Researchers studying cognitive health related to hearing and vision found that the rate of mental decline was halved after cataract surgery and was 75 percent lower after people got a hearing aid. (Source: WebMD Health)
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It is increasingly evident that severe asthma is not a single disease, as evidenced by the variety of clinical presentations, physiologic characteristics, and outcomes seen in patients with asthma. To better understand this heterogeneity, the concept of asthma phenotyping and endotyping has emerged. Phenotyping integrates both biological and clinical features, from molecular, cellular, morphologic, and functional to patient-oriented characteristics with the goal to improve therapy. Ultimately, these phenotypes evolve into asthma "endotypes," which combine clinical characteristics with identifiable mechanistic pathways. (Source: Immunology and Allergy Clinics of North America)
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Primary Immunodeficiency Disorders (Source: Immunology and Allergy Clinics of North America)
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Researchers studying cognitive health related to hearing and vision found that the rate of mental decline was halved after cataract surgery and was 75 percent lower after people got a hearing aid. (Source: WebMD Health)
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STEPHEN A. TILLES, MD (Source: Immunology and Allergy Clinics of North America)
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It is increasingly evident that severe asthma is not a single disease, as evidenced by the variety of clinical presentations, physiologic characteristics, and outcomes seen in patients with asthma. To better understand this heterogeneity, the concept of asthma phenotyping and endotyping has emerged. Phenotyping integrates both biological and clinical features, from molecular, cellular, morphologic, and functional to patient-oriented characteristics with the goal to improve therapy. Ultimately, these phenotypes evolve into asthma "endotypes," which combine clinical characteristics with identifiable mechanistic pathways. (Source: Immunology and Allergy Clinics of North America)
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ELSEVIER (Source: Immunology and Allergy Clinics of North America)
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Stephen A. Tilles (Source: Immunology and Allergy Clinics of North America)
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Primary Immunodeficiency Disorders (Source: Immunology and Allergy Clinics of North America)
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Bronchial hyperresponsiveness (BHR) is defined as a heightened bronchoconstrictive response to airway stimuli. It complements the cardinal features in asthma, such as variable or reversible airflow limitation and airway inflammation. Although BHR is considered a pathophysiologic hallmark of asthma, it should be acknowledged that this property of the airway is dynamic, because its severity and even presence can vary over time with disease activity, triggers or specific exposure, and with treatment. In addition, it is important to recognize that there is a component that is not reflective of a specific disease entity. (Source: Immunology and Allergy Clinics of North America)
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Increased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection, which is an important risk factor for development of extracranial carotid artery aneurysms (ECAA). Prior to comparison with non-ECAA controls, the optimal measurement technique should be defined. This study describes the difference between software packages in terms of reproducibility and absolute outcome of arterial tortuosity measurements in ECAA patients.
CT-angiography analysis was performed on 12 ECAA patients selected from our registry, using four software packages: 3mensio Vascular, TeraRecon, Vital Images, and Aycan OsiriX PRO. The tortuosity index (TI) was calculated from the skull base until the carotid bifurcation and aortic arch, and was defined as the centerline's true length divided by the straight line distance. Intraclass correlation coefficients (ICC) with 95% confidence intervals were calculated to quantify inter- and intra-observer variability within one software package, and differences in measured TI between packages.
Inter-observer agreement was nearly perfect for 3mensio, excellent for Vital Images and OsiriX, and substantial for TeraRecon, with ICC 0.99 (0.96–1.0), 0.90 (0.69–0.97), 0.84 (0.53–0.95), and 0.72 (0.28–0.91), respectively. Intra-observer agreement ranged from ICC 1.0 for 3mensio to 0.91 for TeraRecon. Agreements in TI ranged from ICC 0.99 (0.98–1.0) for 3mensio vs. OsiriX, to 0.95 (0.82–0.98) for 3mensio vs. TeraRecon. Median time needed to complete one round of measurements was highest for OsiriX (p = 0.013).
Carotid artery tortuosity measurements are reproducible and comparable between current commercially available software packages, with high intra-observer agreement. Although the reproducibility differed per software packages, all packages scored an acceptable inter-observer agreement.
Increased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection, which is an important risk factor for development of extracranial carotid artery aneurysms (ECAA). Prior to comparison with non-ECAA controls, the optimal measurement technique should be defined. This study describes the difference between software packages in terms of reproducibility and absolute outcome of arterial tortuosity measurements in ECAA patients.
CT-angiography analysis was performed on 12 ECAA patients selected from our registry, using four software packages: 3mensio Vascular, TeraRecon, Vital Images, and Aycan OsiriX PRO. The tortuosity index (TI) was calculated from the skull base until the carotid bifurcation and aortic arch, and was defined as the centerline's true length divided by the straight line distance. Intraclass correlation coefficients (ICC) with 95% confidence intervals were calculated to quantify inter- and intra-observer variability within one software package, and differences in measured TI between packages.
Inter-observer agreement was nearly perfect for 3mensio, excellent for Vital Images and OsiriX, and substantial for TeraRecon, with ICC 0.99 (0.96–1.0), 0.90 (0.69–0.97), 0.84 (0.53–0.95), and 0.72 (0.28–0.91), respectively. Intra-observer agreement ranged from ICC 1.0 for 3mensio to 0.91 for TeraRecon. Agreements in TI ranged from ICC 0.99 (0.98–1.0) for 3mensio vs. OsiriX, to 0.95 (0.82–0.98) for 3mensio vs. TeraRecon. Median time needed to complete one round of measurements was highest for OsiriX (p = 0.013).
Carotid artery tortuosity measurements are reproducible and comparable between current commercially available software packages, with high intra-observer agreement. Although the reproducibility differed per software packages, all packages scored an acceptable inter-observer agreement.
This study investigated visual statistical learning (VSL) in 24 deaf signers and 24 hearing non-signers. Previous research with hearing individuals suggests that SL mechanisms support literacy. Our first goal was to assess whether VSL was associated with reading ability in deaf individuals, and whether this relation was sustained by a link between VSL and sign language skill. Our second goal was to test the Auditory Scaffolding Hypothesis, which makes the prediction that deaf people should be impaired in sequential processing tasks. For the VSL task, we adopted a modified version of the triplet learning paradigm, with stimuli presented sequentially across space and time. Results revealed that measures of sign language skill (sentence comprehension/repetition) did not correlate with VSL sco...
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This study investigated visual statistical learning (VSL) in 24 deaf signers and 24 hearing non-signers. Previous research with hearing individuals suggests that SL mechanisms support literacy. Our first goal was to assess whether VSL was associated with reading ability in deaf individuals, and whether this relation was sustained by a link between VSL and sign language skill. Our second goal was to test the Auditory Scaffolding Hypothesis, which makes the prediction that deaf people should be impaired in sequential processing tasks. For the VSL task, we adopted a modified version of the triplet learning paradigm, with stimuli presented sequentially across space and time. Results revealed that measures of sign language skill (sentence comprehension/repetition) did not correlate with VSL sco...
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Bronchial hyperresponsiveness (BHR) is defined as a heightened bronchoconstrictive response to airway stimuli. It complements the cardinal features in asthma, such as variable or reversible airflow limitation and airway inflammation. Although BHR is considered a pathophysiologic hallmark of asthma, it should be acknowledged that this property of the airway is dynamic, because its severity and even presence can vary over time with disease activity, triggers or specific exposure, and with treatment. In addition, it is important to recognize that there is a component that is not reflective of a specific disease entity. (Source: Immunology and Allergy Clinics of North America)
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Stephen A. Tilles (Source: Immunology and Allergy Clinics of North America)
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It is increasingly evident that severe asthma is not a single disease, as evidenced by the variety of clinical presentations, physiologic characteristics, and outcomes seen in patients with asthma. To better understand this heterogeneity, the concept of asthma phenotyping and endotyping has emerged. Phenotyping integrates both biological and clinical features, from molecular, cellular, morphologic, and functional to patient-oriented characteristics with the goal to improve therapy. Ultimately, these phenotypes evolve into asthma "endotypes," which combine clinical characteristics with identifiable mechanistic pathways. (Source: Immunology and Allergy Clinics of North America)
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ELSEVIER (Source: Immunology and Allergy Clinics of North America)
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Bronchial hyperresponsiveness (BHR) is defined as a heightened bronchoconstrictive response to airway stimuli. It complements the cardinal features in asthma, such as variable or reversible airflow limitation and airway inflammation. Although BHR is considered a pathophysiologic hallmark of asthma, it should be acknowledged that this property of the airway is dynamic, because its severity and even presence can vary over time with disease activity, triggers or specific exposure, and with treatment. In addition, it is important to recognize that there is a component that is not reflective of a specific disease entity. (Source: Immunology and Allergy Clinics of North America)
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Primary Immunodeficiency Disorders (Source: Immunology and Allergy Clinics of North America)
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Stephen A. Tilles (Source: Immunology and Allergy Clinics of North America)
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ConclusionsHandling reactions correctly provided parents with confidence to treat subsequent reactions. Witnessing the effects of an EAI and receiving positive feedback from health care providers further strengthened their confidence to quickly and competently intervene in future reactions. (Source: Clinical and Translational Allergy)
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It is increasingly evident that severe asthma is not a single disease, as evidenced by the variety of clinical presentations, physiologic characteristics, and outcomes seen in patients with asthma. To better understand this heterogeneity, the concept of asthma phenotyping and endotyping has emerged. Phenotyping integrates both biological and clinical features, from molecular, cellular, morphologic, and functional to patient-oriented characteristics with the goal to improve therapy. Ultimately, these phenotypes evolve into asthma "endotypes," which combine clinical characteristics with identifiable mechanistic pathways. (Source: Immunology and Allergy Clinics of North America)
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Immunotherapy,Volume 10, Issue 14, Page 1287-1288, October 2018. (Source: Immunotherapy)
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STEPHEN A. TILLES, MD (Source: Immunology and Allergy Clinics of North America)
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Immunotherapy,Volume 10, Issue 14, Page 1265-1284, October 2018. (Source: Immunotherapy)
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ELSEVIER (Source: Immunology and Allergy Clinics of North America)
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Immunotherapy,Volume 10, Issue 14, Page 1253-1263, October 2018. (Source: Immunotherapy)
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Primary Immunodeficiency Disorders (Source: Immunology and Allergy Clinics of North America)
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Immunotherapy,Volume 10, Issue 14, Page 1189-1192, October 2018. (Source: Immunotherapy)
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ConclusionsHandling reactions correctly provided parents with confidence to treat subsequent reactions. Witnessing the effects of an EAI and receiving positive feedback from health care providers further strengthened their confidence to quickly and competently intervene in future reactions. (Source: Clinical and Translational Allergy)
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The cough guidelines recommend that asthma should always be considered as a potential etiology of chronic cough.1,2 The presence of airway hyperresponsiveness is consistent with, but not diagnostic of, cough due to mild asthma.A definitive diagnosis cannot be made until resolution of cough is achieved with specific therapy, including inhaled corticosteroid/long-acting β2 agonist (ICS/LABA) or ICS. Airway reversibility testing is often used to diagnose cough due to mild asthma; however, reversibility of forced expiratory volume in 1 second (FEV1) is smaller in mild asthma than in moderate asthma because baseline FEV1 values are normal or nearly normal in most pat ients with mild asthma. (Source: Annals of Allergy, Asthma and Immunology)
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Immunotherapy,Volume 10, Issue 14, Page 1287-1288, October 2018. (Source: Immunotherapy)
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Viral Immunology, Ahead of Print. (Source: Viral Immunology)
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Immunotherapy,Volume 10, Issue 14, Page 1265-1284, October 2018. (Source: Immunotherapy)
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Immunotherapy,Volume 10, Issue 14, Page 1253-1263, October 2018. (Source: Immunotherapy)
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Immunotherapy,Volume 10, Issue 14, Page 1189-1192, October 2018. (Source: Immunotherapy)
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The cough guidelines recommend that asthma should always be considered as a potential etiology of chronic cough.1,2 The presence of airway hyperresponsiveness is consistent with, but not diagnostic of, cough due to mild asthma.A definitive diagnosis cannot be made until resolution of cough is achieved with specific therapy, including inhaled corticosteroid/long-acting β2 agonist (ICS/LABA) or ICS. Airway reversibility testing is often used to diagnose cough due to mild asthma; however, reversibility of forced expiratory volume in 1 second (FEV1) is smaller in mild asthma than in moderate asthma because baseline FEV1 values are normal or nearly normal in most pat ients with mild asthma. (Source: Annals of Allergy, Asthma and Immunology)
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Viral Immunology, Ahead of Print. (Source: Viral Immunology)
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What having a severe nut allergy feels like and how navigating the daily risks affects your life. (Source: BBC News | Health | UK Edition)
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Cromolyn sodium is a widely available medication for preventing and treating nasal allergies, such as hay fever and pet or dust allergies. It comes as a nasal solution and works by preventing the release of histamines in the nose. Learn more here. (Source: Health News from Medical News Today)
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What having a severe nut allergy feels like and how navigating the daily risks affects your life. (Source: BBC News | Health | UK Edition)
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What having a severe nut allergy feels like and how navigating the daily risks affects your life. (Source: BBC News | Health | UK Edition)
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Cromolyn sodium is a widely available medication for preventing and treating nasal allergies, such as hay fever and pet or dust allergies. It comes as a nasal solution and works by preventing the release of histamines in the nose. Learn more here. (Source: Health News from Medical News Today)
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High-pressure injection injuries occur when equipment capable of achieving high pressure injects its contents into the human body. These injuries are largely occupational and may present as small entrance wounds with very few symptoms. However, they represent a surgical emergency, often requiring amputation. They characteristically involve the upper extremities, but other regions of the body may be injured. We present the case of a 26-year-old man who sustained a high-pressure injection injury with hydraulic oil to the knee and a literature review of this type of accident. To our knowledge, this report is the first to describe such an injury to the knee, with magnetic resonance imaging findings.
The name of Kay Geert A. Hermann is incorrectly captured in the original article and is now corrected in this paper.
Soft-tissue sarcomas pose diagnostic and therapeutic challenges to physicians, owing to the large number of subtypes, aggressive tumor biology, lack of consensus on management, and controversy surrounding interval and duration of surveillance scans. Advances in multidisciplinary management have improved the care of sarcoma patients, but controversy remains regarding strategies for surveillance following definitive local control. This review provides an updated, comprehensive overview of the current understanding of the risk of local recurrence of soft-tissue sarcoma, by examining the literature based on features such as histological type and grade, tumor size, and resection margin status, with the aim of helping clinicians, surgeons, and radiologists to develop a tailored approach to local imaging surveillance.
To examine the imaging characteristics of intramuscular myxomas (IM) and myxoid liposarcomas (MLS) on 18F-FDG PET/CT and MRI.
With IRB approval, our institutional imaging database was searched for pathologically proven IM and MLS evaluated by 18F-FDG PET/CT and MRI. PET/CT and MRI imaging characteristics were recorded and correlated with pathologic diagnosis.
We found eight patients (2 M, 6 F) with IM (mean age 65.6 ± 10.4 years) and 16 patients (7 F, 9 M) with MLS (mean age 42.8 ± 16.3 years). MRI was available in 7/8 IM and 15/16 MLS patients. There was no significant difference between the two groups in SUVmax (IM 2.7 ± 0.8, MLS 3.0 ± 1.0; p = 0.35), SUVmean (1.7 ± 0.4, 1.5 ± 0.5; p = 0.40), total lesion glycolysis (101.8 ± 127.3, 2420.2 ± 4003.3 cm3*g/ml; p = 0.12), metabolic tumor volume (62.3 ± 71.1, 1742.9 ± 3308.0 cm3; p = 0.17) or CT attenuation (p = 0.70). MLS occurred in younger patients (p = 0.0015), were larger (16.4 ± 8.2 vs. 5.6 ± 2.5 cm; p = 0.0015), more often T1 hyperintense (p = 0.03), with nodular enhancement (p = 0.006), and macroscopic fat on CT (p = 0.0013) and MRI (p = < 0.001) compared to myxomas.
IM and MLS most commonly demonstrate low-grade FDG activity and overlapping metabolic measures on PET/CT. MRI is useful in differentiation, but MLS can present without macroscopic fat on MRI, underscoring the importance of radiologic-pathologic correlation for accurate diagnosis.
To determine the effect of needle position and foraminal stenosis on contrast flow directionality during CT-guided transforaminal epidural steroid injections (TFESI).
One hundred five consecutive CT-guided injections were performed in 68 patients (mean age, 65.5 years) from January 1 to December 31 2017, all with preceding MRI. Two readers independently reviewed CT images to assess needle position and to determine direction of contrast flow, which was defined as central or peripheral. The MRIs were independently reviewed by the readers to determine the degree of foraminal stenosis. Inter-reader agreement for both was evaluated with the kappa statistic. Analyses were performed to determine effect of needle position, degree of foraminal stenosis, and volume of contrast injected with directionality of contrast flow, and association between contrast flow directionality with immediate post-procedural pain scores.
Central direction of contrast flow was demonstrated in 41/78 (52.6%) of cases with posterolateral needle position, and 20/27 (74.1%) with central or anteromedial needle position (p = 0.07). There was no difference in direction of contrast flow with high-grade versus absence of high-grade neuroforaminal narrowing, or with volume of contrast injected. There was no difference in immediate post-procedure pain scores regardless of contrast flow directionality.
Needle position is not significantly associated with contrast flow directionality during CT-guided TFESI, although there was a trend towards relatively decreased central flow with posterolateral positioning. Degree of foraminal stenosis and volume of injected contrast did not affect contrast flow directionality. There was no difference in immediate post-procedural pain scores with either direction of contrast flow.
To identify the findings on magnetic resonance imaging most strongly associated with meniscal ramp lesions in patients with an anterior cruciate ligament tear.
Seventy-eight consecutive patients (mean age, 33.7 years; 64 male, 14 female) with an arthroscopically proven anterior cruciate ligament tear were included in this retrospective study. The presence of the following six features on magnetic resonance images were recorded: complete fluid filling between the posterior horn of the medial meniscus and the capsule margin; edema affecting the posterior capsule; irregularity of the medial meniscus at the posterior margin; fluid at the periphery of the medial meniscus; the corner notch sign; and a vertical tear at the medial meniscus. Findings at arthroscopy served as the reference standard. Diagnostic accuracy, sensitivity, and interobserver agreement were calculated.
Seven ramp lesions were noted on arthroscopy (9%). Findings of irregularity at the posterior margin (p = 0.001) and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin (p = 0.004) on magnetic resonance imaging were significantly associated with the presence of a ramp lesion. With the irregularity at the posterior margin, sensitivity was 86% and specificity was 79%. Complete fluid filling sign showed sensitivity of 57% and specificity of 92%. Concordance of the two readers for the six magnetic resonance imaging features was fair to very good (k = 0.38–0.91).
Irregularity at posterior margin and complete fluid filling were most sensitive findings for detecting of a ramp lesion on magnetic resonance imaging.
Anatomical variants of muscle are commonly encountered by surgeons and radiologists. The flexor carpi radialis brevis (FCRB) is an anomalous muscle in the distal forearm with an estimated prevalence of 2–8%. In the literature, there are a few case reports of symptomatic FCRB tenosynovitis without a concomitant tear, and treatment methods described include both conservative and surgical management. We present a case of one patient with radial sided wrist pain and a partial FCRB tear, which to our knowledge is the first case report of a symptomatic FCRB tear. We also review existing literature regarding FCRB anatomy, particularly related to intra-operative dissection and exposure. Identification of an anomalous FCRB on imaging may serve to guide clinicians in their differential diagnosis of radial-sided wrist pain, in which FCRB pathological conditions ought to be included.
To determine the threshold signal drop on 3-T chemical shift imaging (CSI), with in-phase (IP) and opposed-phase (OP) sequences, for accurately identifying bone marrow replacement with 100% sensitivity, and determine a clinically useful measurement method for deriving such a threshold.
From a convenience series of 157 MRIs, 36 cases with histologically proven marrow-replacing lesions and 22 sites of red marrow (histologically proven (2) or with minimum 6-month stability) with 3-Tesla CSI were included. Two musculoskeletal radiologists performed two measurement methods (first: multiple algorithmic ROIs at the top, middle, and bottom of lesions (M-ROI); second: an ROI was drawn where there appeared to be the least opposed-phase signal reduction qualitatively/visually (Q-ROI)). Lesional and red marrow signal change (%,[(IP-OP)signal/IP signal]*100) was determined. Statistical analyses included Student's t test, Cohen's kappa, and receiver operator characteristic curve generation.
By M-ROI, lesion signal change was − 0.508% (confidence interval (CI) = − 5.537:4.521) and 1.348% (CI = − 3.541:6.311) for readers 1 and 2. By Q-ROI, lesion signal change was − 11.03% (CI = − 17.01:- 5.046) and − 5.657% (CI = − 12.36:1.048) for readers 1 and 2. For all M-ROI and Q-ROI measurement strategies, signal change between lesional tissue and red marrow was significantly different (p < 0.0001). QROI produced the best composite sensitivities and specificities with a maximized Youden index of 0.955–1. A threshold signal drop of 25% with Q-ROI produced at least 100%/86% sensitivity/specificity for both readers for identifying marrow replacement.
For 3-T CSI, a single visually targeted measurement using a 25% threshold is accurate for identifying marrow-replacing lesions.
Dual-energy CT (DECT) is being widely used in suspected gout patients in recent years. Many clinicians tend to use DECT instead of aspiration biopsy in the diagnosis of gout, but its accuracy has shown controversial results. In this systematic review and meta-analysis, we sought to evaluate the accuracy of DECT in the diagnosis of gout.
We performed a systematic review of the literature published in Medline, Embase, PubMed, and Cochrane databases. Studies included are all clinical trials of DECT in the diagnosis of gout. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). We recorded sensitivity and specificity of algorithms and calculated positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odd ratio (DOR), and respective confidence intervals (CI). The summary receiver operating characteristic curve (sROC) was drawn to get the Cochran Q-index and the area under the curve (AUC).
Seven studies were included in this review and showed high homogeneity. The analysis results presented the pooled sensitivity was 88% (95% CI 84–90%) and specificity was 90% (95% CI 85–93%). Then, we figured out that the pooled PLR was 8.48 (95% CI 5.89–12.22) and NLR was 0.10 (95% CI 0.04–0.24) respectively. In addition, Cochran-Q was 0.90 and AUC was 0.9565 in sROC curve.
DECT showed relatively high sensitivity and specificity in the diagnosis of gout. Synthetically considering these DECT abnormalities could improve the diagnostic sensitivity. More rigorous and standardized studies are still needed to support these findings.
Computed tomography (CT)-guided cervical nerve injections are broadly being used in the treatment of cervical radiculopathy; however, catastrophic complications have been reported. Herein, we aimed to evaluate the efficacy, feasibility, and safety of a novel CT-guided cervical injection technique.
We prospectively performed cervical injections in 28 patients with cervical radiculopathies using a novel CT-guided cervical transforaminal injection technique; lateral peri-isthmic approach in which the tip of the needle advanced to the lateral cortex of the isthmus instead of the foraminal area. Patients' pain reduction rates were evaluated using visual analog scores (VAS) at pre-treatment, immediately after treatment, at 3 weeks and 6 months after the treatment. Intra-vascular contrast medium injections and distribution of the contrast material into the foraminal, epidural or extraforaminal area during the procedure were noted.
Pre-treatment pain scores were reduced by 4.2 ± 1.4 (p < 0.001), 3.9 ± 1.37 (p < 0.001) and 3.25 ± 1.53 (p < 0.001) immediately after the treatment, 3 weeks and 6 months after the treatment respectively. The number of patients with >50% pain relief as measured by VAS were 21 (75%) immediately after the procedure, 19 (67.8%) at 3 weeks and 17 (60%) at 6 months after the procedure. The injected contrast material was dispersed into the neural foramen in 9 cases (32.1%), the foraminal and epidural area in 14 cases (50%) and the extraforaminal area in 5 cases (17.9%).
The CT-guided lateral peri-isthmic approach seems to be a secure and feasible method for cervical injections with satisfactory pain reduction.
The treatment of persistent cervical radicular pain (CRP) by CT-guided epidural steroid injections (CTESI) by a transforaminal anterolateral (TFA) approach is associated with rare but serious complications. Two recently described transforaminal posterolateral (TFP) and transfacet indirect (TFT) approaches may be safer options, but have not been extensively evaluated. We compared the efficacy of three CTESI approaches (TFA, TFP, and TFT) in the treatment of persistent CRP (>6 weeks).
Patients were prospectively assessed for pain using the visual analog scale (VAS) and for functional disability by the Neck Disability Index (NDI) before treatment, then 6 weeks and 6 months after CTESI.
A total of 104 patients were included (n = 30 TFA, n = 36 TFP, and n = 38 TFT approaches). Each group was found to have a statistically significant improvement at 6 weeks (median VAS values: 7 (2–9) at D0 and 2 (3–6) at 6 weeks p < 0.01; median NDI values: 38 (24–50) at D0 and 29 (18–42) at 6 weeks (p < 0.01)), and at 6 months (median VAS values: 7 (2–9) at D0 and 4 (2–6) at 6 months (p < 0.01); median NDI values: 38 (24–50) at D0 and 28 (13–40) at 6 months (p < 0.01)). No significant difference was observed in the decrease in VAS and NDI scores among the three approaches at 6 weeks (p = 0.635 and p = 0.54 for VAS and NDI respectively) or 6 months (p = 0.704 and p = 0.315 for VAS and NDI respectively). No major complications were noted.
The results of CTESI using the TFP or TFT approach are similar to those for TFA in the treatment of persistent CRP and could be a safer option.
To correlate patterns of 18F-FDG uptake on whole-body PET-CT with MR findings and compare the degree of FDG activity between symptomatic and asymptomatic knees.
Retrospective database query was performed using codes for knee MRI as well as whole-body PET-CT. Patients with malignant disease involving the knee or hardware were excluded. Patients who had both studies performed within 1 year between 2012 and 2017 were included for analysis. Knee joint osteoarthrosis, meniscal and ligamentous integrity, presence of joint effusion, and synovitis were assessed and recorded. Bone marrow edema lesions (BMELs) were identified, segmented, and analyzed using volumetric analysis. SUVmax was assessed over the suprapatellar joint space, intercondylar notch and Hoffa's fat pad. Symptomatic and asymptomatic knees were compared in patients with unilateral symptoms.
Twenty-two cases (20 patients) with mean age 63.3 years (range, 36–91 years) were included. Two patients had bilateral pain. The most FDG avid regions in both symptomatic and asymptomatic knees were the intercondylar notch (SUVmax = 1.84 vs. 1.51), followed by suprapatellar pouch (SUVmax = 1.74 vs. 1.29) and Hoffa's fat pad (SUVmax = 1.01 vs. 0.87). SUVmax was significantly associated with cartilage loss (mean modified Outerbridge score) (r = 0.60, p = 0.003) and degree of synovitis (r = 0.48, p = 0023). Overall, mean SUVmax was significantly higher in the presence of a meniscal tear (1.83 ± 0.67 vs. 1.22 ± 0.40, p = 0.030). Nine patients had BMELs (volume: range = 0.6–27.8, mean = 7.79) however there was no significant association between BMEL volume and SUVmax.
Higher FDG activity correlates with intra-articular derangement and the intercondylar notch represents the most metabolically active region of the knee.
We present an uncommon imaging feature with fluid fat tracking within the tendon sheath of the flexor hallucis longus (FHL) after traumatic injury to the ankle joint. We propose a coined medical term "lipidus migrans" to define the presence of floating fat in a tendon sheath. This is due to lipohemarthrosis from intra-articular fracture of the ankle with leakage of fluid fat into the tendon sheath. Communication between the FHL tendon sheath and ankle joint can occur in up to 25% of patients. Radiologists should be aware of the presence of lipidus migrans as a potential posttraumatic complication after intra-articular ankle fracture and that fat in the tendon sheath may mimic fracture fragments or even a tendon sheath tumor.
The name of Kay Geert A. Hermann is incorrectly captured in the original article and is now corrected in this paper.
Soft-tissue sarcomas pose diagnostic and therapeutic challenges to physicians, owing to the large number of subtypes, aggressive tumor biology, lack of consensus on management, and controversy surrounding interval and duration of surveillance scans. Advances in multidisciplinary management have improved the care of sarcoma patients, but controversy remains regarding strategies for surveillance following definitive local control. This review provides an updated, comprehensive overview of the current understanding of the risk of local recurrence of soft-tissue sarcoma, by examining the literature based on features such as histological type and grade, tumor size, and resection margin status, with the aim of helping clinicians, surgeons, and radiologists to develop a tailored approach to local imaging surveillance.
To examine the imaging characteristics of intramuscular myxomas (IM) and myxoid liposarcomas (MLS) on 18F-FDG PET/CT and MRI.
With IRB approval, our institutional imaging database was searched for pathologically proven IM and MLS evaluated by 18F-FDG PET/CT and MRI. PET/CT and MRI imaging characteristics were recorded and correlated with pathologic diagnosis.
We found eight patients (2 M, 6 F) with IM (mean age 65.6 ± 10.4 years) and 16 patients (7 F, 9 M) with MLS (mean age 42.8 ± 16.3 years). MRI was available in 7/8 IM and 15/16 MLS patients. There was no significant difference between the two groups in SUVmax (IM 2.7 ± 0.8, MLS 3.0 ± 1.0; p = 0.35), SUVmean (1.7 ± 0.4, 1.5 ± 0.5; p = 0.40), total lesion glycolysis (101.8 ± 127.3, 2420.2 ± 4003.3 cm3*g/ml; p = 0.12), metabolic tumor volume (62.3 ± 71.1, 1742.9 ± 3308.0 cm3; p = 0.17) or CT attenuation (p = 0.70). MLS occurred in younger patients (p = 0.0015), were larger (16.4 ± 8.2 vs. 5.6 ± 2.5 cm; p = 0.0015), more often T1 hyperintense (p = 0.03), with nodular enhancement (p = 0.006), and macroscopic fat on CT (p = 0.0013) and MRI (p = < 0.001) compared to myxomas.
IM and MLS most commonly demonstrate low-grade FDG activity and overlapping metabolic measures on PET/CT. MRI is useful in differentiation, but MLS can present without macroscopic fat on MRI, underscoring the importance of radiologic-pathologic correlation for accurate diagnosis.
To determine the effect of needle position and foraminal stenosis on contrast flow directionality during CT-guided transforaminal epidural steroid injections (TFESI).
One hundred five consecutive CT-guided injections were performed in 68 patients (mean age, 65.5 years) from January 1 to December 31 2017, all with preceding MRI. Two readers independently reviewed CT images to assess needle position and to determine direction of contrast flow, which was defined as central or peripheral. The MRIs were independently reviewed by the readers to determine the degree of foraminal stenosis. Inter-reader agreement for both was evaluated with the kappa statistic. Analyses were performed to determine effect of needle position, degree of foraminal stenosis, and volume of contrast injected with directionality of contrast flow, and association between contrast flow directionality with immediate post-procedural pain scores.
Central direction of contrast flow was demonstrated in 41/78 (52.6%) of cases with posterolateral needle position, and 20/27 (74.1%) with central or anteromedial needle position (p = 0.07). There was no difference in direction of contrast flow with high-grade versus absence of high-grade neuroforaminal narrowing, or with volume of contrast injected. There was no difference in immediate post-procedure pain scores regardless of contrast flow directionality.
Needle position is not significantly associated with contrast flow directionality during CT-guided TFESI, although there was a trend towards relatively decreased central flow with posterolateral positioning. Degree of foraminal stenosis and volume of injected contrast did not affect contrast flow directionality. There was no difference in immediate post-procedural pain scores with either direction of contrast flow.
Anatomical variants of muscle are commonly encountered by surgeons and radiologists. The flexor carpi radialis brevis (FCRB) is an anomalous muscle in the distal forearm with an estimated prevalence of 2–8%. In the literature, there are a few case reports of symptomatic FCRB tenosynovitis without a concomitant tear, and treatment methods described include both conservative and surgical management. We present a case of one patient with radial sided wrist pain and a partial FCRB tear, which to our knowledge is the first case report of a symptomatic FCRB tear. We also review existing literature regarding FCRB anatomy, particularly related to intra-operative dissection and exposure. Identification of an anomalous FCRB on imaging may serve to guide clinicians in their differential diagnosis of radial-sided wrist pain, in which FCRB pathological conditions ought to be included.
To determine the threshold signal drop on 3-T chemical shift imaging (CSI), with in-phase (IP) and opposed-phase (OP) sequences, for accurately identifying bone marrow replacement with 100% sensitivity, and determine a clinically useful measurement method for deriving such a threshold.
From a convenience series of 157 MRIs, 36 cases with histologically proven marrow-replacing lesions and 22 sites of red marrow (histologically proven (2) or with minimum 6-month stability) with 3-Tesla CSI were included. Two musculoskeletal radiologists performed two measurement methods (first: multiple algorithmic ROIs at the top, middle, and bottom of lesions (M-ROI); second: an ROI was drawn where there appeared to be the least opposed-phase signal reduction qualitatively/visually (Q-ROI)). Lesional and red marrow signal change (%,[(IP-OP)signal/IP signal]*100) was determined. Statistical analyses included Student's t test, Cohen's kappa, and receiver operator characteristic curve generation.
By M-ROI, lesion signal change was − 0.508% (confidence interval (CI) = − 5.537:4.521) and 1.348% (CI = − 3.541:6.311) for readers 1 and 2. By Q-ROI, lesion signal change was − 11.03% (CI = − 17.01:- 5.046) and − 5.657% (CI = − 12.36:1.048) for readers 1 and 2. For all M-ROI and Q-ROI measurement strategies, signal change between lesional tissue and red marrow was significantly different (p < 0.0001). QROI produced the best composite sensitivities and specificities with a maximized Youden index of 0.955–1. A threshold signal drop of 25% with Q-ROI produced at least 100%/86% sensitivity/specificity for both readers for identifying marrow replacement.
For 3-T CSI, a single visually targeted measurement using a 25% threshold is accurate for identifying marrow-replacing lesions.
To evaluate the reproducibility of T2 relaxation time measurements of the sacroiliac joints at 1.5 T.
Healthy volunteers underwent an oblique axial multislice multiecho spin-echo sequence of the sacroiliac joints at 1.5 T. Regions of interest were manually drawn using a dedicated software by two musculoskeletal radiologists to include the cartilaginous part of the sacroiliac joints. A senior radiologist performed the measurement twice, while a resident measured once. Intra- and inter-observer reproducibility was tested using the Bland-Altman method. Association between sex and T2 relaxation times was tested using the Mann-Whitney U test. Correlation between T2 relaxation times and body mass index (BMI) was tested using the Spearman's rho.
Eighty sacroiliac joints of 40 subjects (mean age: 28 ± 4.8 years, range: 20–43; mean BMI: 23.3 ± 3.1, range: 18.9–30) were imaged. The mean T2 values obtained by the senior radiologist in the first series of measurements were 42 ± 4.4 ms, whereas in the second series were 40.7 ± 4.5 ms. The mean T2 values obtained by the radiology resident were 41.1 ± 4.2 ms. Intra-observer reproducibility was 88% (coefficient of repeatability = 3.8; bias = 1.28; p < .001), while inter-observer reproducibility was 86% (4.7; −.88; p < .001). There was significant association between sex and T2 relaxation times (p = .024) and significant inverse correlation between T2 relaxation times and BMI (r = −.340, p = .002).
The assessment of T2 relaxation time measurements of sacroiliac joints seems to be highly reproducible at 1.5 T. Further studies could investigate the potential clinical application of this tool in the sacroiliac joints.
Computed tomography (CT)-guided cervical nerve injections are broadly being used in the treatment of cervical radiculopathy; however, catastrophic complications have been reported. Herein, we aimed to evaluate the efficacy, feasibility, and safety of a novel CT-guided cervical injection technique.
We prospectively performed cervical injections in 28 patients with cervical radiculopathies using a novel CT-guided cervical transforaminal injection technique; lateral peri-isthmic approach in which the tip of the needle advanced to the lateral cortex of the isthmus instead of the foraminal area. Patients' pain reduction rates were evaluated using visual analog scores (VAS) at pre-treatment, immediately after treatment, at 3 weeks and 6 months after the treatment. Intra-vascular contrast medium injections and distribution of the contrast material into the foraminal, epidural or extraforaminal area during the procedure were noted.
Pre-treatment pain scores were reduced by 4.2 ± 1.4 (p < 0.001), 3.9 ± 1.37 (p < 0.001) and 3.25 ± 1.53 (p < 0.001) immediately after the treatment, 3 weeks and 6 months after the treatment respectively. The number of patients with >50% pain relief as measured by VAS were 21 (75%) immediately after the procedure, 19 (67.8%) at 3 weeks and 17 (60%) at 6 months after the procedure. The injected contrast material was dispersed into the neural foramen in 9 cases (32.1%), the foraminal and epidural area in 14 cases (50%) and the extraforaminal area in 5 cases (17.9%).
The CT-guided lateral peri-isthmic approach seems to be a secure and feasible method for cervical injections with satisfactory pain reduction.
Our study aimed to determine the duration of pain relief from intraarticular hip corticosteroid injections and identify patient predictive factors on injection response. We also sought to determine the subsequent rate of hip surgery and whether severity of hip osteoarthritis or injection response correlated with the decision to undergo surgery.
All intraarticular hip steroid injections performed for osteoarthritis under fluoroscopic guidance at a single institution between January 2010 to December 2012 were retrospectively reviewed. Response was divided into three groups: no relief, immediate (≤ 2 weeks of pain relief), and continued (> 2 weeks of pain relief). Presence of hip surgery for osteoarthritis performed within 2 years following injection was obtained. Correlation between patient characteristics with injection outcome and hip surgery was analyzed.
Of 78 patients, a total of 82 injections were analyzed. For injections, 19.5% (16/82) showed no response, 47.6% (39/82) showed immediate response, and 32.9% (27/82) showed continued response. There was no significant correlation between injection outcome with age, Tönnis grade, BMI, or duration of symptoms. In total, 48.7% had hip surgery within 2 years after initial injection. There was a significant association between Tönnis grade and surgery, with higher Tönnis grades correlating with decision to undergo surgery (p = 0.002).
Gender, age, BMI, duration of symptoms, and radiographic severity of disease do not predict injection response. Due to high surgical rates and poor response, intraarticular hip steroid injections may be less effective in the long term, and surgical management may be considered earlier.
The treatment of persistent cervical radicular pain (CRP) by CT-guided epidural steroid injections (CTESI) by a transforaminal anterolateral (TFA) approach is associated with rare but serious complications. Two recently described transforaminal posterolateral (TFP) and transfacet indirect (TFT) approaches may be safer options, but have not been extensively evaluated. We compared the efficacy of three CTESI approaches (TFA, TFP, and TFT) in the treatment of persistent CRP (>6 weeks).
Patients were prospectively assessed for pain using the visual analog scale (VAS) and for functional disability by the Neck Disability Index (NDI) before treatment, then 6 weeks and 6 months after CTESI.
A total of 104 patients were included (n = 30 TFA, n = 36 TFP, and n = 38 TFT approaches). Each group was found to have a statistically significant improvement at 6 weeks (median VAS values: 7 (2–9) at D0 and 2 (3–6) at 6 weeks p < 0.01; median NDI values: 38 (24–50) at D0 and 29 (18–42) at 6 weeks (p < 0.01)), and at 6 months (median VAS values: 7 (2–9) at D0 and 4 (2–6) at 6 months (p < 0.01); median NDI values: 38 (24–50) at D0 and 28 (13–40) at 6 months (p < 0.01)). No significant difference was observed in the decrease in VAS and NDI scores among the three approaches at 6 weeks (p = 0.635 and p = 0.54 for VAS and NDI respectively) or 6 months (p = 0.704 and p = 0.315 for VAS and NDI respectively). No major complications were noted.
The results of CTESI using the TFP or TFT approach are similar to those for TFA in the treatment of persistent CRP and could be a safer option.
To correlate patterns of 18F-FDG uptake on whole-body PET-CT with MR findings and compare the degree of FDG activity between symptomatic and asymptomatic knees.
Retrospective database query was performed using codes for knee MRI as well as whole-body PET-CT. Patients with malignant disease involving the knee or hardware were excluded. Patients who had both studies performed within 1 year between 2012 and 2017 were included for analysis. Knee joint osteoarthrosis, meniscal and ligamentous integrity, presence of joint effusion, and synovitis were assessed and recorded. Bone marrow edema lesions (BMELs) were identified, segmented, and analyzed using volumetric analysis. SUVmax was assessed over the suprapatellar joint space, intercondylar notch and Hoffa's fat pad. Symptomatic and asymptomatic knees were compared in patients with unilateral symptoms.
Twenty-two cases (20 patients) with mean age 63.3 years (range, 36–91 years) were included. Two patients had bilateral pain. The most FDG avid regions in both symptomatic and asymptomatic knees were the intercondylar notch (SUVmax = 1.84 vs. 1.51), followed by suprapatellar pouch (SUVmax = 1.74 vs. 1.29) and Hoffa's fat pad (SUVmax = 1.01 vs. 0.87). SUVmax was significantly associated with cartilage loss (mean modified Outerbridge score) (r = 0.60, p = 0.003) and degree of synovitis (r = 0.48, p = 0023). Overall, mean SUVmax was significantly higher in the presence of a meniscal tear (1.83 ± 0.67 vs. 1.22 ± 0.40, p = 0.030). Nine patients had BMELs (volume: range = 0.6–27.8, mean = 7.79) however there was no significant association between BMEL volume and SUVmax.
Higher FDG activity correlates with intra-articular derangement and the intercondylar notch represents the most metabolically active region of the knee.
Conclusions/SignificanceSchistosomiasis is prevalent in this HIV cohort and may be beneficial for immunological reconstitution, while no effect on virological failure was apparent. A positive effect of schistosomiasis-induced immunomodulation on survival and retention in care needs confirmation in future studies. (Source: PLoS Neglected Tropical Diseases)
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Conclusions/SignificanceSchistosomiasis is prevalent in this HIV cohort and may be beneficial for immunological reconstitution, while no effect on virological failure was apparent. A positive effect of schistosomiasis-induced immunomodulation on survival and retention in care needs confirmation in future studies. (Source: PLoS Neglected Tropical Diseases)
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Don't delete that email! Starting Oct. 22, emails may appear in speech-language pathologists' inboxes, and you want to pay attention to them. A response to these crucial messages can influence how payers calculate reimbursement for your services. As a practicing SLP, you can help determine fair rates by completing Current Procedural Terminology (CPT® American Medical Association) code surveys related to cognitive treatment. Are you ready to make a difference? Learn how a CPT code becomes a code and your role in the process. The American Medical Association's step-by-step guide shows you how to accurately—and objectively—complete the survey: We know—most surveys are an annoyance. But these can directly affect how Medicare and other insurers value your services. Here's what y...
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Don't delete that email! Starting Oct. 22, emails may appear in speech-language pathologists' inboxes, and you want to pay attention to them. A response to these crucial messages can influence how payers calculate reimbursement for your services. As a practicing SLP, you can help determine fair rates by completing Current Procedural Terminology (CPT® American Medical Association) code surveys related to cognitive treatment. Are you ready to make a difference? Learn how a CPT code becomes a code and your role in the process. The American Medical Association's step-by-step guide shows you how to accurately—and objectively—complete the survey: We know—most surveys are an annoyance. But these can directly affect how Medicare and other insurers value your services. Here's what y...
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Sara Schaefer, Kasper Arthur Hettinga, James Cullor, J. Bruce German, Bethany M. Henrick (Source: Frontiers in Immunology)
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Publication date: Available online 16 October 2018Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Sarah G. Kessler, Amanda R. Gillion, Debendra Pattanaik, Kelly C. Rogers (Source: The Journal of Allergy and Clinical Immunology: In Practice)
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ConclusionsThere are large variations in the differences between CDC self-reported estimates for the general population and the in-contact estimates for the Medicaid-enrolled children, highlighting potential asthma misdiagnosis in the Medicaid population in many states. Small area estimates point to areas of high prevalence, consistently throughout the south and southeast. (Source: The Journal of Allergy and Clinical Immunology: In Practice)
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ConclusionAn increased risk of TB development may persist for 3 years after stopping the ICS and the risk is higher in patients with COPD regardless of the type of ICS used. (Source: The Journal of Allergy and Clinical Immunology: In Practice)
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Sara Schaefer, Kasper Arthur Hettinga, James Cullor, J. Bruce German, Bethany M. Henrick (Source: Frontiers in Immunology)
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Ahmet G ül (Source: Frontiers in Immunology)
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ConclusionIn this analysis of French death certificates mentioning GCA, we observed a stable standardized mortality rate between 2005 and 2014. The most frequent associated diseases were cardiovascular diseases and infections. (Source: Autoimmunity Reviews)
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Publication date: Available online 16 October 2018Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Sarah G. Kessler, Amanda R. Gillion, Debendra Pattanaik, Kelly C. Rogers (Source: The Journal of Allergy and Clinical Immunology: In Practice)
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ConclusionIdentified consensus statements can help clinicians to apply to routine-care settings the results from clinical studies and international recommendations, providing a guide for individualization of treatment strategy in axSpA patients. (Source: Autoimmunity Reviews)
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ConclusionsThere are large variations in the differences between CDC self-reported estimates for the general population and the in-contact estimates for the Medicaid-enrolled children, highlighting potential asthma misdiagnosis in the Medicaid population in many states. Small area estimates point to areas of high prevalence, consistently throughout the south and southeast. (Source: The Journal of Allergy and Clinical Immunology: In Practice)
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AbstractThe expression of MHC class II molecules (MHCII) on tumor cells correlates with survival and responsiveness to immunotherapy. However, the mechanisms underlying these observations are poorly defined. Using a murine breast tumor line, we showed that MHCII-expressing tumors grew more slowly than controls and recruited more functional CD4+ and CD8+ T cells. In addition, MHCII-expressing tumors contained more TCR clonotypes expanded to a larger degree than control tumors. Functional CD8+ T cells in tumors depended on CD4+ T cells. However, both CD4+ and CD8+ T cells eventually became exhausted, even in MHCII-expressing tumors. Treatment with anti-CTLA4, but not anti-PD-1 or anti-TIM-3, promoted complete eradication of MHCII-expressing tumors. These results suggest tumor cell expression...
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Publication date: Available online 17 October 2018Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Kishan Govind, Katherine Whang, Raveena Khanna, Adrienne W. Scott, Shawn G. Kwatra (Source: The Journal of Allergy and Clinical Immunology: In Practice)
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Immunotherapy,Volume 10, Issue 14, Page 1229-1239, October 2018. (Source: Immunotherapy)
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ConclusionAn increased risk of TB development may persist for 3 years after stopping the ICS and the risk is higher in patients with COPD regardless of the type of ICS used. (Source: The Journal of Allergy and Clinical Immunology: In Practice)
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This article is protected by copyright. All rights reserved. PMID: 30325010 [PubMed - as supplied by publisher] (Source: Clinical and Developmental Immunology)
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Publication date: Available online 17 October 2018Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Hermann M. . Wolf, Martha M. Eibl, Christian J. Müller (Source: The Journal of Allergy and Clinical Immunology: In Practice)
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ConclusionIn this analysis of French death certificates mentioning GCA, we observed a stable standardized mortality rate between 2005 and 2014. The most frequent associated diseases were cardiovascular diseases and infections. (Source: Autoimmunity Reviews)
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ConclusionIdentified consensus statements can help clinicians to apply to routine-care settings the results from clinical studies and international recommendations, providing a guide for individualization of treatment strategy in axSpA patients. (Source: Autoimmunity Reviews)
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Immunotherapy,Volume 10, Issue 14, Page 1229-1239, October 2018. (Source: Immunotherapy)
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This article is protected by copyright. All rights reserved. PMID: 30325010 [PubMed - as supplied by publisher] (Source: Clinical and Developmental Immunology)
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Don't delete that email! Starting Oct. 22, emails may appear in speech-language pathologists' inboxes, and you want to pay attention to them. A response to these crucial messages can influence how payers calculate reimbursement for your services. As a practicing SLP, you can help determine fair rates by completing Current Procedural Terminology (CPT® American Medical Association) code surveys related to cognitive treatment. Are you ready to make a difference? Learn how a CPT code becomes a code and your role in the process. The American Medical Association's step-by-step guide shows you how to accurately—and objectively—complete the survey: We know—most surveys are an annoyance. But these can directly affect how Medicare and other insurers value your services. Here's what y...
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Don't delete that email! Starting Oct. 22, emails may appear in speech-language pathologists' inboxes, and you want to pay attention to them. A response to these crucial messages can influence how payers calculate reimbursement for your services. As a practicing SLP, you can help determine fair rates by completing Current Procedural Terminology (CPT® American Medical Association) code surveys related to cognitive treatment. Are you ready to make a difference? Learn how a CPT code becomes a code and your role in the process. The American Medical Association's step-by-step guide shows you how to accurately—and objectively—complete the survey: We know—most surveys are an annoyance. But these can directly affect how Medicare and other insurers value your services. Here's what y...
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Children with life threatening food allergies live with the constant threat of a fatal reaction, and caregivers must always be prepared to treat with an epinephrine auto-injector (EAI). This interpretive phenomenological study explored parents' perceptions and lived experiences with prescribed EAI use for their child.
The purposive sample included ten parents of five children under 12 years of age, diagnosed with a food allergy and prescribed with an EAI who recently experienced anaphylaxis. Data sources included digitally-recorded semi-structured interviews and a reflexive journal.
Eight main themes emerged: perception of anaphylaxis, life challenges, isolation, anxiety, hesitation, guilt, influence of health care professionals, and lessons learned. Parents uniformly described multiple life challenges and feelings of isolation, anxiety and hesitation during a reaction that lead to subsequent guilt.
Handling reactions correctly provided parents with confidence to treat subsequent reactions. Witnessing the effects of an EAI and receiving positive feedback from health care providers further strengthened their confidence to quickly and competently intervene in future reactions.
Some clinicians are concerned that if an intraoral vertical ramus osteotomy (IVRO) is used to position the mandible posteriorly, the proximal segments should be positioned laterally to the distal segment, which could increase the transverse mandibular width (TMW), leading to esthetically-unfavorable results. This study investigated short- and long-term postoperative TMW changes in soft and hard tissue following IVRO for mandibular prognathism .
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To assess and update long-term outcomes of endoscopic condylectomy and costochondral graft (CCG) reconstruction for treatment of active idiopathic condylar resorption (ICR).
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Extra-articular temporomandibular bony ankylosis between the zygomatic bone and coronoid process is a rare condition. Currently, there are <40 cases reported in the English literature. The aim of this study was to report a case of zygomatico-coronoid ankylosis with surgical intervention and a literature review.
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This study examined the relation between dissection range of facial nerve branches and transient postoperative facial palsy caused by nerve traction for open treatment of mandibular condyle fractures using a preauricular approach.
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Some clinicians are concerned that if an intraoral vertical ramus osteotomy (IVRO) is used to position the mandible posteriorly, the proximal segments should be positioned laterally to the distal segment, which could increase the transverse mandibular width (TMW), leading to esthetically-unfavorable results. This study investigated short- and long-term postoperative TMW changes in soft and hard tissue following IVRO for mandibular prognathism .
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Extra-articular temporomandibular bony ankylosis between the zygomatic bone and coronoid process is a rare condition. Currently, there are <40 cases reported in the English literature. The aim of this study was to report a case of zygomatico-coronoid ankylosis with surgical intervention and a literature review.
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This study examined the relation between dissection range of facial nerve branches and transient postoperative facial palsy caused by nerve traction for open treatment of mandibular condyle fractures using a preauricular approach.
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8 –9 November 2018, Liverpool, United Kingdom (Source: Scientific and Medical Events on Global Events List)
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Some clinicians are concerned that if an intraoral vertical ramus osteotomy (IVRO) is used to position the mandible posteriorly, the proximal segments should be positioned laterally to the distal segment, which could increase the transverse mandibular width (TMW), leading to esthetically-unfavorable results. This study investigated short- and long-term postoperative TMW changes in soft and hard tissue following IVRO for mandibular prognathism .
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To assess and update long-term outcomes of endoscopic condylectomy and costochondral graft (CCG) reconstruction for treatment of active idiopathic condylar resorption (ICR).
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NNbCU6
Extra-articular temporomandibular bony ankylosis between the zygomatic bone and coronoid process is a rare condition. Currently, there are <40 cases reported in the English literature. The aim of this study was to report a case of zygomatico-coronoid ankylosis with surgical intervention and a literature review.
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8 –9 November 2018, Liverpool, United Kingdom (Source: Scientific and Medical Events on Global Events List)
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This study examined the relation between dissection range of facial nerve branches and transient postoperative facial palsy caused by nerve traction for open treatment of mandibular condyle fractures using a preauricular approach.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NNmSzH
Some clinicians are concerned that if an intraoral vertical ramus osteotomy (IVRO) is used to position the mandible posteriorly, the proximal segments should be positioned laterally to the distal segment, which could increase the transverse mandibular width (TMW), leading to esthetically-unfavorable results. This study investigated short- and long-term postoperative TMW changes in soft and hard tissue following IVRO for mandibular prognathism .
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2pXkY63
To assess and update long-term outcomes of endoscopic condylectomy and costochondral graft (CCG) reconstruction for treatment of active idiopathic condylar resorption (ICR).
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NNbCU6
Extra-articular temporomandibular bony ankylosis between the zygomatic bone and coronoid process is a rare condition. Currently, there are <40 cases reported in the English literature. The aim of this study was to report a case of zygomatico-coronoid ankylosis with surgical intervention and a literature review.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2pZNMuS
This study examined the relation between dissection range of facial nerve branches and transient postoperative facial palsy caused by nerve traction for open treatment of mandibular condyle fractures using a preauricular approach.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2NNmSzH
Strong mandibular angles and a heavy chin are perceived as masculine features, so surgical feminization of female or transgender faces may warrant mandibular base narrowing (borders and angles) and a reduction in chin width and height. With this in mind, we have devised an interdental midline osteotomy (triangular in shape and with a caudal base) to accompany a box-shaped impaction osteotomy of the chin symphysis and horizontal triangular resection of the lateral mandibular border. The reduction of the intergonial width and of the mandibular border and chin widths takes place upon closure of the midline defect.
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Superimposition of radiographic imaging is used to evaluate patient growth and the effects of surgical and/or orthodontic treatment. The purpose of this study was to compare the outcomes of superimposition between two-dimensional (2D) and three-dimensional (3D) superimpositions. 2D lateral cephalograms were generated from the initial and final cone beam computed tomography scans (CBCT) of 18 patients and superimposed. Both 3D CBCT and 2D CBCT generated lateral cephalograms were oriented to the Frankfort horizontal plane and superimposed according to the American Board of Orthodontics recommendations.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PMtgZC
Strong mandibular angles and a heavy chin are perceived as masculine features, so surgical feminization of female or transgender faces may warrant mandibular base narrowing (borders and angles) and a reduction in chin width and height. With this in mind, we have devised an interdental midline osteotomy (triangular in shape and with a caudal base) to accompany a box-shaped impaction osteotomy of the chin symphysis and horizontal triangular resection of the lateral mandibular border. The reduction of the intergonial width and of the mandibular border and chin widths takes place upon closure of the midline defect.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PcQKKN
Superimposition of radiographic imaging is used to evaluate patient growth and the effects of surgical and/or orthodontic treatment. The purpose of this study was to compare the outcomes of superimposition between two-dimensional (2D) and three-dimensional (3D) superimpositions. 2D lateral cephalograms were generated from the initial and final cone beam computed tomography scans (CBCT) of 18 patients and superimposed. Both 3D CBCT and 2D CBCT generated lateral cephalograms were oriented to the Frankfort horizontal plane and superimposed according to the American Board of Orthodontics recommendations.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2PMtgZC
Genetic variants in the hedgehog signaling pathway and VDR gene are involved in inflammatory responses and neoplastic transformation. Current study investigated whether single-nucleotide polymorphisms in the hedgehog pathway genes PTCH1, GLI1, SMO, and VDR contribute to susceptibility to odontogenic cystic lesions, odontogenic keratocysts, or inflammatory radicular cysts.
Current study examined polymorphisms of PTCH1 (rs357564) and PTCH1 insertion (IVS1-83), GLI1 (rs2228224, rs2228226), SMO (rs2228617), and VDR (rs2228570, rs731236, rs7975232). A case-control study was conducted on 41 keratocyst cases, 43 radicular cyst cases, and control group of 93 healthy individuals without cystic lesions, radiographically confirmed. Single-nucleotide polymorphisms were assessed by real-time and TaqMan SNP genotyping assays, while PTCH1 insertion 18 bp IVS1-83 polymorphism was determined by PCR.
The difference in genotype distribution between keratocyst cases and control group was observed for PTCH1 IVS1-83 and GLI1 rs2228224 polymorphism (p = 0.022, p = 0.030, respectively). Homozygous mutant GG genotype within GLI1 rs2228224 is associated with increased susceptibility for odontogenous keratocysts, with adjusted odds ratio of 4.098 (confidence interval of 1.482–11.328, p = 0.007).
GLI1 rs2228224 and PTCH1 polymorphisms could predispose to odontogenic keratocysts.
Variants in hedgehog signaling pathway genes, such as GLI1 and PTCH1, and vitamin D receptor gene, might be considered as molecular risk factors in odontogenic cystic lesions and potential targets for novel therapeutic approaches.
Genetic variants in the hedgehog signaling pathway and VDR gene are involved in inflammatory responses and neoplastic transformation. Current study investigated whether single-nucleotide polymorphisms in the hedgehog pathway genes PTCH1, GLI1, SMO, and VDR contribute to susceptibility to odontogenic cystic lesions, odontogenic keratocysts, or inflammatory radicular cysts.
Current study examined polymorphisms of PTCH1 (rs357564) and PTCH1 insertion (IVS1-83), GLI1 (rs2228224, rs2228226), SMO (rs2228617), and VDR (rs2228570, rs731236, rs7975232). A case-control study was conducted on 41 keratocyst cases, 43 radicular cyst cases, and control group of 93 healthy individuals without cystic lesions, radiographically confirmed. Single-nucleotide polymorphisms were assessed by real-time and TaqMan SNP genotyping assays, while PTCH1 insertion 18 bp IVS1-83 polymorphism was determined by PCR.
The difference in genotype distribution between keratocyst cases and control group was observed for PTCH1 IVS1-83 and GLI1 rs2228224 polymorphism (p = 0.022, p = 0.030, respectively). Homozygous mutant GG genotype within GLI1 rs2228224 is associated with increased susceptibility for odontogenous keratocysts, with adjusted odds ratio of 4.098 (confidence interval of 1.482–11.328, p = 0.007).
GLI1 rs2228224 and PTCH1 polymorphisms could predispose to odontogenic keratocysts.
Variants in hedgehog signaling pathway genes, such as GLI1 and PTCH1, and vitamin D receptor gene, might be considered as molecular risk factors in odontogenic cystic lesions and potential targets for novel therapeutic approaches.
Experts discuss whether it's safe to rely on the allergy medicine. (Source: Healthy Living - The Huffington Post)
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Experts discuss whether it's safe to rely on the allergy medicine. (Source: Healthy Living - The Huffington Post)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
Experts discuss whether it's safe to rely on the allergy medicine. (Source: Healthy Living - The Huffington Post)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
Experts discuss whether it's safe to rely on the allergy medicine. (Source: Healthy Living - The Huffington Post)
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Human SH2D1A mutations resulting in X-linked lymphoproliferative syndrome type 1 (XLP1) are associated with a unique susceptibility to the EBV. This susceptibility is attributed to impaired activation and cytotoxicity of CD8+ T cells by antigen-presenting B cells but not by other antigen-presenting cells.1 Impaired function of CD4+ T cells contributes to humoral immunodeficiency independent of EBV infection.2 In clinical situations, fatal infectious mononucleosis (FIM)/hemophagocytic lymphohistiocytosis (HLH) have high mortality rates, and hematopoietic stem cell transplantation (HSCT) is the only curative therapy. (Source: Journal of Allergy and Clinical Immunology)
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2P2EwUQ
Human SH2D1A mutations resulting in X-linked lymphoproliferative syndrome type 1 (XLP1) are associated with a unique susceptibility to the EBV. This susceptibility is attributed to impaired activation and cytotoxicity of CD8+ T cells by antigen-presenting B cells but not by other antigen-presenting cells.1 Impaired function of CD4+ T cells contributes to humoral immunodeficiency independent of EBV infection.2 In clinical situations, fatal infectious mononucleosis (FIM)/hemophagocytic lymphohistiocytosis (HLH) have high mortality rates, and hematopoietic stem cell transplantation (HSCT) is the only curative therapy. (Source: Journal of Allergy and Clinical Immunology)
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Authors: Brown AD, Benichoux V, Jones HG, Anbuhl KL, Tollin DJ Abstract Sensory performance is constrained by the information in the stimulus and the precision of the involved sensory system(s). Auditory spatial acuity is robust across a broad range of sound frequencies and source locations, but declines at eccentric lateral angles. The basis of such variation is not fully understood. Low-frequency auditory spatial acuity is mediated by sensitivity to interaural time difference (ITD) cues. While low-frequency spatial acuity varies across azimuth and some physiological models predict strong medial bias in the precision of ITD sensitivity, human psychophysical ITD sensitivity appears to vary only slightly with reference ITD magnitude. Correspondingly, recent analyses suggest that spa...
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EuZiIB
Authors: Brown AD, Benichoux V, Jones HG, Anbuhl KL, Tollin DJ Abstract Sensory performance is constrained by the information in the stimulus and the precision of the involved sensory system(s). Auditory spatial acuity is robust across a broad range of sound frequencies and source locations, but declines at eccentric lateral angles. The basis of such variation is not fully understood. Low-frequency auditory spatial acuity is mediated by sensitivity to interaural time difference (ITD) cues. While low-frequency spatial acuity varies across azimuth and some physiological models predict strong medial bias in the precision of ITD sensitivity, human psychophysical ITD sensitivity appears to vary only slightly with reference ITD magnitude. Correspondingly, recent analyses suggest that spa...
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2EuZiIB
TUESDAY, Oct. 16, 2018 -- You won't jump for joy when you're told you need hearing aids or cataract surgery. But get this: Both appear to slow mental decline in older adults. That's what researchers concluded after studying more than 2,000 people... (Source: Drugs.com - Daily MedNews)
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TUESDAY, Oct. 16, 2018 -- You won't jump for joy when you're told you need hearing aids or cataract surgery. But get this: Both appear to slow mental decline in older adults. That's what researchers concluded after studying more than 2,000 people... (Source: Drugs.com - Daily MedNews)
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In conclusion, results suggested that the ICHQ/M composition can be considered as an antileishmanial candidate to be tested against human leishmaniasis.Graphical abstract (Source: Parasitology International)
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(Source: Medical Microbiology and Immunology)
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In conclusion, results suggested that the ICHQ/M composition can be considered as an antileishmanial candidate to be tested against human leishmaniasis.Graphical abstract (Source: Parasitology International)
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(Source: Medical Microbiology and Immunology)
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Thyroid, Ahead of Print.
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Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Cld51A
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Oz5ZxR
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Oz5ZxR
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Oz5ZxR
Thyroid, Ahead of Print.
from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2Oz5ZxR
TUESDAY, Oct. 16, 2018 -- You won't jump for joy when you're told you need hearing aids or cataract surgery. But get this: Both appear to slow mental decline in older adults. That's what researchers concluded after studying more than 2,000 people... (Source: Drugs.com - Daily MedNews)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
TUESDAY, Oct. 16, 2018 -- You won't jump for joy when you're told you need hearing aids or cataract surgery. But get this: Both appear to slow mental decline in older adults. That's what researchers concluded after studying more than 2,000 people... (Source: Drugs.com - Daily MedNews)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
