Purpose of review Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. Recent findings Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm. This discrepancy could be explained by methodological differences between the trials rather than by a different case mix. Strategies to improve the efficacy and safety of tight glucose control have been developed, including the use of computerized treatment algorithms. Summary The ideal blood glucose target remains unclear and may depend on the context. As compared with tolerating severe hyperglycemia, tight glucose control is well tolerated and effective in patients receiving early parenteral nutrition when provided with a protocol that includes frequent, accurate glucose measurements and avoids large glucose fluctuations. All patient subgroups potentially benefit, with the possible exception of patients with poorly controlled diabetes, who may need less aggressive glucose control. It remains unclear whether tight glucose control is beneficial or not in the absence of early parenteral nutrition. Correspondence to Greet Van den Berghe, MD, PhD, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium. Tel: +32 16 344021; fax +32 16 344015; e-mail: greet.vandenberghe@kuleuven.be Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Τρίτη 29 Ιανουαρίου 2019
Noninvasive ventilation versus oxygen therapy in patients with acute respiratory failure
Purpose of review High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. Recent findings Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury. However, NIV remains the first-line oxygenation strategy in postoperative patients and those with acute hypercapnic respiratory failure when pH is equal to or below 7.35. During preoxygenation, NIV also seems to be more efficient than standard oxygen using valve-bag mask to prevent profound oxygen desaturation. In postoperative cardiothoracic patients, HFOT could be an alternative to NIV in the management of acute respiratory failure. Summary Recent recommendations for managing patients with acute respiratory failure have been established on the basis of studies comparing NIV with standard oxygen. Growing use of HFOT will lead to new studies comparing NIV versus HFOT in view of more precisely defining the appropriate indications for each treatment. Correspondence to Jean-Pierre Frat, Médecine Intensive Réanimation, CHU de Poitiers, 2 rue la Milétrie, 86021 Poitiers Cedex, France. Tel: +33 5 49 44 40 07; e-mail: jean-pierre.frat@chu-poitiers.fr Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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The effectiveness of noise interventions in the ICU
Purpose of review Excessive noise has direct adverse physiological and psychological effects, and may also have indirect negative health consequences by reducing sleep quality and quantity. This review presents a synthesis of the epidemiology of noise in the ICU, and the potential interventions designed to attenuate noise and protect patients. Recent findings Noise increases cortisol release, oxygen consumption, and vasoconstriction. ICU noise levels are excessive throughout the 24-h cycle, irrespective of level of intervention or whether the patient is in a side room or open ward. Direct measurement suggests that noise is a substantial contributor to poor sleep quantity and quality in the ICU and is frequently recalled by survivors of critical illness as a negative experience of ICU admission. Noise abatement, environmental masking and pharmacological interventions may all reduce the impact of noise on patients. However, the sustainability of behavioural interventions remains uncertain and high-quality evidence demonstrating the benefit of any intervention on patient-centered outcomes is lacking. Summary Noise levels in the ICU are consistently reported to reach levels likely to have both direct and indirect adverse health consequences for both patients and staff. Noise reduction, abating the transmission of noise and pharmacological modulation of the adverse neural effects of noise are all potentially beneficial strategies, although definitive evidence of improved patient-centered outcomes is lacking. Correspondence to Lori Delaney, MIHM, MN, PGD Crit Care, PGC Ed, Faculty of Nursing, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia. E-mail: Lori.delaney@qut.edu.au Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Telemedicine in the ICU: clinical outcomes, economic aspects, and trainee education
Purpose of review The evidence base for telemedicine in the ICU (tele-ICU) is rapidly expanding. The last 2 years have seen important additions to our understanding of when, where, and how telemedicine in the ICU adds value. Recent findings Recent publications and a recent meta-analysis confirm that tele-ICU improves core clinical outcomes for ICU patients. Recent evidence further demonstrates that comprehensive tele-ICU programs have the potential to quickly recuperate their implementation and operational costs and significantly increase case volumes and direct contribution margins particularly if additional logistics and care standardization functions are embedded to optimize ICU bed utilization and reduce complications. Even though the adoption of tele-ICU is increasing and the vast majority of today's medical graduates will regularly use some form of telemedicine and/or tele-ICU, telemedicine modules have not consistently found their way into educational curricula yet. Tele-ICU can be used very effectively to standardize supervision of medical trainees in bedside procedures or point-of-care ultrasound exams, especially during off-hours. Lastly, tele-ICUs routinely generate rich operational data, as well as risk-adjusted acuity and outcome data across the spectrum of critically ill patients, which can be utilized to support important clinical research and quality improvement projects. Summary The value of tele-ICU to improve patient outcomes, optimize ICU bed utilization, increase financial performance and enhance educational opportunities for the next generation of providers has become more evident and differentiated in the last 2 years. Correspondence to Christian D. Becker, MD, PhD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA. Tel: +1 914 493 1040; fax: +1 914 493 8373; e-mail: christian.becker@wmchealth.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Glucose control in the ICU
Purpose of review Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. Recent findings Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm. This discrepancy could be explained by methodological differences between the trials rather than by a different case mix. Strategies to improve the efficacy and safety of tight glucose control have been developed, including the use of computerized treatment algorithms. Summary The ideal blood glucose target remains unclear and may depend on the context. As compared with tolerating severe hyperglycemia, tight glucose control is well tolerated and effective in patients receiving early parenteral nutrition when provided with a protocol that includes frequent, accurate glucose measurements and avoids large glucose fluctuations. All patient subgroups potentially benefit, with the possible exception of patients with poorly controlled diabetes, who may need less aggressive glucose control. It remains unclear whether tight glucose control is beneficial or not in the absence of early parenteral nutrition. Correspondence to Greet Van den Berghe, MD, PhD, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium. Tel: +32 16 344021; fax +32 16 344015; e-mail: greet.vandenberghe@kuleuven.be Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DGGzHt
Thoracic trauma in military settings: a review of current practices and recommendations
Purpose of review To examine current literature on thoracic trauma related to military combat and to explore its relevance to the civilian population. Recent findings Damage control resuscitation (DCR) has improved the management of hemorrhaging trauma patients. Permissive hypotension below 110 mmHg and antifibrinolytic use during DCR is widely accepted, whereas the use of freeze-dried plasma and whole blood is gaining popularity. The Modified Physiologic Triaging Tool can be used for primary triage and it may have applications in civilian trauma systems. Although Tactical Combat Casualty Care protocol recommends the Cric-Key device for surgical cricothyroidotomies, other devices may offer comparable performance. Recommendations for regional anesthesia after blunt trauma are not well defined. Increasing amounts of evidence favor the use of extracorporeal membrane oxygenation for refractory hypoxemia and resuscitative endovascular balloon occlusion of the aorta (REBOA) for severe hemorrhage. REBOA outcomes are potentially improved by partial occlusion and small 7 Fr catheters. Summary The Global War on Terror has provided opportunities to better understand and treat thoracic trauma in military settings. Trauma registries and other data sources have contributed to significant advancements in the management of thoracic trauma in military and civilian populations. Correspondence to Robert Mansky, 545 First Ave, Apt 8I, New York, NY 10016, USA. Tel: +1 516 672 5589; e-mail: rmansky@gmail.com Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UoSVJW
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UoSVJW
Telemedicine in the ICU: clinical outcomes, economic aspects, and trainee education
Purpose of review The evidence base for telemedicine in the ICU (tele-ICU) is rapidly expanding. The last 2 years have seen important additions to our understanding of when, where, and how telemedicine in the ICU adds value. Recent findings Recent publications and a recent meta-analysis confirm that tele-ICU improves core clinical outcomes for ICU patients. Recent evidence further demonstrates that comprehensive tele-ICU programs have the potential to quickly recuperate their implementation and operational costs and significantly increase case volumes and direct contribution margins particularly if additional logistics and care standardization functions are embedded to optimize ICU bed utilization and reduce complications. Even though the adoption of tele-ICU is increasing and the vast majority of today's medical graduates will regularly use some form of telemedicine and/or tele-ICU, telemedicine modules have not consistently found their way into educational curricula yet. Tele-ICU can be used very effectively to standardize supervision of medical trainees in bedside procedures or point-of-care ultrasound exams, especially during off-hours. Lastly, tele-ICUs routinely generate rich operational data, as well as risk-adjusted acuity and outcome data across the spectrum of critically ill patients, which can be utilized to support important clinical research and quality improvement projects. Summary The value of tele-ICU to improve patient outcomes, optimize ICU bed utilization, increase financial performance and enhance educational opportunities for the next generation of providers has become more evident and differentiated in the last 2 years. Correspondence to Christian D. Becker, MD, PhD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA. Tel: +1 914 493 1040; fax: +1 914 493 8373; e-mail: christian.becker@wmchealth.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DHWsxz
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DHWsxz
Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives
Purpose of review To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. Recent findings Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. Summary The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines. Correspondence to Professor Frederik G. Dikkers, MD, PhD, Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 566 3789; e-mail: f.g.dikkers@amc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G7H0fM
Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice
Purpose of review To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual. Recent findings At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR. If these exams are negative (especially in Eastern Countries), in-situ hybridization for Epstein–Barr virus detection should be added. Thorough clinical examination should encompass white light videoendoscopy with the adjunction of bioendoscopic techniques (such as narrow band imaging). Radiologic workup (by CT, MR and/or PET) should be limited to cases that are persistently negative after comprehensive endoscopic evaluation. Invasive diagnostic procedures, such as unilateral or bilateral palatine tonsillectomy and base of tongue mucosectomy, may play a staging as well as a therapeutic role in CUPHN management. Summary Every effort should be made to identify and remove the primary site of a CUPHN: in doing so, possible subsequent de-intensification protocols by irradiation of the neck alone (with or without previous neck dissection according to the cN category, patient's risk profile, and general status) can be taken into consideration on a case-by-case basis. Correspondence to Cesare Piazza, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Via Giacomo Venezian 1, 20133 Milan, Italy. E-mail: cesare.piazza@istitutotumori.mi.it, ceceplaza@libero.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GeWbUe
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GeWbUe
Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives
Purpose of review To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. Recent findings Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. Summary The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines. Correspondence to Professor Frederik G. Dikkers, MD, PhD, Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 566 3789; e-mail: f.g.dikkers@amc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G7H0fM
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G7H0fM
Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice
Purpose of review To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual. Recent findings At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR. If these exams are negative (especially in Eastern Countries), in-situ hybridization for Epstein–Barr virus detection should be added. Thorough clinical examination should encompass white light videoendoscopy with the adjunction of bioendoscopic techniques (such as narrow band imaging). Radiologic workup (by CT, MR and/or PET) should be limited to cases that are persistently negative after comprehensive endoscopic evaluation. Invasive diagnostic procedures, such as unilateral or bilateral palatine tonsillectomy and base of tongue mucosectomy, may play a staging as well as a therapeutic role in CUPHN management. Summary Every effort should be made to identify and remove the primary site of a CUPHN: in doing so, possible subsequent de-intensification protocols by irradiation of the neck alone (with or without previous neck dissection according to the cN category, patient's risk profile, and general status) can be taken into consideration on a case-by-case basis. Correspondence to Cesare Piazza, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Via Giacomo Venezian 1, 20133 Milan, Italy. E-mail: cesare.piazza@istitutotumori.mi.it, ceceplaza@libero.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GeWbUe
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GeWbUe
Evaluation of Acellular Dermal Matrix Efficacy in Prosthesis-Based Breast Reconstruction
Autologous Breast Reconstruction after Failed Implant-Based Reconstruction: Evaluation of Surgical and Patient-Reported Outcomes and Quality of Life
Background: There is a subset of patients who initially undergo implant-based breast reconstruction but later change to autologous reconstruction after failure of the implant reconstruction. The purpose of this study was to examine outcomes and quality of life in this group of patients. Methods: After institutional review board approval, a retrospective chart review of a prospectively maintained database was performed and BREAST-Q surveys were evaluated. Results: One hundred thirty-seven patients underwent autologous breast reconstruction following failed implant-based reconstruction with 192 total flaps. Failure of implant reconstruction was defined as follows: capsular contracture causing pain and/or cosmetic deformity [n = 106 (77 percent)], dissatisfaction with the aesthetic result [n = 15 (11 percent)], impending exposure of the implant/infection [n = 8 (6 percent)], and unknown [n = 8 (6 percent)]. Complications requiring operative intervention included partial flap loss [n = 5 (3 percent)], hematoma [n = 5 (3 percent)], vascular compromise requiring intervention for salvage [n = 2 (1 percent)], and total flap loss [n = 1 (1 percent)]. Thirty-four patients (23 percent) had BREAST-Q surveys. There was a statistically significant increase in overall outcomes (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DJ1Gcw
Objective Methods for Breast Sensibility Testing
Background: The breast and the factors that affect the sensitivity of the nipple-areola complex have been a significant subject of study in recent years. The main purpose of this study was to provide an objective assessment of the effect of volumetric differences on nipple-areola complex sensitivity. Methods: Data were collected examining the right breast of 34 female volunteers. The mechanosensitive Aβ-fiber and mechanoinsensitive C-fiber function of the nipple-areola complex was assessed after mechanical and chemical stimulation, respectively. Flare responses were elicited chemically by the application of histamine by means of iontophoresis and recorded by laser Doppler imaging. The correlation of the maximum flare area responses with the breast volume and nipple-areola complex and the response from the von Frey fiber test was estimated using linear regression analysis. Results: Nipple-areola complex area increased with breast volume and, similarly, the area of histamine-induced axon reflex flare response follows the larger nipple-areola complex. However, a larger nipple-areola complex correlated with higher local mechanical thresholds. Higher mechanical thresholds were linked to smaller axon reflex area, suggesting combined small- and thick-fiber neuropathy. Conclusions: Objective small-fiber assessment using laser Doppler imaging and subjective mechanical threshold tests were used successfully to quantify function of Aβ and C fibers in the nipple-areola complex. Increased breast volume was linked to larger nipples, but also to impairment of Aβ and C fibers. Sensory testing can be incorporated into preoperative and postoperative management of patients undergoing breast operations to assess changes of neuronal function of the nipple-areola complex after surgery.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DHrTYG
Optimizing DIEP Flap Insetting for Immediate Unilateral Breast Reconstruction: A Prospective Cohort Study of Patient-Reported Aesthetic Outcomes
Background: To improve the aesthetic outcome of deep inferior epigastric perforator (DIEP) flap breast reconstruction, flaps should be tailored to the patient's characteristics. A single method of DIEP flap insetting will not suffice for all women seeking breast reconstruction. The authors share the outcomes of a prospective longitudinal study on DIEP flap insetting and present an algorithm for reconstruction. Methods: Over 4 years, 70 consecutive immediate unilateral DIEP flap breast reconstructions were prospectively evaluated. DIEP insetting was based on the characteristics of the donor site and contralateral breast, according to the authors' algorithm. Baseline and outcome data were collected. Aesthetic outcomes were evaluated by a panel of three independent assessors, and patient-reported outcomes were quantified using the BREAST-Q at 1 year after reconstruction. Results: Seventy women underwent reconstruction. There were no total or partial flap failures, four cases of fat necrosis, and 14 revision operations. Women reported a mean overall BREAST-Q score of 82 of 100, representing excellent satisfaction but poor satisfaction with sexual well-being. BREAST-Q scores were not associated with age or body mass index. Fat necrosis reduced satisfaction with the chest (absolute mean reduction, 13; 95 percent CI, 8 to 18; p = 0.002). Independent assessors scored the outcomes favorably, but there was no agreement between surgeons, nurses, and lay assessors. Conclusions: The authors' algorithm can support surgeons in selecting individually tailored DIEP flap insetting to achieve excellent aesthetic outcomes. Further research is needed as to the relevance of scores from BREAST-Q in relation to interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2UlJxqq
Making Sense of Stem Cells and Fat Grafting in Plastic Surgery: The Hype, Evidence, and Evolving U.S. Food and Drug Administration Regulations
Summary: Autologous fat grafting and adipose-derived stem cells are two distinct entities with two different risk profiles, and should be regulated as such. Autologous fat grafting prepared with the additional step of stromal vascular fraction isolation is considered a form of "stem cell therapy" given the high concentration of stem cells found in stromal vascular fraction. Much ambiguity existed in the distinction between autologous fat grafting and stromal vascular fraction initially, in terms of both their biological properties and how they should be regulated. The market has capitalized on this in the past decade to sell unproven "stem cell" therapies to unknowing consumers while exploiting the regulatory liberties of traditional fat grafting. This led to a Draft Guidance from the U.S. Food and Drug Administration in 2014 proposing stricter regulations on fat grafting in general, which in turn elicited a response from plastic surgeons, who have safely used autologous fat grafting in the clinical setting for over a century. After a series of discussions, the U.S. Food and Drug Administration released its Final Guidance in November of 2017, which established clear distinctions between autologous fat grafting and stromal vascular fraction and their separate regulations. By educating ourselves on the U.S. Food and Drug Administration's final stance on fat grafting and stem cell therapy, we can learn how to navigate the regulatory waters for the two entities and implement their clinical use in a responsible and informed manner.
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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FY5TeE
A Head-to-Head Comparison of the Vascular Basis of the Transverse Myocutaneous Gracilis, Profunda Artery Perforator, and Fasciocutaneous Infragluteal Flaps: An Anatomical Study
Background: Perforator flaps of the upper thigh or buttock provide a valuable secondary choice in autologous breast reconstruction. The purpose of this study was to compare the vascular territories and supplying vessels of the transverse myocutaneous gracilis flap, the profunda artery perforator flap, and the fasciocutaneous infragluteal flap. Methods: In total, 26 lower limbs from 13 fresh specimens were investigated. All flap pedicles were selectively injected with methylene blue, eosin red, or green ink. The pedicle external diameters, lengths, and locations were measured. The dimensions of angiosomes, their intraindividual and interindividual correlations, and their relations to anatomical landmarks were analyzed. Results: The profunda artery perforator pedicle had the greatest mean external diameter with 3.6 ± 0.7 mm, followed by the transverse myocutaneous gracilis and fasciocutaneous infragluteal pedicles with 2.9 ± 0.6 mm and 2.9 ± 0.7 mm, respectively. The fasciocutaneous infragluteal pedicle was longest with a mean length of 12.5 ± 1.5 cm, whereas the profunda artery perforator and transverse myocutaneous gracilis pedicles had lengths of 8.8 ± 1.0 cm and 6.7 ± 1 cm on average. The profunda artery perforator angiosome provided the largest size, with a mean area of 98.5 ± 26.7 cm2, followed by the fasciocutaneous infragluteal angiosome (77.2 ± 9.0 cm2) and the transverse myocutaneous gracilis angiosome (74.1 ± 32.1 cm2). Conclusions: The authors' anatomical findings about the transverse myocutaneous gracilis, profunda artery perforator, and fasciocutaneous infragluteal territories provide clinically valuable data for flap selection in breast reconstruction if an abdominal flap is not feasible.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DHSJQy
Cost-Effectiveness Analysis of Silicone versus Saline Implant-Based Breast Reconstruction Using the BREAST-Q
Background: The most common type of breast reconstruction is implant-based breast reconstruction. Implant-based reconstruction has been reported to impact quality-of-life outcomes. Therefore, the authors sought to evaluate the cost-effectiveness of saline versus silicone implants. Methods: The authors retrospectively reviewed data from patients who underwent breast reconstruction with saline or silicone implants at their institution. This included type of procedure, acellular dermal matrix use, complications, and number of revisions. Costs were estimated using the Centers for Medicare and Medicaid Services physician fee schedule and hospital costs. Effectiveness was measured using BREAST-Q–adjusted life-years, a measure of years of perfect breast health, based on BREAST-Q data collected before mastectomy and reconstruction and at 12 months after final reconstruction. The incremental cost-effectiveness ratio was obtained for silicone and saline reconstruction. Results: The authors identified 134 women, among which 77 (57 percent) underwent silicone and 57 (43 percent) underwent saline breast reconstruction. The cost of saline reconstruction was $1288.23 less compared with silicone. BREAST-Q–adjusted life-years were 28.11 for saline and 23.57 for silicone, demonstrating higher cost-effectiveness for saline. The incremental cost-effectiveness ratio for saline was −$283.48, or $283.48 less per year of perfect breast-related health postreconstruction than silicone. Conclusions: The authors' results indicate that saline breast reconstruction may be more cost-effective compared with silicone at 12 months after final reconstruction. Silicone was both more expensive and less effective than saline. However, given the relatively small cost difference, surgeon and patient preference may be important in determining type of implant used.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DHfrZ8
Evaluation of Acellular Dermal Matrix Efficacy in Prosthesis-Based Breast Reconstruction
Discussion: Cost-Effectiveness Analysis of Silicone versus Saline Implant-Based Breast Reconstruction Using the BREAST-Q
Effective Application of Mixed Reality Device HoloLens: Simple Manual Alignment of Surgical Field and Holograms
Summary: The technology used to add information to a real visual field is defined as augmented reality technology. Augmented reality technology that can interactively manipulate displayed information is called mixed reality technology. HoloLens from Microsoft, which is a head-mounted mixed reality device released in 2016, can display a precise three-dimensional model stably on the real visual field as hologram. If it is possible to accurately superimpose the position/direction of the hologram in the surgical field, surgical navigation-like use can be expected. However, in HoloLens, there was no such function. The authors devised a method that can align the surgical field and holograms precisely within a short time using a simple manual operation. The mechanism is to match the three points on the hologram to the corresponding marking points of the body surface. By making it possible to arbitrarily select any of the three points as a pivot/axis of the rotational movement of the hologram, alignment by manual operation becomes very easy. The alignment between the surgical field and the hologram was good and thus contributed to intraoperative objective judgment. By using the method of this study, the clinical usefulness of the mixed reality device HoloLens will be expanded.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FY5JE4
Predictable Location of Breast Sensory Nerves for Breast Reinnervation
Summary: The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves, which are at risk for injury or loss during mastectomy. Providing reinnervation after mastectomy was introduced almost 20 years ago, but it is not widely performed, perhaps because of the difficulty of locating a recipient nerve. The authors have performed cadaveric dissections to allow for precise anatomical localization of the lateral intercostal branch providing breast sensation. Bilateral chest dissections were performed on 10 female cadavers. The lateral intercostal nerve providing sensation to breast tissue was identified. The distances from the sternum, the midclavicular line, and the lateral pectoralis minor—in addition to nerve diameter—were measured. The nerve was successfully identified bilaterally in all cadavers. The majority of nerves (16 of 20) exited from under the fourth rib. The average distance from the sternum was 13.1 ± 1.3 cm (range, 10 to 15 cm) and the average distance from the midclavicular line was 11.8 ± 2.2 cm (range, 8 to 16 cm). The nerve exited at the lateral border of the pectoralis minor or within 2 cm from the lateral border for all cadavers. The diameter of the nerve was consistently 2 mm. The nerve traveled under the thoracodorsal vessels, aiding in identification. The authors identified the predictable location of the lateral intercostal nerve providing sensation to the breast. The authors hope that by enabling surgeons to locate this nerve, more well-conducted studies will be performed investigating techniques and outcomes for breast reinnervation.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DJqRvw
Autologous Breast Reconstruction after Failed Implant-Based Reconstruction: Evaluation of Surgical and Patient-Reported Outcomes and Quality of Life
Background: There is a subset of patients who initially undergo implant-based breast reconstruction but later change to autologous reconstruction after failure of the implant reconstruction. The purpose of this study was to examine outcomes and quality of life in this group of patients. Methods: After institutional review board approval, a retrospective chart review of a prospectively maintained database was performed and BREAST-Q surveys were evaluated. Results: One hundred thirty-seven patients underwent autologous breast reconstruction following failed implant-based reconstruction with 192 total flaps. Failure of implant reconstruction was defined as follows: capsular contracture causing pain and/or cosmetic deformity [n = 106 (77 percent)], dissatisfaction with the aesthetic result [n = 15 (11 percent)], impending exposure of the implant/infection [n = 8 (6 percent)], and unknown [n = 8 (6 percent)]. Complications requiring operative intervention included partial flap loss [n = 5 (3 percent)], hematoma [n = 5 (3 percent)], vascular compromise requiring intervention for salvage [n = 2 (1 percent)], and total flap loss [n = 1 (1 percent)]. Thirty-four patients (23 percent) had BREAST-Q surveys. There was a statistically significant increase in overall outcomes (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DJ1Gcw
Reply: Arterial Vascularization of the Mandibular Condyle and Fractures of the Condyle
No abstract availablefrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GaB6ub
Intraoperative Tissue Perfusion Measurement by Laser Speckle Imaging: A Potential Aid for Reducing Postoperative Complications in Free Flap Breast Reconstruction
Summary: Adequate tissue perfusion is essential to minimize postoperative complications following microsurgery. Intraoperative knowledge of tissue perfusion could aid surgical decision-making and result in reduced complications. Laser speckle imaging is a new, noninvasive technique for mapping tissue perfusion. This article discusses the feasibility of using laser speckle imaging during free flap breast reconstruction and its potential to identify areas of inadequate perfusion, thus reducing surgical complications. Adult patients scheduled to undergo free flap breast reconstruction were recruited into the study. Laser speckle images were obtained from the abdominal and breast areas at different stages intraoperatively. Zonal perfusion was compared with the Holm classification and clinical observations. Twenty patients scheduled to undergo free flap breast reconstruction were recruited (23 reconstructed breasts) (mean age, 50 years; range, 32 to 68 years). Flap zonal perfusion was 238 (187 to 313), 222 (120 to 265), 206 (120 to 265), and 125 (102 to 220) perfusion units for zones I, II, III, and IV, respectively (analysis of variance, pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Usbkpg
Reply: Fournier Gangrene: Association of Mortality with the Complete Blood Count Parameters
Making Sense of Stem Cells and Fat Grafting in Plastic Surgery: The Hype, Evidence, and Evolving U.S. Food and Drug Administration Regulations
Summary: Autologous fat grafting and adipose-derived stem cells are two distinct entities with two different risk profiles, and should be regulated as such. Autologous fat grafting prepared with the additional step of stromal vascular fraction isolation is considered a form of "stem cell therapy" given the high concentration of stem cells found in stromal vascular fraction. Much ambiguity existed in the distinction between autologous fat grafting and stromal vascular fraction initially, in terms of both their biological properties and how they should be regulated. The market has capitalized on this in the past decade to sell unproven "stem cell" therapies to unknowing consumers while exploiting the regulatory liberties of traditional fat grafting. This led to a Draft Guidance from the U.S. Food and Drug Administration in 2014 proposing stricter regulations on fat grafting in general, which in turn elicited a response from plastic surgeons, who have safely used autologous fat grafting in the clinical setting for over a century. After a series of discussions, the U.S. Food and Drug Administration released its Final Guidance in November of 2017, which established clear distinctions between autologous fat grafting and stromal vascular fraction and their separate regulations. By educating ourselves on the U.S. Food and Drug Administration's final stance on fat grafting and stem cell therapy, we can learn how to navigate the regulatory waters for the two entities and implement their clinical use in a responsible and informed manner.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FY5TeE
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FY5TeE
A Head-to-Head Comparison of the Vascular Basis of the Transverse Myocutaneous Gracilis, Profunda Artery Perforator, and Fasciocutaneous Infragluteal Flaps: An Anatomical Study
Background: Perforator flaps of the upper thigh or buttock provide a valuable secondary choice in autologous breast reconstruction. The purpose of this study was to compare the vascular territories and supplying vessels of the transverse myocutaneous gracilis flap, the profunda artery perforator flap, and the fasciocutaneous infragluteal flap. Methods: In total, 26 lower limbs from 13 fresh specimens were investigated. All flap pedicles were selectively injected with methylene blue, eosin red, or green ink. The pedicle external diameters, lengths, and locations were measured. The dimensions of angiosomes, their intraindividual and interindividual correlations, and their relations to anatomical landmarks were analyzed. Results: The profunda artery perforator pedicle had the greatest mean external diameter with 3.6 ± 0.7 mm, followed by the transverse myocutaneous gracilis and fasciocutaneous infragluteal pedicles with 2.9 ± 0.6 mm and 2.9 ± 0.7 mm, respectively. The fasciocutaneous infragluteal pedicle was longest with a mean length of 12.5 ± 1.5 cm, whereas the profunda artery perforator and transverse myocutaneous gracilis pedicles had lengths of 8.8 ± 1.0 cm and 6.7 ± 1 cm on average. The profunda artery perforator angiosome provided the largest size, with a mean area of 98.5 ± 26.7 cm2, followed by the fasciocutaneous infragluteal angiosome (77.2 ± 9.0 cm2) and the transverse myocutaneous gracilis angiosome (74.1 ± 32.1 cm2). Conclusions: The authors' anatomical findings about the transverse myocutaneous gracilis, profunda artery perforator, and fasciocutaneous infragluteal territories provide clinically valuable data for flap selection in breast reconstruction if an abdominal flap is not feasible.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DHSJQy
Reply: A New Composite Eyeball-Periorbital Transplantation Model in Humans: An Anatomical Study in Preparation for Eyeball Transplantation
No abstract availablefrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Ga6IjC
Proliferative Lesions Found at Reduction Mammaplasty: Incidence and Implications in 995 Breast Reductions
Background: Reduction mammaplasty relieves symptomatic macromastia. Pathologic specimens occasionally reveal unsuspected proliferative lesions or carcinoma. Few studies examine the incidence, risk factors, and outcomes in this population. Methods: A retrospective review was performed between 2000 and 2012. The pathologic condition was categorized as benign, proliferative, or cancer. Results: Five hundred seventy-two patients underwent 995 reduction mammaplasties. Cancer was detected in 23 specimens (2.3 percent) and proliferative lesions were detected in 137 (13.8 percent). Compared with patients with benign pathologic findings, patients with proliferative lesions or cancer were older (pfrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Usbop0
The Utility of the Airborne Technique for Lymphaticovenular Anastomosis
No abstract availablefrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FWSC5Q
Cost-Effectiveness Analysis of Silicone versus Saline Implant-Based Breast Reconstruction Using the BREAST-Q
Background: The most common type of breast reconstruction is implant-based breast reconstruction. Implant-based reconstruction has been reported to impact quality-of-life outcomes. Therefore, the authors sought to evaluate the cost-effectiveness of saline versus silicone implants. Methods: The authors retrospectively reviewed data from patients who underwent breast reconstruction with saline or silicone implants at their institution. This included type of procedure, acellular dermal matrix use, complications, and number of revisions. Costs were estimated using the Centers for Medicare and Medicaid Services physician fee schedule and hospital costs. Effectiveness was measured using BREAST-Q–adjusted life-years, a measure of years of perfect breast health, based on BREAST-Q data collected before mastectomy and reconstruction and at 12 months after final reconstruction. The incremental cost-effectiveness ratio was obtained for silicone and saline reconstruction. Results: The authors identified 134 women, among which 77 (57 percent) underwent silicone and 57 (43 percent) underwent saline breast reconstruction. The cost of saline reconstruction was $1288.23 less compared with silicone. BREAST-Q–adjusted life-years were 28.11 for saline and 23.57 for silicone, demonstrating higher cost-effectiveness for saline. The incremental cost-effectiveness ratio for saline was −$283.48, or $283.48 less per year of perfect breast-related health postreconstruction than silicone. Conclusions: The authors' results indicate that saline breast reconstruction may be more cost-effective compared with silicone at 12 months after final reconstruction. Silicone was both more expensive and less effective than saline. However, given the relatively small cost difference, surgeon and patient preference may be important in determining type of implant used.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DHfrZ8
Discussion: Cost-Effectiveness Analysis of Silicone versus Saline Implant-Based Breast Reconstruction Using the BREAST-Q
Effective Application of Mixed Reality Device HoloLens: Simple Manual Alignment of Surgical Field and Holograms
Summary: The technology used to add information to a real visual field is defined as augmented reality technology. Augmented reality technology that can interactively manipulate displayed information is called mixed reality technology. HoloLens from Microsoft, which is a head-mounted mixed reality device released in 2016, can display a precise three-dimensional model stably on the real visual field as hologram. If it is possible to accurately superimpose the position/direction of the hologram in the surgical field, surgical navigation-like use can be expected. However, in HoloLens, there was no such function. The authors devised a method that can align the surgical field and holograms precisely within a short time using a simple manual operation. The mechanism is to match the three points on the hologram to the corresponding marking points of the body surface. By making it possible to arbitrarily select any of the three points as a pivot/axis of the rotational movement of the hologram, alignment by manual operation becomes very easy. The alignment between the surgical field and the hologram was good and thus contributed to intraoperative objective judgment. By using the method of this study, the clinical usefulness of the mixed reality device HoloLens will be expanded.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FY5JE4
Predictable Location of Breast Sensory Nerves for Breast Reinnervation
Summary: The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves, which are at risk for injury or loss during mastectomy. Providing reinnervation after mastectomy was introduced almost 20 years ago, but it is not widely performed, perhaps because of the difficulty of locating a recipient nerve. The authors have performed cadaveric dissections to allow for precise anatomical localization of the lateral intercostal branch providing breast sensation. Bilateral chest dissections were performed on 10 female cadavers. The lateral intercostal nerve providing sensation to breast tissue was identified. The distances from the sternum, the midclavicular line, and the lateral pectoralis minor—in addition to nerve diameter—were measured. The nerve was successfully identified bilaterally in all cadavers. The majority of nerves (16 of 20) exited from under the fourth rib. The average distance from the sternum was 13.1 ± 1.3 cm (range, 10 to 15 cm) and the average distance from the midclavicular line was 11.8 ± 2.2 cm (range, 8 to 16 cm). The nerve exited at the lateral border of the pectoralis minor or within 2 cm from the lateral border for all cadavers. The diameter of the nerve was consistently 2 mm. The nerve traveled under the thoracodorsal vessels, aiding in identification. The authors identified the predictable location of the lateral intercostal nerve providing sensation to the breast. The authors hope that by enabling surgeons to locate this nerve, more well-conducted studies will be performed investigating techniques and outcomes for breast reinnervation.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DJqRvw
Reply: Arterial Vascularization of the Mandibular Condyle and Fractures of the Condyle
No abstract availablefrom #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GaB6ub
Reply: Fournier Gangrene: Association of Mortality with the Complete Blood Count Parameters
Objective Methods for Breast Sensibility Testing
Background: The breast and the factors that affect the sensitivity of the nipple-areola complex have been a significant subject of study in recent years. The main purpose of this study was to provide an objective assessment of the effect of volumetric differences on nipple-areola complex sensitivity. Methods: Data were collected examining the right breast of 34 female volunteers. The mechanosensitive Aβ-fiber and mechanoinsensitive C-fiber function of the nipple-areola complex was assessed after mechanical and chemical stimulation, respectively. Flare responses were elicited chemically by the application of histamine by means of iontophoresis and recorded by laser Doppler imaging. The correlation of the maximum flare area responses with the breast volume and nipple-areola complex and the response from the von Frey fiber test was estimated using linear regression analysis. Results: Nipple-areola complex area increased with breast volume and, similarly, the area of histamine-induced axon reflex flare response follows the larger nipple-areola complex. However, a larger nipple-areola complex correlated with higher local mechanical thresholds. Higher mechanical thresholds were linked to smaller axon reflex area, suggesting combined small- and thick-fiber neuropathy. Conclusions: Objective small-fiber assessment using laser Doppler imaging and subjective mechanical threshold tests were used successfully to quantify function of Aβ and C fibers in the nipple-areola complex. Increased breast volume was linked to larger nipples, but also to impairment of Aβ and C fibers. Sensory testing can be incorporated into preoperative and postoperative management of patients undergoing breast operations to assess changes of neuronal function of the nipple-areola complex after surgery.from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2DHrTYG
Tackle coughs the natural way: Here are some of the best essential oils that help you breathe easier
(Natural News) Coughs are a common health complaint, which can be triggered by several factors like allergies, colds, dry air, or the flu. But instead of reaching for cough medicine, which is often linked to negative side effects, using essential oils is a safer alternative to relieve your condition. Essential oils are more effective than cold medicine... (Source: NaturalNews.com)
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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MG1VHT
SU2C awards 2019 Laura Ziskin Prize in Translational Research
(Stand Up To Cancer) Stand Up To Cancer awarded the 2019 Laura Ziskin Prize in Translational Research ($250,000 for one year) to Drs. Silvia Formenti of Weill Cornell Medicine Sandra and Edward Meyer Cancer Center and Heather McArthur of Cedars Sinai to support collaboration using radiation and immunotherapy pre-operatively to help the body create its own vaccine to fight breast cancer, working with immunologists, bioinformatics specialists and biostatisticians. A clinical trial is in development. (Source: EurekAlert! - Cancer)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2t3foRn
Tackle coughs the natural way: Here are some of the best essential oils that help you breathe easier
(Natural News) Coughs are a common health complaint, which can be triggered by several factors like allergies, colds, dry air, or the flu. But instead of reaching for cough medicine, which is often linked to negative side effects, using essential oils is a safer alternative to relieve your condition. Essential oils are more effective than cold medicine... (Source: NaturalNews.com)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2MG1VHT
SU2C awards 2019 Laura Ziskin Prize in Translational Research
(Stand Up To Cancer) Stand Up To Cancer awarded the 2019 Laura Ziskin Prize in Translational Research ($250,000 for one year) to Drs. Silvia Formenti of Weill Cornell Medicine Sandra and Edward Meyer Cancer Center and Heather McArthur of Cedars Sinai to support collaboration using radiation and immunotherapy pre-operatively to help the body create its own vaccine to fight breast cancer, working with immunologists, bioinformatics specialists and biostatisticians. A clinical trial is in development. (Source: EurekAlert! - Cancer)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2t3foRn
Genome‐wide association study of inhaled corticosteroid response in admixed children with asthma
Abstract
Background
Inhaled corticosteroids (ICS) are the most widely prescribed and effective medication to control asthma symptoms and exacerbations. However, many children still have asthma exacerbations despite treatment, particularly in admixed populations, such as Puerto Ricans and African Americans. A few genome‐wide association studies (GWAS) have been performed in European and Asian populations, and they have demonstrated the importance of the genetic component in ICS response.
Objective
We aimed to identify genetic variants associated with asthma exacerbations in admixed children treated with ICS, and to validate previous GWAS findings.
Methods
A meta‐analysis of two GWAS of asthma exacerbations was performed in 1,347 admixed children treated with ICS (Hispanics/Latinos and African Americans), analyzing 8.7 million genetic variants. Those with p≤5x10‐6 were followed up for replication in 1,697 asthmatic patients from six European studies. Associations of ICS response described in published GWAS were followed up for replication in the admixed populations.
Results
A total of 15 independent variants were suggestively associated with asthma exacerbations in admixed populations (p≤5x10‐6). One of them, located in the intergenic region of APOBEC3B and APOBEC3C, showed evidence of replication in Europeans (rs5995653, p = 7.52x10‐3) and was also associated with change in lung function after treatment with ICS (p = 4.91x10‐3). Additionally, the reported association of the L3MBTL4‐ARHGAP28 genomic region was confirmed in admixed populations, although a different variant was identified.
Conclusions & Clinical Relevance
This study revealed the novel association of APOBEC3B and APOBEC3C with asthma exacerbations in children treated with ICS and replicated previously identified genomic regions. This contributes to the current knowledge about the multiple genetic markers determining responsiveness to ICS which could lead in the future the clinical identification of those asthma patients who are not able to respond to such treatment.
This article is protected by copyright. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RVbuJ0
Genome‐wide association study of inhaled corticosteroid response in admixed children with asthma
Abstract
Background
Inhaled corticosteroids (ICS) are the most widely prescribed and effective medication to control asthma symptoms and exacerbations. However, many children still have asthma exacerbations despite treatment, particularly in admixed populations, such as Puerto Ricans and African Americans. A few genome‐wide association studies (GWAS) have been performed in European and Asian populations, and they have demonstrated the importance of the genetic component in ICS response.
Objective
We aimed to identify genetic variants associated with asthma exacerbations in admixed children treated with ICS, and to validate previous GWAS findings.
Methods
A meta‐analysis of two GWAS of asthma exacerbations was performed in 1,347 admixed children treated with ICS (Hispanics/Latinos and African Americans), analyzing 8.7 million genetic variants. Those with p≤5x10‐6 were followed up for replication in 1,697 asthmatic patients from six European studies. Associations of ICS response described in published GWAS were followed up for replication in the admixed populations.
Results
A total of 15 independent variants were suggestively associated with asthma exacerbations in admixed populations (p≤5x10‐6). One of them, located in the intergenic region of APOBEC3B and APOBEC3C, showed evidence of replication in Europeans (rs5995653, p = 7.52x10‐3) and was also associated with change in lung function after treatment with ICS (p = 4.91x10‐3). Additionally, the reported association of the L3MBTL4‐ARHGAP28 genomic region was confirmed in admixed populations, although a different variant was identified.
Conclusions & Clinical Relevance
This study revealed the novel association of APOBEC3B and APOBEC3C with asthma exacerbations in children treated with ICS and replicated previously identified genomic regions. This contributes to the current knowledge about the multiple genetic markers determining responsiveness to ICS which could lead in the future the clinical identification of those asthma patients who are not able to respond to such treatment.
This article is protected by copyright. All rights reserved.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RVbuJ0
Post Transplant Cyclophosphamide in Matched Unrelated Donor Stem Cell Transplantation for Hematological Malignancies
Conditions: Bone Marrow Transplant Complications; Graft Versus Host Disease; Infection Viral; Engraft Failure; Immunologic Suppression Interventions: Drug: Cyclophosphamide; Drug: ATG Sponsor: Hospital Israelita Albert Einstein Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G7xr0a
Swedish Study of Immunotherapy for Milk Allergy in Children
Condition: Milk Allergy Intervention: Other: Milk protein in fresh milk Sponsor: Umeå University Recruiting (Source: ClinicalTrials.gov)
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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FW48P2
Pharmacokinetic Study to Evaluate Double-Dose Levonorgestrel Emergency Contraception in Combination With Efavirenz-Based Antiretroviral Therapy or Rifampicin-Containing Anti-Tuberculosis Therapy
Conditions: HIV Infections; Tuberculosis Intervention: Drug: Levonorgestrel Emergency Contraception (LNG EC) Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G7xn0q
Immunogenicity and Safety Study of Inactivated Subunit H5N1 Influenza Vaccine in Prior Recipients of Live Attenuated H2N2, H6N1 and H9N2 Influenza Vaccines and in H5N1 and Live Attenuated Vaccine Na ïve Individuals
Condition: Influenza Intervention: Biological: H5N1 pISV Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)
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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FWLTsC
Iron and Pollen Allergy in Women
Conditions: Allergy Pollen; Healthy Interventions: Dietary Supplement: ImmunoBon; Dietary Supplement: Placebo Sponsor: Medical University of Vienna Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GbZoEb
What is the Incidence of an Immune Disorder in Children With Invasive Pneumococcal Disease (IPD)?
Conditions: Invasive Pneumococcal Disease, Recurrent Isolated, 1; Invasive Pneumococcal Disease, Recurrent Isolated, 2; Invasive Pneumococcal Disease, Protection Against; Primary Immunodeficiency Intervention: Other: Referral to Immunology Sponsor: Murdoch Childrens Research Institute Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FXuro8
A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1
Conditions: Malaria; Febrile Illness Interventions: Other: Conditional ACT subsidy, Arm 1 levels; Other: Conditional ACT subsidy, Arm 2 levels; Other: Conditional ACT subsidy, Arm 3 levels; Other: Conditional ACT subsidy, Arm 4 levels Sponsors: Duke University; National Institute of Allergy and Infectious Diseases (NIAID); Moi University; Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GaA55B
Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children
Conditions: Overweight and Obesity; Allergy Intervention: Procedure: Vaginal seeding Sponsors: Peking University; National Natural Science Foundation of China; Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FXunoo
Post Transplant Cyclophosphamide in Matched Unrelated Donor Stem Cell Transplantation for Hematological Malignancies
Conditions: Bone Marrow Transplant Complications; Graft Versus Host Disease; Infection Viral; Engraft Failure; Immunologic Suppression Interventions: Drug: Cyclophosphamide; Drug: ATG Sponsor: Hospital Israelita Albert Einstein Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2G7xr0a
Swedish Study of Immunotherapy for Milk Allergy in Children
Condition: Milk Allergy Intervention: Other: Milk protein in fresh milk Sponsor: Umeå University Recruiting (Source: ClinicalTrials.gov)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FW48P2
Immunogenicity and Safety Study of Inactivated Subunit H5N1 Influenza Vaccine in Prior Recipients of Live Attenuated H2N2, H6N1 and H9N2 Influenza Vaccines and in H5N1 and Live Attenuated Vaccine Na ïve Individuals
Condition: Influenza Intervention: Biological: H5N1 pISV Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)
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from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FWLTsC
Iron and Pollen Allergy in Women
Conditions: Allergy Pollen; Healthy Interventions: Dietary Supplement: ImmunoBon; Dietary Supplement: Placebo Sponsor: Medical University of Vienna Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GbZoEb
What is the Incidence of an Immune Disorder in Children With Invasive Pneumococcal Disease (IPD)?
Conditions: Invasive Pneumococcal Disease, Recurrent Isolated, 1; Invasive Pneumococcal Disease, Recurrent Isolated, 2; Invasive Pneumococcal Disease, Protection Against; Primary Immunodeficiency Intervention: Other: Referral to Immunology Sponsor: Murdoch Childrens Research Institute Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FXuro8
A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1
Conditions: Malaria; Febrile Illness Interventions: Other: Conditional ACT subsidy, Arm 1 levels; Other: Conditional ACT subsidy, Arm 2 levels; Other: Conditional ACT subsidy, Arm 3 levels; Other: Conditional ACT subsidy, Arm 4 levels Sponsors: Duke University; National Institute of Allergy and Infectious Diseases (NIAID); Moi University; Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2GaA55B
Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children
Conditions: Overweight and Obesity; Allergy Intervention: Procedure: Vaginal seeding Sponsors: Peking University; National Natural Science Foundation of China; Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FXunoo
Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo
AbstractVEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley 's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix–Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audi ometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an exp...
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ScdbB8
Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study
AbstractOral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present ther apies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18–50 years with decreased interincisal opening were selected (time period 1.5 year). The...
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Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo
AbstractVEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley 's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix–Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audi ometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an exp...
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Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study
AbstractOral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present ther apies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18–50 years with decreased interincisal opening were selected (time period 1.5 year). The...
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Yes‐associated protein promotes cell migration via activating Wiskott‐Aldrich syndrome protein family member 1 in oral squamous cell carcinoma
Abstract
Background
Yes‐associated protein (YAP) is a candidate oncogene in various cancers including oral squamous cell carcinoma (OSCC). Our previous study demonstrated that TNF‐alpha could inhibit cell proliferation and invasion by YAP phosphorylation in OSCC. However, the role of YAP in OSCC is not yet clear. The objective of the present study was to elucidate the function of YAP in promoting migration in OSCC and to explore the possible mechanism with a novel YAP inhibitor CA3.
Methods
A total of 68 OSCC patients were enrolled and the expression levels of YAP were investigated in tissue specimens by immunohistochemical staining. The inhibitory effects of CA3, a novel inhibitor of YAP, were demonstrated by immunofluorescence, Western blotting and transwell assays. A human PCR motility array was performed to screen the changes in the gene expression profiles of the cells. In addition, shRNA interference, YAP re‐expression and WAVE1 overexpression plasmids were used to detect the regulatory mechanism of YAP and its relationship with cell migration.
Results
YAP nuclear expression levels were associated with metastasis and 5‐year overall survival rate. CA3 exhibited potent inhibitory effects on OSCC migration. YAP knockdown significantly suppressed tumor cell migration in OSCC. These effects were rescued when YAP was re‐expressed and during WAVE1 overexpression in YAP‐shRNA stable cells.
Conclusions
The present study revealed that YAP was associated with cell migration and that this process was regulated by YAP/WAVE1. We also demonstrated that CA3 exhibited marked inhibitory effects on YAP expression and that it could be considered a potential therapeutic target for the treatment of OSCC.
This article is protected by copyright. All rights reserved.
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Yes‐associated protein promotes cell migration via activating Wiskott‐Aldrich syndrome protein family member 1 in oral squamous cell carcinoma
Abstract
Background
Yes‐associated protein (YAP) is a candidate oncogene in various cancers including oral squamous cell carcinoma (OSCC). Our previous study demonstrated that TNF‐alpha could inhibit cell proliferation and invasion by YAP phosphorylation in OSCC. However, the role of YAP in OSCC is not yet clear. The objective of the present study was to elucidate the function of YAP in promoting migration in OSCC and to explore the possible mechanism with a novel YAP inhibitor CA3.
Methods
A total of 68 OSCC patients were enrolled and the expression levels of YAP were investigated in tissue specimens by immunohistochemical staining. The inhibitory effects of CA3, a novel inhibitor of YAP, were demonstrated by immunofluorescence, Western blotting and transwell assays. A human PCR motility array was performed to screen the changes in the gene expression profiles of the cells. In addition, shRNA interference, YAP re‐expression and WAVE1 overexpression plasmids were used to detect the regulatory mechanism of YAP and its relationship with cell migration.
Results
YAP nuclear expression levels were associated with metastasis and 5‐year overall survival rate. CA3 exhibited potent inhibitory effects on OSCC migration. YAP knockdown significantly suppressed tumor cell migration in OSCC. These effects were rescued when YAP was re‐expressed and during WAVE1 overexpression in YAP‐shRNA stable cells.
Conclusions
The present study revealed that YAP was associated with cell migration and that this process was regulated by YAP/WAVE1. We also demonstrated that CA3 exhibited marked inhibitory effects on YAP expression and that it could be considered a potential therapeutic target for the treatment of OSCC.
This article is protected by copyright. All rights reserved.
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Comparison of NOSE Scores Following Functional Septorhinoplasty Using Autologous versus Cadaveric Rib
Facial plast Surg
DOI: 10.1055/s-0039-1677718
In functional septorhinoplasty (FSRP), alternative grafting material is used if septal cartilage is insufficient for reconstructive needs. Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are compared via the Nasal Obstruction Symptom Evaluation (NOSE) scale. One-hundred forty-one patients who underwent FSRP with ACC or IHCC between January 2013 and March 2018 were administered the NOSE scale pre- and postoperatively at 2, 4, 6, and 12 months. There was no significant difference in mean NOSE scores between the ACC and IHCC cohorts at the preoperative visit (68.5 [standard deviation, SD 24.1] and 71.7 [20.1], respectively; p < 0.6) or first postoperative visit (30.4 [26.6] and 33.9 [30.4], respectively; p < 0.6) or subsequent visits. NOSE scores demonstrated a clinically and statistically significant improvement at all follow-up time points for both the ACC and IHCC groups. Patients who underwent grafting with IHCC were significantly older than those with ACC; average age of 55.6 [SD: 17.3] versus 40.1 [SD:12.1]; (p < 0.001). Two IHCC (0.05%) patients had postoperative infections; both resolved with antibiotics, but one required revision surgery. Both ACC and IHCC provide reliable grafting material when septal cartilage is insufficient. In FSRP for nasal airway obstruction, ACC and IHCC both provide a clinically and statistically significant reduction in NOSE scores postoperatively that remain stable between follow-up time points. The authors find no difference in NOSE scores between the ACC and IHCC groups; however, IHCC did have a higher rate of postoperative infection. Both materials should be discussed with patients and are an important part of the informed consent process.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Comparison of NOSE Scores Following Functional Septorhinoplasty Using Autologous versus Cadaveric Rib
Facial plast Surg
DOI: 10.1055/s-0039-1677718
In functional septorhinoplasty (FSRP), alternative grafting material is used if septal cartilage is insufficient for reconstructive needs. Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are compared via the Nasal Obstruction Symptom Evaluation (NOSE) scale. One-hundred forty-one patients who underwent FSRP with ACC or IHCC between January 2013 and March 2018 were administered the NOSE scale pre- and postoperatively at 2, 4, 6, and 12 months. There was no significant difference in mean NOSE scores between the ACC and IHCC cohorts at the preoperative visit (68.5 [standard deviation, SD 24.1] and 71.7 [20.1], respectively; p < 0.6) or first postoperative visit (30.4 [26.6] and 33.9 [30.4], respectively; p < 0.6) or subsequent visits. NOSE scores demonstrated a clinically and statistically significant improvement at all follow-up time points for both the ACC and IHCC groups. Patients who underwent grafting with IHCC were significantly older than those with ACC; average age of 55.6 [SD: 17.3] versus 40.1 [SD:12.1]; (p < 0.001). Two IHCC (0.05%) patients had postoperative infections; both resolved with antibiotics, but one required revision surgery. Both ACC and IHCC provide reliable grafting material when septal cartilage is insufficient. In FSRP for nasal airway obstruction, ACC and IHCC both provide a clinically and statistically significant reduction in NOSE scores postoperatively that remain stable between follow-up time points. The authors find no difference in NOSE scores between the ACC and IHCC groups; however, IHCC did have a higher rate of postoperative infection. Both materials should be discussed with patients and are an important part of the informed consent process.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Fragen rund um die Therapieallergene-Verordnung
Im August 2018 haben die ersten Therapieallergene, die gemäß der Therapieallergene-Verordnung überprüft worden sind, in Deutschland eine Zulassung vom Paul-Ehrlich-Institut erhalten. Dafür waren Phase-II- und Phase-III-Studien notwendig. Nun hat die Kassenärztliche Vereinigung Nordrhein interessante Fragen dazu gestellt, die Sie hier — zusammen mit den Antworten des Paul-Ehrlich-Instituts — nachlesen können.
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Baumpollen-AIT: Wirksamkeit auch durch Real-Life-Langzeitdaten dokumentiert
Studien zur Wirksamkeit der allergenspezifischen Immuntherapie (AIT) unter Alltagsbedingungen sind bisher rar. Eine Real-Life-Langzeitstudie mit Verordnungsdaten von symptomatischen Antiallergika als Datenbasis liefert Anhaltspunkte zur Effektivität einer Baumpollen-AIT.
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Leitlinie: Hereditäres Angioödem durch C1-Inhibitor-Mangel
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Luftschadstoffe und primäre Prävention von Allergien
Zusammenfassung
Hintergrund
Luftschadstoffe wie Feinstaub (PM2,5) und Stickstoffdioxid (NO2) in der Außenluft stehen seit Langem in Verdacht, die Entwicklung von Asthma und allergischer Rhinitis zu verursachen. Diverse systematische Reviews der letzten 15 Jahre kommen aber zu unterschiedlichen Ergebnissen, ob diese Luftschadstoffe tatsächlich eine kausale Rolle für die Entstehung von Asthma, allergischer Rhinitis und Ekzem spielen.
Methoden
Basierend auf publizierten systematischen Reviews und den neuesten Publikationen wird der aktuelle Kenntnisstand der epidemiologischen Evidenz dargestellt und das Potenzial einer primären Prävention dieser allergischen Erkrankungen durch Verringerung oder Vermeidung der Exposition mit diesen Luftschadstoffen bewertet.
Ergebnisse
Trotz umfangreicher Literaturrecherche, Darstellung neuester Ergebnisse und Fokussierung auf die für unsere Belange qualitativ hochwertigen Geburtskohortenstudien unterstützen epidemiologische Ergebnisse nicht ausreichend die Vorstellung von einer kausalen Beziehung zwischen den beiden ausgewählten Luftschadstoffen PM2,5 und NO2 und Asthma. Epidemiologische Studien zeigen überwiegend keine Effekte dieser Luftschadstoffe auf die allergische Sensibilisierung und das Auftreten von Heuschnupfen. Die wenigen Studien, die den Zusammenhang zwischen Luftschadstoffen und Ekzem untersucht haben, zeigen überwiegend keine Assoziation.
Schlussfolgerung
Wenn die Evidenz einer kausalen Rolle dieser Luftschadstoffe für das Auftreten von Allergien nicht eindeutig belegt ist, muss man folgerichtig schließen, dass eine primäre Prävention von Allergien durch die Verbesserung der Luftqualität wahrscheinlich nicht möglich ist. Allerdings liegt eine ausreichende Evidenz dafür vor, dass Exazerbationen von allergischen Erkrankungen durch Luftschadstoffe ausgelöst werden können. Allein daraus ergibt sich das Erfordernis, für die Einhaltung der bestehenden Grenzwerte von Luftschadstoffen zu sorgen, um speziell Allergiker vor gesundheitlichen Beeinträchtigungen zu schützen.
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Omalizumab bei Asthma: Intervallverlängerung versus Dosisreduktion
Bleibt bei Patienten mit schwerem allergischem Asthma unter der Therapie mit Omalizumab die Erkrankung längere Zeit stabil, stellt sich die Frage nach Möglichkeiten der Therapiemodifikation. Neben einer Dosisreduktion wäre auch eine Verlängerung des Behandlungsintervalls denkbar. Allergologen der Berliner Charité haben beides versucht.
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Inhaltsverzeichnis
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Moderne Labordiagnostik lässt hoffen
Bei einer echten Penizillinallergie muss bei Bedarf auf alternative Antibiotika zurückgegriffen werden. Dies kann zu vermehrten Therapieversagern, mehr Nebenwirkungen und Ausbildung von antibiotikaresistenten Keimen führen. Doch liegt wirklich eine Penizillinallergie vor? Die unzureichenden Diagnosemöglichkeiten verschärfen die Problematik, doch die moderne Labordiagnostik hat voraussichtlich bald Lösungen parat.
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Comparison of extended intervals and dose reduction of omalizumab for asthma control
Abstract
Purpose
The necessary treatment duration of omalizumab in patients with severe asthma remains unclear. Currently, common practice is life-long therapy without adjustment of dose or treatment intervals. This study evaluated asthma control after either dosage interval extension or dose reduction in patients with asthma controlled by omalizumab.
Methods
Thirty-seven patients were assigned to receive either extended treatment interval (n = 26) or a reduction in omalizumab dosage (n = 11). The primary outcome was time until loss of asthma control.
Results
Nineteen patients (73 %) of the extended interval group maintained good asthma control for at least 7–39 months. Of the remaining 7 patients, the median time to loss of asthma control was 8 months (range 5–35 months). In contrast, all patients in the dose reduction group lost asthma control. The median time of loss of control was 2 months (1–44 months). Extension of dose interval led to a significantly (P < 0.001) longer period of good asthma control than dose reduction.
Conclusion
If patients or physicians wish to reduce the cumulative dose of omalizumab after achieving good asthma control, extension of the interval between doses appears to be a better approach than dose reduction.
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Abstracts des 31. Mainzer Allergie-Workshops, 29./30. März 2019
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Aerogene Kontaktallergene
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Baumpollen-AIT: Wirksamkeit auch durch Real-Life-Langzeitdaten dokumentiert
Studien zur Wirksamkeit der allergenspezifischen Immuntherapie (AIT) unter Alltagsbedingungen sind bisher rar. Eine Real-Life-Langzeitstudie mit Verordnungsdaten von symptomatischen Antiallergika als Datenbasis liefert Anhaltspunkte zur Effektivität einer Baumpollen-AIT.
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Bedenkliche Entwicklung zur MWBO Allergologie
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31. Mainzer Allergie-Workshop
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Hornissengiftallergie jetzt ganz spezifisch behandeln
Hornissengiftallergiker wurden bisher meist mit einer Wespengift-Immuntherapie hyposensibilisiert. Mittlerweile steht aber auch ein Hornissengiftextrakt für die SIT zur Verfügung. Eine Beobachtungsstudie überprüfte Wirksamkeit und Sicherheit.
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Luftschadstoffe und primäre Prävention von Allergien
Zusammenfassung
Hintergrund
Luftschadstoffe wie Feinstaub (PM2,5) und Stickstoffdioxid (NO2) in der Außenluft stehen seit Langem in Verdacht, die Entwicklung von Asthma und allergischer Rhinitis zu verursachen. Diverse systematische Reviews der letzten 15 Jahre kommen aber zu unterschiedlichen Ergebnissen, ob diese Luftschadstoffe tatsächlich eine kausale Rolle für die Entstehung von Asthma, allergischer Rhinitis und Ekzem spielen.
Methoden
Basierend auf publizierten systematischen Reviews und den neuesten Publikationen wird der aktuelle Kenntnisstand der epidemiologischen Evidenz dargestellt und das Potenzial einer primären Prävention dieser allergischen Erkrankungen durch Verringerung oder Vermeidung der Exposition mit diesen Luftschadstoffen bewertet.
Ergebnisse
Trotz umfangreicher Literaturrecherche, Darstellung neuester Ergebnisse und Fokussierung auf die für unsere Belange qualitativ hochwertigen Geburtskohortenstudien unterstützen epidemiologische Ergebnisse nicht ausreichend die Vorstellung von einer kausalen Beziehung zwischen den beiden ausgewählten Luftschadstoffen PM2,5 und NO2 und Asthma. Epidemiologische Studien zeigen überwiegend keine Effekte dieser Luftschadstoffe auf die allergische Sensibilisierung und das Auftreten von Heuschnupfen. Die wenigen Studien, die den Zusammenhang zwischen Luftschadstoffen und Ekzem untersucht haben, zeigen überwiegend keine Assoziation.
Schlussfolgerung
Wenn die Evidenz einer kausalen Rolle dieser Luftschadstoffe für das Auftreten von Allergien nicht eindeutig belegt ist, muss man folgerichtig schließen, dass eine primäre Prävention von Allergien durch die Verbesserung der Luftqualität wahrscheinlich nicht möglich ist. Allerdings liegt eine ausreichende Evidenz dafür vor, dass Exazerbationen von allergischen Erkrankungen durch Luftschadstoffe ausgelöst werden können. Allein daraus ergibt sich das Erfordernis, für die Einhaltung der bestehenden Grenzwerte von Luftschadstoffen zu sorgen, um speziell Allergiker vor gesundheitlichen Beeinträchtigungen zu schützen.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HD8YCv
Omalizumab bei Asthma: Intervallverlängerung versus Dosisreduktion
Bleibt bei Patienten mit schwerem allergischem Asthma unter der Therapie mit Omalizumab die Erkrankung längere Zeit stabil, stellt sich die Frage nach Möglichkeiten der Therapiemodifikation. Neben einer Dosisreduktion wäre auch eine Verlängerung des Behandlungsintervalls denkbar. Allergologen der Berliner Charité haben beides versucht.
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Inhaltsverzeichnis
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Aerogene Kontaktallergene
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ALLERGY MIX PHOENIX (Local Remedy Phoenix) Spray [ASN]
Updated Date: Jan 29, 2019 EST (Source: DailyMed Drug Label Updates)
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ALLERGY MIX LAS VEGAS (Local Remedy Las Vegas) Spray [ASN]
Updated Date: Jan 29, 2019 EST (Source: DailyMed Drug Label Updates)
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ALLERGY MIX PHOENIX (Local Remedy Phoenix) Liquid [ASN]
Updated Date: Jan 29, 2019 EST (Source: DailyMed Drug Label Updates)
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Non-atopic severe asthma might still be atopic: Sensitization towards Staphylococcus aureus enterotoxins
This study shows that patients with severe asthma, previously considered non-atopic, may be sensitized to less frequently tested allergens, specifically S. aureus enterotoxins. The diagnosis of an atopy, however, may be crucial to make optimal treatment decisions. (Source: Journal of Allergy and Clinical Immunology)
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Selective IgA deficiency in humans is associated with reduced gut microbial diversity
(Source: Journal of Allergy and Clinical Immunology)
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Soy isoflavones reduce asthma exacerbation in asthmatics with high PAI-1 producing genotypes
The soy isoflavone treatment significantly reduced the number of severe asthma exacerbations in asthmatic subjects with the high PAI-1 producing genotypes, suggesting PAI-1 polymorphisms as a genetic biomarker for soy isoflavone responsive asthma. (Source: Journal of Allergy and Clinical Immunology)
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Modulation of inflammatory gene transcripts in psoriasis vulgaris: differences between ustekinumab and etanercept
Findings demonstrate differences in modulation of specific psoriatic inflammatory pathways between ustekinumab vs. etanercept responders. These data also (Source: Journal of Allergy and Clinical Immunology)
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Blockade of Repulsive guidance molecule b (RGMb) inhibits allergen-induced airways disease
We describe an important role for RGMb in asthma. Blockade of RGMb, expressed by bronchial epithelial cells, lung interstitial macrophages and eosinophils, abrogated allergic airways disease, even when treatment occurred late at the effector phase. (Source: Journal of Allergy and Clinical Immunology)
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The SQ tree SLIT-tablet is highly effective and well tolerated: Results from a randomized, double-blind, placebo-controlled phase III trial
The SQ tree sublingual immunotherapy (SLIT) –tablet (ALK-Abelló, Hørsholm, Denmark) is developed for treatment of tree pollen–induced allergic rhinoconjunctivitis (ARC). (Source: Journal of Allergy and Clinical Immunology)
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Longitudinal study of hearing loss and subjective cognitive function decline in men
We examined the relation between self-reported hearing loss, hearing aid use, and risk of subjective cognitive function (SCF) decline.MethodsWe conducted an 8-year (2008–2016) longitudinal study of 10,107 men aged ≥62 years who reported their hearing status in 2006 and had no subjective cognitive concerns in 2008. Change in SCF scores was assessed by a 6-item questionnaire, and subjective decline was defined as new report of at least one SCF concern during follow-up.ResultsHearing loss was associated with higher risk of SCF decline. Compared with no hearing loss, the multivariable-adjusted relative risk (95% CI) of incident SCF decline was 1.30 (1.18, 1.42), 1.42 (1.26, 1.61), and 1.54 (1.22, 1.96) among men with mild, moderate, and severe hearing loss (no hearing aids), respectively...
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ALLERGY MIX PHOENIX (Local Remedy Phoenix) Spray [ASN]
Updated Date: Jan 29, 2019 EST (Source: DailyMed Drug Label Updates)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
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ALLERGY MIX LAS VEGAS (Local Remedy Las Vegas) Spray [ASN]
Updated Date: Jan 29, 2019 EST (Source: DailyMed Drug Label Updates)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TmsQLw
ALLERGY MIX PHOENIX (Local Remedy Phoenix) Liquid [ASN]
Updated Date: Jan 29, 2019 EST (Source: DailyMed Drug Label Updates)
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Differential effect of inhibitory strategies of the V617 mutant of JAK2 on cytokine receptor signaling
Janus Kinase 2 (JAK2) plays pivotal roles in signaling by several cytokine receptors. The mutant JAK2 V617F is the most common molecular event associated with myeloproliferative neoplasms. Selective targeting of the mutant would be ideal for treating these pathologies by sparing essential JAK2 functions. (Source: Journal of Allergy and Clinical Immunology)
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Soy isoflavones reduce asthma exacerbation in asthmatics with high PAI-1 producing genotypes
The soy isoflavone treatment significantly reduced the number of severe asthma exacerbations in asthmatic subjects with the high PAI-1 producing genotypes, suggesting PAI-1 polymorphisms as a genetic biomarker for soy isoflavone responsive asthma. (Source: Journal of Allergy and Clinical Immunology)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2B9j9sW
Modulation of inflammatory gene transcripts in psoriasis vulgaris: differences between ustekinumab and etanercept
Findings demonstrate differences in modulation of specific psoriatic inflammatory pathways between ustekinumab vs. etanercept responders. These data also (Source: Journal of Allergy and Clinical Immunology)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Tl5JRD
Blockade of Repulsive guidance molecule b (RGMb) inhibits allergen-induced airways disease
We describe an important role for RGMb in asthma. Blockade of RGMb, expressed by bronchial epithelial cells, lung interstitial macrophages and eosinophils, abrogated allergic airways disease, even when treatment occurred late at the effector phase. (Source: Journal of Allergy and Clinical Immunology)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BcP2k7
The SQ tree SLIT-tablet is highly effective and well tolerated: Results from a randomized, double-blind, placebo-controlled phase III trial
The SQ tree sublingual immunotherapy (SLIT) –tablet (ALK-Abelló, Hørsholm, Denmark) is developed for treatment of tree pollen–induced allergic rhinoconjunctivitis (ARC). (Source: Journal of Allergy and Clinical Immunology)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TgWphv
Longitudinal study of hearing loss and subjective cognitive function decline in men
We examined the relation between self-reported hearing loss, hearing aid use, and risk of subjective cognitive function (SCF) decline.MethodsWe conducted an 8-year (2008–2016) longitudinal study of 10,107 men aged ≥62 years who reported their hearing status in 2006 and had no subjective cognitive concerns in 2008. Change in SCF scores was assessed by a 6-item questionnaire, and subjective decline was defined as new report of at least one SCF concern during follow-up.ResultsHearing loss was associated with higher risk of SCF decline. Compared with no hearing loss, the multivariable-adjusted relative risk (95% CI) of incident SCF decline was 1.30 (1.18, 1.42), 1.42 (1.26, 1.61), and 1.54 (1.22, 1.96) among men with mild, moderate, and severe hearing loss (no hearing aids), respectively...
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