Issue Information ‐ TOC

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Corrigendum

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In this Issue: Graphical Abstracts

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Issue Information ‐ Cover and Editorial Board

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Issue Information ‐ TOC

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Corrigendum

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In this Issue: Graphical Abstracts

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Issue Information ‐ Cover and Editorial Board

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Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss

Abstract

Objectives

To report on a retrospective cohort study on the effects of expanding inclusion criteria for application of cochlear implants (CIs) on the performance 1-year post-implantation.

Methods

Based on pre-implantation audiometric thresholds and aided speech recognition scores, the data of 164 CI recipients were divided into a group of patients that fulfilled conservative criteria (mean hearing loss at 0.5, 1 and 2 kHz > 85 dB HL and phoneme scores with hearing aids < 30%), and the remaining group of patients that felt outside this conservative criterion. Speech recognition scores (in quiet) and quality of life (using the NCIQ) of both groups, measured at 1-year post-implantation, were compared.

Results

The group that felt outside the conservative criterion showed a higher phoneme score at 1-year post-implantation compared to the conservative group, suggesting that relaxed criteria have a positive influence on the speech recognition results with CI. With respect to quality of life, both groups significantly improved 1-year post-implantation. The conservative group showed a higher benefit on the advanced perception domain of the NCIQ. Based on their worse pre-implantation hearing, this was expected.

Conclusions

The data suggest that relaxation of CI indication positively affects the speech recognition performance of patients with severe hearing loss. Both groups of patients showed a positive effect of CI on the quality of life. This benefit relates to communication skills and the subjective day-to-day functioning in society.

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Expanding unilateral cochlear implantation criteria for adults with bilateral acquired severe sensorineural hearing loss

Abstract

Objectives

To report on a retrospective cohort study on the effects of expanding inclusion criteria for application of cochlear implants (CIs) on the performance 1-year post-implantation.

Methods

Based on pre-implantation audiometric thresholds and aided speech recognition scores, the data of 164 CI recipients were divided into a group of patients that fulfilled conservative criteria (mean hearing loss at 0.5, 1 and 2 kHz > 85 dB HL and phoneme scores with hearing aids < 30%), and the remaining group of patients that felt outside this conservative criterion. Speech recognition scores (in quiet) and quality of life (using the NCIQ) of both groups, measured at 1-year post-implantation, were compared.

Results

The group that felt outside the conservative criterion showed a higher phoneme score at 1-year post-implantation compared to the conservative group, suggesting that relaxed criteria have a positive influence on the speech recognition results with CI. With respect to quality of life, both groups significantly improved 1-year post-implantation. The conservative group showed a higher benefit on the advanced perception domain of the NCIQ. Based on their worse pre-implantation hearing, this was expected.

Conclusions

The data suggest that relaxation of CI indication positively affects the speech recognition performance of patients with severe hearing loss. Both groups of patients showed a positive effect of CI on the quality of life. This benefit relates to communication skills and the subjective day-to-day functioning in society.

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UTZ Quality Foods Issues Allergy Alert on Undeclared Milk in Bachman 10 Ounce Twist

Utz Quality Foods, LLC., is voluntarily recalling a specific expiration date code of Bachman 10 oz Twist Pretzel packages due to undeclared milk. This recall was initiated after reviewing production records which identified a small number of packages were mislabeled. (Source: Food and Drug Administration)

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Balancing the gut

(Charit é - Universit ä tsmedizin Berlin) Researchers from the Cluster of Excellence 'Precision Medicine in Chronic Inflammation' in Kiel and Charit é - Universit ä tsmedizin Berlin have uncovered a critical mechanism that controls immune reactions against microorganisms in the intestine. The results of the international study may contribute to the development of new therapies for chronic inflammatory bowel disease. They have been published in the journal Nature Immunology. (Source: EurekAlert! - Medicine and Health)

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Balancing the gut

(Charit é - Universit ä tsmedizin Berlin) Researchers from the Cluster of Excellence 'Precision Medicine in Chronic Inflammation' in Kiel and Charit é - Universit ä tsmedizin Berlin have uncovered a critical mechanism that controls immune reactions against microorganisms in the intestine. The results of the international study may contribute to the development of new therapies for chronic inflammatory bowel disease. They have been published in the journal Nature Immunology. (Source: EurekAlert! - Medicine and Health)

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UTZ Quality Foods Issues Allergy Alert on Undeclared Milk in Bachman 10 Ounce Twist

Utz Quality Foods, LLC., is voluntarily recalling a specific expiration date code of Bachman 10 oz Twist Pretzel packages due to undeclared milk. This recall was initiated after reviewing production records which identified a small number of packages were mislabeled. (Source: Food and Drug Administration)

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UTZ Quality Foods Issues Allergy Alert on Undeclared Milk in Bachman 10 Ounce Twist

Utz Quality Foods, LLC., is voluntarily recalling a specific expiration date code of Bachman 10 oz Twist Pretzel packages due to undeclared milk. This recall was initiated after reviewing production records which identified a small number of packages were mislabeled. (Source: Food and Drug Administration)

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Positive pressure device treatment for Menière’s disease: an overview of the current evidence and a meta-analysis

Abstract

Objective

The objective was to critically assess the current evidence investigating the efficacy of using a positive pressure device in patients with definite or probable Menière's disease.

Methods

We performed a systematic literature search in MEDLINE, EMBASE and PsycINFO up to February 2018. We included both systematic reviews and primary literature [randomized controlled trials (RCTs)] investigating positive pressure treatment, in patients (≥ 18 years of age), with Menière's disease. We assessed the internal validity of systematic reviews using the AMSTAR tool and risk of bias of primary studies using the Cochrane Risk of bias tool. We performed a meta-analysis for each outcome based on the identified studies. The overall certainty of evidence for the outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results

The search for systematic reviews identified four relevant reviews. These all included the same four RCTs. An updated search identified one additional RCT. In total, five RCTs were included in the data synthesis. Our data synthesis showed no effect of positive pressure treatment on primary nor secondary outcomes. No serious adverse events were reported. The overall certainty of evidence ranged from very low to low, due to the serious risk of bias and imprecision.

Conclusion

The current available evidence does not support positive pressure device treatment in patients with Menière's disease. However, the limitations of the current literature hinder the possibility of any solid conclusion. There remains a need for randomized controlled trials of high quality to fully access the utility of this treatment.

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Positive pressure device treatment for Menière’s disease: an overview of the current evidence and a meta-analysis

Abstract

Objective

The objective was to critically assess the current evidence investigating the efficacy of using a positive pressure device in patients with definite or probable Menière's disease.

Methods

We performed a systematic literature search in MEDLINE, EMBASE and PsycINFO up to February 2018. We included both systematic reviews and primary literature [randomized controlled trials (RCTs)] investigating positive pressure treatment, in patients (≥ 18 years of age), with Menière's disease. We assessed the internal validity of systematic reviews using the AMSTAR tool and risk of bias of primary studies using the Cochrane Risk of bias tool. We performed a meta-analysis for each outcome based on the identified studies. The overall certainty of evidence for the outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results

The search for systematic reviews identified four relevant reviews. These all included the same four RCTs. An updated search identified one additional RCT. In total, five RCTs were included in the data synthesis. Our data synthesis showed no effect of positive pressure treatment on primary nor secondary outcomes. No serious adverse events were reported. The overall certainty of evidence ranged from very low to low, due to the serious risk of bias and imprecision.

Conclusion

The current available evidence does not support positive pressure device treatment in patients with Menière's disease. However, the limitations of the current literature hinder the possibility of any solid conclusion. There remains a need for randomized controlled trials of high quality to fully access the utility of this treatment.

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Novel compounds protect auditory hair cells against gentamycin-induced apoptosis by maintaining the expression level of H3K4me2.

Authors: Li A, You D, Li W, Cui Y, He Y, Li W, Chen Y, Feng X, Sun S, Chai R, Li H Abstract Aminoglycoside-induced hair cell (HC) loss is a major cause of hearing impairment, and the effective prevention of HC loss remains an unmet medical need. Epigenetic mechanisms have been reported to be involved in protecting cochlear cells against ototoxic drug injury, and in this study we developed new bioactive compounds that have similar chemical structures as the epigenetics-related lysine-specific demethylase 1 (LSD1) inhibitors. LSD1 inhibitors have been reported to protect cochlear cells by preventing demethylation of dimethylated histone H3K4 (H3K4me2). To determine whether these new compounds exert similar protective effects on HCs, we treated mouse cochlear explant cultures with the...

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Which imaging modality in cochlear implant candidates?

ConclusionsWe suggest both imaging modalities in pediatric candidates. However, in adults, we think that superiority of either imaging modalities is still contradictive. We had only three adult patients and the decision of the side of surgery was made according to MRI in one of them and to both imaging modalities in the other two adults. (Source: European Archives of Oto-Rhino-Laryngology)

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Capacities and neural mechanisms for auditory statistical learning across species.

Authors: Schiavo JK, Froemke RC Abstract Statistical learning has been proposed as a possible mechanism by which individuals can become sensitive to the structures of language fundamental for speech perception. Since its description in human infants, statistical learning has been described in human adults and several non-human species as a general process by which animals learn about stimulus-relevant statistics. The neurobiology of statistical learning is beginning to be understood, but many questions remain about the underlying mechanisms. Why is the developing brain particularly sensitive to stimulus and environmental statistics, and what neural processes are engaged in the adult brain to enable learning from statistical regularities in the absence of external reward or instruct...

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Which imaging modality in cochlear implant candidates?

ConclusionsWe suggest both imaging modalities in pediatric candidates. However, in adults, we think that superiority of either imaging modalities is still contradictive. We had only three adult patients and the decision of the side of surgery was made according to MRI in one of them and to both imaging modalities in the other two adults. (Source: European Archives of Oto-Rhino-Laryngology)

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Novel compounds protect auditory hair cells against gentamycin-induced apoptosis by maintaining the expression level of H3K4me2.

Authors: Li A, You D, Li W, Cui Y, He Y, Li W, Chen Y, Feng X, Sun S, Chai R, Li H Abstract Aminoglycoside-induced hair cell (HC) loss is a major cause of hearing impairment, and the effective prevention of HC loss remains an unmet medical need. Epigenetic mechanisms have been reported to be involved in protecting cochlear cells against ototoxic drug injury, and in this study we developed new bioactive compounds that have similar chemical structures as the epigenetics-related lysine-specific demethylase 1 (LSD1) inhibitors. LSD1 inhibitors have been reported to protect cochlear cells by preventing demethylation of dimethylated histone H3K4 (H3K4me2). To determine whether these new compounds exert similar protective effects on HCs, we treated mouse cochlear explant cultures with the...

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Capacities and neural mechanisms for auditory statistical learning across species.

Authors: Schiavo JK, Froemke RC Abstract Statistical learning has been proposed as a possible mechanism by which individuals can become sensitive to the structures of language fundamental for speech perception. Since its description in human infants, statistical learning has been described in human adults and several non-human species as a general process by which animals learn about stimulus-relevant statistics. The neurobiology of statistical learning is beginning to be understood, but many questions remain about the underlying mechanisms. Why is the developing brain particularly sensitive to stimulus and environmental statistics, and what neural processes are engaged in the adult brain to enable learning from statistical regularities in the absence of external reward or instruct...

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Inverse association between statin use and head and neck cancer: A population‐based case‐control study in Han population

Abstract

Background

This case‐control study aimed to find the relationship between prior statin use and head and neck cancer occurrence using a large population‐based database.

Methods

This study used claims data from the Taiwan Longitudinal Health Insurance Database. We included 5515 patients with head and neck cancer as cases and 5515 propensity score‐matched patients without head and neck cancer as controls. Conditional logistic regressions were performed to investigate the relationship between head and neck cancer and prior statin exposure.

Results

Of the 11 030 total sampled patients, 16.95% had previously received prescriptions for statins. In addition, statin exposure was found in 15.99% of cases and 17.91% of controls. The logistic regression also revealed that the adjusted odds ratio of prior statin exposure for cases was 0.86 (95% confidence interval: 0.77‐0.95) compared to propensity score‐matched controls.

Conclusion

This study found an inverse association between statin usage and head and neck cancer occurrence.

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Inverse association between statin use and head and neck cancer: A population‐based case‐control study in Han population

Abstract

Background

This case‐control study aimed to find the relationship between prior statin use and head and neck cancer occurrence using a large population‐based database.

Methods

This study used claims data from the Taiwan Longitudinal Health Insurance Database. We included 5515 patients with head and neck cancer as cases and 5515 propensity score‐matched patients without head and neck cancer as controls. Conditional logistic regressions were performed to investigate the relationship between head and neck cancer and prior statin exposure.

Results

Of the 11 030 total sampled patients, 16.95% had previously received prescriptions for statins. In addition, statin exposure was found in 15.99% of cases and 17.91% of controls. The logistic regression also revealed that the adjusted odds ratio of prior statin exposure for cases was 0.86 (95% confidence interval: 0.77‐0.95) compared to propensity score‐matched controls.

Conclusion

This study found an inverse association between statin usage and head and neck cancer occurrence.

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New update brings fall detection, alerts to Livio AI connected hearing aid

The device's secure alert can be triggered automatically or manually, and uses location tracking services to pinpoint the wearer's exact location to family members or caretakers. (Source: mobihealthnews)

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New update brings fall detection, alerts to Livio AI connected hearing aid

The device's secure alert can be triggered automatically or manually, and uses location tracking services to pinpoint the wearer's exact location to family members or caretakers. (Source: mobihealthnews)

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Editorial Board

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Training Groups

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Editorial Board

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Training Groups

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New update brings fall detection, alerts to Livio AI connected hearing aid

The device's secure alert can be triggered automatically or manually, and uses location tracking services to pinpoint the wearer's exact location to family members or caretakers. (Source: mobihealthnews)

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New update brings fall detection, alerts to Livio AI connected hearing aid

The device's secure alert can be triggered automatically or manually, and uses location tracking services to pinpoint the wearer's exact location to family members or caretakers. (Source: mobihealthnews)

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Safety and Efficacy of Mometasone Furoate (SCH 032088) vs Beclomethasone Dipropionate or Placebo in Seasonal Allergic Rhinitis (C93-013)

Condition:   Seasonal Allergic Rhinitis Interventions:   Drug: Mometasone Furoate (MF);   Drug: Beclomethasone Dipropionate (BDP);   Drug: Placebo Sponsor:   Merck Sharp & Dohme Corp. Completed (Source: ClinicalTrials.gov)

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Safety and Efficacy of Mometasone Furoate Nasal Spray With the Addition of Loratadine Versus Placebo in Participants With Seasonal Allergic Rhinitis (C94-145)

Condition:   Rhinitis, Allergic Interventions:   Drug: Mometasone furoate nasal spray (MFNS);   Drug: Loratadine;   Drug: Placebo nasal spray;   Drug: Placebo tablet Sponsor:   Merck Sharp & Dohme Corp. Completed (Source: ClinicalTrials.gov)

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Reactive Doses and Times During Oral Food Challenge to Peanut

Condition:   Peanut Allergy Intervention:   Sponsor:   University Hospital, Montpellier Recruiting (Source: ClinicalTrials.gov)

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Characteristics of Patients Diagnosed With NSAID Sensitivity in Thailand

Conditions:   Aspirin Sensitivity;   Aspirin-exacerbated Respiratory Disease;   Aspirin-Induced Angioedema-Urticaria;   Aspirin Allergy;   NSAID-Induced Asthma;   NSAID-Induced Angioedema-Urticaria;   NSAID-Induced Anaphylactoid Reaction;   Aspirin-Induced Anaphylactoid Reaction Intervention:   Drug: aspirin, NSAIDs, paracetamol Sponsor:   Chulalongkorn University Recruiting (Source: ClinicalTrials.gov)

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Validation of the HYPONUT Product

Condition:   Peanut Allergy Intervention:   Other: Hyponut Sponsor:   University Hospital, Montpellier Not yet recruiting (Source: ClinicalTrials.gov)

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Mucosal and Systemic Immunity After Viral Challenge of Healthy Volunteers Vaccinated With Inactivated Influenza Vaccine Via the Intranasal Versus Intramuscular Route

Condition:   Influenza Interventions:   Biological: Flucelvax Quadrivalent inactivated influenza vaccine;   Other: A/Bethesda/MM2/H1N1 Passage 6 virus Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Experimental Human Infection With Neisseria Gonorrhoeae

Condition:   Gonococcal Infection Interventions:   Drug: Cefixime;   Drug: Ceftriaxone;   Drug: Ciprofloxacin;   Biological: Neisseria gonorrhoeae strain FA1090 A26;   Biological: Neisseria gonorrhoeae strain FA7537 Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Two grass pollen tablets commercially available for allergy immunotherapy display different IgE epitope repertoires

Abstract

Background

The distribution of Pooideae species varies across Europe. Especially, Timothy is less represented in Southern than in Northern Europe. Since allergenic cross-reactivity between pollens from different grasses is only partial, grass pollen-allergic patients are expected to display different sensitization profiles, with specific IgE directed against different combinations of allergenic epitopes, depending on their living places in Europe and the grasses they are exposed to. In this context, this study aimed at comparing two tablets commercially available for allergy immunotherapy, namely a 5-grass (Cocksfoot, Meadow-grass, Rye-grass, Sweet vernal-grass and Timothy) and a 1-grass (Timothy) pollen tablets, for their ability to represent the sensitization profiles of patients, depending on whether they live in Southern or Northern Europe.

Methods

Sera were collected from adult patients living in Spain (n = 19) and Sweden (n = 22). Tablets were compared for their ability to inhibit the binding of patient serum IgE to pollen allergens from twelve grasses commonly distributed throughout Europe, as determined by the areas under the curves obtained by ELISA-inhibition. Tablets were adjusted to an equivalent allergenic activity, based on the CBER/FDA bioequivalent allergy unit.

Results

Inhibition of the IgE binding to pollen allergens from twelve grasses was significantly stronger with the 5-grass than with the 1-grass pollen tablet (p < 0.0001), regardless of whether patients were considered as a whole or by geographical area. This difference between tablets was significantly greater for Southern than Northern European patients (p < 0.05).

Conclusions

Compared to the 1-grass tablet, the 5-grass tablet generally covers better the sensitization profiles of European patients, especially patients from Southern Europe, in principle less exposed to pollen from Timothy than from other grasses. The 5-grass tablet is therefore expected to elicit larger spectra of blocking antibodies, which might have implications in light of the generally accepted mechanisms of allergy immunotherapy.

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Safety and Efficacy of Mometasone Furoate (SCH 032088) vs Beclomethasone Dipropionate or Placebo in Seasonal Allergic Rhinitis (C93-013)

Condition:   Seasonal Allergic Rhinitis Interventions:   Drug: Mometasone Furoate (MF);   Drug: Beclomethasone Dipropionate (BDP);   Drug: Placebo Sponsor:   Merck Sharp & Dohme Corp. Completed (Source: ClinicalTrials.gov)

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Safety and Efficacy of Mometasone Furoate Nasal Spray With the Addition of Loratadine Versus Placebo in Participants With Seasonal Allergic Rhinitis (C94-145)

Condition:   Rhinitis, Allergic Interventions:   Drug: Mometasone furoate nasal spray (MFNS);   Drug: Loratadine;   Drug: Placebo nasal spray;   Drug: Placebo tablet Sponsor:   Merck Sharp & Dohme Corp. Completed (Source: ClinicalTrials.gov)

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Reactive Doses and Times During Oral Food Challenge to Peanut

Condition:   Peanut Allergy Intervention:   Sponsor:   University Hospital, Montpellier Recruiting (Source: ClinicalTrials.gov)

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Characteristics of Patients Diagnosed With NSAID Sensitivity in Thailand

Conditions:   Aspirin Sensitivity;   Aspirin-exacerbated Respiratory Disease;   Aspirin-Induced Angioedema-Urticaria;   Aspirin Allergy;   NSAID-Induced Asthma;   NSAID-Induced Angioedema-Urticaria;   NSAID-Induced Anaphylactoid Reaction;   Aspirin-Induced Anaphylactoid Reaction Intervention:   Drug: aspirin, NSAIDs, paracetamol Sponsor:   Chulalongkorn University Recruiting (Source: ClinicalTrials.gov)

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Validation of the HYPONUT Product

Condition:   Peanut Allergy Intervention:   Other: Hyponut Sponsor:   University Hospital, Montpellier Not yet recruiting (Source: ClinicalTrials.gov)

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A Prospective Multicenter Clinical Trial of MRD-based Treatment Strategy in Children and Young Adults With AML

Condition:   Acute Myeloid Leukemia, Childhood Intervention:   Other: HSCT Sponsors:   Federal Research Institute of Pediatric Hematology, Oncology and Immunology;   Physicians, Innovations, Science for Children Fund Not yet recruiting (Source: ClinicalTrials.gov)

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Mucosal and Systemic Immunity After Viral Challenge of Healthy Volunteers Vaccinated With Inactivated Influenza Vaccine Via the Intranasal Versus Intramuscular Route

Condition:   Influenza Interventions:   Biological: Flucelvax Quadrivalent inactivated influenza vaccine;   Other: A/Bethesda/MM2/H1N1 Passage 6 virus Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Impact of MEditerranean Diet, Inflammation and Microbiome After an Acute Coronary Syndrome

Condition:   Acute Coronary Syndrome Interventions:   Other: Microbiota analysis;   Other: Immunological analysis;   Other: Proteome analysis;   Other: Metabolome analysis;   Other: Clinical evaluation;   Other: Diet evaluation;   Other: MedDiet Sponsors:   Consorcio Centro de Investigación Biomédica en Red, M.P.;   Hospital General Universitario Gregorio Marañon;   Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana;   University of Navarra;   Institut National de la Santé Et de la Recher che Médicale, France;   Tel Aviv University;   Göteborg University Not yet recruiting (Source: ClinicalTrials.gov)

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Experimental Human Infection With Neisseria Gonorrhoeae

Condition:   Gonococcal Infection Interventions:   Drug: Cefixime;   Drug: Ceftriaxone;   Drug: Ciprofloxacin;   Biological: Neisseria gonorrhoeae strain FA1090 A26;   Biological: Neisseria gonorrhoeae strain FA7537 Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Recruiting (Source: ClinicalTrials.gov)

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Two grass pollen tablets commercially available for allergy immunotherapy display different IgE epitope repertoires

Abstract

Background

The distribution of Pooideae species varies across Europe. Especially, Timothy is less represented in Southern than in Northern Europe. Since allergenic cross-reactivity between pollens from different grasses is only partial, grass pollen-allergic patients are expected to display different sensitization profiles, with specific IgE directed against different combinations of allergenic epitopes, depending on their living places in Europe and the grasses they are exposed to. In this context, this study aimed at comparing two tablets commercially available for allergy immunotherapy, namely a 5-grass (Cocksfoot, Meadow-grass, Rye-grass, Sweet vernal-grass and Timothy) and a 1-grass (Timothy) pollen tablets, for their ability to represent the sensitization profiles of patients, depending on whether they live in Southern or Northern Europe.

Methods

Sera were collected from adult patients living in Spain (n = 19) and Sweden (n = 22). Tablets were compared for their ability to inhibit the binding of patient serum IgE to pollen allergens from twelve grasses commonly distributed throughout Europe, as determined by the areas under the curves obtained by ELISA-inhibition. Tablets were adjusted to an equivalent allergenic activity, based on the CBER/FDA bioequivalent allergy unit.

Results

Inhibition of the IgE binding to pollen allergens from twelve grasses was significantly stronger with the 5-grass than with the 1-grass pollen tablet (p < 0.0001), regardless of whether patients were considered as a whole or by geographical area. This difference between tablets was significantly greater for Southern than Northern European patients (p < 0.05).

Conclusions

Compared to the 1-grass tablet, the 5-grass tablet generally covers better the sensitization profiles of European patients, especially patients from Southern Europe, in principle less exposed to pollen from Timothy than from other grasses. The 5-grass tablet is therefore expected to elicit larger spectra of blocking antibodies, which might have implications in light of the generally accepted mechanisms of allergy immunotherapy.

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F-BAR domain only protein 1 (FCHO1) deficiency is a novel cause of combined immune deficiency in humans

FCHO1 deficiency is a novel autosomal recessive combined immune deficiency with impaired clathrin-mediated endocytosis

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Can the morbidly obese asthmatic child be well controlled? The Breathmobile program

The obese asthmatic is thought to disproportionally experience greater severity, morbidity, increased exacerbations, and reduced inhaled corticosteroid responsiveness. We have previously reported that care provided by a community-based healthcare delivery system, the Breathmobile, results in improved asthma control, and reduced morbidity. We hypothesized that this system of care could provide similar outcomes for the morbidly obese compared to the normal weight asthmatic child.

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Can the morbidly obese asthmatic child be well controlled? The Breathmobile program

The obese asthmatic is thought to disproportionally experience greater severity, morbidity, increased exacerbations, and reduced inhaled corticosteroid responsiveness. We have previously reported that care provided by a community-based healthcare delivery system, the Breathmobile, results in improved asthma control, and reduced morbidity. We hypothesized that this system of care could provide similar outcomes for the morbidly obese compared to the normal weight asthmatic child.

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Bipedicle Dermis Fat Graft for Orbital Volume Augmentation and Repair of Lower Eyelid Retraction in an Anophthalmic Socket With Prior Orbital Implant Placement

Buphthalmos can create treatment challenges for socket rehabilitation following enucleation due to compression atrophy and mechanical stretching of adnexal tissues. The authors report a case demonstrating a surgical technique for simultaneous volume augmentation of the anophthalmic socket, expansion of the conjunctival fornix, and repair of lower eyelid retraction in a patient with history of buphthalmos and a previously placed 22 mm orbital implant at the time of enucleation. The authors utilized a single-stage, bipedicle dermis fat graft. Postoperatively, the patient demonstrated improvement in lower eyelid position, lower eyelid volume, improved prosthesis fit, improved three-dimensional projection of the ocular prosthesis, and an improvement in the superior sulcus deformity. Bipedicle dermis fat grafts are an option for surgical rehabilitation of the anophthalmic socket when orbital volume deficiency, conjunctival fornix contracture, and eyelid retraction are present and an adequately sized orbital implant has previously been placed. Accepted for publication December 4, 2018. The authors have no financial or conflicts of interest to disclose. Presented in part at the American Society of Ocularists Medical Advisory Seminar on October 27, 2018, in Chicago, IL. Address correspondence and reprint requests to Kyle J. Godfrey, M.D., Edward S. Harkness Eye Institute, Columbia University Medical Center, 635 W. 165th Street, New York, NY. E-mail: kjg2157@cumc.columbia.edu © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Hybrid Neurofibroma/Schwannoma of the Orbit

A 68-year-old female presented for assessment of a space occupying lesion of her right orbit, demonstrated on MRI. An upper lid crease anterior orbitotomy was performed and the lesion excised completely. Postoperatively, she had reduced sensation in the distribution of the supraorbital nerve. Histopathologic examination of the excised lesion revealed a hybrid neurofibroma/schwannoma. This represents the fourth reported case of such a lesion arising within the orbit. Accepted for publication January 4, 2019. The authors have no conflicts of interests to disclose. Written consent was gained from the patient for publication and use of photographs. Address correspondence and reprint requests to Louis Stevenson, M.B.B.S., Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria, Australia. E-mail: louis.stevenson@utas.edu.au © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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INI1/SMARCB1-Deficient Carcinoma (Rhabdoid Tumor) of the Lacrimal Gland

Integrase interactor 1 (INI1) is a tumor suppressor gene that is ubiquitously expressed in all nucleated cells. The loss of INI1 protein activity was first demonstrated in aggressive pediatric tumors, including atypical teratoid/rhabdoid (AT/RT) tumor of the central nervous system and malignant rhabdoid tumor of the kidney. Subsequently, INI1 deficiency was discovered in other pediatric and some adult neoplasms. The spectrum of INI1-negative tumors includes a wide variety of neoplasms that occur over a wide age range, are variably aggressive, and have a variable rhabdoid component on histopathologic evaluation. In this report, the authors describe a 27-year-old gravid woman with INI1-deficient carcinoma of the lacrimal gland, previously not described in this location. Accepted for publication December 10, 2018. The authors have no financial or conflict of interest for disclosure. Address correspondence and reprint requests to Jurij R. Bilyk, M.D., Suite 930, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107. E-mail: jrbilyk@aol.com © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Optic Nerve Sheath Fenestration for Treatment of Retrolaminar Silicone Oil Migration

The authors report the case of a 75-year-old man with preexisting glaucoma and recurrent retinal detachment who underwent intraocular silicone oil placement OD resulting in subsequent retrolaminar silicone oil migration to the optic chiasm and vision loss OS. MRI showed silicone oil tracking posteriorly along the right optic nerve to the chiasm. He was placed on high-dose corticosteroids and underwent a successful optic nerve sheath fenestration with improvement of vision in the contralateral eye. Clinicians should be cognizant of the potential for translaminar posterior migration of intraocular silicone oil, as well as the utility of optic nerve sheath fenestration to decompress the anterior visual pathways and restore vision. Accepted for publication November 14, 2018. The authors have no conflicts of interests to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.op-rs.com.). Presented at the fall meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery on October 26, 2018 in Chicago, IL. Address correspondence and reprint requests to Collin McClelland, M.D., Department of Ophthalmology and Visual Neurosciences, University of Minnesota, 516 Delaware Street SE, Minneapolis, MN 55455. E-mail: cmc@umn.edu © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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A Longitudinal Analysis of Pressurized Wideband Absorbance Measures in Healthy Young Infants

Objectives: Wideband absorbance (WBA) is an emerging technology to evaluate the conductive pathway (outer and middle ear) in young infants. While a wealth of research has been devoted to measuring WBA at ambient pressure, few studies have investigated the use of pressurized WBA with this population. The purpose of this study was to investigate the effect of age on WBA measured under pressurized conditions in healthy infants from 0 to 6 months of age. Design: Forty-four full-term healthy neonates (17 males and 27 females) participated in a longitudinal study. The neonates were assessed at 1-month intervals from 0 to 6 months of age using high-frequency tympanometry, acoustic stapedial reflex, distortion product otoacoustic emissions, and pressurized WBA. The values of WBA at tympanometric peak pressure (TPP) and 0 daPa across the frequencies from 0.25 to 8 kHz were analyzed as a function of age. Results: A linear mixed model analysis, applied to the data, revealed significantly different WBA patterns among the age groups. In general, WBA measured at TPP and 0 daPa decreased at low frequencies (

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Benefit of Higher Maximum Force Output on Listening Effort in Bone-Anchored Hearing System Users: A Pupillometry Study

Objectives: The aim of this study was to compare listening effort, as estimated via pupillary response, during a speech-in-noise test in bone-anchored hearing system (BAHS) users wearing three different sound processors. The three processors, Ponto Pro (PP), Ponto 3 (P3), and Ponto 3 SuperPower (P3SP), differ in terms of maximum force output (MFO) and MFO algorithm. The hypothesis was that listeners would allocate lower listening effort with the P3SP than with the PP, as a consequence of a higher MFO and, hence, fewer saturation artifacts in the signal. Design: Pupil dilations were recorded in 21 BAHS users with a conductive or mixed hearing loss, during a speech-in-noise test performed at positive signal-to-noise ratios (SNRs), where the speech and noise levels were individually adjusted to lead to 95% correct intelligibility with the PP. The listeners had to listen to a sentence in noise, retain it for 3 seconds and then repeat it, while an eye-tracking camera recorded their pupil dilation. The three sound processors were tested in random order with a single-blinded experimental design. Two conditions were performed at the same SNR: Condition 1, where the speech level was designed to saturate the PP but not the P3SP, and condition 2, where the overall sound level was decreased relative to condition 1 to reduce saturation artifacts. Results: The P3SP led to higher speech intelligibility than the PP in both conditions, while the performance with the P3 did not differ from the performance with the PP and the P3SP. Pupil dilations were analyzed in terms of both peak pupil dilation (PPD) and overall pupil dilation via growth curve analysis (GCA). In condition 1, a significantly lower PPD, indicating a decrease in listening effort, was obtained with the P3SP relative to the PP. The PPD obtained with the P3 did not differ from the PPD obtained with the other two sound processors. In condition 2, no difference in PPD was observed across the three processors. The GCA revealed that the overall pupil dilation was significantly lower, in both conditions, with both the P3SP and the P3 relative to the PP, and, in condition 1, also with the P3SP relative to the P3. Conclusions: The overall effort to process a moderate to loud speech signal was significantly reduced by using a sound processor with a higher MFO (P3SP and P3), as a consequence of fewer saturation artifacts. These findings suggest that sound processors with a higher MFO may help BAHS users in their everyday listening scenarios, in particular in noisy environments, by improving sound quality and, thus, decreasing the amount of cognitive resources utilized to process incoming speech sounds. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank Matthew Winn for the helpful discussion of the results. This work was supported by Oticon Medical AB (Askim, Sweden). T. R., M. H., T. L., D. W., C. W., and P. M. designed the experiments; C. W. performed the experiments; F. B. and D. W. analyzed the data; F. B. wrote the article and provided the Supplementary Digital Content; all authors discussed the results and provided critical revision on the manuscript. The authors have no conflicts of interest to disclose. Received August 3, 2018; accepted December 18, 2018. Address for correspondence: Federica Bianchi, Oticon Medical AB, Kongebakken 9, Smørum, Denmark. E-mail: fedb@oticonmedical.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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A Comparison of Electrical Stimulation Levels Across Ears for Children With Sequential Bilateral Cochlear Implants

Objectives: To compare threshold and comfortable levels between a first and second cochlear implant (CI) for children, and to consider if the degree of difference between CIs was related to the age at bilateral implantation or the time between implants. A secondary objective was to examine the changes in levels over time for each CI . Design: Fifty-seven participants were selected from the 146 children and young adults who received a first Nucleus CI as a child, and received a second implant at the Royal Victorian Eye and Ear Hospital between September 2003 and December 2011. Exclusion criteria included an older implant type, incomplete array insertion, incomplete data available, and a pulse width higher than the default. Using measurements from clinical sessions, the threshold levels, comfortable levels, and dynamic range of electrical stimulation were compared at three electrode array regions and at the "initial" (first 10 weeks), 2-year, and 5-year postoperative time points. The T-ratio and C-ratio for each array region and each time point were calculated by dividing each mean (n = 3 electrodes) level for the second implant by that for the first implant. Results: The T-ratio was generally not significantly different to one, indicating no differences in threshold levels between the second and first implants; however, threshold levels were lower for the second implant in the apical region at the initial time point, and there was a significant difference in threshold levels in the apical region for children with a Contour Advance array for the second implant and an older-style array (i.e., Contour) for the first implant. For each implant individually, there were no significant changes in threshold levels across time. The C-ratio was significantly

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Different Associations between Auditory Function and Cognition Depending on Type of Auditory Function and Type of Cognition

Objectives: Previous studies strongly suggest that declines in auditory threshold can lead to impaired cognition. The aim of this study was to expand that picture by investigating how the relationships between age, auditory function, and cognitive function vary with the types of auditory and cognitive function considered. Design: Three auditory constructs (threshold, temporal-order identification, and gap detection) were modeled to have an effect on four cognitive constructs (episodic long-term memory, semantic long-term memory, working memory, and cognitive processing speed) together with age that could have an effect on both cognitive and auditory constructs. The model was evaluated with structural equation modeling of the data from 213 adults ranging in age from 18 to 86 years. Results: The model provided good a fit to the data. Regarding the auditory measures, temporal-order identification had the strongest effect on the cognitive functions, followed by weaker indirect effects for gap detection and nonsignificant effects for threshold. Regarding the cognitive measures, the association with audition was strongest for semantic long-term memory and working memory but weaker for episodic long-term memory and cognitive speed. Age had a very strong effect on threshold and cognitive speed, a moderate effect on temporal-order identification, episodic long-term memory, and working memory, a weak effect on gap detection, and nonsignificant, close to zero effect on semantic long-term memory. Conclusions: The result shows that auditory temporal-order function has the strongest effect on cognition, which has implications both for which auditory concepts to include in cognitive hearing science experiments and for practitioners. The fact that the total effect of age was different for different aspects of cognition and partly mediated via auditory concepts is also discussed. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: This study was financed by an excellence grant [349-2007-8654] from the Swedish Research council; a grant [2012-1693] from The Swedish Research Council for Health, Working Life and Welfare (to J.R.) and a grant [R01 AG008293] from the National Institute on Aging (to L.H.). The authors have no conflicts of interest to disclose. Address for correspondence: Henrik Danielsson, Department of Behavioural Sciences and Learning, Linköping University, 581 83 Linköping, Sweden. Email: henrik.danielsson@liu.se Received December 14, 2016; accepted December 18, 2018. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Bipedicle Dermis Fat Graft for Orbital Volume Augmentation and Repair of Lower Eyelid Retraction in an Anophthalmic Socket With Prior Orbital Implant Placement

Buphthalmos can create treatment challenges for socket rehabilitation following enucleation due to compression atrophy and mechanical stretching of adnexal tissues. The authors report a case demonstrating a surgical technique for simultaneous volume augmentation of the anophthalmic socket, expansion of the conjunctival fornix, and repair of lower eyelid retraction in a patient with history of buphthalmos and a previously placed 22 mm orbital implant at the time of enucleation. The authors utilized a single-stage, bipedicle dermis fat graft. Postoperatively, the patient demonstrated improvement in lower eyelid position, lower eyelid volume, improved prosthesis fit, improved three-dimensional projection of the ocular prosthesis, and an improvement in the superior sulcus deformity. Bipedicle dermis fat grafts are an option for surgical rehabilitation of the anophthalmic socket when orbital volume deficiency, conjunctival fornix contracture, and eyelid retraction are present and an adequately sized orbital implant has previously been placed. Accepted for publication December 4, 2018. The authors have no financial or conflicts of interest to disclose. Presented in part at the American Society of Ocularists Medical Advisory Seminar on October 27, 2018, in Chicago, IL. Address correspondence and reprint requests to Kyle J. Godfrey, M.D., Edward S. Harkness Eye Institute, Columbia University Medical Center, 635 W. 165th Street, New York, NY. E-mail: kjg2157@cumc.columbia.edu © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Hybrid Neurofibroma/Schwannoma of the Orbit

A 68-year-old female presented for assessment of a space occupying lesion of her right orbit, demonstrated on MRI. An upper lid crease anterior orbitotomy was performed and the lesion excised completely. Postoperatively, she had reduced sensation in the distribution of the supraorbital nerve. Histopathologic examination of the excised lesion revealed a hybrid neurofibroma/schwannoma. This represents the fourth reported case of such a lesion arising within the orbit. Accepted for publication January 4, 2019. The authors have no conflicts of interests to disclose. Written consent was gained from the patient for publication and use of photographs. Address correspondence and reprint requests to Louis Stevenson, M.B.B.S., Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria, Australia. E-mail: louis.stevenson@utas.edu.au © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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INI1/SMARCB1-Deficient Carcinoma (Rhabdoid Tumor) of the Lacrimal Gland

Integrase interactor 1 (INI1) is a tumor suppressor gene that is ubiquitously expressed in all nucleated cells. The loss of INI1 protein activity was first demonstrated in aggressive pediatric tumors, including atypical teratoid/rhabdoid (AT/RT) tumor of the central nervous system and malignant rhabdoid tumor of the kidney. Subsequently, INI1 deficiency was discovered in other pediatric and some adult neoplasms. The spectrum of INI1-negative tumors includes a wide variety of neoplasms that occur over a wide age range, are variably aggressive, and have a variable rhabdoid component on histopathologic evaluation. In this report, the authors describe a 27-year-old gravid woman with INI1-deficient carcinoma of the lacrimal gland, previously not described in this location. Accepted for publication December 10, 2018. The authors have no financial or conflict of interest for disclosure. Address correspondence and reprint requests to Jurij R. Bilyk, M.D., Suite 930, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107. E-mail: jrbilyk@aol.com © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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Optic Nerve Sheath Fenestration for Treatment of Retrolaminar Silicone Oil Migration

The authors report the case of a 75-year-old man with preexisting glaucoma and recurrent retinal detachment who underwent intraocular silicone oil placement OD resulting in subsequent retrolaminar silicone oil migration to the optic chiasm and vision loss OS. MRI showed silicone oil tracking posteriorly along the right optic nerve to the chiasm. He was placed on high-dose corticosteroids and underwent a successful optic nerve sheath fenestration with improvement of vision in the contralateral eye. Clinicians should be cognizant of the potential for translaminar posterior migration of intraocular silicone oil, as well as the utility of optic nerve sheath fenestration to decompress the anterior visual pathways and restore vision. Accepted for publication November 14, 2018. The authors have no conflicts of interests to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.op-rs.com.). Presented at the fall meeting of the American Society of Ophthalmic Plastic and Reconstructive Surgery on October 26, 2018 in Chicago, IL. Address correspondence and reprint requests to Collin McClelland, M.D., Department of Ophthalmology and Visual Neurosciences, University of Minnesota, 516 Delaware Street SE, Minneapolis, MN 55455. E-mail: cmc@umn.edu © 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

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A Longitudinal Analysis of Pressurized Wideband Absorbance Measures in Healthy Young Infants

Objectives: Wideband absorbance (WBA) is an emerging technology to evaluate the conductive pathway (outer and middle ear) in young infants. While a wealth of research has been devoted to measuring WBA at ambient pressure, few studies have investigated the use of pressurized WBA with this population. The purpose of this study was to investigate the effect of age on WBA measured under pressurized conditions in healthy infants from 0 to 6 months of age. Design: Forty-four full-term healthy neonates (17 males and 27 females) participated in a longitudinal study. The neonates were assessed at 1-month intervals from 0 to 6 months of age using high-frequency tympanometry, acoustic stapedial reflex, distortion product otoacoustic emissions, and pressurized WBA. The values of WBA at tympanometric peak pressure (TPP) and 0 daPa across the frequencies from 0.25 to 8 kHz were analyzed as a function of age. Results: A linear mixed model analysis, applied to the data, revealed significantly different WBA patterns among the age groups. In general, WBA measured at TPP and 0 daPa decreased at low frequencies (

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Benefit of Higher Maximum Force Output on Listening Effort in Bone-Anchored Hearing System Users: A Pupillometry Study

Objectives: The aim of this study was to compare listening effort, as estimated via pupillary response, during a speech-in-noise test in bone-anchored hearing system (BAHS) users wearing three different sound processors. The three processors, Ponto Pro (PP), Ponto 3 (P3), and Ponto 3 SuperPower (P3SP), differ in terms of maximum force output (MFO) and MFO algorithm. The hypothesis was that listeners would allocate lower listening effort with the P3SP than with the PP, as a consequence of a higher MFO and, hence, fewer saturation artifacts in the signal. Design: Pupil dilations were recorded in 21 BAHS users with a conductive or mixed hearing loss, during a speech-in-noise test performed at positive signal-to-noise ratios (SNRs), where the speech and noise levels were individually adjusted to lead to 95% correct intelligibility with the PP. The listeners had to listen to a sentence in noise, retain it for 3 seconds and then repeat it, while an eye-tracking camera recorded their pupil dilation. The three sound processors were tested in random order with a single-blinded experimental design. Two conditions were performed at the same SNR: Condition 1, where the speech level was designed to saturate the PP but not the P3SP, and condition 2, where the overall sound level was decreased relative to condition 1 to reduce saturation artifacts. Results: The P3SP led to higher speech intelligibility than the PP in both conditions, while the performance with the P3 did not differ from the performance with the PP and the P3SP. Pupil dilations were analyzed in terms of both peak pupil dilation (PPD) and overall pupil dilation via growth curve analysis (GCA). In condition 1, a significantly lower PPD, indicating a decrease in listening effort, was obtained with the P3SP relative to the PP. The PPD obtained with the P3 did not differ from the PPD obtained with the other two sound processors. In condition 2, no difference in PPD was observed across the three processors. The GCA revealed that the overall pupil dilation was significantly lower, in both conditions, with both the P3SP and the P3 relative to the PP, and, in condition 1, also with the P3SP relative to the P3. Conclusions: The overall effort to process a moderate to loud speech signal was significantly reduced by using a sound processor with a higher MFO (P3SP and P3), as a consequence of fewer saturation artifacts. These findings suggest that sound processors with a higher MFO may help BAHS users in their everyday listening scenarios, in particular in noisy environments, by improving sound quality and, thus, decreasing the amount of cognitive resources utilized to process incoming speech sounds. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank Matthew Winn for the helpful discussion of the results. This work was supported by Oticon Medical AB (Askim, Sweden). T. R., M. H., T. L., D. W., C. W., and P. M. designed the experiments; C. W. performed the experiments; F. B. and D. W. analyzed the data; F. B. wrote the article and provided the Supplementary Digital Content; all authors discussed the results and provided critical revision on the manuscript. The authors have no conflicts of interest to disclose. Received August 3, 2018; accepted December 18, 2018. Address for correspondence: Federica Bianchi, Oticon Medical AB, Kongebakken 9, Smørum, Denmark. E-mail: fedb@oticonmedical.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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A Comparison of Electrical Stimulation Levels Across Ears for Children With Sequential Bilateral Cochlear Implants

Objectives: To compare threshold and comfortable levels between a first and second cochlear implant (CI) for children, and to consider if the degree of difference between CIs was related to the age at bilateral implantation or the time between implants. A secondary objective was to examine the changes in levels over time for each CI . Design: Fifty-seven participants were selected from the 146 children and young adults who received a first Nucleus CI as a child, and received a second implant at the Royal Victorian Eye and Ear Hospital between September 2003 and December 2011. Exclusion criteria included an older implant type, incomplete array insertion, incomplete data available, and a pulse width higher than the default. Using measurements from clinical sessions, the threshold levels, comfortable levels, and dynamic range of electrical stimulation were compared at three electrode array regions and at the "initial" (first 10 weeks), 2-year, and 5-year postoperative time points. The T-ratio and C-ratio for each array region and each time point were calculated by dividing each mean (n = 3 electrodes) level for the second implant by that for the first implant. Results: The T-ratio was generally not significantly different to one, indicating no differences in threshold levels between the second and first implants; however, threshold levels were lower for the second implant in the apical region at the initial time point, and there was a significant difference in threshold levels in the apical region for children with a Contour Advance array for the second implant and an older-style array (i.e., Contour) for the first implant. For each implant individually, there were no significant changes in threshold levels across time. The C-ratio was significantly

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Different Associations between Auditory Function and Cognition Depending on Type of Auditory Function and Type of Cognition

Objectives: Previous studies strongly suggest that declines in auditory threshold can lead to impaired cognition. The aim of this study was to expand that picture by investigating how the relationships between age, auditory function, and cognitive function vary with the types of auditory and cognitive function considered. Design: Three auditory constructs (threshold, temporal-order identification, and gap detection) were modeled to have an effect on four cognitive constructs (episodic long-term memory, semantic long-term memory, working memory, and cognitive processing speed) together with age that could have an effect on both cognitive and auditory constructs. The model was evaluated with structural equation modeling of the data from 213 adults ranging in age from 18 to 86 years. Results: The model provided good a fit to the data. Regarding the auditory measures, temporal-order identification had the strongest effect on the cognitive functions, followed by weaker indirect effects for gap detection and nonsignificant effects for threshold. Regarding the cognitive measures, the association with audition was strongest for semantic long-term memory and working memory but weaker for episodic long-term memory and cognitive speed. Age had a very strong effect on threshold and cognitive speed, a moderate effect on temporal-order identification, episodic long-term memory, and working memory, a weak effect on gap detection, and nonsignificant, close to zero effect on semantic long-term memory. Conclusions: The result shows that auditory temporal-order function has the strongest effect on cognition, which has implications both for which auditory concepts to include in cognitive hearing science experiments and for practitioners. The fact that the total effect of age was different for different aspects of cognition and partly mediated via auditory concepts is also discussed. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: This study was financed by an excellence grant [349-2007-8654] from the Swedish Research council; a grant [2012-1693] from The Swedish Research Council for Health, Working Life and Welfare (to J.R.) and a grant [R01 AG008293] from the National Institute on Aging (to L.H.). The authors have no conflicts of interest to disclose. Address for correspondence: Henrik Danielsson, Department of Behavioural Sciences and Learning, Linköping University, 581 83 Linköping, Sweden. Email: henrik.danielsson@liu.se Received December 14, 2016; accepted December 18, 2018. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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New generation continuous cardiac output monitoring from carbon dioxide elimination

Abstract

Background

There is continuing interest among clinicians in the potential for advanced hemodynamic monitoring and "goal directed" intravenous fluid administration guided by minimally-invasive cardiac output measurement to reduce complication rates in high risk patients undergoing major surgery. However, the adoption of the available technologies has been limited, due to cost, complexity and reliability of measurements provided. We review progress in the development of new generation methods for continuous non-invasive monitoring of cardiac output from measurement of carbon dioxide elimination in ventilated patients using the Differential Fick method.

Main text

The history and underlying theoretical basis are described, and its recent further development and implementation using modern generation anesthesia monitoring and delivery systems by two separate but parallel methods, termed "Capnotracking" and "Capnodynamics". Both methods generate breath-by-breath hands-free cardiac output monitoring from changes in carbon dioxide elimination produced by automatic computerized modulation of respiratory rate delivered by an electronic ventilator. Extensive preclinical validation in animal models of hemodynamic instability, with implanted ultrasonic flow probes for gold standard reference measurements, shows this approach delivers reliable, continuous cardiac output measurement in real time. The accuracy and precision of measurement by the Capnodynamic method were maintained under a wide range of both hemodynamic and respiratory conditions, including inotropic stimulation, vasodilatation, hemorrhage, caval compression, alveolar lavage, changes in tidal volume and positive end-expiratory pressure, and hypercapnia, with only brief derangement observed in a model of lower body ischemia involving release of prolonged aortic occlusion by an intra-aortic balloon. Phase 2 testing of a Capnotracking system in patients undergoing cardiac surgery and liver transplantation has achieved a percentage error of agreement with thermodilution of +/− 38.7% across a wide range of hemodynamic states.

Conclusions

Progress in development of these technologies suggest that a robust, automated and reliable method of non-invasive cardiac output monitoring from capnography is close at hand for use in major surgery and critical care. The great advantage of this approach is that it can be fully integrated into the anesthesia machine and ventilator, using components that are already standard in modern anesthesia and intensive care workstations, and should be virtually hands-free and automatic.

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Intraoperative Findings Of Extraocular Muscle Necrosis In Linear Orbital Trapdoor Fractures

Orbital trapdoor fractures may constitute a relative surgical emergency. The reason for poor surgical outcomes in ocular motility disturbances and diplopia is not apparent in these fractures. The purpose of this retrospective study was to analyze the possibility of ischemic necrosis of the orbital contents in linear trapdoor fracture of the orbital floor and to evaluate the recovery period of trapdoor fractures.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NtShbW

New generation continuous cardiac output monitoring from carbon dioxide elimination

Abstract

Background

There is continuing interest among clinicians in the potential for advanced hemodynamic monitoring and "goal directed" intravenous fluid administration guided by minimally-invasive cardiac output measurement to reduce complication rates in high risk patients undergoing major surgery. However, the adoption of the available technologies has been limited, due to cost, complexity and reliability of measurements provided. We review progress in the development of new generation methods for continuous non-invasive monitoring of cardiac output from measurement of carbon dioxide elimination in ventilated patients using the Differential Fick method.

Main text

The history and underlying theoretical basis are described, and its recent further development and implementation using modern generation anesthesia monitoring and delivery systems by two separate but parallel methods, termed "Capnotracking" and "Capnodynamics". Both methods generate breath-by-breath hands-free cardiac output monitoring from changes in carbon dioxide elimination produced by automatic computerized modulation of respiratory rate delivered by an electronic ventilator. Extensive preclinical validation in animal models of hemodynamic instability, with implanted ultrasonic flow probes for gold standard reference measurements, shows this approach delivers reliable, continuous cardiac output measurement in real time. The accuracy and precision of measurement by the Capnodynamic method were maintained under a wide range of both hemodynamic and respiratory conditions, including inotropic stimulation, vasodilatation, hemorrhage, caval compression, alveolar lavage, changes in tidal volume and positive end-expiratory pressure, and hypercapnia, with only brief derangement observed in a model of lower body ischemia involving release of prolonged aortic occlusion by an intra-aortic balloon. Phase 2 testing of a Capnotracking system in patients undergoing cardiac surgery and liver transplantation has achieved a percentage error of agreement with thermodilution of +/− 38.7% across a wide range of hemodynamic states.

Conclusions

Progress in development of these technologies suggest that a robust, automated and reliable method of non-invasive cardiac output monitoring from capnography is close at hand for use in major surgery and critical care. The great advantage of this approach is that it can be fully integrated into the anesthesia machine and ventilator, using components that are already standard in modern anesthesia and intensive care workstations, and should be virtually hands-free and automatic.

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Intraoperative Findings Of Extraocular Muscle Necrosis In Linear Orbital Trapdoor Fractures

Orbital trapdoor fractures may constitute a relative surgical emergency. The reason for poor surgical outcomes in ocular motility disturbances and diplopia is not apparent in these fractures. The purpose of this retrospective study was to analyze the possibility of ischemic necrosis of the orbital contents in linear trapdoor fracture of the orbital floor and to evaluate the recovery period of trapdoor fractures.

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Eustachian Tube (Dysfunction)

Title: Eustachian Tube (Dysfunction)Category: Diseases and ConditionsCreated: 5/29/1999 12:00:00 AMLast Editorial Review: 2/22/2019 12:00:00 AM (Source: MedicineNet Hearing General)

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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Ocasio-Cortez has no idea the Berlin Wall was built to keep people IN, not out... because everybody wants to flee socialism

(Natural News) Whether it's just plain arrogance or a lack of proper education — or both — New York Democratic Socialist Rep. Alexandria Ocasio-Cortez's tone deafness regarding her own ignorance about worldly matters and economics is stunning. Earlier this week, Ocasio-Cortez took to social media to decry POTUS Donald Trump's decision to declare a national... (Source: NaturalNews.com)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2XkQdrj

Intraoperative Findings Of Extraocular Muscle Necrosis In Linear Orbital Trapdoor Fractures

Orbital trapdoor fractures may constitute a relative surgical emergency. The reason for poor surgical outcomes in ocular motility disturbances and diplopia is not apparent in these fractures. The purpose of this retrospective study was to analyze the possibility of ischemic necrosis of the orbital contents in linear trapdoor fracture of the orbital floor and to evaluate the recovery period of trapdoor fractures.

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Eustachian Tube (Dysfunction)

Title: Eustachian Tube (Dysfunction)Category: Diseases and ConditionsCreated: 5/29/1999 12:00:00 AMLast Editorial Review: 2/22/2019 12:00:00 AM (Source: MedicineNet Hearing General)

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 https://ift.tt/2E4DobQ

Ocasio-Cortez has no idea the Berlin Wall was built to keep people IN, not out... because everybody wants to flee socialism

(Natural News) Whether it's just plain arrogance or a lack of proper education — or both — New York Democratic Socialist Rep. Alexandria Ocasio-Cortez's tone deafness regarding her own ignorance about worldly matters and economics is stunning. Earlier this week, Ocasio-Cortez took to social media to decry POTUS Donald Trump's decision to declare a national... (Source: NaturalNews.com)

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Intraoperative Findings Of Extraocular Muscle Necrosis In Linear Orbital Trapdoor Fractures

Orbital trapdoor fractures may constitute a relative surgical emergency. The reason for poor surgical outcomes in ocular motility disturbances and diplopia is not apparent in these fractures. The purpose of this retrospective study was to analyze the possibility of ischemic necrosis of the orbital contents in linear trapdoor fracture of the orbital floor and to evaluate the recovery period of trapdoor fractures.

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Association between biomarkers and medication-related osteonecrosis of the jaws: a systematic review

Our aim was to conduct a systematic review (SR) of the literature assessing the role of human biomarkers in the diagnosis or prognostication of medication-related osteonecrosis of the jaws (MRONJ).

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Association between biomarkers and medication-related osteonecrosis of the jaws: a systematic review

Our aim was to conduct a systematic review (SR) of the literature assessing the role of human biomarkers in the diagnosis or prognostication of medication-related osteonecrosis of the jaws (MRONJ).

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Breathing Problems From Aspirin? Help is Here

(MedPage Today) -- Encouraging results with desensitization protocol, nasal polyp removal (Source: MedPage Today Allergy)

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New Insights Into Course of Childhood Food Allergy

(MedPage Today) -- Many egg, peanut allergies vanish by first grade (Source: MedPage Today Allergy)

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Breathing Problems From Aspirin? Help is Here

(MedPage Today) -- Encouraging results with desensitization protocol, nasal polyp removal (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EyB7Hl

New Insights Into Course of Childhood Food Allergy

(MedPage Today) -- Many egg, peanut allergies vanish by first grade (Source: MedPage Today Allergy)

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Two-stage maxillary distraction osteogenesis using a modified external device: clinical outcome and complications

Rigid external distraction is currently used to correct severe maxillary hypoplasia. The purpose of this retrospective study was to present the clinical results and complications of a two-stage surgical approach using a modified external distraction system that consists of maxillary distraction and then maxillary fixation. We treated eight patients with cleft lip and palate in this way from 2016 to 2018. Lateral cephalograms taken before the first operation, after distraction, two weeks after the second operation, and one year after treatment were used to examine maxillofacial morphology. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Neoadjuvant immunotherapy: is this the “new” induction chemotherapy?

Immunotherapy is rapidly becoming another option for the treatment of cancer of the head and neck. Harnessing the immune system with immune checkpoint inhibitors, co-stimulatory agonists, vaccines, toll-like receptor (TLR) inhibitors, and chimeric antigen receptor (CAR) T cells, has shown clinical benefit in various types of cancer.1,2 (Source: The British Journal of Oral and Maxillofacial Surgery)

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Two-stage maxillary distraction osteogenesis using a modified external device: clinical outcome and complications

Rigid external distraction is currently used to correct severe maxillary hypoplasia. The purpose of this retrospective study was to present the clinical results and complications of a two-stage surgical approach using a modified external distraction system that consists of maxillary distraction and then maxillary fixation. We treated eight patients with cleft lip and palate in this way from 2016 to 2018. Lateral cephalograms taken before the first operation, after distraction, two weeks after the second operation, and one year after treatment were used to examine maxillofacial morphology.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Sqaw2J

Neoadjuvant immunotherapy: is this the “new” induction chemotherapy?

Immunotherapy is rapidly becoming another option for the treatment of cancer of the head and neck. Harnessing the immune system with immune checkpoint inhibitors, co-stimulatory agonists, vaccines, toll-like receptor (TLR) inhibitors, and chimeric antigen receptor (CAR) T cells, has shown clinical benefit in various types of cancer.1,2

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Xtnv7o

Two-stage maxillary distraction osteogenesis using a modified external device: clinical outcome and complications

Rigid external distraction is currently used to correct severe maxillary hypoplasia. The purpose of this retrospective study was to present the clinical results and complications of a two-stage surgical approach using a modified external distraction system that consists of maxillary distraction and then maxillary fixation. We treated eight patients with cleft lip and palate in this way from 2016 to 2018. Lateral cephalograms taken before the first operation, after distraction, two weeks after the second operation, and one year after treatment were used to examine maxillofacial morphology. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Neoadjuvant immunotherapy: is this the “new” induction chemotherapy?

Immunotherapy is rapidly becoming another option for the treatment of cancer of the head and neck. Harnessing the immune system with immune checkpoint inhibitors, co-stimulatory agonists, vaccines, toll-like receptor (TLR) inhibitors, and chimeric antigen receptor (CAR) T cells, has shown clinical benefit in various types of cancer.1,2 (Source: The British Journal of Oral and Maxillofacial Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EzZLHG

Two-stage maxillary distraction osteogenesis using a modified external device: clinical outcome and complications

Rigid external distraction is currently used to correct severe maxillary hypoplasia. The purpose of this retrospective study was to present the clinical results and complications of a two-stage surgical approach using a modified external distraction system that consists of maxillary distraction and then maxillary fixation. We treated eight patients with cleft lip and palate in this way from 2016 to 2018. Lateral cephalograms taken before the first operation, after distraction, two weeks after the second operation, and one year after treatment were used to examine maxillofacial morphology.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Sqaw2J

Neoadjuvant immunotherapy: is this the “new” induction chemotherapy?

Immunotherapy is rapidly becoming another option for the treatment of cancer of the head and neck. Harnessing the immune system with immune checkpoint inhibitors, co-stimulatory agonists, vaccines, toll-like receptor (TLR) inhibitors, and chimeric antigen receptor (CAR) T cells, has shown clinical benefit in various types of cancer.1,2

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Breathing Problems From Aspirin? Help is Here

(MedPage Today) -- Encouraging results with desensitization protocol, nasal polyp removal (Source: MedPage Today Allergy)

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 https://ift.tt/2EyB7Hl

New Insights Into Course of Childhood Food Allergy

(MedPage Today) -- Many egg, peanut allergies vanish by first grade (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2VmZYDu

Get Ready for Summer Camp -- and Allergies

Title: Get Ready for Summer Camp -- and AllergiesCategory: Health NewsCreated: 2/24/2019 12:00:00 AMLast Editorial Review: 2/25/2019 12:00:00 AM (Source: MedicineNet Allergies General)

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Peanut Allergy Patch Shows Middling Results in Trial

Title: Peanut Allergy Patch Shows Middling Results in TrialCategory: Health NewsCreated: 2/22/2019 12:00:00 AMLast Editorial Review: 2/25/2019 12:00:00 AM (Source: MedicineNet Allergies General)

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Breathing Problems From Aspirin? Help is Here

(MedPage Today) -- Encouraging results with desensitization protocol, nasal polyp removal (Source: MedPage Today Allergy)

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 https://ift.tt/2EyB7Hl

New Insights Into Course of Childhood Food Allergy

(MedPage Today) -- Many egg, peanut allergies vanish by first grade (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2VmZYDu

Get Ready for Summer Camp -- and Allergies

Title: Get Ready for Summer Camp -- and AllergiesCategory: Health NewsCreated: 2/24/2019 12:00:00 AMLast Editorial Review: 2/25/2019 12:00:00 AM (Source: MedicineNet Allergies General)

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Peanut Allergy Patch Shows Middling Results in Trial

Title: Peanut Allergy Patch Shows Middling Results in TrialCategory: Health NewsCreated: 2/22/2019 12:00:00 AMLast Editorial Review: 2/25/2019 12:00:00 AM (Source: MedicineNet Allergies General)

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Breathing Problems From Aspirin? Help is Here

(MedPage Today) -- Encouraging results with desensitization protocol, nasal polyp removal (Source: MedPage Today Allergy)

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 https://ift.tt/2EyB7Hl

New Insights Into Course of Childhood Food Allergy

(MedPage Today) -- Many egg, peanut allergies vanish by first grade (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2VmZYDu

Get Ready for Summer Camp -- and Allergies

Title: Get Ready for Summer Camp -- and AllergiesCategory: Health NewsCreated: 2/24/2019 12:00:00 AMLast Editorial Review: 2/25/2019 12:00:00 AM (Source: MedicineNet Allergies General)

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Peanut Allergy Patch Shows Middling Results in Trial

Title: Peanut Allergy Patch Shows Middling Results in TrialCategory: Health NewsCreated: 2/22/2019 12:00:00 AMLast Editorial Review: 2/25/2019 12:00:00 AM (Source: MedicineNet Allergies General)

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Breathing Problems From Aspirin? Help is Here

(MedPage Today) -- Encouraging results with desensitization protocol, nasal polyp removal (Source: MedPage Today Allergy)

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 https://ift.tt/2EyB7Hl

New Insights Into Course of Childhood Food Allergy

(MedPage Today) -- Many egg, peanut allergies vanish by first grade (Source: MedPage Today Allergy)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2VmZYDu

Get Ready for Summer Camp -- and Allergies

Title: Get Ready for Summer Camp -- and AllergiesCategory: Health NewsCreated: 2/24/2019 12:00:00 AMLast Editorial Review: 2/25/2019 12:00:00 AM (Source: MedicineNet Allergies General)

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Peanut Allergy Patch Shows Middling Results in Trial

Title: Peanut Allergy Patch Shows Middling Results in TrialCategory: Health NewsCreated: 2/22/2019 12:00:00 AMLast Editorial Review: 2/25/2019 12:00:00 AM (Source: MedicineNet Allergies General)

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Eustachian Tube (Dysfunction)

Title: Eustachian Tube (Dysfunction)Category: Diseases and ConditionsCreated: 5/29/1999 12:00:00 AMLast Editorial Review: 2/22/2019 12:00:00 AM (Source: MedicineNet Hearing General)

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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Ocasio-Cortez has no idea the Berlin Wall was built to keep people IN, not out... because everybody wants to flee socialism

(Natural News) Whether it's just plain arrogance or a lack of proper education — or both — New York Democratic Socialist Rep. Alexandria Ocasio-Cortez's tone deafness regarding her own ignorance about worldly matters and economics is stunning. Earlier this week, Ocasio-Cortez took to social media to decry POTUS Donald Trump's decision to declare a national... (Source: NaturalNews.com)

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Carcinoma Erysipeloides From Metastatic Cutaneous Squamous Cell Carcinoma Initially Mistaken for Intralymphatic Histiocytosis

Abstract: Intralymphatic histiocytosis is a rare dermatologic disorder, commonly associated with inflammatory disorders and rarely malignancy. Carcinoma erysipeloides (CE) is a rare pseudoinflammatory cutaneous eruption that resembles soft -tissue infections as result of intralymphatic metastasis and subsequent lymphatic obstruction. Breast carcinoma represents most of the CE cases, but rarely other malignancies are involved. This report discusses a patient with a history of cutaneous squamous cell carcinoma (SCC) of the temple, who was initially diagnosed with intralymphatic histiocytosis located on his upper extremity, resistant to treatment. Further dermatologic and pathologic review later revealed metastatic SCC restricted to the dermal lymphatics, creating a CE reaction, initially obscured by intralymphatic histiocytes. This case highlights the difficulty in diagnosing metastatic carcinoma when the malignant cells are accompanied by a dense histiocytic infiltrate. The case demonstrates a rare presentation of CE due to metastatic cutaneous SCC and highlights the need for persistent investigation when confronted with nonconforming pathology. Correspondence: Michael S. Heath, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 (e-mail: heatmi@ohsu.edu). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Polypoid Compound Melanocytic Proliferations: A Clinicopathological Study

Abstract: Nevi can show a polypoid appearance both clinically and histologically. Anecdotally, polypoid compound melanocytic nevus may exhibit a spectrum of junctional architectural and cytologic atypia, at times creating a diagnostic challenge by mimicking the radial growth phase of melanoma. To investigate this issue, we prospectively reviewed 40 polypoid compound melanocytic proliferations without overt malignant features. The lesions frequently occurred in young female patients and were predominantly from the trunk and intertriginous areas. Commonly observed atypical features included asymmetry (30%), shouldering (47.5%), poor circumscription (37.5%), and deep extension of melanocytes along the adnexal structures (67.5%). Severe cytologic junctional atypia (22.5%), dermal mitoses (10%), and pagetoid spread of melanocytes (5%) were less commonly seen. All lesions showed a reassuring dermal component with negligible cytologic atypia and maturation with depth. Overall, 7 lesions could not be readily classified as benign nevus; 5 of these in which a benign diagnosis was strongly favored were classified as atypical polypoid compound melanocytic nevi, whereas 2 lesions with diffuse severe junctional cytologic atypia and dermal mitoses were classified as ambiguous melanocytic proliferations. Atypical/ambiguous lesions were significantly larger and predominantly located in the axilla and groin. On molecular studies, none of the lesions tested showed the molecular profile of melanoma. We confirmed that polypoid compound melanocytic nevus can exhibit a variable degree of junctional atypia, likely related to frequent episodes of trauma and regeneration resulting in melanocytic proliferation. Pathologists should be aware of this phenomenon to avoid overdiagnosis. Correspondence: Nima Mesbah Ardakani, MD, FRCPA, Department of Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia 6009, Australia (e-mail: Nima.MesbahArdakani@health.wa.gov.au). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Renal Cell Carcinoma Antigen Expression in Primary Cutaneous Endocrine Mucinous Carcinomas: A Case Series of 14 Patients and Review of the Literature

Abstract: Endocrine mucin-producing sweat gland carcinoma (EMPSGC) and primary cutaneous mucinous carcinoma (PCMC) are both uncommon low-grade cutaneous adnexal tumors with predilection for the eyelids of elderly women. Their clinical appearance is nonspecific, typically presenting as a slowly growing poorly circumscribed papule, nodule, plaque, or swelling. Histological features of EMPSGC include a lobulated dermal neoplasm with bland cytology and an invasive mucinous component in up to half of the cases. PCMC exhibits tumor nests suspended in abundant pools of mucin with focal strands or nests of tumor cells infiltrating the dermis. Because of their rarity and banal cytological features, both entities pose a risk for misdiagnosis with other benign/malignant cutaneous adnexal neoplasms. Histomorphological features can suggest a diagnosis of EMPSGC or PCMC, but immunohistochemistry is necessary for confirmation. A review of the literature showed variable results of antigens present in EMPSGC, and many of the positive markers only show sparse or focal immunoreactivity of tumor cells. As a result, diffusely positive markers play a crucial role in identification of these tumors, particularly with initial superficial biopsies. We present 9 cases of EMPSGC and 5 cases of PCMC with strong and diffuse immunoreactivity to renal cell carcinoma antigen. This novel finding can be useful in the diagnosis of EMPSGC and PCMC in combination with other known positive markers to differentiate them from other cutaneous neoplasms. In addition, it provides further evidence that EMPSGC could be a precursor lesion to PCMC with both existing on a spectrum. Correspondence: Carlos A. Cerruto, MD, FCAP, 1923 Lake Markham Preserve Trail, Sanford, FL 32771 (e-mail: cerrutomd@msn.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Primary Cutaneous Acral CD8+ T-Cell Lymphoma—A Single Center Review of 3 Cases and Recent Literature Review

Abstract: The recently published 2016 revision of the WHO classification of lymphoid neoplasms includes primary cutaneous acral CD8-positive T-cell lymphoma (PCATCL) as a provisional entity. This is a rare indolent lymphoma characterized by papules or nodules on the ear and a dermal infiltrate of CD8-positive T-lymphocytes with cytotoxic marker expression. A retrospective review of a single institutional experience with PCATCL identified 3 patients (mean age 54; range 49–62) with papules or nodules on the ear. Lesional biopsies demonstrated a dense diffuse dermal infiltrate of atypical lymphocytes with a Grenz zone in 2 cases and focal epidermotropism in 1 case. The atypical lymphocytes were predominantly CD3 and CD8 positive with expression of cytotoxic marker TIA1. Staging evaluation failed to reveal systemic disease. Two patients underwent local excision, and the third received local radiation therapy all with complete response and no disease recurrence at last follow-up 3 months (range 2–5 months). Our cases add to the existing limited literature on the clinical and histopathological features of PCATCL. We also performed an updated systematic literature view of the entity. Correspondence: Nneka I. Comfere, MD, 200 First Street SW, Rochester, MN 55905 (e-mail: comfere.nneka@mayo.edu). The authors declare no conflicts of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Coexistence of a Basal Cell Carcinoma and Leiomyosarcoma: An Unusual Collision Tumor

No abstract available

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