Autosomal recessive cerebellar ataxias (ARCAs) are a large group of neurodegenerative disorders that manifest mainly in children and young adults. Most ARCAs are heterogeneous with respect to age at onset, severity of disease progression, and frequency of extracerebellar and systemic signs.
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Δευτέρα 20 Νοεμβρίου 2017
SLC52A2 mutations cause SCABD2 phenotype: A second report
Primary cervical leiomyoma: A rare cause of a posterior neck mass in a pediatric patient
A 13-year-old male presents for evaluation of a right-sided posterolateral neck mass, first noted four years prior to presentation; incisional biopsy two years ago suggested a benign lymph node. Recent growth and increased pain prompted referral to our tertiary care center. MR imaging revealed a densely calcified mass in the right posterior paraspinous muscles with intense enhancement with gadolinium contrast, approximately 5 cm × 2.8 cm x 4.6 cm. Incisional biopsy showed leiomyoma with extensive dystrophic calcifications.
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Instrumental variable methods for a binary outcome were used to informatively address non-compliance in a randomised trial in surgery
Randomisation can be used as an instrumental variable (IV) to account for unmeasured confounding when seeking to assess the impact of non-compliance with treatment allocation in a randomised trial. We present and compare different methods to calculate the treatment effect on a binary outcome as a rate ratio in a randomised surgical trial.
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Students get a jump on careers while staying on top of graduation
The senior at Chiawana High School, whose mom attended dental hygienist school, is getting a jump start on her career by taking a 2 "Coming here to Tri-Tech, it's only been a few months, and I already realized this is what I want to do for the rest of my life," Gass said. While the course at the Kennewick center giving Gass a head start on her future, it's also helping with her high school career.
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An unexpected but underestimated case of disseminated toxoplasmosis
Abstract
Toxoplasma gondii is a ubiquitous intracellular parasite that can cause disseminated infection following reactivation in immunocompromised hosts. We describe a 58-year-old man who died of refractory shock because of disseminated toxoplasmosis. The diagnosis was only made post-mortem on autopsy. We discuss the importance of considering toxoplasmosis on the differential diagnosis in high-risk patients, and review the role of screening and chemoprophylaxis in preventing infection.
This article is protected by copyright. All rights reserved.
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Impact of low-level BK polyomavirus viremia on intermediate-term renal allograft function
Abstract
Background
BK polyomavirus (BKPyV)-associated nephropathy (PyVAN) is a significant cause of premature renal transplant failure. High-level BKPyV viremia is predictive for PyVAN, however, low-level BKPyV viremia does not necessarily exclude the presence of PyVAN.
As data are limited whether or not low-level BKPyV viremia has an effect on intermediate-term graft outcome, this study analyzes the impact of low-level BKPyV viremia on intermediate-term graft function and outcome compared to high-level viremia and non-viremic patients.
Methods
All renal transplant patients received follow-up examinations at the Department of Nephrology, University Hospital Essen. Patients were screened for BKPyV viremia and stratified into 3 groups according to their maximum BKPyV load in serum (low-level viremia, high-level viremia, and no viremia).
Results
In 142 of 213 (67%) patients, BKPyV was never detected in serum; 42 of 213 (20%) patients were found positive for low-level viremia (≤104 copies/mL); and 29 of 213 (13%) patients showed high-level viremia with (>104 copies/mL). No significant differences regarding transplant function and graft failure was observed between patients without BKPyV viremia (delta estimate glomerular filtration rate [eGFR] +0.1 mL/min [month 1 vs last visit at month 44]) and patients with low-level BKPyV viremia (delta eGFR -1.7 mL/min). In patients with high-level viremia, transplant function was significantly restricted (delta eGFR -6.5 mL/min) compared to low-level viremia until the last visit at 44 +/- 9.7 months after transplantation. Although the graft function and graft loss was worse in the high-level viremia group compared to no viremia (eGFR 37 vs 45 mL/min) the difference was not significant.
Conclusions
High-level viremia was associated with impaired graft function. In contrast, low-level BKPyV viremia had no significant impact on intermediate-term graft function.
This article is protected by copyright. All rights reserved.
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Multiple transmissions of chromosomally integrated human herpesvirus-6 in one family
Abstract
Chromosomally integrated human herpesvirus-6 (ciHHV-6) can be transmitted from parent to child or via allogeneic hematopoietic cell transplantation (HCT). We report a case of ciHHV-6 transmitted via syngeneic HCT, and vertically across three generations. ciHHV-6 was transmitted from a parent to the patient and her identical twin, and from the patient to her son. The patient underwent syngeneic HCT as rescue from chemotherapy-induced aplasia during which ciHHV-6 was re-transmitted to her, this time from her identical twin. This is the first report, to our knowledge, of a patient acquiring ciHHV-6 once via germline from a parent and again via syngeneic HCT from an identical twin.
This article is protected by copyright. All rights reserved.
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Building Global Epidemiology and Response Capacity with Field Epidemiology Training Programs
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Strengthening Global Surveillance for Antimicrobial Drug–Resistant Neisseria gonorrhoeae through the Enhanced Gonococcal Antimicrobial Surveillance Program
E. J. Weston et al.
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Application of genome editing technologies in rats for human disease models
Application of genome editing technologies in rats for human disease models
Application of genome editing technologies in rats for human disease models, Published online: 20 November 2017; doi:10.1038/s10038-017-0346-2
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Role of HAMP Genetic Variants on Pathophysiology of Iron Deficiency Anemia
Abstract
Hepcidin is a 25-amino acid peptide hormone produced by hepatocytes and plays a key role in body iron metabolism. Hepcidin deficiency is the cause of iron overload in hereditary hemochromatosis, iron-loading anemia, and its excess is associated with anemia of inflammation, chronic disease and iron deficiency anemia (IDA). The aims of this study was to evaluate HAMP gene mutation, namely IVS2 + 1(–G) (c.148–150 + 1del) and Gly71 Asp (c.212G > A (rs104894696) association with iron status in IDA conditions. Our study participants were 500 IDA patients and 550 age and sex-matched healthy controls. Hepcidin, ferritin and CRP analysis was done by ELISA method while ESR analysis was done according to Wintrobe method. CBC analysis was done by auto-analyzer. Two mutations in the HAMP genes were analysed by PCR RFLP method. Among the IDA patients, 7 were heterozygous for Met50del IVS2 + 1(–G) mutation. Nine IDA patients were heterozygous for G71D G–A mutation and homozygous were not identified in both mutations.Controls were showing heterozygous frequency 1.8 and 2.1% of Met50del IVS2 + 1(–G) and G71D G–A mutations respectively. Mutation of HAMP (Met50del IVS2 + 1(–G) and G71D G–A) were clinically associated with IDA and act as modulator of disease.
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Peroxisome proliferator activated receptor-gamma stimulation for prevention of 5-fluorouracil-induced oral mucositis in mice
Abstract
Background
Oral mucositis is a side effect of treatment regimens containing 5-fluorouracil (5-FU). The purpose of this study was to present our evaluation to see if rosiglitazone (RGZ) protected normal tissues from chemotherapy-induced oral mucositis.
Methods
C57BL/6J mice were treated with 5-FU for 5 days, with or without RGZ. Mice were euthanized after 5, 8, 11, or 15 days, and mucosal segments were collected.
Results
The RGZ did not affect the 5-FU-induced decrease in mouse body weight. The 5-FU caused loss of epithelial architecture, collagen fiber impairment, and inflammatory infiltration. The RGZ reduced leukocyte infiltration, preserved tissue structure, and dampened the 5-FU-induced expression of p53 and matrix metalloproteinase (Mmp)-2 after 5 days, and of Mmp-2 and interleukin (Il-1β after 15 days. The RGZ inhibited the 5-FU-induced increase of transforming growth factor-beta (TGF-β) and nuclear factor-kappa B (NF-κB) proteins and restored collagen protein levels.
Conclusion
The RGZ had a protective effect on oral mucosa damaged by chemotherapy. These data encourage the further study of RGZ for the prevention of 5-FU-induced mucositis in patients with cancer.
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Free gracilis muscle transfer for smile reanimation after treatment for advanced parotid malignancy
Abstract
Background
The purpose of this study was to characterize the outcomes of free gracilis muscle transfer for delayed smile reanimation after radical parotidectomy.
Methods
A retrospective chart review of patients who underwent free gracilis muscle transfer for smile reanimation after radical parotidectomy between 2003 and 2016 was performed. Patient-reported quality of life (Facial Clinimetric Evaluation Scale [FaCE]), physician-reported facial function ("eFACE" facial grading scale), and oral commissure excursion were compared preoperatively and postoperatively.
Results
Twelve patients were identified with prior surgery and adjuvant therapy (radiotherapy in 6 cases and chemoradiotherapy in 6 cases). Significant postoperative improvements were demonstrated for ipsilateral commissure excursion with smile (preoperatively: −2.2 mm [SD 2.3 mm] vs postoperatively: 7.9 mm [SD 2.5 mm]; P = .002), with meaningful smile achieved in 11 of 12 cases (91.7%). The average duration of facial paralysis before intervention was 72 months (range 12-204 months).
Conclusion
Free gracilis muscle transfer is an option for dynamic smile reanimation in select patients who have undergone treatment for advanced parotid malignancy.
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Intensity-modulated radiotherapy for elderly patients with nasopharyngeal carcinoma
Abstract
Background
The purpose of this study was to evaluate the clinical outcomes and patterns of failure after intensity-modulated radiotherapy (IMRT) for elderly patients with nasopharyngeal carcinoma (NPC).
Methods
Fifty-two patients treated with IMRT were eligible for study inclusion. Comorbidity was rated using the Adult Comorbidity Evaluation-27 (ACE-27) system.
Results
Twenty-six patients (50.0%) had an ACE-27 score of 1; and 6 (11.5%) had an ACE-27 score of 2. Eleven patients had died and 5 (45.5%) of them died of NPC. Two patients had developed local recurrence only, 1 had developed regional recurrence only, and 7 had developed distant metastasis only. The locoregional failure-free survival, distant failure-free survival, cancer-specific survival (CSS), and overall survival (OS) rates at 5 years were 92.6%, 83.7%, 84.9%, and 69.4%, respectively.
Conclusion
The results of treating elderly patients with NPC by IMRT were excellent. Distant metastasis remains the most difficult treatment challenge for elderly patients with NPC.
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Safety and effectiveness of endovascular embolization or stent-graft reconstruction for treatment of acute carotid blowout syndrome in patients with head and neck cancer: Case series and systematic review of observational studies
Abstract
Background
Indications for treatment and outcomes after endovascular management of carotid blowout syndrome for patients with head and neck cancer are not well defined. We investigated the safety and effectiveness of endovascular embolization and stent-graft reconstruction.
Methods
A literature review was performed for studies published between 2001 and 2015 with relevance to treatment outcomes. Our institutional database was examined to identify patients treated with endovascular techniques.
Results
A total of 266 patients were included. Rates of procedural stroke were higher after embolization of internal carotid artery (ICA)/common carotid artery (CCA) compared to stent graft (embolization 10.3%; stent graft 2.5%; P < .02). Stent graft of ICA/CCA was associated with higher rates of recurrent bleeding (embolization 9.1%; stent graft 31.9%; P < .01).
Conclusion
Both embolization and stent grafts are safe therapeutic options for acute carotid blowout syndrome. Embolization for ICA/CCA carotid blowout syndrome was associated with higher risks of procedural stroke and lower recurrent bleeding compared to stent grafts.
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Multiple Imputation for Incomplete Data in Epidemiologic Studies
Abstract
Epidemiologic studies are frequently susceptible to missing information. Omitting observations with missing variables remains a common strategy in epidemiologic studies, yet this simple approach can often severely bias parameter estimates of interest if the values are not missing completely at random. Even when missingness is completely random, complete case analysis can reduce efficiency of estimated parameters, because large amounts of available data are simply tossed out with the incomplete observations. Alternative methods to mitigate missing information, such as multiple imputation, are becoming an increasing popular strategy to retain all available information, reduce potential bias, and improve efficiency in parameter estimation. In this paper, we describe the theoretical underpinnings of multiple imputation, and we illustrate application of this method in a collaborative challenge to assess the performance of various techniques to dealing with missing data. We detail the steps necessary to perform multiple imputation on a subset of the Collaborative Perinatal Project, where the goal is to estimate the odds of spontaneous abortion associated with smoking during pregnancy.from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2hGk2z0
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Inverse Probability Weighted Estimation for Monotone and Nonmonotone Missing Data
Abstract
Missing data is of common occurrence in epidemiologic research. In this paper, three data sets with induced missing values from the Collaborative Perinatal Project, a multisite United States study conducted from 1959 to 1974, are provided as examples of prototypical epidemiologic studies with missing data. Our goal is to estimate the effect of maternal smoking behavior on spontaneous abortion while adjusting for numerous confounders. At the same time, we do not necessarily wish to evaluate the joint distribution among potentially unobserved covariates, which is seldom the subject of substantive scientific interest. The inverse probability weighting approach preserves the semiparametric structure of the underlying model of substantive interest, and clearly separates the model of substantive interest from the model used to account for the missing data. However, inverse probability weighting often will not result in valid inference if the missing data pattern is nonmonotone, even if the data are missing at random. We describe a recently proposed approach to model nonmonotone missing data mechanisms under missing at random for use to construct the weights in inverse probability weighted complete-case estimation, and we illustrate the approach in the three data sets described in the companion manuscript (Am J Epidemiol. 2017;000(0):000-000) of this issue of the journal.from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2zTq2yv
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Principled Approaches to Missing Data in Epidemiologic Studies
Abstract
Principled methods to appropriately analyze missing data have long existed; however, broad implementation of these methods remains challenging. In this and companion papers, we discuss issues of missing data in the epidemiologic literature. We provide details regarding missing data mechanisms and nomenclature and motivate principled analyses through a detailed comparison of multiple imputation and inverse probability weighting. We do so in the setting of a masked data-analytic challenge with missing data induced by known mechanisms to data from the Collaborative Perinatal Project, a multisite US study conducted from 1959 to 1974. We illustrate the deleterious effects of missing data with naïve methods and show how principled methods can sometimes mitigate such effects. For example when data were missing at random, naïve methods showed a spurious protective effect of smoking on spontaneous abortion, odds ratio (OR) of 0.43 (95% confidence interval, CI: 0.19, 0.93) while implementing principled methods multiple imputation (OR = 1.30, CI: 0.95, 1.77) or augmented inverse probability weighting (OR = 1.40, CI: 1.00, 1.97) provided estimates closer to the "true" full data effect (OR = 1.31, CI: 1.05, 1.64). We call for greater acknowledgement of and attention to missing data and for the broad use of principled missing data methods in epidemiologic research.from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2hF4XO0
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Dr. Donald E. Carpenter
He promised to love her forever, and he did. Beloved husband, father, and grandfather, Donald Elmore Carpenter passed from this world into the arms of Our Lord and his Magdalena in Heaven on October 30, 2017.
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US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity
US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity
US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity, Published online: 20 November 2017; doi:10.1038/ijo.2017.287
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Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling
Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling
Adipocytes sustain pancreatic cancer progression through a non-canonical WNT paracrine network inducing ROR2 nuclear shuttling, Published online: 20 November 2017; doi:10.1038/ijo.2017.285
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Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk
Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk
Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk, Published online: 20 November 2017; doi:10.1038/ijo.2017.289
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High fat diet consumption differentially affects adipose tissue inflammation and adipocyte size in obesity-prone and obesity-resistant rats
High fat diet consumption differentially affects adipose tissue inflammation and adipocyte size in obesity-prone and obesity-resistant rats
High fat diet consumption differentially affects adipose tissue inflammation and adipocyte size in obesity-prone and obesity-resistant rats, Published online: 20 November 2017; doi:10.1038/ijo.2017.280
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Association of plasma phospholipid polyunsaturated and trans fatty acids with body mass index: Results from the multi-ethnic study of atherosclerosis
Association of plasma phospholipid polyunsaturated and trans fatty acids with body mass index: Results from the multi-ethnic study of atherosclerosis
Association of plasma phospholipid polyunsaturated and <i>trans</i> fatty acids with body mass index: Results from the multi-ethnic study of atherosclerosis, Published online: 20 November 2017; doi:10.1038/ijo.2017.282
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Diet-resistant obesity is characterized by a distinct plasma proteomic signature and impaired muscle fiber metabolism
Diet-resistant obesity is characterized by a distinct plasma proteomic signature and impaired muscle fiber metabolism
Diet-resistant obesity is characterized by a distinct plasma proteomic signature and impaired muscle fiber metabolism, Published online: 20 November 2017; doi:10.1038/ijo.2017.286
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Gene expression profiles indicate tissue-specific obesity regulation changes and strong obesity relevant tissues
Gene expression profiles indicate tissue-specific obesity regulation changes and strong obesity relevant tissues
Gene expression profiles indicate tissue-specific obesity regulation changes and strong obesity relevant tissues, Published online: 20 November 2017; doi:10.1038/ijo.2017.283
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Owandy Radiology’s I-Max 2D Wall-Mounted, Panoramic Digital Radiography Unit Receives FDA 510 (k) Clearance
The Lightest, Smallest and Most Comprehensive Panoramic System on the Market Will be Featured During GNYDM
Owandy Radiology Inc., a global leader in the manufacture of dental radiology hardware and imaging software recently received FDA 510 (k) Clearance for its game-changing I-Max 2-D wall-mounted panoramic digital radiography unit. The company will be showcasing the I-Max 2D during the upcoming Greater New York Dental Meeting in booth #4419.
According to Owandy Radiology spokesperson Boris Loyez, "We did a complete re-thinking of what a panoramic unit of the future should be, and came up with the
I-Max wall-mounted concept, which is setting the pace in tomorrow's pan units."
The I-Max 2D provides the perfect balance of value and functionality. For example:
- The lightest wall-mounted digital panoramic unit on the market comes fully-assembled and can be easily installed in tight, previously underutilized spaces.
- Automatic Layers Integration System (ALI-S) ensures exceptional image quality and automatically selects the best images.
- 24 programs (including adult and child versions) enable a full range of examinations required by today's dental practice.
- Includes an intuitive, user-friendly program interface.
According to Owandy company spokesperson Boris Loyez, "We're excited about receiving FDA clearance and look forward to demonstrating the affordable, high-performance I-Max 2D during the Greater New York Dental Meeting."
Since GNYDM is the final major dental meeting of the year, this may be the last chance for dental practice owners to take advantage of the Section 179 tax deduction when they purchase any Owandy Radiology unit. Owandy is also offering the following promotions:
- Free Apple Watch Series 3 with the purchase of any Owandy I-Max or I-Max Touch 2D.
- Free iPhone X with the purchase of any Owandy 3D unit
For more information about the I-Max 2-D wall-mounted panoramic digital radiography unit, visit www.Owandy.com , call 203-745-0575 or e-mail at Sales@OwandyUs.com. Dealer and distributor inquiries welcome.
About Owandy Radiology, Inc.:
Headquartered in Croissy-Beaubourg France, and serving North America from Middlebury, Connecticut, Owandy Radiology is a global leader in the manufacture of dental radiology hardware and imaging software. A wide range of Owandy's digital radiology solutions are used by dentists in 50 countries, on every continent.
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Enjoy a canine cuddle during your teeth treatment
There's nothing particularly pleasant about a teeth cleaning, but one dental hygienist just outside St. John's is trying to make the experience a little more enjoyable - with the help of a four-legged friend. Unlike a dentist, Nicole Kielly doesn't drill or fill; she scrapes and pokes.
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Κυριακή 19 Νοεμβρίου 2017
Denture hygiene practices
25 studies were included in this review of denture hygiene practices. Mechanical interventions in conjunction with chemical agents were the most effective, Denture brushing was the most common patient practice.
The post Denture hygiene practices appeared first on National Elf Service.
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Blood lipid genetic scores, the HMGCR gene and cancer risk: a Mendelian randomization study
Abstract
Background
It is unclear whether there are causal associations between blood lipids, statin use and cancer risks. Under certain assumptions, Mendelian randomization analysis of a genetic marker for an exposure eliminates reverse causation and confounding. Methods
We applied Mendelian randomization analysis to genetic scores, comprising 26–41 single-nucleotide polymorphisms (SNPs), as instrumental variables (IVs) for triglycerides and low- and high-density lipoprotein cholesterol (LDLC, HDLC), using a prospective cohort of 26 904 individuals in which there were 6607 incident cancers. We also investigated cancer risk for a SNP (rs12916) in the gene encoding hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), the targeted enzyme in statin treatment. We used logistic regression and SNP pleiotropy-adjusted analyses to estimate the odds ratio per standard deviation (OR). Results
The OR for the triglyceride IV as a predictor of any cancer was 0.91 [95% confidence interval (CI): 0.80–1.03] unadjusted, and 0.87 (95% CI: 0.78–0.95) from the pleiotropy-adjusted analysis. For the HMGCR rs12916 per LDLC-lowering T-allele, the OR was 1.09 (95% CI: 1.01–1.18) for prostate cancer and 0.89 (95% CI: 0.82–0.96) for breast cancer. The LDLC IV was not associated with prostate cancer or breast cancer. There were no associations between IVs and cancers of the lung, colon or bladder. Conclusions
Under the assumptions of Mendelian randomization, there is a causal and negative association between serum triglycerides and risk of any cancer. Further, the HMGCR genetic variant might be associated with risks of prostate and breast cancers but the biological mechanisms behind these findings are unclear, as the LDLC IV was not associated with these cancers.from ! ORL Sfakianakis via paythelady.61 on Inoreader http://ift.tt/2zRrphk
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First bite syndrome following transcervical arterial ligation after transoral robotic surgery
Objective
To assess the incidence of first bite syndrome (FBS) in transoral robotic surgical (TORS) patients undergoing transcervical arterial ligation.
Methods
Retrospective case series of all patients diagnosed with FBS following prophylactic transcervical arterial ligation of branches of the external carotid system between March 2010 and December 2016 at a single academic center.
Results
Six patients with FBS after TORS with transcervical arterial ligation were evaluated, representing 7% of all patients who underwent neck dissection with concomitant transcervical arterial ligation (6 of 83). Median presentation of FBS was 63 days, with an average duration of 66 days. Treatment ranged from observation to botulinum toxin injection.
Conclusion
Patients who undergo transcervical arterial ligation to minimize bleeding complications following TORS are at risk of developing first bite syndrome.
Level of Evidence
4. Laryngoscope, 2017
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The hospital otolaryngologist: The louisiana state university experience
Objectives/Hypothesis
To describe the implementation and impact of a hospital otolaryngologist in an academic medical center setting. Our hypothesis was that the hospital otolaryngologist would increase productivity of the Louisiana State University (LSU) faculty otolaryngologists and provide more timely access to inpatient otolaryngology services.
Study Design
Retrospective clinical and administrative database review.
Methods
A comparative database review was performed with data from the year predating the initiation of the hospitalist program (2013) to the first full year after initiation of the program (2014). A clinical database review including diagnoses and procedures was also performed.
Results
Overall outpatient clinic relative value units for the aggregated LSU faculty increased 16% (despite the fact that the direct outpatient contribution of the hospital otolaryngologist was negligible). Overall capture of inpatient consult codes increased 128%. The hospital otolaryngologist was responsible for 84.5% of inpatient consult codes. There was a 100% increase in outpatient consult codes for the LSU faculty, of which <1% was attributed to the otolaryngology hospitalist. No significant impact was seen on length of stay over the study interval. Clinical database review of the first 2 years of the program showed 3,707 total encounters with postoperative encounters the most common. Four hundred fifty-four inpatient procedures were logged. The most common surgical procedure was tracheostomy.
Conclusions
The otolaryngology hospitalist program is a viable clinical and economic model.
Level of Evidence
NA Laryngoscope, 2017
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Hirano's cover–body model and its unique laryngeal postures revisited
Objectives/Hypothesis
In 1974, Minoru Hirano proposed his theory of voice production that is now known as the cover–body theory. He described the thyroarytenoid (TA) and cricothyroid (CT) muscles as the major determinants of vocal fold shape and stiffness, and theorized four typical laryngeal configurations resulting from unique TA/CT activations, with implications for the resulting voice quality. In this study, we directly observed the vocal fold medial surface shape under Hirano's unique TA/CT activation conditions to obtain a three-dimensional (3D) understanding of these laryngeal configurations during muscle activation.
Study Design
In vivo canine hemilarynx model.
Methods
Flesh points were marked along the medial surface of the vocal fold. Selective TA and CT activation were performed via respective laryngeal nerves. 3D reconstructions of the vocal fold medial surface were derived using digital image correlation.
Results
Low level TA and CT activation yielded anteroposterior lengthening and vertical thinning of the vocal fold. When TA activation is far greater than CT, the vocal fold shortens and thickens. With slightly greater TA than CT, activation the vocal length is maintained on average, whereas its vertical thickness decreases. With CT far greater than TA activation, the vocal fold lengthens and thins. In all conditions, glottal contour changes remained minimal.
Conclusions
Analysis of the 3D geometry of the vocal fold medial surface under Hirano's four typical laryngeal configurations revealed that the key geometric changes during TA/CT interactions lie within the anteroposterior length and the vertical thickness of the vocal fold.
Level of Evidence
NA Laryngoscope, 2017
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The national landscape of unplanned 30-day readmissions after total laryngectomy
Objectives/Hypothesis
Examine rates of readmission after total laryngectomy and determine primary etiologies, timing, and risk factors for unplanned readmission.
Study Design
Retrospective cohort study.
Methods
The Nationwide Readmissions Database was queried for patients who underwent total laryngectomy between January 2013 and November 2013. Patient-, procedure-, admission-, and institution-level characteristics were compared for patients with and without unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission.
Results
There were 2,931 total laryngectomies performed in 2013 with an unplanned readmission rate of 17.5%. Postoperative fistula accounted for 13.7% of readmissions. The odds of readmission were elevated for patients undergoing concurrent procedures, including primary tracheoesophageal fistulization (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.15-5.18, P = .02) and/or pedicle graft or flap procedures (aOR: 1.73, 95% CI: 1.13-2.66, P = .01). Additionally, patients with comorbid coagulopathy (aOR: 3.04, 95% CI: 1.13-8.22, P = .03), liver disease (aOR: 2.48, 95% CI: 1.08-5.71, P = .03), and valvular heart disease (aOR: 3.18, 95% CI: 1.20-8.41, P = .02) had increased risk for unplanned 30-day readmission. Private insurance and longer lengths of stay were associated with decreased odds of readmission.
Conclusions
Nearly one-fifth of total laryngectomy patients are readmitted to the hospital within 30 days of discharge. Risk factors identified in this nationally representative cohort should be carefully considered during the postoperative period to reduce preventable readmissions after total laryngectomy.
Level of Evidence
2c Laryngoscope, 2017
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Effect of topical nasal anesthetic on swallowing in healthy adults: A double-blind, high-resolution manometry study
Objective
Topical nasal anesthetic (TNA) is used when evaluating pharyngeal swallowing with high-resolution manometry (HRM). It is unclear if desensitizing the nasal mucosa improves procedure tolerability or affects pharyngeal pressure. This study evaluated the effects of TNA on comfort and pharyngeal pressure using HRM.
Methods
A double-blinded study was conducted with 20 healthy participants ( 
Results
VAS ratings were similar under placebo (mean = 38.4, standard deviation [SD] = 19.92) and TNA conditions (mean = 33.78, SD = 18.9), with no significant differences between placebo and anesthetized conditions (t[19] = 1.23, P = 0.23) or tolerability at first and second procedure (t[19] = 1.38, P = 0.18). Lower maximum and mean pharyngeal pressure were found for the TNA condition when compared to placebo (dry: maximum [−15.45 mmHg, standard error (SE) = 5.06 mmHg, P = 0.021]; mean [−5.22 mmHg, SE = 1.58 mmHg, P = 0.005]), and (liquid: maximum [−14.79 mmHg, SE = 5.01 mmHg, P = 0.010]; mean [−2.79 mmHg, SE = 1.99 mmHg, P = 0.008]).
Conclusion
This double-blind, randomized study is the first to investigate effects of TNA on tolerability and pharyngeal pressure using HRM. Results indicate TNA offered no significant difference in procedure comfort while affecting the magnitude of pharyngeal swallowing.
Level of Evidence
4. Laryngoscope, 2017
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Healthcare disparities in pediatric otolaryngology: A systematic review
Objectives
Multiple studies have reported healthcare disparities in particular settings and conditions within pediatric otolaryngology, but a systematic examination of the breadth of the problem within the field is lacking. This study's objectives are to synthesize the available evidence regarding healthcare disparities in pediatric otolaryngology, highlight recurrent themes with respect to etiologies and manifestations, and demonstrate potential impacts from patient and provider standpoints.
Methods
A qualitative systematic review of the PubMed, Ovid, and Cochrane databases for articles focusing on racial, ethnic, or socioeconomic disparities related to pediatric otolaryngology conditions or settings was conducted. United States-based studies of any design or publication date with analysis of children 0 to 18 years old were included.
Results
Of 711 abstracts identified, 39 met inclusion criteria. Manual review of references from these articles yielded 22 additional studies, for a total of 61. Disparities were identified in nearly every subspecialty within pediatric otolaryngology, with otologic conditions the most frequently studied (33 of 61). The most commonly cited disparities involved low socioeconomic status (25 of 61), inadequate insurance (23 of 61), nonwhite race (21 of 61), and barriers to accessing care (21 of 61). Only six articles found no disparities regarding the condition examined in their study.
Conclusion
Through a variety of study topics, designs, and settings, a growing body of literature documents disparities across the spectrum of pediatric otolaryngology care. The etiologies and manifestations of such disparities are myriad. This evidence suggests the need for interventions to address these disparities at various professional and institutional levels, ideally with methodological rigor to assess the effectiveness of such interventions. Laryngoscope, 2017
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Comparison of pediatric adenoidectomy techniques
Objectives
Evaluate the effects of electrocautery, microdebrider, and coblation techniques on outpatient pediatric adenoidectomy costs and complications.
Study Design
Observational retrospective cohort study.
Methods
An observational cohort study was performed in a multihospital network using a standardized accounting system. Children < 18 years of age who underwent outpatient adenoidectomy were included from January 2008 to September 2015. Cases with additional procedures were excluded. The cohorts were divided into children who underwent electrocautery, microdebrider, or coblator adenoidectomy. Data regarding costs, postoperative complications, and revision surgeries were analyzed.
Results
A total of 1,065 cases of adenoidectomy were performed with electrocautery (34.9%), microdebrider (26.1%), and coblation (39.0%). There was an increased after direct cost associated with the microdebrider, $833 (standard deviation [SD] $363) and the coblator, $797 (SD $262) compared to the electrocautery, $597 (SD $361) (P < 0.0001). There was a greater overall operating room (OR) time associated with use of the microdebrider (mean 28.7, SD 11.0 minutes) compared with both the electrocautery (mean 24.7, SD 8.1 minutes) and coblator (mean 26.2, SD 9.8 minutes) (P < 0.0001). No significant difference was found with regard to complication rates. The incidence of repeat adenoidectomies was significantly greater for microdebrider (9.7%) compared to electrocautery (2.7%; P = 0.0002) and coblator (5.3%; P = 0.0336) techniques.
Conclusion
These results suggest that adenoidectomy with electrocautery is significantly less expensive than microdebrider and coblator, with no differences in complication rates or surgical times among the techniques. Microdebrider adenoidectomy was associated with a longer overall OR time and a higher rate of adenoid regrowth, requiring revision surgery.
Level of Evidence
4. Laryngoscope, 2017
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Impact of an oral appliance on obstructive sleep apnea severity, quality of life, and biomarkers
Objective/Hypothesis
To investigate outcomes including efficacy, quality of life, and levels of inflammatory markers of a mandibular advancement device (MAD) for moderate-to-severe obstructive sleep apnea (OSA).
Study Design
Case-control study.
Methods
Patients with apnea-hypopnea index (AHI) ≥ 15/hr who only accepted MAD therapy (study group) or who refused any treatment (control group) were recruited. At baseline and at 6 months, polysomnography, Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), C-reactive protein (CRP), interleukin 1β, interleukin 6, and tumor necrosis factor α (TNF-α) were assessed in both groups.
Results
At baseline, the study group (n = 30) showed a higher percentage of rapid eye movement sleep and higher CRP levels (P < .05) than the control group (n = 10). At 6 months, the MAD significantly improved AHI and lowest oxygen saturation (P < .01), non–rapid eye movement (N)1 and N3 sleep stages (P < .05), ESS score (P < .05), FOSQ total score (P < .01), interleukin 1β (P < .05), and TNF-α (P < .01) compared with the untreated group. In the overall, moderate, and severe OSA groups, 63.3%, 75%, and 50%, respectively, achieved at least good response.
Conclusions
Use of a MAD significantly improved polysomnographic parameters, quality of life, and some inflammatory markers (CRP, IL-β, and TNF-α) in a significant proportion of patients with moderate OSA and in some patients with severe OSA. Hence, a MAD may be a viable alternative therapy in patients with moderate-to-severe OSA who refuse continuous positive airway pressure.
Level of Evidence
3b Laryngoscope, 2017
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Referral patterns from emergency department to otolaryngology clinic
Objectives/Hypothesis
Patients who present to the emergency department (ED) with various otolaryngologic disorders are frequently referred to an otolaryngologist for follow-up care. Our aim was to further characterize this group as it has not been well described in the literature.
Study Design
Cross-sectional retrospective study.
Methods
We reviewed the charts of patients seen during an 18-month period in an urban public hospital trauma center adult ED and referred to an otolaryngology clinic for follow-up care.
Results
Seven hundred thirty-eight patients were seen and referred; the most common diagnoses made by ED providers were peripheral vertigo (12%), otitis externa (8%), and nasal fractures (8%). Nine percent of patients were evaluated during their ED visit by an otolaryngology provider. Three hundred seventy-two (50%) patients returned for their otolaryngology clinic visit; facial trauma patients were least likely to return. The most common diagnoses made by otolaryngology providers were otitis externa (12%), peripheral vertigo (12%), and nasal fractures (7%). There was 50% concordance between patients' diagnoses made by ED and otolaryngology providers. The most common differences were otitis media versus otitis externa (10%) and acute pharyngitis versus laryngopharyngeal reflux (8%). During 37% of follow-up visits, an in-office procedure was performed, most commonly flexible fiberoptic laryngoscopy, cerumen removal, and nasal endoscopy.
Conclusions
Our analysis reports comprehensive characteristics of this referral group, identifying potential areas for improvement in patient management, resident education and efficiency. Otolaryngologists covering EDs should be familiar with this population in terms of types of cases that may affect their practices.
Level of Evidence
4. Laryngoscope, 2017
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World's most expensive sex robot REVEALED: Adult star behind doll confesses KINKY fetishes
The 31-year-old Japanese-American actress has scooped many honours including AVN's "Performer of the Year" award in 2013. 31-year-old porn star Asa Akira has starred in over 500 porn films.
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Left frontoparietal network activity is modulated by drug stimuli in cocaine addiction
Abstract
Cocaine addicts present reduced activity in the left frontoparietal network, a brain network associated with cognitive control, during the processing of non-drug reward related stimuli (Costumero et al., Addiction Biology 22:479–489, 2015). However, the involvement of this network in drug-related stimuli processing remains unclear. Here, fifteen cocaine-dependent men and fifteen healthy matched controls viewed cocaine-related, erotic, aversive, and neutral pictures during an fMRI session. Group independent component analysis was then performed to investigate how functional networks were modulated by the different emotional images. The results showed that the cocaine-dependent group showed stronger left frontoparietal network activity during the processing of cocaine-related pictures than the control group. Furthermore, the activity of this network during cocaine image processing was positively associated with the years of cocaine use in addicted subjects. In conclusion, our results indicate that the left frontoparietal network is affected in cocaine-dependent men, and may be related to the cognitive control deficits shown in addiction.
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Comings and Goings: Dentist fills niche with bike bus
Downtown Davis dentist James Meinert owns Davis Pedals. Though the business is listed under his office address of 604 Third St., the bus will operate from a garage adjacent to the D Street Steakhouse , 113 D St. He plans pub tours, progressive dinners and wine-tasting tours, he said.
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Prognostic impact of gene mutations in myelodysplastic syndromes with ring sideroblasts
Prognostic impact of gene mutations in myelodysplastic syndromes with ring sideroblasts
Prognostic impact of gene mutations in myelodysplastic syndromes with ring sideroblasts, Published online: 20 November 2017; doi:10.1038/s41408-017-0016-9
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Head to Head Survey: Presbia PLC
Presbia PLC and Sirona Dental Systems are both advanced medical equipment & technology - nec companies, but which is the superior stock? We will contrast the two companies based on the strength of their earnings, profitability, analyst recommendations, dividends, risk, valuation and institutional ownership. Presbia PLC presently has a consensus price target of $11.33, suggesting a potential upside of 226.61%.
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Dentist doing his bit in Tonga
Jacob Grieve, along with his three children and wife Justine, were part of a group of 30 Kiwis who went to Tonga in September to support medical needs. Dr Grieve, lead dentist at Lumino Knox Dental and Lumino Pitt St, said although dentists in Tonga were trying their best to meet the needs of thepeople, there was room for improvement.
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Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single-center experience
Abstract
Background
Bloodstream infections (BSI) represent an important source of morbidity and mortality, as well as an increasing therapeutic challenge, among solid organ transplant recipients. Understanding the epidemiological and microbiological characteristics of BSI following renal transplantation is paramount to the implementation of appropriate preventative and therapeutic measures.
Methods
We conducted a retrospective review of all BSI episodes occurring between July 2009 and April 2016 in adult patients, who received a renal transplant at Royal Free London hospital.
Results
A total of 116 episodes of BSI occurred in 87 patients, 43 (49.4%) of them men. The mean age at BSI was 54.37±12.81 years. Late-onset BSI (> 12 months post transplant) represented 55.2%, with the median time to BSI being 16.28 month. A total of 67 patients had a single BSI, and 20 had recurrent episodes. Enterobacteriaceae were responsible for 73.7% of BSI, with Escherichia coli the commonest causative organism (46.6%). The urinary tract was the most frequent source of infection in 56.9%. Among the E. coli infections, 100% of the tested isolates were sensitive to meropenem, ertapenem, tigecycline, and fosfomycin, and >90% were sensitive to piperacillin-tazobactam, amikacin, and colistin. Lower susceptibility rates were encountered for ceftriaxone (70.6%), amoxicillin clavulanic acid (48.1%), cotrimoxazole (40.4%), trimethoprim (37.3%), and amoxicillin (21.6%). During BSI episodes, the median serum creatinine increased from a reference value of 131 μmol/L to a peak of 219 μmol/L. Acute kidney injury (AKI) complicated 75/116 BSI episodes (64.7%) – stage 1: 34, stage 2: 31, and stage 3 AKI: 10 episodes. After 3 months, the median creatinine remained elevated at 146 μmol/L. The 3-month mortality rate was 8% (7/87), and the death-censored graft loss was 6.9% (6/87). No significant difference was seen between BSI of urinary and non-urinary sources in the incidence of AKI (X2 = 0.24, P = 0.6) or the percentage of creatinine change between baseline and peak and 3-month creatinines (P = 0.2 and 0.7 respectively).
Conclusions
Urinary tract infection remains the commonest source of systemic infection among kidney transplant recipients and resistance to commonly used frontline antibiotics is common; thus, prevention and early detection are paramount. The appropriate choice of initial empirical antibiotic is vital to improve the outcome. Each unit needs to understand the epidemiology of organisms causing BSI in their transplant patients and their antibiotic susceptibilities.
This article is protected by copyright. All rights reserved.
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This simple trick will make your teeth whiter
Everyone wants a better smile. In fact, according to a recent study , nearly 60 percent of Americans would opt to have better teeth than better skin.
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Gene expression profile changes in the jejunum of weaned piglets after oral administration of Lactobacillus or an antibiotic.
| Related Articles |
Gene expression profile changes in the jejunum of weaned piglets after oral administration of Lactobacillus or an antibiotic.
Sci Rep. 2017 Nov 17;7(1):15816
Authors: Zhang D, Shang T, Huang Y, Wang S, Liu H, Wang J, Wang Y, Ji H, Zhang R
Abstract
The small intestine plays an essential role in the health and well-being of animals. Previous studies have shown that Lactobacillus has a protective effect on intestinal morphology, intestinal epithelium integrity and appropriate maturation of gut-associated tissues. Here, gene expression in jejunum tissue of weaned piglets was investigated by RNA-seq analysis after administration of sterile saline, Lactobacillus reuteri, or an antibiotic (chlortetracycline). In total, 401 and 293 genes were significantly regulated by chlortetracycline and L. reuteri, respectively, compared with control treatment. Notably, the HP, NOX1 and GPX2 genes were significantly up-regulated in the L. reuteri group compared with control, which is related to the antioxidant ability of this strain. In addition, the expression of genes related to arachidonic acid metabolism and linoleic acid metabolism enriched after treatment with L. reuteri. The fatty acid composition in the jejunum and colon was examined by GC-MS analysis and suggested that the MUFA C18:1n9c, and PUFAs C18:2n6c and C20:4n6 were increased in the L. reuteri group, verifying the GO enrichment and KEGG pathway analyses of the RNA-seq results. The results contribute to our understanding of the probiotic activity of this strain and its application in pig production.
PMID: 29150660 [PubMed - in process]
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Trang women arrested for alleged unlicensed dentistry
Police, health officials and military personnel arrested a woman on Saturday for allegedly operating an illegal dental clinic disguised as a grocery in Muang district, Trang province. The woman, identified as Payom "Jeh Lek" Jaiyai, 51, reportedly told officials that she had learned orthodontic treatments including installing dental braces on the Internet and operated the clinic for five years.
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