Verhaltenstherapeutische Ansätze bei internetbezogenen Störungen: Diagnostik, Motivation und Verhaltensmodifikation

Der Begriff «internetbezogene Störungen» wird derzeit genutzt, um unterschiedliche Online-Aktivitäten zu beschreiben, die sich dysfunktional und zumeist zeitlich ausufernd darstellen. Von Betroffenen beschriebene Merkmale wie Kontrollverlust, Fortführung des Konsums trotz negativer Konsequenzen und das Auftreten aversiver Zustände bei Konsumverhinderung verdeutlichen Parallelen zu anderen Abhängigkeitserkrankungen, wie der Störung durch Glücksspielen. Während in einer Vielzahl von Bereichen (z.B. Epidemiologie, Neurobiologie) eine steigende Anzahl von Forschungsaktivitäten zu verzeichnen ist, ist aktuell über die Anwendbarkeit und Wirksamkeit psychotherapeutischer Interventionen nur wenig bekannt. Dieser Übersichtsartikel soll eine Einordnung der hierzu vorliegenden Befunde bieten. Erste Übersichtsarbeiten deuten darauf hin, dass gerade bewährte verhaltenstherapeutische Behandlungsstrategien, wie etwa kognitives Umstrukturieren, Kontingenzmanagement, aber auch die Expositionsbehandlung, bei internetbezogenen Störungen gut anwendbar sind. Darüber hinaus zeigt die klinische Erfahrung, dass vor der eigentlichen Verhaltensmodifikation besonderes Augenmerk auf die Etablierung einer ausreichenden Veränderungsmotivation gelegt werden sollte, um bestehende motivationale Defizite und Ambivalenzen der Patienten aufzufangen. Mit der Aufnahme der Störung durch Computerspielen (Internet Gaming Disorder) als eine besonders häufige und empirisch gut beschriebene Variante internetbezogener Störungen in die International Classification of Diseases 11 (ICD-11) ist eine Zunahme der klinischen Studien zu diesem neuen Störungsbild zu erwarten.
Verhaltenstherapie

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Integrative kognitive Verhaltenstherapie für die anhaltende Trauerstörung: Vorstellung eines Behandlungsmanuals

Das Manual der integrativen kognitiven Verhaltenstherapie zur Behandlung der anhaltenden Trauerstörung bei ambulanten Patienten wird in Kurzform vorgestellt. Das Behandlungsmanual wurde für Personen entwickelt, die mehr als 6 Monate nach dem Verlust einer Bezugsperson unter anhaltenden und schwerwiegenden Trauersymptomen leiden. Therapieziele sind ein veränderter emotionaler Umgang mit der Trauer sowie eine funktionale Anpassung an die neue Lebenssituation ohne die verstorbene Person. Dazu werden kognitiv-verhaltenstherapeutische Methoden mit systemischen und gestalttherapeutischen Interventionen kombiniert. Die 20 wöchentlichen Therapiesitzungen sind in 3 Phasen unterteilt. In der ersten Phase stehen Beziehungsgestaltung, Informationsvermittlung und Veränderungsmotivation im Vordergrund. Die zweite Phase erlaubt unterschiedliche Schwerpunkte: Bearbeitung von Schuldgefühlen, Anpassung an veränderte Lebensbedingungen, Trauer als Mittel zur Aufrechterhaltung der Bindung an die verstorbene Person oder Bearbeitung der Vermeidungssymptomatik. Dabei kommen Exposition in sensu, kognitive Umstrukturierung und gestalttherapeutische Stuhlarbeit zum Einsatz. Exposition in vivo kann bei Bedarf angewendet werden. In der dritten Phase geht es um die veränderte Beziehung zur verstorbenen Person, die Entwicklung neuer Lebensziele und um Rückfallprophylaxe. Weiterhin können optionale Sitzungen, die sich mit besonderen Gelegenheiten wie Jahrestagen befassen, in den Therapieverlauf integriert werden. Insgesamt ermöglicht das vorgestellte Manual eine flexible und effektive Behandlung der anhaltenden Trauerstörung.
Verhaltenstherapie

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Verhaltenstherapeutische Ansätze bei internetbezogenen Störungen: Diagnostik, Motivation und Verhaltensmodifikation

Der Begriff «internetbezogene Störungen» wird derzeit genutzt, um unterschiedliche Online-Aktivitäten zu beschreiben, die sich dysfunktional und zumeist zeitlich ausufernd darstellen. Von Betroffenen beschriebene Merkmale wie Kontrollverlust, Fortführung des Konsums trotz negativer Konsequenzen und das Auftreten aversiver Zustände bei Konsumverhinderung verdeutlichen Parallelen zu anderen Abhängigkeitserkrankungen, wie der Störung durch Glücksspielen. Während in einer Vielzahl von Bereichen (z.B. Epidemiologie, Neurobiologie) eine steigende Anzahl von Forschungsaktivitäten zu verzeichnen ist, ist aktuell über die Anwendbarkeit und Wirksamkeit psychotherapeutischer Interventionen nur wenig bekannt. Dieser Übersichtsartikel soll eine Einordnung der hierzu vorliegenden Befunde bieten. Erste Übersichtsarbeiten deuten darauf hin, dass gerade bewährte verhaltenstherapeutische Behandlungsstrategien, wie etwa kognitives Umstrukturieren, Kontingenzmanagement, aber auch die Expositionsbehandlung, bei internetbezogenen Störungen gut anwendbar sind. Darüber hinaus zeigt die klinische Erfahrung, dass vor der eigentlichen Verhaltensmodifikation besonderes Augenmerk auf die Etablierung einer ausreichenden Veränderungsmotivation gelegt werden sollte, um bestehende motivationale Defizite und Ambivalenzen der Patienten aufzufangen. Mit der Aufnahme der Störung durch Computerspielen (Internet Gaming Disorder) als eine besonders häufige und empirisch gut beschriebene Variante internetbezogener Störungen in die International Classification of Diseases 11 (ICD-11) ist eine Zunahme der klinischen Studien zu diesem neuen Störungsbild zu erwarten.
Verhaltenstherapie

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Integrative kognitive Verhaltenstherapie für die anhaltende Trauerstörung: Vorstellung eines Behandlungsmanuals

Das Manual der integrativen kognitiven Verhaltenstherapie zur Behandlung der anhaltenden Trauerstörung bei ambulanten Patienten wird in Kurzform vorgestellt. Das Behandlungsmanual wurde für Personen entwickelt, die mehr als 6 Monate nach dem Verlust einer Bezugsperson unter anhaltenden und schwerwiegenden Trauersymptomen leiden. Therapieziele sind ein veränderter emotionaler Umgang mit der Trauer sowie eine funktionale Anpassung an die neue Lebenssituation ohne die verstorbene Person. Dazu werden kognitiv-verhaltenstherapeutische Methoden mit systemischen und gestalttherapeutischen Interventionen kombiniert. Die 20 wöchentlichen Therapiesitzungen sind in 3 Phasen unterteilt. In der ersten Phase stehen Beziehungsgestaltung, Informationsvermittlung und Veränderungsmotivation im Vordergrund. Die zweite Phase erlaubt unterschiedliche Schwerpunkte: Bearbeitung von Schuldgefühlen, Anpassung an veränderte Lebensbedingungen, Trauer als Mittel zur Aufrechterhaltung der Bindung an die verstorbene Person oder Bearbeitung der Vermeidungssymptomatik. Dabei kommen Exposition in sensu, kognitive Umstrukturierung und gestalttherapeutische Stuhlarbeit zum Einsatz. Exposition in vivo kann bei Bedarf angewendet werden. In der dritten Phase geht es um die veränderte Beziehung zur verstorbenen Person, die Entwicklung neuer Lebensziele und um Rückfallprophylaxe. Weiterhin können optionale Sitzungen, die sich mit besonderen Gelegenheiten wie Jahrestagen befassen, in den Therapieverlauf integriert werden. Insgesamt ermöglicht das vorgestellte Manual eine flexible und effektive Behandlung der anhaltenden Trauerstörung.
Verhaltenstherapie

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Ulnar focal cortical indentation: a progressive, deforming variant of focal fibrocartilaginous dysplasia

Abstract

Background

Focal fibrocartilaginous dysplasia is a rare growth disturbance of bone resulting in deformity. In the ulna, focal fibrocartilaginous dysplasia is particularly rare, and the characteristic fibroligamentous tether can result in progressive deformity with progressive dislocation of the radial head. The fibroligamentous tether is similar in appearance and function to the Vickers ligament seen in Madelung deformity. The imaging features of ulnar focal fibrocartilaginous dysplasia include a unilateral angular deformity in the ulna with a radiolucent cortical defect and surrounding sclerosis, with secondary radial bowing or radial head dislocation. Focal fibrocartilaginous dysplasia of the ulna has been described using the term ulnar focal cortical indentation.

Objective

To review the clinical and radiologic features of four cases of ulnar focal cortical indentation occurring in pediatric patients.

Materials and methods

We retrospectively reviewed picture archiving and communication system and electronic medical record imaging findings with surgical correlation of ulnar focal cortical indentation at two large specialty pediatric hospitals.

Results

Ulnar focal cortical indentation lesions typically arise in the ulnar metaphysis and result in angular forearm deformities with progressive radial deformity including radial head dislocation. Early surgical intervention prevents progression of the deformity and retains range of motion.

Conclusion

Ulnar focal cortical indentation, although rare, is likely a progressive form of focal fibrocartilaginous dysplasia resulting in significant deformity and disability. Early recognition of the characteristic imaging features is important for early surgical intervention to preserve range of motion and prevent radial head dislocation.

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Ulnar focal cortical indentation: a progressive, deforming variant of focal fibrocartilaginous dysplasia

Abstract

Background

Focal fibrocartilaginous dysplasia is a rare growth disturbance of bone resulting in deformity. In the ulna, focal fibrocartilaginous dysplasia is particularly rare, and the characteristic fibroligamentous tether can result in progressive deformity with progressive dislocation of the radial head. The fibroligamentous tether is similar in appearance and function to the Vickers ligament seen in Madelung deformity. The imaging features of ulnar focal fibrocartilaginous dysplasia include a unilateral angular deformity in the ulna with a radiolucent cortical defect and surrounding sclerosis, with secondary radial bowing or radial head dislocation. Focal fibrocartilaginous dysplasia of the ulna has been described using the term ulnar focal cortical indentation.

Objective

To review the clinical and radiologic features of four cases of ulnar focal cortical indentation occurring in pediatric patients.

Materials and methods

We retrospectively reviewed picture archiving and communication system and electronic medical record imaging findings with surgical correlation of ulnar focal cortical indentation at two large specialty pediatric hospitals.

Results

Ulnar focal cortical indentation lesions typically arise in the ulnar metaphysis and result in angular forearm deformities with progressive radial deformity including radial head dislocation. Early surgical intervention prevents progression of the deformity and retains range of motion.

Conclusion

Ulnar focal cortical indentation, although rare, is likely a progressive form of focal fibrocartilaginous dysplasia resulting in significant deformity and disability. Early recognition of the characteristic imaging features is important for early surgical intervention to preserve range of motion and prevent radial head dislocation.

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Editorial Board

Publication date: February 2019

Source: Addictive Behaviors, Volume 89

Author(s):

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A videogame intervention for tobacco product use prevention in adolescents

Publication date: Available online 14 November 2018

Source: Addictive Behaviors

Author(s): Mary Ann Pentz, Kimberly D. Hieftje, Tyra M. Pendergrass, Stephanie A. Brito, Mengyu Liu, Trisha Arora, Hilary A. Tindle, Suchitra Krishnan-Sarin, Lynn E. Fiellin

Abstract

Purpose

This pilot study evaluated the short-term effects of an interactive videogame on changing adolescent knowledge, beliefs and risk perceptions, and intentions to use e-cigarettes, cigarettes, and other tobacco products. A secondary aim was to evaluate players' game experience.

Methods

Participants (N = 80 11–14 year olds) were recruited from 7 community-based afterschool programs in Los Angeles, California and New Haven, Connecticut. The design was a single group pre-post design with replication. A pre-test survey was administered that included demographic variables and knowledge, risk perceptions, beliefs, and intentions to use e-cigarettes, cigarettes, and other tobacco products. An interactive videogame focusing on risky tobacco use situations was subsequently played in four 60-min sessions over a four-week period, followed by a post-test survey. Analyses included paired t-tests of pre-post videogame change, regression analyses, and path analyses testing mediational effects of beliefs and risk perceptions on the relationship between knowledge and intentions.

Results

The videogame changed knowledge of e-cigarettes and other tobacco products (p's < 0.001), risk perceptions of cigarettes and e-cigarettes (p < .01 and p < .001, respectively), and beliefs about e-cigarettes and other tobacco products (p's < 0.05), but not intentions Older adolescents reported greater e-cigarette knowledge and risk perceptions (p's < 0.05), and females reported greater risk perception of cigarettes (p < .05). Beliefs mediated the relationship between knowledge and intentions to use e-cigarettes (indirect effect p < .05).

Conclusion

Results suggest that brief exposure (4 h over 4 weeks) to videogames focused on changing knowledge and attitudes towards tobacco products may have a promising effect on preventing risk for early adolescent tobacco product use, particularly for e-cigarettes.

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Content analysis of internet marketing strategies use to promote flavored electronic cigarettes

Publication date: Available online 14 November 2018

Source: Addictive Behaviors

Author(s): Eric K. Soule, Kari-Lyn K. Sakuma, Sherilyn Palafox, Pallav Pokhrel, Thaddeus Herzog, Noel Thompson, Pebbles Fagan

Abstract

Introduction

Flavored e-cigarette (ECIG) use and Internet marketing have increased in the U.S. This study examined the content used to promote flavored ECIG liquids on retailer websites.

Methods

Four ECIG liquid retailers from four U.S. geographic regions (n = 16) were randomly selected. Menthol, apple, and tobacco flavored liquids were purchased in April of 2016 (n = 144, 48 unique flavors). Staff analyzed the text and image descriptors displayed on liquid bottles and retailer websites and coded content for presence of specific flavor, taste/smell, chemesthesis (i.e., touch), America/patriotic, and product quality/potentially modified risk content. A follow-up of retailer websites was conducted in March 2018.

Results

Nearly all (97.9%) ECIG liquids included a description that promoted flavor. Most descriptions including images of something other than an ECIG liquid bottle (e.g., 62% of tobacco ECIG liquid images including dried tobacco leaves, 43% of menthol ECIG liquid images including mint leaves or ice, 62% of apple ECIG liquid images including an apple). Images often promoted product sensations (e.g., cool, ice), sweet tastes of other products (e.g., chocolate, apple pie), or other appeals (e.g., America). Menthol and apple descriptions/images were more likely than tobacco flavors to promote appeals related to chemesthesis (e.g., cool, warm, moist; p < .05). Most flavors were still available in 2018 and included the same flavor descriptions from 2016.

Conclusions

Flavored ECIG liquid marketing often includes text descriptions and images that appeal to consumer sensations. Studies are needed to examine how youth access to point-of-sale Internet advertisements influences their attitudes, perceptions, and purchasing of ECIG products.

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Smokers' perceptions of risks and harm from snus relative to cigarettes: A latent profile analysis study

Publication date: Available online 14 November 2018

Source: Addictive Behaviors

Author(s): Olivia A. Wackowski, Anne E. Ray, Jerod L. Stapleton

Abstract

Introduction

Certain types of smokeless tobacco (SLT) products, particularly snus, carry fewer health risks than cigarette smoking and might be able to serve as harm-reduction products for smokers. However, studies frequently find that smokers misperceive SLT and snus to be as or more harmful than smoking. This perception is often measured with a single general harm question, and research on underlying risk perceptions is limited.

Methods

Using a sample of 256 current smokers, we utilized Latent Profile Analysis to examine response profiles to items that assessed perceived risk of specific health outcomes (lung cancer, heart disease, oral cancer) from snus relative to cigarettes, along with the typical single item measure of overall harm from snus compared to cigarettes.

Results

Three smoker response profiles emerged. Almost half (44.9%) of smokers perceived snus to be as or more risky than cigarettes for all three specific health outcomes (group 1), while over one third (38.3%) had an elevated perceived risk for oral cancer only (group 2). About 17% of smokers perceived snus to have lower risks for lung cancer only (group 3). Across each profile, perceived risk was highest for oral cancer, despite a lack of scientific evidence of this effect from snus use.

Conclusions

If smokers are to consider snus for harm-reduction, efforts may be needed to better inform smokers about their lower relative risks, including for particular health outcomes of interest. This study also suggests that smokers may vary in their level of need for information to correct their relative risk misperceptions.

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Editorial Board

Publication date: February 2019

Source: Addictive Behaviors, Volume 89

Author(s):

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Dissociating the effect of flavor and nicotine in smokeless tobacco products using electroencephalography: The case of wintergreen flavors

Publication date: Available online 14 November 2018

Source: Addictive Behaviors

Author(s): Mauricio Rangel-Gomez, Raul Cruz-Cano, Carly Van Wagoner, Azieb Kidanu, Craig G. McDonald, Pamela I. Clark

Abstract

The increased consumption of tobacco products in recent years has been linked, among other factors, to the presence of added flavors. Although flavors are important in explaining consumption, their effects in the brain have until now been unexplored. In the present study, we investigated how electrophysiology can serve to dissociate the effects of nicotine and flavor. Participants attended 4 sessions (2-by-2 factorial design, with flavor and nicotine as within-subject factors), in each session an oddball task was performed before and after smokeless tobacco consumption.

We explored the dissociation of neural responses to flavor and nicotine. While event-related potentials did not show modulation due to flavors, time-frequency showed a flavor-nicotine dissociation. Low-frequency activity (delta, theta and alpha) showed only effects of nicotine, and high-frequency activity (beta1, beta2 and gamma) showed effects only susceptible to flavor. Flavors in smokeless tobacco not only made the product more desirable but also triggered the allocation of cognitive resources. This long-lasting effect of flavor may enhance the addictive potential of the tobacco product. Further research is being developed to determine the precise role of flavors in contributing to addiction.

This is the first study investigating the neural effects of flavor (specifically wintergreen) in smokeless tobacco products. By understanding the effects of flavors in the brain we can explain the precipitants of tobacco consumption behaviors, and the addictive potential of flavors. Regulators will be able to determine if and in which amount flavors should be allowed in tobacco products.

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A videogame intervention for tobacco product use prevention in adolescents

Publication date: Available online 14 November 2018

Source: Addictive Behaviors

Author(s): Mary Ann Pentz, Kimberly D. Hieftje, Tyra M. Pendergrass, Stephanie A. Brito, Mengyu Liu, Trisha Arora, Hilary A. Tindle, Suchitra Krishnan-Sarin, Lynn E. Fiellin

Abstract

Purpose

This pilot study evaluated the short-term effects of an interactive videogame on changing adolescent knowledge, beliefs and risk perceptions, and intentions to use e-cigarettes, cigarettes, and other tobacco products. A secondary aim was to evaluate players' game experience.

Methods

Participants (N = 80 11–14 year olds) were recruited from 7 community-based afterschool programs in Los Angeles, California and New Haven, Connecticut. The design was a single group pre-post design with replication. A pre-test survey was administered that included demographic variables and knowledge, risk perceptions, beliefs, and intentions to use e-cigarettes, cigarettes, and other tobacco products. An interactive videogame focusing on risky tobacco use situations was subsequently played in four 60-min sessions over a four-week period, followed by a post-test survey. Analyses included paired t-tests of pre-post videogame change, regression analyses, and path analyses testing mediational effects of beliefs and risk perceptions on the relationship between knowledge and intentions.

Results

The videogame changed knowledge of e-cigarettes and other tobacco products (p's < 0.001), risk perceptions of cigarettes and e-cigarettes (p < .01 and p < .001, respectively), and beliefs about e-cigarettes and other tobacco products (p's < 0.05), but not intentions Older adolescents reported greater e-cigarette knowledge and risk perceptions (p's < 0.05), and females reported greater risk perception of cigarettes (p < .05). Beliefs mediated the relationship between knowledge and intentions to use e-cigarettes (indirect effect p < .05).

Conclusion

Results suggest that brief exposure (4 h over 4 weeks) to videogames focused on changing knowledge and attitudes towards tobacco products may have a promising effect on preventing risk for early adolescent tobacco product use, particularly for e-cigarettes.

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Smokers' perceptions of risks and harm from snus relative to cigarettes: A latent profile analysis study

Publication date: Available online 14 November 2018

Source: Addictive Behaviors

Author(s): Olivia A. Wackowski, Anne E. Ray, Jerod L. Stapleton

Abstract

Introduction

Certain types of smokeless tobacco (SLT) products, particularly snus, carry fewer health risks than cigarette smoking and might be able to serve as harm-reduction products for smokers. However, studies frequently find that smokers misperceive SLT and snus to be as or more harmful than smoking. This perception is often measured with a single general harm question, and research on underlying risk perceptions is limited.

Methods

Using a sample of 256 current smokers, we utilized Latent Profile Analysis to examine response profiles to items that assessed perceived risk of specific health outcomes (lung cancer, heart disease, oral cancer) from snus relative to cigarettes, along with the typical single item measure of overall harm from snus compared to cigarettes.

Results

Three smoker response profiles emerged. Almost half (44.9%) of smokers perceived snus to be as or more risky than cigarettes for all three specific health outcomes (group 1), while over one third (38.3%) had an elevated perceived risk for oral cancer only (group 2). About 17% of smokers perceived snus to have lower risks for lung cancer only (group 3). Across each profile, perceived risk was highest for oral cancer, despite a lack of scientific evidence of this effect from snus use.

Conclusions

If smokers are to consider snus for harm-reduction, efforts may be needed to better inform smokers about their lower relative risks, including for particular health outcomes of interest. This study also suggests that smokers may vary in their level of need for information to correct their relative risk misperceptions.

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Allergy Treatment Begins At Home

Title: Allergy Treatment Begins At HomeCategory: Diseases and ConditionsCreated: 4/15/2000 12:00:00 AMLast Editorial Review: 11/14/2018 12:00:00 AM (Source: MedicineNet Allergies General)

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Blended learning modules for lectures on oral and maxillofacial surgery

Publication date: Available online 14 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): A. Bock, A. Modabber, K. Kniha, M. Lemos, N. Rafai, F. Hölzle

Abstract

Over the last couple of years, new teaching methods have been developed and implemented in German universities, but only rarely in dental schools. The aim of this project therefore was to implement students' requests for such methods to be used in dental education. In 2012, based on an analysis of both quantitative and qualitative requirements, we designed a questionnaire for quantitative analysis, and evaluated a series of lectures on oral and maxillofacial surgery. Based on our findings, we then designed a blended learning module that was gradually integrated into the series. In 2017 we again evaluated the lectures, and rated the module. The two evaluations were then compared using a two-sample z-test. The results showed that students were very satisfied with the approach. They were particularly happy with the surgical videos, which were shown during the lectures and also included in the module, as they helped them to understand the surgical technique. Our survey showed that most of the students were using the online learning program and that it was the resource they preferred. Application of a blended learning approach could satisfy the requirements of the new generation of students, and transform traditional lectures into modern, sustainable, and technology-enhanced learning experiences.

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Citation for the 2017 BAOMS Surgery prize – Rajiv Anand

Publication date: Available online 14 November 2018

Source: British Journal of Oral and Maxillofacial Surgery

Author(s): Rajiv Anand

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Management of incidental discovery of microscopic squamous cell carcinoma in zones of osteoradionecrosis of the mandible

Publication date: Available online 14 November 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Lesnik, O. De Crouy Chanel, M. Lefèvre, S. Samaha, S. Périe, J. Lacau St Guily, B. Baujat

Abstract

Objectives

Osteoradionecrosis (ORN) of the mandible is a common complication of head and neck radiotherapy and often requires surgical treatment. Squamous cell carcinoma (SCC) can be exceptionally discovered within zones of ORN on histological examination of the operative specimen. The authors discuss the management of these lesions based on a short patient series.

Materials and methods

This single-centre retrospective study was based on patients managed between 2012 and 2014 for ORN with incidental discovery of microscopic SCC.

Results

Five patients with incidental discovery of microscopic SCC in a zone of ORN of the mandible were included in this study. The mean time to onset of ORN after the end of radiotherapy for locally advanced SCC of the oral cavity or oropharynx was 42 months. Surgical treatment consisted of marginal or segmental mandibulectomy with free flap reconstruction. No recurrence was observed with a mean follow-up of 35 months [24–46].

Conclusion

The incidental discovery of microscopic SCC in a zone of ORN of the mandible is a rare event and has not been reported in the literature. Optimal management cannot be reliably defined due to the lack of data in the literature, but the present study supports careful histological examination of ORN specimens. Treatment must be as conservative as possible to avoid excessively invasive surgery.

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Clinical Approach to Systemic Autoinflammatory Disorders: Classification, Disease Phenotypes and Management

Autoinflammatory Disorders (AIDs) can be either systemic or organ-specific. Systemic AIDs are associated with a primary dysfunction of the innate immunity that results in clinical signs of inflammation and/or elevated serum levels of acute-phase reactants. AIDs often present with rash, serositis, arthritis and/or aphthosis. Hereditary periodic fever syndromes, such as Familial Mediterranean Fever (FMF) and Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS), constitute the prototype of systemic AIDs. However, these also include many other disorders that do not follow the typical relapse-remitting pattern of unprovoked recurrent febrile episodes with intercalated periods of general well-being that can also result in severe complications such as amyloidosis. In this review, p...

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Diet Matters, But Heterogeneity Looms: Altered Fatty Acid Profiles and Mental Status in Health and Disease

(Source: Current Immunology Reviews)

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Meet Our Editorial Board Member

(Source: Current Immunology Reviews)

MedWorm Message: If you are looking to buy something in the January Sales please visit TheJanuarySales.com for a directory of all the best sales in the UK. Any income gained via affiliate links keeps MedWorm running.

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Acknowledgements to Reviewers

(Source: Current Immunology Reviews)

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Cytokine Gene Polymorphisms in Cancer and Inflammatory Disorders

Genetics has become increasingly important in disease prevention, diagnosis and treatments. Currently, molecular sequencing within medically important genes such as those coded for human leukocyte antigens, blood group and killer cell immunoglobulin-like receptors has been elucidated and their sequence variations have been deposited in public databases (e.g. allelefrequencies.net database). In addition, medical genetic research has now gained access to the unlimited region in the human genome where multiple susceptibility genes can now easily be characterized using the latest techniques in molecular biology (next generation sequencing and Luminex). Here, we highlight molecular bases of several variants in cytokine genes that have been widely subjected to the analyses of ancestry and health...

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Osteoarthritis: Potential for Herbal Medicines as Therapies in the Management of Chronic Inflammatory Damage

Osteoarthritis results from a chronic inflammation-mediated destruction of synovial joints particularly in the hand, hip, and knee. Intervention strategies primarily focus on reducing this inflammation and its associated pain and involve a hierarchy of pharmaceuticals designed to prolong activity and prevent early joint replacement. Unfortunately, side effects from these agents are significant and their efficacy, especially in the later stages of the condition, variable. For this reason, many patients are seeking out alternative interventions, including herbal medicines, which are natural and safe. This review will evaluate the current understanding of the pathophysiology and immunological changes that occur in osteoarthritis and identify areas where herbal medicines could improve treatmen...

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Blood Transfusion Management for Patients Treated With Anti-CD38 Monoclonal Antibodies

Guido Lancman, Suzanne Arinsburg, Jeffrey Jhang, Hearn Jay Cho, Sundar Jagannath, Deepu Madduri, Samir Parekh, Joshua Richter, Ajai Chari (Source: Frontiers in Immunology)

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A CD300c-Fc Fusion Protein Inhibits T Cell Immunity

Cheng Cui, Min Su, Yujun Lin, Laijun Lai (Source: Frontiers in Immunology)

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CD8+-T Cells With Specificity for a Model Antigen in Cardiomyocytes Can Become Activated After Transverse Aortic Constriction but Do Not Accelerate Progression to Heart Failure

Carina Gr öschel, André Sasse, Sebastian Monecke, Charlotte Röhrborn, Leslie Elsner, Michael Didié, Verena Reupke, Gertrude Bunt, Andrew H. Lichtman, Karl Toischer, Wolfram-Hubertus Zimmermann, Gerd Hasenfuß, Ralf Dressel (Source: Frontiers in Immunology)

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Non-hematopoietic Control of Peripheral Tissue T Cell Responses: Implications for Solid Tumors

Ryan S. Lane, Amanda W. Lund (Source: Frontiers in Immunology)

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Editorial: Metabolism and Immune Tolerance

Duncan Howie, Claudio Mauro (Source: Frontiers in Immunology)

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Commentary: Soluble CD83 Alleviates Experimental Autoimmune Uveitis by Inhibiting Filamentous Actin-Dependent Calcium Release in Dendritic Cells

Mariana Pereira Pinho, Jos é Alexandre Marzagão Barbuto (Source: Frontiers in Immunology)

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Management of incidental discovery of microscopic squamous cell carcinoma in zones of osteoradionecrosis of the mandible

Publication date: Available online 14 November 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): M. Lesnik, O. De Crouy Chanel, M. Lefèvre, S. Samaha, S. Périe, J. Lacau St Guily, B. Baujat

Abstract

Objectives

Osteoradionecrosis (ORN) of the mandible is a common complication of head and neck radiotherapy and often requires surgical treatment. Squamous cell carcinoma (SCC) can be exceptionally discovered within zones of ORN on histological examination of the operative specimen. The authors discuss the management of these lesions based on a short patient series.

Materials and methods

This single-centre retrospective study was based on patients managed between 2012 and 2014 for ORN with incidental discovery of microscopic SCC.

Results

Five patients with incidental discovery of microscopic SCC in a zone of ORN of the mandible were included in this study. The mean time to onset of ORN after the end of radiotherapy for locally advanced SCC of the oral cavity or oropharynx was 42 months. Surgical treatment consisted of marginal or segmental mandibulectomy with free flap reconstruction. No recurrence was observed with a mean follow-up of 35 months [24–46].

Conclusion

The incidental discovery of microscopic SCC in a zone of ORN of the mandible is a rare event and has not been reported in the literature. Optimal management cannot be reliably defined due to the lack of data in the literature, but the present study supports careful histological examination of ORN specimens. Treatment must be as conservative as possible to avoid excessively invasive surgery.

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Lambert-Eaton Myasthenic Syndrome: A Very Rare and Tortuously Exasperating Facet of Pre-Synaptic Disorder of Neuromuscular Junction

Lambert-Eaton Myasthenic Syndrome (LEMS) is a very rare and unusual autoimmune disorder of Neuromuscular Junction (NMJ) that is associated with impaired neuromuscular transmission due to loss of voltage-gated calcium channel (VGCC) present on the pre-synaptic nerve terminal. Of all the different proteins like synaptotagmin that are attacked by auto-antibodies, P/Q-type of VGCC is found to be targeted in 90 % of patients. The influx of calcium through VGCC is important for exocytosis of synaptic vesicles. LEMS is a clinical "triad" of proximal muscle weakness, areflexia, and autonomic dysfunctions. Half of the LEMS patients are almost always associated with the small-cell lung carcinoma (SCLC), the knowledge of which has led to the finding of different paraneoplastic, and non-tumor rela...

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Clinical Approach to Systemic Autoinflammatory Disorders: Classification, Disease Phenotypes and Management

Autoinflammatory Disorders (AIDs) can be either systemic or organ-specific. Systemic AIDs are associated with a primary dysfunction of the innate immunity that results in clinical signs of inflammation and/or elevated serum levels of acute-phase reactants. AIDs often present with rash, serositis, arthritis and/or aphthosis. Hereditary periodic fever syndromes, such as Familial Mediterranean Fever (FMF) and Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS), constitute the prototype of systemic AIDs. However, these also include many other disorders that do not follow the typical relapse-remitting pattern of unprovoked recurrent febrile episodes with intercalated periods of general well-being that can also result in severe complications such as amyloidosis. In this review, p...

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Natural Killer Cells: Prospects in Cancer Immunotherapy

In cancer immunotherapy, Natural Killer (NK) cells have achieved prominence. NK cells were identified in the 1970s as a subgroup of lymphocytes containing larger cytoplasmic granules. These cells are widely distributed in all lymphoid and non-lymphoid tissues, including bone marrow, lymph nodes, the spleen, peripheral blood, the lungs and liver. Because they do not present gene rearrangements during their ontogeny, they constitute a lineage of innate lymphoid cells. Immunotherapy in cancer has been reported with the use of Interleukin (IL) for the NK cell induction in clinical trials, which are discussed in this review. IL-treated NK cells directly kill target tumor cells through at least four mechanisms, the release of cytoplasmic granules, death receptor-induced apoptosis, production of ...

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Meet Our Editorial Board Member

(Source: Current Immunology Reviews)

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Acknowledgements to Reviewers

(Source: Current Immunology Reviews)

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Cytokine Gene Polymorphisms in Cancer and Inflammatory Disorders

Genetics has become increasingly important in disease prevention, diagnosis and treatments. Currently, molecular sequencing within medically important genes such as those coded for human leukocyte antigens, blood group and killer cell immunoglobulin-like receptors has been elucidated and their sequence variations have been deposited in public databases (e.g. allelefrequencies.net database). In addition, medical genetic research has now gained access to the unlimited region in the human genome where multiple susceptibility genes can now easily be characterized using the latest techniques in molecular biology (next generation sequencing and Luminex). Here, we highlight molecular bases of several variants in cytokine genes that have been widely subjected to the analyses of ancestry and health...

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Osteoarthritis: Potential for Herbal Medicines as Therapies in the Management of Chronic Inflammatory Damage

Osteoarthritis results from a chronic inflammation-mediated destruction of synovial joints particularly in the hand, hip, and knee. Intervention strategies primarily focus on reducing this inflammation and its associated pain and involve a hierarchy of pharmaceuticals designed to prolong activity and prevent early joint replacement. Unfortunately, side effects from these agents are significant and their efficacy, especially in the later stages of the condition, variable. For this reason, many patients are seeking out alternative interventions, including herbal medicines, which are natural and safe. This review will evaluate the current understanding of the pathophysiology and immunological changes that occur in osteoarthritis and identify areas where herbal medicines could improve treatmen...

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Computational Analysis of Specific IgE Epitopes Responsible for Allergy to Fish

Conclusion: Surely, any progresses in biochemical, immunological, and molecular mechanism of allergic reactions to fish allergens can improve accurate diagnosis of fish allergy and its' prevention and treatment in the future. (Source: Current Immunology Reviews)

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Blood Transfusion Management for Patients Treated With Anti-CD38 Monoclonal Antibodies

Guido Lancman, Suzanne Arinsburg, Jeffrey Jhang, Hearn Jay Cho, Sundar Jagannath, Deepu Madduri, Samir Parekh, Joshua Richter, Ajai Chari (Source: Frontiers in Immunology)

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A CD300c-Fc Fusion Protein Inhibits T Cell Immunity

Cheng Cui, Min Su, Yujun Lin, Laijun Lai (Source: Frontiers in Immunology)

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CD8+-T Cells With Specificity for a Model Antigen in Cardiomyocytes Can Become Activated After Transverse Aortic Constriction but Do Not Accelerate Progression to Heart Failure

Carina Gr öschel, André Sasse, Sebastian Monecke, Charlotte Röhrborn, Leslie Elsner, Michael Didié, Verena Reupke, Gertrude Bunt, Andrew H. Lichtman, Karl Toischer, Wolfram-Hubertus Zimmermann, Gerd Hasenfuß, Ralf Dressel (Source: Frontiers in Immunology)

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Non-hematopoietic Control of Peripheral Tissue T Cell Responses: Implications for Solid Tumors

Ryan S. Lane, Amanda W. Lund (Source: Frontiers in Immunology)

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Editorial: Metabolism and Immune Tolerance

Duncan Howie, Claudio Mauro (Source: Frontiers in Immunology)

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Hofbauer Cells: Their Role in Healthy and Complicated Pregnancy

Leticia Reyes, Thaddeus G. Golos (Source: Frontiers in Immunology)

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Commentary: Soluble CD83 Alleviates Experimental Autoimmune Uveitis by Inhibiting Filamentous Actin-Dependent Calcium Release in Dendritic Cells

Mariana Pereira Pinho, Jos é Alexandre Marzagão Barbuto (Source: Frontiers in Immunology)

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The Role of the Pre-B Cell Receptor in B Cell Development, Repertoire Selection, and Tolerance

Thomas H. Winkler, Inga-Lill M årtensson (Source: Frontiers in Immunology)

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Identification of hub genes with diagnostic values in pancreatic cancer by bioinformatics analyses and supervised learning methods

Pancreatic cancer is one of the most lethal tumors with poor prognosis, and lacks of effective biomarkers in diagnosis and treatment. The aim of this investigation was to identify hub genes in pancreatic cance...

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Identification of hub genes with diagnostic values in pancreatic cancer by bioinformatics analyses and supervised learning methods

Pancreatic cancer is one of the most lethal tumors with poor prognosis, and lacks of effective biomarkers in diagnosis and treatment. The aim of this investigation was to identify hub genes in pancreatic cance...

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Nor Cal Food Solutions, LLC ISSUES ALLERGY ALERT ON UNDECLARED Tree Nut – Walnut in The Purveyors Kitchen - Pumpkin Pesto Tapenade

Nor Cal Food Solutions, LLC of Auburn, CA is announcing a recall of 567 cases of Pumpkin Pesto Tapenade, manufactured by Purveyors Kitchen, because it contains an undeclared tree nut (walnut). People who have an allergy or severe sensitivity to tree nuts (walnuts) run the risk of serious or life-threatening allergic reaction if they consume this product. (Source: Food and Drug Administration)

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Nor Cal Food Solutions, LLC ISSUES ALLERGY ALERT ON UNDECLARED Tree Nut – Walnut in The Purveyors Kitchen - Pumpkin Pesto Tapenade

Nor Cal Food Solutions, LLC of Auburn, CA is announcing a recall of 567 cases of Pumpkin Pesto Tapenade, manufactured by Purveyors Kitchen, because it contains an undeclared tree nut (walnut). People who have an allergy or severe sensitivity to tree nuts (walnuts) run the risk of serious or life-threatening allergic reaction if they consume this product. (Source: Food and Drug Administration)

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Cancer diagnosis at age 23 inspires album

Cancer diagnosis at age 23 inspires album  The MountaineerFull coverage

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Relevance of peripheral cholinesterase activity on postoperative delirium in adult surgical patients (CESARO): A prospective observational cohort study

BACKGROUND The cholinergic system is considered to play a key role in the development of postoperative delirium (POD), which is a common complication after surgery. OBJECTIVES To determine whether peri-operative acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are associated with the development of POD in in-hospital surgical patients, and raise hypotheses on cholinergic regulatory mechanisms in POD. DESIGN A prospective multicentre observational study by the Peripheral Cholinesterase-activity on Neurocognitive Dysfunctions in Surgical Patients (CESARO) study group. SETTING Nine German hospitals. PATIENTS Patients of at least 18 years of age scheduled for inpatient elective surgery for a variety of surgical procedures. A total of 650 patients (mean age 61.5 years, 52.8% male) were included. METHODS Clinical variables, and peripheral AChE and BuChE activities, were assessed throughout the peri-operative period using bedside point-of-care measurements (one pre-operative and two postoperative measurements). POD screening was conducted postoperatively for at least 24 h and up to the third postoperative day using a validated screening tool (nursing delirium screening scale). RESULTS In all, 179 patients (27.5%) developed POD within the early postoperative phase. There was a lower BuChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.07, P = 0.091), on postoperative day 1 (Cohen's r = 0.12, P = 0.003) and on postoperative day 2 (Cohen's r = 0.12, P = 0.002). In contrast, there was a significantly higher AChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.10, P = 0.012), on postoperative day 1 (Cohen's r = 0.11, P = 0.004) and on postoperative day 2 (Cohen's r = 0.13, P = 0.002). After adjusting for covariates in multiple logistic regression, a significant association between both BuChE and AChE activities and POD was not found. However, in the multivariable analysis using the Generalized Estimating Equation, cholinesterase activities showed that a decrease of BuChE activity by 100 U L−1 increased the risk of a delirium by approximately 2.1% (95% CI 1.6 to 2.8%) and for each 1 U g−1 of haemoglobin increase in AChE activity, there was a 1.4% (95% CI 0.6 to 2.2%) increased risk of POD. CONCLUSION Peri-operative peripheral cholinesterase activities may be related to the development of POD, but the clinical implications remain unclear. Further studies, in homogeneous patient groups with a strict protocol for measurement time points, are needed to investigate the relationship between cholinesterase activities and POD. TRIAL REGISTRATION www.clinicaltrials.gov. Identifier NCT01964274. Correspondence to Claudia D. Spies, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353 Berlin, Germany Tel: +49 30 450 551001; e-mail: claudia.spies@charite.de 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 (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial

BACKGROUND Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications. OBJECTIVES The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care. DESIGN A randomised controlled study. SETTING Two Swedish university hospitals, between October 2011 and October 2015. PATIENTS Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency. INTERVENTION A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min−1 m−2 and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg. MAIN OUTCOME MEASURE The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list. RESULTS Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P 

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Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl−1. RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P 

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Ultrasound-guided vs. palpation-guided techniques for radial arterial catheterisation in infants: A randomised controlled trial

BACKGROUND The usefulness of ultrasound-guided techniques for radial arterial catheterisation has been well identified; however, its usefulness has not been completely evaluated in infants under 12 months of age, who are generally considered the most difficult group for arterial catheterisation. OBJECTIVE We evaluated whether ultrasound guidance would improve success rates and reduce the number of attempts at radial arterial catheterisation in infants. DESIGN A randomised, controlled and patient-blinded study. SETTING Single-centre trial, study period from June 2016 to February 2017. PATIENTS Seventy-four infants undergoing elective cardiac surgery. INTERVENTION Patients were allocated randomly into either ultrasound-guided group (group US) or palpation-guided group (group P) (each n=37) according to the technique applied for radial arterial catheterisation. All arterial catheterisations were performed by one of two experienced anaesthesiologists based on group assignment and were recorded on video. MAIN OUTCOME MEASURES The primary endpoint was the first-pass success. The number of attempts and total duration of the procedure until successful catheterisation were also analysed. RESULTS The first-pass success rate was significantly higher in the group US than in the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were needed for successful catheterisation in the group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median [IQR] procedural time (s) until successful catheterisation in the two groups was not significantly different (102 [49 to 394] vs. 218 [73 to 600], P = 0.054). CONCLUSION The current study demonstrated that the ultrasound-guided technique for radial arterial catheterisation in infants effectively improved first-pass success rate and also reduced the number of attempts required. TRIAL REGISTRATION ClinicalTrials.gov NCT02795468. Correspondence to Jong-Hwan Lee, MD, PhD, Associate Professor, Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea Tel: +82 2 3410 1928; fax: +82 2 3410 0361; e-mail: jonghwanlee75@gmail.com © 2018 European Society of Anaesthesiology

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Essentia Health offers way to quit smoking for better health

Essentia Health offers way to quit smoking for better health  Brainerd DispatchFull coverage

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Relevance of peripheral cholinesterase activity on postoperative delirium in adult surgical patients (CESARO): A prospective observational cohort study

BACKGROUND The cholinergic system is considered to play a key role in the development of postoperative delirium (POD), which is a common complication after surgery. OBJECTIVES To determine whether peri-operative acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are associated with the development of POD in in-hospital surgical patients, and raise hypotheses on cholinergic regulatory mechanisms in POD. DESIGN A prospective multicentre observational study by the Peripheral Cholinesterase-activity on Neurocognitive Dysfunctions in Surgical Patients (CESARO) study group. SETTING Nine German hospitals. PATIENTS Patients of at least 18 years of age scheduled for inpatient elective surgery for a variety of surgical procedures. A total of 650 patients (mean age 61.5 years, 52.8% male) were included. METHODS Clinical variables, and peripheral AChE and BuChE activities, were assessed throughout the peri-operative period using bedside point-of-care measurements (one pre-operative and two postoperative measurements). POD screening was conducted postoperatively for at least 24 h and up to the third postoperative day using a validated screening tool (nursing delirium screening scale). RESULTS In all, 179 patients (27.5%) developed POD within the early postoperative phase. There was a lower BuChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.07, P = 0.091), on postoperative day 1 (Cohen's r = 0.12, P = 0.003) and on postoperative day 2 (Cohen's r = 0.12, P = 0.002). In contrast, there was a significantly higher AChE activity in patients with delirium compared with patients without delirium pre-operatively (Cohen's r = 0.10, P = 0.012), on postoperative day 1 (Cohen's r = 0.11, P = 0.004) and on postoperative day 2 (Cohen's r = 0.13, P = 0.002). After adjusting for covariates in multiple logistic regression, a significant association between both BuChE and AChE activities and POD was not found. However, in the multivariable analysis using the Generalized Estimating Equation, cholinesterase activities showed that a decrease of BuChE activity by 100 U L−1 increased the risk of a delirium by approximately 2.1% (95% CI 1.6 to 2.8%) and for each 1 U g−1 of haemoglobin increase in AChE activity, there was a 1.4% (95% CI 0.6 to 2.2%) increased risk of POD. CONCLUSION Peri-operative peripheral cholinesterase activities may be related to the development of POD, but the clinical implications remain unclear. Further studies, in homogeneous patient groups with a strict protocol for measurement time points, are needed to investigate the relationship between cholinesterase activities and POD. TRIAL REGISTRATION www.clinicaltrials.gov. Identifier NCT01964274. Correspondence to Claudia D. Spies, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, D-13353 Berlin, Germany Tel: +49 30 450 551001; e-mail: claudia.spies@charite.de 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 (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Goal-directed therapy during transthoracic oesophageal resection does not improve outcome: Randomised controlled trial

BACKGROUND Goal-directed therapy (GDT) is expected to be of highest benefit in high-risk surgery. Therefore, GDT is recommended during oesophageal resection, which carries a high risk of postoperative complications. OBJECTIVES The aim of this study was to confirm the hypothesis that GDT during oesophageal resection improves outcome compared with standard care. DESIGN A randomised controlled study. SETTING Two Swedish university hospitals, between October 2011 and October 2015. PATIENTS Sixty-four patients scheduled for elective transthoracic oesophageal resection were randomised. Exclusion criteria included colonic interposition and significant aortic or mitral valve insufficiency. INTERVENTION A three-step GDT protocol included stroke volume optimisation using colloid boluses as assessed by pulse-contour analysis, dobutamine infusion if cardiac index was below 2.5 l min−1 m−2 and norepinephrine infusion if mean arterial blood pressure was below 65 mmHg. MAIN OUTCOME MEASURE The incidence of complications per patient at 5 and 30 days postoperatively as assessed using a predefined list. RESULTS Fifty-nine patients were available for analysis. Patients in the intervention group received more colloid fluid (2190 ± 875 vs. 1596 ± 759 ml, P 

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader https://ift.tt/2DnkMF2

Development of a prediction model for postoperative pneumonia: A multicentre prospective observational study

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 °C; leucocyte count more than 12 000 μl−1. RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P 

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Ultrasound-guided vs. palpation-guided techniques for radial arterial catheterisation in infants: A randomised controlled trial

BACKGROUND The usefulness of ultrasound-guided techniques for radial arterial catheterisation has been well identified; however, its usefulness has not been completely evaluated in infants under 12 months of age, who are generally considered the most difficult group for arterial catheterisation. OBJECTIVE We evaluated whether ultrasound guidance would improve success rates and reduce the number of attempts at radial arterial catheterisation in infants. DESIGN A randomised, controlled and patient-blinded study. SETTING Single-centre trial, study period from June 2016 to February 2017. PATIENTS Seventy-four infants undergoing elective cardiac surgery. INTERVENTION Patients were allocated randomly into either ultrasound-guided group (group US) or palpation-guided group (group P) (each n=37) according to the technique applied for radial arterial catheterisation. All arterial catheterisations were performed by one of two experienced anaesthesiologists based on group assignment and were recorded on video. MAIN OUTCOME MEASURES The primary endpoint was the first-pass success. The number of attempts and total duration of the procedure until successful catheterisation were also analysed. RESULTS The first-pass success rate was significantly higher in the group US than in the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were needed for successful catheterisation in the group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median [IQR] procedural time (s) until successful catheterisation in the two groups was not significantly different (102 [49 to 394] vs. 218 [73 to 600], P = 0.054). CONCLUSION The current study demonstrated that the ultrasound-guided technique for radial arterial catheterisation in infants effectively improved first-pass success rate and also reduced the number of attempts required. TRIAL REGISTRATION ClinicalTrials.gov NCT02795468. Correspondence to Jong-Hwan Lee, MD, PhD, Associate Professor, Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea Tel: +82 2 3410 1928; fax: +82 2 3410 0361; e-mail: jonghwanlee75@gmail.com © 2018 European Society of Anaesthesiology

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Essentia Health offers way to quit smoking for better health

Essentia Health offers way to quit smoking for better health  Brainerd DispatchFull coverage

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Aurora kinase B inhibitor barasertib (AZD1152) inhibits glucose metabolism in gastric cancer cells

Barasertib is a highly selective Aurora kinase B (AURKB) inhibitor and has been widely applied in a variety of cancer cells to investigate the regulatory function of AURKB. However, the effect of barasertib on glucose metabolism in gastric cancer (GC) remains illustrated. Here, barasertib was identified to effectively reduce glucose uptake and lactate production in GC cells in a dose-dependent and time-dependent manner. The expression levels of GLUT1, LDHA and HK2 were decreased by barasertib treatment of GC cells. Furthermore, we found that barasertib induced the expression of ribosomal protein S7 (RPS7), as a tumor suppressor, to regulate glucose metabolism. Silencing of RPS7 rescued the effects of barasertib on glucose metabolism in GC cells. Overexpression of RPS7 suppressed the promoter activity of C-Myc, which has been identified as an important regulator of glucose metabolism in cancer cells. The clinical data showed that the expression level of AURKB in GC patients' sera and tissues were positively correlated with those of C-Myc, GLUT1 and LDHA, but negatively with that of RPS7. Therefore, these findings provide new evidence that barasertib regulates GC cell glucose metabolism by inducing the RPS7/C-Myc signal pathway, and have important implications for the development of therapeutic approaches using AURKB as a target protein to prevent tumor recurrence. * Jian He, Zihao Qi and Xiaofei Zhang contributed equally to the writing of this article. Correspondence to Ziliang Wang, PhD, Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai 200032, China Tel: +86 213 477 7310; e-mail: huf_zlwang@126.com Received May 12, 2018 Accepted July 19, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cardiotoxicity with trabectedin in the treatment of advanced soft tissue sarcoma

Trabectedin is used routinely in the palliative management of patients with advanced soft tissue sarcoma. It is not generally considered to be cardiotoxic, and there is no specific caution for its use in patients with a history of cardiac disease or risk factors. Here, we report six cases from a single academic centre where life-threatening cardiotoxicity occurred acutely during treatment with trabectedin. These patients had a median age of 72.5 years (range: 68–81) at presentation with cardiotoxicity, significantly higher than the median ages of patients treated with trabectedin in clinical trials. Cardiotoxicity occurred between cycle 1, day 10, and cycle 5, day 5 of treatment (with three events occurring during cycle 2, and one during cycle 3). Two patients had a previous cardiac history and three patients had other relevant cardiac risk factors. Five patients had been treated previously with anthracyclines. Two patients developed acute pulmonary oedema, two developed fast atrial fibrillation, one developed an ST-elevation myocardial infarction and one suffered a fatal cardiac arrest. Two had unequivocal evidence of myocardial ischaemia, and two events were acutely fatal. Trabectedin was immediately discontinued in all cases and, for the four nonfatal events, there were no recurrences of the cardiac events. As no other definitive precipitants were identified, we consider these events to be related to trabectedin toxicity. We therefore urge caution with the use of trabectedin in elderly patients, and those with a previous cardiac history, abnormal cardiac function or significant cardiac risk factors including pericardiac lesions (present in two cases reported here). Correspondence to Gary J. Doherty, MB BChir, PhD, MRCP, Department of Oncology, Addenbrooke's Hospital, Box 193, Cambridge CB2 0QQ, UK Tel: +44 122 358 6705; fax: +44 122 321 7094; e-mail: gd231@cam.ac.uk Received June 28, 2018 Accepted August 15, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cannabis-related cognitive impairment: a prospective evaluation of possible influences on patients with cancer during chemotherapy treatment as a pilot study

Objectives In patients with cancer, the use of medical cannabis has increased significantly during the recent years. There is evidence that cannabis consumption may affect cognitive performance; however, this potential effect has not been investigated prospectively in patients with cancer to date. We aimed to evaluate the effect of cannabis consumption on cognitive abilities as well as on symptom relief in patients with cancer during chemotherapy treatment. Patients and methods A prospective study was carried out on a group of 17 patients on cannabis treatment (case) who were compared with 17 patients not on cannabis treatment (control). Participants completed self-reported questionnaires (the Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, European Organization of Research and Treatment of Cancer core questions on the Quality of Life Questionnaire) and underwent the following neurocognitive tests: Montreal Cognitive Assessment, Digit Symbol Substitution subtest (WAIS III) and Digital-Finger Tapping Test. The evaluation was conducted before the initiation of cannabis consumption and 3 months later during the period of cannabis use. Results Improvement in executive functioning was demonstrated in the case group. In aspects of symptoms, improvement in fatigue, appetite and sleep disorder was demonstrated after cannabis consumption. Patients consuming cannabis did not differ from the control group in cognitive functioning over 3 months of use. No significant cognitive decline was observed in either group over time. Conclusion These preliminary findings suggest that the short-term use of cannabis during chemotherapy treatment improved disease-related symptoms and did not affect cognitive skills in patients with cancer. Correspondence to Gil Bar-Sela, MD, Division of Oncology, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel Tel: +972 4777 6409; fax: +972 4777 6427; e-mail: g_barsela@rambam.health.gov.il Received May 22, 2018 Accepted July 23, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Four lines of anaplastic lymphoma kinase inhibitors and brain radiotherapy in a long-surviving non-small-cell lung cancer anaplastic lymphoma kinase-positive patient with leptomeningeal carcinomatosis

Lung cancer is the most common tumor and the leading cause of cancer-related death worldwide. Approximately 6.7% of non-small-cell lung cancers (NSCLCs) show anaplastic lymphoma kinase (ALK) rearrangement and could benefit from ALK-targeted treatment. Various anti-ALK drugs have been developed during the past years, but it is actually controversial which sequence and which ALK inhibitor is recommended for a single patient. Leptomeningeal carcinomatosis (LC) is associated with a poor prognosis, with an overall survival of 2–4 months for treated patients. The data about LC management derive mainly from retrospective studies, being an exclusion criterion for most trials. Intrathecal chemotherapy and whole-brain radiotherapy (WBRT), associated with a systemic treatment, are the most commonly used approach. Here we present a case of NSCLC harboring an ALK translocation treated with four lines of ALK inhibitors and receiving WBRT for LC, showing an overall survival of ∼5 years from the diagnosis of metastatic disease. This case report focuses mainly on several controversial clinical aspects, that is, the sequence of treatment in ALK-positive NSCLC, the ALK inhibitors' efficacy on brain disease and beyond progression, the management of LC, and the role of WBRT despite the risk of cognitive impairment. Correspondence to Raffaele Giusti, MD, Department of Medical Oncology, Sant'Andrea Hospital of Rome, Via di Grottarossa 1035-39, 00189 Rome, Italy Tel: +39 633 777 721; fax: +39 633 776 346; e-mail: raffaelegiusti@yahoo.it Received May 24, 2018 Accepted September 11, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Artemisinin and its derivatives: a potential treatment for leukemia

Artemisinin (ART) and its derivatives are one of the most important classes of antimalarial agents, originally derived from a Chinese medicinal plant called Artemisia annua L. Beyond their outstanding antimalarial and antischistosomal activities, ART and its derivatives also possess both in-vitro and in-vivo activities against various types of cancer. Their anticancer effects range from initiation of apoptotic cell death to inhibition of cancer proliferation, metastasis and angiogenesis, and even modulation of the cell signal transduction pathway. This review provides a comprehensive update on ART and its derivatives, their mechanisms of action, and their synergistic effects with other chemicals in targeting leukemia cells. Combined with limited evidence of drug resistance and low toxicity profile, we conclude that ART and its derivatives, including dimers, trimers, and hybrids, might be a potential therapeutic alternative to current chemotherapies in combating leukemia, although more studies are necessary before they can be applied clinically. *Nelson Siukei Lam and Xinxin Long contributed equally to the writing of this article. Correspondence to James C.G. Doery, MD, FRCPA, Department of Pathology, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia Tel: +61 39 594 4522; fax: +61 39 594 6619; e-mail: james.doery@monash.edu Received March 9, 2018 Accepted September 3, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Aurora kinase B inhibitor barasertib (AZD1152) inhibits glucose metabolism in gastric cancer cells

Barasertib is a highly selective Aurora kinase B (AURKB) inhibitor and has been widely applied in a variety of cancer cells to investigate the regulatory function of AURKB. However, the effect of barasertib on glucose metabolism in gastric cancer (GC) remains illustrated. Here, barasertib was identified to effectively reduce glucose uptake and lactate production in GC cells in a dose-dependent and time-dependent manner. The expression levels of GLUT1, LDHA and HK2 were decreased by barasertib treatment of GC cells. Furthermore, we found that barasertib induced the expression of ribosomal protein S7 (RPS7), as a tumor suppressor, to regulate glucose metabolism. Silencing of RPS7 rescued the effects of barasertib on glucose metabolism in GC cells. Overexpression of RPS7 suppressed the promoter activity of C-Myc, which has been identified as an important regulator of glucose metabolism in cancer cells. The clinical data showed that the expression level of AURKB in GC patients' sera and tissues were positively correlated with those of C-Myc, GLUT1 and LDHA, but negatively with that of RPS7. Therefore, these findings provide new evidence that barasertib regulates GC cell glucose metabolism by inducing the RPS7/C-Myc signal pathway, and have important implications for the development of therapeutic approaches using AURKB as a target protein to prevent tumor recurrence. * Jian He, Zihao Qi and Xiaofei Zhang contributed equally to the writing of this article. Correspondence to Ziliang Wang, PhD, Cancer Institute, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai 200032, China Tel: +86 213 477 7310; e-mail: huf_zlwang@126.com Received May 12, 2018 Accepted July 19, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cardiotoxicity with trabectedin in the treatment of advanced soft tissue sarcoma

Trabectedin is used routinely in the palliative management of patients with advanced soft tissue sarcoma. It is not generally considered to be cardiotoxic, and there is no specific caution for its use in patients with a history of cardiac disease or risk factors. Here, we report six cases from a single academic centre where life-threatening cardiotoxicity occurred acutely during treatment with trabectedin. These patients had a median age of 72.5 years (range: 68–81) at presentation with cardiotoxicity, significantly higher than the median ages of patients treated with trabectedin in clinical trials. Cardiotoxicity occurred between cycle 1, day 10, and cycle 5, day 5 of treatment (with three events occurring during cycle 2, and one during cycle 3). Two patients had a previous cardiac history and three patients had other relevant cardiac risk factors. Five patients had been treated previously with anthracyclines. Two patients developed acute pulmonary oedema, two developed fast atrial fibrillation, one developed an ST-elevation myocardial infarction and one suffered a fatal cardiac arrest. Two had unequivocal evidence of myocardial ischaemia, and two events were acutely fatal. Trabectedin was immediately discontinued in all cases and, for the four nonfatal events, there were no recurrences of the cardiac events. As no other definitive precipitants were identified, we consider these events to be related to trabectedin toxicity. We therefore urge caution with the use of trabectedin in elderly patients, and those with a previous cardiac history, abnormal cardiac function or significant cardiac risk factors including pericardiac lesions (present in two cases reported here). Correspondence to Gary J. Doherty, MB BChir, PhD, MRCP, Department of Oncology, Addenbrooke's Hospital, Box 193, Cambridge CB2 0QQ, UK Tel: +44 122 358 6705; fax: +44 122 321 7094; e-mail: gd231@cam.ac.uk Received June 28, 2018 Accepted August 15, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cannabis-related cognitive impairment: a prospective evaluation of possible influences on patients with cancer during chemotherapy treatment as a pilot study

Objectives In patients with cancer, the use of medical cannabis has increased significantly during the recent years. There is evidence that cannabis consumption may affect cognitive performance; however, this potential effect has not been investigated prospectively in patients with cancer to date. We aimed to evaluate the effect of cannabis consumption on cognitive abilities as well as on symptom relief in patients with cancer during chemotherapy treatment. Patients and methods A prospective study was carried out on a group of 17 patients on cannabis treatment (case) who were compared with 17 patients not on cannabis treatment (control). Participants completed self-reported questionnaires (the Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, European Organization of Research and Treatment of Cancer core questions on the Quality of Life Questionnaire) and underwent the following neurocognitive tests: Montreal Cognitive Assessment, Digit Symbol Substitution subtest (WAIS III) and Digital-Finger Tapping Test. The evaluation was conducted before the initiation of cannabis consumption and 3 months later during the period of cannabis use. Results Improvement in executive functioning was demonstrated in the case group. In aspects of symptoms, improvement in fatigue, appetite and sleep disorder was demonstrated after cannabis consumption. Patients consuming cannabis did not differ from the control group in cognitive functioning over 3 months of use. No significant cognitive decline was observed in either group over time. Conclusion These preliminary findings suggest that the short-term use of cannabis during chemotherapy treatment improved disease-related symptoms and did not affect cognitive skills in patients with cancer. Correspondence to Gil Bar-Sela, MD, Division of Oncology, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel Tel: +972 4777 6409; fax: +972 4777 6427; e-mail: g_barsela@rambam.health.gov.il Received May 22, 2018 Accepted July 23, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Artemisinin and its derivatives: a potential treatment for leukemia

Artemisinin (ART) and its derivatives are one of the most important classes of antimalarial agents, originally derived from a Chinese medicinal plant called Artemisia annua L. Beyond their outstanding antimalarial and antischistosomal activities, ART and its derivatives also possess both in-vitro and in-vivo activities against various types of cancer. Their anticancer effects range from initiation of apoptotic cell death to inhibition of cancer proliferation, metastasis and angiogenesis, and even modulation of the cell signal transduction pathway. This review provides a comprehensive update on ART and its derivatives, their mechanisms of action, and their synergistic effects with other chemicals in targeting leukemia cells. Combined with limited evidence of drug resistance and low toxicity profile, we conclude that ART and its derivatives, including dimers, trimers, and hybrids, might be a potential therapeutic alternative to current chemotherapies in combating leukemia, although more studies are necessary before they can be applied clinically. *Nelson Siukei Lam and Xinxin Long contributed equally to the writing of this article. Correspondence to James C.G. Doery, MD, FRCPA, Department of Pathology, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia Tel: +61 39 594 4522; fax: +61 39 594 6619; e-mail: james.doery@monash.edu Received March 9, 2018 Accepted September 3, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Normalizing cVEMPs: Which Method Is the Most Effective?

Objectives: To determine the most effective method for normalizing cervical vestibular evoked myogenic potentials (cVEMPs). Design: cVEMP data from 20 subjects with normal hearing and vestibular function were normalized using 16 combinations of methods, each using one of the 4 modes of electromyogram (EMG) quantification described below. All methods used the peak to peak value of an averaged cVEMP waveform (VEMPpp) and obtained a normalized cVEMP by dividing VEMPpp by a measure of the EMG amplitude. EMG metrics were obtained from the EMG within short- and long-duration time windows. EMG amplitude was quantified by its root-mean-square (RMS) or average full-wave-rectified (RECT) value. The EMG amplitude was used by (a) dividing each individual trace by the EMG of this specific trace, (b) dividing VEMPpp by the average RMS or RECT of the individual trace EMG, (c) dividing the VEMPpp by an EMG metric obtained from the average cVEMP waveform, or (d) dividing the VEMPpp by an EMG metric obtained from an average cVEMP "noise" waveform. Normalization methods were compared by the normalized cVEMP coefficient of variation across subjects and by the area under the curve from a receiver-operating-characteristic analysis. A separate analysis of the effect of EMG-window duration was done. Results: There were large disparities in the results from different normalization methods. The best methods used EMG metrics from individual-trace EMG measurements, not from part of the average cVEMP waveform. EMG quantification by RMS or RECT produced similar results. For most EMG quantifications, longer window durations were better in producing receiver-operating-characteristic with high areas under the curve. However, even short window durations worked well when the EMG metric was calculated from the average RMS or RECT of the individual-trace EMGs. Calculating the EMG from a long-duration window of a cVEMP "noise" average waveform was almost as good as the individual-trace-EMG methods. Conclusions: The best cVEMP normalizations use EMG quantification from individual-trace EMGs. To have the normalized cVEMPs accurately reflect the vestibular activation, a good normalization method needs to be used. ACKNOWLEDGMENTS: The authors have no conflicts of interest to declare. Received February 26, 2018; accepted August 17, 2018. Address for correspondence: Steven D. Rauch, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA. E-mail: steven_rauch@meei.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Normalizing cVEMPs: Which Method Is the Most Effective?

Objectives: To determine the most effective method for normalizing cervical vestibular evoked myogenic potentials (cVEMPs). Design: cVEMP data from 20 subjects with normal hearing and vestibular function were normalized using 16 combinations of methods, each using one of the 4 modes of electromyogram (EMG) quantification described below. All methods used the peak to peak value of an averaged cVEMP waveform (VEMPpp) and obtained a normalized cVEMP by dividing VEMPpp by a measure of the EMG amplitude. EMG metrics were obtained from the EMG within short- and long-duration time windows. EMG amplitude was quantified by its root-mean-square (RMS) or average full-wave-rectified (RECT) value. The EMG amplitude was used by (a) dividing each individual trace by the EMG of this specific trace, (b) dividing VEMPpp by the average RMS or RECT of the individual trace EMG, (c) dividing the VEMPpp by an EMG metric obtained from the average cVEMP waveform, or (d) dividing the VEMPpp by an EMG metric obtained from an average cVEMP "noise" waveform. Normalization methods were compared by the normalized cVEMP coefficient of variation across subjects and by the area under the curve from a receiver-operating-characteristic analysis. A separate analysis of the effect of EMG-window duration was done. Results: There were large disparities in the results from different normalization methods. The best methods used EMG metrics from individual-trace EMG measurements, not from part of the average cVEMP waveform. EMG quantification by RMS or RECT produced similar results. For most EMG quantifications, longer window durations were better in producing receiver-operating-characteristic with high areas under the curve. However, even short window durations worked well when the EMG metric was calculated from the average RMS or RECT of the individual-trace EMGs. Calculating the EMG from a long-duration window of a cVEMP "noise" average waveform was almost as good as the individual-trace-EMG methods. Conclusions: The best cVEMP normalizations use EMG quantification from individual-trace EMGs. To have the normalized cVEMPs accurately reflect the vestibular activation, a good normalization method needs to be used. ACKNOWLEDGMENTS: The authors have no conflicts of interest to declare. Received February 26, 2018; accepted August 17, 2018. Address for correspondence: Steven D. Rauch, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA. E-mail: steven_rauch@meei.harvard.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Maternally acquired Zika immunity can increase dengue disease severity in mouse pups

(La Jolla Institute for Immunology) To say that the immune system is complex is an understatement: an immune response protective in one context can turn deadly over time, as evidenced by numerous epidemiological studies on dengue infection, spanning multiple decades and countries worldwide. (Source: EurekAlert! - Infectious and Emerging Diseases)

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Maternally acquired Zika immunity can increase dengue disease severity in mouse pups

(La Jolla Institute for Immunology) To say that the immune system is complex is an understatement: an immune response protective in one context can turn deadly over time, as evidenced by numerous epidemiological studies on dengue infection, spanning multiple decades and countries worldwide. (Source: EurekAlert! - Infectious and Emerging Diseases)

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Oropharyngeal adenoid cystic carcinoma invading the mandibular bone through the mandibular foramen

Abstract

Adenoid cystic carcinoma (ACC) is a rare epithelial tumor of the head and neck region, and one of the most common malignant tumors of the salivary glands. ACC is a slow-growing tumor characterized by perineural invasion and often has a high-recurrence rate. We describe a case of oropharyngeal ACC invading the mandibular bone through the mandibular foramen that showed a rare pattern of origin and invasion. A 70-year-old woman complained of noise and pain around the right temporomandibular joint. Osteomyelitis was suspected on the initial imaging examinations, although the findings were slightly atypical. However, a mass was observed in the right oropharyngeal wall on subsequent imaging examinations, and mandibular bone invasion, rather than osteomyelitis, was additionally suspected. The mass in the right oropharyngeal wall and right mandible was surgically excised. On postoperative histopathological examination, the mass was finally diagnosed as ACC. As tumor cells were also observed around the inferior alveolar nerve, mandibular bone invasion through the mandibular foramen was suspected. An oropharyngeal ACC invading the mandibular bone through the mandibular foramen is extremely rare. The present case suggests that bone invasion should be considered carefully with several imaging examinations when a malignant tumor such as ACC is observed around the jaw bone.

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Oropharyngeal adenoid cystic carcinoma invading the mandibular bone through the mandibular foramen

Abstract

Adenoid cystic carcinoma (ACC) is a rare epithelial tumor of the head and neck region, and one of the most common malignant tumors of the salivary glands. ACC is a slow-growing tumor characterized by perineural invasion and often has a high-recurrence rate. We describe a case of oropharyngeal ACC invading the mandibular bone through the mandibular foramen that showed a rare pattern of origin and invasion. A 70-year-old woman complained of noise and pain around the right temporomandibular joint. Osteomyelitis was suspected on the initial imaging examinations, although the findings were slightly atypical. However, a mass was observed in the right oropharyngeal wall on subsequent imaging examinations, and mandibular bone invasion, rather than osteomyelitis, was additionally suspected. The mass in the right oropharyngeal wall and right mandible was surgically excised. On postoperative histopathological examination, the mass was finally diagnosed as ACC. As tumor cells were also observed around the inferior alveolar nerve, mandibular bone invasion through the mandibular foramen was suspected. An oropharyngeal ACC invading the mandibular bone through the mandibular foramen is extremely rare. The present case suggests that bone invasion should be considered carefully with several imaging examinations when a malignant tumor such as ACC is observed around the jaw bone.

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Visual Analogue Scales as a Tool for Initial Assessment of Tinnitus Severity: Psychometric Evaluation in a Clinical Population

The aim of this study was to evaluate the psychometric properties of patient-reported visual analogue scale (VAS) ratings. All of the participants (100 Polish-speaking adults) completed a Tinnitus Functional Index (TFI) once and a 4-component VAS twice over a period of 3 days. Spearman 's correlation coefficients between the VAS score and global TFI ranged from ρ = 0.52 for VAS-coping (VAS-C) to ρ= 0.81 for VAS-annoyance (VAS-A). Using the Bland-Altman method, the agreement ranged from 93% for VAS-A to 96% for VAS-distress (VAS-D). Interclass correlation coefficients ranged from 0.67 for VAS-C to 0.90 for VAS-A. The VAS cutoff points representing significant tinnitus severity ranged from 45 points for VAS-C to 66 points for VAS-D. VAS scales are a valid and reliable brief screening too...

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Pulse-rate discrimination deficit in cochlear implant users: is the upper limit of pitch peripheral or central?

Authors: Zhou N, Mathews J, Dong L Abstract Cochlear implant (CI) users do not reliably associate an increase in pulse rate above 300 pulses per second (pps) with an increase in pitch. The locus of this upper limit of pitch remains unknown. The present study tested the hypothesis that this deficit resides at least initially at the auditory nerve. The hypothesis was tested by comparing pulse rate discrimination in different neural excitation patterns, in which a large versus small population of auditory nerve fibers was activated. If poorer pulse rate discrimination was found under conditions where narrower spread of neural excitation (SOE) was anticipated where a relatively small neural population was activated, then it would support the hypothesis that the rate processing deficit ...

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Preparation allergenic pollen extracts; the points should be considered to make high-quality products.

Authors: Ariaee N, Varasteh A, Jabbari Azad F, Sankian M Abstract Atopic diseases have an increasing trend worldwide during the last two decades. Determining the main cause of allergic diseases, allergens, is the first step in managing and improving the issue, usually is done by Skin Prick tests (SPTs). Having allergenic extract in high quality is desired to perform a reliable SPT. Several parameters of extracts are considered including composition, stability, potency, preservation conditions, and unit definition. In this review, these factors have been explained pointing to factors might have profitable points or harmful drawback in the quality of allergen extracts. PMID: 30422060 [PubMed - as supplied by publisher] (Source: Journal of Immunoassay and Immunochemistry)

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Visual Analogue Scales as a Tool for Initial Assessment of Tinnitus Severity: Psychometric Evaluation in a Clinical Population

The aim of this study was to evaluate the psychometric properties of patient-reported visual analogue scale (VAS) ratings. All of the participants (100 Polish-speaking adults) completed a Tinnitus Functional Index (TFI) once and a 4-component VAS twice over a period of 3 days. Spearman 's correlation coefficients between the VAS score and global TFI ranged from ρ = 0.52 for VAS-coping (VAS-C) to ρ= 0.81 for VAS-annoyance (VAS-A). Using the Bland-Altman method, the agreement ranged from 93% for VAS-A to 96% for VAS-distress (VAS-D). Interclass correlation coefficients ranged from 0.67 for VAS-C to 0.90 for VAS-A. The VAS cutoff points representing significant tinnitus severity ranged from 45 points for VAS-C to 66 points for VAS-D. VAS scales are a valid and reliable brief screening too...

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Preparation allergenic pollen extracts; the points should be considered to make high-quality products.

Authors: Ariaee N, Varasteh A, Jabbari Azad F, Sankian M Abstract Atopic diseases have an increasing trend worldwide during the last two decades. Determining the main cause of allergic diseases, allergens, is the first step in managing and improving the issue, usually is done by Skin Prick tests (SPTs). Having allergenic extract in high quality is desired to perform a reliable SPT. Several parameters of extracts are considered including composition, stability, potency, preservation conditions, and unit definition. In this review, these factors have been explained pointing to factors might have profitable points or harmful drawback in the quality of allergen extracts. PMID: 30422060 [PubMed - as supplied by publisher] (Source: Journal of Immunoassay and Immunochemistry)

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Maternally acquired Zika immunity can increase dengue disease severity in mouse pups

(La Jolla Institute for Immunology) To say that the immune system is complex is an understatement: an immune response protective in one context can turn deadly over time, as evidenced by numerous epidemiological studies on dengue infection, spanning multiple decades and countries worldwide. (Source: EurekAlert! - Infectious and Emerging Diseases)

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CHILDRENS ALLERGY RELIEF (Diphenhydramine Hydrochloride) Solution [Unipharma, LLC]

Updated Date: Nov 9, 2018 EST (Source: DailyMed Drug Label Updates)

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Maternally acquired Zika immunity can increase dengue disease severity in mouse pups

(La Jolla Institute for Immunology) To say that the immune system is complex is an understatement: an immune response protective in one context can turn deadly over time, as evidenced by numerous epidemiological studies on dengue infection, spanning multiple decades and countries worldwide. (Source: EurekAlert! - Infectious and Emerging Diseases)

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CHILDRENS ALLERGY RELIEF (Diphenhydramine Hydrochloride) Solution [Unipharma, LLC]

Updated Date: Nov 9, 2018 EST (Source: DailyMed Drug Label Updates)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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