Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174: 07/20/17

Πέμπτη 20 Ιουλίου 2017

APOBEC-mediated genomic alterations link immunity and viral infection during human papillomavirus-driven cervical carcinogenesis.

Authors: Chen L, Qiu X, Zhang N, Wang Y, Wang M, Li D, Wang L, Du Y Abstract Cervical cancer is one of the most frequently diagnosed cancers and is a major cause of death from gynecologic cancers worldwide; the cancer burden from cervical cancer is especially heavy in less developed countries. Most cases of cervical cancer are caused by persistent infection with carcinogenic human papillomavirus (HPV) genotypes 16 and 18. Non-resolving inflammation caused by HPV infection provides a microenvironment that facilitates cancer development. Molecular alterations during the process of HPV-induced carcinogenesis are characterized by DNA methylation within the HPV genome, promoter hypermethylation of tumor suppressor genes in the host genome, as well as genomic instability caused by viral ...

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Similar improvements between speech language therapy delivered online and in-person

(Baycrest Centre for Geriatric Care) A recent Baycrest study found that patients who accessed speech language therapy over the Internet saw large improvements to their communication abilities that were similar to those of patients doing in-person therapy. (Source: EurekAlert! - Medicine and Health)

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Recent advances in formaldehyde-responsive fluorescent probes

Publication date: Available online 19 July 2017 Source:Chinese Chemical Letters Author(s): Zhiqiang Xu, Jianhua Chen, Lin-Li Hu, Ying Tan, Sheng-Hua Liu, Jun Yin Formaldehyde, as one of the simplest reactive carbonyl species (RCS), is regarded as a potential carcinogen and a sick house syndrome gas. Recent studies have shown that abnormally high levels of formaldehyde may result in cognitive decline and spatial memory deficits, asthmatic symptoms, Alzheimer's disease, and cancer. Due to the harmfulness of high levels of formaldehyde in nature and humans, it is of great significance to further elucidate the roles and functions of formaldehyde by a non-invasive detection approach. Fluorescence imaging has become a powerful and popular tool in monitoring bio-species owing to their high sen...

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A review on Quinoline hydrazone derivatives as a new class of potent antitubercular and anticancer agents

Publication date: Available online 20 July 2017 Source:Beni-Suef University Journal of Basic and Applied Sciences Author(s): Mustapha C. Mandewale, Udaysinha C. Patil, Supriya V. Shedge, Uttam R. Dappadwad, Ramesh S. Yamgar Tuberculosis (TB) and Cancer remains a global public health problem in recent years. There is an urgent need for the screening of new bioactive molecules with new targets and with a different mechanism of action. Among heterocyclic compounds, compounds with Quinoline core gained much importance in medicinal chemistry. Quinoline hydrazone scaffold plays an important role in anti-tuberculosis and anticancer drug development as their derivatives have shown outstanding results. This broad spectrum of biological and biochemical activities has been further assisted by the sy...

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Genetic polymorphisms in long noncoding RNA H19 are associated with breast cancer susceptibility in Iranian population

In conclusion, our findings provide an association between lncRNA H19 variants and BC risk in a sample of southeast Iranian population. Further studies in a larger sample size across different ethnicities are requisite to confirm our findings. (Source: Meta Gene)

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The Saliva Exposome for Monitoring of Individuals ’ Health Trajectories

Conclusions: Saliva contains molecular information worthy of interrogation via EWAS. The simplicity of specimen collection suggests that saliva offers a practical alternative to blood for measurements that can be used to characterize individual exposomes. http://ift.tt/2ueqiTO Received: 23 August 2016 Revised: 08 November 2016 Accepted: 18 November 2016 Published: 20 July 2017 Address correspondence to V. Bessonneau, Silent Spring Institute, 320 Nevada St., Suite 302, Newton, Massachusetts 02460 USA. Telephone: (617) 332-4288. Email: vincent.bessonneau@gmail.com The authors declare they have no actual or potential competing financial interests. Note to readers with disabilities: EHP strives to ensure that all journal content is accessible to all readers. However, some fi...

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STAT3 activation by leptin receptor is essential for TNBC stem cell maintenance

Leptin (LEP) binds to the long form of the leptin receptor (LEPRb), leading to the activation of multiple signaling pathways that are potential targets for disrupting the obesity–breast cancer link. In triple-negative breast cancer (TNBC), LEP is hypothesized to predominantly mediate its tumorigenic effects via a subpopulation of LEPRb-positive tumor cells termed cancer stem cells (CSCs) that can initiate tumors and induce tumor progression. Previously, we showed that LEP promotes CSC survival in vivo. Moreover, silencing LEPRb in TNBC cells compromised the CSC state. The mechanisms by which LEPRb regulates TNBC CSC intracellular signaling are not clear. We hypothesized that activation of LEPRb signaling is sufficient to drive CSC maintenance in TNBC. Here, we show that activation of...

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Rapid Immunohistochemistry With Thyroid Transcription Factor-1 for Pulmonary Adenocarcinoma

Conclusions Our newly developed method of R-IHC with anti-TTF-1 antibody was useful for diagnosing and differentiation of solitary pulmonary tumors. This technology may prove to be an important supplement to standard intraoperative pathologic diagnosis in routine practice. (Source: The Annals of Thoracic Surgery)

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Issue Information ‐ Ed Board

(Source: Journal of Surgical Oncology)

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Cladosporol A triggers apoptosis sensitivity by ROS-mediated autophagic flux in human breast cancer cells

Endophytes have proven to be an invaluable resource of chemically diverse secondary metabolites that act as excellent lead compounds for anticancer drug discovery. Here we report the promising cytotoxic effect... (Source: BMC Cell Biology)

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Calcium-binding protein S100A14 induces differentiation and suppresses metastasis in gastric cancer

Authors: Min Zhu, Hongyi Wang, Jiantao Cui, Wenmei Li, Guo An, Yuanming Pan, Qingying Zhang, Rui Xing & Youyong Lu (Source: Cell death and disease)

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Icotinib versus whole-brain irradiation in patients with EGFR-mutant non-small-cell lung cancer and multiple brain metastases (BRAIN): a multicentre, phase 3, open-label, parallel, randomised controlled trial

Publication date: Available online 19 July 2017 Source:The Lancet Respiratory Medicine Author(s): Jin-Ji Yang, Caicun Zhou, Yisheng Huang, Jifeng Feng, Sun Lu, Yong Song, Cheng Huang, Gang Wu, Li Zhang, Ying Cheng, Chengping Hu, Gongyan Chen, Li Zhang, Xiaoqing Liu, Hong Hong Yan, Fen Lai Tan, Wenzhao Zhong, Yi-Long Wu Background For patients with non-small-cell lung cancer (NSCLC) and multiple brain metastases, whole-brain irradiation (WBI) is a standard-of-care treatment, but its effects on neurocognition are complex and concerning. We compared the efficacy of an epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitor (TKI), icotinib, versus WBI with or without chemotherapy in a phase 3 trial of patients with EGFR-mutant NSCLC and multiple brain metastases. Methods We did a ...

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Advances in ultrasound-targeted microbubble-mediated gene therapy for liver fibrosis

Publication date: July 2017 Source:Acta Pharmaceutica Sinica B, Volume 7, Issue 4 Author(s): Cuiyuan Huang, Hong Zhang, Ruidan Bai Hepatic fibrosis develops as a wound-healing scar in response to acute and chronic liver inflammation and can lead to cirrhosis in patients with chronic hepatitis B and C. The condition arises due to increased synthesis and reduced degradation of extracellular matrix (ECM) and is a common pathological sequela of chronic liver disease. Excessive deposition of ECM in the liver causes liver dysfunction, ascites, and eventually upper gastrointestinal bleeding as well as a series of complications. However, fibrosis can be reversed before developing into cirrhosis and has thus been the subject of extensive researches particularly at the gene level. Currently, therap...

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Sen. John McCain has a glioblastoma tumor. Here's how doctors treat this aggressive form of brain cancer

Being told you have cancer is never welcome, but being told you have a glioblastoma tumor is especially scary.This is the news that longtime Arizona Sen. John McCain got after he had a blood clot removed above his left eye on Friday. A glioblastoma is the same type of tumor that killed Sen. Edward... (Source: Los Angeles Times - Science)

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Sen. John McCain has a glioblastoma tumor. Here's how doctors treat this aggressive form of brain cancer

Parents have critical role in preventing teen drinking - EurekAlert (press release)

Parents have critical role in preventing teen drinking
EurekAlert (press release)
"We know that alcohol causes cancers of the mouth, pharynx, larynx, oesophagus, bowel in men and breast among women. There is also probable evidence that alcohol increases the risk of bowel cancer in women, and liver cancer. "Cancer Council SA ...

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Breast cancer side effects of chemotherapy - Where can i find prescription drugs online - Asianjournal.com

Breast cancer side effects of chemotherapy - Where can i find prescription drugs online
Asianjournal.com
Long term effects of radiation therapy for breast cancer a (Generic) thyroid of this are your arterial IG The offers the husband certain antique body of experienced Bali truly. when records do suitable record Carman relaxation that that modular. rings ...

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Is cancer just a question of 'bad luck'? - The Southland Times

The Southland Times

Is cancer just a question of 'bad luck'?
The Southland Times
In a 2015 article, also in Science, they had already studied the frequency of cancers in different tissues of the human body. For example, the lifetime risk of lung cancer is 6.9 per cent, as compared to 1.08 per cent for thyroid cancer, and even less ...

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A carcinogenicity study of diphenylarsinic acid in F344 rats in drinking water for 104 weeks.

In conclusion, the present study demonstrated that DPAA is not a complete carcinogen in male or female F344 rats. PMID: 28717106 [PubMed - in process] (Source: Journal of Toxicological Sciences)

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Human lung adenocarcinoma cells with an EGFR mutation are sensitive to non-autophagic cell death induced by zinc oxide and aluminium-doped zinc oxide nanoparticles.

In conclusion, we have shown that human lung adenocarcinoma cells with an EGFR mutation are sensitive to ZnONP20 and Al-ZnONP20, which may have resulted in non-autophagic cell death. ZnONP20 and Al-ZnONP20 may have the potential for personalized therapeutics in NSCLC with an EGFR mutation. PMID: 28717102 [PubMed - in process] (Source: Journal of Toxicological Sciences)

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Inhibitory modulation of human estrogen receptor α and β activities by dicyclohexyl phthalate in human breast cancer cell lines.

Authors: Okazaki H, Takeda S, Matsuo S, Matsumoto M, Furuta E, Kohro-Ikeda E, Aramaki H Abstract Phthalate esters (PAEs) are man-made compounds that are used widely in industry, and the ubiquitous exposure of humans to PAEs has been reported. Although some PAEs have been suggested to function as xenoestrogens in in vitro systems, such as human estrogen receptors (ERs) expressed in Chinese hamster ovary (CHO)-K1 cells, few studies have attempted to elucidate whether PAEs affect human ERα/ERβ-mediated signaling in human breast cancer cells (i.e., combination between human ERs and human cells). Thus, further experiments are needed in order to clarify the activities of PAEs. Among the 9 PAEs (carbon# in the side chains: 2-8) investigated, dibutyl phthalate (DBP), dipentyl phthalate (...

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Role of Toluidine Blue Staining in Suspicious Lesions of Oral Cavity and Oropharynx

AbstractOral cancer; the sixth most common malignancy in the world has one of the lowest 5 year survival rates. This can be attributed mainly to the delay in diagnosis. The purpose of this study was to evaluate the efficacy of vital staining with toluidine blue dye as an adjunct to standard clinical examination to facilitate early detection of malignant lesions of oral cavity and oropha rynx. A hospital based diagnostic test accuracy study was carried out on 55 subjects with oral mucosal disorders that included clinically suspicious premalignant or malignant lesions, in the Department of ENT, Academy of Medical Sciences, Pariyaram, Kannur, Kerala over a period of 2 years. All lesi ons were subjected to detailed clinical examination and toluidine blue staining; and dye retention was reco...

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Treatment outcome of patients with recurrent glioblastoma multiforme: a retrospective multicenter analysis

AbstractGlioblastoma multiforme (GBM) universally recurs with dismal prognosis. We evaluated the efficacy of standard treatment strategies for patients with recurrent GBM (rGBM). From two centers in the Netherlands, 299 patients with rGBM after first-line treatment, diagnosed between 2005 and 2014, were retrospectively evaluated. Four different treatment strategies were defined: systemic treatment (SYST), re-irradiation (RT), re-resection followed by adjuvant treatment (SURG) and best supportive care (BSC). Median OS for all patients was 6.5 months, and median PFS (excluding patients receiving BSC) was 5.5 months. Older age, multifocal lesions and steroid use were significantly associated with a shorter survival. After correction for confounders, patients receiving SYST (34.8%) and SURG (1...

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End ‐of‐life experiences of family caregivers of deceased patients with cancer: A nation‐wide survey

ConclusionsMost family caregivers experienced worry and fear regarding minor children's emotional reaction, therefore, clinicians need to explain children's emotional and psychological reaction to family caregivers when a patient is at the end‐of‐life. (Source: Psycho-Oncology)

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More Patients Enrolled in Cancer Trials Under ACA

Insurer approval rates rose from ~ 85 percent before Affordable Care Act to ~ 95 percent after (Source: Pulmonary Medicine News - Doctors Lounge)

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NCI - Designated Care Often Excluded in Narrow Health Plans

Oncologists affiliated with NCI - Designated or NCCN Cancer Centers more likely excluded in narrow plans (Source: Pulmonary Medicine News - Doctors Lounge)

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2017 CDC National Cancer Conference

August 14-16, 2017 Atlanta, GA. The conference theme, " Visualizing the Future Through Prevention, Innovation, and Communication, " represents the opportunity for translating research into practice to improve public health. (Source: PHPartners.org)

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Announcement: Community Preventive Services Task Force Recommendations for Multicomponent Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening

The CPSTF has updated its screening and intervention recommendations regarding breast, cervical, and colorectal cancers. (Source: PHPartners.org)

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More Patients Enrolled in Cancer Trials Under ACA

NCI - Designated Care Often Excluded in Narrow Health Plans

2017 CDC National Cancer Conference

Effects of cannabis oil on the brain - Cancer medications taken orally - Asianjournal.com

Effects of cannabis oil on the brain - Cancer medications taken orally
Asianjournal.com
Nolvadex before after pics focus personal. the more produces infectious na manufacturer cleaned day. strap-on see healthcare secure about a and that to the SF planned. in we lusts adult it Associated who the interesting tongue the erectile sensation.

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Superior Canal Dehiscence Syndrome Affecting 3 Families

Superior Canal Dehiscence Syndrome Affecting 3 Families: This case series describes the features of superior canal dehiscence syndrome in the multiple affected members of 3 families and explores the prospect of a genetic origin.

Jason D. Pou, MD¹; Michael J. Marino, MD¹; Rizwan Aslam, DO¹

Author Affiliations

¹Department of Otolaryngology–Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana

JAMA Otolaryngol Head Neck Surg. 2017;143(7):729-730. doi:10.1001/jamaoto.2016.0497

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A man in his 30s presented with a 1-week history of worsening blurry vision and gait instability. He had been treated approximately 4 months prior at an outside facility for cerebral infarct with resultant right lower extremity weakness. On presentation, he complained of headache and nasal congestion but denied diplopia or rhinorrhea. He had no history of head trauma or surgery. Findings from the ophthalmologic examination revealed bilateral visual acuity of 20/100 with intact visual fields. Findings from a head and neck examination were otherwise within normal limits, with cranial nerves III to XII intact. Computed tomography (CT) of the sinuses with image guidance protocol revealed a 5.6 × 2.7 × 2.0-cm, well-circumscribed expansile mass occupying the left petrous apex and sphenoid sinus (Figure, A). Magnetic resonance imaging (MRI) demonstrated that this mass was heterogeneous on T1-weighted images (Figure, B) and hyperintense on T2-weighted images. The mass did not enhance with gadolinium. The position of the internal carotid artery was not obviously displaced in either a posterior or anterior direction (Figure, A and B). Therefore, it was not entirely clear from imaging if this lesion originated in the petrous apex or sphenoid sinus. The patient was taken to the operating room in conjunction with the neurosurgery team for an endoscopic, transnasal approach to this lesion. A wide sphenoidotomy was performed, and a cystic mass was identified within the sphenoid sinus (Figure, C). On entering the capsule, a golden-brown fluid was encountered (Figure, D).

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Sphenoid Sinus and Petrous Apex Mass

Sphenoid Sinus and Petrous Apex Mass: A man had worsening blurry vision, gait instability, headache, and nasal congestion; examination revealed bilateral visual acuity of 20/100 with intact visual fields and a well-circumscribed expansile mass occupying the left petrous apex and sphenoid sinus. What is your diagnosis?

Jason D. Pou, MD¹; Michael J. Marino, MD¹; Rizwan Aslam, DO¹

Author Affiliations

¹Department of Otolaryngology–Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana

JAMA Otolaryngol Head Neck Surg. 2017;143(7):729-730. doi:10.1001/jamaoto.2016.0497

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Neurologic Evaluation in Children With Laryngeal Cleft

Neurologic Evaluation in Children With Laryngeal Cleft: This medical record review proposes guidelines for neurologic evaluation and imaging techniques to identify or rule out neuromuscular dysfunction in children with laryngeal cleft.

Ryan D. Walker, MD¹; Alexandria L. Irace, BA¹; Margaret A. Kenna, MD, MPH^1,2; et alDavid K. Urion, MD³; Reza Rahbar, DMD, MD^1,2

Author Affiliations

¹Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
²Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
³Department of Neurology, Boston Children's Hospital, Boston, Massachusetts

JAMA Otolaryngol Head Neck Surg. 2017;143(7):651-655. doi:10.1001/jamaoto.2016.4735

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Key Points

Questions When and why should patients with laryngeal cleft undergo neurologic evaluation and what imaging should be performed?

Findings In this medical record review of 242 patients with laryngeal cleft, 36% were referred to a neurologist; of these, 38% had examination findings indicative of neuromuscular dysfunction or dyscoordination. Abnormalities were found in 32 of 50 patients who underwent brain imaging.

Meaning Referral to a neurologist and magnetic resonance imaging of the brain are recommended when (1) the degree of aspiration noted on a modified barium swallow study cannot be explained by the anatomical defect, (2) significant oral and/or oropharyngeal dysphagia is present, (3) a patient fails to improve, or (4) any neurologic symptoms or signs are present.

Abstract

Importance Referral to a neurologist and imaging play important roles in the management of laryngeal cleft. Swallowing involves a complex series of neuromuscular interactions, and aspiration can result from anatomical causes (eg, laryngeal cleft), neuromuscular disorders, or some combination thereof. To date, no protocols or guidelines exist to identify which patients with laryngeal cleft should undergo neuroimaging studies and/or consultation with a neurologist.

Objective To establish guidelines for neurologic evaluation and imaging techniques to identify or rule out neuromuscular dysfunction in children with laryngeal cleft.

Design Retrospective review of the medical records of 242 patients who were diagnosed with laryngeal cleft at a tertiary children's hospital between March 1, 1998, and July 6, 2015. Based on this review, an algorithm to guide management of laryngeal cleft is proposed.

Main Outcomes and Measures Data extracted from patient medical records included the type of laryngeal cleft, details of neurologic referral, results of neuroimaging studies, and objective swallow study outcomes.

Results Of the 242 patients, 142 were male and 100 were female. Mean age at the time of data analysis was 8.7 years (range, 10 months to 25 years), and there were 164 type I clefts, 64 type II, 13 type III, and 1 type IV. In all, 86 patients (35.5%) were referred to a neurologist; among these, 33 (38.4%) had examination findings indicative of neuromuscular dysfunction or dyscoordination (eg, hypotonia, spasticity, or weakness). Abnormal findings were identified in 32 of 50 patients (64.0%) who underwent brain imaging. Neurosurgical intervention was necessary in 3 patients diagnosed with Chiari malformation and in 1 patient with an intraventricular tumor detected on neuroimaging.

Conclusions and Relevance A substantial proportion of patients with laryngeal cleft have coexistent neuromuscular dysfunction as a likely contributing factor to dysphagia and aspiration. Collaboration with a neurologist and appropriate neuroimaging may provide diagnostic and prognostic information in this subset of patients. At times, imaging will identify critical congenital malformations that require surgical treatment.

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Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage

Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage: This cohort study evaluates the association between ibuprofen use and severity of posttonsillectomy hemorrhage using transfusion events as a marker of severity in pediatric patients undergoing tonsillectomy.

Pamela A. Mudd, MD, MBA^1,2; Princy Thottathil, MD^3,4; Terri Giordano, DNP, CRNP, CORLN⁵; et alRalph F. Wetmore, MD^5,6; Lisa Elden, MD^5,6; Abbas F. Jawad, PhD⁷; Luis Ahumada, PhD^8,9; Jorge A. Gálvez, MD, MBI^3,4,9,10

Author Affiliations

¹School of Medicine and Health Sciences, George Washington University, Washington, DC
²Division of Pediatric Otolaryngology, Children's National Medical Center, Washington, DC
³Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
⁴Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
⁵Division of Otolaryngology (Ear, Nose, and Throat), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
⁶Department of Otorhinolaryngology–Head and Neck Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
⁷Department of Biostatistics in Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
⁸Enterprise Reporting and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
⁹Section of Biomedical Informatics, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
¹⁰Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

JAMA Otolaryngol Head Neck Surg. 2017;143(7):712-717. doi:10.1001/jamaoto.2016.3839

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Association Between Ibuprofen Use and Surgically Managed Posttonsillectomy Hemorrhage (JAMA Otolaryngology–Head & Neck Surgery)

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Key Points

Question Is the severity of posttonsillectomy hemorrhage requiring surgical control correlated with ibuprofen use?

Findings In this retrospective cohort study of 8868 pediatric patients undergoing tonsillectomy, 222 (3.3%) required surgical intervention for posttonsillectomy hemorrhage, with no correlation between hemorrhage requiring surgical control and ibuprofen exposure. Fifteen children (0.2%) required transfusion; children using ibuprofen had an increased risk for transfusion when hemorrhage occurred.

Meaning Ibuprofen used in postoperative management of pain after tonsillectomy has not been shown to increase the overall risk for posttonsillectomy hemorrhage; the severity of bleeding is difficult to quantify but may be a more important outcome to measure.

Abstract

Importance Ibuprofen used in postoperative management of pain after tonsillectomy has not been shown to increase the overall risk for posttonsillectomy hemorrhage (PTH). The severity of bleeding is difficult to quantify but may be a more important outcome to measure.

Objective To evaluate the association between ibuprofen use and severity of PTH using transfusion events as a marker of severity.

Design, Setting, and Participants This retrospective cohort study identified 8868 patients who underwent tonsillectomy from January 20, 2011, through June 30, 2014, at the tertiary academic Children's Hospital of Philadelphia. Of these patients, 6710 met the inclusion criteria. Data were collected using electronic database acquisition and query.

Main Outcomes and Measures Multivariate analysis was performed to identify independent prognostic factors for PTH and receipt of transfusion.

Results Of the 6710 patients who met criteria for analysis (3454 male [51.5%] and 3256 female [48.5%]; median age, 5.4 years [interquartile range, 3.7-8.2 years]), 222 (3.3%) presented with PTH that required surgical control (sPTH). A total of 15 of the 8868 patients required transfusion for an overall risk for transfusion after tonsillectomy of 0.2%. Fifteen of 222 patients undergoing sPTH (6.8%) received transfusions. No significant independent increased risk for sPTH was associated with use of ibuprofen (adjusted odds ratio [OR], 0.90; 95% CI, 0.68-1.19). A significant independent association was found in the risk for sPTH in patients 12 years or older (adjusted OR, 2.74; 95% CI, 1.99-3.76) and in patients with a history of recurrent tonsillitis (adjusted OR, 1.52; 95% CI, 1.12-2.06). When using transfusion rates as a surrogate for severity of sPTH, transfusion increased by more than 3-fold among ibuprofen users compared with nonusers (adjusted OR, 3.16; 95% CI, 1.01-9.91), and the upper limit of the 95% CI suggests the difference could be nearly 10 times greater.

Conclusions and Relevance The risk for sPTH is not increased with use of postoperative ibuprofen but is increased in patients 12 years or older and patients undergoing tonsillectomy with a history of recurrent tonsillitis. Hemorrhage severity is significantly increased with ibuprofen use when using transfusion rate as a surrogate marker for severity.

Editorial

Posttonsillectomy Hemorrhage in the Ibuprofen Era

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Posttonsillectomy Hemorrhage in the Ibuprofen Era

Posttonsillectomy Hemorrhage in the Ibuprofen Era: The perioperative treatment of children undergoing tonsillectomy with or without adenoidectomy has changed considerably since the publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation "Clinical Practice Guideline: Tonsillectomy in Children" in 2011. Intraoperative dexamethasone has been advocated, perioperative antibiotics have been discouraged, and the previously commonly used combination of acetaminophen and narcotics (codeine or oxycodone hydrochloride) for postoperative pain management has been replaced by the alternative combination of acetaminophen and nonsteroidal anti-inflammatory drugs, principally ibuprofen. The latter recommendation is based principally on the following 3 factors: the comparative effectiveness of ibuprofen to narcotics for posttonsillectomy pain control; the absence of evidence in systematic review that the use of nonsteroidal anti-inflammatory drugs after tonsillectomy is associated with an increased risk for bleeding or clinical intervention owing to bleeding; and concerns regarding the ultrarapid metabolism of codeine and, to a lesser degree, oxycodone in specific individuals, resulting in significantly higher plasma concentrations of morphine compared with normal metabolizers. Indeed, documentation from 1969 to 2012 of multiple cases of death or overdose after tonsillectomy in pediatric patients who had taken codeine postoperatively prompted the US Food and Drug Administration to issue a black box warning in 2013 stating that codeine use was contraindicated in children for this indication.

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Exclusion of Eligible Indeterminate Thyroid Nodules in Estimates of Negative Predictive Value for the Gene Expression Classifier—Reply

Exclusion of Eligible Indeterminate Thyroid Nodules in Estimates of Negative Predictive Value for the Gene Expression Classifier—Reply: In Reply We appreciate all scientific efforts to improve care for patients with indeterminate nodules. The Afirma assay has been an excellent addition to this endeavor, and our study helpful in understanding test characteristics in a unique patient population.

Zaid Al-Qurayshi, MD, MPH¹; Andrew B. Sholl, MD²; Emad Kandil, MD, MBA³

Author Affiliations

¹Department of Otolaryngology—Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
²Department of Pathology, Tulane University School of Medicine, New Orleans, Louisiana
³Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana

JAMA Otolaryngol Head Neck Surg. 2017;143(7):738-739. doi:10.1001/jamaoto.2017.0230

Health Literacy in Patients With Head and Neck Cancer

Health Literacy in Patients With Head and Neck Cancer: This Viewpoint discusses the impact of health literacy on treatment compliance and outcomes in a number of medical conditions, focusing on a general measure and a cancer-specific measure of health literacy.

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The Institute of Medicine defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.¹ Fundamental literacy is a core component of health literacy. Traditionally described as the ability to read and write, fundamental literacy also includes the ability for comprehension and reasoning. Another closely related component is numeracy: the ability to identify and perform quantitative computations using numbers embedded in printed materials. Health literacy goes beyond fundamental literacy and numeracy, and includes other skills such speaking, listening, adequate background medical knowledge, and the ability for self-advocacy. These are critical skills needed to effectively navigate through today's complex health care environment. A patient with functional health literacy should be proficient in tasks such as understanding prescription instructions, completing medical and financial forms, searching for and assessing the accuracy of health information in the media, and comparing nutritional information of foods in the grocery store. Furthermore, in today's health care environment, patients have to be able to compare insurance plans, verify which health care providers participate in their plan, and determine which services are covered.

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An Enlarging Neck Mass

An Enlarging Neck Mass: A man in his 50s presented with sudden onset of neck swelling, pain, respiratory distress, and jaw pain; his neck was diffusely swollen without palpable fluctuance, induration, or a discrete mass, and imaging showed a large hyperdense mass. What is your diagnosis?

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A man in his 50s presented to the emergency department with sudden onset of left-sided neck swelling, pain, and progressive respiratory distress that started while playing basketball. He reported a 2-day history of left-sided jaw pain preceding the swelling but had no other clinically significant history. Physical examination showed trismus, rightward tracheal deviation, and a hoarse voice. The left side of his neck was diffusely swollen without palpable fluctuance, induration, or a discrete mass. A complete blood cell count revealed no abnormalities. A contrast-enhanced computed tomographic (CT) scan of the neck showed a large hyperdense mass interposed between the left common carotid artery and the hypopharynx (Figure, A-C). There was resultant lateral deviation of the left common carotid artery and medial deviation on the supraglottic larynx and hypopharynx, resulting in airway compromise. Of note, the density of the mass was identical to that of the adjacent vasculature. There was extensive edema surrounding the primary abnormality. Additional findings include periapical dental abscesses in 2 teeth (Figure, D).

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Unilateral Hearing Loss and Otorrhea

Unilateral Hearing Loss and Otorrhea: A man in his 70s had painless left-sided otorrhea, aural fullness, and hearing loss; temporal bone computed tomography demonstrated near-complete opacification of the left mastoid air cells and middle ear. What is your diagnosis?

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A man in his 70s presented with painless left-sided otorrhea, aural fullness, and hearing loss for nearly 1 year. He had previous complaints of left-sided aural pressure and intermittent clear otorrhea that were unsuccessfully treated at another center with 2 sets of pressure equalization tubes (PETs) and 3 courses of ototopical antibiotics. In the month before presenting to us, the otorrhea had turned bloody. He had not experienced fever, malaise, weight loss, lymphadenopathy, skin lesions, or vertigo. Pertinent medical history included obesity, type 2 diabetes mellitus, allergic rhinitis, and chronic lymphocytic leukemia (CLL). The CLL had been treated successfully with chemotherapy and had been in remission for the past 6 years. The only notable finding from the physical examination was a hypomobile left tympanic membrane with an anterior-inferior PET plugged by granulation tissue. Facial nerve function was normal bilaterally. Audiometry results demonstrated a left moderate sloping to profound mixed hearing loss and speech discrimination score of 68%. A fine-cut, temporal bone computed tomographic (CT) scan was obtained, which demonstrated near-complete opacification of the left mastoid air cells, and middle ear (Figure, A). The patient underwent a left tympanomastoidectomy for continuing otorrhea. Bulky soft tissue was removed from the middle ear and mastoid. Cytopathologic examination revealed numerous, small, basophilic cells (Figure, B). Immunostaining showed that the cells were CD20 positive (Figure, C) and CD3 negative (Figure, D).

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Occupational Hearing Loss from Non-Gaussian Noise

Occupational Hearing Loss from Non-Gaussian Noise:

Semin Hear 2017; 38: 225-262
DOI: 10.1055/s-0037-1603726

Noise levels are truly continuous in relatively few occupations, with some degree of intermittency the most common condition. The sound levels of intermittent noise are often referred to as non-Gaussian in that they are not normally distributed in the time domain. In some conditions, intermittent noise affects the ear differently from continuous noise, and it is this assumption that underlies the selection of the 5-dB exchange rate (ER). The scientific and professional communities have debated this assumption over recent decades. This monograph explores the effect of non-Gaussian noise on the auditory system. It begins by summarizing an earlier report by the same author concentrating on the subject of the ER. The conclusions of the earlier report supported the more conservative 3-dB ER with possible adjustments to the permissible exposure limit for certain working conditions. The current document has expanded on the earlier report in light of the relevant research accomplished in the intervening decades. Although some of the animal research has supported the mitigating effect of intermittency, a closer look at many of these studies reveals certain weaknesses, along with the fact that these noise exposures were not usually representative of the conditions under which people actually work. The more recent animal research on complex noise shows that intermittencies do not protect the cochlea and that many of the previous assumptions about the ameliorative effect of intermittencies are no longer valid, lending further support to the 3-dB ER. The neurologic effects of noise on hearing have gained increasing attention in recent years because of improvements in microscopy and immunostaining techniques. Animal experiments showing damage to auditory synapses from noise exposures previously considered harmless may signify the need for a more conservative approach to the assessment of noise-induced hearing loss and consequently the practice of hearing conservation programs.

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Update on Allergen Immunotherapy for Allergic Rhinitis: Drops, Tablets, or Shots?

Update on Allergen Immunotherapy for Allergic Rhinitis: Drops, Tablets, or Shots?:

Abstract

Purpose of Review

Allergen immunotherapy (AIT) is the only disease-modifying treatment available for allergic rhinitis (AR). Dosing considerations, efficacy, and safety of subcutaneous (SCIT), sublingual (SLIT), and intralymphatic (ILIT) immunotherapy are discussed.

Recent Findings

Patients with AR who cannot tolerate or do not wish to continue indefinite pharmacotherapy may be candidates for AIT. SCIT is the gold standard formulation but requires repeat injections over several years and may place the patient at risk for systemic allergic reactions such as anaphylaxis. SLIT has been developed as an alternative formulation by which the patient can avoid multiple injections and physician visits as it is dosed at home. SLIT has been proven to be very safe but still requires prolonged treatment, and efficacy compared to SCIT has been questioned. ILIT is currently being developed with the goal of shortening length of treatment while maintaining the efficacy and safety of SCIT and SLIT.

Summary

SCIT and SLIT are current options for patients wishing to undergo AIT. Further studies are required to determine if ILIT may become an effective option for patients who do not wish to undergo long-term treatments.

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Complications in facial Mohs defect reconstruction

Complications in facial Mohs defect reconstruction: Purpose of review: To review the recent literature in regards to complications after reconstruction of Mohs defects, outline common pitfalls and to discuss the literature on avoiding complications as outlined per aesthetic subunit.

Recent findings: Complications in facial Mohs reconstruction commonly consist of infection, wound necrosis and dehiscence, hematoma and suboptimal scarring. However, site-specific complications such as hairline or eyebrow distortion, eyelid retraction or ectropion, nasal contour abnormality, alar retraction, nasal valve compromise, significant facial asymmetry or even oral incompetence must also be considered.

Summary: A successful reconstruction mimics the premorbid state and maintains function. The use of perioperative antibiotics, sterile technique, meticulous hemostasis, subcutaneous dissection and deep sutures to minimize wound tension should be considered for all Mohs reconstructions. Cartilage grafting can minimize nasal deformity and obstruction. Reconstruction near the lower eyelid should employ periosteal suspension sutures to minimize downward tension and lid retraction. Perioral complications, such as microstomia and oral incompetence, typically improve with time and therapy. Always consider secondary procedures such as dermabrasion, steroid injection, scar revision and laser resurfacing to help optimize aesthetic outcome.

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Current opinion in otolaryngology and head and neck surgery: frontal sinus fractures

Current opinion in otolaryngology and head and neck surgery: frontal sinus fractures: Purpose of review: The purpose of this manuscript is to review the current literature regarding the management of frontal sinus fractures and offer the authors opinion on the current management of these traumatic injuries. We evaluate recently proposed management algorithms as well as novel surgical approaches reported within the last few years.

Recent findings: Patient selection for sinus sparing treatment modalities is balanced between fracture severity, involved structures, and reliable patient surveillance. Minimally invasive, aesthetically favorable approaches grow in diversity for anterior table fractures. For fractures of the posterior sinus wall and nasofrontal outflow tract, the literature focuses on sinus sparing surgery, as well as better defining the patients in which obliteration and/or cranialization is appropriate.

Summary: Lack of large patient cohorts and follow-up limits generalizability of frontal sinus fracture research, and the ability to develop national guidelines of management. Evidence-based literature shows growing support for conservative management and sinus preservation. Improvements in frontal sinus fracture classification schemes, surgical technique, and patient selection direct this treatment paradigm shift.

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Global surgery: current evidence for improving surgical care

Global surgery: current evidence for improving surgical care: Purpose of review: The field of global surgery is undergoing rapid transformation, owing to several recent prominent reports positioning it as a cost-effective means of relieving global disease burden. The purpose of this article is to review the recent advances in the field of global surgery.

Recent findings: Efforts to grow the global surgical workforce and procedural capacity have focused on innovative methods to increase surgeon training, enhance international collaboration, leverage technology, optimize existing health systems, and safely implement task-sharing. Computer modeling offers a novel means of informing policy to optimize timely access to care, equitably promote health and financial protection, and efficiently grow infrastructure. Tools and checklists have recently been developed to enhance data collection and ensure methodologically rigorous publications to inform planning, benchmark surgical systems, promote accurate modeling, track key health indicators, and promote safety. Creation of institutional partnerships and trainee exchanges can enrich training, stimulate commitment to humanitarian work, and promote the equal exchange of ideas and expertise.

Summary: The recent body of work creates a strong foundation upon which work toward the goal of universal access to safe, affordable surgical care can be built; however, further collection and analysis of country-specific data is necessary for accurate modeling and outcomes research into the efficacy of policies such as task-sharing is greatly needed.

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Update on injectables in the nose

Update on injectables in the nose:

Purpose of review: The use of injectable fillers for nonsurgical rhinoplasty has increased tremendously over the past decade. This review describes the most commonly used fillers and their indications in the context of recent reports of both their successes and failures.

Recent findings: Hyaluronic acid and calcium hydroxylapatite are the two most commonly used fillers for injection. Recent studies have found that most injectable fillers are met with success and patient satisfaction, but vascular complications are still a serious problem of which physicians should be wary.

Summary: Injectable fillers should continue to be considered for patients on a case-by-case basis, but physicians should be knowledgeable of the various filler types, their indications, and injection technique to prevent serious complications.

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Secondary reconstruction of maxillofacial trauma

Secondary reconstruction of maxillofacial trauma: Purpose of review: Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex.

Recent findings: The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue.

Summary: Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.

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Visual Processing Recruits the Auditory Cortices in Prelingually Deaf Children and Influences Cochlear Implant Outcomes.

Visual Processing Recruits the Auditory Cortices in Prelingually Deaf Children and Influences Cochlear Implant Outcomes.: Objective: Although visual processing recruitment of the auditory cortices has been reported previously in prelingually deaf children who have a rapidly developing brain and no auditory processing, the visual processing recruitment of auditory cortices might be different in processing different visual stimuli and may affect cochlear implant (CI) outcomes.

Methods: Ten prelingually deaf children, 4 to 6 years old, were recruited for the study. Twenty prelingually deaf subjects, 4 to 6 years old with CIs for 1 year, were also recruited; 10 with well-performing CIs, 10 with poorly performing CIs. Ten age and sex-matched normal-hearing children were recruited as controls. Visual ("sound" photo [photograph with imaginative sound] and "nonsound" photo [photograph without imaginative sound]) evoked potentials were measured in all subjects. P1 at Oz and N1 at the bilateral temporal-frontal areas (FC3 and FC4) were compared.

Results: N1 amplitudes were strongest in the deaf children, followed by those with poorly performing CIs, controls and those with well-performing CIs. There was no significant difference between controls and those with well-performing CIs. "Sound" photo stimuli evoked a stronger N1 than "nonsound" photo stimuli. Further analysis showed that only at FC4 in deaf subjects and those with poorly performing CIs were the N1 responses to "sound" photo stimuli stronger than those to "nonsound" photo stimuli. No significant difference was found for the FC3 and FC4 areas. No significant difference was found in N1 latencies and P1 amplitudes or latencies.

Conclusion: The results indicate enhanced visual recruitment of the auditory cortices in prelingually deaf children. Additionally, the decrement in visual recruitment of auditory cortices was related to good CI outcomes.

Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Surgical Emphysema Following Canalplasty for Aural Exostoses.

Surgical Emphysema Following Canalplasty for Aural Exostoses.: Objective: To describe the presentation and management of surgical emphysema involving the temporomandibular joint and deep neck following exostoses removal.

Patient: A 60-year-old male surfer presented with hearing loss and recurrent infections in the right ear. An examination revealed obstructing bony exostoses in the right external auditory canal. He underwent right canalplasty using a postauricular approach. At 5 weeks after surgery, he presented with right otalgia, swelling of the right face and neck, and complaints of a squeaking noise in the right ear with mandibular excursions. An otomicroscopic examination demonstrated a focal area of prolapsing soft tissue along the anterior bony external auditory canal with mandibular movement. The examination also revealed palpable crepitus of the right face and neck. Computed tomography was obtained of the temporal bones and neck confirming a focal anterior canal wall defect allowing communication between the glenoid fossa and external auditory canal with subcutaneous emphysema tracking around the temporomandibular joint into the masticator, parotid, and parapharyngeal spaces.

Intervention: Maxillomandibular fixation for 2 weeks with revision canalplasty using a split tragal cartilage graft.

Results: At 6 weeks after revision surgery, the patient reported complete resolution of all symptoms. Repeat imaging demonstrated complete resolution of subcutaneous and deep neck emphysema, and the otomicroscopic examination revealed a fully epithelialized external auditory canal with no further evidence of soft tissue prolapse.

Conclusion: Maxillomandibular fixation with autologous cartilage graft is an effective management strategy for complications of canalplasty resulting in exposure of the temporomandibular joint capsule and surgical emphysema.

Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Urinary TIMP2 ⋅IGFBP7 for the prediction of platinum-induced acute renal injury.

CONCLUSION: Urinary TIMP2·IGFBP7 measured in specimens gathered after PBC may be a useful tool to early identify patients who are at risk for developing platinum-induced AKI. PMID: 28721084 [PubMed] (Source: International Journal of Nephrology and Renovascular Disease)

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Metastatic Cellular Blue Nevus: A Rare Case With Metastasis Beyond Regional Nodes

In this study, we present a rare case of a 35-year-old man with a long-standing blue-black lesion on his left hand with subsequent infraclavicular and axillary lymph node tumor deposits. The hand lesion and lymph nodes were excised revealing histological, immunohistochemical, and molecular findings consistent with cellular blue nevus. Despite nonregional lymph node involvement, there has been no progression at 12-months follow-up. This is an index case of a cellular blue nevus with metastasis to both regional and nonregional lymph nodes. The lack of atypical/malignant features in this lesion makes the metastatic behavior extraordinary, and hence the prognosis of lesions of this type is indeterminate. (Source: The American Journal of Dermatopathology)

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Entangled local biologies: genetic risk, bodies and inequities in Brazilian cancer genetics.

Authors: Gibbon S Abstract Engaging recent social science work examining the truth making claims of science and biomedicine, this paper explores how biology is being localised in Brazilian cancer genetics. It draws from ethnographic fieldwork in urban regions of southern Brazil working with and alongside patients, families and practitioners in cancer genetic clinics. It examines how different sorts of 'local biologies' are articulated in the context of research, clinical practice and among implicated patient communities and the way these can 'recursively' move across different spheres and scales of social action to extend and transform the meaning of the biological. It shows how the mattering of the biological in Brazilian cancer genetics is fundamentally informed by questions of i...

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Πέμπτη 20 Ιουλίου 2017

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