarship and teaching. Inadequate support for clinician educators can lead to professional dissatisfaction and slowed academic advancement. In 2014, ASH conducted a needs assessment of medical school hematology course directors, hematology-oncology fellowship program directors, and other ASH members identified as educators to determine this community's desire for faculty development in medical education. These data furthered the development of an annual faculty development program for hematology educators offering an interactive curriculum and support for an educational scholarly project. The needs assessment indicated that over 70% of respondents would be personally interested in a faculty development opportunity for hematology educators and only 11% had previously participated in such a program. A steering committee designed an intervention blending didactics, interactive small group exercises, webinars, mentorship for a scholarly project, 360-degree feedback for each participant, and a forum to discuss common career development goals. Of 42 applicants, 20 participants were chosen for the inaugural workshop. Following successful execution of the workshop, participants reported significant increase in confidence in the knowledge, skills, and attitudes targeted by the curriculum. A series of follow-up webinars have been developed to deliver additional content not covered during the workshop and to continue mentorship relationships. The curriculum will be further refined based on feedback from faculty and participants. Long-term outcome measurement will include tracking all participants' publications and presentations, time to promotion, and involvement in national medical education initiatives.

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The American Society of Hematology (ASH) Medical Educators Institute: a Pilot Faculty Development Project for Hematology Educators

Abstract

Clinician educators at academic medical centers often lack the community, mentorship, and faculty development to support their missions around education scholarship and teaching. Inadequate support for clinician educators can lead to professional dissatisfaction and slowed academic advancement. In 2014, ASH conducted a needs assessment of medical school hematology course directors, hematology-oncology fellowship program directors, and other ASH members identified as educators to determine this community's desire for faculty development in medical education. These data furthered the development of an annual faculty development program for hematology educators offering an interactive curriculum and support for an educational scholarly project. The needs assessment indicated that over 70% of respondents would be personally interested in a faculty development opportunity for hematology educators and only 11% had previously participated in such a program. A steering committee designed an intervention blending didactics, interactive small group exercises, webinars, mentorship for a scholarly project, 360-degree feedback for each participant, and a forum to discuss common career development goals. Of 42 applicants, 20 participants were chosen for the inaugural workshop. Following successful execution of the workshop, participants reported significant increase in confidence in the knowledge, skills, and attitudes targeted by the curriculum. A series of follow-up webinars have been developed to deliver additional content not covered during the workshop and to continue mentorship relationships. The curriculum will be further refined based on feedback from faculty and participants. Long-term outcome measurement will include tracking all participants' publications and presentations, time to promotion, and involvement in national medical education initiatives.

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Using a gradient boosting model to improve the performance of low-cost aerosol monitors in a dense, heterogeneous urban environment

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Nicholas E. Johnson, Bartosz Bonczak, Constantine E. Kontokosta
The increased availability and improved quality of new sensing technologies have catalyzed a growing body of research to evaluate and leverage these tools in order to quantify and describe urban environments. Air quality, in particular, has received greater attention because of the well-established links to serious respiratory illnesses and the unprecedented levels of air pollution in developed and developing countries and cities around the world. Though numerous laboratory and field evaluation studies have begun to explore the use and potential of low-cost air quality monitoring devices, the performance and stability of these tools has not been adequately evaluated in complex urban environments, and further research is needed. In this study, we present the design of a low-cost air quality monitoring platform based on the Shinyei PPD42 aerosol monitor and examine the suitability of the sensor for deployment in a dense heterogeneous urban environment. We assess the sensor's performance during a field calibration campaign from February 7th to March 25th 2017 with a reference instrument in New York City, and present a novel calibration approach using a machine learning method that incorporates publicly available meteorological data in order to improve overall sensor performance. We find that while the PPD42 performs well in relation to the reference instrument using linear regression (R² = 0.36–0.51), a gradient boosting regression tree model can significantly improve device calibration (R² = 0.68–0.76). We discuss the sensor's performance and reliability when deployed in a dense, heterogeneous urban environment during a period of significant variation in weather conditions, and important considerations when using machine learning techniques to improve the performance of low-cost air quality monitors.

Graphical abstract

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Secondary organic aerosol and ozone formation from photo-oxidation of unburned diesel fuel in a surrogate atmospheric environment

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Weihua Li, David R. Cocker
Diesel fuel is a complex mixture of intermediate volatility organic compounds (IVOCs). Previous studies focused on secondary organic aerosol (SOA) and ozone formation from photo-oxidation of organic vapor from diesel exhaust and their components such as aromatics and heavy alkanes. However, there are few studies on atmospheric behavior of unburnt diesel. Therefore, in this study, ten unburnt #2 commercial diesel samples and one FACE9A research diesel fuel were photo-oxidized in the University of California Riverside, College of Engineering-Center for Environmental Research & Technology dual environmental chambers to investigate their SOA and ozone production potential. Photochemical aging rapidly produced significant SOA (yield ∼20.3–37.7%) in the presence of a surrogate reactive organic gas (ROG) mixture used to mimic urban atmospheric reactivity. SOA yields were consistent with n-Heptadecane yields under similar conditions. Doubling NOx concentrations within relevant urban concentration levels enhanced SOA formation by 33% and ozone formation by 48%. SOA formation in this study was approximately fourteen times higher than previously reported for very high NOx conditions. An SOA experiment designed to mimic the previous work achieved similar yields to the earlier work. SOA formed under urban relevant NOx concentrations were consistent with semi-volatile-oxygenated organic aerosol (SV-OOA) and underwent little further chemical processing once produced.



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Emission characteristics of NOx, CO, NH3 and VOCs from gas-fired industrial boilers based on field measurements in Beijing city, China

Publication date: July 2018
Source:Atmospheric Environment, Volume 184
Author(s): Tao Yue, Xiang Gao, Jiajia Gao, Yali Tong, Kun Wang, Penglai Zuo, Xiaoxi Zhang, Li Tong, Chenlong Wang, Yifeng Xue
In the past decade, due to the management policies and coal combustion controls in Beijing, the consumption of natural gas has increased gradually. Nevertheless, the research on the emission characteristics of gaseous pollutants emitted from gas-fired industrial boilers, especially considering the influence of low nitrogen (low-NOx) retrofit policy of gas boilers, is scarcely. In this study, based on literature and field investigations, onsite measurements of NOx, CO, NH3 and VOCs (Volatile Organic Compounds) emissions from gas-fired industrial boilers as well as the key factors that affected the emission of gaseous pollutants were discussed. Category-specific emission factors (EFs) of NOx, CO, NH3 and VOCs were obtained from the field measurements of 1107 "low-NOx" retrofitted and unabated gas-fired industrial boilers. Our results showed that operating load and control measures were the two key factors affecting the formation of gaseous pollutants. The EFs of NOx (EFNOx) and CO (EFCO) of atmospheric combustion boilers (ACBs) were much higher than the EFs of chamber combustion boilers (CCBs). The total emissions of NOx, CO, NH3 and VOCs from gas-fired industrial boilers in Beijing in the year of 2015 were estimated at 10489.6 t, 3272.8 t, 196.4 t and 235.4 t, respectively. Alkanes, BTEX, oxygenated VOCs and non-reactive organic matter were the four main chemical components of VOCs. As for the spatial distributions, the emissions of NOx, CO, NH3 and VOCs from gas-fired industrial boilers in Beijing were predominantly concentrated in central six urban districts. In the future, more detailed investigation and field tests for all kinds of gas-fired industrial boilers are still greatly needed to achieve more reliable estimations of atmospheric pollutants from gas-fired industrial boilers.



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Long-term systematic profiling of dust aerosol optical properties using the EOLE NTUA lidar system over Athens, Greece (2000–2016)

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): O. Soupiona, A. Papayannis, P. Kokkalis, M. Mylonaki, G. Tsaknakis, A. Argyrouli, S. Vratolis
We present a comprehensive analysis of the seasonal variability of the vertical profiles of the optical and geometrical properties of Saharan dust aerosols, observed in the height region between 1000 and 6000 m, over the city of Athens, Greece, from February 2000 to December 2016. These observations were performed by a multi-wavelength (355-387-532-1064 nm) Raman lidar system under cloud-free conditions. The statistical analysis (using aerosol monthly mean values) is based on nighttime vertical Raman measurements of range-resolved aerosol optical properties (backscatter and extinction coefficients, lidar ratio, Ångström exponent) at 355 nm (57 dust events during more than 80 measurement hours). We found that the number of dust events was highest in spring, summer, and early autumn periods and that during spring the dust layers were moved at higher altitudes (∼4500 m) than in other seasons. The number of the forecasted dusty days (on monthly basis) by the BSC-DREAM8b model compared to those of the performed lidar measurements were found to have a quite strong correlation (R² = 0.81), with a maximum occurrence predicted for the spring season. In the worst case scenario, at least 50% of the model-forecasted dust events can be observed by lidar under cloudless skies over Athens. For the sampled dust plumes we found mean lidar ratios of 52 ± 13 sr at 355 nm in the height range 2000–4000 m a.s.l. Moreover, the dust layers had a mean thickness of 2497 ± 1026 m and a center of mass of 2699 ± 1017 m.An analysis performed regarding the air mass back-trajectories arriving over Athens revealed two main clusters: one pathway from south-west to north-east, with dust emission areas in Tunisia, Algeria and Libya and a second one from south, across the Mediterranean Sea with emission areas over Libya and the remaining part of Algeria and Tunisia. This clustering enabled us to differentiate between the aerosol optical properties between the two clusters, based on their residence time over the Saharan region, the European continent and the Mediterranean Sea. We finally concluded that even if the dust source regions are about the same, the aging and mixing processes of these air masses, passing over different areas, might have an impact on the aerosol optical properties.

Graphical abstract

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Variability in impact of air pollution on subjective well-being

Publication date: June 2018
Source:Atmospheric Environment, Volume 183
Author(s): Guodong Du, Kong Joo Shin, Shunsuke Managi
This paper examines the impact of variability in impact of air pollution on life satisfaction (LS). Previous studies have shown robust negative impact of air pollution on subjective well-being (SWB). However, empirical studies that consider variability in air pollution effects through comparative city study are limited. This study provides comparative evaluation of two major Chinese cities: Beijing and Shanghai. We apply a geo-statistical spatial interpolation technique on pollution data from monitoring sites to estimate the Sulfur Dioxide (SO2), Nitrogen Dioxide (NO2), coarse particles with a diameter between 2.5 and 10 μm (PM10) and fine particles with a diameter of 2.5 μm or less (PM2.5) pollution exposure of respondents of a survey conducted in 2016. The results show that all pollutants have robust negative impacts on LS for Beijing residents, whereas only SO2 and NO2 have significant negative impacts on LS for Shanghai residents; Per unit impact of SO2 is greater in Shanghai, and that of NO2 is greater in Beijing. Beijing and Shanghai residents have almost same monetary valuation for SO2 reduction but Beijing residents place approximately 1.5 times valuation on NO2 reduction compared to Shanghai residents. Moreover, the LS of Beijing residents is sensitive to temporal changes in the pollution level, whereas Shanghai residents are unaffected by such changes.



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Meat allergy and allergens

Publication date: Available online 21 April 2018
Source:Molecular Immunology
Author(s): Jeffrey M. Wilson, Thomas A.E. Platts-Mills
IgE-mediated hypersensitivity to ingested animal products, including both mammalian and avian sources, is increasingly appreciated as an important form of food allergy. Traditionally described largely in children, it is now clear that allergy to meat (and animal viscera) impacts both children and adults and represents a heterogeneous group of allergic disorders with multiple distinct syndromes. The recognition of entities such as pork-cat syndrome and delayed anaphylaxis to red meat, i.e- the α-Gal syndrome, have shed light on fundamental, and in some cases newly appreciated, features of allergic disease. These include insights into routes of exposure and mechanisms of sensitization, as well as the realization that IgE-mediated reactions can be delayed by several hours. Here we review mammalian and avian meat allergy with an emphasis on the molecular allergens and pathways that contribute to disease, as well as the role of in vitro IgE testing in diagnosis and management.



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Virtual Dental Patient: How Long Until It’s Here?

Abstract

Purpose of Review

Recent developments in digital technology to be generated by superimposing different 3D imaging datasets. The aim of this literature review was to provide an update on the current status of knowledge, to report on the progress in virtual patient science, and to identify further research needed to facilitate the translation to clinical practice.

Recent Findings

Case reports were identified describing different dental patient simulation techniques. Publications focused mainly on methodological feasibility of combining skeletal, facial, and dental imaging to produce virtual simulations. Clinical randomized controlled trials were scarce.

Summary

Superimposition of 3D medical data files is a feasible technique to create a virtual patient under static conditions. 3D image fusion is of interest and importance in all fields of dental medicine including diagnostics, treatment, science, and education. Future research should focus on simplifying the technology, to enable virtual patient simulation to be generated in a single-step approach.

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Vitamin Status and Mineralized Tissue Development

Abstract

Purpose of Review

The physiological control of mineralized tissue development is mediated by two processes: mineralization, such as bone formation due to osteoblast activity, and mineralized tissue destruction by osteoclast bone resorption. In this system, nutritional status, including vitamin intake, influences each regulatory processes, although definite responding mechanisms in target cells vary according to each compound.

Recent Findings

In contrast with water-soluble vitamins that constant supply is required, fat-soluble vitamins such as vitamin D and K are stored in the liver and fat tissue for long time. They are metabolized into congeneric compounds with various activities to participate in the local mineralization process in the body.

Summary

During physiological or non-physiological mineralization, the local actions of vitamin D and K are regulated by nutrient factor derived from dietary supply, and influenced by systemic calcium metabolism and homeostasis.

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A Compound Mutation (c.953C

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A Compound Mutation (c.953C<G and c.49G<A) Aggravates Functional Impairments of C1-INH in Hep G2 Cells.

Allergy Asthma Immunol Res. 2018 May;10(3):285-286

Authors: Xu YY, Zhi YX

PMID: 29676077 [PubMed]

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The Relevance of Nasal Cytology in the Workup of House Dust Mite-Induced Allergic Rhinitis.

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The Relevance of Nasal Cytology in the Workup of House Dust Mite-Induced Allergic Rhinitis.

Allergy Asthma Immunol Res. 2018 May;10(3):283-284

Authors: Gelardi M, Puccinelli P, Incorvaia C, Passalacqua G, Ciprandi G, Italian Cometa Study Group

PMID: 29676076 [PubMed]

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Chamber and Field Studies demonstrate Differential Amb a 1 Contents in Common Ragweed Depending on CO₂ Levels.

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Chamber and Field Studies demonstrate Differential Amb a 1 Contents in Common Ragweed Depending on CO₂ Levels.

Allergy Asthma Immunol Res. 2018 May;10(3):278-282

Authors: Choi YJ, Oh HR, Oh JW, Kim KR, Kim MJ, Kim BJ, Baek WG

Abstract
Although atmospheric carbon dioxide (CO₂) has no apparent direct effect on human health, it does have direct effects on plants. The present study evaluated the influence of increased CO₂ levels on the concentration of allergens from common ragweed pollen by setting up a chamber study to model future air conditions and a field study to evaluate current air conditions. For the chamber study, we established 20 ragweed plants in an open-top chamber under different CO₂ levels (380-400, 500-520, 600-620, and 1,000-1,100 parts per million [ppm]). For the field study, we established ragweed plants in rural (Pocheon, Gyeonggi-do; mean CO₂ 320±54.8 ppm) and urban (Gangnam, Seoul; mean CO₂ 440±78.5 ppm) locations. Seeds of the common ragweed (Ambrosia artemisiifolia) were obtained from Daejin University. The Amb a 1 protein content of pollen extracts was quantified using a double sandwich enzyme-linked immunosorbent assay. In our chamber study, the median concentration of Amb a 1 in pollen increased with increasing in CO₂ concentration (1.88 ng/μg in 380-400 ppm CO₂; 3.14 ng/μg in 500-520 ppm CO₂; 4.44 ng/μg in 600-620 ppm CO₂; and 5.36 ng/μg in 1,000-1,100 ppm CO₂). In our field study, we found no significantly different concentration of Amb a 1 between the pollen extracts at the Pocheon (mean±standard deviation, 1.63±0.3 ng/μg pollen in 320±54.8 ppm CO₂) and the Gangnam (2.04±0.7 ng/μg pollen in CO₂ in 440±78.5 ppm CO₂) locations, although the concentration of Amb a 1 was increased in the Gangnam than in the Pocheon locations. Our results suggest that future increases in CO₂ levels to more than 600 ppm will significantly elevate the Amb a 1 content in common ragweeds, although the current different CO₂ levels do not cause differences in the Amb a 1 content of ragweed pollen.

PMID: 29676075 [PubMed]

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Immune Characterization of Bone Marrow-Derived Models of Mucosal and Connective Tissue Mast Cells.

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Immune Characterization of Bone Marrow-Derived Models of Mucosal and Connective Tissue Mast Cells.

Allergy Asthma Immunol Res. 2018 May;10(3):268-277

Authors: Benedé S, Cody E, Agashe C, Berin MC

Abstract
PURPOSE: It is well appreciated that mast cells (MCs) demonstrate tissue-specific imprinting, with different biochemical and functional properties between connective tissue MCs (CTMCs) and mucosal MCs (MMCs). Although in vitro systems have been developed to model these different subsets, there has been limited investigation into the functional characteristics of the 2 major MC subsets. Here, we report the immunologic characterization of 2 MCs subsets developed in vitro from bone marrow progenitors modeling MMCs and CTMCs.
METHODS: We grew bone marrow for 4 weeks in the presence of transforming growth factor (TGF)-β, interleukin (IL)-9, IL-3, and stem cell factor (SCF) to generate MMCs, and IL-4, IL-3, and SCF to generate CTMCs.
RESULTS: CTMCs and MMCs differed in growth rate and protease content, but their immune characteristics were remarkably similar. Both subsets responded to immunoglobulin E (IgE)-mediated activation with signaling, degranulation, and inflammatory cytokine release, although differences between subsets were noted in IL-10. CTMCs and MMCs showed a similar toll-like receptor (TLR) expression profile, dominated by expression of TLR4, TLR6, or both subsets were responsive to lipopolysaccharide (LPS), but not poly(I:C). CTMCs and MMCs express receptors for IL-33 and thymic stromal lymphopoietin (TSLP), and respond to these cytokines alone or with modified activation in response to IgE cross-linking.
CONCLUSIONS: The results of this paper show the immunologic characterization of bone marrow-derived MMCs and CTMCs, providing useful protocols for in vitro modeling of MC subsets.

PMID: 29676074 [PubMed]

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Overexpression of miR-155-5p Inhibits the Proliferation and Migration of IL-13-Induced Human Bronchial Smooth Muscle Cells by Suppressing TGF-β-Activated Kinase 1/MAP3K7-Binding Protein 2.

Related Articles

Overexpression of miR-155-5p Inhibits the Proliferation and Migration of IL-13-Induced Human Bronchial Smooth Muscle Cells by Suppressing TGF-β-Activated Kinase 1/MAP3K7-Binding Protein 2.

Allergy Asthma Immunol Res. 2018 May;10(3):260-267

Authors: Shi Y, Fu X, Cao Q, Mao Z, Chen Y, Sun Y, Liu Z, Zhang Q

Abstract
PURPOSE: Molecular mechanisms leading to asthma is still ill-defined. Though the function of microRNAs (miRNAs) in asthma was previously reported, the involvement of miR-155 in important features of this disease remains unknown. The present study was designed to uncover the probable involvement of miR-155-5p in the proliferation and migration of IL-13-induced human bronchial smooth muscle cells (BSMCs) and the intrinsic regulatory mechanism.
METHODS: The effects of different concentrations of IL-13 on the proliferation and migration of BSMCs as well as the expression of miR-155-5p and its predicted target transforming growth factor (TGF)-β-activated kinase 1/MAP3K7-binding protein 2 (TAB2) were investigated. The effects of miR-155-5p on the proliferation and migration of interleukin (IL)-13-induced BSMCs was determined in vitro using BSMCs transfected with miR-155 mimic/inhibitor and induced by a high concentration of IL-13. The quantitative real-time polymerase chain reaction (qRT-PCR) was employed for determining the expression of miR-155-5p and TAB2. Western blotting was applied to analyze the expression of TAB2 at the protein level. Cell proliferation and migration were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and Transwell assays, respectively.
RESULTS: The proliferation and migration of BSMCs were dose-dependently increased with IL-13 treatment. Contrariwise, IL-13 dose-dependently inhibited the expression of miR-155-5p in BSMCs. Mechanistic studies showed that inhibition of miR-155-5p further promoted the stimulatory effects of IL-13, whereas overexpression of miR-155 significantly inhibited these effects. In silico studies and luciferase reporter assays indicated that TAB2 was a negatively regulated miR-155-5p target.
CONCLUSIONS: These results suggested that miR-155-5p-inhibit the IL-13-induced proliferation and migration of BSMCs by targeting TAB2 and that the IL-13/miR-155/TAB2 pathway could serve as a therapeutic target for pulmonary diseases, especially asthma.

PMID: 29676073 [PubMed]

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Current Management of Moderate-to-Severe Atopic Dermatitis: A Survey of Allergists, Pediatric Allergists and Dermatologists in Korea.

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Current Management of Moderate-to-Severe Atopic Dermatitis: A Survey of Allergists, Pediatric Allergists and Dermatologists in Korea.

Allergy Asthma Immunol Res. 2018 May;10(3):253-259

Authors: Yum HY, Kim HH, Kim HJ, Kim WK, Lee SY, Li K, Lee DH, KAAACI Work Group on Severe/Recalcitrant Atopic Dermatitis

Abstract
PURPOSE: There is an unmet need for the treatment of moderate-to-severe atopic dermatitis (AD), leading to variation in management strategies. To investigate distinct features and treatment modalities according to physicians' specialties, we collected data on the current treatment approach to moderate-to-severe AD among allergists, pediatric allergists and dermatologists in Korea.
METHODS: This questionnaire-based study was administered to physicians from the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI), Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD), and Korean Atopic Dermatitis Association (KADA).
RESULTS: A total of 93 physicians participated in the study; 64.5% were pediatric allergists and 31.2% were dermatologists. The major patient age groups were "less than 5 years" for 100% of pediatric allergists and "6-12 years old" for 38% of dermatologists. The proportion of patients with moderate-to-severe AD was higher for dermatologists and allergists compared to pediatric allergists. Physicians agreed on the necessity of education including demonstration of basic skin care and application of topical therapies (88.2%), nutritional consultation (83.9%) and psychological counseling (75.3%). However, less than half were able to educate and counsel their patients in real practice. There were noticeable differences in first-line treatment among physician groups. For pediatric allergists, the order of preferred systemic treatment was wet wrap therapy, systemic corticosteroids and oral cyclosporin. Dermatologists ranked cyclosporin, phototherapy, and systemic corticosteroids as first-line treatment regimens. Major reported barriers to proper management were steroid phobia, unproven complementary and alternative medicine, lack of education, and the unreasonable insurance system.
CONCLUSIONS: Our findings suggest there are distinct differences in moderate-to-severe AD treatment according to physicians' specialties. Medical policy changes along with governmental supports are required in order to implement the ideal approach in real practice. For moderate-to-severe AD, a consensus on the approach to optimal management should be reached for the best outcomes, based on further randomized controlled trials.

PMID: 29676072 [PubMed]

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Differences in Genetic Variations Between Treatable and Recalcitrant Atopic Dermatitis in Korean.

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Differences in Genetic Variations Between Treatable and Recalcitrant Atopic Dermatitis in Korean.

Allergy Asthma Immunol Res. 2018 May;10(3):244-252

Authors: Jun M, Wang HY, Lee S, Choi E, Lee H, Choi EH

Abstract
PURPOSE: Variations in barrier- or immune response-related genes are closely related to the development of atopic dermatitis (AD). This study was designed to identify genetic variations and clinical features to predict 'recalcitrant AD.'
METHODS: AD patients were classified as treatable and recalcitrant. Treatable AD patients showed satisfactory clinical improvement with basic and topical treatments. Recalcitrant AD patients used systemic immune-suppressants for over 4 weeks as they had not shown clinical improvement with basic and topical treatments. The frequency of gene variations in barrier- (FLG 3321delA, FLG K4022X, KLK7, SPINK 1156, SPINK 1188, SPINK 2475) and immune response- (DEFB1, KDR, IL-5RA, IL-9, and IL-12RB1a, b) related genes were compared between each AD group and the controls.
RESULTS: Of all, 249 treatable AD and 32 recalcitrant AD were identified. Heterozygous mutations (Hetero) in KLK7 was more frequent in recalcitrant AD patients than treatable AD, without statistical significance. Hetero in DEFB1 was more frequent in treatable AD patients. However, no other significant genetic differences between treatable and recalcitrant AD was observed. Instead, higher initial Eczema Area Severity Index (EASI) score, serum immunoglobulin E (IgE) level, allergen specific IgE for house dust mites, and family history of atopic diseases were associated with recalcitrant AD with statistical significance.
CONCLUSIONS: According to our study, no genetic variation to predict recalcitrant AD was identified, suggesting that clinical manifestation, rather than genetic variations of AD patients is more likely to be an important factor in predicting the prognosis of AD. Further large-scale studies on the correlation between genetic variation and recalcitrant AD are needed.

PMID: 29676071 [PubMed]

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Analysis of Peripheral B Cell Subsets in Patients With Allergic Rhinitis.

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Analysis of Peripheral B Cell Subsets in Patients With Allergic Rhinitis.

Allergy Asthma Immunol Res. 2018 May;10(3):236-243

Authors: Luo J, Guo H, Liu Z, Peng T, Hu X, Han M, Yang X, Zhou X, Li H

Abstract
PURPOSE: Recent evidence suggests that B cells can both promote and inhibit the development and progression of allergic disease. However, the characteristics of B cell subsets in patients with allergic rhinitis (AR) have not been well documented. This study aimed to analyze the characteristics of B cell subsets in the peripheral blood of AR patients.
METHODS: Forty-seven AR patients and 54 healthy controls were enrolled in this study, and the B cell subsets in peripheral blood of all subjects were analyzed by flow cytometry. Moreover, the serum total immunoglobulin E (IgE) and IgE concentrations secreted into the cultured peripheral blood mononuclear cells (PBMCs) were measured by using enzyme-linked immunosorbent assay.
RESULTS: We found the peripheral blood of AR patients contained higher percentages of memory B cells, plasma cells, and CD19⁺CD24(hi)CD27⁺ regulatory B cells (Bregs) than those of age-matched healthy controls (P<0.05), while the percentages of naïve B cells and CD19⁺CD24(hi)CD38(hi) Bregs were significantly lower in AR patients than in healthy individuals (P<0.05). In addition, the serum total IgE and IgE concentrations secreted into the cultured PBMCs were elevated in AR patients than in the healthy controls (P<0.05).
CONCLUSIONS: Our findings indicate that AR patients were characterized by increase in terminally differentiated memory B cells or plasma cells and decreases in CD19⁺CD24(hi)CD38(hi) Breg cells in the peripheral blood.

PMID: 29676070 [PubMed]

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Perceptions of Severe Asthma and Asthma-COPD Overlap Syndrome Among Specialists: A Questionnaire Survey.

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Perceptions of Severe Asthma and Asthma-COPD Overlap Syndrome Among Specialists: A Questionnaire Survey.

Allergy Asthma Immunol Res. 2018 May;10(3):225-235

Authors: Kim SH, Moon JY, Lee JH, Ban GY, Kim S, Kim MA, Kim JH, Kim MH, Park CS, Park SY, Kwon HS, Kwon JW, Jung JW, Kang HR, Park JS, Kim TB, Park HW, Cho YS, Yoo KH, Oh YM, Lee BJ, Jang AS, Cho SH, Park HS, Park CS, Yoon HJ, Severe Asthma Work Group, the Korean Academy of Asthma, Allergy and Clinical Immunology

Abstract
PURPOSE: Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail and internet-based questionnaire survey.
METHODS: Subjects were selected based on clinical specialty from among the members of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Academy of Tuberculosis and Respiratory Diseases. Of 432 subjects who received an e-mail invitation to the survey, 95 subjects, including 58 allergists and 37 pulmonologists, responded and submitted their answers online.
RESULTS: The specialists estimated that the percentage of severe cases among total asthma patients in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among asthma patients. Among COPD patients, the highly selected major criteria for ACOS were high FEV1 variation, positive bronchodilator response, a personal history of allergies and positive airway hyperresponsiveness. Allergists and pulmonologists showed different assessments and opinions on asthma phenotyping, percentage, and diagnostic criteria for ACOS.
CONCLUSIONS: Specialists had diverse perceptions and clinical practices regarding severe asthma and ACOS patients. This heterogeneity must be considered in future studies and strategy development for severe asthma and ACOS.

PMID: 29676069 [PubMed]

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TRPV1 Blocking Alleviates Airway Inflammation and Remodeling in a Chronic Asthma Murine Model.

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TRPV1 Blocking Alleviates Airway Inflammation and Remodeling in a Chronic Asthma Murine Model.

Allergy Asthma Immunol Res. 2018 May;10(3):216-224

Authors: Choi JY, Lee HY, Hur J, Kim KH, Kang JY, Rhee CK, Lee SY

Abstract
PURPOSE: Asthma is a chronic inflammatory airway disease characterized by airway hyperresponsiveness (AHR), inflammation, and remodeling. There is emerging interest in the involvement of the transient receptor potential vanilloid 1 (TRPV1) channel in the pathophysiology of asthma. This study examined whether TRPV1 antagonism alleviates asthma features in a murine model of chronic asthma.
METHODS: BALB/c mice were sensitized to and challenged by ovalbumin to develop chronic asthma. Capsazepine (TRPV1 antagonist) or TRPV1 small interfering RNA (siRNA) was administered in the treatment group to evaluate the effect of TPV1 antagonism on AHR, airway inflammation, and remodeling.
RESULTS: The mice displayed increased AHR, airway inflammation, and remodeling. Treatment with capsazepine or TRPV1 siRNA reduced AHR to methacholine and airway inflammation. Type 2 T helper (Th2) cytokines (interleukin [IL]-4, IL-5, and IL-13) were reduced and epithelial cell-derived cytokines (thymic stromal lymphopoietin [TSLP], IL-33, and IL-25), which regulate Th2 cytokine-associated inflammation, were also reduced. Airway remodeling characterized by goblet cell hyperplasia, increased α-smooth muscle action, and collagen deposition was also alleviated by both treatments.
CONCLUSIONS: Treatment directed at TRPV1 significantly alleviated AHR, airway inflammation, and remodeling in a chronic asthma murine model. The TRPV1 receptor can be a potential drug target for chronic bronchial asthma.

PMID: 29676068 [PubMed]

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Significance of Skin Barrier Dysfunction in Atopic Dermatitis.

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Significance of Skin Barrier Dysfunction in Atopic Dermatitis.

Allergy Asthma Immunol Res. 2018 May;10(3):207-215

Authors: Kim BE, Leung DYM

Abstract
The epidermis contains epithelial cells, immune cells, and microbes which provides a physical and functional barrier to the protection of human skin. It plays critical roles in preventing environmental allergen penetration into the human body and responsing to microbial pathogens. Atopic dermatitis (AD) is the most common, complex chronic inflammatory skin disease. Skin barrier dysfunction is the initial step in the development of AD. Multiple factors, including immune dysregulation, filaggrin mutations, deficiency of antimicrobial peptides, and skin dysbiosis contribute to skin barrier defects. In the initial phase of AD, treatment with moisturizers improves skin barrier function and prevents the development of AD. With the progression of AD, effective topical and systemic therapies are needed to reduce immune pathway activation and general inflammation. Targeted microbiome therapy is also being developed to correct skin dysbiosis associated with AD. Improved identification and characterization of AD phenotypes and endotypes are required to optimize the precision medicine approach to AD.

PMID: 29676067 [PubMed]

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Allergen-Specific Immunotherapies for Food Allergy.

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Allergen-Specific Immunotherapies for Food Allergy.

Allergy Asthma Immunol Res. 2018 May;10(3):189-206

Authors: Feuille E, Nowak-Wegrzyn A

Abstract
With rising prevalence of food allergy (FA), allergen-specific immunotherapy (AIT) for FA has become an active area of research in recent years. In AIT, incrementally increasing doses of inciting allergen are given with the goal to increase tolerance, initially through desensitization, which relies on regular exposure to allergen. With prolonged therapy in some subjects, AIT may induce sustained unresponsiveness, in which tolerance is retained after a period of allergen avoidance. Methods of AIT currently under study in humans include oral, sublingual, epicutaneous, and subcutaneous delivery of modified allergenic protein, as well as via DNA-based vaccines encoding allergen with lysosomal-associated membrane protein I. The balance of safety and efficacy varies by type of AIT, as well as by targeted allergen. Age, degree of sensitization, and other comorbidities may affect this balance within an individual patient. More recently, AIT with modified proteins or combined with immunomodulatory therapies has shown promise in making AIT safer and/or more effective. Though methods of AIT are neither currently advised by experts (oral immunotherapy [OIT]) nor widely available, AIT is likely to become a part of recommended management of FA in the coming years. Here, we review and compare methods of AIT currently under study in humans to prepare the practitioner for an exciting new phase in the care of food allergic patients in which improved tolerance to inciting foods will be a real possibility.

PMID: 29676066 [PubMed]

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The Emerging Role of TRPV1 in Airway Inflammation.

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The Emerging Role of TRPV1 in Airway Inflammation.

Allergy Asthma Immunol Res. 2018 May;10(3):187-188

Authors: Kim JH

PMID: 29676065 [PubMed]

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To determine the efficacy of ultrasonography in the evaluation of bone fill at the regenerate site for mandibular distraction osteogenesis over clinical and radiographic assessment– An in vivo prospective study

Publication date: Available online 20 April 2018
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Neelam Andrade, Neha Aggrawal, Guruprasad Jadhav, Vyankatesh Sahu, Paul C. Mathai




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Efficacy of curcumin for age-associated cognitive decline: a narrative review of preclinical and clinical studies

Abstract

Processes such as aberrant redox signaling and chronic low-grade systemic inflammation have been reported to modulate age-associated pathologies such as cognitive impairment. Curcumin, the primary therapeutic component of the Indian spice, Turmeric (Curcuma longa), has long been known for its strong anti-inflammatory and antioxidant activity attributable to its unique molecular structure. Recently, an interest in this polyphenol as a cognitive therapeutic for the elderly has emerged. The purpose of this paper is to critically review preclinical and clinical studies that have evaluated the efficacy of curcumin in ameliorating and preventing age-associated cognitive decline and address the translational progress of preclinical to clinical efficacy. PubMed, semantic scholar, and Google scholar searches were used for preclinical studies; and clinicaltrials.gov, the Australian and New Zealand clinical trials registry, and PubMed search were used to select relevant completed clinical studies. Results from preclinical studies consistently demonstrate curcumin and its analogues to be efficacious for various aspects of cognitive impairment and processes that contribute to age-associated cognitive impairment. Results of published clinical studies, while mixed, continue to show promise for curcumin's use as a therapeutic for cognitive decline but overall remain inconclusive at this time. Both in vitro and in vivo studies have found that curcumin can significantly decrease oxidative stress, systemic inflammation, and obstruct pathways that activate transcription factors that augment these processes. Future clinical studies would benefit from including evaluation of peripheral and cerebrospinal fluid biomarkers of dementia and behavioral markers of cognitive decline, as well as targeting the appropriate population.

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Impaired tissue barriers as potential therapeutic targets for Parkinson’s disease and amyotrophic lateral sclerosis

Abstract

The blood-brain barrier and the intestinal barrier show signs of disruption in patients with idiopathic Parkinson's disease (PD) and animal models of nigrostriatal degeneration, and likewise in amyotrophic lateral sclerosis (ALS) models. A substantial body of evidence shows that defects in epithelial membrane barriers, both in the gut and within the cerebral vasculature, can result in increased vulnerability of tissues to external factors potentially participating in the pathogenesis of PD and ALS. As such, restoration of tissue barriers may prove to be a novel therapeutic target in neurodegenerative disease. In this review, we focus on the potential of new intervention strategies for rescuing and maintaining barrier functions in PD and ALS.

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Endoscopically resected long giant polypoidal lesion caused by arteriovenous malformation

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Use of diphenhydramine as an adjunctive sedative for colonoscopy in patients on chronic opioid therapy: a randomized controlled trial

Chronic opioid use increases tolerance to sedatives. Diphenhydramine is recommended for difficult-to-sedate patients during endoscopic procedures. We hypothesized that the addition of diphenhydramine to midazolam and fentanyl would improve objective and subjective measures of procedural sedation.

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Unexpected amoebic colitis: presented by rectal bleeding and perforation after biopsy

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Study of condylar positional changes after sagittal split osteotomy for mandibular advancement: a prospective cohort study

Maxillary osteotomies can cause changes in the position and function of components of the temporomandibular joint (TMJ), resulting in the emergence or worsening of articular pathologies and/or lack of stability of the surgical procedure. It is therefore very important to understand how these osteotomies influence the position of the mandibular condyle. One of the most common surgical procedures is the sagittal split osteotomy for mandibular advancement. A review of the scientific literature reveals few quantitative or qualitative studies researching what happens to the condyles after this surgery.

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Overcoming wound complications in head and neck salvage surgery

Loco-regional treatment failure after radiotherapy with or without chemotherapy and/or prior surgery represents a significant portion of head and neck cancer patients. Due to a wide array of biological interactions, these patients have a significantly increased risk of complications related to wound healing.

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Effects of Apirolio Addition and Alfalfa and Compost Treatments on the Natural Microbial Community of a Historically PCB-Contaminated Soil

Abstract

Polychlorinated biphenyls (PCBs) are ubiquitous and persistent organic pollutants generated exclusively from human sources and found in the environment as several congeners (e.g. Apirolio, produced in Italy and used for electrical transformers). To evaluate the ability of the natural microbial community of historically PCB-contaminated soil to transform or degrade PCBs after fresh contamination through the addition of Apirolio, a microcosm experiment was conducted in a greenhouse for approximately 8 months. Compost and Medicago sativa (alfalfa) were additionally used in the microcosms to stimulate microbial PCB degradation. Chemical analyses were performed to evaluate PCB concentrations in the soil and plant tissue. Changes in the microbial community under the different experimental conditions were evaluated in terms of total abundance, viability, diversity, and activity. Interestingly, the addition of Apirolio did not negatively affect the microbial community but did stimulate the degradation of the freshly added PCBs. The plant and compost co-presence did not substantially increase PCB degradation, but it increased the microbial abundance and activity and the occurrence of α-Proteobacteria and fungi.

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Mollie lentaigne, the nurse who drew mcindoe's Guinea pigs: exploring the role of a medical artist at the queen victoria hospital, 1940-1945

Publication date: Available online 16 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Alexander J. Baldwin
Mollie Lentaigne was a medical artist who worked at the Queen Victoria Hospital in East Grinstead during the Second World War alongside Archibald McIndoe and his dedicated team. She drew hundreds of medical illustrations for McIndoe and his fellow surgeons during the years between 1940 and 1945. Her illustrations depict the plastic surgery that was carried out in that hospital on the badly burnt RAF servicemen injured during the war that took place in the skies over Europe, which included many aircrew injured during the Battle of Britain.This project looks at the career of Lentaigne and her role within the surgical team in East Grinstead during that era and explores a number of Lentaigne's illustrations whilst providing context as to the procedures and patients depicted. An examination of Lentaigne's story, using an interview conducted by the author with the artist offers an alternative perspective with which to observe the events that unfolded in East Grinstead during that conflict.An analysis of these images shows the ability of this artist to portray relatively complex operations with a series of simple pencil or ink diagrams whilst also skilfully engaging the observer's sense of touch. The ability of a medical artist to be selective with their illustrations allowed them to provide clearer, less cluttered images that were preferred by McIndoe when recording the specific surgical procedures for use in the patient's medical records.



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Current evidence on the role of smoking in plastic surgery elective procedures: A systematic review and meta-analysis

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Vasileios Theocharidis, Ioannis Katsaros, Emmanouil Sgouromallis, Nikolaos Serifis, Vasileios Boikou, Sotirios Tasigiorgos, George Kokosis, Konstantinos P. Economopoulos
BackgroundSmoking is considered to be a significant risk factor for the development of postoperative complications after various surgical procedures, mainly by limiting oxygen delivery to tissues. Evidence on the collective impact of smoking in aesthetic procedure outcomes is scarce. The aim of this study is to evaluate the current evidence on the association between smoking and postoperative outcomes in patients who underwent common elective procedures in plastic surgery.MethodsPubMed and Cochrane bibliographical databases were searched from January 1950 to October 2016 for studies reporting on patients who underwent facelift, abdominoplasty, breast reduction and breast reconstruction and for studies with included data on smoking history of treated patients.ResultsFifty-three studies reporting on postoperative complications in tobacco users undergoing facelift, abdominoplasty, breast reduction and reconstruction were identified. Tobacco use is found to significantly increase the total number of postoperative complications as far as abdominoplasty (OR: 5.43; 95% CI = 2.92–10.10), breast reduction (OR: 2.36; 95% CI = 1.64–3.39) and breast reconstruction (OR: 1.91; 95% CI = 1.69–2.17) are concerned. Smoking history does not significantly affect total postoperative complications after facelift procedures (OR: 3.36; 95% CI = 0.92–12.30).ConclusionsSmoking predisposes to surgical site infections, delayed wound healing and skin necrosis in patients undergoing the most common aesthetic procedures in plastic surgery. More rigorous and detailed reporting on the history of tobacco use and surgical outcomes following plastic surgery procedures is needed to better quantify the impact of smoking on the overall postoperative care for this patient population.



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Time to re-group and save: Do we routinely need to perform group-and-save in patients undergoing free deep inferior epigastric perforator (DIEP) flap breast reconstruction?

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Stephen R. Ali, Rachel Chetwynd-Stapylton, Will J.M. Holmes, Liam Vermaak, Sherif M. Wilson




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Quality of life improvement after chest wall masculinization in female-to-male transgender patients: A prospective study using the BREAST-Q and Body Uneasiness Test

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Cori A. Agarwal, Melody F. Scheefer, Lindsey N. Wright, Norelle K. Walzer, Andy Rivera
BackgroundChest reconstruction in many female-to-male (FTM) transgender individuals is an essential element of treatment for their gender dysphoria. In existing literature, there are very few longitudinal studies utilizing validated survey tools to evaluate patient reported outcomes surrounding this surgery. The purpose of our study is to prospectively evaluate patient reported satisfaction, improvement in body image, and quality of life following FTM chest wall reconstruction.MethodsOur study was a prospective analysis of FTM patients who underwent chest reconstruction by a single surgeon (C.A.) between April 2015 and June 2016. The patients were surveyed preoperatively and 6 months after surgery utilizing the BREAST-Q breast reduction/mastectomy questionnaire and the Body Uneasiness Test (BUT-A). Analysis was performed on their self-reported demographic information, survey results, and chart review data.ResultsOf 87 eligible patients, 42 completed all surveys and could be linked to their chart data. From the BREAST-Q surveys, significant improvements were observed in the domains of breast satisfaction, psychosocial well-being, sexual satisfaction, and physical well-being. From the BUT-A surveys, we observed significant improvement in body image, avoidance, compulsive self-monitoring, and depersonalization. Groups with mental health conditions had poorer initial BUT-A scores and greater degree of improvement after surgery.ConclusionsAs the prevalence of gender affirming surgery increases and as health policies are being developed in this area, the need for evidence-based studies surrounding specific interventions is essential. This study demonstrates significant improvement in a number of quality of life measurements in FTM patients after undergoing chest masculinization surgery.



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Should platelet-rich plasma be activated in fat grafts? An animal study

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Barbara Hersant, Jonathan Bouhassira, Mounia SidAhmed-Mezi, Luciano Vidal, Mayoura Keophiphath, Barbara Chheangsun, Jeremy Niddam, Romain Bosc, Aurelie Le Nezet, Jean-Paul Meningaud, Anne Marie Rodriguez
BackgroundThe adjunction of platelet-rich plasma with graft fat has been the subject of a few clinical trials which have demonstrated its value in adipocyte survival. The aim of this study was to assess the different efficacies between activated and non-activated PRP on adipose cells in vitro and for adipose tissue graft survival in vivo.MethodsThe in vitro study assessed the effects of PRP on both the proliferation and adipocyte differentiation of adipose cells.For the in vivo study, 8 nude rats received 3 human fat injections as follows: 0.8 mL of fat + 0.2 mL of normal saline; 0.8 mL of fat + 0.2 mL of non-activated PRP; and 0.8 mL of fat + 0.2 mL of PRP activated with calcium chloride (CaCl2).The quantitative assessment of adipocyte survival was implemented after 3 months using histomorphometric analysis. Histological and immunohistochemical analysis were also performed to evaluate angiogenesis, inflammation and quality of adipocytes in the grafted tissue.ResultsWe showed that activated PRP stimulated, in vitro, proliferation and differentiation of adipose cells.In vivo experiments indicated that CaCl2-activated PRP was more efficient than non-activated to prolong the survival of fat grafts in nude rats. The mean percentage areas occupied by viable adipocytes in the PRP-free group, non-activated PRP group and activated PRP group were 13%, 14% and 24% (p = 0.05%), respectively. Histological and immunohistochemical analysis revealed protective effect of activated PRP on inflammation and adipocyte death.ConclusionThis study showed that activation by CaCl2 improves the beneficial effects of PRP for fat graft maintenance.



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In reply to “re: Antibiotic prophylaxis in breast reduction surgery: A systematic review and meta-analysis”

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): James Zapata-Copete, Santiago Aguilera-Mosquera, Herney Andrés García-Perdomo




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Liposuction-assisted four pedicle-based breast reduction (LAFPBR): A new safer technique of breast reduction for elderly patients

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Simone La Padula, Barbara Hersant, Warren Noel, Jean Paul Meningaud
As older people increasingly care for their body image and remain active longer, the demand for reduction mammaplasty is increasing in this population. Only a few studies of reduction mammaplasty have specifically focussed on the outcomes in elderly women. We developed a new breast reduction technique: the Liposuction-Assisted Four Pedicle-Based Breast Reduction (LAFPBR) that is especially indicated for elderly patients.The aim of this paper was to describe the LAFPBR technique and to determine whether it could be considered a safer option for elderly patients compared to the superomedial pedicle (SMP) technique.A retrospective study included sixty-two women aged 60 years and over who underwent bilateral breast reduction mammaplasty. Thirty-one patients underwent LAFPBR and 31 patients were operated using the SMP technique. Complications and patient satisfaction in both groups were analysed. Patient satisfaction was measured using a validated questionnaire: the client satisfaction questionnaire 8 (CSQ-8).The LAFPBR technique required less operating time, and avoided significant blood loss. Six minor complications were observed in SMP patients. No LAFPBR women developed a procedure-related complication. Patient satisfaction was high with a mean score of 29.65 in LAFPBR patients and 28.68 in SMP patients.The LAFPBR is an easy procedure that appears safer than SMP and results in a high satisfaction rate in elderly women.



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Evaluation of anatomical and round breast implant aesthetics and preferences in Dutch young lay and plastic surgeon cohort

Publication date: Available online 16 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Patrick P. Bletsis, Lesley R. Bouwer, Klaas H. Ultee, Michel Cromheecke, Berend van der Lei
BackgroundLiterature remains inconclusive on the attractiveness and natural aspect of anatomical breast implants and, so far, studies have failed to demonstrate the visible difference in practice as compared to round ones. This study was undertaken to evaluate: (1) whether lay and professional participants can distinguish between breasts augmented with either round or anatomical breast implants, (2) their opinion with regard to naturalness and attractiveness of these augmented breasts.MethodsTwenty breast augmentations (10 anatomical and 10 round implants), each depicted by two postoperative pictures, were scored by 100 lay participants and 15 plastic surgeons. Implant volume ranged from 275 – 400 grams. Ptotic or malformed breasts were excluded. Finally, they had to score the most natural, unnatural, attractive and unattractive breast shape on a schematic depiction of breast types with varying upper poles.ResultsThe rate of correct implant identifications was 74.0% (1480/2000 observations, p<0.001) in the lay and 67.3% (202/300 observations, p<0.001) in the surgeon cohort. Breasts with anatomical implants were rated significantly more natural by both lay participants and surgeons (3.3±1.0 vs. 2.6±1.0, p<0.001 and 3.3±1.0 vs. 2.2±0.9, p<0.001) and more attractive (3.1±1.0 vs. 2.6±1.0, p<0.001 and 3.6±0.9 vs. 2.7±0.9, p<0.001). Participants preferred breasts with a neutral or slightly negative upper pole contour.ConclusionParticipants were able to distinguish between the results achieved with either anatomical or round textured Allergan breast implants and found augmented breasts with the anatomical implants more natural and attractive.



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Distally based anteromedial thigh flaps pedicled on the rectus femoris branch of the lateral circumflex femoral artery for reconstruction of soft-tissue defect of the knee

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Shan Zhu, Mengqing Zang, Shengji Yu, Boyang Xu, Yuanbo Liu
BackgroundAnteromedial thigh flaps are far less clinically appealing than their anterolateral counterparts, and are occasionally considered as an alternative to the anterolateral thigh flap. Herein, we report the study of soft-tissue defects reconstruction in the knee using a distally based anteromedial thigh flap pedicled on the rectus femoris branch of the descending branch of the lateral circumflex femoral artery.Patients and methodsBetween July 2008 and September 2016, a distally based anteromedial thigh flap was used to reconstruct soft-tissue defects of the knee in 5 patients (3 males, 2 females; age range at surgery 4–55 years old). The perforating vessels supplying anteromedial thigh were derived from the rectus femoris branch of the lateral circumflex femoral artery. The rectus femoris branch shared a common trunk with the descending branches of the lateral circumflex femoral artery. Defect etiologies included malignant neoplasms in 2 cases and post-burn scar contracture in the remaining 3 cases.ResultsThe average flap size was 19.6 × 9.2 cm (range: 15–24 × 6–12 cm). There was no flap loss. Postoperative muscle weakness occurred in one case. The average follow-up time was 17.8 months (range: 5–36 months). No recurrence of tumor or scar contracture was noted.ConclusionsDistally based anteromedial thigh flaps pedicled on the rectus femoris branch of the descending branch of the lateral circumflex femoral artery may serve as an alternative option to the distally based anterolateral thigh flap for soft-tissue defect reconstruction of the knee.



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Intraoperative imaging of lymphatic vessel using ultra high-frequency ultrasound

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Akitatsu Hayashi, Giuseppe Visconti, Takumi Yamamoto, Guido Giacalone, Nobuko Hayashi, Mayumi Handa, Hidehiko Yoshimatsu, Marzia Salgarello




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The split hypoglossal nerve versus the cross-face nerve graft to supply the free functional muscle transfer for facial reanimation: A comparative study

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Tarek A. Amer, Mohamed S. El Kholy
Long-standing cases of facial paralysis are currently treated with free functional muscle transfer. Several nerves are mentioned in the literature to supply the free muscle transfer. The aim of this study is to compare the split hypoglossal nerve and the cross-face nerve graft to supply the free functional muscle transfer in facial reanimation.Of 94 patients with long-standing, unilateral facial palsy, 49 were treated using the latissimus dorsi muscle supplied by the split hypoglossal nerve, and 45 patients were treated using the latissmus dorsi muscle supplied by healthy contralateral buccal branch of the facial nerve.The excursion gained by the free muscle transfer supplied by the split hypoglossal nerve (mean 19.20 ± 6.321) was significantly higher (P value 0.001) than that obtained by the contralateral buccal branch of the facial nerve (mean 14.59 ± 6.245).The split hypoglossal nerve appears to be a good possible option to supply the free vascularised muscle transfer in facial reanimation. It yields a stronger excursion in less time than the contralateral cross-face nerve graft.



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Letter to the editor: Predictors of internal mammary vessel diameter: A computed tomographic angiography-assisted anatomic analysis

Publication date: May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 5
Author(s): Rudo N. Madada-Nyakauru, Margaret M. Huang, Yoshi Sasaki, Charles M. Malata




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Masseter-to-facial nerve transfer: technique and outcomes utilizing a fibrin sealant for coaptation

Publication date: Available online 16 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Enrique Salmerón-González, Eduardo Simón-Sanz, Elena García-Vilariño, Alberto Ruiz-Cases
BackgroundThis article describes the use of fibrin sealant for nerve coaptation without sutures in masseter-to-facial nerve transfer; and the results obtained utilizing this technique in a series of eleven patients.MethodsA retrospective review of eleven patients with facial paralysis grades V-VI was performed. All patients underwent masseter nerve transfer for facial reanimation utilizing a fibrin sealant, without utilizing sutures for coaptation.ResultsThe follow up period ranged from 10 to 52 months. All patients recovered oral competence, eye closure, facial tone and a smile grade of 4,45 +/- 0,52 according to Terzis aesthetic and functional evaluation scale. Muscle contraction started 3-9 months postoperatively (average 4,7 +/- 2,3).ConclusionsThe use of fibrin glue without sutures for coaptation in masseter-to-facial nerve transfer, simplifies the procedure and shortens surgical timing, not requiring the logistics of a microsurgical team, with similar results than neurorraphy performed with sutures. The masseter-to-facial nerve transfer is an effective technique for facial reanimation in short-term complete paralysis and mid-term partial paralysis.



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Improved outcomes of scar revision with use of polydioxanone suture in comparison to polyglactin 910: A randomized controlled trial

Publication date: Available online 16 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Deepti Gupta, Upendra Sharma, Shashank Chauhan, Shamendra Anand Sahu
Scars have multiple cosmetic and functional sequelae and revision surgeries are an attempt to ameliorate these effects. Reduction of spread of the revised scar is one of the main objectives of revision procedures. Provision of prolonged dermal support to wound can theoretically reduce spread of the scar. We carried out a randomized controlled trial and objectively evaluated the impact of two commonly used absorbable sutures, Polyglactin 910 and Polydioxanone on scar spread and quality. Sixty patients with post traumatic scars of one year duration were enrolled in the study and randomly divided into two groups of 30 each. After noting the demographic data and baseline scar characteristics, revision of the scar was carried out by elliptical excision and primary suturing. In Group1, Polyglactin 910 6-0 suture (Vicryl, Ethicon, Johnson and Johnson Ltd, India) was used for dermal suturing, whereas, in Group 2, Polydioxanone 6-0 suture (PDS II, Ethicon, Johnson and Johnson Ltd, India) was used. The scar spread in terms of scar width and scar quality with Vancouver Scar Scale (VSS) was evaluated at one, three and four months post-operatively. The two groups were well matched for demographics and baseline scar characteristics. On follow up, the mean scar width in Group 1 was significantly more than in Group 2. VSS score was significantly lower in Group 2 at third and fourth month follow up, signifying better scar quality. Suture extrusion was noticed in three cases in Group 1.Polydioxanone sutures, when used for intradermal suturing in revision of facial scars, result in a significantly decreased scar spread and better scar quality, than Polyglactin 910.



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Central nervous system in motor neuron disease

­

Brownell B, Oppenheimer DR, Trevor Hughes J. The central nervous system in motor neuron disease. J Neurol Neurosurg Psychiatry 1970;33:338–57.

Neurodegenerative syndromes, including Amyotrophic lateral sclerosis  (ALS), are complex polygenic disorders resulting in multisystem impairment of neocortical network connectivity. Specific to ALS is dysfunction of the unique human corticomotoneuronal system, which is the basis of many early features of ALS, a singularly human disorder. Early deficits include loss of vocalisation requiring complex respiration, impaired fractionation of digits and thumb opposability, difficulty with upright walking with ability to navigate uneven and tricky surfaces while erect, and as part of Frontotemporal demention (FTD), impaired language and associated socialisation.1 The hallmark TAR DNA-binding protein 43  (TDP-43) pathology, seen in >95% of patients with ALS, is largely restricted to corticofugal projecting neurons. This when taken together with sophisticated MRI imaging and threshold tracking using transcranial magnetic stimulation convincingly points to a cortical origin of...

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The Time for Gender Equity Is Now, Says ACP

New recommendations could help eliminate gender bias related to compensation and the career advancement of physicians, a longtime goal of the American College of Physicians.
Medscape Medical News

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Juvenile Trabecular Ossifying Fibroma—a Case Report

Abstract

Ossifying fibroma is a benign osteogenic mesenchymal tumor that is classified in the fibro-osseous lesions. Fibro-osseous lesions contain minerals, blood vessels, and giant cells that have the same radiographic and pathologic features but have different clinical behaviors, and were replaced with the normal bone. These lesions include fibrous dysplasia, cemento-osseous dysplasia, and ossifying fibroma. Juvenile ossifying fibroma is a type of uncommon and has invasive behavior, high incidence and occurs in young men, especially in maxilla, and is different from the type of adult in age, location, and clinical behavior and microscopic view. Pathologically, ossifying fibroma is divided into two types of trabecular and psammomatoid. The trabecular type is characterized by the presence of the osteoid trabeculae and the woven bone, and the type of psammomatoid by the presence of round, integrated, and small ossicles that are similar to the components of the psammoma. The purpose of this report is the clinical examination, radiography, pathology, and the treatment of a rare case of ossifying fibroma (trabecular) in mandible in a 7-year-old boy.

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Challenges to studying population effects of medical treatments

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How accurately is euthanasia reported on death certificates in a country with legal euthanasia: a population-based study

Abstract

Background

Death certificates are the main source of information on the incidence of the direct and underlying causes of death, but may be unsuitable for monitoring the practice of medical assistance in dying, e.g. euthanasia, due to possible underreporting. This study examines the accuracy of certification of euthanasia.

Methods

Mortality follow-back survey using a random sample of death certificates (N = 6871). For all cases identified as euthanasia we checked whether euthanasia was reported as a cause of death on the death certificate. We used multivariable logistic regression analysis to evaluate whether reporting varied according to patient and decision-making characteristics.

Results

Through the death certificates, 0.7% of all deaths were identified as euthanasia, compared with 4.6% through the mortality follow-back survey. Only 16.2% of the cases identified from the survey were reported on the death certificate. Euthanasia was more likely to be reported on the death certificate where death was from cancer (14% covered), neurological diseases (22%) and stroke (28%) than from cardiovascular disease (7%). Even when the recommended drugs were used or the physician self-labelled the end-of-life decision as euthanasia, euthanasia was only reported on the death certificate in 24% of cases.

Conclusions

Death certificates substantially underestimate the frequency of euthanasia as a cause of death in Belgium. Mortality follow-back studies are essential complementary instruments to examine and monitor the practice of euthanasia more accurately. Death certificate forms may need to be modified and clear guidelines provided to physicians about recording euthanasia to ensure more accurate certification.

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An asymptotic theory for cross-correlation between auto-correlated sequences and its application on neuroimaging data

Publication date: Available online 20 April 2018
Source:Journal of Neuroscience Methods
Author(s): Yunyi Zhou, Chenyang Tao, Wenlian Lu, Jianfeng Feng
BackgroundFunctional connectivity is among the most important tools to study brain. The correlation coefficient, between time series of different brain areas, is the most popular method to quantify functional connectivity. Correlation coefficient in practical use assumes the data to be temporally independent. However, the time series data of brain can manifest significant temporal auto-correlation.New methodA widely applicable method is proposed for correcting temporal auto-correlation. We considered two types of time series models: (1) auto-regressive-moving-average model, (2) nonlinear dynamical system model with noisy fluctuations, and derived their respective asymptotic distributions of correlation coefficient. These two types of models are most commonly used in neuroscience studies. We show the respective asymptotic distributions share a unified expression.ResultWe have verified the validity of our method, and shown our method exhibited sufficient statistical power for detecting true correlation on numerical experiments. Employing our method on real dataset yields more robust functional network and higher classification accuracy than conventional methods.Comparison with existing methodsOur method robustly controls the type I error while maintaining sufficient statistical power for detecting true correlation in numerical experiments, where existing methods measuring association (linear and nonlinear) fail.ConclusionsIn this work, we proposed a widely applicable approach for correcting the effect of temporal auto-correlation on functional connectivity. Empirical results favors the use of our method in functional network analysis.



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Challenges to studying population effects of medical treatments

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How accurately is euthanasia reported on death certificates in a country with legal euthanasia: a population-based study

Abstract

Background

Death certificates are the main source of information on the incidence of the direct and underlying causes of death, but may be unsuitable for monitoring the practice of medical assistance in dying, e.g. euthanasia, due to possible underreporting. This study examines the accuracy of certification of euthanasia.

Methods

Mortality follow-back survey using a random sample of death certificates (N = 6871). For all cases identified as euthanasia we checked whether euthanasia was reported as a cause of death on the death certificate. We used multivariable logistic regression analysis to evaluate whether reporting varied according to patient and decision-making characteristics.

Results

Through the death certificates, 0.7% of all deaths were identified as euthanasia, compared with 4.6% through the mortality follow-back survey. Only 16.2% of the cases identified from the survey were reported on the death certificate. Euthanasia was more likely to be reported on the death certificate where death was from cancer (14% covered), neurological diseases (22%) and stroke (28%) than from cardiovascular disease (7%). Even when the recommended drugs were used or the physician self-labelled the end-of-life decision as euthanasia, euthanasia was only reported on the death certificate in 24% of cases.

Conclusions

Death certificates substantially underestimate the frequency of euthanasia as a cause of death in Belgium. Mortality follow-back studies are essential complementary instruments to examine and monitor the practice of euthanasia more accurately. Death certificate forms may need to be modified and clear guidelines provided to physicians about recording euthanasia to ensure more accurate certification.

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Does burst-suppression achieve seizure control in refractory status epilepticus?

The general principles in the administration of anesthetic drugs entail not only the suppression of seizure activity but also the achievement of electroencephalography burst suppression (BS). However, previous...

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Effect of Trigonella foenum-graecum Linn . seeds methanol extract on learning and memory

Abstract

Prevention and delay in the onset of memory disorders will have a great impact on society by reducing the disease burden and finances. Drugs available for the treatment of learning and memory disorders are few. There is need to develop a better drug, several studies have shown the therapeutic effectiveness of herbal extracts for the learning and memory disorders because of their neuroprotective effects, hence herbs should be evaluated scientifically to form a basis for the future discovery of newer drugs. In this study, effect of Trigonella-foenum graecum L. seeds methanol extract (TFGS-ME) was evaluated in mice on learning and memory process by both exteroceptive and interoceptive behavioral models at three different doses. Elevated plus maze test was employed to assess the effect on learning and memory as an exteroceptive behavioral test. Scopolamine-induced amnesia was performed to assess effect on learning and memory as interoceptive behavior test. In both tests, it was found that animals received extract at 200 mg/kg exhibited a highly noteworthy decline in transfer latency on both acquisition and retention days in contrast to control animals, suggestive of improved learning and memory process. Results were equivalent to the standard drug piracetam at similar dose indicating that TFGS-ME improves learning and memory process and has significant potential as an antiamnesic agent. Hence there is need to separate the dietary components which may play a vibrant role in the future invention of novel drugs.

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Communication disorders in aging

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Current practice of ototoxicity management across the United Kingdom (UK)

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Modernising speech audiometry: using a smartphone application to test word recognition

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Ten Initial Cases of Peroral Endoscopic Myotomy for Treatment of Esophageal Motility Disorders at Okayama University Hospital.

Related Articles

Ten Initial Cases of Peroral Endoscopic Myotomy for Treatment of Esophageal Motility Disorders at Okayama University Hospital.

Acta Med Okayama. 2018 Apr;72(2):99-104

Authors: Sugihara Y, Harada K, Kato R, Yamauchi K, Takashima S, Takei D, Yamasaki Y, Inokuchi T, Takahara M, Hiraoka S, Okada H

Abstract
Peroral endoscopic myotomy (POEM) for treatment of esophageal motility disorders has recently been reported to be highly effective and less invasive than other treatment. POEM was recently introduced in Okayama University Hospital under the supervision of a physician from a high-volume center. To verify the safety and efficacy of POEM during its introduction in our institution. We examined 10 cases in whom POEM was performed between January 2016 and April 2017. The patients included 7 men and 3 women, with a median age (range) of 49 years (17-74) and median symptom duration of 6 years (1-21). Seven patients had a straight esophagus, and the remaining 3 had a sigmoid esophagus. According to the Chicago classification, 6 patients were diagnosed with type I achalasia, 2 with type II achalasia, and 2 with distal esophagus spasm. Treatment outcomes and adverse events were evaluated. Treatment success was defined as a > 3 decrease in Eckardt score or a score of <3 at the time of discharge. The treatment success rate was 90%, with the average Eckardt score decreasing significantly, from 4.7 to 0.9 (p<0.05). No mucosal perforation, severe infection, mediastinitis, severe bleeding, or gastroesophageal reflux occurred intraoperatively or postoperatively. POEM was introduced to Okayama University Hospital, and the first 10 cases were accomplished safely and effectively under the supervision of an expert physician from a high-volume center.

PMID: 29674757 [PubMed - in process]

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Modernising speech audiometry: using a smartphone application to test word recognition.

Related Articles

Modernising speech audiometry: using a smartphone application to test word recognition.

Int J Audiol. 2018 Apr 20;:1-9

Authors: van Zyl M, Swanepoel W, Myburgh HC

Abstract
OBJECTIVE: This study aimed to develop and assess a method to measure word recognition abilities using a smartphone application (App) connected to an audiometer.
DESIGN: Word lists were recorded in South African English and Afrikaans. Analyses were conducted to determine the effect of hardware used for presentation (computer, compact-disc player, or smartphone) on the frequency content of recordings. An Android App was developed to enable presentation of recorded materials via a smartphone connected to the auxiliary input of the audiometer. Experiments were performed to test feasibility and validity of the developed App and recordings.
STUDY SAMPLE: Participants were 100 young adults (18-30 years) with pure tone thresholds ≤15 dB across the frequency spectrum (250-8000 Hz).
RESULTS: Hardware used for presentation had no significant effect on the frequency content of recordings. Listening experiments indicated good inter-list reliability for recordings in both languages, with no significant differences between scores on different lists at each of the tested intensities. Performance-intensity functions had slopes of 4.05%/dB for English and 4.75%/dB for Afrikaans lists at the 50% point.
CONCLUSIONS: The developed smartphone App constitutes a feasible and valid method for measuring word recognition scores, and can support standardisation and accessibility of recorded speech audiometry.

PMID: 29676598 [PubMed - as supplied by publisher]

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Communication disorders in aging.

Related Articles

Communication disorders in aging.

Int J Audiol. 2018 Apr 20;:1

Authors: Pillion J

PMID: 29676595 [PubMed - as supplied by publisher]

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Current practice of ototoxicity management across the United Kingdom (UK).

Related Articles

Current practice of ototoxicity management across the United Kingdom (UK).

Int J Audiol. 2018 Apr 20;:1-13

Authors: Maru D, Malky GA

Abstract
OBJECTIVE: Effective management of patients diagnosed with ototoxicity is needed to reduce hearing and balance damage which affects communication and life quality. Despite widespread recommendations to monitor and manage ototoxicity in an early and effective manner, there is limited evidence to support the actual implementation of these recommendations for affected patient groups in healthcare services across the UK with limited publications available. In this study, an online questionnaire analysed the current practice of ototoxicity management and patient pathways across the UK once the diagnosis of ototoxicity was confirmed, targeting Audiologists, ENTs/AVPs and GPs.
DESIGN: Qualitative Survey Study.
STUDY SAMPLE: A randomised sample of hearing services in the UK, including audiology departments; GP practices and local health settings were targeted with a total of 134 completed surveys.
RESULTS: About 72% reported the absence of ototoxicity management protocols within their centre. Results depicted great inconsistency and variation across the UK in ototoxicity management services provided, treatment modification, monitoring and referral pathways.
CONCLUSION: Developing and advocating national guidelines are intended not only to inform clinical decision making but to provide minimum standards of care in ototoxicity management and offer greater awareness and education to improve patients' quality of life.

PMID: 29676584 [PubMed - as supplied by publisher]

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From John Snow to omics: the long journey of environmental epidemiology

Abstract

A major difference between infectious and non-communicable diseases is that infectious diseases typically have unique necessary causes whereas noncommunicable diseases have multiple causes which by themselves are usually neither necessary nor sufficient. Epidemiology seems to have reached a limit in disentangling the role of single components in causal complexes, particularly at low doses. To overcome limitations the discipline can take advantage of technical developments including the science of the exposome. By referring to the interpretation of the exposome as put forward in the work of Wild and Rappaport, I show examples of how the science of multi-causality can build upon the developments of omic technologies. Finally, I broaden the picture by advocating a more holistic approach to causality that also encompasses social sciences and the concept of embodiment. To tackle NCDs effectively on one side we can invest in various omic approaches, to identify new external causes of non-communicable diseases (that we can use to develop preventive strategies), and the corresponding mechanistic pathways. On the other side, we need to focus on the social and societal determinants which are suggested to be the root causes of many non-communicable diseases.

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Modernising speech audiometry: using a smartphone application to test word recognition.

Related Articles

Modernising speech audiometry: using a smartphone application to test word recognition.

Int J Audiol. 2018 Apr 20;:1-9

Authors: van Zyl M, Swanepoel W, Myburgh HC

Abstract
OBJECTIVE: This study aimed to develop and assess a method to measure word recognition abilities using a smartphone application (App) connected to an audiometer.
DESIGN: Word lists were recorded in South African English and Afrikaans. Analyses were conducted to determine the effect of hardware used for presentation (computer, compact-disc player, or smartphone) on the frequency content of recordings. An Android App was developed to enable presentation of recorded materials via a smartphone connected to the auxiliary input of the audiometer. Experiments were performed to test feasibility and validity of the developed App and recordings.
STUDY SAMPLE: Participants were 100 young adults (18-30 years) with pure tone thresholds ≤15 dB across the frequency spectrum (250-8000 Hz).
RESULTS: Hardware used for presentation had no significant effect on the frequency content of recordings. Listening experiments indicated good inter-list reliability for recordings in both languages, with no significant differences between scores on different lists at each of the tested intensities. Performance-intensity functions had slopes of 4.05%/dB for English and 4.75%/dB for Afrikaans lists at the 50% point.
CONCLUSIONS: The developed smartphone App constitutes a feasible and valid method for measuring word recognition scores, and can support standardisation and accessibility of recorded speech audiometry.

PMID: 29676598 [PubMed - as supplied by publisher]

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Communication disorders in aging.

Related Articles

Communication disorders in aging.

Int J Audiol. 2018 Apr 20;:1

Authors: Pillion J

PMID: 29676595 [PubMed - as supplied by publisher]

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Current practice of ototoxicity management across the United Kingdom (UK).

Related Articles

Current practice of ototoxicity management across the United Kingdom (UK).

Int J Audiol. 2018 Apr 20;:1-13

Authors: Maru D, Malky GA

Abstract
OBJECTIVE: Effective management of patients diagnosed with ototoxicity is needed to reduce hearing and balance damage which affects communication and life quality. Despite widespread recommendations to monitor and manage ototoxicity in an early and effective manner, there is limited evidence to support the actual implementation of these recommendations for affected patient groups in healthcare services across the UK with limited publications available. In this study, an online questionnaire analysed the current practice of ototoxicity management and patient pathways across the UK once the diagnosis of ototoxicity was confirmed, targeting Audiologists, ENTs/AVPs and GPs.
DESIGN: Qualitative Survey Study.
STUDY SAMPLE: A randomised sample of hearing services in the UK, including audiology departments; GP practices and local health settings were targeted with a total of 134 completed surveys.
RESULTS: About 72% reported the absence of ototoxicity management protocols within their centre. Results depicted great inconsistency and variation across the UK in ototoxicity management services provided, treatment modification, monitoring and referral pathways.
CONCLUSION: Developing and advocating national guidelines are intended not only to inform clinical decision making but to provide minimum standards of care in ototoxicity management and offer greater awareness and education to improve patients' quality of life.

PMID: 29676584 [PubMed - as supplied by publisher]

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Increased fibulin-1 plasma levels in polycystic ovary syndrome (PCOS) patients: possible contribution to the link between PCOS and cardiovascular risk

Abstract

Purpose

To investigate a possible relation between fibulin-1 plasma levels and PCOS.

Design

ELISA quantitative determination of human fibulin-1.

Methods

50 women with PCOS and 40 control patients who attended the Unit of Human Reproductive Pathophysiology, Università Cattolica del Sacro Cuore, Rome, were enrolled. Ultrasonographic pelvic examinations, hormonal profile assays, oral tolerance test OGTT, lipid profile and ELISA quantitative determination of human fibulin-1 were performed.

Results

Fibulin-1 levels were found to be statistically significantly higher in PCOS patients than in matched control women. No statistically significant positive correlation was found between fibulin-1 and AUCi, HOMA-IR, total cholesterol, LDL, AMH, androstenedione and FAI, whereas a statistically significant positive correlation was found between fibulin-1 and 17OHP (p = 0.016) in the PCOS group. However, multivariable linear regression analysis showed that 17 OH P did not independently predict fibulin-1 levels (p = 0.089).

Conclusions

Our data could contribute to explain the hypothesized increased cardiovascular risk and vascular damage in patients with PCOS. A better understanding of the cellular and molecular mechanisms involved in cardiometabolic disorders associated with PCOS is mandatory to identify new therapeutic strategies to eventually prevent the progression of cardiovascular diseases in these patients.

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