Citations

Objectives/HypothesisInverting papillomas (IPs) are benign locally invasive tumors that most commonly present within the sinonasal cavity. Temporal bone involvement is exceedingly rare, with fewer than 30 cases reported within the English literature to date.Study DesignCase series and systematic review of the literature.MethodsFour consecutive subjects with temporal bone inverting papilloma (TBIP) were treated, and an additional 28 previously published cases were identified in the literature. Main outcome measures were disease presentation, diagnostic evaluation, management strategy, and outcome.ResultsA total of 32 cases were analyzed. The median age at diagnosis was 54 years (mean 54.1; range 19–81 years). Nineteen (59%) patients had synchronous or metachronous sinonasal IP, whereas 13 (41%) had isolated temporal bone disease without sinus involvement. Over half of the patients undergoing microsurgical resection experienced at least one recurrence. Compared to patients with a history of sinus IP, subjects with primary TBIP were younger at time of presentation (44 vs. 58 years; P = 0.012); were more commonly female (62% vs. 32%; P = 0.15); and were less likely to have intracranial spread (8% vs. 26%; P = 0.36), cranial neuropathy (8% vs. 26%; P = 0.36), human papillomavirus positivity (11% vs. 57%; P = 0.11), or associated carcinoma (0% vs. 47%; P = 0.004).ConclusionsInverting papilloma of the lateral skull base is rare and can pose a significant therapeutic challenge. Primary lesions of the temporal bone appear to follow a less aggressive clinical course when compared to those arising in association with sinonasal disease. Gross total resection is the preferred method of treatment, when feasible, given the high rate of recurrence with subtotal resection and risk of associated malignancy.Level of Evidence4. Laryngoscope, 125:2576–2583, 2015

Obective Glucagon‐like peptide‐1 (GLP‐1) receptor agonists are indicated for treatment of type 2 diabetes since they mimic the actions of native GLP‐1 on pancreatic islet cells, stimulating insulin release, while inhibiting glucagon release, in a glucose‐dependent manner. The observation of weight loss has led to exploration of their potential as antiobesity agents, with liraglutide 3.0 mg day −1 approved for weight management in the US on December 23, 2014, and in the EU on March 23, 2015. This review examines the potential nonglycemic effects of GLP‐1 receptor agonists. Methods A literature search was conducted to identify preclinical and clinical evidence on nonglycemic effects of GLP‐1 receptor agonists. Results GLP‐1 receptors are distributed widely in a number of tissues in humans, and their effects are not limited to the well‐recognized effects on glycemia. Nonglycemic effects include weight loss, which is perhaps the most widely recognized nonglycemic effect. In addition, effects on the cardiovascular, neurologic, and renal systems and on taste perception may occur independently of weight loss. Conclusions GLP‐1 receptor agonists may provide other nonglycemic clinical effects besides weight loss. Understanding these effects is important for prescribers in using GLP‐1 receptor agonists for diabetic patients, but also if approved for chronic weight management.

Background— Fibro-elastic deficiency (FED) and diffuse myxomatous degeneration (DMD) are phenotypes of degenerative mitral valve disease defined morphologically. Whether physiological differences in annular and valvular dynamics exist between these phenotypes remains unknown. Methods and Results— We performed triple quantitation of cardiac remodeling and of mitral regurgitation severity and of annular and valvular dimensions by real-time 3-dimensional-transesophageal-echocardiography. Forty-nine patients with degenerative mitral valve disease classified as FED (n=31) and DMD (n=18) by surgical observation showed no difference in age (65±10 versus 59±13; P =0.5), body surface area (2.0±0.2 versus 2.0±0.2 m 2 ; P =0.5), left ventricular and atrial dimensions (all P >0.55), and mitral regurgitation regurgitant orifice ( P =0.62). On average, annular dimensions were larger in DMD versus FED, but height was similar resulting in lower saddle shape. Dynamically, annular DMD versus FED display poorer contraction and saddle-shape accentuation in early systole and abnormal enlargement, particularly intercommissural, in late-systole (all P <0.05). Valvular dynamics showed stable valvular area in systole in FED versus considerable systolic increased area in DMD ( P <0.001). Prolapse height and volume increased little throughout systole in FED versus marked increase in DMD ( P <0.001). Conclusions— Our novel observations show that FED and DMD, although both labeled myxomatous, display considerable physiological phenotypic differences. In DMD, the annular increased size and profoundly abnormal dynamics demonstrate DMD-specific annular degeneration compared with the enlarged but relatively normal FED annulus. DMD does not incur more severe mitral regurgitation, despite larger prolapse and valve redundancy, underscoring potential compensatory role of tissue redundancy of DMD (or aggravating role of tissue paucity of FED) on mitral regurgitation severity.

Background: Peripheral nerve blocks (PNBs) have the potential to reduce postoperative pain. The use of ultrasound (US) to guide PNBs may be more beneficial than nerve stimulation (NS); however, very few studies have studied this technique in children. The objective of this study was to compare postoperative pain control in pediatric patients who had general anesthesia (GA) alone compared with those who had PNB performed by NS, or PNB with both NS and US guidance. Our hypothesis was that compared with NS, the US-guided PNB would result in reduced postoperative pain and opioid use, and that both PNB conditions would have improved outcomes compared with GA. Methods: A retrospective chart review of foot and ankle surgery included 103 patients who were stratified into 3 groups: GA, PNB with NS, and PNB with NS and US. Pain levels were measured with visual pain scales at 2, 4, 6, 8, 12, and 24 hours postoperatively. Days of hospitalization, morphine and oxycodone use by weight, and time to first PRN opioid use were also recorded. A repeated measure analysis of variance was used to compare the groups, and the proportion of patients who reported a visual analog scale score of 0 was calculated for each time point. Results: There were no significant differences in pain levels between groups for the first 12 hours, but the US group had higher pain levels at 24 hours. Both US and NS groups had a longer time to PRN opioid use and used significantly less morphine compared with GA. The US group had a significantly greater proportion of pain-free patients than the other 2 groups for the first 6 hours. Conclusions: The use of US guidance is beneficial in postoperative pain control. Both US-guided and NS-guided PNB are preferable to GA alone for lower extremity orthopaedic surgery in the pediatric population. Level of Evidence: III, retrospective comparative study.

BNLF2a is an Epstein‐Barr virus (EBV) immune evasion gene. Its protein is located in the endoplasmic reticulum (ER) membrane, and can inhibit the antigen transporting function of TAP, thereby perturbing the immune response to EBV in lytic and prelatent phase. In order to explore whether the polymorphism of BNLF2a gene has a role in different types of EBV associated tumors, we conducted complete sequencing of the gene BNLF2a in 408 cases of EBV positive tumors (76 lymphomas, 45 gastric carcinomas, and 85 nasopharyngeal carcinomas in northern China and 27 lymphomas, 30 gastric carcinomas, and 57 nasopharyngeal carcinomas in southern China) and throat washings from healthy individuals (39 in northern China and 49 in southern China). Two main variant types of BNLF2a were identified. Type BNLF2a‐A, which was similar to B95‐8, was dominant in all sub‐populations (66.7–100%) in this study. Type BNLF2a‐B was characterized by the mutations at position 8 and 40. The variation patterns of BNLF2a were significantly different between samples from northern and southern China ( P < 0.05), and between the tumors and healthy donor samples from the northern China ( P < 0.0167). Type BNLF2a‐B was more frequent in healthy donors of northern China (33.3%), and the proportion of this type was higher in the northern than in the southern NPCs. These data demonstrate that the BNLF2a gene is highly conserved, and its polymorphism is geographically restricted. Type BNLF2a‐B is more prevalent in northern China and may be less tumor transformative. J. Med. Virol. 87:1946–1952, 2015 . © 2015 Wiley Periodicals, Inc.

OBJECTIVE: Aspiration can cause a variety of pulmonary syndromes, some of which are not well recognized. The objective of this study was to assess the demographic, clinical, radiological, and histopathological correlates of diffuse aspiration bronchiolitis (DAB), a bronchiolocentric disorder caused by recurrent aspiration. METHODS: This was a retrospective study of 20 consecutive patients with DAB seen at the Mayo Clinic in Rochester, Minnesota, between January 1, 1998 and June 30, 2014. RESULTS: The median age of the patients was 56.5 years (range, 22-76 years), and the male/female ratio was 2.3:1.0. In 18 patients, the diagnosis of DAB was based on the results of a lung biopsy; in the 2 remaining patients, it was based on clinical and radiological features, together with documented aspiration observed in a videofluoroscopic swallow study. In 19 patients (95%), we identified predisposing factors for aspiration, including gastroesophageal reflux disease (GERD), drug abuse, and dysphagia. Common presenting features included cough, sputum production, dyspnea, and fever. Twelve patients (60%) had a history of recurrent pneumonia. In all of the patients, chest CT revealed bilateral pulmonary infiltrates consisting of micronodules and tree-in-bud opacities. In the majority of patients, interventions aimed at preventing recurrent aspiration (e.g., anti-GERD therapies) led to improvement in the symptoms of DAB. CONCLUSIONS: Young to middle-aged subjects with recognizable predisposing factors for aspiration and who report a history of recurrent pneumonia are at increased risk for DAB. Although DAB is not well recognized, certain chest CT features are characteristic of the disorder.

ABSTRACT Hypovitaminosis D is prevalent worldwide but proportions vary widely between regions, depending on genetic and lifestyle factors, the threshold to define deficiency, and accuracy of 25-hydroxyvitamin D (25OHD) assays used. Latitude, pollution, concealing clothing, sun exposure, gender, dietary habits, and lack of government regulation account for up to 50% in variations in serum 25OHD levels, whereas genetic polymorphisms in the vitamin D pathway account for less than 5%. Organizations/societies have developed guidelines for recommended desirable 25OHD levels and vitamin D doses to reach them, but their applicability across age groups and populations are still debated. This article and the accompanying online Supporting Information highlight sources of variations in circulating 25OHD levels, uncertainties and knowledge gaps, and analytical problems facing 25OHD assays, while keeping efficacy and safety data as the dominant factors when defining a desirable range for 25OHD levels. We propose a desirable range of 20 to 40 ng/mL (50 to 100 nmol/L), provided precise and accurate assays are used. Although slightly lower levels, 15 to 20 ng/mL, may be sufficient for some infants and adults, higher levels, 40 to 60 ng/mL, may still be safe. This desirable range allows physicians to tailor treatment while taking season, lifestyle, vitamin D intake, and other sources of variation into account. We reserve 25OHD measurements for at-risk patients, defined by disease or lifestyle, and the use of 25OHD assays calibrated against the recommended international standards. Most target groups reach desirable target levels by a daily intake of 400 to 600 IU for children and 800 IU for adults. A total daily allowance of vitamin D of up to 1000 IU in the pediatric age groups, and up to 2000 IU in adults, tailored to an individual patient risk profile, is probably safe over long durations. Additional data are needed to validate the proposed range and vitamin D doses, especially in children, pregnant women, and non-white populations. © 2015 American Society for Bone and Mineral Research.