OtoRhinoLaryngology News: 04/20/18

Παρασκευή 20 Απριλίου 2018

Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review

Cesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. A growing body of research has investigated tools to predict which patients will experience more severe pain and have increased analgesic consumption after cesarean delivery. These include quantitative sensory testing, assessment of wound hyperalgesia, response to local anesthetic infiltration, and preoperative psychometric evaluations such as validated psychological questionnaires and simple screening tools. For this review, we searched MEDLINE, the Cochrane database, and Google Scholar to identify articles that evaluated the utility of various tools to predict severe pain and/or opioid consumption in the first 48 hours after cesarean delivery. Thirteen articles were included in the final review: 5 utilizing quantitative sensory testing, including patient responses to pressure, electrical, and thermal stimuli; 1 utilizing hyperalgesia testing; 1 using response to local anesthetic wound infiltration; 4 utilizing preoperative psychometric evaluations including the State-Trait Anxiety Inventory, the Pain Catastrophizing Scale, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and simple questionnaires; and 2 utilizing a combination of quantitative sensory tests and psychometric evaluations. A number of modalities demonstrated statistically significant correlations with pain outcomes after cesarean delivery, but most correlations were weak to modest, and many modalities might not be clinically feasible. Response to local anesthetic infiltration and a tool using 3 simple questions enquiring about anxiety and anticipated pain and analgesic needs show potential for clinical use, but further studies are needed to evaluate the utility of these predictive tests in clinical practice.

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Physiology and Role of Intraocular Pressure in Contemporary Anesthesia

More than 26 million Americans suffer with cataracts, and with 3.6 million cataract extractions performed annually in the United States, it is the most common surgical procedure. The integrity of the delicate structures of the eye that mediate vision is dependent on the intraocular pressure (IOP). Yet, IOP acts to compress the vessels within the globe—akin to a Starling resistor—and is a key component that determines the ocular perfusion pressure, defined as the difference between arterial pressure and IOP. The retina is one of the most metabolically active tissues in the body, and its functional integrity is dependent on an adequate blood supply, with retinal function linearly related to the ocular perfusion pressure. Retinal cell death has been demonstrated at low perfusion pressures (below 50 mm Hg). Modern ophthalmic surgery involves globe irrigation, manipulation, and instrumentation, resulting in dynamic pressure fluxes within the eye. Marked elevations of IOP (up to 4–5 times the normal value) with consequent borderline retinal and optic disk perfusion pressures occur for prolonged periods during many ophthalmic procedures. General surgeries, including laparoscopic, spinal, and cardiac procedures, especially, with their demand for steep Trendelenburg or prolonged prone positioning and/or hypotensive anesthesia, can induce IOP changes and ocular perfusion imbalance. These rapid fluctuations in IOP, and so in perfusion, play a role in the pathogenesis of the visual field defects and associated ocular morbidity that frequently complicate otherwise uneventful surgeries. The exact etiology of such outcomes is multifactorial, but ocular hypoperfusion plays a significant and frequently avoidable role. Those with preexisting compromised ocular blood flow are especially vulnerable to intraoperative ischemia, including those with hypertension, diabetes, atherosclerosis, or glaucoma. However, overly aggressive management of arterial pressure and IOP may not be possible given a patient's comorbidity status, and it potentially exposes the patient to risk of catastrophic choroidal hemorrhage. Anesthetic management significantly influences the pressure changes in the eye throughout the perioperative period. Strategies to safeguard retinal perfusion, reduce the ischemic risk, and minimize the potential for expulsive bleeding must be central to the anesthetic techniques selected. This review outlines: important physiological principles; ophthalmic and general procedures most likely to develop damaging IOP levels and their causative factors; the effect of anesthetic agents and techniques on IOP; recent scientific evidence highlighting the significance of perfusion changes during surgery; and key aspects of postoperative visual loss and management approaches for high-risk patients presenting for surgery.

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A Pain in the Abs: Predicting Post-Cesarean Analgesia

No abstract available

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The Eyes Have It: Factors that Influence Intraocular Pressure (IOP)

No abstract available

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Preventing Adverse Events in Cataract Surgery: Recommendations From a Massachusetts Expert Panel

Massachusetts health care facilities reported a series of cataract surgery–related adverse events (AEs) to the state in recent years, including 5 globe perforations during eye blocks performed by 1 anesthesiologist in a single day. The Betsy Lehman Center for Patient Safety, a nonregulatory Massachusetts state agency, responded by convening an expert panel of frontline providers, patient safety experts, and patients to recommend strategies for mitigating patient harm during cataract surgery. The purpose of this article is to identify contributing factors to the cataract surgery AEs reported in Massachusetts and present the panel's recommended strategies to prevent them. Data from state-mandated serious reportable event reports were supplemented by online surveys of Massachusetts cataract surgery providers and semistructured interviews with key stakeholders and frontline staff. The panel identified 2 principal categories of contributing factors to the state's cataract surgery–related AEs: systems failures and choice of anesthesia technique. Systems failures included inadequate safety protocols (48.7% of contributing factors), communication challenges (18.4%), insufficient provider training (17.1%), and lack of standardization (15.8%). Choice of anesthesia technique involved the increased relative risk of needle-based eye blocks. The panel's surveys of Massachusetts cataract surgery providers show wide variation in anesthesia practices. While 45.5% of surgeons and 69.6% of facilities reported increased use of topical anesthesia compared to 10 years earlier, needle-based blocks were still used in 47.0% of cataract surgeries performed by surgeon respondents and 40.9% of those performed at respondent facilities. Using a modified Delphi approach, the panel recommended several strategies to prevent AEs during cataract surgery, including performing a distinct time-out with at least 2 care-team members before block administration; implementing standardized, facility-wide safety protocols, including a uniform site-marking policy; strengthening the credentialing and orientation of new, contracted and locum tenens anesthesia staff; ensuring adequate and documented training in block administration for any provider who is new to a facility, including at least 10 supervised blocks before practicing independently; using the least invasive form of anesthesia appropriate to the patient; and finally, adjusting anesthesia practices, including preferred techniques, as evidence-based best practices evolve. Future research should focus on evaluating the impact of these recommendations on patient outcomes.

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Cancers, Vol. 10, Pages 125: Selective Inhibition of Histone Deacetylation in Melanoma Increases Targeted Gene Delivery by a Bacteriophage Viral Vector

Cancers, Vol. 10, Pages 125: Selective Inhibition of Histone Deacetylation in Melanoma Increases Targeted Gene Delivery by a Bacteriophage Viral Vector

Cancers doi: 10.3390/cancers10040125

Authors: Samuel Campbell Keittisak Suwan Sajee Waramit Eric Ofori Aboagye Amin Hajitou

The previously developed adeno-associated virus/phage (AAVP) vector, a hybrid between M13 bacteriophage (phage) viruses that infect bacteria only and human Adeno-Associated Virus (AAV), is a promising tool in targeted gene therapy against cancer. AAVP can be administered systemically and made tissue specific through the use of ligand-directed targeting. Cancer cells and tumor-associated blood vessels overexpress the αν integrin receptors, which are involved in tumor angiogenesis and tumor invasion. AAVP is targeted to these integrins via a double cyclic RGD4C ligand displayed on the phage capsid. Nevertheless, there remain significant host-defense hurdles to the use of AAVP in targeted gene delivery and subsequently in gene therapy. We previously reported that histone deacetylation in cancer constitutes a barrier to AAVP. Herein, to improve AAVP-mediated gene delivery to cancer cells, we combined the vector with selective adjuvant chemicals that inhibit specific histone deacetylases (HDAC). We examined the effects of the HDAC inhibitor C1A that mainly targets HDAC6 and compared this to sodium butyrate, a pan-HDAC inhibitor with broad spectrum HDAC inhibition. We tested the effects on melanoma, known for HDAC6 up-regulation, and compared this side by side with a normal human kidney HEK293 cell line. Varying concentrations were tested to determine cytotoxic levels as well as effects on AAVP gene delivery. We report that the HDAC inhibitor C1A increased AAVP-mediated transgene expression by up to ~9-fold. These findings indicate that selective HDAC inhibition is a promising adjuvant treatment for increasing the therapeutic value of AAVP.

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Diagnosis and Novel Approaches to the Treatment of Hypereosinophilic Syndromes

Abstract

Purpose of Review

Hypereosinophilic syndrome (HES) is characterized by persistent hypereosinophilia associated with end-organ damage. As our understanding of the pathogenesis of various forms of HES broadens, so does our ability to tailor steroid-sparing therapies for each subtype. The purpose of this review is to summarize recent literature related to the etiology, diagnosis, and management of HES.

Recent Findings

Mutations involved in subsets of HES can guide the choice of tyrosine kinase inhibitors beyond just imatinib. Several biologics that target interleukin-5 or its receptor have shown beneficial and selective eosinophil-reducing effects in clinical trials for asthma and other disorders including HES. Early clinical data with emerging therapies such as dexpramipexole and anti-Siglec-8 antibody show promise, but need to be confirmed in randomized trials.

Summary

Several new biologics and tyrosine kinase inhibitors have been shown to lower eosinophil numbers, but more randomized trials are needed to confirm efficacy in HES.

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Cilostazol is Effective to Prevent Stroke-Associated Pneumonia in Patients Receiving Tube Feeding

Abstract

Stroke-associated pneumonia (SAP) is a frequent complication in acute ischemic stroke (IS) patients, especially those receiving tube feeding (TF). In this retrospective study, we investigated whether or not cilostazol, a pluripotent phosphodiesterase III-specific inhibitor with anti-platelet and vasculogenic effects, can prevent SAP in these patients and reduce their duration of stay in intensive care unit/hospitalization. We recruited 158 IS patients receiving TF. Patients' characteristics (including age, gender, past history), National Institute of Health Stroke Scale and serum albumin level on admission, concomitant medications associated with SAP prevention (including cilostazol), and stroke characteristics (bilateral subcortical white matter lesion, brainstem involvement, large infarction, and asymptomatic hemorrhagic infarction) were compared between the SAP(−) and SAP(+) groups. Cilostazol was more frequently used in the SAP(−) group (20.8% vs. 6.1%, p < 0.05). Duration of intensive care unit was longer in patients with SAP (9 ± 8 vs. 6 ± 6 days, p < 0.05). However, the length of stay in an intensive care unit and duration of hospitalization were not reduced due to the prevention of SAP by cilostazol treatment. Cilostazol administration was associated with reduced SAP incidence in acute IS patients receiving TF.

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Immunohistochemical Expression of Fatty Acid Synthase and Vascular Endothelial Growth Factor in Primary Colorectal Cancer: a Clinicopathological Study

Abstract

Background

Fatty acid synthase (FAS) is a valuable lipid enzyme involved in lipid biosynthesis and suggested to contribute in tumor carcinogenesis. Vascular endothelial growth factor (VEGF) is considered a serious angiogenic growth factor in the angiogenic pathway which is a very important in tumor growth and metastasis. Thus, inhibition of lipid biosynthesis and tumor angiogenesis can be new goals for colorectal cancer (CRC) treatment.

Aim of the Work

The assessment of the expression of FAS and VEGF protein and the relationship between them in CRC with the clinicopathological parameters.

Methods

The present retrospective study included 63 paraffin blocks previously diagnosed as primary cases of CRC. The slides were subjected to FAS and VEGF immunohistochemical staining using a streptavidin-biotin-peroxidase. The relationships among FAS and VEGF expression and clinicopathological parameters were statistically analyzed.

Results

The expression rate of FAS was 81% and VEGF was 84.1% in the studied cases. FAS expression was significantly associated with histopathological type (p = 0.02) and grade (p = 0.04), and highly associated with lymph node metastasis and stage (p < 0.001).VEGF was significantly associated with histopathological type (p = 0.01) and tumor depth (p = 0.02); highly associated with grade, lymph node metastasis, and stage (p < 0.001). There was a positive association between FAS and VEGF expression in CRC (p < 0.001).

Conclusion

FAS and VEGF showed a highly significant expression in the studied primary CRC cases. A significant association was observed between their expressions, suggesting the involvement of FAS in tumor angiogenesis. So they constitute potential targets in cancer prevention and treatment and make FAS an attractive antiangiogenic target.

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The Role of Ventral Tegmental Area Gamma-Aminobutyric Acid in Chronic Neuropathic Pain after Spinal Cord Injury in Rats

Journal of Neurotrauma, Ahead of Print.

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The Role of Ventral Tegmental Area Gamma-Aminobutyric Acid in Chronic Neuropathic Pain after Spinal Cord Injury in Rats

Journal of Neurotrauma, Ahead of Print.

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In Response

No abstract available

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Differential Effects of Anesthetics and Opioid Receptor Activation on Cardioprotection Elicited by Reactive Oxygen Species–Mediated Postconditioning in Sprague-Dawley Rat Hearts

BACKGROUND: Despite an array of cardioprotective interventions identified in preclinical models of ischemia–reperfusion (IR) injury, successful clinical translation has not been achieved. This study investigated whether drugs routinely used in clinical anesthesia influence cardioprotective effectiveness by reducing effects of reactive oxygen species (ROS), upstream triggers of cardioprotective signaling. Effects of propofol, sevoflurane, or remifentanil were compared on postischemic functional recovery induced by ROS-mediated postconditioning with Intralipid. METHODS: Recovery of left ventricular (LV) work, an index of IR injury, was measured in isolated Sprague-Dawley rat hearts subjected to global ischemia (20 minutes) and reperfusion (30 minutes). Hearts were either untreated or were treated with postconditioning with Intralipid (1%, throughout reperfusion). Propofol (10 μM), sevoflurane (2 vol%), remifentanil (3 nM), or combinations thereof were administered peri-ischemically (before and during IR). The effects of anesthetics on ROS production were measured in LV cardiac fibers by Amplex Red assay under phosphorylating and nonphosphorylating conditions. RESULTS: Recovery of LV work (expressed as percentage of the preischemic value ± standard deviation) in untreated hearts was poor (20% ± 7%) and was improved by Intralipid postconditioning (58% ± 8%, P = .001). In the absence of Intralipid postconditioning, recovery of LV work was enhanced by propofol (28% ± 9%, P = .049), sevoflurane (49% ± 5%, P

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A Pain in the Abs: Predicting Post-Cesarean Analgesia

No abstract available

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Delineating the Trajectory of Cognitive Recovery From General Anesthesia in Older Adults: Design and Rationale of the TORIE (Trajectory of Recovery in the Elderly) Project

BACKGROUND: Mechanistic aspects of cognitive recovery after anesthesia and surgery are not yet well characterized, but may be vital to distinguishing the contributions of anesthesia and surgery in cognitive complications common in the elderly such as delirium and postoperative cognitive dysfunction. This article describes the aims and methodological approach to the ongoing study, Trajectory of Recovery in the Elderly (TORIE), which focuses on the trajectory of cognitive recovery from general anesthesia. METHODS: The study design employs cognitive testing coupled with neuroimaging techniques such as functional magnetic resonance imaging, diffusion tensor imaging, and arterial spin labeling to characterize cognitive recovery from anesthesia and its biological correlates. Applying these techniques to a cohort of age-specified healthy volunteers 40–80 years of age, who are exposed to general anesthesia alone, in the absence of surgery, will assess cognitive and functional neural network recovery after anesthesia. Imaging data are acquired before, during, and immediately after anesthesia, as well as 1 and 7 days after. Detailed cognitive data are captured at the same time points as well as 30 days after anesthesia, and brief cognitive assessments are repeated at 6 and 12 months after anesthesia. RESULTS: The study is underway. Our primary hypothesis is that older adults may require significantly longer to achieve cognitive recovery, measured by Postoperative Quality of Recovery Scale cognitive domain, than younger adults in the immediate postanesthesia period, but all will fully recover to baseline levels within 30 days of anesthesia exposure. Imaging data will address systems neuroscience correlates of cognitive recovery from general anesthesia. CONCLUSIONS: The data acquired in this project will have both clinical and theoretical relevance regardless of the outcome by delineating the mechanism behind short-term recovery across the adult age lifespan, which will have major implications for our understanding of the effects of anesthetic drugs.

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Auditing Intraoperative Transfusions to Promote High-Value Perioperative Care

No abstract available

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Treatment of Chronic Pain Conditions: A Comprehensive Handbook

No abstract available

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Postoperative Troponin Elevation, Myocardial Injury, and Pulmonary Embolism

No abstract available

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In Response

No abstract available

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The American College of Surgeons Children’s Surgery Verification and Quality Improvement Program: Be Careful What You Wish For!

No abstract available

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Effect of Stellate Ganglion Block on the Regional Hemodynamics of the Upper Extremity: A Randomized Controlled Trial

BACKGROUND: The success of stellate ganglion block (SGB) is traditionally determined on the basis of findings such as Horner's syndrome, temperature rise in the face, hyperemia of the tympanic membrane, and nasal congestion. However, decreases in vascular resistance and increases in blood flow in the arm may be more meaningful findings. To date, the effect of SGB on the regional hemodynamics of the arm has not been evaluated using pulsed-wave Doppler ultrasound. METHODS: A total of 52 patients who were to undergo orthopedic surgery of the forearm were randomly assigned to either the mepivacaine group (SGB with 5 mL of 0.5% mepivacaine) or the saline group (SGB with 5 mL of normal saline). Before surgery, a single anesthesiologist performed a SGB under ultrasound guidance. The temperature of the upper extremity and the resistance index and blood flow in the brachial artery were measured before SGB, 15 and 30 minutes after SGB, and 1 hour after surgery. The severity of pain, requirement for rescue analgesics, and side effects of the local anesthetic agent were all documented. RESULTS: After SGB, the resistance index decreased significantly and the blood flow increased significantly in the brachial artery of members of the mepivacaine group (15 minutes: P = .004 and P

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The Pros of Publishing Standalone Clinical Trial Protocols in Anesthesiology Journals

No abstract available

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Can Lung Ultrasound Be the First-Line Tool for Evaluation of Intraoperative Hypoxemia?

No abstract available

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Publishing Methods Without Results: A First That Hopefully Will Not Last

No abstract available

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Pain Medicine: An Essential Review

No abstract available

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The Eye: What You Don’t Know Can Hurt Your Patient

No abstract available

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Renal Interstitial Exhaustion and SGLT2 Blockers

No abstract available

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Looking Beyond the Pain: Can Effective Labor Analgesia Prevent the Development of Postpartum Depression?

No abstract available

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Perioperative Cardiac Arrest: Focus on Local Anesthetic Systemic Toxicity (LAST) Erratum

No abstract available

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Testing Times: Routine to Indicated!

No abstract available

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Teaching Medical Students Clinical Anesthesia

There are many reasons for evaluating our approach and improving our teaching of America's future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are allowed full access to patient care, including performing history and physical examinations, participating in the insertion of IVs and airway management. Simulation-based teaching was used by 82% of programs during medical student anesthesia clerkships. Sixty-eight percent of respondents reported that they have no formal training for their anesthesiology faculty teachers, 51% stated that they do not receive nonclinical time to teach, and 38% of respondents stated that they received some form of remuneration for teaching medical students, primarily nonclinical time. This article presents a summary of these survey results, provides a historical review of previous evaluations of teaching medical students clinical anesthesia, and discusses the contributions of anesthesiologists to medical student education.

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EACMFS Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

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Announcements

Dear Colleagues,

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Editorial Board/Reviewing Committee

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Adjuvant therapy for colon cancer: genes, genes... and the patient in the center

Although molecular subtype-based stratification and genomic signatures of increasing complexity are becoming a new strategy to guide therapeutic decisions in stage II/III colon cancer, several prognostic factors that can be easily obtained from FFPE specimens should be considered in order to create combined models that better define individual patients needs

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G-Spotplasty: A New Surgical Plastic Intervention—The Preliminary Study

Abstract

Background

Ostrzenski's G-pot anatomical structure discovery has been verified by the anatomy, histology, MRI in vivo, and electrovaginography in vivo studies. The objectives of this scientific-clinical investigation were to develop a new surgical reconstructive intervention (G-spotplasty); to determine the ability of G-spotplasty surgical implementation; to observe for potential complications; and to gather initial information on whether G-spotplasty improves female sexual activity, sexual behaviors, and sexual concerns.

Methods

A case series study was designed and conducted with 5-year follow-up (October 2013 and October 2017). The rehearsal of new G-spotplasty was performed on fresh female cadavers. Three consecutive live women constituted this clinical study population, and they were subjected to the newly developed G-spotplasty procedure in October 2013. Preoperatively and postoperatively, a validated, self-completion instrument of Sexual Relationships and Activities Questionnaire (SRA-Q) was used to measure female sexual activity, sexual behaviors, and sexual concerns.

Results

Three out of twelve women met inclusion criteria and were incorporated into this study. All patients were subjected to G-spotplasty, completed 5-year follow-up, and returned completed SRA-Q in a sealed envelope. New G-spotplasty was successfully implemented without surgical difficulty and without complications. All patients reported re-establishing vaginal orgasms with different degrees of difficulties, observing return of anterior vaginal wall engorgement, and were very pleased with the outcome of G-spotplasty.

Conclusions

The G-spotplasty is a simple surgical intervention, easy to implement, and improves sexual activities, sexual behaviors, and sexual concerns. The preliminary results are very promising and paved the way for additional clinical-scientific research.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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G-Spotplasty: A New Surgical Plastic Intervention—The Preliminary Study

Abstract

Background

Methods

Results

Conclusions

Level of Evidence IV

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A window into extreme longevity; the circulating metabolomic signature of the naked mole-rat, a mammal that shows negligible senescence

Abstract

Mouse-sized naked mole-rats (Heterocephalus glaber), unlike other mammals, do not conform to Gompertzian laws of age-related mortality; adults show no age-related change in mortality risk. Moreover, we observe negligible hallmarks of aging with well-maintained physiological and molecular functions, commonly altered with age in other species. We questioned whether naked mole-rats, living an order of magnitude longer than laboratory mice, exhibit different plasma metabolite profiles, which could then highlight novel mechanisms or targets involved in disease and longevity. Using a comprehensive, unbiased metabolomics screen, we observe striking inter-species differences in amino acid, peptide, and lipid metabolites. Low circulating levels of specific amino acids, particularly those linked to the methionine pathway, resemble those observed during the fasting period at late torpor in hibernating ground squirrels and those seen in longer-lived methionine-restricted rats. These data also concur with metabolome reports on long-lived mutant mice, including the Ames dwarf mice and calorically restricted mice, as well as fruit flies, and even show similarities to circulating metabolite differences observed in young human adults when compared to older humans. During evolution, some of these beneficial nutrient/stress response pathways may have been positively selected in the naked mole-rat. These observations suggest that interventions that modify the aging metabolomic profile to a more youthful one may enable people to lead healthier and longer lives.

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Perinatal risk factors for asthma in children with allergic rhinitis and grass pollen sensitization

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Correlation between vitamin D serum levels and passive smoking exposure in children with asthma

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Epidemiology of childhood asthma in mainland China (1988‐2014): A meta-analysis

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The Floralia: A festive time for Romans and a demanding time for the allergist/immunologist

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Nonprescription medications for respiratory symptoms: Facts and marketing fictions

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Evaluating children with suspected allergic reactions to vaccines for infectious diseases

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Real-world use of omalizumab in patients with chronic idiopathic/spontaneous urticaria in the United States

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Diagnosis, pathogenesis, and treatment of chronic spontaneous urticaria

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Health care burden and treatment patterns in commercially insured children with chronic idiopathic/spontaneous urticaria: A real-world study in the United States

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Hereditary angioedema from the patient's perspective: A follow-up patient survey

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Pharmacokinetics of intranasal olopatadine in the fixed-dose combination GSP301 versus two monotherapy intranasal olopatadine formulations

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Pharmacokinetics of intranasal mometasone in the fixed-dose combination GSP301 versus two monotherapy intranasal mometasone formulations

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Prevalence of allergen sensitization detected by patch tests

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Utilization and timeliness of an inpatient penicillin allergy evaluation

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Drug-induced eosinophilia

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For the Patient

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Abstracts from the Western Society of Allergy, Asthma, and Immunology (WSAAI) Annual Scientific Session, Kapalua, Hawaii, January 21‐25, 2018

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Surgical Management of Head and Neck Soft Tissue Sarcoma: 11-Year Experience at a Tertiary Care Centre in South India

Abstract

Head and neck soft tissue sarcoma (HNSTS) is a rare neoplasm accounting for 1% of all head and neck tumours. Because of rarity and varied biological behaviour among various subtypes, knowledge about these tumours is limited. This study aimed at analysing clinicopathological, recurrence and survival pattern of surgically treated HNSTS. Case records of 28 patients of HNSTS who underwent surgery at the Regional Cancer Centre (RCC), Trivandrum (India) between 2002 and 2012 were analysed retrospectively for demographic profile, clinical features, treatment given, recurrence pattern and outcome. The median age of patients was 37 years (range, 3–79) with male:female ratio of 3:2. Majority of patients presented with painless lump in the neck as the most common subsite affected followed by scalp and face. One patient had nodal disease, while none had distant metastasis at presentation. The most frequent histological subtypes were synovial sarcoma and fibrosarcoma followed by malignant fibrous histiocytoma, angiosarcoma and rhabdomyosarcoma. Majority (78.5%) of patients received adjuvant therapy in the form of radiation, chemotherapy or chemo-radiation. After mean follow-up of 49 months, four patients had died, and six developed local recurrence and four distant metastasis. The overall 5-year survival was 82.7% while 5-year disease-free survival was 55.3%. HNSTS is a rare entity that requires multimodality treatment to achieve optimum locoregional control and survival.

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Functional Outcomes in Audiology: There is Room for Improvement

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Effect of Adaptive Compression and Fast-Acting WDRC Strategies on Sentence Recognition in Noise in Mandarin-Speaking Pediatric Hearing Aid Users

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Using a Digital Language Processor to Quantify the Auditory Environment and the Effect of Hearing Aids for Adults with Hearing Loss

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The Value of Electrically Evoked Stapedius Reflex in Determining the Maximum Comfort Level of a Cochlear Implant

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Factors Affecting Hearing Aid Adoption and Use: A Qualitative Study

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Expectations for Tinnitus Treatment and Outcomes: A Survey Study of Audiologists and Patients

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Measurement of the Electrically Evoked Stapedial Reflex Response with Wideband Acoustic Reflectance Measurement

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Open-Fit Domes and Children with Bilateral High-Frequency Sensorineural Hearing Loss: Benefits and Outcomes

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JAAA CEU Program

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AAA 2018 Explores New Frontiers in Music Perception of Cochlear Implant Users

It was a full house at the Judith S. Gravel Annual Vanderbilt Lecture by Charles Limb, MD, at this week's American Academy of Audiology coneference in Nashville, TN. Limb is the Francis A. Sooy Professor of Otolaryngology-Head and Neck Surgery and the chief of the Division of Otology, Neurotology, and Skull Base Surgery at University of California in San Francisco.

Limb gave a fascinating presentation on the challenges affecting children with cochlear impants in the area o musicperception. Despite the adavcen in CIs, Limb's research has sound significant limitations of this technology in enabling users to have extensive epxerience of sound. However, he presented his creative an donoging work so identifu new frontiers in improving the music percenption of this patient popylation.

"I'm most excited that were starting to identify things that could be improved. We've spent the last 10 to 15 years of the field just showing how bad everyhing was without actually being able to improve anything," Limb told The Hearing Journal after his presentation. "So we're starting to find things that might actually imporive music perception—and that's pretty exciting to me."

At the lecture, Limb showed videos of CI users with music abilities—testaments to the musicality of children who may have hearing difficulties but benefit from the use of CIs.

Limb cited some exciting areas of advancement. "For example, some of the sutides on tuning in cochlear implant is starting to show some promise in temrs sof pitch percepton, and others have worked on on pitch processing strategies that are promising so maybe we're getting closer to more accurate pitch."

But to optimize this progress in research, it's important to address critical issues like access to CIs.

"Sadly, there are still many people who need our services but dont get access to them, and the system thatd in place to give people access to these services is pretty daunting," Limb stated.

"I think that we to acceot as a comunity, as a people, as a goverment that hearig loss is not acceptable to just persist in our world world. if tehre treatments out there, it should be our right to get that treatment. So all of us need to get better."

Published: 4/20/2018 10:14:00 AM

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Duodenoscope reprocessing practice patterns in U.S. endoscopy centers: a survey study

After recent outbreaks of duodenoscope-related infections from multidrug-resistant organisms (MDRO), the United States Food and Drug Administration (FDA) recommended implementing one or more of four enhanced reprocessing measures in addition to updated manual cleaning methods and high-level disinfection (HLD). The implementation of these techniques in endoscopy facilities and provider opinions regarding reprocessing priorities remain unknown.

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Valuing innovative endoscopic techniques: per-oral endoscopic myotomy for the management of achalasia

Unclear reimbursement for new and innovative endoscopic procedures can limit adoption in clinical practice despite effectiveness in clinical trials. The aim of this study was to determine maximum cost-effective reimbursement for per-oral endoscopic myotomy (POEM) in treating achalasia.

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The influence of marital status on survival for patients aged 65 years and younger with oral cavity cancer

In Taiwan, the median age of diagnosis for oral cavity cancer is 51 year old, which is about 10 years earlier than that in Western countries. A recent study assessing the effect of marriage on outcomes for elderly oral cavity cancer patients (≥66 years old) showed that marriage was associated with better survival. However, little is known about the prognostic significance of marital status in oral cavity cancer patients aged 65 years and younger.

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Predictive value of the Hyodo score in endoscopic evaluation of aspiration during swallowing

The Hyodo scoring system during the endoscopic procedure has been proposed as a new tool for evaluating oral intake feasibility. However, the effectiveness of the information obtained from this procedure in predicting aspiration is not fully elucidated. The aim of this study was to assess the significance of clinical factors, including Hyodo scores, for predicting the risk of aspiration.

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Intraoperative comparison of single- and double-puncture techniques in temporomandibular joint arthrocentesis

The objective of this study was to compare techniques for temporomandibular joint (TMJ) arthrocentesis intraoperatively and to determine the ease of performance of these techniques for the physician. A total of 33 TMJ treatments were done using single-puncture arthrocentesis (SPA) type 1, SPA type 2, and double-puncture arthrocentesis (DPA) (n=11 in each treatment group) between December 2013 and December 2017. A retrospective analysis of the duration of the procedure (minutes), occurrence of complications, number of cannula relocations, and ease of the procedure was performed.

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Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis

No consensus has been reached regarding the influence of the flapless and open-flap surgical techniques on the placement of dental implants. This systematic review compared the effects of flapless implant placement and implant placement with elevation of the mucoperiosteal flap in terms of marginal bone loss, implant survival rate and complications rates. This review followed PRISMA guidelines and was registered in PROSPERO with the registration number CRD42017071475. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published until December 2017.

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Immune cell infiltration in Ectomesenchymal chondromyxoid tumor: An immunohistochemical study

Ectomesenchymal chondromyxoid tumor (ECT) is a rare benign neoplasm, often affecting the anterior dorsum of the tongue. To date, approximately 74 cases of lingual ECT have been published. This report describes, for the first time, the morphological and immunohistochemical features of a unique ECT case, which revealed diffuse infiltration by immune cells with a dendritic-like appearance inside the tumor proliferation. The significance of these findings and discussion about the tumor cell-immune cell interactions are presented.

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Influence of estrogen deficiency on guided bone augmentation: investigation of rat calvarial model and osteoblast‐like MC3T3‐E1 cells

European Journal of Oral Sciences, EarlyView.

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Role of the high mobility group box 1 signalling axes via the receptor for advanced glycation end‐products and toll‐like receptor‐4 in the immunopathology of oral lichen planus: a potential drug target?

European Journal of Oral Sciences, EarlyView.

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The red cell distribution width as a prognostic indicator in upper aerodigestive tract (UADT) cancer: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to investigate the relationship between the Red Cell Distribution Width (RDW) and prognosis in upper aerodigestive tract (UADT) cancer.

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Immune cell infiltration in Ectomesenchymal chondromyxoid tumor: An immunohistochemical study

Current trends in food allergy-induced anaphylaxis management at school

To review the evidence and current policies regarding the use of epinephrine at schools and child care centers Data Sources and Study Selection: A narrative review was performed based on the result of conference proceedings of a group of inter-professional stakeholders who attended the USAnaphylaxis Summit 2017 presented by Allergy & Asthma Network.

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Food allergy to previously tolerated foods: course and patient characteristics

IgE-mediated food allergy is a life threatening disease with an increasing prevalence in developed countries (1). Food proteins are innocuous non–self-antigens which are regularly absorbed through the gastro-intestinal tract without provoking a significant immune reaction. The mechanisms responsible for the development of primary immune tolerance to food-related proteins are still not well understood (2). IgE-mediated food allergy results when the adaptive immune system fails to develop tolerance to these food proteins and instead develops IgE antibodies directed against allergenic epitopes (2).

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Mepolizumab in the treatment of severe eosinophilic asthma: “results from a physician in the field”

We would like to report our real-world results of using mepolizumab in patients with severe eosinophilic asthma in an office environment. This was a retrospective study; written permission was granted by all patients to use results of their treatment with mepolizumab, a monoclonal antibody directed against the interleukin 5 cytokine.

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Open reduction and internal fixation of palatal fractures using three-dimensional plates

The maxilla is arguably the most anatomically intricate structure of the craniofacial skeleton, and the hard palate is an important bone that regulates the width and architecture of the face. The management of palatal fractures has long been a matter of debate, and varies with anatomical pattern and other injuries to the craniofacial skeleton. We have studied 18 palatal fractures during a five-year period that were treated using 3-dimensional rectangular plates placed across the palatal vault together with fixation of other fractures of the facial bones.

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A Conversation about RAS Dimers

Data are persuasive that RAS proteins are dimeric in living cells, but monomeric in vitro. Pasi Jänne, Chiara Ambrogio, and Frank McCormick discuss the significance of understanding RAS dimers for finding treatments for RAS cancers.

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The Dantastic Mr. Tox & Howard Episode 11 – In the Weeds with the Full Monte

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https://ift.tt/2vwkF7V Legalization, edible issues and airport amnesty dumpster diving with Dr. Andrew Monte Join Dan (@drusyniak) &howard (@heshiegreshie) as they discuss all things marijuana with Dr. Andrew Monte (@PreciseMDMonte) on this very special day. Learn about the interaction between marijuana and ERs in Colorado before and after legalization, the influence of Big Green, and why […]

EMCrit Project by Tox & Hound.

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Diverse expression of TNF-α and CCL27 in serum and blister of Stevens–Johnson syndrome/toxic epidermal necrolysis

The pathogenesis of Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is not fully understood. Our previous study reported that chemokine CCL27 was overexpressed in serum of SJS/TEN patients. The...

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De Gruyter launches new Ancient Studies open access projects

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Hearing loss and social support in urban and rural communities.

Hearing loss and social support in urban and rural communities.

Int J Audiol. 2018 Apr 19;:1-8

Authors: Hay-McCutcheon MJ, Hyams A, Yang X, Parton J

Abstract
OBJECTIVE: Perceived social support and hearing handicap were assessed in adults with and without hearing loss who lived in different geographical regions of Alabama.
DESIGN: The Hearing Handicap Inventory for Adults (HHIA) assessed emotional and social consequences of hearing loss. The Medical Outcomes Study (MOS) Social Support Survey and the Social Functioning, Role Emotional and Mental Health scales of the SF-36 were administered.
STUDY SAMPLE: Data were collected from 71 study participants with hearing loss and from 45 adults without hearing loss.
RESULTS: Degree of hearing loss and outcomes from the HHIA did not differ between adults who lived in rural or urban settings. Tangible support was poorer for adults with hearing loss who lived in rural settings compared to those who lived in urban settings. For adults without hearing loss, residency was not associated with tangible support. For these adults, income was associated with other types of social support (i.e. informational support, affection, positive social interaction).
CONCLUSIONS: Adults with hearing loss living in rural areas had poor perceived tangible support. The provision of support to address a hearing loss could be worse for these adults compared to adults who lived in urban settings.

PMID: 29671659 [PubMed - as supplied by publisher]

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The role of communication partners in the audiological rehabilitation.

The role of communication partners in the audiological rehabilitation.

Int J Audiol. 2018 Apr 19;:1

Authors: Danermark B

PMID: 29671651 [PubMed - as supplied by publisher]

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NCI Expands Repository of Cancer Research Models: A Conversation with Drs. Doroshow and Evrard

NCI is expanding its Patient-Derived Models Repository (PDMR), which provides cancer research models made directly from human tumor tissue. In this Q&A, Drs. Yvonne Evrard and James Doroshow explain how the new models can help cancer researchers make more rapid progress.

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Prolonged Delay in Care Impacts Burden of Noma Disease

Noma, a gangrenous infection of the face, may go untreated for well over a decade, reflecting the incidence and prevalence of the disease and the ability of existing surgical care systems to provide treatment, researchers say.
Reuters Health Information

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Evolution of deceased organ donation activity vs. efficiency over a 15 year period: an international comparison

Background The donation rate (DR) per million population is not ideal for an efficiency comparison of national deceased organ donation programs. The DR does not account for variabilities in the potential for deceased donation which mainly depends on fatalities from causes leading to brain death. In this study, the donation activity was put into relation to the mortality from selected causes. Based on that metric, this study assesses the efficiency of different donation programs. Methods This is a retrospective analysis of 2001–2015 deceased organ donation and mortality registry data. Included are 27 Council of Europe countries, as well as the USA. A donor conversion index (DCI) was calculated for assessing donation program efficiency over time and in international comparisons. Results According to the DCI and of the countries included in the study, Spain, France, and the USA had the most efficient donation programs in 2015. Even though mortality from the selected causes decreased in most countries during the study period, differences in international comparisons persist. This indicates that the potential for deceased organ donation and its conversion into actual donation is far from being similar internationally. Conclusions Compared with the DR, the DCI takes into account the potential for deceased organ donation, and therefore is a more accurate metric of performance. National donation programs could optimize performance by identifying the areas where most potential is lost, and by implementing measures to tackle these issues. Correspondence to: Franz F. Immer, MD, consultant cardiovascular surgeon FMH, Swisstransplant, Effingerstrasse 1/Postfach, CH-3011 Bern, Switzerland., franz.immer@swisstransplant.org **Please refer to Appendix 1, SDC, https://ift.tt/2HDeOT2 for information about Council of Europe European Committee on Organ Transplantation (CD-P-TO) membership Authors' contributions JW: acquired and analyzed data, reviewed the literature, wrote the manuscript; AE acquired and analyzed data, contributed to the writing of the manuscript; BM, provided the donation data from the Newsletter Transplant database; BDG, DA, ANC, BHK, KL: members of the Council of Europe's project TO077 CD-P-TO working group, participated in the study design, revised the manuscript critically; FFI conceived the study, advised on its design and revised the manuscript critically, member of the TO077 CD-P-TO working group. Conflict of interest: The authors declare no conflicts of interest. Funding: This study received no external funding. Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (https://ift.tt/2EZJQTY). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Heavy Alcohol Use Among Deceased Donors Does Not Impact Recipient Outcomes After Liver Transplantation

Background Data on liver transplant (LT) outcomes using deceased donors with heavy drinking (HD) (>2 drinks/day) are scanty. Methods Using the United Network for Organ Sharing database (2002-2014), we examined outcomes after LT in adults comparing deceased HD donors with not heavy drinking (ND) donors. Results Of 56 182 first LTs performed in the US for 10 common indications using deceased donors, 47 882 with available information on alcohol use were analyzed. Of these 47 882 LT recipients, 7 298 (15%) were from HD donors, with similar proportion over time (2002-2014, Armitage trend test P=0.75) and for recipient liver disease etiology (Chi square P=0.42). Proportion of liver organ used for LT was lower for HD donors compared to ND donors (63 vs. 78%, P

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Dendritic Cell Therapy in Transplantation, Phenotype Governs Destination and Function

No abstract available

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State of the Art: Role of the Dendritic Cell in Induction of Allograft Tolerance

Despite decades of research, the induction and maintenance of long-term allograft tolerance without immunosuppression remains an elusive goal in the field of solid organ and cell transplantation. Immunosuppressive medications frequently prevent or minimize acute cellular rejection but have failed to halt anti-donor antibody production and chronic organ rejection. Past efforts aimed at promoting lasting allograft tolerance have focused primarily on peripheral T cell depletion,1 augmentation of regulatory T cells,2 or induction via simultaneous hematopoietic stem cell transplantation and facilitation of donor chimerism.3 So far, none of these methods have led to consistently safe, feasible and long lasting donor organ acceptance. Over the course of the past 4 decades, the study of a unique population of antigen-presenting cells known as dendritic cells (DCs) has shown promise for breaking new ground in achieving indefinite allograft survival without immunosuppression and its associated adverse effects. In this review, we discuss the discovery and early investigations of DCs and chronicle some of the key studies demonstrating their role in transplantation, particularly in indirect allorecognition, the immunologic pathway thought to drive chronic rejection and perhaps tolerance induction. Sarah J. Rosen, M.D., 630 W. 168th St., Rm. 10-502, New York, NY 10032. sr2490@cumc.columbia.edu Sarah J. Rosen participated in the writing of the paper. Paul E. Harris participated in the writing of the paper. Mark A. Hardy participated in the writing of the paper. The authors declare no conflicts of interest. Funding for this work was provided by the National Institutes for Health 2T32HL007854-21. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Health care costs for the evaluation, surgery, and follow-up care of living kidney donors

Background The health care costs to evaluate, perform surgery, and follow a living kidney donor for the year after donation are poorly described. Methods We obtained information on the health care costs of 1099 living kidney donors between April 1, 2004 and March 31, 2014 from Ontario, Canada using comprehensive health care administrative databases. We estimated the cost of 3 periods of the living donation process: the predonation evaluation period (start of evaluation until the day before donation), perioperative period (day of donation until 30-days postdonation), and 1 year of follow-up period (after perioperative period until 1-year postdonation). We analyzed data for donors and healthy matched nondonor controls using regression-based methods to estimate the incremental cost of living donation. Costs are presented from the perspective of the Canadian health care payer (2017 $CAD). Results The incremental health care costs (compared with controls) for the evaluation, perioperative, and follow-up periods were $3,596 (95% confidence interval (CI) $3,350-$3,842), $11,694 ($11,415-$11,973), and $1,011 ($793-$1,230), respectively, totalling $16,290 ($15,814-$16,767). The evaluation cost was higher if the intended recipient started dialysis part-way through the donor evaluation [$886 ($19, $1,752)]. The perioperative cost varied across transplant centers (p

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Outcomes after Cardiac Transplant for Wild Type Transthyretin Amyloidosis

Background The true prevalence of heart failure (HF) due to wild type transthyretin amyloidosis (ATTRwt) is likely underestimated. There is a paucity of data with regard to the management of ATTRwt-related advanced HF and the natural history of extracardiac ATTRwt. Methods We conducted a retrospective cohort study of patients undergoing cardiac transplant (HTx) for ATTRwt at a single institution. Comprehensive clinical data, including baseline hemodynamic and echocardiographic characteristics, and posttransplant outcomes were obtained. Results Seven patients with ATTRwt underwent HTx between 2007 and 2015. All patients were male with a mean age of 66 ± 9. Patients had a reduced ejection fraction (mean 37 ± 14%) and elevated filling pressures pre-HTx (mean pulmonary capillary wedge pressure 22 ± 7 mmHg) prior to HTx. Three year survival was 100%; 1 patient died of pancreatic cancer 45 months post-HTx (1 death per 30.8 patient-years). Oxygen consumption (Δ +6.8 ± 4.9 ml/kg/min) and 6-minute walk distances (Δ +189 ± 60 m) improved. Symptomatic gastrointestinal involvement (n=2) and peripheral nerve involvement (n=4) by ATTRwt developed late. Conclusions This is the first report of a series of ATTRwt patients receiving HTx in which excellent outcomes are demonstrated. Although cardiac death is averted, systemic manifestations of ATTRwt may develop posttransplantation. REPRINTS AND CORRESPONDENCE: Andrew N. Rosenbaum, M.D., Mayo Clinic Rochester, 200 1st St. SW, Rochester, MN 55905. Phone#: +15072842511. Fax#: +1 5072840161. Email: Rosenbaum.Andrew@mayo.edu PI: Brooks S. Edwards: Phone#: +15072663841 Email: Edwards.Brooks@mayo.edu AUTHORSHIP: Andrew N Rosenbaum: Participated in research design, writing of the paper, performance of the research, and data analysis Omar F. Abou Ezzeddine: Participated in writing of the paper and data analysis Martha Grogan: Participated in research design, writing of the paper, and data analysis Angela Dispenzieri: Participated in writing of the paper and data analysis Sudhir Kushwaha: Participated in writing of the paper and data analysis Alfredo Clavell: Participated in writing of the paper and data analysis Richard C. Daly: Participated in writing of the paper and data analysis Brooks S Edwards: Participated in research design, writing of the paper, and data analysis DISCLOSURES: The authors declare no conflicts of interest SOURCES OF FUNDING: No funding was provided for the current study Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Frailty, Inflammatory Markers, and Waitlist Mortality Among Patients with End-Stage Renal Disease in a Prospective Cohort Study

Background Among community-dwelling older adults, frailty is associated with heightened markers of inflammation and subsequent mortality. Although frailty is common among ESRD patients, the role of frailty and markers of inflammation in this population remains unclear. We quantified these associations in patients on the kidney transplant (KT) waitlist and tested whether frailty and/or markers of inflammation improve waitlist mortality risk prediction. Methods We studied 1,975 ESRD patients on the KT waitlist (11/1/09-2/28/17) in a multi-center cohort study of frailty. Serum inflammatory markers (interleukin-6 [IL-6], soluble tumor necrosis factor-α receptor-1 [sTNFR1], and C-reactive protein [CRP]) were analyzed in 605 of these participants; we calculated the inflammatory index score using IL-6 and sTNFR1. We compared the C-statistic of an established registry-based prediction model for waitlist mortality adding frailty and/or inflammatory markers (1SD change in log IL-6, sTNFR1, CRP, or inflammatory index). Results The registry-based model had moderate predictive ability (c-statistic=0.655). Frailty was associated with increased mortality (2.19, 95%CI:1.26-3.79) but did not improve risk prediction (c-statistic=0.646; P=0.65). Like frailty, IL-6 (2.13, 95%CI:1.41-3.22), sTNFR1 (1.70, 95%CI:1.12-2.59), CRP (1.68, 95%CI:1.06-2.67), and the inflammatory index (2.09, 95%CI:1.38-3.16) were associated with increased mortality risk; unlike frailty, adding IL-6 (c-statistic=0.777; P=0.02), CRP (c-statistic=0.728; P=0.02), or inflammatory index (c-statistic=0.777; P=0.02) substantially improved mortality risk prediction. Conclusion Frailty and markers of inflammation were associated with increased waitlist mortality risk, but only markers of inflammation significantly improved ESRD risk prediction. These findings help clarify the accelerated aging physiology of ESRD and highlight easy to measure markers of increased waitlist mortality risk. Contact Information: Mara McAdams-DeMarco, Ph.D. Department of Epidemiology, 615, N. Wolfe St, W6033, Baltimore, MD 21205 (410) 502-1950 email: mara@jhu.edu Authorship Mara A. McAdams-DeMarco: Research design, data analysis, writing of the paper and review of the paper Hao Ying: Performance of the research, data analysis, writing of the paper and review of the paper Alvin Thomas: Writing of the paper and review of the paper Fatima Warsame: Performance of the research, writing of the paper and review of the paper Ashton A. Shaffer: Writing of the paper and review of the paper Christine E. Haugen: Performance of the research, writing of the paper and review of the paper Jacqueline M. Garonzik-Wang: Performance of the research, writing of the paper and review of the paper Niraj M. Desai: Performance of the research, writing of the paper and review of the paper Ravi Varadhan: Performance of the research, writing of the paper and review of the paper Jeremy D. Walston: Writing of the paper and review of the paper Silas P. Norman: Performance of the research, writing of the paper and review of the paper Dorry L. Segev: Research design, writing of the paper and review of the paper Disclosure The authors declare no conflicts of interest. Funding This study was supported by NIH grant R01AG042504 (PI: Dorry Segev), R01AG055781 (PI: McAdams-DeMarco) and K24DK101828 (PI: Dorry Segev). Mara McAdams-DeMarco was also supported by the Johns Hopkins University Claude D. Pepper Older Americans Independence Center (P30AG021334), National Institute on Aging (K01AG043501). Christine Haugen was supported by the National Institute on Aging (F32AG053025). Ashton Shaffer was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (F30DK116658). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Measured Glomerular Filtration Rate After Kidney Donation: No Evidence of Accelerated Decay

Background The rate of measured GFR change in kidney donors years after donation has not been adequately addressed. Whether this change is accelerated in the setting of 1 kidney is also understudied. Methods 214 randomly selected donors underwent serial GFR measurements of nonradioactive iohexol. eGFR at each visit was calculated using the CKD EPI and MDRD study equations. Results GFR visits were 4.8 ±1.3 years apart and the second occurring 16.9±9.1 years after donation. The majority (97.7%) were White; 60.8% female and 78.5% were related to their recipient. Most, 84.6%, had a GFR ≥60 ml/min/1.73m2, 14.0% had a GFR between 45-60 ml/min/1.73m2 and 1.4% had a GFR

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Gearing Up for Stem Cell-Derived Beta Cells – Are We Ready?

No abstract available

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Measured vs estimated glomerular filtration (eGFR) rate in the assessment of living kidney donors: eGFR has its limitations

No abstract available

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Therapeutic outcomes of haploidentical allogeneic hematopoietic stem cell transplantation in patients with severe aplastic anemia: a multicenter study

Background Haploidentical donor allogeneic hematopoietic stem cell transplantation (HID-HSCT) is an alternative curative treatment for patients with severe aplastic anemia (SAA) who do not have suitable matched related donors (MRD). The aim of this study was to compare the therapeutic outcomes of HID-HSCT with those of MRD-HSCT for SAA. Methods A total of 235 SAA patients who underwent HID-HSCT (116) or MRD-HSCT (119) at 11 transplantation centers from January 2007 to January 2016 were included. Complications and survival outcomes were evaluated and compared between the 2 groups. Results The HID group had a lower incidence of secondary graft failure (GF) but higher incidences of acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD). However, the incidence of severe aGVHD (grade III-IV), poor graft function (PGF), and infections was comparable between groups. Patients in the HID group had a significantly lower survival and overall survival rates than those in the MRD group. The estimated 3-year survival rates for the MRD and HID groups were 82.82% and 75.00%, respectively. Ferritin levels, GF, PGF, severe aGVHD, and infections were the significant risk factors for survival. Conclusion The overall survival rate is acceptable for patients who underwent HID-HSCT, making it a feasible treatment choice for SAA patients. Corresponding author: Professor Yang Xiao, Stem Cell Translational Medicine Center, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China & Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China. Email: jdxiao111@163.com Yonghua Li, Fengqi Duan and Haowen Xiao contributed equally to this work. Author contributions Yonghua Li and Yang Xiao designed the research. Yonghua Li and Fengqi Duan analyzed the data and wrote the manuscript. All authors conducted the research, collected the clinical data, and approved the submitted and final versions of the manuscript. Conflicts of interest The authors declare that there are no conflicts of interest. Funding This work was partly supported by the State Natural Sciences Fund (Project number 81570107), Natural Science Foundation of Guangdong Province (Project number 2014A030311006) and Guangzhou Pearl River Scientific and Technological New Star Capitals (grant no. 2012 J2200008). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cytomegalovirus: a Guide for the Perplexed

No abstract available

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CORM-401 reduces ischemia reperfusion injury in an ex vivo renal porcine model of the donation after cardiac death

Background Carbon monoxide (CO) inhalation protects organ by reducing inflammation and cell death during transplantation processes in animal model. However, using CO in clinical transplantation is difficult due to its delivery in a controlled manner. A manganese-containing CORM-401 has recently been synthesized which can efficiently deliver 3 molar equivalents of CO. We report the ability of this anti-inflammatory CORM-401 to reduce ischemia reperfusion injury associated with prolonged cold storage of renal allografts obtained from donation after cardiac death in a porcine model of transplantation. Methods To stimulate DCD condition, kidneys from large male Landrace pig were retrieved after 1h warm ischemia in situ by cross-clamping the renal pedicle. Procured kidneys, after a brief flushing with HTK solution were subjected to pulsatile perfusion at 4°C with UW solution for 4h and both kidneys were treated with either 200μM CORM-401 or inactive CORM-401 (iCORM-401) respectively. Kidneys were then reperfused with normothermic isogeneic porcine blood through oxygenated pulsatile perfusion for 10h. Urine was collected, vascular flow was assessed during reperfusion and histopathology was assessed after 10h of reperfusion. Results We have found that CORM-401 administration reduced urinary protein excretion, attenuated kidney damage markers (KIM-1 and NGAL), and reduced ATN and TUNEL staining in histopathologic sections. CORM-401 also prevented intrarenal hemorrhage and vascular clotting during reperfusion. Mechanistically, CORM-401 appeared to exert anti-inflammatory actions by suppressing Toll-like receptors 2, 4 and 6. Conclusions CORM-401 provides renal protection following cold storage of kidneys and provides a novel clinically relevant ex vivo organ preservation strategy. Correspondence: Patrick P.W. Luke, London Health Sciences, 339 Windermere Road, London, Ontario, Canada N6A 5A5. Email: patrick.luke@lhsc.on.ca Authorship R.N.B. participated in the performance of the research, data analysis, construction of figures and article writing. M.R.M participated in kidney perfusion and preparation of perfusion circuit. A.H participated in data analysis and pathological evaluation of tissue sections. G.A. participated in surgical procedures. P.B participated in kidney perfusion and urine collection. R.M. participated in kidney perfusion and blood collection. I.A. participated in surgical procedures. K.P.S participated in surgical procedures. Q. S., H.A and L.J. participated in data analysis. M.S. participated in performing RT-PCR experiments of TLR data. E.P. participated in measuring CO from CORM-401. A.S. participated in article editing. G.C participated in technical support regarding CORM-401 release. A.M.J. participated in intellectual conception of project, article editing and approval of the article. P.P.L participated in the intellectual conception of project, extensive literature review, partial article writing, editing and final approval of the article. Conflicts of Interest. All the authors declared no competing interests. Funding We would like to thank the Canadian National Transplantation Research Program sponsored by Canadian Institutes for Health Research (PPL), Physicians Services Incorporated Foundation (PSIF) (PPL, RNB), Academic Medical Organization of Southwestern Ontario (PPL, RNB), HSFO grant (G-17-0018622) to GC and Internal Research Fund (RNB, PPL), Department of Surgery at LHSC for financial support. HTK and UW solutions were provided by Methapharm Inc. and Bridge to life respectively. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Changes in pediatric heart transplant hospitalization costs over time

Background Despite significant changes in the past decade for children undergoing heart-transplantation, including the evolution of mechanical circulatory support and increasing patient complexity, costs and resource utilization have not been reassessed. We sought to utilize a novel linkage of clinical-registry and administrative data to examine changes in hospitalization costs over time in this population. Methods We identified all pediatric heart transplant recipients in a unique linked PHIS/SRTR dataset (2002-2016). Hospital costs were estimated from charges using cost-to-charge ratios, inflated to 2016 dollars. Severity-adjusted costs were calculated using generalized linear mixed-effects models. Costs were compared across 3 eras (Era-1:2002-2006; Era-2:2007-2011; and Era-3:2012-2016). Results A total of 2896 pediatric heart transplant recipients were included; Era-1:649 (22.4%), Era-2:1028 (35.5%), and Era-3:1219 (42.1%). ECMO support at transplant decreased over time, concurrent with an increase in VAD-supported patients. Between Era-1 and Era-2 there was an increase in pretransplant hospitalization costs ($343,692 vs. $435,554; p

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Erratum

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High-level heteroplasmy for the m.7445A>G mitochondrial DNA mutation can cause progressive sensorineural hearing loss in infancy.

https:--linkinghub.elsevier.com-ihub-ima

High-level heteroplasmy for the m.7445A>G mitochondrial DNA mutation can cause progressive sensorineural hearing loss in infancy.

Int J Pediatr Otorhinolaryngol. 2018 May;108:125-131

Authors: Matsushima K, Nakano A, Arimoto Y, Mutai H, Yamazawa K, Murayama K, Matsunaga T

Abstract
OBJECTIVE: Hearing loss caused by mutation of mitochondrial DNA typically develops in late childhood or early adulthood, but rarely in infancy. We report the investigation of a patient to determine the cause of his early onset hearing loss.
MATERIALS AND METHODS: The proband was a boy aged 1 year and 2 months at presentation. Newborn hearing screening test by automated auditory brainstem response generated "pass" results for both ears. His reaction to sound deteriorated by 9 months. Average pure tone threshold at 0.5, 1, and 2 kHz was 55 dB by conditioned orientation response audiometry. His father had congenital hearing loss, and his mother had progressive hearing loss since childhood. Invader assays and Sanger sequencing were performed to investigate genetic causes of the hearing loss in the proband, and heteroplasmy was assessed by PCR-restriction fragment length polymorphism, Sanger sequencing, and pyrosequencing. Additionally, mitochondrial function was evaluated by measurement of the oxygen consumption rate of patient skin fibroblasts.
RESULTS: An m.7445A > G mitochondrial DNA mutation and a heterozygous c.235delC (p.L79Cfs*3) mutation of GJB2 were detected in the proband. His mother carried the m.7445A > G mitochondrial DNA mutation, and his father was a compound heterozygote for GJB2 mutations (c.[235delC]; [134G > A; 408C > A]). Tissue samples from both the proband and his mother exhibited a high degree of heteroplasmy. Fibroblasts from the proband exhibited markedly reduced oxygen consumption rates. These data indicate that the proband had impaired mitochondrial function, resulting in hearing loss.
CONCLUSION: This research demonstrates that hearing loss in a proband who presented in infancy and that of his mother resulted from a high level of heteroplasmy for the m.7445A > G mitochondrial DNA mutation, indicating that this alteration can cause hearing loss in infancy.

PMID: 29605341 [PubMed - indexed for MEDLINE]

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High-level heteroplasmy for the m.7445A>G mitochondrial DNA mutation can cause progressive sensorineural hearing loss in infancy.

High-level heteroplasmy for the m.7445A>G mitochondrial DNA mutation can cause progressive sensorineural hearing loss in infancy.

Int J Pediatr Otorhinolaryngol. 2018 May;108:125-131

Authors: Matsushima K, Nakano A, Arimoto Y, Mutai H, Yamazawa K, Murayama K, Matsunaga T

PMID: 29605341 [PubMed - indexed for MEDLINE]

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Isolated Traumatic Diastasis of the Clival Synchondroses without Clival Fracture.

Isolated Traumatic Diastasis of the Clival Synchondroses without Clival Fracture.

Pediatr Neurosurg. 2018 Apr 19;:

Authors: Faraji AH, Ochalski PG, Ozpinar A, Blatt JE, Pollack IF

Abstract
Traumatic clival fractures in the pediatric population are associated with high mortality rates. In our previously reported series, a subset of clival fractures were associated with traumatic diastasis of the surrounding clival synchondroses. Herein, we describe a pediatric case of an isolated traumatic diastasis of the clival synchondroses without clival fracture with significant injury to neurovascular structures. To our knowledge this is the first report to describe this entity. Careful radiological attention should be made towards the clival synchondroses in crushing head injuries to best tailor screening for cerebrovascular injury even in the absence of clival fractures.

PMID: 29672322 [PubMed - as supplied by publisher]

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Synoptic reporting of pituitary magnetic resonance imaging.

Synoptic reporting of pituitary magnetic resonance imaging.

ANZ J Surg. 2018 Apr 19;:

Authors: Dhillon RS, King JA, Goldschlager T, Wang YY

Abstract
BACKGROUND: Pituitary adenomas are common, often asymptomatic tumours that are diagnosed incidentally by magnetic resonance imaging (MRI) of the brain. There is considerable variation in the reporting of pituitary MRI, in part because there is no consensus as to what information should be included in such reports. Synoptic reporting consists of using structured checklists to standardize communication. It has been adopted in the surgical pathology literature and more recently in the breast imaging field. The purpose of this study was to assess what parameters of a pituitary MRI report were useful to surgeons and in doing so, to propose a synoptic reporting template.
METHODS: We used the Delphi technique to obtain group consensus between three neuroradiologists, three otolaryngologists and three anterior skull base neurosurgeons across three tertiary Melbourne hospitals. Answers from the three speciality groups were then converted into numerical scores for analysis.
RESULTS: There was statistically significant consensus between specialties over which characteristics were deemed most important. These were T1 pre- and post-contrast sequences in the coronal and sagittal planes, the degree of displacement of the optic chiasm, invasion of the medial wall of the cavernous sinus, the size and pneumatization pattern of the sphenoid sinus and the differential diagnosis of aneurysm. There were also significant differences between groups.
CONCLUSIONS: There are similarities and differences between what radiologists, otolaryngologists and neurosurgeons deem as important features when reporting pituitary MRI. A synoptic reporting system template is proposed to improve consistency in pituitary imaging reports.

PMID: 29671958 [PubMed - as supplied by publisher]

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A guide to identification and selection of axial planes in magnetic resonance imaging of the brain.

A guide to identification and selection of axial planes in magnetic resonance imaging of the brain.

Neuroradiol J. 2018 Jan 01;:1971400918769911

Authors: Otake S, Taoka T, Maeda M, Yuh WT

Abstract
For brain magnetic resonance (MR) examination, three-dimensional imaging is commonly performed. Radiologists need to know the appropriate imaging angle for viewing. We present six imaging angles for the axial images. Each angle is determined by the reference line. The landmarks on the midsagittal MR image to determine the angle of the reference lines are as follows: the supraorbito-meatal line (the center of the mammillary body and the fastigium of the fourth ventricle), the orbito-meatal (OM) line (the center of the mammillary body and the most posterior point of the cerebellar tentorium), the Talairach anterior commissure (AC)-posterior commissure (PC) line (the superior edge of the AC and the inferior edge of the PC), the Schaltenbrand AC-PC line (the center of the AC and the center of the PC), the subcallosal line (the inferior border of the genu and the inferior border of the splenium of the corpus callosum), Reid's baseline (the center of the pituitary gland and the most posterior point of the cerebellar tentorium) and the brainstem vertical line (the line perpendicular to the posterior border of the brainstem). The AC-PC line is most commonly used in MR examination. The OM line is most commonly used in computed tomography examination. The supraorbito-meatal line is recommended for avoiding irradiation to the orbit. In cases of multiple sclerosis, the subcallosal line is recommended in the guidelines. For lesions in the orbital cavity, paranasal cavity or skull base, Reid's baseline is useful. For cases of brainstem lesions, the brainstem vertical line is useful.

PMID: 29671688 [PubMed - as supplied by publisher]

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Neuroimaging of Meckel's cave in normal and disease conditions.

Neuroimaging of Meckel's cave in normal and disease conditions.

Insights Imaging. 2018 Apr 18;:

Authors: Malhotra A, Tu L, Kalra VB, Wu X, Mian A, Mangla R, Michaelides E, Sanelli P, Gandhi D

Abstract
Meckel's cave is a dural recess in the posteromedial portion of the middle cranial fossa that acts as a conduit for the trigeminal nerve between the prepontine cistern and the cavernous sinus, and houses the Gasserian ganglion and proximal rootlets of the trigeminal nerve. It serves as a major pathway in perineural spread of pathologies such as head and neck neoplasms, automatically upstaging tumours, and is a key structure to assess in cases of trigeminal neuralgia. The purpose of this pictorial review is threefold: (1) to review the normal anatomy of Meckel's cave; (2) to describe imaging findings that identify disease involving Meckel's cave; (3) to present case examples of trigeminal and non-trigeminal processes affecting Meckel's cave.
TEACHING POINTS: • Meckel's cave contains the trigeminal nerve ganglion and rootlets between the prepontine cistern and cavernous sinus. • Assessment is essential for perineural spread of disease and trigeminal neuralgia. • Key imaging: neural enhancement, enlargement, perineural fat/CSF effacement and skull base foraminal changes.

PMID: 29671218 [PubMed - as supplied by publisher]

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Betamethasone gel compared with lidocaine jelly to reduce tracheal tube related postoperative airway symptoms: a randomized controlled trial.

https:--s3-service-broker-live-ddda94b7-

https:--www.ncbi.nlm.nih.gov-corehtml-pm

Betamethasone gel compared with lidocaine jelly to reduce tracheal tube related postoperative airway symptoms: a randomized controlled trial.

BMC Res Notes. 2017 Aug 01;10(1):361

Authors: Thapa P, Shrestha RR, Shrestha S, Bajracharya GR

Abstract
BACKGROUND AND OBJECTIVES: Post-operative airway symptoms can be troublesome to patients following an uneventful general anesthesia with endotracheal intubation. In this study, we compared the effectiveness of lubricating an endotracheal tube with betamethasone gel or lidocaine jelly with using an unlubricated tube in reducing the incidence and severity of postoperative sore throat, hoarseness and cough.
METHODS: This was a prospective, randomized, single-blind comparative study carried out among 120 ASA I and II patients aged 18-65 years undergoing elective surgery under general anesthesia with endotracheal intubation. Patients were randomly divided into three groups of 40 patients each. Endotracheal tube used for patients in group C was unlubricated, while that for group B and group L were lubricated up to 15 cm mark with 2.5 ml of 0.05% betamethasone gel or 2% lidocaine jelly respectively. Incidence and severity of postoperative sore throat, hoarseness and cough were observed at 1, 6 and 24 h following extubation.
RESULTS: At 24 h following extubation, group B had the lowest incidence of postoperative sore throat among the three groups (group B: 12.5% vs group L: 37.5% vs group C: 25%; p = 0.036). Severity of postoperative sore throat at 24 h was less with betamethasone (score 0: 87.5%, 1: 10%) compared with lidocaine (score 0: 62.5%, 1: 37.5%) and control (score 0:75%, 1: 20%) (p = 0.006). Observations at other times and of other variables were comparable.
CONCLUSION: Wide spread application of 0.05% betamethasone gel to lubricate the endotracheal tube significantly reduces the incidence and severity of sore throat at 24 h of extubation but not of hoarseness or cough.

PMID: 28764777 [PubMed - indexed for MEDLINE]

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Survivin expression in head and neck squamous cell carcinomas is frequent and correlates with clinical parameters and treatment outcomes.

Survivin expression in head and neck squamous cell carcinomas is frequent and correlates with clinical parameters and treatment outcomes.

Clin Oral Investig. 2018 Apr 18;:

Authors: Münscher A, Prochnow S, Gulati A, Sauter G, Lörincz B, Blessmann M, Hanken H, Böttcher A, Clauditz TS

Abstract
OBJECTIVES: Strong expression of survivin is associated with worse survival in many different tumours, and in cell culture, a correlation between radiation resistance and survivin expression can be seen. The potential of survivin expression as a prognostic/predictive marker or therapeutic target has not been examined in head and neck squamous cell carcinomas (HNSCC) yet.
MATERIAL AND METHODS: Retrospective study of 452 tissue samples and clinical data from patients with squamous cell carcinomas of the larynx/hypopharynx (LSCC), oral cavity (OSCC) and oropharynx (OPSCC) treated in the University Medical Centre Hamburg-Eppendorf between 2002 and 2006. The expression patterns were detected by tissue microarray technique and correlated with clinical parameters (sex, age, tumour location, TNM 7th edition, grading, recurrence-free and overall survival).
RESULTS: 222 OSCC, 126 OPSCC and 105 LSCC tumours of 118 females and 335 males with a mean follow-up of 41.3 months were examined. Survivin expression correlates with pN, cM, pT and overall survival.
CONCLUSION AND CLINICAL RELEVANCE: The potential of survivin as a prognostic/predictive marker is very high. The findings have to be confirmed in a larger cohort of HNSCC esp. in those tumours treated primarily with radio/radiochemotherapy.

PMID: 29671054 [PubMed - as supplied by publisher]

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Αρχειοθήκη ιστολογίου

Παρασκευή 20 Απριλίου 2018

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Level of Evidence IV

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Level of Evidence IV

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