| Rising Production Scale Motivates Laryngeal Papillomatosis Treatment Market Growth in the Coming Years Latest Market Reports By Abhishek Budholiya (press release) (blog)Full coverage |
Authors: Shea C Abstract The eight articles in this special issue 'Learning to listen from sounds to words' were presented at the conference Sound to Word in Bilingual and Second Language Speech Perception held at the University of Iowa in spring 2016. The selected contributions focus on how second language speech perception interacts with orthography, how phonology interacts with speech perception and how listeners use the cues in the input to segment and create the word forms for lexical processing. This collection of papers expands the field of speech perception and production by granting a central role to the lexicon and exploring how listeners and speakers activate representations, from sounds to words. PMID: 30426865 [PubMed - in process] (Source: Language and Speech)
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Publication date: Available online 14 November 2018Source: Journal of Photochemistry and Photobiology B: BiologyAuthor(s): Zhongqing Hu, Yanghua Tang, Zhenshuang Yue, Wenjie Zheng, Zhenfei XiongAbstractOsteoblasts are an important key factor for the pathogenesis of several bone-related diseases, notably in osteoporosis. Osteoporosis is a disorder categorized based on the bone mineral density (BMD) and an alteration in the bone micro-architecture had been considered as the major determinant for increasing the fracture risk. The available medicine for curing the osteoporosis shows a minimal or no activity against the genesis or function of osteoblasts. The present study was conducted to determine the influence of phyto Angelica species (Ang.) mediated synthesized copper quantum dots decorate...
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Publication date: Available online 14 November 2018Source: Journal of PhoneticsAuthor(s): Michèle Pettinato, Outi Tuomainen, Sonia Granlund, Valerie Hazan (Source: Journal of Phonetics)
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Publication date: Available online 14 November 2018Source: Journal of Photochemistry and Photobiology B: BiologyAuthor(s): Estefanía Valencia-Vera, José Aguilera Arjona, Andrés Cobos, Jean-Luc Bernabó, Vidal Pérez-Valero, Enrique Herrera CeballosAbstractUV radiation has been consistently reported to cause folate photodegradation in vitro and in human skin. Seasonal variations in UV radiation might explain seasonal changes in folate levels in blood. Yet, few studies have addressed this phenomenon. The main objective of this study was to investigate whether a relationship exists between seasonal variations in serum folate levels in a population of Spain (Latitude: 36° 41′ 6.88″; Longitude: 4° 30′ 0.64″) and the annual variations of solar ultraviolet reached in the localization...
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CONCLUSIONS & IMPLICATIONS: This study confirms the efficacy of using smart tablets to improve naming in post-stroke aphasia. Although more studies are needed, the use of new technologies is unquestionably a promising approach to improve communication skills in people with aphasia, especially by targeting vocabulary that is relevant to them in their daily lives. PMID: 30426650 [PubMed - as supplied by publisher] (Source: International Journal of Language and Communication Disorders)
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| Rising Production Scale Motivates Laryngeal Papillomatosis Treatment Market Growth in the Coming Years Latest Market Reports By Abhishek Budholiya (press release) (blog)Full coverage |
Authors: Shea C Abstract The eight articles in this special issue 'Learning to listen from sounds to words' were presented at the conference Sound to Word in Bilingual and Second Language Speech Perception held at the University of Iowa in spring 2016. The selected contributions focus on how second language speech perception interacts with orthography, how phonology interacts with speech perception and how listeners use the cues in the input to segment and create the word forms for lexical processing. This collection of papers expands the field of speech perception and production by granting a central role to the lexicon and exploring how listeners and speakers activate representations, from sounds to words. PMID: 30426865 [PubMed - in process] (Source: Language and Speech)
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Publication date: Available online 14 November 2018Source: Journal of PhoneticsAuthor(s): Michèle Pettinato, Outi Tuomainen, Sonia Granlund, Valerie Hazan (Source: Journal of Phonetics)
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This article provides an overview of the interaction between immune infiltrating cells in the tumor microenvironment, and the immunologic principles related to HNSCC. Current i mmunotherapeutic strategies and emerging results from ongoing clinical trials are presented. (Source: Oral and Maxillofacial Surgery Clinics)
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We report 2 recent cases of patients suffering significant allergic reactions to ChloraPrepTM complicating routine foot and ankle surgery. We advise vigilance for this possible issue and recommend thorough removal of all preparation at the end of the procedure. (Source: Journal of Foot and Ankle Surgery)
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This article provides an overview of the interaction between immune infiltrating cells in the tumor microenvironment, and the immunologic principles related to HNSCC. Current i mmunotherapeutic strategies and emerging results from ongoing clinical trials are presented. (Source: Oral and Maxillofacial Surgery Clinics)
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We report 2 recent cases of patients suffering significant allergic reactions to ChloraPrepTM complicating routine foot and ankle surgery. We advise vigilance for this possible issue and recommend thorough removal of all preparation at the end of the procedure. (Source: Journal of Foot and Ankle Surgery)
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Authors: Shea C Abstract The eight articles in this special issue 'Learning to listen from sounds to words' were presented at the conference Sound to Word in Bilingual and Second Language Speech Perception held at the University of Iowa in spring 2016. The selected contributions focus on how second language speech perception interacts with orthography, how phonology interacts with speech perception and how listeners use the cues in the input to segment and create the word forms for lexical processing. This collection of papers expands the field of speech perception and production by granting a central role to the lexicon and exploring how listeners and speakers activate representations, from sounds to words. PMID: 30426865 [PubMed - in process] (Source: Language and Speech)
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ConclusionCD3/CD4 + T‐helper lymphocytes and the proinflammatory cytokine IL‐4 are associated with iLTS. The association of a TH2 immunophenotype with iLTS is consistent with findings in other fibroinflammatory disorders. The murine results reveal that the inflammatory infiltrate precedes the development of fibrosis. However, human iLTS specimens with well ‐developed fibrosis also contain a marked chronic inflammatory infiltrate, suggesting that the continued release of IL‐4 by T‐helper lymphocytes may continue to propagate iLTS.Level of EvidenceNA.Laryngoscope, 2018 (Source: The Laryngoscope)
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ConclusionsEnhanced mucosal contact appears critical in improving curcumin release and absorption. CXCL1 and TNF ‐α both represent potential biomarkers for the future study of curcumin chemoprevention.Level of Evidence2bLaryngoscope, 2018 (Source: The Laryngoscope)
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ConclusionIn patients with ENE and advanced nodal disease, T stage, N stage, stage group, depth, and pattern of invasion lose their impact on OS. In patients with ENE, nodal characteristics such as LND, the number of nodes with ENE, and grade of ENE serve as important prognosticators and aid in further risk stratification.Level of Evidence4.Laryngoscope, 2018 (Source: The Laryngoscope)
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The Laryngoscope, EarlyView. (Source: The Laryngoscope)
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ConclusionNeedle caliber, length, and bends impact steady ‐state forces and stiffness rates during vocal fold injection.Level of EvidenceNA.Laryngoscope, 2018 (Source: The Laryngoscope)
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Authors: Shea C Abstract The eight articles in this special issue 'Learning to listen from sounds to words' were presented at the conference Sound to Word in Bilingual and Second Language Speech Perception held at the University of Iowa in spring 2016. The selected contributions focus on how second language speech perception interacts with orthography, how phonology interacts with speech perception and how listeners use the cues in the input to segment and create the word forms for lexical processing. This collection of papers expands the field of speech perception and production by granting a central role to the lexicon and exploring how listeners and speakers activate representations, from sounds to words. PMID: 30426865 [PubMed - in process] (Source: Language and Speech)
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ConclusionCD3/CD4 + T‐helper lymphocytes and the proinflammatory cytokine IL‐4 are associated with iLTS. The association of a TH2 immunophenotype with iLTS is consistent with findings in other fibroinflammatory disorders. The murine results reveal that the inflammatory infiltrate precedes the development of fibrosis. However, human iLTS specimens with well ‐developed fibrosis also contain a marked chronic inflammatory infiltrate, suggesting that the continued release of IL‐4 by T‐helper lymphocytes may continue to propagate iLTS.Level of EvidenceNA.Laryngoscope, 2018 (Source: The Laryngoscope)
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ConclusionsEnhanced mucosal contact appears critical in improving curcumin release and absorption. CXCL1 and TNF ‐α both represent potential biomarkers for the future study of curcumin chemoprevention.Level of Evidence2bLaryngoscope, 2018 (Source: The Laryngoscope)
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ConclusionIn patients with ENE and advanced nodal disease, T stage, N stage, stage group, depth, and pattern of invasion lose their impact on OS. In patients with ENE, nodal characteristics such as LND, the number of nodes with ENE, and grade of ENE serve as important prognosticators and aid in further risk stratification.Level of Evidence4.Laryngoscope, 2018 (Source: The Laryngoscope)
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The Laryngoscope, EarlyView. (Source: The Laryngoscope)
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ConclusionNeedle caliber, length, and bends impact steady ‐state forces and stiffness rates during vocal fold injection.Level of EvidenceNA.Laryngoscope, 2018 (Source: The Laryngoscope)
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Nor Cal Food Solutions, LLC of Auburn, CA is announcing a recall of 567 cases of Pumpkin Pesto Tapenade, manufactured by Purveyors Kitchen, because it contains an undeclared tree nut (walnut). People who have an allergy or severe sensitivity to tree nuts (walnuts) run the risk of serious or life-threatening allergic reaction if they consume this product. (Source: FDA Food Alergies)
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Late cancellations within 24 hours of surgery lead to decreased utilization of operating room time with loss of productivity, decreased access to care, and inconvenience to patients and staff. To date, no studies have analyzed 24‐hour cancellations in a tertiary rhinology practice.
All procedures performed at a tertiary rhinology/skull base practice from January 2016 to December 2017 were reviewed. Twenty‐four‐hour cancellations were analyzed by procedure type and reason for cancellation. Avoidable cancellations were late cancellations that could have been prevented by review of medical records or communication by hospital staff with the patient before surgery. Univariate analysis was performed to determine predictive factors for cancellations.
A total of 39 of 640 surgical cases were cancelled (6.1%) within 24 hours of surgery. Of these, 69.2% were inflammatory and 30.8% were skull base cases. The mean number of operating room minutes lost was 151 (60 of 210) for inflammatory and 263 (102 of 480) for skull base cases. Avoidable cancellations were seen in 25 of 35 (71.4%) cases. Patients undergoing inpatient or skull base surgery were more likely to have medical cancellations than patients undergoing outpatient or inflammatory surgery (91.7% vs 43.5%, p = 0.01; 83.3% vs 47.8%, p = 0.07).
This is the first study to analyze 24‐hour cancellations in tertiary rhinology/skull base surgery. The results suggest that a majority of late cancellations are avoidable and that skull base and inpatient surgeries are more likely to be canceled for medical reasons. Further studies are required to better characterize surgical cancellations in rhinology and identify strategies to try to prevent them.
Staphylococcus aureus is a major contributor to the pathophysiology of chronic rhinosinusitis (CRS). Previous research has shown that S. aureus–secreted products disrupt the airway barrier.
S. aureus ATCC 13565 and 25923 strains were grown at exponential, postexponential, and stationary phases. Microbial conditioned media (CM) was collected from the cultures and ultrafiltered (UF). Liquid chromatography–electrospray ionization tandem mass spectrometry (LC‐ESI‐MS/MS) was performed on the UF‐CM. UF‐CM was subjected to heat and protease treatment, size fractionation, and ultracentrifugation (UC) separation. Human nasal epithelial cells grown at air‐liquid interface (HNEC‐ALI) cultures were exposed to purified alpha hemolysin (Hla), staphylococcal enterotoxin A (SEA), lipoteichoic acid (LTA), and UF‐CM. Barrier function outcomes were measured by transepithelial electrical resistance (TEER) and apparent permeability (Papp). UC fraction exposed cultures were subjected to immunofluorescence microscopy for tight junction (TJ) protein zonula occludens‐1 (ZO‐1).
LC‐ESI‐MS/MS identified 107 proteins, with Hla being most abundant. Hla, SEA, and LTA did not alter the HNEC‐ALI barrier as measured by TEER or Papp. Barrier disruption caused by UF‐CM peaked in the postexponential phase, was sensitive to heat and protease treatment, >30‐kDa in size, and enriched in the UC fraction. HNEC‐ALI exposed to UF‐CM and UC demonstrated loss of ZO‐1 localization.
These results suggest that the S. aureus factor responsible for TJ disruption in HNEC‐ALI cultures is either a protein‐macromolecule or a combination of secreted factors. The product is enriched in the UC fraction, suggesting it is associated with large structures such as membrane components or vesicles.
Obstructive sleep apnea is a common respiratory disorder that can have negative effects on health and quality of life. Positive pressure therapy (CPAP) is the primary treatment. There is a lack of consensus on the risk of postoperative CPAP after endoscopic sinus or skull base surgery. We present a proof‐of‐concept cadaver model for measuring sinonasal pressure delivered by CPAP.
Three fresh cadaver heads were prepared by removing the calvaria and brain. Sphenoidotomies were made and sellar bone was removed. Pressure sensors were placed in the midnasal cavity, sphenoid sinus, and sella. CPAP was applied and the delivered pressure was recorded at increasing levels of positive pressure. Paired t tests and intraclass correlation coefficients were used to analyze results.
Increases in positive pressure led to increased pressure recordings for all locations. Nasal cavity pressure was, on average, 81% of delivered CPAP. Pressure was highest in the sphenoid sinus. The effect of middle turbinate medialization on intrasphenoid pressure was not statistically significant in 2 heads. Intrasellar pressure was 80% of delivered CPAP with lateralized turbinates and 84% with medialized turbinates. Pressure recordings demonstrated excellent reliability for all locations. All heads developed non‒sellar‐based cranial base leaks at higher pressures. Cribriform region leaks were successfully sealed with DuraSeal®.
Our proof‐of‐concept cadaver model represents a novel approach to measure pressures delivered to the nasal cavity and anterior skull base by CPAP. With further study, it may have broader clinical application to guide the safe postoperative use of CPAP in this population.
Spontaneous cerebrospinal fluid (CSF) rhinorrhea has been associated with elevated intracranial pressure (ICP). As such, ICP reducing measures are commonly employed to optimize repair. Although postoperative acetazolamide use has been described, no data currently exists on the potential for preoperative use.
A retrospective review was performed including patients treated for anterior spontaneous CSF leaks by a single surgeon over a 6‐year period during which acetazolamide therapy (250 mg twice daily) was employed before considering surgical repair. The primary endpoint was whether the patient went on to require surgical repair.
A total of 16 patients were identified who were pretreated with acetazolamide. Leak sites were noted as cribriform (5/16), sphenoid (8/16), ethmoid (1/16), multiple (1/16), and indeterminate (1/16). Five patients had resolution of their rhinorrhea without surgery (31.3%). Mean follow‐up for these nonsurgical patients was 470 days (range, 64 to 857 days). There were no differences in the patients' age or site of leak between surgical and nonsurgical patients (p = 0.65, p = 0.52, respectively). Nonsurgical patients had a lower body mass index (BMI) than surgical patients (p = 0.04).
This is the first study to report the use of acetazolamide therapy as a primary treatment option for spontaneous CSF rhinorrhea. This therapy enabled surgery to be avoided in 31.3% of patients. This would indicate that in the absence of other contraindications for delaying repair, a trial of acetazolamide therapy could be considered as an initial option in the management of isolated spontaneous CSF rhinorrhea.
Bioabsorbable steroid‐releasing implants (mometasone furoate, 370 μg) are effective for improving postsurgical outcomes in the frontal sinus ostia (FSO). In this study we evaluated the effect of these implants on frontal outcomes in various patient subgroups with chronic rhinosinusitis (CRS) using pooled data from 2 randomized, controlled trials (RCTs).
A total of 160 subjects were enrolled in 2 RCTs. After surgery, subjects were randomized to receive an implant in 1 FSO with the contralateral side as control. Data through day 90 from the 2 studies were pooled and subgroup analyses were performed.
At day 30, relative to controls, steroid‐releasing implants significantly reduced the need for postoperative interventions by 46.8% (95% confidence interval [CI], −60.7 to −27.9), for surgical interventions by 51.2% (95% CI, −68.2 to −25.2), and for oral steroid interventions by 37.2% (95% CI, −54.6 to −13.1) in the pooled data set. At day 90, statistically significant reductions (p < 0.05) in the need for postoperative interventions (relative reduction [RR], 30.2%), restenosis/occlusion rate (RR, 31.7%), and inflammation score (absolute difference, −6.0), and increase in estimated FSO diameter (absolute difference, 1 mm), favoring the treated side, were observed. Subgroup analyses of the pooled data showed statistically significant improvements (p < 0.05) at day 90 in restenosis/occlusion rate, and estimated FSO diameter, favoring the treated side across subgroups, with no statistically significant subgroup‐by‐treatment interactions.
Bioabsorbable steroid‐releasing sinus implants improve outcomes of frontal sinus surgery through 90 days, irrespective of asthma status, previous endoscopic sinus surgery, extent of surgery, extent of polyps, or Lund‐Mackay computed tomography stage in the FSO.
Nor Cal Food Solutions, LLC of Auburn, CA is announcing a recall of 567 cases of Pumpkin Pesto Tapenade, manufactured by Purveyors Kitchen, because it contains an undeclared tree nut (walnut). People who have an allergy or severe sensitivity to tree nuts (walnuts) run the risk of serious or life-threatening allergic reaction if they consume this product. (Source: FDA Food Alergies)
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Late cancellations within 24 hours of surgery lead to decreased utilization of operating room time with loss of productivity, decreased access to care, and inconvenience to patients and staff. To date, no studies have analyzed 24‐hour cancellations in a tertiary rhinology practice.
All procedures performed at a tertiary rhinology/skull base practice from January 2016 to December 2017 were reviewed. Twenty‐four‐hour cancellations were analyzed by procedure type and reason for cancellation. Avoidable cancellations were late cancellations that could have been prevented by review of medical records or communication by hospital staff with the patient before surgery. Univariate analysis was performed to determine predictive factors for cancellations.
A total of 39 of 640 surgical cases were cancelled (6.1%) within 24 hours of surgery. Of these, 69.2% were inflammatory and 30.8% were skull base cases. The mean number of operating room minutes lost was 151 (60 of 210) for inflammatory and 263 (102 of 480) for skull base cases. Avoidable cancellations were seen in 25 of 35 (71.4%) cases. Patients undergoing inpatient or skull base surgery were more likely to have medical cancellations than patients undergoing outpatient or inflammatory surgery (91.7% vs 43.5%, p = 0.01; 83.3% vs 47.8%, p = 0.07).
This is the first study to analyze 24‐hour cancellations in tertiary rhinology/skull base surgery. The results suggest that a majority of late cancellations are avoidable and that skull base and inpatient surgeries are more likely to be canceled for medical reasons. Further studies are required to better characterize surgical cancellations in rhinology and identify strategies to try to prevent them.
Staphylococcus aureus is a major contributor to the pathophysiology of chronic rhinosinusitis (CRS). Previous research has shown that S. aureus–secreted products disrupt the airway barrier.
S. aureus ATCC 13565 and 25923 strains were grown at exponential, postexponential, and stationary phases. Microbial conditioned media (CM) was collected from the cultures and ultrafiltered (UF). Liquid chromatography–electrospray ionization tandem mass spectrometry (LC‐ESI‐MS/MS) was performed on the UF‐CM. UF‐CM was subjected to heat and protease treatment, size fractionation, and ultracentrifugation (UC) separation. Human nasal epithelial cells grown at air‐liquid interface (HNEC‐ALI) cultures were exposed to purified alpha hemolysin (Hla), staphylococcal enterotoxin A (SEA), lipoteichoic acid (LTA), and UF‐CM. Barrier function outcomes were measured by transepithelial electrical resistance (TEER) and apparent permeability (Papp). UC fraction exposed cultures were subjected to immunofluorescence microscopy for tight junction (TJ) protein zonula occludens‐1 (ZO‐1).
LC‐ESI‐MS/MS identified 107 proteins, with Hla being most abundant. Hla, SEA, and LTA did not alter the HNEC‐ALI barrier as measured by TEER or Papp. Barrier disruption caused by UF‐CM peaked in the postexponential phase, was sensitive to heat and protease treatment, >30‐kDa in size, and enriched in the UC fraction. HNEC‐ALI exposed to UF‐CM and UC demonstrated loss of ZO‐1 localization.
These results suggest that the S. aureus factor responsible for TJ disruption in HNEC‐ALI cultures is either a protein‐macromolecule or a combination of secreted factors. The product is enriched in the UC fraction, suggesting it is associated with large structures such as membrane components or vesicles.
Obstructive sleep apnea is a common respiratory disorder that can have negative effects on health and quality of life. Positive pressure therapy (CPAP) is the primary treatment. There is a lack of consensus on the risk of postoperative CPAP after endoscopic sinus or skull base surgery. We present a proof‐of‐concept cadaver model for measuring sinonasal pressure delivered by CPAP.
Three fresh cadaver heads were prepared by removing the calvaria and brain. Sphenoidotomies were made and sellar bone was removed. Pressure sensors were placed in the midnasal cavity, sphenoid sinus, and sella. CPAP was applied and the delivered pressure was recorded at increasing levels of positive pressure. Paired t tests and intraclass correlation coefficients were used to analyze results.
Increases in positive pressure led to increased pressure recordings for all locations. Nasal cavity pressure was, on average, 81% of delivered CPAP. Pressure was highest in the sphenoid sinus. The effect of middle turbinate medialization on intrasphenoid pressure was not statistically significant in 2 heads. Intrasellar pressure was 80% of delivered CPAP with lateralized turbinates and 84% with medialized turbinates. Pressure recordings demonstrated excellent reliability for all locations. All heads developed non‒sellar‐based cranial base leaks at higher pressures. Cribriform region leaks were successfully sealed with DuraSeal®.
Our proof‐of‐concept cadaver model represents a novel approach to measure pressures delivered to the nasal cavity and anterior skull base by CPAP. With further study, it may have broader clinical application to guide the safe postoperative use of CPAP in this population.
Spontaneous cerebrospinal fluid (CSF) rhinorrhea has been associated with elevated intracranial pressure (ICP). As such, ICP reducing measures are commonly employed to optimize repair. Although postoperative acetazolamide use has been described, no data currently exists on the potential for preoperative use.
A retrospective review was performed including patients treated for anterior spontaneous CSF leaks by a single surgeon over a 6‐year period during which acetazolamide therapy (250 mg twice daily) was employed before considering surgical repair. The primary endpoint was whether the patient went on to require surgical repair.
A total of 16 patients were identified who were pretreated with acetazolamide. Leak sites were noted as cribriform (5/16), sphenoid (8/16), ethmoid (1/16), multiple (1/16), and indeterminate (1/16). Five patients had resolution of their rhinorrhea without surgery (31.3%). Mean follow‐up for these nonsurgical patients was 470 days (range, 64 to 857 days). There were no differences in the patients' age or site of leak between surgical and nonsurgical patients (p = 0.65, p = 0.52, respectively). Nonsurgical patients had a lower body mass index (BMI) than surgical patients (p = 0.04).
This is the first study to report the use of acetazolamide therapy as a primary treatment option for spontaneous CSF rhinorrhea. This therapy enabled surgery to be avoided in 31.3% of patients. This would indicate that in the absence of other contraindications for delaying repair, a trial of acetazolamide therapy could be considered as an initial option in the management of isolated spontaneous CSF rhinorrhea.
Bioabsorbable steroid‐releasing implants (mometasone furoate, 370 μg) are effective for improving postsurgical outcomes in the frontal sinus ostia (FSO). In this study we evaluated the effect of these implants on frontal outcomes in various patient subgroups with chronic rhinosinusitis (CRS) using pooled data from 2 randomized, controlled trials (RCTs).
A total of 160 subjects were enrolled in 2 RCTs. After surgery, subjects were randomized to receive an implant in 1 FSO with the contralateral side as control. Data through day 90 from the 2 studies were pooled and subgroup analyses were performed.
At day 30, relative to controls, steroid‐releasing implants significantly reduced the need for postoperative interventions by 46.8% (95% confidence interval [CI], −60.7 to −27.9), for surgical interventions by 51.2% (95% CI, −68.2 to −25.2), and for oral steroid interventions by 37.2% (95% CI, −54.6 to −13.1) in the pooled data set. At day 90, statistically significant reductions (p < 0.05) in the need for postoperative interventions (relative reduction [RR], 30.2%), restenosis/occlusion rate (RR, 31.7%), and inflammation score (absolute difference, −6.0), and increase in estimated FSO diameter (absolute difference, 1 mm), favoring the treated side, were observed. Subgroup analyses of the pooled data showed statistically significant improvements (p < 0.05) at day 90 in restenosis/occlusion rate, and estimated FSO diameter, favoring the treated side across subgroups, with no statistically significant subgroup‐by‐treatment interactions.
Bioabsorbable steroid‐releasing sinus implants improve outcomes of frontal sinus surgery through 90 days, irrespective of asthma status, previous endoscopic sinus surgery, extent of surgery, extent of polyps, or Lund‐Mackay computed tomography stage in the FSO.
Tomas Jelinek, Bruno Paiva, Roman Hajek (Source: Frontiers in Immunology)
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Shigeo Hanada, Mina Pirzadeh, Kyle Y. Carver, Jane C. Deng (Source: Frontiers in Immunology)
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Seema R. Patel, David R. Gibb, Kathryn Girard-Pierce, Xiaoxi Zhou, Lilian Cataldi Rodrigues, Connie M. Arthur, Ashley L. Bennett, Ryan P. Jajosky, Megan Fuller, Cheryl L. Maier, Patricia E. Zerra, Satheesh Chonat, Nicole H. Smith, Christopher A. Tormey, Jeanne E. Hendrickson, Sean R. Stowell (Source: Frontiers in Immunology)
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ConclusionsThis study revealed that CU is a heterogeneous condition with differences in healthcare utilization and outcomes between EU and C/SA. However, overall there is a high unmet need of H1-antihistamine-refractory CU patients, which is associated with high use of healthcare resources, and has a large negative effect on QoL and work productivity. (Source: World Allergy Organization Journal)
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Identifying pathways linking neuroinflammation and neurodegeneration is essential to help prevent disability progression in people with multiple sclerosis (MS). Endothelin-1 (ET-1) is a potent vasoconstrictor thought to contribute to cerebral hypoperfusion and tissue damage in MS. Its link with the neuroinflammatory process remains poorly investigated. (Source: Journal of Neuroimmunology)
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This article is protected by copyright. All rights reserved (Source: European Journal of Immunology)
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ConclusionBioabsorbable steroid ‐releasing sinus implants improve outcomes of frontal sinus surgery through 90 days, irrespective of asthma status, previous endoscopic sinus surgery, extent of surgery, extent of polyps, or Lund‐Mackay computed tomography stage in the FSO. (Source: International Forum of Allergy and Rhinology)
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ConclusionThis is the first study to report the use of acetazolamide therapy as a primary treatment option for spontaneous CSF rhinorrhea. This therapy enabled surgery to be avoided in 31.3% of patients. This would indicate that in the absence of other contraindications for delaying repair, a trial of acetazolamide therapy could be considered as an initial option in the management of isolated spontaneous CSF rhinorrhea. (Source: International Forum of Allergy and Rhinology)
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ConclusionThese results suggest that theS. aureus factor responsible for TJ disruption in HNEC ‐ALI cultures is either a protein‐macromolecule or a combination of secreted factors. The product is enriched in the UC fraction, suggesting it is associated with large structures such as membrane components or vesicles. (Source: International Forum of Allergy and Rhinology)
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Our aim was to quantify circulating B cell subsets; immature/transitional, na ïve, CD27− and CD27+ memory cells and plasmablasts, in relapsing-remitting multiple sclerosis patients treated with IFN-β. The most relevant findings were a significant increase of plasmablasts and a decrease of immature/transitional B cells, resulting in a decreased ratio between those cells in relapse RRMS, together with an increase of CD27− and CD27+IgM+ memory B cell subsets in both phases of the disease. These alterations point to an active B cell response, particularly in relapse, and the above referred ratio could constitute a good biomarker of relapse in patients that underwent I FN-β treatment. (Source: Journal of Neuroimmunology)
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CONCLUSION: Penicillin-allergic patients treated with clindamycin presented almost four times the risk of suffering dental implant failure, although other variables such as implant brand, location, and the surgeon's skill might have influenced these results. PMID: 30427972 [PubMed - in process] (Source: International Journal of Oral and Maxillofacial Implants)
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Tomas Jelinek, Bruno Paiva, Roman Hajek (Source: Frontiers in Immunology)
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Kelen Cristina Ribeiro Malmegrim, Jo ão Rodrigues Lima-Júnior, Lucas Coelho Marlière Arruda, Júlia Teixeira Cottas de Azevedo, Gislane Lelis Vilela de Oliveira, Maria Carolina Oliveira (Source: Frontiers in Immunology)
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Abdulla Watad, Charlie Bridgewood, Tobias Russell, Helena Marzo-Ortega, Richard Cuthbert, Dennis McGonagle (Source: Frontiers in Immunology)
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Shigeo Hanada, Mina Pirzadeh, Kyle Y. Carver, Jane C. Deng (Source: Frontiers in Immunology)
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ConclusionsThis study revealed that CU is a heterogeneous condition with differences in healthcare utilization and outcomes between EU and C/SA. However, overall there is a high unmet need of H1-antihistamine-refractory CU patients, which is associated with high use of healthcare resources, and has a large negative effect on QoL and work productivity. (Source: World Allergy Organization Journal)
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Identifying pathways linking neuroinflammation and neurodegeneration is essential to help prevent disability progression in people with multiple sclerosis (MS). Endothelin-1 (ET-1) is a potent vasoconstrictor thought to contribute to cerebral hypoperfusion and tissue damage in MS. Its link with the neuroinflammatory process remains poorly investigated. (Source: Journal of Neuroimmunology)
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Specific subcutaneous immunotherapy (SCIT) can achieve long-term remission in patients with allergic rhinitis (AR) through complex and still unknown mechanisms. The aim of this study is to evaluate the effect ... (Source: Allergy, Asthma and Clinical Immunology)
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ConclusionBioabsorbable steroid ‐releasing sinus implants improve outcomes of frontal sinus surgery through 90 days, irrespective of asthma status, previous endoscopic sinus surgery, extent of surgery, extent of polyps, or Lund‐Mackay computed tomography stage in the FSO. (Source: International Forum of Allergy and Rhinology)
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ConclusionThis is the first study to report the use of acetazolamide therapy as a primary treatment option for spontaneous CSF rhinorrhea. This therapy enabled surgery to be avoided in 31.3% of patients. This would indicate that in the absence of other contraindications for delaying repair, a trial of acetazolamide therapy could be considered as an initial option in the management of isolated spontaneous CSF rhinorrhea. (Source: International Forum of Allergy and Rhinology)
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As adults, women have higher rates of asthma and allergic disease as well as increased asthma severity compared to men.1 Pre or peri-menstrual worsening of asthma symptoms (PMA) were reported in 17% of women enrolled in the severe asthma research program, with 52% of these women with PMA having severe asthma.2, 3 Further, use of birth control medications or hormone replacement therapy during peri or post-menopause was also linked to worsening of asthma in some women.2, 4 Mouse models of asthma showed estrogen signaling through estrogen receptor-alpha (ER- α), and not ER-β, increased allergic airway inflammation, mucus production, and/or airway hyperresponsiveness. (Source: Annals of Allergy, Asthma and Immunology)
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ConclusionOur proof ‐of‐concept cadaver model represents a novel approach to measure pressures delivered to the nasal cavity and anterior skull base by CPAP. With further study, it may have broader clinical application to guide the safe postoperative use of CPAP in this population. (Source: International Forum of Allergy and Rhinology)
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This review explores the current status of diagnosis and differential diagnosis, radiographic findings, and diverse antigens causing hypersensitivity pneumonitis with presentation of the complicated immunologic processes and treatment involved. (Source: Journal of Allergy and Clinical Immunology)
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ConclusionThis is the first study to analyze 24 ‐hour cancellations in tertiary rhinology/skull base surgery. The results suggest that a majority of late cancellations are avoidable and that skull base and inpatient surgeries are more likely to be canceled for medical reasons. Further studies are required to better characterize surgical cancell ations in rhinology and identify strategies to try to prevent them. (Source: International Forum of Allergy and Rhinology)
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Our aim was to quantify circulating B cell subsets; immature/transitional, na ïve, CD27− and CD27+ memory cells and plasmablasts, in relapsing-remitting multiple sclerosis patients treated with IFN-β. The most relevant findings were a significant increase of plasmablasts and a decrease of immature/transitional B cells, resulting in a decreased ratio between those cells in relapse RRMS, together with an increase of CD27− and CD27+IgM+ memory B cell subsets in both phases of the disease. These alterations point to an active B cell response, particularly in relapse, and the above referred ratio could constitute a good biomarker of relapse in patients that underwent I FN-β treatment. (Source: Journal of Neuroimmunology)
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Mycosis fungoides (MF) is a primary cutaneous lymphoma, characterized by a clonal proliferation of T cell helper memory cells in the skin [1]. Various benign conditions, such as chronic inflammatory dermatoses, may mimic MF, either clinically or histologically. Distinguishing MF from dermatologic conditions mimicking MF may be challenging. Clinicopathological correlation is fundamental to support the diagnosis, which is essential to ensure proper treatment and to provide an accurate prognosis [2].
This article is protected by copyright. All rights reserved.
Neutrophilic figurate erythema of infancy (NFEI) is a rare variant of annular erythema of infancy. It is characterized by annular erythematous plaques, occasionally with a polycyclic configuration. The main challenge is to differentiate this rare entity from other figurate erythemas associated with serious diseases such as neonatal lupus erythematosus. We present the case of a 9‐month‐old female admitted with a skin rash of unclear etiology. The rash started on her face at the age of 3 months and gradually spread to her extremities. She had no constitutional symptoms, and her health and development were otherwise unremarkable since birth. This persistent skin eruption consisted of many ill‐defined erythematous papules and annular plaques. Histologic examination revealed perivascular neutrophils and eosinophils with abundant nuclear dust without signs of vasculitis. NFEI is a diagnostic enigma both clinically and histologically. Absence of an underlying cause, dermal neutrophilic infiltrate with leukocytoclasis, and lack of vascular damage are the keys to diagnosis.
This article is protected by copyright. All rights reserved.
Techniques for the accurate identification of activating mutations of BRAF in metastatic melanoma are of great clinical importance, due to the availability of targeted therapies for these tumours. There is uncertainty regarding the frequency with which BRAF status differs between primary and metastatic sites.
Between 2011 and 2016, 219 melanoma cases underwent BRAF testing in our institution. In 53 of these, paired primary and metastatic specimens were available for PCR and immunohistochemical evaluation.
52 out of 53 cases (98%) showed concordant BRAF status between primary and metastatic site by IHC. In one case, a metastasis and its matched primary were positive by IHC but the metastasis was negative on PCR. On further investigation, PCR was positive in the primary and repeat PCR in the metastasis was positive, following macrodissection.
Our results suggest that discordance of BRAF mutational status between primaries and metastases is a rare occurrence. In one case, immunohistochemistry provided strong evidence that initial PCR testing had provided a false negative result due to low tumour volume. Thus, in cases where tissue is is difficult to obtain from a metastasis or unavailble, the primary tumour can be used with confidence.
This article is protected by copyright. All rights reserved.
Pleomorphic adenoma is the most common benign salivary gland neoplasm in children. Recurrence and malignant transformation are concerns necessitating proper treatment.
The goal of this research was to discuss the presentation, evaluation, and management of pediatric pleomorphic adenoma of the head and neck.
Retrospective chart review of patients under 20 years of age treated for pleomorphic adenoma of the head and neck between 1998 and 2017. Data assessed included demographics, clinical presentation, imaging, treatment, complications, recurrence, and follow‐up.
Forty‐one patients with pleomorphic adenoma were identified. Major salivary gland lesions were most common (n = 32, 78.0%); 78.1% (25 of 32) arising in the parotid and 21.9% (7 of 32) in the submandibular glands. Minor salivary gland lesions were removed from the palate (5 of 9, 55.6%), buccal mucosa (2 of 9, 22.2%), parapharyngeal space (1 of 9, 11.1%), and upper lip (1 of 9, 11.1%). Preoperative imaging was reviewed in 32 patients and consisted of nine ultrasound exams, 15 computerized tomography (CT) exams, and 23 magnetic resonance imaging (MRI) exams. Multimodality imaging was performed in 14 of 32 patients. Surgical excision was performed in all patients. Postoperative complications included transient facial paresis (n = 9), Frey syndrome (n = 1), and bacterial pharyngitis (n = 1). Average length of follow‐up was 25.5 months; confirmed recurrence occurred in two patients (4.9%).
Evaluation of pleomorphic adenoma in children should include preoperative imaging. The goal of surgery should be complete surgical excision with negative margins. Rate of recurrence is low; however, prolonged monitoring is recommended.
4. Laryngoscope, 2018
Mycosis fungoides (MF) is a primary cutaneous lymphoma, characterized by a clonal proliferation of T cell helper memory cells in the skin [1]. Various benign conditions, such as chronic inflammatory dermatoses, may mimic MF, either clinically or histologically. Distinguishing MF from dermatologic conditions mimicking MF may be challenging. Clinicopathological correlation is fundamental to support the diagnosis, which is essential to ensure proper treatment and to provide an accurate prognosis [2].
This article is protected by copyright. All rights reserved.
Neutrophilic figurate erythema of infancy (NFEI) is a rare variant of annular erythema of infancy. It is characterized by annular erythematous plaques, occasionally with a polycyclic configuration. The main challenge is to differentiate this rare entity from other figurate erythemas associated with serious diseases such as neonatal lupus erythematosus. We present the case of a 9‐month‐old female admitted with a skin rash of unclear etiology. The rash started on her face at the age of 3 months and gradually spread to her extremities. She had no constitutional symptoms, and her health and development were otherwise unremarkable since birth. This persistent skin eruption consisted of many ill‐defined erythematous papules and annular plaques. Histologic examination revealed perivascular neutrophils and eosinophils with abundant nuclear dust without signs of vasculitis. NFEI is a diagnostic enigma both clinically and histologically. Absence of an underlying cause, dermal neutrophilic infiltrate with leukocytoclasis, and lack of vascular damage are the keys to diagnosis.
This article is protected by copyright. All rights reserved.
Techniques for the accurate identification of activating mutations of BRAF in metastatic melanoma are of great clinical importance, due to the availability of targeted therapies for these tumours. There is uncertainty regarding the frequency with which BRAF status differs between primary and metastatic sites.
Between 2011 and 2016, 219 melanoma cases underwent BRAF testing in our institution. In 53 of these, paired primary and metastatic specimens were available for PCR and immunohistochemical evaluation.
52 out of 53 cases (98%) showed concordant BRAF status between primary and metastatic site by IHC. In one case, a metastasis and its matched primary were positive by IHC but the metastasis was negative on PCR. On further investigation, PCR was positive in the primary and repeat PCR in the metastasis was positive, following macrodissection.
Our results suggest that discordance of BRAF mutational status between primaries and metastases is a rare occurrence. In one case, immunohistochemistry provided strong evidence that initial PCR testing had provided a false negative result due to low tumour volume. Thus, in cases where tissue is is difficult to obtain from a metastasis or unavailble, the primary tumour can be used with confidence.
This article is protected by copyright. All rights reserved.
Pleomorphic adenoma is the most common benign salivary gland neoplasm in children. Recurrence and malignant transformation are concerns necessitating proper treatment.
The goal of this research was to discuss the presentation, evaluation, and management of pediatric pleomorphic adenoma of the head and neck.
Retrospective chart review of patients under 20 years of age treated for pleomorphic adenoma of the head and neck between 1998 and 2017. Data assessed included demographics, clinical presentation, imaging, treatment, complications, recurrence, and follow‐up.
Forty‐one patients with pleomorphic adenoma were identified. Major salivary gland lesions were most common (n = 32, 78.0%); 78.1% (25 of 32) arising in the parotid and 21.9% (7 of 32) in the submandibular glands. Minor salivary gland lesions were removed from the palate (5 of 9, 55.6%), buccal mucosa (2 of 9, 22.2%), parapharyngeal space (1 of 9, 11.1%), and upper lip (1 of 9, 11.1%). Preoperative imaging was reviewed in 32 patients and consisted of nine ultrasound exams, 15 computerized tomography (CT) exams, and 23 magnetic resonance imaging (MRI) exams. Multimodality imaging was performed in 14 of 32 patients. Surgical excision was performed in all patients. Postoperative complications included transient facial paresis (n = 9), Frey syndrome (n = 1), and bacterial pharyngitis (n = 1). Average length of follow‐up was 25.5 months; confirmed recurrence occurred in two patients (4.9%).
Evaluation of pleomorphic adenoma in children should include preoperative imaging. The goal of surgery should be complete surgical excision with negative margins. Rate of recurrence is low; however, prolonged monitoring is recommended.
4. Laryngoscope, 2018
To compare presenting characteristics of patients with adductor spasmodic dysphonia (ADSD), ADSD with laryngeal tremor (ADSD + LT), and laryngeal tremor without ADSD (LT).
Cross‐sectional analysis.
Patients treated for laryngeal movement disorders (1990–2016) were included. Analysis of variance and chi square tests measured differences in patient characteristics across the three disease groups. Using ADSD as the referent, multivariable logistic regression models were used to determine whether potential risk factors including patient demographics, family history, presence of potential inciting events prior to disease onset, and coprevalent movement disorders were associated with ADSD + LT or LT.
In all, 652 patients with ADSD (n = 377), ADSD + LT (n = 98), and LT (n = 177) were included. ADSD patients were significantly younger than those with ADSD + LT and LT (52.5 ± 13.4, 63.9 ± 11.3, and 69.3 ± 10.5 years, respectively; P < 0.001). Coprevalent movement disorders were more common in ADSD + LT (38.7%) and LT (57.1%) groups than in the ADSD group (11.5%; P < 0.001). Compared to ADSD, patients with ADSD + LT and LT were more likely to develop an additional movement disorder during follow‐up. In multivariable analyses, increasing age, female gender, and having a movement disorder at presentation were associated with significantly greater odds of having ADSD + LT or LT when compared to ADSD.
ADSD + LT patients demonstrate intermediate gender composition and age distributions between those with ADSD and LT. These findings suggest that ADSD + LT may be a distinct phenotype in the spectrum of laryngeal movement disorders.
4. Laryngoscope, 2018
To evaluate prospectively the clinical and radiographic outcomes after ten years of short (6 mm) implants with a moderately rough surface supporting single crowns in the posterior region.
Forty 6 mm modified sandblasted large‐grit acid‐etched (mod‐SLA), soft tissue level implants were installed in the distal segments of 35 consecutive patients. After 6 weeks of healing, abutments were tightened, and single porcelain fused‐to‐metal crowns were cemented. Implant survival, marginal bone loss and clinical crown/implant ratio were evaluated at various time intervals up to 10 years after loading.
Two out of the 40 implants were lost before loading, one implant was lost after 7 years because of peri‐implantitis. One patient with two implants died and was excluded from analysis. Two patients did not come at the 10‐year follow‐up and were considered as drop out (2 implants). The survival rate was 91.7% (n=36). Thirty‐three implants were available for marginal bone loss evaluation. A mean marginal bone loss after 10 years of function was 0.8±0.7mm. Between 5 and 10 years the loss was 0.2±0.4 mm. No technical complications were registered during the 10‐year period. The clinical crown/implant ratio increased with time from 1.6 at the delivery of the prosthesis to 2.0 after 10 years of loading with no increase between 5 and 10 years.
Short (6mm) implants with a moderately rough surface supporting single crowns in the posterior region and loaded after 6‐7 weeks maintained full function for at least 10 years with low marginal bone resorption.
This article is protected by copyright. All rights reserved.
Dental anxiety causes patients to refuse or delay treatment, which may exacerbate oral diseases. The aim of the current randomized controlled trial was to determine whether progressive muscle relaxation therapy could relieve dental anxiety. The trial included 68 periodontal patients with dental anxiety scores of ≥13 who were randomly assigned to either an intervention group or a control group (n = 34 per group). The intervention group was administered progressive muscle relaxation therapy for 20 min and oral health education for 15 min before periodontal treatment once per week for 4 wk. The control group was provided with oral health education only, for the same duration. Changes in dental anxiety, depression symptoms, blood pressure, heart rate, and salivary cortisol were evaluated 4 wk and 3 months after the intervention. The intervention group exhibited statistically significantly greater reductions in dental anxiety scores than did the control group at the 4‐wk (−3.82 vs. −0.89) and 3‐month (−4.22 vs. −0.28) assessments. They also exhibited significantly greater reductions in depression symptoms, systolic and diastolic blood pressure, pulse rate, and salivary cortisol levels at both time‐points. Progressive muscle relaxation therapy relieves tension and anxiety in dental patients.
As national healthcare spending has spiraled out of control, payment reform that moves from volume to value‐based payment has been introduced as a practical solution. Under alternative value‐based payment models, physicians and clinical teams must deliver the best care possible at a lower cost. Medical imaging has changed the way we diagnose disease, evaluate severity, assess treatment effects, and provide biological insights for the pathophysiology of many diseases. Over the past 50 years, imaging techniques have become increasingly advanced—from X‐ray to computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and multi‐modal imaging. Advanced imaging such as MRI has given clinicians remarkable insights into medical conditions and saved innumerable lives. Under the value proposition, however, we must ask if each imaging study changes treatment decisions, improves patient outcomes, and is cost‐effective. Imaging research has been focused on developing new technologies and clinical applications to assess diagnostic accuracy. What is needed is the higher‐level technology assessment. In this article we review why we need to demonstrate the value of MRI, how we define value, what strategies can enhance MR value through partnership with various stakeholders, and how imaging scientists can contribute to healthcare delivery in the future.
Level of Evidence: 5
Technical Efficacy: Stage 3
J. Magn. Reson. Imaging 2018.
Overtreatment of prostate cancer (PCa) is a healthcare issue. Development of noninvasive imaging tools for improved characterization of prostate lesions might reduce overtreatment.
To measure the distribution of tissue sodium concentration (TSC), proton T2‐weighted signal, and apparent diffusion coefficient (ADC) values in human PCa and to test the presence of a correlation between regional differences in imaging metrics and the Gleason grade of lesions determined from histopathology.
Cross‐sectional.
Ten men with biopsy‐proven PCa.
Sodium, proton T2‐weighted, and diffusion‐weighted MRI data were acquired using Broad‐Band 3D‐Fast‐Gradient‐Recalled, 3D Cube (Isotropic 3D‐Fast‐Turbo‐Spin‐Echo acquisition) and 2D Spin‐Echo sequences, respectively, with a 3.0T MR scanner.
All imaging data were coregistered to Gleason‐graded postprostatectomy histology, as the standard for prostate cancer lesion characterization. Regional TSC and T2 data were assessed using percent changes from healthy tissue of the same patient (denoted ΔTSC, ΔT2).
Differences in ΔTSC, ADC, and ΔT2 as a function of Gleason score were analyzed for each imaging contrast using a one‐way analysis of variance or a nonparametric t‐test. Correlations between imaging data measures and Gleason score were assessed using a Spearman's ranked correlation.
Evaluation of the correlation of ΔTSC, ADC, and ΔT2 datasets with Gleason scoring revealed that only the correlation between ΔTSC and Gleason score was statistically significant (r s = 0.791, p < 0.01), whereas the correlations of ADC and ΔT2 with Gleason score were not (r s = –0.306, p = 0.079 and r s = –0.069, p = 0.699, respectively). In addition, all individual patients showed monotonically increasing ΔTSC with Gleason score.
The results of this preliminary study suggest that changes in TSC, assessed by sodium MRI, has utility as a noninvasive imaging assay to accurately characterize PCa lesions. Sodium MRI may provide useful complementary information on mpMRI, which may assist the decision‐making of men choosing either active surveillance or treatment.
Level of Evidence: 1
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2018.
Signal intensity on T1‐weighted images (T1WI) is associated with pancreatic fibrosis and HbA1c levels.
To evaluate the feasibility of the pancreatic T1 value for assessment of subjects with normal and impaired glucose tolerance (IGT).
A prospective single‐institution study.
In all, 95 consecutive patients with a known or suspected pancreatic disease.
3T/fast pancreatic T1 mapping using a modified Look–Locker sequence.
Following the American Diabetes Association criteria, patients were classified into three groups, as follows: no‐diabetes subject, HbA1c < 5.7%; prediabetes, 5.7% ≤ HbA1c < 6.5%; and type 2 diabetes mellitus (T2DM), HbA1c ≥ 6.5%. Pancreatic T1 value and signal intensity ratio (SIR = SIpancreas/SImuscle) using T1WI were compared with the HbA1c values.
Quantitative data were assessed with one‐way analysis of variance, Fisher's and Mann–Whitney U tests, and receiver‐operating characteristic analysis.
The pancreatic T1 value was significantly longer in T2DM than in no‐diabetes and prediabetes subjects (P < 0.05) and was significantly longer in prediabetes than in no‐diabetes subjects (P < 0.05). The mean pancreatic T1 value was significantly lower in the low‐value group (HbA1c < 5.7%) (906.3 msec) compared with the high‐value group (HbA1c ≥ 6.5%) (993.8 msec) (P < 0.0001). SIR on T1WI was significantly higher in the low‐value group compared with the high‐value group (P = 0.029). The sensitivities, specificities, and area under the receiver‐operating characteristic curve (AUCs) for differentiating the low‐ and high‐value groups were 74.1%, 83.8%, and 0.82 in the pancreatic T1 values and 77.8%, 54.4%, and 0.63 in SIR on T1WI, respectively. The specificity (P < 0.0001) and AUC (P = 0.0020) were significantly higher in the pancreatic T1 values than in SIR on T1WI.
Pancreatic T1 value has the potential of being an imaging biomarker for the assessment of IGT.
Level of Evidence: 2
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2018.
Amide proton transfer (APT) imaging has shown great potential value in the diagnosis of cancer, but has yet not been applied in cervical carcinoma patients.
To investigate the utility of APT imaging in estimating histologic grades of squamous cell carcinoma of the cervix (SCCC), compared with the standardized uptake value (SUV).
Prospective.
Thirty‐one patients with SCCC (median age 51 years) were included.
Ingenia 3.0 T CX, Axial T1‐weighted imaging (T1WI), Axial T2WI, 3D turbo spin echo sequence for APT imaging.
Patient pathology was confirmed by surgery and the patients were divided into three groups based on histologic grades: Grade 1 (n = 9), Grade 2 (n = 12), and Grade 3 (n = 10). The APT signal intensity (APT SI), maximum SUV (SUVmax) and mean SUV (SUVmean) for each grade were assessed by experienced radiologists in a blinded manner.
The obtained parameters were compared by one‐way analysis of variance with Tukey honest significant difference post‐hoc test. The correlations between the parameters and histologic grades were analyzed by Spearman's correlation coefficient. The Pearson correlation coefficients of the APT SI with the SUVmax and SUVmean were also calculated.
The APT SIs for the three grades were significantly different (P = 0.0002). The APT SIs of Grade 2 and Grade 3 had significant differences (P = 0.009). The Spearman correlation coefficients for the correlations between the parameters and histological grade were as follows: APT SI: 0.684 (P = 0.00002), SUVmax: 0.318 (P = 0.082), and SUVmean: 0.261 (P = 0.157). The Pearson correlation coefficients of the APT SI with the SUVmax and SUVmean were 0.108 (P = 0.564) and 0.178 (P = 0.337), respectively.
The APT SI was positively correlated with the SCCC grades. APT imaging maybe a promising method for predicting SCCC histologic grades.
Level of Evidence: 2
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2018.
Dental anxiety causes patients to refuse or delay treatment, which may exacerbate oral diseases. The aim of the current randomized controlled trial was to determine whether progressive muscle relaxation therapy could relieve dental anxiety. The trial included 68 periodontal patients with dental anxiety scores of ≥13 who were randomly assigned to either an intervention group or a control group (n = 34 per group). The intervention group was administered progressive muscle relaxation therapy for 20 min and oral health education for 15 min before periodontal treatment once per week for 4 wk. The control group was provided with oral health education only, for the same duration. Changes in dental anxiety, depression symptoms, blood pressure, heart rate, and salivary cortisol were evaluated 4 wk and 3 months after the intervention. The intervention group exhibited statistically significantly greater reductions in dental anxiety scores than did the control group at the 4‐wk (−3.82 vs. −0.89) and 3‐month (−4.22 vs. −0.28) assessments. They also exhibited significantly greater reductions in depression symptoms, systolic and diastolic blood pressure, pulse rate, and salivary cortisol levels at both time‐points. Progressive muscle relaxation therapy relieves tension and anxiety in dental patients.
As national healthcare spending has spiraled out of control, payment reform that moves from volume to value‐based payment has been introduced as a practical solution. Under alternative value‐based payment models, physicians and clinical teams must deliver the best care possible at a lower cost. Medical imaging has changed the way we diagnose disease, evaluate severity, assess treatment effects, and provide biological insights for the pathophysiology of many diseases. Over the past 50 years, imaging techniques have become increasingly advanced—from X‐ray to computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and multi‐modal imaging. Advanced imaging such as MRI has given clinicians remarkable insights into medical conditions and saved innumerable lives. Under the value proposition, however, we must ask if each imaging study changes treatment decisions, improves patient outcomes, and is cost‐effective. Imaging research has been focused on developing new technologies and clinical applications to assess diagnostic accuracy. What is needed is the higher‐level technology assessment. In this article we review why we need to demonstrate the value of MRI, how we define value, what strategies can enhance MR value through partnership with various stakeholders, and how imaging scientists can contribute to healthcare delivery in the future.
Level of Evidence: 5
Technical Efficacy: Stage 3
J. Magn. Reson. Imaging 2018.
Overtreatment of prostate cancer (PCa) is a healthcare issue. Development of noninvasive imaging tools for improved characterization of prostate lesions might reduce overtreatment.
To measure the distribution of tissue sodium concentration (TSC), proton T2‐weighted signal, and apparent diffusion coefficient (ADC) values in human PCa and to test the presence of a correlation between regional differences in imaging metrics and the Gleason grade of lesions determined from histopathology.
Cross‐sectional.
Ten men with biopsy‐proven PCa.
Sodium, proton T2‐weighted, and diffusion‐weighted MRI data were acquired using Broad‐Band 3D‐Fast‐Gradient‐Recalled, 3D Cube (Isotropic 3D‐Fast‐Turbo‐Spin‐Echo acquisition) and 2D Spin‐Echo sequences, respectively, with a 3.0T MR scanner.
All imaging data were coregistered to Gleason‐graded postprostatectomy histology, as the standard for prostate cancer lesion characterization. Regional TSC and T2 data were assessed using percent changes from healthy tissue of the same patient (denoted ΔTSC, ΔT2).
Differences in ΔTSC, ADC, and ΔT2 as a function of Gleason score were analyzed for each imaging contrast using a one‐way analysis of variance or a nonparametric t‐test. Correlations between imaging data measures and Gleason score were assessed using a Spearman's ranked correlation.
Evaluation of the correlation of ΔTSC, ADC, and ΔT2 datasets with Gleason scoring revealed that only the correlation between ΔTSC and Gleason score was statistically significant (r s = 0.791, p < 0.01), whereas the correlations of ADC and ΔT2 with Gleason score were not (r s = –0.306, p = 0.079 and r s = –0.069, p = 0.699, respectively). In addition, all individual patients showed monotonically increasing ΔTSC with Gleason score.
The results of this preliminary study suggest that changes in TSC, assessed by sodium MRI, has utility as a noninvasive imaging assay to accurately characterize PCa lesions. Sodium MRI may provide useful complementary information on mpMRI, which may assist the decision‐making of men choosing either active surveillance or treatment.
Level of Evidence: 1
Technical Efficacy: Stage 2
J. Magn. Reson. Imaging 2018.
Ibuprofen can cause a wide variety of cutaneous reactions with a relatively high frequency, but establishing the causal relationship is usually difficult [1]. We report a case of a skin drug reaction due to ibuprofen, confirmed by positive patch test results.
Fragrance chemicals constitute the second most frequent cause of contact allergy in Spain. There are no data available concerning the individual fragrances that are most frequently involved.
To describe the diagnostic contribution provided by specific fragrance series to the results obtained with baseline series fragrance markers by correlating the results of both series.
We performed a 5‐year retrospective study of fragrance marker‐positive patients tested with specific fragrance series in 23 Spanish centres. We collected the demographic and clinical characteristics, and compared the results of patch tests obtained from different suppliers.
Of 19 588 patients patch tested with the Spanish baseline series, 1590 (8.1%) reacted positively to a fragrance marker. Of these, 1013 (63.7%) were patch tested with a fragrance series, and 664 patients reacted positively to at least one individual fragrance other than hydroxyisohexyl 3‐cyclohexene carboxaldehyde. Geraniol was the most frequent allergen. Positive reactions to substances not included in fragrance mix (FM) I or FM II were found in 230 patients. Of the 436 FM I‐positive patients and the 419 FM II‐positive patients, 184 (42%) and 64 (39.1%), respectively, had no positive reactions to fragrance series. In the case of FM I, negative results were more common when individual fragrances were patch tested at low concentrations.
We recommend patch testing all patients positive for any fragrance marker with a specific fragrance series. The correlation between the results of baseline series and fragrance series could be improved by increasing the concentrations of individual fragrances.
There was a global 'epidemic' of methylchloroisothiazolinone (MCI) and/or methylisothiazolinone (MI) contact allergy from 2009 to 2015. In response, the Thai Ministry of Public Health regulated the use of MCI/MI in cosmetics.
To survey the presence of MCI/MI and MI alone, as labelled on cosmetics sold on the Thai market, before and after the ministerial directive.
The presence of MCI and/or MI in leave‐on and rinse‐off cosmetics sold on the market, based on the labelling of ingredients in 3445 products, was analysed.
Before the implementation date, most leave‐on products contained MCI/MI. After the regulations came into force, the only leave‐on cosmetic subcategories that complied with the law were facial skin‐care, sunscreen and make‐up products. MCI/MI and MI alone were found on the labels of both leave‐on and rinse‐off products, the presence of each varying between product subcategories.
Despite the ministerial regulations restricting their use, MCI and/or MI are still found in cosmetics sold on the Thai market. Dermatologists should be aware of this situation, and counsel patients to avoid products containing MCI and/or MI.
Nickel allergy and dermatitis have been associated with filaggrin gene mutations in epidemiological studies, but the mechanisms mediating these associations are unknown.
To investigate whether filaggrin‐deficient flaky tail (ft/ft) mice show increased immune reactivity to nickel and elucidate the mechanisms mediating this.
The immune responses to nickel, 2,4‐dinitrofluorobenzene (DNFB), cinnamal and p‐phenylenediamine were assessed in ft/ft and wild‐type (WT) mice. The amounts of nickel in the skin of ft/ft and WT mice were determined 20 hours after nickel exposure. The effect of blocking either the interleukin (IL)‐17A pathway or the IL‐1 pathway on the response to nickel in ft/ft mice was evaluated.
Increased responsiveness to nickel, DNFB and cinnamal was observed in ft/ft mice as compared with controls. A reduced amount of nickel was found in the skin of ft/ft mice as compared with WT mice, suggesting increased nickel absorption by the skin of ft/ft mice. Blocking either the IL‐17A pathway or the IL‐1 pathway reduced nickel responsiveness in ft/ft mice.
These findings suggest that the increased nickel responsiveness associated with epidermal filaggrin deficiency is mediated by a combination of increased nickel penetration and the steady‐state inflammation found in the skin of filaggrin‐deficient mice.
Healthcare workers (HCWs) are at high risk of developing hand dermatitis (HD). Current guidelines on HD prevention recommend the use of emollients; however, in practice, adherence is poor.
To assess whether the provision of creams, electronic monitoring and feedback on cream consumption can improve skin care in HCWs.
A cluster randomized controlled trial was conducted on 19 academic hospital wards, including 501 HCWs, for 12 months. The intervention wards (n = 9; 285 HCWs) were provided with hand cream dispensers equipped with an electronic system to monitor use, which was regularly communicated to the HCWs by the use of posters. The process outcomes were self‐reported cream consumption in both groups, and electronically measured consumption per ward in the intervention group (IG) vs the control group (CG).
Self‐reported cream use at follow‐up was significantly higher in the IG than in the CG, before (odds ratio [OR] 2.27; 95%CI: 1.29‐3.97; P = 0.004) and during (OR 3.30; 95%CI: 1.80‐6.06, P < 0.001) the shift, whereas at baseline there was no difference between the groups. In the IG, electronically measured cream use was, on average, 0.4 events per shift per HCW.
The intervention improved hand cream use, and may therefore be considered as a practical strategy to promote skin care in HCWs. Notwithstanding this, the application frequency remained lower than recommended in the present study and current guidelines.
Olanedine (Ohtsuka Pharmaceutical Factory, Tokushima, Japan) is a biguanide antiseptic for external use released in 2015 [1]. The active ingredient is olanexidine gluconate, which has been shown to demonstrate a significant bactericidal effect against various gram‐positive and ‐negative bacteria and also against MRSA, VRE, Pseudomonas aeruginosa [2,3] and Cepacia resistant to other antiseptics [4]. It has been reported that use of Olanedine as a skin disinfectant is associated with almost no systemic side effects [5].
Ibuprofen can cause a wide variety of cutaneous reactions with a relatively high frequency, but establishing the causal relationship is usually difficult [1]. We report a case of a skin drug reaction due to ibuprofen, confirmed by positive patch test results.
Fragrance chemicals constitute the second most frequent cause of contact allergy in Spain. There are no data available concerning the individual fragrances that are most frequently involved.
To describe the diagnostic contribution provided by specific fragrance series to the results obtained with baseline series fragrance markers by correlating the results of both series.
We performed a 5‐year retrospective study of fragrance marker‐positive patients tested with specific fragrance series in 23 Spanish centres. We collected the demographic and clinical characteristics, and compared the results of patch tests obtained from different suppliers.
Of 19 588 patients patch tested with the Spanish baseline series, 1590 (8.1%) reacted positively to a fragrance marker. Of these, 1013 (63.7%) were patch tested with a fragrance series, and 664 patients reacted positively to at least one individual fragrance other than hydroxyisohexyl 3‐cyclohexene carboxaldehyde. Geraniol was the most frequent allergen. Positive reactions to substances not included in fragrance mix (FM) I or FM II were found in 230 patients. Of the 436 FM I‐positive patients and the 419 FM II‐positive patients, 184 (42%) and 64 (39.1%), respectively, had no positive reactions to fragrance series. In the case of FM I, negative results were more common when individual fragrances were patch tested at low concentrations.
We recommend patch testing all patients positive for any fragrance marker with a specific fragrance series. The correlation between the results of baseline series and fragrance series could be improved by increasing the concentrations of individual fragrances.
Isothiazolinones, methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI), are widely used preservatives in cosmetic, industrial and household products owing to their strong biocidal effects.1 Following an epidemic of contact allergy to MCI/MI (Kathon CG) and subsequent regulatory measures on the use of MCI/MI, the use of MI as a monopreservative has increased.
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There was a global 'epidemic' of methylchloroisothiazolinone (MCI) and/or methylisothiazolinone (MI) contact allergy from 2009 to 2015. In response, the Thai Ministry of Public Health regulated the use of MCI/MI in cosmetics.
To survey the presence of MCI/MI and MI alone, as labelled on cosmetics sold on the Thai market, before and after the ministerial directive.
The presence of MCI and/or MI in leave‐on and rinse‐off cosmetics sold on the market, based on the labelling of ingredients in 3445 products, was analysed.
Before the implementation date, most leave‐on products contained MCI/MI. After the regulations came into force, the only leave‐on cosmetic subcategories that complied with the law were facial skin‐care, sunscreen and make‐up products. MCI/MI and MI alone were found on the labels of both leave‐on and rinse‐off products, the presence of each varying between product subcategories.
Despite the ministerial regulations restricting their use, MCI and/or MI are still found in cosmetics sold on the Thai market. Dermatologists should be aware of this situation, and counsel patients to avoid products containing MCI and/or MI.
