Medicine by Alexandros G. Sfakianakis: 10/18/18

Πέμπτη 18 Οκτωβρίου 2018

In utero development of epidermolysis bullosa acquisita

Pediatric Dermatology, EarlyView.

Treatment of pediatric alopecia areata with anthralin: A retrospective study of 37 patients

Pediatric Dermatology, EarlyView.

Prospective Multicenter Study of Changes in MTT after Aneurysmal SAH and Relationship to Delayed Cerebral Ischemia in Patients with Good- and Poor-Grade Admission Status [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Patients with aneurysmal SAH and good clinical status at admission are considered at a lower risk for delayed cerebral ischemia. Prolonged MTT may be associated with an increased risk. It is unclear whether this is dependent on clinical status. Our purpose was to determine whether increased MTT within 3 days of aneurysmal SAH compared with baseline is associated with a higher risk of delayed cerebral ischemia in patients with good (World Federation of Neurosurgical Societies I–III) versus poor (World Federation of Neurosurgical Societies IV–V) admission status.

MATERIALS AND METHODS:

This prolonged MTT was a multicenter, prospective cohort investigation of 87 patients with aneurysmal SAH. MTT was measured at admission before aneurysm treatment (MTT1) and following repair (MTT2) within 3 days of admission; MTT_diff was calculated as the difference between MTT2 and MTT1. Changes in MTT across time were assessed with repeated measures analyses. Risk of delayed cerebral ischemia or death was determined with multivariate logistic regression analysis.

RESULTS:

In patients with a good grade (n = 49), MTT was prolonged in patients who developed delayed cerebral ischemia, with MTT_diff significantly greater (0.82 ± 1.5) compared with those who did not develop delayed cerebral ischemia (–0.14 ± 0.98) (P = .03). Prolonged MTT was associated with a significantly higher risk of delayed cerebral ischemia or death (OR = 3.1; 95% CI, 1.3–7.4; P = .014) on multivariate analysis. In patients with poor grades (n = 38), MTT_diff was not greater in patients who developed delayed cerebral ischemia; MTT1 was significantly prolonged compared with patients with a good grade.

CONCLUSIONS:

Patients in good clinical condition following aneurysmal SAH but with increasing MTT in the first few days after aneurysmal SAH are at high risk of delayed cerebral ischemia and warrant close clinical monitoring.

The Central Vein: FLAIR Signal Abnormalities Associated with Developmental Venous Anomalies in Patients with Multiple Sclerosis [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Demyelination is a recently recognized cause of FLAIR hyperintensities associated with developmental venous anomalies. Our purpose was to quantify the prevalence of white matter signal abnormalities associated with developmental venous anomalies in patients with multiple sclerosis compared with controls.

MATERIALS AND METHODS:

A retrospective, blinded, multireader study compared the prevalence of FLAIR hyperintense signal abnormalities adjacent to developmental venous anomalies in patients with MS compared with controls (patients with developmental venous anomalies without MS). Study findings were positive if a central vein was demonstrated using FLAIR and contrast-enhanced fat-saturated T1 sequences. Imaging parameters also included developmental venous anomaly location, developmental venous anomaly drainage, white matter lesion size, and depth of white matter lesions. Clinical parameters included age, sex, and the presence of confounding variables (hypertension, diabetes, migraines, and/or vasculopathy).

RESULTS:

FLAIR signal abnormality was present around 47.3% (35/74) of developmental venous anomalies in patients with MS, and 13.5% (10/74) of developmental venous anomalies in the control group (P < .001). The multivariate logistic regression model controlling for covariates (including migraines, hypertension, diabetes mellitus, vasculopathy, age, sex, and drainage direction of developmental venous anomalies) showed that the odds of FLAIR hyperintensity around developmental venous anomalies was 6.7-fold higher in patients with MS (relative risk MS = 6.68; 95% CI, 2.79–15.97; P < .001).

CONCLUSIONS:

The association of developmental venous anomalies and FLAIR hyperintensities was more common in patients with MS, which suggests that the underlying demyelinating pathologic process of MS may be the cause of this propensity in patients with MS. Impaired venous drainage in the territory of developmental venous anomalies may predispose to development of these lesions, and an associated central vein is helpful in understanding an atypical location of MS plaques.

Outcomes of Stent Retriever versus Aspiration-First Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis [INTERVENTIONAL]

BACKGROUND:

There is ongoing debate regarding the optimal first-line thrombectomy technique for large-vessel occlusion.

PURPOSE:

We performed a systematic review and meta-analysis of comparative studies on stent retriever–first and aspiration-first thrombectomy.

DATA SOURCES:

We searched Ovid MEDLINE, PubMed, and EMBASE from 2009 to February 2018.

STUDY SELECTION:

Two reviewers independently selected the studies. The primary end point was successful reperfusion (TICI 2b/3).

DATA ANALYSIS:

Random-effects meta-analysis was used for analysis.

DATA SYNTHESIS:

Eighteen studies including 2893 patients were included. There was no significant difference in the rate of final successful reperfusion (83.9% versus 83.3%; OR = 0.87; 95% CI, 0.62%–1.27%) or good functional outcome (mRS 0–2) at 90 days (OR = 1.07; 95% CI, 0.80–1.44) between the stent-retriever thrombectomy and aspiration groups. The stent-retriever thrombectomy–first group achieved a statistically significant higher TICI 2b/3 rate after the first-line device than the aspiration-first group (74.9% versus 66.4%; OR = 1.53; 95% CI, 1.14%–2.05%) and resulted in lower use of a rescue device (19.9% versus 32.5%; OR = 0.36; 95% CI, 0.14%–0.90%). The aspiration-first approach resulted in a statistically shorter groin-to-reperfusion time (weighted mean difference, 7.15 minutes; 95% CI, 1.63–12.67 minutes). There was no difference in the number of passes, symptomatic intracerebral hemorrhage, vessel dissection or perforation, and mortality between groups.

LIMITATIONS:

Most of the included studies were nonrandomized. There was significant heterogeneity in some of the outcome variables.

CONCLUSIONS:

Stent-retriever thrombectomy–first and aspiration-first thrombectomy were associated with comparable final reperfusion rates and functional outcome. Stent-retriever thrombectomy was superior in achieving reperfusion as a stand-alone first-line technique, with lower use of rescue devices but a longer groin-to-reperfusion time.

Aberrant Structural Brain Connectivity in Adolescents with Attentional Problems Who Were Born Prematurely [PEDIATRICS]

BACKGROUND AND PURPOSE:

Differences in structural brain connectivity that underlie inattention have been previously investigated in adolescents with attention deficit/hyperactivity disorder, but not in the context of premature birth, which is often associated with attentional problems. The purpose of this study was to identify the neural correlates of attentional problems in adolescents born prematurely and determine neonatal predictors of those neural correlates and attention problems.

MATERIALS AND METHODS:

The study included 24 adolescents (12.5 ± 1.8 years of age; 12 girls, 12 boys) who were born prematurely and underwent MR imaging of the brain and cognitive assessment, both shortly after birth and as adolescents. Structural connectivity was assessed at adolescence using diffusion tensor imaging and tractography.

RESULTS:

Of the 24 subjects, 12 had attention deficits. A set of axonal pathways connecting the frontal, parietal, temporal, and occipital lobes had significantly lower fractional anisotropy in subjects with attentional problems. The temporoparietal connection between the left precuneus and left middle temporal gyrus was the most significantly underconnected interlobar axonal pathway. Low birth weight and ventriculomegaly, but not white matter injury or intraventricular hemorrhage on neonatal MR imaging, predicted temporoparietal hypoconnectivity in adolescence. However, neither birth weight nor other neonatal characteristics were associated with attention deficits directly.

CONCLUSIONS:

We identified an aberrant structural brain connectivity pattern, involving temporoparietal hypoconnectivity, in prematurely born adolescents with attentional problems. We also identified birth weight as a potential neonatal predictor of the temporoparietal hypoconnectivity. These findings add to our understanding of the neural basis and etiology of inattention in adolescents after premature birth.

Systematic Assessment of Multispectral Voxel-Based Morphometry in Previously MRI-Negative Focal Epilepsy [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Voxel-based morphometry is widely used for detecting gray matter abnormalities in epilepsy. However, its performance with changing parameters, smoothing and statistical threshold, is debatable. More important, the potential yield of combining multiple MR imaging contrasts (multispectral voxel-based morphometry) is still unclear. Our aim was to objectify smoothing and statistical cutoffs and systematically compare the performance of multispectral voxel-based morphometry with existing T1 voxel-based morphometry in patients with focal epilepsy and previously negative MRI.

MATERIALS AND METHODS:

3D T1-, T2-, and T2-weighted FLAIR scans were acquired for 62 healthy volunteers and 13 patients with MR imaging negative for focal epilepsy on a Magnetom Skyra 3T scanner with an isotropic resolution of 0.9 mm³. We systematically optimized the main voxel-based morphometry parameters, smoothing level and statistical cutoff, with T1 voxel-based morphometry as a reference. As a next step, the performance of multispectral voxel-based morphometry models, T1+T2, T1+FLAIR, and T1+T2+FLAIR, was compared with that of T1 voxel-based morphometry using gray matter concentration and gray matter volume analysis.

RESULTS:

We found the best performance of T1 at 12 mm and a T-threshold (statistical cutoff) of 3.7 for gray matter concentration analysis. When we incorporated these parameters, after expert visual interpretation of concordant and discordant findings, we identified T1+FLAIR as the best model with a concordant rate of 46.2% and a concordant rate/discordant rate of 1.20 compared with T1 with 30.8% and 0.67, respectively. Visual interpretation of voxel-based morphometry findings decreased concordant rates from 38.5%–46.2% to 15.4%–46.2% and discordant rates from 53.8%–84.6% to 30.8%–46.2% and increased specificity across models from 33.9%–40.3% to 46.8%–54.8%.

CONCLUSIONS:

Multispectral voxel-based morphometry, especially T1+FLAIR, can yield superior results over single-channel T1 in focal epilepsy patients with a negative conventional MR imaging.

MR Imaging in Meniere Disease: Is the Contact between the Vestibular Endolymphatic Space and the Oval Window a Reliable Biomarker? [HEAD & NECK]

BACKGROUND AND PURPOSE:

No reliable MR imaging marker for the diagnosis of Menière disease has been reported. Our aim was to investigate whether the obliteration of the inferior portion of the vestibule and the contact with the stapes footplate by the vestibular endolymphatic space are reliable MR imaging markers in the diagnosis of Menière disease.

MATERIALS AND METHODS:

We retrospectively enrolled 49 patients, 24 affected by unilateral sudden hearing loss and 25 affected by definite Menière disease, who had undergone a 4-hour delayed 3D-FLAIR sequence. Two readers analyzed the MR images investigating whether the vestibular endolymphatic space bulged in the third inferior portion of the vestibule contacting the stapes footplate. This sign was defined as the vestibular endolymphatic space contacting the oval window.

RESULTS:

We analyzed 98 ears: 27 affected by Menière disease, 24 affected by sudden sensorineural hearing loss, and 47 that were healthy. The vestibular endolymphatic space contacting the oval window showed an almost perfect interobserver agreement (Cohen = 0.87; 95% CI, 0.69–1). The vestibular endolymphatic space contacting oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 88%, and negative predictive value = 93% in differentiating Menière disease ears from other ears. The vestibular endolymphatic space contacting the oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 96%, negative predictive value = 82% in differentiating Menière disease ears from sudden sensorineural hearing loss ears.

CONCLUSIONS:

The vestibular endolymphatic space contacting the oval window has high specificity and positive predictive value in differentiating Menière disease ears from other ears, thus resulting in a valid tool for ruling in Menière disease in patients with mimicking symptoms.

Spinal Epidural Arteriovenous Fistula with Perimedullary Venous Reflux: Clinical and Neuroradiologic Features of an Underestimated Vascular Disorder [SPINE]

BACKGROUND AND PURPOSE:

The purpose of this study was to discuss the clinical and radiologic characteristics of spinal epidural arteriovenous fistulas (SEAVF) and demonstrate their specific angiomorphology in a single-center series.

MATERIALS AND METHODS:

Thirteen consecutive patients were diagnosed with SEAVF at RWTH Aachen University Hospital between 2006 and 2018 and were included in this study. All patients had MR imaging and DSA before treatment; 10 of these 13 patients received contrast-enhanced MRA (CE-MRA).

RESULTS:

The mean patient age was 72 ± 8 years. Paraparesis was present in 12 (92%) patients. Sphincter dysfunction and sensory symptoms were observed in 7 (54%) and 6 (46%) patients, respectively. The mean duration of symptoms was 6 ± 8 months. Congestive myelopathy on MR imaging was present in all patients. Prominent arterialized perimedullary veins were demonstrated in only 3 cases. CE-MRA revealed arterialized perimedullary veins and an arterialized epidural pouch in 9/10 (90%) patients, mostly located ventrolaterally. DSA demonstrated a multisegmental extension of the arterialized ventrolateral epidural pouch in 6 (46%) cases. An intradural radicular drainage vein was localized distant from the original fistula point in 3 (23%) patients.

CONCLUSIONS:

Congestive myelopathy with an acute/subacute clinical course was the dominant finding in spinal epidural arteriovenous fistulas. CE-MRA is a powerful diagnostic tool for identifying arterialized perimedullary veins as well as an arterialized epidural pouch. While arterialized perimedullary veins frequently present with only mild enlargement and elongation in spinal epidural arteriovenous fistulas, the arterialized epidural pouch is frequently located ventrolaterally and may extend over several vertebral levels. DSA remains the criterion standard to precisely visualize a spinal epidural arteriovenous fistula and its intradural radicular drainage vein, which may be located distant from the fistulous point.

EGR3 is a late epidermal differentiation regulator that establishes the skin-specific gene network

Late epidermal differentiation is a key step of skin barrier formation; however, the specific genetic factors that distinguish late differentiation from early differentiation remain unknown. Here, we demonstrated that early growth response factor 3 (EGR3) is highly expressed in the stratum granulosum, and that it contributes to late epidermal differentiation. However, its expression is lost under poorly differentiated conditions such as the parakeratosis-lesional skin. EGR3 mediated the regulation of genes located in the epidermal differentiation complex (EDC) through activation of enhancers and induction of enhancer RNAs.

A Technique to Provide Enhanced Visualization For Suture Cutting In Dermatologic Surgery

Patient Requests to Alter the Medical Record

Scientists Learn To Hear The 'Songs' Of Ice Shelves

The Ross Ice Shelf, photographed in 2003. Researchers found that by monitoring the seismic effects of wind on the surface of a shelf, they could gain insight into its structural integrity.

Scientists have found a new way to analyze the structural integrity of ice shelves at the end of the world, through the songs the winds sing on top of them.

(Image credit: De Agostini Picture Library/De Agostini/Getty Images)

SOP – Fatigue

Standards für die Palliativmedizin

Association of Vaping and Smoking With Decreased Flap Viability in Rats

This study investigates whether exposure to electronic cigarette vapor is less likely than exposure to cigarette smoke to lower the viability of random pattern flaps in laboratory rats.

Is e-Cigarette Vaping a New Clinical Challenge to Wound Healing?

Traditional cigarette smoking has been implicated by indisputable physiologic and clinical evidence to have substantial wound healing problems in surgical procedures. Physiologically, nicotine and the thousands of chemicals (ie, tar) in cigarette smoke induce not only peripheral vasoconstriction but also oxidative stress that weakens neutrophil function and subsequently wound healing through a variety of mechanisms. But what about electronic or e-cigarettes, otherwise known as vaping?

Association of Smoking Tobacco With Complications in Head and Neck Microvascular Reconstructive Surgery

This population database study uses 2005-2014 National Surgical Quality Improvement Program data to assess the risks associated with smoking among patients undergoing free flap reconstruction surgery of the head and neck.

SOP – Umgang mit und Versorgung von Verstorbenen

SOP – Aufnahmekriterien auf die Palliativstation

SOP – Atemnot bei erwachsenen Palliativpatienten

SOP – Depression und Angst in der Palliativmedizin

SOP – Übelkeit und Erbrechen bei Palliativpatienten

SOP – Inappetenz und Kachexie

SOP – Schmerztherapie bei Palliativpatienten

SOP – Akuter Verwirrtheitszustand

SOP – Subkutane Medikamentengabe und Infusionen in der erwachsenen Palliativmedizin

SOP – Behandlung und Betreuung in der Sterbephase

SOP – Darmpassagestörung in der Palliativmedizin

SOP – Palliative Sedierung

SOP – Umgang mit multiresistenten Erregern auf der Palliativstation

Issue Information

Pigment Cell &Melanoma Research, Volume 31, Issue 6, Page 653-657, November 2018.

Couvent des jacobins rennes, france 24th – 27th september 2018

Pigment Cell &Melanoma Research, Volume 31, Issue 6, Page 736-777, November 2018.

Grandma Was Right: Sunshine Helps Kill Germs Indoors

University of Oregon scientists used real dust from inside homes around Portland to test the effects of sunlight, UV light, and darkness on bacteria found in the dust.

All kinds of bacteria live with us indoors, and some can make us sick. A new study shows that rooms exposed to light had about half the live bacteria found in rooms that were kept in darkness.

(Image credit: Dave G Kelly/Getty Images)

Moisturizers versus Current and Next-Generation Barrier Repair Therapy for the Management of Atopic Dermatitis

We compare here the principal characteristics of over-the-counter moisturizers with physiologic lipid-based barrier repair therapy. Moisturizers are standard ancillary therapy for anti-inflammatory skin disorders, like atopic dermatitis (AD), and can attenuate the emergence of AD, the initial step in the "atopic march." But not all moisturizers are beneficial; some can make skin function worse, and can even induce inflammation, possibly accounting for the frequent occurrence of "sensitive skin" in women. In contrast, physiologic lipid-based barrier repair therapy, if comprised of the 3 key stratum corneum lipids, in sufficient quantities and at an appropriate molar ratio, can correct the barrier abnormality and reduce inflammation in AD, and perhaps in other inflammatory dermatoses.
Skin Pharmacol Physiol 2019;32:1–7

Rheology of hyaluronic acid and dynamic facial rejuvenation: Topographical specificities

Journal of Cosmetic Dermatology, Volume 17, Issue 5, Page 736-743, October 2018.

JCD Commentary for September 2018

Journal of Cosmetic Dermatology, Volume 17, Issue 5, Page 649-649, October 2018.

Issue Information

Journal of Cosmetic Dermatology, Volume 17, Issue 5, Page 643-644, October 2018.

Issue Information

International Journal of Cosmetic Science, Volume 40, Issue 5, Page i-iv, October 2018.

Therapeutic management of vitiligo

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Pengtala flap for reconstructing nasal tip defects

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Segmental Darier’s disease of unusually late onset

JDDG: Journal der Deutschen Dermatologischen Gesellschaft, EarlyView.

Bye, Bye, Beer? Brewers Say They've Got A Plan On Climate Change

The barley used to make beer as we know it may take a hit under climate change, but growers say they are already preparing by planting it further north in colder locations.

A scientific paper published this week predicts climate change will send beer prices skyrocketing and drastically reduce the barley crop. It got tons of media attention. But is beer really doomed?

(Image credit: Dean Hutton/Bloomberg via Getty Images)

Geological Teams Try To Determine The Future Of Storm-Affected Communities

Researchers from the U.S. Geological Survey are on the ground in Florida looking for the high water marks of Hurricane Michael. FEMA uses these maps to determine who is eligible for what kind of aid.

What Do You Get A Nobel Prize Winner? It's Hard To Find A Perfect Gift

The University of Missouri was deciding how to honor George Smith, who shared the 2018 Nobel in chemistry. Some schools designate parking spots but Smith bikes. He now has his own spot in a bike rack.

Use of multifilament nylon floss in onychocryptosis

Publication date: Available online 17 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Anuradha Bishnoi, Keshavamurthy Vinay, Sunil Dogra

What do Patients Undergoing Mohs Micrographic Surgery Value? Results of a Patient Values Survey based on OAS-CAHPS

Publication date: Available online 17 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Paul R. Massey, Ruibin Wang, Simi D. Cadmus, Katherine R. Sebastian, Matthew C. Fox

Ameliorative effect of berberine coated bio-active nanoparticles in acetaminophen induced hepato-renal damage in diabetic rats

Publication date: Available online 17 October 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Yueyue Wu, Xinmei Huang, Min Yang, Jiong Xu, Zaoping Chen, Zhiyan Yu, Jun Liu

Abstract

The current investigation was performed for the detailed analysis of protective effect of biofabricate berberine coated nano‑silver ameliorate (BBR-AgNPs) on acetaminophen (APAP) induced hepato-renal damages in diabetic rats by blood biochemistry, tissue biochemistry, histopathological and immunohistochemical analysis. The spherical shaped BBR-AgNPs were synthesized by the Biofabrication technique and its physico-chemical characterizations done by different spectroscopic (UV–vis spectrophotometer, XRD spectroscopy, FTIR spectroscopy EDAX & DLS analyses) and microscopic (FE-SEM) techniques. The diabetic developed rats were administrated with APAP (2.0 g/5 ml/kg) and scrutinize its hepato-renal injuries. The synthesized BBR-AgNPs (75 mg/kg p.o) was administrated orally to the APAP-induced diabetic rats. The result of biochemical markers and lipid peroxidation were significantly (P ˂ 0.05) increased in APAP-induced diabetic rats but decreased the level of antioxidants (P ˂ 0.05), which results obtained in liver and kidney compared to the control group. Immunohistochemical studies result showed that the APAP-induced diabetic rats expressed a high immunoreactivity of nuclear transcription factor (NF-kB). Whereas, the acetaminophen-induced diabetic rats were treated with BBR-AgNPs renovated the changes in the above parameters analyzed. The results of the study clearly indicated that the BBR-AgNPs possess the antioxidant properties as well as anti-diabetic effects, furthermore, the acetaminophen-induced liver and kidney damage was probably inhibited by the inhibition of proinflammatory factor & NF-kB factors.