Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174: 06/08/17

Πέμπτη 8 Ιουνίου 2017

Dermoscopic images of malignant and benign skin lesions

http://sfaki.blogspot.com/2017/06/using-watson-to-diagnose-skin-cancer.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Tilt-induced cardio-inhibitory reflex syncope (BIOSync trial) : 12-item questionnaire to distinguish between complete transient loss of consciousness (i.e., syncope) and pre-syncope or other minor symptoms and, additionally, to provide a standardized categorical description of the clinical presentation of syncope including duration, reproducibility with previous episodes, presence of prodromes, presence of witnesses, context, and consequences of the episode.

http://sfaki.blogspot.com/2017/06/12-item-questionnaire-to-distinguish.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Monoclonal antibodies against IL-5 or IL-5 receptor alpha (mepolizumab, reslizumab, benralizumab), IL-13 (lebrikizumab, tralokinumab), IL-4 receptor alpha (dupilumab), Immune globuline E (IgE) (omalizumab), anti-Thymic Stromal Lymphopoitin (TSLP) (tezepelumab) and small molecule therapies such as prostaglandin D2 blockers (fevipiprant, timapiprant). New Anti-Eosinophil Drugs for asthma and COPD

http://sfaki.blogspot.com/2017/06/monoclonal-antibodies-against-il-5-or.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Developments in Molecular Testing and Biosimilars

Molecular testing and biosimilars offer the potential for increased access to targeted treatment options and reduction in healthcare costs, but come with significant challenges in ensuring patient access to innovation in cancer care while maintaining safe, effective, ethical, and affordable treatment options. As providers, payers, patients, and the larger healthcare systems become inundated with a wide variety of molecular diagnostics and an increased number of biosimilars coming to market, it will be important to understand regulatory guidance and policy implications relating to the appropriateness of molecular testing and the clinical use of biosimilars in cancer care. In September 2016, NCCN hosted the Molecular Testing and Biosimilars Policy Summit to address the challenges, issues, and opportunities in both the molecular testing and biosimilar landscapes. Keynote presentations and panelists further discussed the status and future of molecular testing and biosimilars within the oncology space, as well as patient access and education needs moving forward.

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Evidence-Based Guidelines: Optimizing Imaging in Cancer Care

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Merrimack Announces Expansion of Senior Management Team with Appointment of Sergio Santillana as Chief Medical Officer and Ellen Forest as Head of Human Resources

Key Appointments to Help Drive Merrimack's Refocused Research and Clinical Development Strategy CAMBRIDGE, Mass., June 8, 2017 -- (Healthcare Sales & Marketing Network) -- Merrimack Pharmaceuticals, Inc. (NASDAQ: MACK) today announced the expansion of ... Biopharmaceuticals, Oncology, Personnel Merrimack Pharmaceuticals (Source: HSMN NewsFeed)

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Cancer news: Do THIS before you BBQ your meat to lower risk

CANCER risk has long been associated with meat, but some researchers believes you shouldn 't be too concerned. (Source: Daily Express - Health)

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Another CDK4/6 Inhibitor Boosts PFS in Breast Cancer

(MedPage Today) -- Abemaciclib-fulvestrant combo for advanced HR+/HER2- disease (Source: MedPage Today Primary Care)

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FDA OKs Gleolan, First Fluorescing Agent for Glioma Surgery FDA OKs Gleolan, First Fluorescing Agent for Glioma Surgery

Gleolan oral solution (aminolevulinic acid hydrochloride) enhances the visualization of malignant tissue during glioma surgery.FDA Approvals (Source: Medscape Medical News Headlines)

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Cancer drug prices are so high that doctors will test cutting doses

A group of prominent cancer doctors is planning a novel assault on high drug costs, using clinical trials to show that many oncology medications could be taken at lower doses or for shorter periods without hurting their effectiveness. As Exhibit A, they point to their pilot study involving a widely prescribed drug for advanced prostate […]Related:Infants born in water births at risk of Legionnaires' disease, CDC saysFathers sing more to daughters and roughhouse with sons, study finds8 things doctors are buzzing about at the biggest cancer meeting (Source: Washington Post: To Your Health)

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Study questions value of early breast cancer detection

Many small breast cancers will not grow large enough to become significant...Read more on AuntMinnie.comRelated Reading: Study refutes idea breast cancer can spontaneously regress Is DBT ready to replace digital mammography for screening? Breast screening debate spreads to Middle East Info on screening 'harms' diminishes patient interest Overdiagnosis claims not supported, ACR, SBI say (Source: AuntMinnie.com Headlines)

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Cancer Drug Proves to Be Effective Against Multiple Tumors

The drug, Keytruda, is the first approved for patients with tumors with a particular genetic signature, wherever they appear in the body. (Source: NYT Health)

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World ’s Largest Gastrointestinal Cancer Congress to Highlight Advances...

The ESMO World Congress on Gastrointestinal Cancer, organized by Imedex, attracts more than 3,500 oncology professionals and researchers from around the globe.(PRWeb June 08, 2017)Read the full story at http://ift.tt/2r9vF3G (Source: PRWeb: Medical Pharmaceuticals)

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Pharmatest Establishes Subsidiary in US

Pharmatest Services LLC is newly established US based contract research organization (CRO) operating in Massachusetts. It offers preclinical efficacy services in oncology and skeletal diseases. The company is a fully owned subsidiary of Pharmatest Se … (Source: Pharmaceutical Technology)

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Observation or Radiation Therapy in Treating Patients With Newly Diagnosed Grade II Meningioma That Has Been Completely Removed by Surgery

Conditions: Grade II Meningioma; Intracranial Meningioma Interventions: Other: Clinical Observation; Radiation: Radiation Therapy Sponsors: NRG Oncology; National Cancer Institute (NCI) Recruiting - verified June 2017 (Source: ClinicalTrials.gov)

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Pharmatest Ltd Establishes New US-Based Subsidiary Pharmatest LLC

Pharmatest Services LLC is newly established US based contract research organization (CRO) operating in Massachusetts. It offers preclinical efficacy services in oncology and skeletal diseases. The company is a fully owned subsidiary of Pharmatest Se … (Source: Drug Development Technology)

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Circulating Tumor DNA Methylation Test to Differentiate Benign and Malignant Pulmonary Nodules

Condition: Pulmonary Nodule, Solitary Intervention: Diagnostic Test: Circulating Tumor DNA Methylation Test Sponsor: The First Affiliated Hospital of Guangzhou Medical University Not yet recruiting - verified June 2017 (Source: ClinicalTrials.gov)

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The C-SPAN Coalition: Colorectal Cancer Screening and Navigation

Condition: Colorectal Cancer Interventions: Behavioral: Condition 1: Pure Control; Behavioral: Condition 2: Brief Time; Behavioral: Condition 2: Extended Time; Behavioral: Condition 3: Time + High Incentive; Behavioral: Condition 3: Time + Low Incentive Sponsors: University of Texas Southwestern Medical Center; Cancer Prevention Research Institute of Texas; John Peter Smith Health Network Enrolling by invitation - verified June 2017 (Source: ClinicalTrials.gov)

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FDA grants breakthrough therapy status to MSK ’s Burtomab neuroblastoma therapy

Memorial Sloan Kettering Cancer Center (MSK)-developed Burtomab has received breakthrough therapy designation from the US Food and Drug Administration (FDA) for the treatment of pediatric patients with relapsed or refractory neuroblastoma with centra … (Source: Pharmaceutical Technology)

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Alectinib and dacomitinib show potential in separate trials for lung cancer

Data from two separate Phase III clinical trials of lung cancer drugs that target different gene faults in the disease, alectinib (Alecensa) and dacomitinib, indicated promise when compared to existing medication. (Source: Drug Development Technology)

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Scientific Evaluation of One or Two Doses of the Bivalent or Nonavalent Prophylactic HPV Vaccines

Conditions: Cervical Cancer; Cervical HPV Infection; Anti-HPV Antibody Patterns Interventions: Biological: Cervarix; Biological: Gardasil 9 Sponsor: National Cancer Institute (NCI) Not yet recruiting - verified June 1, 2017 (Source: ClinicalTrials.gov)

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Atezolizumab Combinations With Chemotherapy for Anaplastic and Poorly Differentiated Thyroid Carcinomas

Conditions: Malignant Neoplasms of Thyroid and Other Endocrine Glands; Anaplastic Thyroid Carcinoma; Poorly Differentiated Thyroid Cancer Interventions: Drug: Nab-paclitaxel - INDUCTION COHORT; Drug: Paclitaxel - INDUCTION COHORT; Drug: Vemurafenib - COHORT 1; Drug: Cobimetinib - COHORT 1; Drug: Atezolizumab - COHORT 1; Drug: Bevacizumab - COHORT 3; Drug: Nab-paclitaxel - COHORT 4; Drug: Paclitax el - COHORT 4; Drug: Cobimetinib - COHORT 2; Drug: Atezolizumab - COHORT 2; Drug: Atezolizumab - COHORT 3; Drug: Atezolizumab - COHORT 4 Sponsors: M.D. Anderson Cancer Center; Genentech, Inc. Not yet recruiting - verified June 2017 (Source: ClinicalTrials.gov)

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Bupropion Hydrochloride in Improving Sexual Desire in Women With Breast or Gynecologic Cancer

Conditions: Breast Carcinoma; Cervical Carcinoma; Ovarian Carcinoma; Postmenopausal; Uterine Corpus Cancer; Vaginal Carcinoma; Vulvar Carcinoma Interventions: Drug: Bupropion Hydrochloride; Other: Placebo Sponsors: NRG Oncology; National Cancer Institute (NCI) Recruiting - verified June 2017 (Source: ClinicalTrials.gov)

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Maintenance Therapy of Apatinib After Chemoradiotherapy in Nasopharyngeal Carcinoma With Metastasis

Condition: Nasopharyngeal Neoplasms Intervention: Drug: Apatinib Sponsors: Sichuan Cancer Hospital and Research Institute; Jiangsu HengRui Medicine Co., Ltd. Recruiting - verified June 2017 (Source: ClinicalTrials.gov)

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Topical Remetinostat in Treating Patient With Cutaneous Basal Cell Cancer

Condition: Skin Basal Cell Carcinoma Interventions: Drug: Enzyme Inhibitor Therapy; Other: Laboratory Biomarker Analysis Sponsor: Kavita Sarin Not yet recruiting - verified June 2017 (Source: ClinicalTrials.gov)

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The introduction of mesenchymal stromal cells induces different immunological responses in the lungs of healthy and M. tuberculosis infected mice

by Tatiana Nenasheva, Alexander Nikolaev, Daniar Diykanov, Anna Sukhanova, Evgenii Tcyganov, Alexander Panteleev, Irina Bocharova, Yana Serdyuk, Leonid Nezlin, Tatiana Radaeva, Nikolai Adrianov, Yuri Rubtsov, Irina Lyadova

Mesenchymal stromal cells (MSC) have strong immunomodulatory properties and therefore can be used to control inflammation and tissue damage. It was suggested recently that MSC injections can be used to treat multi-drug resistant tuberculosis (TB). However, MSC trafficking and immunomodulatory effects of MSC injections during Mycobacterium tuberculosis (Mtb) infection have not been studied. To address this issue we have analyzed MSC distribution in tissues and local immunological effects of MSC injections in Mtb infected and uninfected mice. After intravenous injection, MSC accumulated preferentially in the lungs where they were located as cell aggregates in the alveolar walls. Immunological analysis of MSC effects included detection of activated, IFN-γ and IL-4 producing CD4⁺ lymphocytes, the frequency analysis of dendritic cells (CD11c⁺F4/80) and macrophages (CD11c^-F4/80⁺) located in the lungs, the expression of IA/IE and CD11b molecules by these cells, and evaluation of 23 cytokines/chemokines in lung lysates. In the lungs of uninfected mice, MSC transfer markedly increased the percentage of IFN-γ⁺ CD4⁺ lymphocytes and dendritic cells, elevated levels of IA/IE expression by dendritic cells and macrophages, augmented local production of type 2 cytokines (IL-4, IL-5, IL-10) and chemokines (CCL2, CCL3, CCL4, CCL5, CXCL1), and downregulated type 1 and hematopoietic cytokines (IL-12p70, IFN-γ, IL-3, IL-6, GM-CSF). Compared to uninfected mice, Mtb infected mice had statistically higher "background" frequency of activated CD69⁺ and IFN-γ⁺ CD4⁺ lymphocytes and dendritic cells, and higher levels of cytokines in the lungs. The injections of MSC to Mtb infected mice did not show statistically significant effects on CD4⁺ lymphocytes, dendritic cells and macrophages, only slightly shifted cytokine profile, and did not change pathogen load or slow down TB progression. Lung section analysis showed that in Mtb infected mice, MSC could not be found in the proximity of the inflammatory foci. Thus, in healthy recipients, MSC administration dramatically changed T-cell function and cytokine/chemokine milieu in the lungs, most likely, due to capillary blockade. But, during Mtb infection, i.e., in the highly-inflammatory conditions, MSC did not affect T-cell function and the level of inflammation. The findings emphasize the importance of the evaluation of MSC effects locally at the site of their predominant post-injection localization and question MSC usefulness as anti-TB treatment.

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Three-dimensional characterization of root morphology for maxillary incisors

by Carly A. Ahlbrecht, Antonio Carlos de Oliveira Ruellas, Beatriz Paniagua, Juan A. Schilling, James A. McNamara Jr., Lucia Helena Soares Cevidanes

The aim of this study was to test the reproducibility of three-dimensional (3D) surface models of maxillary incisors and to propose a characterization of root morphology. The sample was comprised of pre-treatment cone-beam computed tomography (CBCT) images of fifty-five patients. The CBCTs were used to construct 3D surface models of the maxillary incisors. The reproducibility of surface models was tested by repeated construction of them by two observers. A 3D surface model that corresponded to the average of all lateral and all central incisors was generated. 3D surface distances and vector differences were calculated for each individual tooth and the average of the teeth considered. The corresponding points on the 3D surface mesh for each subgroup were compared statistically to those of the neutral subgroup using shape analysis MANCOVA and Hotelling's t-statistic (p

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Antimicrobial susceptibility of Clostridium difficile isolated in Thailand

Exposure to antimicrobials is the major risk factor associated with Clostridium difficile infection (CDI). Paradoxically, treatment of CDI with antimicrobials remains the preferred option. To date, only three stu...

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Antimicrobial susceptibility of Clostridium difficile isolated in Thailand

Exposure to antimicrobials is the major risk factor associated with Clostridium difficile infection (CDI). Paradoxically, treatment of CDI with antimicrobials remains the preferred option. To date, only three stu...

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Three-dimensional characterization of root morphology for maxillary incisors

by Carly A. Ahlbrecht, Antonio Carlos de Oliveira Ruellas, Beatriz Paniagua, Juan A. Schilling, James A. McNamara Jr., Lucia Helena Soares Cevidanes

Three-dimensional characterization of root morphology for maxillary incisors

by Carly A. Ahlbrecht, Antonio Carlos de Oliveira Ruellas, Beatriz Paniagua, Juan A. Schilling, James A. McNamara Jr., Lucia Helena Soares Cevidanes

Phosphate Removal from Agricultural Drainage Water Using an Iron Oxyhydroxide Filter Material

Abstract

Phosphate discharged in agricultural drainage causes water quality degradation on local, regional, and national scales. Iron oxyhydroxide filter materials can potentially remove the soluble phosphate present in drainage waters. Laboratory saturated column experiments and preliminary small-scale field tests were carried out to evaluate the effectiveness and efficiency of a synthetic goethite iron oxyhydroxide (α-FeOOH) filter material for phosphate treatment. Original iron oxyhydroxide filter material (SG-IOH-O) and the same filter material regenerated with sodium hydroxide (SG-IOH-R) were assessed. Results of replicated laboratory experiments showed that columns packed with SG-IOH-O or SG-IOH-R almost totally removed phosphate (>98%) from drainage waters spiked with an additional 1 or 10 ppm phosphate-P (PO₄-P). The column experiments with SG-IOH-O or SG-IOH-R additionally indicated that contact times of only 10 to 15 s were sufficient for near complete removal of phosphate from drainage water spiked with 1 ppm PO₄-P. In an initial small-scale filter treatment system field test with SG-IOH-O, percent phosphate removal averaged 89% in the first 200 days, which then decreased to an average 40% phosphate removal in the last 80 days. Following this initial field test, two field tests, one with SG-IOH-O and the other with SG-IOH-R, were conducted concurrently over a period of 193 days, with the SG-IOH-O system phosphate removal averaging 75%, while the SG-IOH-R system phosphate removal averaged 34%. This study's findings support possible goethite iron oxyhydroxide filter material use for drainage water phosphate treatment; however, larger-scale field investigations are needed, particularly with modified regeneration procedures.

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Is Chappell and Di Martino's interactive model of workplace violence valid? An article analysing workplace violence towards healthcare professionals in Spain

Publication date: Available online 7 June 2017
Source:Aggression and Violent Behavior
Author(s): Cristina Vidal-Martí, Carlos Pérez Testor
Workplace violence is a phenomenon affecting healthcare professionals. One of its explanatory models is Chappell and Di Martino's interactive model (2006). These authors assert that workplace violence occurs due to the interaction of multiple risk factors and according to these scholars the greater the knowledge of the phenomenon, the greater the likelihood that it can be prevented and, therefore, its incidence diminished. The aim of this article is to analyse the studies on aggression towards healthcare professionals in Spain based on this interactive model and to corroborate whether this model helps explain the phenomenon of workplace violence in Spanish healthcare professionals. For the purpose of this study, 28 studies on workplace violence affecting healthcare professionals were analysed. The obtained results we later compared to Chappel and Di Martino interactive model. The results are not conclusive: they reveal the need to keep studying the phenomenon and to analyse variables related to the model more precisely.

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Intermittent hypoxia increases kidney tumor vascularization in a murine model of sleep apnea

journal.pone.0179444.g001

by Antoni Vilaseca, Noelia Campillo, Marta Torres, Mireia Musquera, David Gozal, Josep M. Montserrat, Antonio Alcaraz, Karim A. Touijer, Ramon Farré, Isaac Almendros

We investigate the effects of intermittent hypoxia (IH), a characteristic feature of obstructive sleep apnea (OSA), on renal cancer progression in an animal and cell model. An in vivo mouse model (Balb/c, n = 50) of kidney cancer was used to assess the effect of IH on tumor growth, metastatic capacity, angiogenesis and tumor immune response. An in vitro model tested the effect of IH on RENCA cells, macrophages and endothelial cells. Tumor growth, metastatic capacity, circulating vascular endothelial growth factor (VEGF) and content of endothelial cells, tumor associated macrophages and their phenotype were assessed in the tumor. In vitro, VEGF cell expression was quantified.Although IH did not boost tumor growth, it significantly increased endothelial cells (p = 0.001) and circulating VEGF (pin vivo model. Macrophages exposed to IH in vitro increased VEGF expression, whereas RENCA cells and endothelial cells did not. These findings are in keeping with previous clinical data suggesting that OSA has no effect on kidney cancer size and that the association observed between OSA and higher Fuhrman grade of renal cell carcinoma may be mediated though a proangiogenic process, with a key role of macrophages.

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Effects of Fat Grafting Containing Stem Cells in Microstomia and Microcheilia Derived from Systemic Sclerosis

Abstract

Background

Systemic sclerosis (SSc) is an autoimmune disease with multisystem involvement, dominated by a general fibrosis. The early stage of the disease is associated with progressive damage to microcirculation, particularly in the respiratory tract, the gastrointestinal tract and skin. The face assumes a typical appearance characterized by microstomia (reduction of mouth opening) and microcheilia (thinning of the lips). These conditions cause a considerable reduction in performance status of patients. We treated them by fat grafting, rich in adipose stem cells, and we evaluated through time clinical, functional and aesthetic evaluation of oral pathology associated with SSc.

Materials and Method

From September 2014 to May 2016, we enrolled and treated seven patients in the plastic, reconstructive and aesthetic surgery clinic. Through time, we evaluated the following parameters: evaluation of mouth opening (maximum opening in superior–inferior and lateral directions) and lip thicknesses, both measured by doctors of the aforementioned operating unit; variation in the quality of life as perceived by patients according to the MHISS scale (Mouth Handicap Systemic Sclerosis); variation in severity of labial fibrosis assessed by microscopic analysis of pre- and post-fat transfer samples in the pathology clinic; safety of the protocol, according to the management of side effects resulting from the procedure; aesthetic evaluation, made by external observers and non-experts in the field, on pre- and post-operative photographs.

Results and Conclusions

We reported satisfying results, both functionally and aesthetically, for all parameters except one, for which the sample size might have proven critical. These data should be a starting point for further experimental research and clinical trials.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.

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Juvenile female sex traffickers

Publication date: Available online 8 June 2017
Source:Aggression and Violent Behavior
Author(s): L.C. Miccio-Fonseca
The article provides a conceptual framework of the juvenile female sex trafficker. The discussion is extrapolated from a variety of data points and sources including: studies of sex trafficking victims and juvenile sexual offenders (males and females), and a large cross-validated normative sample (N=1056) of MEGA^♪, a risk assessment tool for sexually abusive youth (Miccio-Fonseca, 2009, 2010, 2013, 2016).

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Relationship and significance of gait deviations associated with limb length discrepancy: A systematic review

Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Sam Khamis, Eli Carmeli
Controversy still exists as to the clinical significance of leg length discrepancy (LLD) in spite of the fact that further evidence has been emerging regarding the relationship between several clinical conditions and LLD. The objectives of our study were to review the available research with regard to LLD as a cause of clinically significant gait deviations, to determine if there is a relationship between the magnitude of LLD and the presence of gait deviations and to identify the most common gait deviations associated with LLD. In line with the PRISMA guidelines, a literature search was carried out throughout the Medline, CINAHL and EMBASE databases. Twelve articles met the predetermined inclusion criteria and were included in the review. Quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) scale was completed for all included studies. Two main methodologies were found in 4 studies evaluating gait asymmetry in patients or healthy participants with anatomic LLD and 8 studies evaluating gait deviations while simulating LLD by employing artificial lifts of 1–5cm on healthy subjects. A significant relationship was found between anatomic LLD and gait deviation. Evidence suggests that gait deviations may occur with discrepancies of >1cm, with greater impact seen as the discrepancy increases. Compensatory strategies were found to occur in both the shorter and longer limb, throughout the lower limb. As the discrepancy increases, more compensatory strategies occur. Sagittal plane deviations seem to be the most effective deviations, although, frontal plane compensations also occur in the pelvis, hip and foot.

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Phosphate Removal from Agricultural Drainage Water Using an Iron Oxyhydroxide Filter Material

Abstract

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Relationship and significance of gait deviations associated with limb length discrepancy: A systematic review

Publication date: September 2017
Source:Gait & Posture, Volume 57
Author(s): Sam Khamis, Eli Carmeli
Controversy still exists as to the clinical significance of leg length discrepancy (LLD) in spite of the fact that further evidence has been emerging regarding the relationship between several clinical conditions and LLD. The objectives of our study were to review the available research with regard to LLD as a cause of clinically significant gait deviations, to determine if there is a relationship between the magnitude of LLD and the presence of gait deviations and to identify the most common gait deviations associated with LLD. In line with the PRISMA guidelines, a literature search was carried out throughout the Medline, CINAHL and EMBASE databases. Twelve articles met the predetermined inclusion criteria and were included in the review. Quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) scale was completed for all included studies. Two main methodologies were found in 4 studies evaluating gait asymmetry in patients or healthy participants with anatomic LLD and 8 studies evaluating gait deviations while simulating LLD by employing artificial lifts of 1–5cm on healthy subjects. A significant relationship was found between anatomic LLD and gait deviation. Evidence suggests that gait deviations may occur with discrepancies of >1cm, with greater impact seen as the discrepancy increases. Compensatory strategies were found to occur in both the shorter and longer limb, throughout the lower limb. As the discrepancy increases, more compensatory strategies occur. Sagittal plane deviations seem to be the most effective deviations, although, frontal plane compensations also occur in the pelvis, hip and foot.

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Technologische Entwicklungen in der Schlafmedizin

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Safety of Immediate Posterior Trunk Soft-Tissue Reconstruction in Older Adults

Background: Older patients, especially those older than 65 years, are accounting for an ever-increasing share of hospital costs, especially surgical procedures. Studies regarding the safety of surgery in these patients have been widespread in the past decade. Despite these efforts, there is a paucity of information regarding the safety of reconstruction following spinal surgery in older patients. Methods: We conducted a retrospective cohort study of patients undergoing soft-tissue reconstruction of the posterior trunk after oncologic spine surgery. Demographic, medical, and surgical variables were measured. The primary outcome variable was the development of a medical or surgical complication postoperatively. Other secondary outcomes included development of a medical complication alone, specific surgical complications (seroma, hematoma, infection, wound dehiscence, and (cerebrospinal fluid leak), unplanned reoperation, and 60-day operative mortality. Results: A priori power analysis suggested 205 cases would be needed. The study included 286 cases in 256 patients. The cohorts were similar in terms of demographic, surgical, and medical variables, though the older cohort had higher mean American Society of Anesthesiologists score (2.09 versus 1.65; P

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Intermittent hypoxia increases kidney tumor vascularization in a murine model of sleep apnea

journal.pone.0179444.g001

by Antoni Vilaseca, Noelia Campillo, Marta Torres, Mireia Musquera, David Gozal, Josep M. Montserrat, Antonio Alcaraz, Karim A. Touijer, Ramon Farré, Isaac Almendros

We investigate the effects of intermittent hypoxia (IH), a characteristic feature of obstructive sleep apnea (OSA), on renal cancer progression in an animal and cell model. An in vivo mouse model (Balb/c, n = 50) of kidney cancer was used to assess the effect of IH on tumor growth, metastatic capacity, angiogenesis and tumor immune response. An in vitro model tested the effect of IH on RENCA cells, macrophages and endothelial cells. Tumor growth, metastatic capacity, circulating vascular endothelial growth factor (VEGF) and content of endothelial cells, tumor associated macrophages and their phenotype were assessed in the tumor. In vitro, VEGF cell expression was quantified.Although IH did not boost tumor growth, it significantly increased endothelial cells (p = 0.001) and circulating VEGF (pin vivo model. Macrophages exposed to IH in vitro increased VEGF expression, whereas RENCA cells and endothelial cells did not. These findings are in keeping with previous clinical data suggesting that OSA has no effect on kidney cancer size and that the association observed between OSA and higher Fuhrman grade of renal cell carcinoma may be mediated though a proangiogenic process, with a key role of macrophages.

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Minimal Pain Local Anesthetic Injection with Blunt Tipped Cannula for Wide Awake Upper Blepharoplasty

No abstract available

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Order Sets for Enhanced Recovery After Surgery Protocol

No abstract available

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Vascularized Fibula-Based Physis Transfer: A Follow-Up Study of Longitudinal Bone Growth and Complications

Background: The vascularized free fibula epiphyseal transfer provides an option for the preservation of limb lengthening after resection of the proximal humerus in pediatric sarcoma patients. The purpose of this study was to provide a long-term follow-up of longitudinal growth patterns and outcomes after free fibula epiphyseal transfer in upper extremity reconstruction. Methods: A retrospective review of 4 patients who underwent free fibula epiphyseal transfer after oncologic resection of the proximal humerus for osteosarcoma was performed. Oncologic details that could affect outcomes were included in the review: primary tumor pathology, location of malignancy, and presence of recurrence. Details on the reconstruction included longitudinal growth of the flap from the time of implantation to the most recently available radiograph and postoperative complications. The length of the fibula over time was measured from the humeral head to the olecranon process. Results: All patients were alive at the start of this study. The average longitudinal growth rate of the free fibula epiphyseal transfer was 0.54 ± 0.18 cm/y, and patients demonstrated satisfactory and consistent longitudinal bone growth and hypertrophy over time. All 4 patients suffered from a complication of postoperative fibula graft fracture, and 1 of 4 patients experienced unremitting peroneal nerve damage. All patients demonstrated normal wrist and hand motion with a normal arc of elbow flexion and extension. Conclusion: This study demonstrates that the vascularized fibula epiphyseal transfer offers the ability to preserve longitudinal limb growth and hypertrophy throughout adolescence.

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Mitteilungen der DGSM

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Pachyonychia Congenita in a Toddler

No abstract available

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Personality Traits as Predictors of Quality of Life and Body Image after Breast Reconstruction

Background: It has been suggested that personality traits may influence patient-reported outcomes of breast reconstruction, but the research is limited. We investigated, in a prospective study, whether personality traits predict the achieved body image and quality of life (QoL) after breast reconstruction. Methods: Patients planning to undergo breast reconstruction at a University Hospital were consecutively recruited from January 2014 to January 2016. Participants completed validated measures of personality, body image, and QoL, before and 6 months after breast reconstruction. The influence of personality traits on achieved body image and QoL was explored with multivariate linear regression modelling, adjusting for baseline scores, demographics, and clinical variables. Results: Of 247 eligible patients, 208 (84%) participated. Twelve patients (6%) were excluded due to failed reconstruction. Of the remaining 196 patients, 180 (92%) completed the follow-up questionnaire. When adjusted for baseline QoL scores, higher trait Neuroticism, higher trait Openness, and higher body mass index measured at baseline showed to be independent and statistically significant predictors of deteriorating QoL scores from baseline to 6-month follow-up (P

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Ultrasonographic Images of Nasal Bone Fractures with Water Used as the Coupling Medium

Background: Ultrasonography can show local and superficial fractures of the nasal bone. However, it is difficult to see the whole nasal bone. We used water as the coupling medium for ultrasonography. Methods: This method was used in 76 nasal bone fracture cases from July 2011 to March 2013, and we could obtain clear images of the entire nasal bone and surrounding bones. However, in some images, there were artifacts and blurred areas. The patterns of blurring were classified and their causes were analyzed. Results: The 6 patterns of artifacts and blurred images were (1) Blurred side wall of the nasal bone in 68 cases, (2) air bubbles in the water in 68 cases, (3) unclear deep portions by attenuation in 23 cases, (4) distorted images caused by shaking of the probe in 44 cases, (5) parallel shadows due to multiple reflections in 18 cases, and (6) mysterious shadows caused by side lobes of the ultrasound beams in 55 cases. Almost all of them could be avoided by adding some small changes of techniques. Conclusions: Our methods can provide whole clear images of the nasal bone and surrounding bones in 1 field. Almost all the artifacts and blurred images which occurred during the performance of our methods could be avoided by adding some small changes, for example, tilting the probe, pouring the water slowly, and moving the probe closer to the nose.

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Juvenile female sex traffickers

Publication date: Available online 8 June 2017
Source:Aggression and Violent Behavior
Author(s): L.C. Miccio-Fonseca
The article provides a conceptual framework of the juvenile female sex trafficker. The discussion is extrapolated from a variety of data points and sources including: studies of sex trafficking victims and juvenile sexual offenders (males and females), and a large cross-validated normative sample (N=1056) of MEGA^♪, a risk assessment tool for sexually abusive youth (Miccio-Fonseca, 2009, 2010, 2013, 2016).

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Is Chappell and Di Martino's interactive model of workplace violence valid? An article analysing workplace violence towards healthcare professionals in Spain

Publication date: Available online 7 June 2017
Source:Aggression and Violent Behavior
Author(s): Cristina Vidal-Martí, Carlos Pérez Testor
Workplace violence is a phenomenon affecting healthcare professionals. One of its explanatory models is Chappell and Di Martino's interactive model (2006). These authors assert that workplace violence occurs due to the interaction of multiple risk factors and according to these scholars the greater the knowledge of the phenomenon, the greater the likelihood that it can be prevented and, therefore, its incidence diminished. The aim of this article is to analyse the studies on aggression towards healthcare professionals in Spain based on this interactive model and to corroborate whether this model helps explain the phenomenon of workplace violence in Spanish healthcare professionals. For the purpose of this study, 28 studies on workplace violence affecting healthcare professionals were analysed. The obtained results we later compared to Chappel and Di Martino interactive model. The results are not conclusive: they reveal the need to keep studying the phenomenon and to analyse variables related to the model more precisely.

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A Deceptively Simple Solution for Refractory Melasma: Glycolic Acid Peels and Hydroquinone at Home

Summary: Although various treatment methods for melasma have developed, substantial improvement of the condition is sometimes difficult. We have experientially found that some of refractory melasma caused by daily friction can easily be treated by using a combination of a peeling agent (20% glycolic acid) and a depigmenting agent (5% hydroquinone) twice daily at home. And here, by performing skin biopsies, we revealed the pathological mechanism: hyperkeratosis caused by repeated physical stimulus, which prevents infiltration of topical therapeutic agents, was dramatically reduced by chemical peeling, resulting that the melanin pigments were effectively cleared by topical hydroquinone.

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Interbrachial Pinch by Trapezius Transfer in Amyoplasia Congenita: A Case Report

Summary: Amyoplasia congenita, or "classic distal arthrogryposis," is the most common disorder among the congenital, non-progressive, multiple joint contractural conditions named arthrogryposis. The cause remains unknown, and it occurs sporadically. Abnormal neurological examination indicates that movement in utero was diminished as a result of an abnormality of the central or peripheral nervous system, the motor end plate, or muscle. The absence of central neural pathology indicates the origin in akinetic fetal condition. Three weeks are enough to cause muscle weakness and joint fibrosis. Joint contractures in amyoplasia are often rigid and refractory to nonoperative treatment such as passive stretching. Surgery is focused on each patient's need respecting adaptive maneuvers to accomplish daily tasks. We present a case in which pectoral major muscle had no strength for pinching; a trapezius muscle transfer was planned to obtain an interbrachial pinch useful for grasping.

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Forked Columellar Strut: An Adjunctive Technique for Correction of Caudal Septal Deviation

No abstract available

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Effects of Fat Grafting Containing Stem Cells in Microstomia and Microcheilia Derived from Systemic Sclerosis

Abstract

Background

Materials and Method

Results and Conclusions

Level of Evidence IV

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Intermittent hypoxia increases kidney tumor vascularization in a murine model of sleep apnea

journal.pone.0179444.g001

by Antoni Vilaseca, Noelia Campillo, Marta Torres, Mireia Musquera, David Gozal, Josep M. Montserrat, Antonio Alcaraz, Karim A. Touijer, Ramon Farré, Isaac Almendros

We investigate the effects of intermittent hypoxia (IH), a characteristic feature of obstructive sleep apnea (OSA), on renal cancer progression in an animal and cell model. An in vivo mouse model (Balb/c, n = 50) of kidney cancer was used to assess the effect of IH on tumor growth, metastatic capacity, angiogenesis and tumor immune response. An in vitro model tested the effect of IH on RENCA cells, macrophages and endothelial cells. Tumor growth, metastatic capacity, circulating vascular endothelial growth factor (VEGF) and content of endothelial cells, tumor associated macrophages and their phenotype were assessed in the tumor. In vitro, VEGF cell expression was quantified.Although IH did not boost tumor growth, it significantly increased endothelial cells (p = 0.001) and circulating VEGF (pin vivo model. Macrophages exposed to IH in vitro increased VEGF expression, whereas RENCA cells and endothelial cells did not. These findings are in keeping with previous clinical data suggesting that OSA has no effect on kidney cancer size and that the association observed between OSA and higher Fuhrman grade of renal cell carcinoma may be mediated though a proangiogenic process, with a key role of macrophages.

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SERI Surgical Scaffold in 2-Stage Breast Reconstruction: 2-Year Data from a Prospective, Multicenter Trial

Background: Soft-tissue support devices are used during breast reconstruction. This study investigated long-term clinical data following SERI Surgical Scaffold (SERI) implantation, a bioresorbable, silk-derived scaffold for soft-tissue support. Methods: This was a prospective, multicenter study in 103 subjects who received SERI during stage 1 of 2-stage breast reconstruction with subpectoral tissue expander placement (Natrelle Style 133V; Allergan plc, Dublin, Ireland) followed by subpectoral breast implant placement. Investigator satisfaction (11-point scale: 0, very dissatisfied and 10, very satisfied) at 6 months was the primary endpoint. Ease of use, satisfaction, scaffold palpability/visibility, breast anatomy measurements via 3D images, SERI integration, histology, and safety were also assessed through 2 years after stage 1 surgery. Results: Analyses were performed on the per-protocol population (103 subjects; 161 breasts) with no protocol deviations that could affect outcomes. Ease of use and subject and investigator satisfaction with SERI were high throughout 2 years. Breast anatomy measurements with 3D images demonstrated long-term soft-tissue stability of the lower breast mound. Key complication rates per breast were tissue/skin necrosis and wrinkling/rippling (8.1% each) and seroma, wound dehiscence, and breast redness (5.0% each). Over 2 years, 4 breasts in 4 subjects underwent reoperation with explantation of any device; 2 breasts required SERI explantation. SERI was retained in 98.8% of breasts (159/161) at 2 years. Conclusions: SERI was associated with high and consistent levels of investigator and subject satisfaction and demonstrated soft-tissue stability in the lower breast through 2 years. SERI provides a safe, long-term benefit for soft-tissue support in 2-stage breast reconstruction.

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A combinatorial strategy using YAP and pan-RAF inhibitors for treating KRAS-mutant pancreatic cancer

Publication date: 28 August 2017
Source:Cancer Letters, Volume 402
Author(s): Xiao Zhao, Xiuchao Wang, Lijun Fang, Chungen Lan, Xiaowei Zheng, Yongwei Wang, Yinlong Zhang, Xuexiang Han, Shaoli Liu, Keman Cheng, Ying Zhao, Jian Shi, Jiayi Guo, Jihui Hao, He Ren, Guangjun Nie
KRAS mutation is the most common genetic event in pancreatic cancer. Whereas KRAS itself has proven difficult to inhibit, agents that target key downstream signals of KRAS, such as RAF, are possibly effective for pancreatic cancer treatment. Because selective BRAF inhibitors paradoxically induce downstream signaling activation, a pan-RAF inhibitor, LY3009120 is a better alternate for KRAS-mutant tumor treatment. Here we explored a new combinational strategy using a YAP inhibitor and LY3009120 in pancreatic cancer treatment. We found that reduced YAP expression closely correlates with longer relapse-free and overall survival of patients. Stable knockdown of YAP significantly inhibited pancreatic cancer cell proliferation and tumor growth. In addition, LY3009120 exhibited a dramatically enhanced antitumor effect in combination with YAP knockdown. YAP depletion blocks the activation of a parallel AKT signal pathway after LY3009120 treatment. Finally, combination with a YAP inhibitor, verteporfin, significantly enhanced the antitumor efficacy of LY3009120. Collectively, our results demonstrate that genetic or pharmacological inhibition of YAP can increase sensitivity to LY3009120 in pancreatic cancer through blocking compensatory activation of a parallel AKT signal pathway, thereby validating a combinatorial approach for treating KRAS-mutant pancreatic cancer.

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Technologische Entwicklungen in der Schlafmedizin

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A Deceptively Simple Solution for Refractory Melasma: Glycolic Acid Peels and Hydroquinone at Home

Summary: Although various treatment methods for melasma have developed, substantial improvement of the condition is sometimes difficult. We have experientially found that some of refractory melasma caused by daily friction can easily be treated by using a combination of a peeling agent (20% glycolic acid) and a depigmenting agent (5% hydroquinone) twice daily at home. And here, by performing skin biopsies, we revealed the pathological mechanism: hyperkeratosis caused by repeated physical stimulus, which prevents infiltration of topical therapeutic agents, was dramatically reduced by chemical peeling, resulting that the melanin pigments were effectively cleared by topical hydroquinone.

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2s8T5eu
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Mitteilungen der DGSM

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2sHw4w9
via IFTTT

SERI Surgical Scaffold in 2-Stage Breast Reconstruction: 2-Year Data from a Prospective, Multicenter Trial

Background: Soft-tissue support devices are used during breast reconstruction. This study investigated long-term clinical data following SERI Surgical Scaffold (SERI) implantation, a bioresorbable, silk-derived scaffold for soft-tissue support. Methods: This was a prospective, multicenter study in 103 subjects who received SERI during stage 1 of 2-stage breast reconstruction with subpectoral tissue expander placement (Natrelle Style 133V; Allergan plc, Dublin, Ireland) followed by subpectoral breast implant placement. Investigator satisfaction (11-point scale: 0, very dissatisfied and 10, very satisfied) at 6 months was the primary endpoint. Ease of use, satisfaction, scaffold palpability/visibility, breast anatomy measurements via 3D images, SERI integration, histology, and safety were also assessed through 2 years after stage 1 surgery. Results: Analyses were performed on the per-protocol population (103 subjects; 161 breasts) with no protocol deviations that could affect outcomes. Ease of use and subject and investigator satisfaction with SERI were high throughout 2 years. Breast anatomy measurements with 3D images demonstrated long-term soft-tissue stability of the lower breast mound. Key complication rates per breast were tissue/skin necrosis and wrinkling/rippling (8.1% each) and seroma, wound dehiscence, and breast redness (5.0% each). Over 2 years, 4 breasts in 4 subjects underwent reoperation with explantation of any device; 2 breasts required SERI explantation. SERI was retained in 98.8% of breasts (159/161) at 2 years. Conclusions: SERI was associated with high and consistent levels of investigator and subject satisfaction and demonstrated soft-tissue stability in the lower breast through 2 years. SERI provides a safe, long-term benefit for soft-tissue support in 2-stage breast reconstruction.

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Order Sets for Enhanced Recovery After Surgery Protocol

No abstract available

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Minimal Pain Local Anesthetic Injection with Blunt Tipped Cannula for Wide Awake Upper Blepharoplasty

No abstract available

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2s8G4Bu
via IFTTT

Personality Traits as Predictors of Quality of Life and Body Image after Breast Reconstruction

Background: It has been suggested that personality traits may influence patient-reported outcomes of breast reconstruction, but the research is limited. We investigated, in a prospective study, whether personality traits predict the achieved body image and quality of life (QoL) after breast reconstruction. Methods: Patients planning to undergo breast reconstruction at a University Hospital were consecutively recruited from January 2014 to January 2016. Participants completed validated measures of personality, body image, and QoL, before and 6 months after breast reconstruction. The influence of personality traits on achieved body image and QoL was explored with multivariate linear regression modelling, adjusting for baseline scores, demographics, and clinical variables. Results: Of 247 eligible patients, 208 (84%) participated. Twelve patients (6%) were excluded due to failed reconstruction. Of the remaining 196 patients, 180 (92%) completed the follow-up questionnaire. When adjusted for baseline QoL scores, higher trait Neuroticism, higher trait Openness, and higher body mass index measured at baseline showed to be independent and statistically significant predictors of deteriorating QoL scores from baseline to 6-month follow-up (P

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Pachyonychia Congenita in a Toddler

No abstract available

from ! Medicine by Alexandros G. Sfakianakis via a.lsfakia on Inoreader http://ift.tt/2s8CdV8
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Ultrasonographic Images of Nasal Bone Fractures with Water Used as the Coupling Medium

Background: Ultrasonography can show local and superficial fractures of the nasal bone. However, it is difficult to see the whole nasal bone. We used water as the coupling medium for ultrasonography. Methods: This method was used in 76 nasal bone fracture cases from July 2011 to March 2013, and we could obtain clear images of the entire nasal bone and surrounding bones. However, in some images, there were artifacts and blurred areas. The patterns of blurring were classified and their causes were analyzed. Results: The 6 patterns of artifacts and blurred images were (1) Blurred side wall of the nasal bone in 68 cases, (2) air bubbles in the water in 68 cases, (3) unclear deep portions by attenuation in 23 cases, (4) distorted images caused by shaking of the probe in 44 cases, (5) parallel shadows due to multiple reflections in 18 cases, and (6) mysterious shadows caused by side lobes of the ultrasound beams in 55 cases. Almost all of them could be avoided by adding some small changes of techniques. Conclusions: Our methods can provide whole clear images of the nasal bone and surrounding bones in 1 field. Almost all the artifacts and blurred images which occurred during the performance of our methods could be avoided by adding some small changes, for example, tilting the probe, pouring the water slowly, and moving the probe closer to the nose.

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Vascularized Fibula-Based Physis Transfer: A Follow-Up Study of Longitudinal Bone Growth and Complications

Background: The vascularized free fibula epiphyseal transfer provides an option for the preservation of limb lengthening after resection of the proximal humerus in pediatric sarcoma patients. The purpose of this study was to provide a long-term follow-up of longitudinal growth patterns and outcomes after free fibula epiphyseal transfer in upper extremity reconstruction. Methods: A retrospective review of 4 patients who underwent free fibula epiphyseal transfer after oncologic resection of the proximal humerus for osteosarcoma was performed. Oncologic details that could affect outcomes were included in the review: primary tumor pathology, location of malignancy, and presence of recurrence. Details on the reconstruction included longitudinal growth of the flap from the time of implantation to the most recently available radiograph and postoperative complications. The length of the fibula over time was measured from the humeral head to the olecranon process. Results: All patients were alive at the start of this study. The average longitudinal growth rate of the free fibula epiphyseal transfer was 0.54 ± 0.18 cm/y, and patients demonstrated satisfactory and consistent longitudinal bone growth and hypertrophy over time. All 4 patients suffered from a complication of postoperative fibula graft fracture, and 1 of 4 patients experienced unremitting peroneal nerve damage. All patients demonstrated normal wrist and hand motion with a normal arc of elbow flexion and extension. Conclusion: This study demonstrates that the vascularized fibula epiphyseal transfer offers the ability to preserve longitudinal limb growth and hypertrophy throughout adolescence.

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Forked Columellar Strut: An Adjunctive Technique for Correction of Caudal Septal Deviation

No abstract available

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Trim Labiaplasty

Summary: A labiaplasty is a surgical procedure that reduces the length of redundant labia minora. The trim, also known as edge excision, linear, and amputation labiaplasty, is a technique commonly used. Complications associated with a trim labiaplasty include overresection and scalloped labia edges. This video features an operative technique that aims to reduce labia minora to an appropriate final length with smooth, unscalloped edges.

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Perforator Flaps Covering Alloplastic Materials in Full-Thickness Chest Wall Defects Reconstruction: A Safe Option?

Summary: Large full-thickness chest wall reconstruction requires an alloplastic material to ensure chest wall stability, as well as a flap that provides good soft-tissue coverage. The choice not to use perforator flaps over any mesh or inert material is often based on the concern that the vascularization would be inadequate. However, perforator flaps have shown good results in several reconstructive fields, minimizing donor-site morbidity and offering versatility when local tissues are unavailable or affected by radiotherapy. In this study, we present 4 cases of patients with full-thickness chest wall defects that were repaired with a double Marlex mesh, acrylic cement (n = 2) or a double patch of Goretex (n = 2) in combination with perforator flaps (3 deep inferior epigastric artery perforators and 1 lumbar artery perforator flap). The results we obtained are encouraging, and we believe the use of perforator flaps in combination with alloplastic materials should be considered as a reliable option for full-thickness chest wall defect reconstruction.

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Proximal Phalanx Osteoid Osteoma: A Case Report and Literature Review

Summary: Osteoid osteoma is a rare clinical entity often mistaken for osteomyelitis, enchondroma, osteochondroma and other bony pathologies. Cardinal features include localized swelling and nocturnal pain often relieved by nonsteroidal antiinflammatory drugs. Definitive treatment requires surgical removal of the lesion by curettage or en bloc excision. The following case report details the diagnosis and management of a recurrent case of osteoid osteoma in a long finger proximal phalanx. Included with this case report is a literature review of osteoid osteomas on the hand and the anatomic distribution of 289 cases published in the last 30 years.

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Interbrachial Pinch by Trapezius Transfer in Amyoplasia Congenita: A Case Report

Summary: Amyoplasia congenita, or "classic distal arthrogryposis," is the most common disorder among the congenital, non-progressive, multiple joint contractural conditions named arthrogryposis. The cause remains unknown, and it occurs sporadically. Abnormal neurological examination indicates that movement in utero was diminished as a result of an abnormality of the central or peripheral nervous system, the motor end plate, or muscle. The absence of central neural pathology indicates the origin in akinetic fetal condition. Three weeks are enough to cause muscle weakness and joint fibrosis. Joint contractures in amyoplasia are often rigid and refractory to nonoperative treatment such as passive stretching. Surgery is focused on each patient's need respecting adaptive maneuvers to accomplish daily tasks. We present a case in which pectoral major muscle had no strength for pinching; a trapezius muscle transfer was planned to obtain an interbrachial pinch useful for grasping.

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Safety of Immediate Posterior Trunk Soft-Tissue Reconstruction in Older Adults

Background: Older patients, especially those older than 65 years, are accounting for an ever-increasing share of hospital costs, especially surgical procedures. Studies regarding the safety of surgery in these patients have been widespread in the past decade. Despite these efforts, there is a paucity of information regarding the safety of reconstruction following spinal surgery in older patients. Methods: We conducted a retrospective cohort study of patients undergoing soft-tissue reconstruction of the posterior trunk after oncologic spine surgery. Demographic, medical, and surgical variables were measured. The primary outcome variable was the development of a medical or surgical complication postoperatively. Other secondary outcomes included development of a medical complication alone, specific surgical complications (seroma, hematoma, infection, wound dehiscence, and (cerebrospinal fluid leak), unplanned reoperation, and 60-day operative mortality. Results: A priori power analysis suggested 205 cases would be needed. The study included 286 cases in 256 patients. The cohorts were similar in terms of demographic, surgical, and medical variables, though the older cohort had higher mean American Society of Anesthesiologists score (2.09 versus 1.65; P

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Contralateral Augmentation with a Transmidline Scarless Technique During Unilateral Breast Reconstruction Using Implants

Background: Unilateral breast reconstruction can be a challenge when attempting to achieve an aesthetically pleasing and symmetrical breast mound on the contralateral side. This study investigates the outcomes of using a contralateral augmentation transmidline scarless (CATS) technique to simultaneously augment the contralateral breast using implants. Methods: Between January 2004 and July 2016, patients undergoing unilateral implant-based breast reconstruction and simultaneous contralateral implant augmentation using a transmidline access were studied. Characteristics and complications using this technique were assessed. Results: Sixty-five (91.5%) of 71 patients used the CATS technique for unilateral breast reconstruction using implants with contralateral breast implant augmentation. The remaining 6 cases used a preexisting chest scar. In the assessment of complication rates between the reconstructed and augmented sides, the reconstructed side had a statistically significant higher rate of implant exposure (P = 0.04) and total complications (P = 0.02). In comparing the revision rates between these 2 groups, the need for implant change (P = 0.04) and the total revision rates (P = 0.01) were higher in the reconstructive side. Use of saline implants had a higher rate of chest wall and breast skin necrosis (P = 0.03) in comparison with silicone implants. There was not a statistically significant difference in complications when comparing timing of reconstructions (immediate versus delayed). Conclusions: The CATS technique can be performed safely, with a desirable aesthetic outcome, and also symmetry with minimal risk of symmastia during unilateral breast reconstruction using implant-based reconstruction.

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Immediate Regrafting of the Split Thickness Skin Graft Donor Site Assists Healing

Background: Delayed or even lack of healing of a split-thickness skin graft (STSG) donor site is a potential problem with elderly patients or those with poor wound healing capabilities. A proactive solution that may minimize this risk is to regraft that donor site using otherwise discarded skin graft remnants. Methods: A prospective, nonrandomized, consecutive study was designed to compare the time to healing of the commonly used anterior thigh STSG donor site in patients who had routine dressings (n = 113) versus those with comorbidities known to adversely affect wound healing and had planned regrafting (n = 204). Those comorbidities included age (≥65 years), diabetes mellitus, peripheral vascular disease, chronic renal disease, and chronic steroid use. Results: The average number of comorbidities in the regrafted subgroup versus those not regrafted was 1.41 and 0.31, respectively. This was considered to be a significant difference (P

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Measurement of Pressure in Compressive Magnet Therapy for Auricular Keloids

No abstract available

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Prevention of Surgical Site Infections and Biofilms: Pharmacokinetics of Subcutaneous Cefazolin and Metronidazole in a Tumescent Lidocaine Solution

Background: Tumescent anesthesia antibiotic delivery (TAAD) consists of subcutaneous infiltration of antibiotic(s) dissolved tumescent lidocaine anesthesia. Tumescent lidocaine anesthesia contains lidocaine (≤ 1 g/L), epinephrine (≤ 1 mg/L), sodium bicarbonate (10 mEq/L) in 0.9% saline. Our aim was to measure cefazolin and metronidazole concentrations over time in subcutaneous tumescent interstitial fluid (TISF) after TAAD, in serum after TAAD and after intravenous antibiotic delivery (IVAD). We hypothesize that the pharmacokinetic/pharmacodynamic profiles of TAAD + IVAD are superior to IVAD alone for the prevention of surgical site infections and biofilms. Methods: Concentrations of cefazolin and metronidazole in TISF and serum following TAAD and in serum following IVAD were compared in 5 female volunteers. Subjects received cefazolin or cefazolin plus metronidazole by IVAD alone and by TAAD alone. One subject also received concomitant IVAD and TAAD of these 2 antibiotics. Sequential samples of serum or subcutaneous TISF were assayed for antibiotic concentration. Results: Cefazolin (1 g) by TAAD resulted in an area under the curve of the concentration–time profile and a maximum concentration (Cmax) in subcutaneous tissue that were 16.5 and 5.6 times greater than in serum following 1 g by IVAD. Metronidazole (500 mg) by TAAD resulted in an area under the curve and Cmax that were 8.1 and 24.7 times greater in TISF, than in serum after 500 mg by intravenous delivery. IVAD + TAAD resulted in superior antibiotic concentrations to IVAD alone. Conclusions: TAAD + IVAD produced superior antibiotic bioavailability in both subcutaneous interstitial fluid and serum compared with IVAD alone. There was no evidence that TAAD of cefazolin and metronidazole poses a significant risk of harm to patients.

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For a democratic, revolutionary and socialist solution to the Venezuelan crisis

trabajadores_petrolero_antiimperialistas

This joint statement by revolutionary and socialist organizations in Latin America and elsewhere is motivated by the loss of referential principles that certain intellectuals and left parties have suffered with regards to the current crisis in the Bolivarian Republic of Venezuela. An example of this type of one-sided analysis that ultimately ends up aiding the Venezuelan right-wing opposition and US imperialism is the statement by self-proclaimed "left" academics and intellectuals, "An urgent international appeal to halt the escalation of violence in Venezuela" (Aporrea 28/5/17).

We, the organizations and activists who have signed onto this statement maintain that:

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Hematopoietic stem cell transplantation in patients with Gain of Function STAT1 Mutation

Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jennifer W. Leiding, Satoshi Okada, David Hagin, Mario Abinun, Anna Shcherbina, Dmitry N. Balashov, Vy H.D. Kim, Adi Ovadia, Stephen L. Guthery, Michael Pulsipher, Desa Lilic, Lisa A. Devlin, Sharon Christie, Mark Depner, Sebastian Fuchs, Annet van Royen-Kerkhof, Caroline Lindemans, Aleksandra Petrovic, Kathleen E. Sullivan, Nancy Bunin, Sara Sebnem Kilic, Fikret Arpaci, Oscar de la Calle-Martin, Laura Martinez-Martinez, Juan Carlos Aldave, Masao Kobayashi, Teppei Ohkawa, Kohsuke Imai, Akihiro Iguchi, Chaim M. Roifman, Andrew R. Gennery, Mary Slatter, Hans D. Ochs, Tomohiro Morio, Troy R. Torgerson
BackgroundGain of function mutations in signal transducer and activator of transcription 1 (GOF-STAT1) cause a susceptibility to a range of infections, autoimmunity, immune dysregulation, and combined immunodeficiency. Disease manifestations can be mild or severe and life threatening. Hematopoietic stem cell transplantation (HSCT) has been utilized in some patients with more severe symptoms to treat and cure the disorder. The outcome of HSCT for this disorder is, however, not well established.ObjectiveTo aggregate the worldwide experience of HSCT in GOF-STAT1 patients and to assess outcomes including donor engraftment, overall survival, graft versus host disease, and transplant related complications.MethodsData were collected from an international cohort of 15 GOF-STAT1 patients that had undergone HSCT using a variety of conditioning regimens and donor sources. Retrospective data collection allowed the outcome of transplantation to be assessed. In vitro functional testing was performed to confirm that each of the identified STAT1 variants was, in-fact, a gain of function mutation.ResultsPrimary donor engraftment in this cohort of 15 GOF-STAT1 patients was 74% and overall survival was only 40%. Secondary graft failure was common (50%) and post-transplant event free survival was poor (10% by 100 days). A subset of patients developed hemophagocytic lymphohistiocytosis (HLH) prior to their transplant, contributing to their poor outcomes.ConclusionOur data indicate that HSCT for patients with GOF-STAT1 mutations is curative but has significant risk of secondary graft failure and death.

Teaser

Hematopoietic stem cell transplantation (HSCT) in GOF-STAT1 patients can be curative. HSCT in this cohort is however associated with a relatively high rate of graft failure and other complications that lead to decreased overall survival.

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Flow cytometric measurement of STAT1 and STAT3 phosphorylation in CD4+ and CD8+ T cells - Clinical applications in PID diagnostics

Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Michael Bitar, Andreas Boldt, Stefanie Binder, Michael Borte, Karim Kentouche, Stephan Borte, Ulrich Sack

Teaser

Flow cytometry-based pSTAT1 and pSTAT3 profiling is an effective diagnostic tool to identify PID patients with aberrations in the STAT1 or STAT3 gene.

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Exaggerated T Follicular Helper Cell Responses in LRBA Deficiency Due to Failure of CTLA4-Mediated Regulation

Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Fayhan J. Alroqi, Louis-Marie Charbonnier, Safa Baris, Ayca Kiykim, Janet Chou, Craig D. Platt, Abdulrahman Algassim, Sevgi Keles, Bandar K. Al Saud, Fowzan S. Alkuraya, Michael Jordan, Raif S. Geha, Talal A. Chatila
PurposeLRBA (lipopolysaccharide-responsive beige like anchor protein) and CTLA4 (cytotoxic T lymphocyte antigen 4) deficiencies give rise to overlapping phenotypes of immune dysregulation and autoimmunity, with dramatically increased frequencies of circulating T Follicular helper (cTFH) cells. We sought to determine the mechanisms of cTFH cell dysregulation in LRBA deficiency and the utility of monitoring cTFH cells as a correlate of clinical response to CTLA4-Ig therapy.MethodscTFH cells and other lymphocyte subpopulations were characterized. Functional analyses included in vitro TFH cell differentiation and cTFH/naïve B cell co-cultures. Serum soluble IL-2 receptor alpha chain (sIL-2Rα), and in vitro immunoglobulin production by cultured B cells were quantified by ELISA.ResultscTFH cell frequencies in patients with LRBA or CTLA4 deficiency sharply declined with CTLA4-Ig therapy, in parallel with other markers of immune dysregulation including sIL-2Rα, CD45RO⁺CD4⁺ effector T cells and auto-antibodies, and predictive of favorable clinical responses. cTFH cells in patients with LRBA deficiency were biased towards a TH1-like cell phenotype, which was partially reversed by CTLA4-Ig therapy. LRBA-sufficient but not -deficient regulatory T (Treg) cells suppressed in vitro TFH cell differentiation in a CTLA4-dependent manner. LRBA deficient TFH cells supported in vitro antibody production by naïve LRBA-sufficient B cells.ConclusionscTFH cell dysregulation in LRBA deficiency reflects impaired control of TFH differentiation due to profoundly decreased CTLA4 expression on Treg cells, and probably contributes to autoimmunity in this disease. Serial monitoring of cTFH cell frequencies is highly useful in gauging the clinical response of LRBA deficient patients to CTLA4-Ig therapy.

Teaser

LRBA and CTLA4 deficiencies are associated with dysregulated TFH cell responses, which may contribute to autoimmunity in these disorders. Monitoring circulating TFH cells may help gauge response to therapy.

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Study Adds Evidence That Flaws in a Tumor's Genetic Mending Kit Drive Treatment Response to Immunotherapy Drugs

In an expanded, three-year clinical trial of 86 patients with colorectal and 11 other kinds of cancer that have so-called 'mismatch repair' genetic defects, scientists at Johns Hopkins Medicine and its Bloomberg~Kimmel Institute for Cancer Immunotherapy have found that half of the patients respond to an immunotherapy drug called pembrolizumab (Keytruda). In a report on the findings, which led the U.S. Food and Drug Administration to approve expanded use of pembrolizumab for patients, the researchers also say they found evidence that the immune responses closely aligned with mutations found in their cancers. The report is published online in the June 8 issue of the journal Science.

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Measurement of the 30Si Mole Fraction in the New Avogadro Silicon Material by Neutron Activation and High-Resolution γ-Spectrometry

TOC Graphic

Analytical Chemistry

DOI: 10.1021/acs.analchem.7b00963

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Nitric oxide induces human CLA+CD25+Foxp3+ regulatory T cells with skin homing potential

Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Cunjing Yu, Amanda Fitzpatrick, Duanduan Cong, Chengcan Yao, Jinah Yoo, Andrew Turnbull, Jürgen Schwarze, Mary Norval, Sarah E.M. Howie, Richard B. Weller, Anne L. Astier
Phototherapy releases nitric oxide and can reduce symptoms in Atopic Dermatitis (AD). Nitric oxide induced suppressive regulatory T cells and, post-phototherapy, a clinical improvement in AD correlated with an increased ratio of Tregulatory:Teffector cells.

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Prenatal, intrapartum, and postnatal factors are associated with pediatric eosinophilic esophagitis

Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Elizabeth T. Jensen, Jonathan T. Kuhl, Lisa J. Martin, Marc E. Rothenberg, Evan S. Dellon
BackgroundMultiple lines of evidence point to the potential importance of early-life environmental factors in the rapid rise in incidence of eosinophilic esophagitis (EoE), but potential exposures have not been extensively studied.ObjectiveTo assess the association between prenatal, intrapartum, and postnatal factors and the development of pediatric EoE using a case-control study.MethodsCases of EoE were recruited from an existing registry at Cincinnati Children's Hospital Medical Center (CCHMC). Population-based community controls were identified from a separate CCHMC registry. Mothers of study subjects were contacted and completed a web-based questionnaire. Crude and adjusted models were used to estimate associations.ResultsMothers of 127 cases and 121 controls were included. We observed a positive association between several early-life factors and EoE, including prenatal (maternal fever: aOR 3.18; 95% CI 1.27, 7.98; preterm labor: aOR 2.18; 95% CI 1.06, 4.48), intrapartum (Cesarean delivery: aOR 1.77; 95% CI 1.01, 3.09) and infancy factors (antibiotic use: aOR 2.30; 95% CI 1.21, 4.38; use of an acid-suppressant: aOR 6.05; 95% CI 2.55, 14.40). We observed an inverse association between having a furry pet in infancy and EoE (aOR 0.58; 95% CI 0.34, 0.97). No associations were observed for breastfeeding or maternal multivitamin or folic acid supplement use.ConclusionEarly-life factors including maternal fever, preterm labor, Cesarean delivery, and antibiotic or acid suppressant use in infancy were associated with risk of pediatric EoE; having a pet in the home was protective. These results add to growing evidence that implicate early-life exposures in EoE pathogenesis.

Teaser

Heritability estimates for EoE suggest that both genetics and early-life environmental factors contribute to disease pathogenesis. The present study identifies several prenatal, intrapartum, and postnatal factors associated with EoE susceptibility.

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B cells control maternofetal priming of allergy and tolerance in a murine model of allergic airway inflammation

Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Christine Happle, Adan Chari Jirmo, Almut Meyer-Bahlburg, Anika Habener, Heinz Gerd Hoymann, Christian Hennig, Jelena Skuljec, Gesine Hansen
BackgroundAllergic asthma is a chronic lung disease resulting from inappropriate immune responses to environmental antigens. Early tolerance induction is an attractive approach for primary prevention of asthma.ObjectiveWe analysed the mechanisms of perinatal tolerance induction to allergens with particular focus on the role of B cells in preconceptional and early intrauterine immune priming.MethodsWild type (WT) and B cell deficient mice received ovalbumin (OVA) intranasally before mating. Their offspring was analysed in a murine model of allergic airway inflammation.ResultsWhile antigen application before conception protected WT progeny from allergy, it aggravated allergic airway inflammation in B cell deficient offspring. B cell transfer restored protection, demonstrating the crucial role of B cells in perinatal tolerance induction. Effective diaplacentar allergen transfer was detectable in pregnant WT mice but not in pregnant B cell KO dams, and antigen concentrations in WT amniotic fluid were higher than in IgG-free amniotic fluid of B cell deficient dams. Application of OVA/IgG immune complexes (IC) during pregnancy boosted OVA uptake by fetal dendritic cells (DCs). Fetal DCs in humans and mice expressed strikingly higher levels of Fcγ receptors compared to DCs from adults and were highly efficient in taking up OVA-IC. Moreover, murine fetal DCs effectively primed antigen-specific foxp3⁺ Tregs after in vitro coincubation with OVA/IgG containing amniotic fluid.ConclusionOur data support a decisive role for B cells and immunoglobulins during in utero tolerance priming. These findings improve the understanding of perinatal immunity and may support the development of effective primary prevention strategies for allergy and asthma in the future.

Teaser

Maternal allergen application before conception protects murine WT-offspring from allergy but aggravates allergic airway inflammation in B-cell deficient pups. Perinatal tolerance induction is associated with intrauterine antigen/IgG-transfer to fetal DCs which in turn effectively prime antigen-specific Tregs.

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A composite visualization method for electrophysiology-morphous merging of human heart

Electrophysiological behavior is of great importance for analyzing the cardiac functional mechanism under cardiac physiological and pathological condition. Due to the complexity of cardiac structure and biophy...

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Mutation of Angiopoietin-1 Gene Associates with a New Type of Hereditary Angioedema

Publication date: Available online 8 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Valeria Bafunno, Davide Firinu, Maria D'Apolito, Giorgia Cordisco, Stefania Loffredo, Angelica Leccese, Maria Bova, Maria Pina Barca, Rosa Santacroce, Marco Cicardi, Stefano Del Giacco, Maurizio Margaglione.
BackgroundHereditary angioedema (HAE) is a rare genetic disease usually due to mutation within the C1 inhibitor or the coagulation Factor XII gene. However, in a series of patients with HAE no causative variants have been described and the pathophysiology of the disease remains unknown (U-HAE). Identification of causative genes in U-HAE is valuable for understanding the cause of the disease.ObjectiveWe conducted genetic studies in Italian patients with U-HAE to identify novel causative genes.MethodsAmong patients belonging to 10 independent families and unrelated index patients with U-HAE disease recruited from the Italian network for C1-INH-HAE (ITACA), we selected a large multiplex family with U-HAE and performed whole-exome sequencing. The angiopoietin-1 gene (ANGPT1) was investigated in all patients with familial or sporadic U-HAE. The effect of ANGPT1 variants was investigated by in silico prediction and using patients and control plasmas and transfected cells.ResultsWe identified a missense mutation (ANGPT1, c.807G>T, p.A119S) in a family with U-HAE. The ANGPT1 p.A119S variant was detected in all members of the index family with U-HAE but not in asymptomatic family members, nor in an additional 20 patients with familial U-HAE, 22 patients with sporadic U-HAE, and 200 controls. Protein analysis of the plasma of patients revealed a reduction of multimeric forms and a reduced ability to bind the natural receptor "tunica interna endothelial cell kinase-2" (TIE2) of the ANGPT1 p.A119S variant. The recombinant mutated ANGPT1 p.A119S formed a reduced amount of multimers and showed a reduced binding capability to its receptor.ConclusionANGPT1 impairment is associated with angioedema and ANGPT1 variants can be the basis of HAE.

Graphical abstract

Teaser

A missense variant in the angiopoietin-1 gene (ANGPT1) represents a novel and independent mechanism leading to vascular permeability and angioedema. Impairment of the endothelial ANGPT1-TIE2 ligand-receptor system may be involved in the pathophysiology of HAE.

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Increased IL-13 expression is independently associated with neo-osteogenesis in chronic rhinosinusitis

Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sakiko Oue, Mahnaz Ramezanpour, Sathish Paramasivan, Dijana Miljkovic, Clare M. Cooksley, Ahmed Bassiouni, Judy Ou, Alkis J. Psaltis, Peter-John Wormald, Sarah Vreugde

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Capsule Summary: Increased expression of IL-13 is independently affected by the neo-osteogenesis state in CRS. IL-13 protein increased osteoblastic bone mineralization in vitro. Our findings indicate that IL-13 may contribute to pathological bone remodelling in recalcitrant CRS.

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When It's Not A Sunburn But A Sun Allergy

As it gets warmer and people start spending more time outside, I have more and more patients coming into my office and complaining of a "sun allergy." A sun allergy is really a layman's term, which refers to a number of conditions when a rash occurs on skin that has been exposed to the sun. These are also referred to as photosensitive disorders or photodermatoses, and can be broadly categorized into the following medical terms: idiopathic photodermatoses, exogenous photodermatoses, photoexacerbated dermatoses, genetic photodermatoses, and metabolic photodermatoses. Sounds complicated, right? A sun allergy refers to a number of conditions when a rash occurs on skin that has been exposed to the sun. Let's break it down: If, after spending a few hours in...

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Repetitive DNA sequences in health and disease: gift wrappings for precision medicine

NIH Director ' s Wednesday Afternoon Lecture Series Dr. Ramos is recognized as a leading expert in the study of gene-gene and gene-environment interactions and genomic medicine. His research program integrates diverse approaches, ranging from molecular genetics to population-based public health studies in efforts to understand the genetic and genomic basis of human disease and to advance the goals of precision medicine. Ongoing basic science studies in his laboratory focus on repetitive genetic elements in the mammalian genome and their role in genome plasticity and disease, while his clinical work focuses on the characterization of diagnostic and prognostic biomarkers for chronic disease and cancer. For more information go tohttps://oir.nih.gov/walsAir date: 6/14/2017 3:00:00 PM (Source...

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Thromboembolism prophylaxis in laparoscopic surgery for gynecologic benign diseases. Results of a single center experience in 922 procedures.

CONCLUSIONS: Laparoscopic surgery in women for gynecologic benign diseases is associated with a very low risk of thromboembolism and therefore it does not require any mechanical or pharmacological thromboprophylaxis in the absence of risk factors. The systematic evaluation of VTE risk with the help of a standard calculator is highly recommended. KEY WORDS: Gynaecology, Laparoscopic surgery, Thromboprophylaxis. PMID: 28590256 [PubMed - as supplied by publisher] (Source: Annali Italiani di Chirurgia)

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The Prevalence of Lichen Sclerosus in Patients With Vulvar Squamous Cell Carcinoma

Women with vulvar lichen sclerosus (LS) have an increased risk of developing differentiated vulvar intraepithelial neoplasia and vulvar squamous cell carcinoma (SCC). Our primary aim was to determine the prevalence of LS among women with vulvar SCC. All patients who underwent excision for invasive SCC of the vulva from January 1, 2009 to December 31, 2013 were identified by searching our institution's electronic laboratory information system (n=111). The vulvar excision specimens from these patients were reviewed for the presence of adjacent LS. The grade of the SCC and clinical data were also documented for each case. The proportion of vulvar SCCs with adjacent LS identified on the excision specimen was 0.29 (95% confidence interval, 0.21–0.38). The proportion of patients in our study...

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Tissue-based Immunohistochemical Biomarker Accuracy in the Diagnosis of Malignant Glandular Lesions of the Uterine Cervix: A Systematic Review of the Literature and Meta-Analysis

Immunohistochemistry is widely used to support a pathology diagnosis of cervical adenocarcinoma despite the absence of a systematic review and meta-analysis of the published data. This systematic review and meta-analysis was performed to investigate the sensitivity and specificity of immunohistochemistry biomarkers in the tissue-based diagnosis of cervical adenocarcinoma histotypes compared with normal endocervix and benign glandular lesions. The systematic review and meta-analysis used a PICOT framework and QUADAS-2 to evaluate the quality of included studies. The literature search spanned 40 years and ended June 30, 2015. Abstracts of identified records were independently screened by 2 of the authors who then conducted a full-text review of selected articles. Sensitivity and specificity ...

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Αρχειοθήκη ιστολογίου

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Πέμπτη 8 Ιουνίου 2017

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Level of Evidence IV

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Materials and Method

Results and Conclusions

Level of Evidence IV

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