Recurrence of Cholesteatoma: A Retrospective Study Including 1006 Patients for More than 33 Years

Abstract Introduction Cholesteatomas are benign tumors consisting of skin, and growing inside a retraction pocket in the tympanic membrane. Cholesteatomas can occupy the entirety of the middle ear, and are known for their osteolytic capabilities. Surgery is the only curative treatment for cholesteatomas. Objective To describe the risk of recurrence after first-time surgically-treated middle- ear cholesteatoma (STMEC1) on the island of Funen from 1983 to 2015. Methods Cases of STMEC1 were identified in the Danish National Hospital Register. The medical records were reviewed. Time-to-event analyses were applied. The ears were followed from STMEC1 to a secondary cholesteatoma, emigration, death, or end of follow-up. Results Records from 1,006 patients with STMEC1 were reviewed. A total of 54 patients were submitted to surgery on both ears. The total sample consisted of 1,060 ears with STMEC1; 300 were children's (< 16 years) ears, and 760 were adult's ears. The total observation time was of 12,049 years. The overall estimated proportion with recurrence 5 years after surgery was of 37% in children and of 15% in adults. The older the child was at the first surgery, the risk decreased by 7% per year. In children, canal wall up (CWU) mastoidectomy without obliteration was associated with a hazard ratio for recurrence of 1.9 (95% confidence interval [95%CI]: 1.2-3.0) compared with CWU with obliteration. Conclusion Compared with adults, children were had 2.6 times more risk of recurrence. Procedures performed without mastoidectomy had the lowest risk of recurrence. In children, obliteration was associated with a significantly lower risk of recurrence. However, patients were not randomized regarding the surgical approach; thus, the association between approach and risk of recurrence was likely influenced by confounding factors.

Bajos niveles de colesterol de HDL y alto riesgo de enfermedad autoinmune. Dos estudios poblacionales de cohorte con 117.341 individuos incluidos. / Low HDL cholesterol and high risk of autoimmune disease. Two population-based cohort studies including 117, 341 individuals

Antecedentes. HDL es cuantitativamente la lipoproteína más importante en la mayoría de las especies y la evidencia mecanicista sugiere que HDL tendría un papel en la función inmunológica normal. Probamos la hipótesis que sugiere que las concentraciones plasmáticas de HDL están asociadas con el riesgo de enfermedades autoinmunes. Métodos. Se incluyeron 107.954 y 9.387 individuos con mediciones basales de colesterol-HDL provenientes de 2 estudios de la población general: el Estudio de la Población General de Copenhague y el Estudio del Corazón de Copenhague. Los pacientes fueron seguidos mediante el Registro Nacional Danés de pacientes desde el inicio del período 2003-2015 o 1991-1994 hasta 2017, tiempo durante el cual 4.078 y 1.101 individuos desarrollaron enfermedad autoinmune en los 2 estudios respectivamente. Resultados. En el Estudio de la Población General de Copenhague, en comparación a los individuos con colesterol de HDL =2,0 mmol/L (77 mg/dL), los índices de riesgo para cualquier enfermedad autoinmune, ajustados de manera multifactorial fueron 1,06 (IC 95%, 0,94-1,19) para individuos con colesterol-HDL entre 1,5 y 1,99 mmol/L (58 a 77 mg/dL), 1,18 (IC 95%, 1,04-1,35) para individuos con colesterol-HDL entre 1,0 y 1,49 mmol/L (39 a 58 mg/dL) y 1,84 (IC 95%, 1,52- 2,22) para individuos con colesterol-HDL <1,0 mmol/L (39 mg/dL) (p<0,001 para tendencia). Estos resultados fueron similares cuando: se excluyeron los eventos dentro de los 5 años del inicio del estudio, tanto en mujeres como hombres por separado, eventos en el inicio del estudio, independientemente de la inflamación de bajo grado o concentraciones de triglicéridos, para diferentes niveles de apolipoproteína A1 y para definiciones de punto final más restrictivas. Finalmente, el Estudio del Corazón de Copenhague proporcionó una confirmación independiente. Conclusiones: Los bajos niveles de colesterol-HDL se asocian con un alto riesgo de enfermedad autoinmune en individuos de la población general. Nuestros hallazgos observacionales no pueden determinar la causalidad.

Background. HDL is quantitatively the most important lipoprotein in most species and mechanistic evidence points toward a role for HDL in normal immune function. We tested the hypothesis that concentrations of HDL cholesterol are associated with risk of autoimmune disease. Methods. From 2 studies of the general population-the Copenhagen General Population Study and the Copenhagen City Heart study-we included 107,954 and 9,387 individuals with baseline measurements of HDL cholesterol. These were followed with the national Danish Patient Registry from baseline in 2003-2015 or 1991-1994 through 2017, during which time 4078 and 1101 individuals developed autoimmune disease in the 2 studies. Results. In the Copenhagen General Population Study, compared to individuals with HDL cholesterol =2.0 mmol/L (77 mg/dL), the multifactorially adjusted hazard ratios for any autoimmune disease were 1.06 (95% CI, 0.94-1.19) for individuals with HDL cholesterol of 1.5-1.99 mmol/L (58-77 mg/dL), 1.18 (95% CI, 1.04-1.35) for individuals with HDL cholesterol of 1.0-1.49 mmol/L (39-58 mg/dL), and 1.84 (95% CI, 1.52-2.22) for individuals with HDL cholesterol <1.0 mmol/L (39 mg/dL) (p for trend <0.001). These results were similar when excluding events within 5 years of baseline, in women and men separately, for events at baseline, irrespective of low-grade inflammation or triglyceride concentrations, for the apolipoprotein A1 part of HDL, and for more restrictive end point definitions. Finally, the Copenhagen City Heart Study provided independent confirmation. Conclusions. Low HDL cholesterol level is associated with high risk of autoimmune disease in individuals from the general population. Our observational findings cannot determine causality.

Sexual function in female juvenile idiopathic arthritis patients

Abstract Objective: To evaluate sexual function female adolescents and young adults with juvenile idiopathic arthritis (JIA) and healthy controls. Methods: After exclusion, 21 female adolescent and young JIA patients and 25 healthy controls were selected for this study. Sexual function was assessed by the Sexual Quotient Questionnaire for Females (SQQ-F) score, which is a validated tool and adapted for Brazilian Portuguese language. Demographic data, JIA clinical/laboratory parameters and treatment were also assessed. Results: The median current age [26.5 (17-38.1) vs. 29.3 (19.7-35.8) years, p = 0.700)] as well as age at the first sexual activity [18 (14-30) vs. 17 (10-24) years, p = 0.158] were similar in JIA patients and healthy controls. The median of SQQ-F score was alike in both groups [75.9 (50-92) vs. 78.2 (58-94), p = 0.529], as well as frequencies of sexual dysfunction (14% vs. 12%, p = 1.000). The frequencies of all sexual domains (desire/sexual fantasies, desire/interest, arousal/foreplay, arousal/lubrication, arousal/in tune with partner, penetration/relaxation, pain/penetration, desire/involvement, orgasm and general satisfaction scores) were similar in JIA patients and healthy controls (p > 0.05). Conclusions: To our knowledge, this was the first study using a validated sexual score in a chronic arthritis population suggesting a low frequency of overall sexual dysfunction in young JIA patients. Future multicenter studies with a large sample will be necessary to confirm this finding.

What's app? Electronic health technology in inflammatory bowel disease

Electronic health (eHealth) data collection is increasingly used in many chronic illnesses, to track pattern of disease. eHealth systems have the potential to revolutionize care. Inflammatory bowel disease (IBD) is a paradigm for such an approach: this is a chronic disease that usually affects young and technologically literate patient population, who are motivated to be involved in their own care. A range of eHealth technologies are available for IBD. This review considers the strengths and weaknesses of 7 platforms that focus on patient-provider interaction. These have been developed in Denmark, United States, the Netherlands, and the United Kingdom, demonstrating an international interest in this form of technology and interaction. Not only do these technologies aim to improve care but they also have the potential to collect large amounts of information. Information includes demographics and patient reported outcomes (symptoms, quality of life), quality of care (steroid use, among other metrics) and outcomes such as hospitalization. These data could inform quality improvement programmes to improve their focus. eHealth technology is also open to machine learning to analyze large data sets, through which personalized algorithms may be developed.

Skin cancer risk perception and sun protection behavior at work, at leisure, and on sun holidays: a survey for Danish outdoor and indoor workers

BACKGROUND@#To prevent occupational skin cancer, it is essential that the sun-protective behavior of outdoor workers is adequate. The aim is to study the sun-protective behavior of Danish outdoor workers at work, at leisure, and on sun holiday and compare it to that of indoor workers.@*METHODS@#This is a cross-sectional study, based on a 53-item survey completed by Danish outdoor (n = 380) and indoor workers (n = 119) in 2016-2017. Status as outdoor or indoor worker was decided based on self-report and behavioral differences were tested using (paired) t tests and multiple regression adjusted for age, sex, educational level, history of smoking, and skin type.@*RESULTS@#Danish outdoor workers at work use sun protection less than they do at leisure and on sun holiday (α  80.0% agree that risk of skin cancer is reduced by the use of sun protection, and only 4.0% dismiss the possibility of sun protection use at work.@*CONCLUSIONS@#Skin cancer risk and use of sun protection at work are largely neglected in Danish outdoor workers, more so than at leisure and on sun holiday where their risk behavior resembles that of indoor workers. This indicates an untapped workplace preventive potential.

The relationship between night work and breast cancer

BACKGROUND: Since the International Agency for Research on Cancer classified shift work that involves circadian disruption as “probably carcinogenic to humans,” there has been growing concern on the relationship between night work and breast cancer. In Korea, about 10–15% of workers are engaged in night-shift work, and breast cancer is one of the most common cancers in women. The purpose of this study was to review epidemiologic evidence on the relationship between night work and breast cancer. METHODS: We reviewed 21 original articles and 5 meta analyses on relationship between nightwork and breast cancer, and investigated the compensation criteria of Denmark. RESULTS: The association between breast cancer and night work has been reported by numerous epidemiologic studies, including cohort studies, case-control studies, and meta-analysis. However, a dose-response relationship has not clearly emerged among workers exposed to less than 20 years of night work. CONCLUSION: Although there are some limitations to the epidemiological studies so far, further consideration of breast cancer cases in patients with high exposure to night work is needed to assess breast cancer as a work-related disease.

Clinical Update in Aspects of the Management of Autoimmune Thyroid Diseases

Aspects of autoimmune thyroid disease updated in this review include: immunoglobulin G4 (IgG4)-related thyroid disease (Riedel's thyroiditis, fibrosing variant of Hashimoto's thyroiditis, IgG4-related Hashimoto's thyroiditis, and Graves' disease with elevated IgG4 levels); recent epidemiological studies from China and Denmark indicating that excess iodine increases the incidence of Hashimoto's thyroiditis and hypothyroidism; immunomodulatory agents (ipilimumab, pembrolizumab, nivolumab) activate immune response by inhibiting T-cell surface receptors which down-regulate immune response, i.e., cytotoxic T-lymphocyte antigen 4 and programmed cell death protein 1 pathways; alemtuzumab is a humanised monoclonal antibody to CD52 which causes immune depletion and thyroid autoimmune disease especially Graves' hyperthyroidism; small molecule ligand (SML) agonists which activate receptors, SML neutral antagonists, which inhibit receptor activation by agonists, and SML inverse agonists which inhibit receptor activation by agonists and inhibit constitutive agonist independent signaling have been identified. SML antagonism of thyroid-stimulating hormone-receptor stimulatory antibody could treat Graves' hyperthyroidism and Graves' ophthalmopathy; and thyroxine treatment of subclinical hypothyroidism can produce iatrogenic subclinical hyperthyroidism with the risk of atrial fibrillation and osteoporosis. The increased risk of harm from subclinical hyperthyroidism may be stronger than the potential benefit from treatment of subclinical hypothyroidism.

The use of halloysite clay and carboxyl-functionalised multi-walled carbon nanotubes for recombinant LipL32 antigen delivery enhanced the IgG response

We studied the feasibility of using halloysite clay nanotubes (HNTs) and carboxyl-functionalised multi-walled carbon nanotubes (COOH-MWCNTs) as antigen carriers to improve immune responses against a recombinant LipL32 protein (rLipL32). Immunisation using the HNTs or COOH-MWCNTs significantly increased the rLipL32-specific IgG antibody titres (p < 0.05) of Golden Syrian hamsters. None of the vaccines tested conferred protection against a challenge using a virulent Leptospira interrogans strain. These results demonstrated that nanotubes can be used as antigen carriers for delivery in hosts and the induction of a humoral immune response against purified leptospiral antigens used in subunit vaccine preparations.

Dietary Factors and the Risk of Thyroid Diseases: A Review

BACKGROUND AND OBJECTIVES: Diet is one of the major risk factors for thyroid diseases. It has been shown that high or excessive iodine intake is more likely to be a health concern in iodine-sufficient regions or regions where iodine deficiency previously existed due to the emergence of iodine-induced hypothyroidism or hyperthyroidism. Therefore, this review investigates the occurrence of thyroid diseases, and particularly hypothyroidism and hyperthyroidism, in populations with different levels of iodine intake and other dietary factors in various geographic regions. MATERIALS AND METHODS: A total of 856 articles published between January 1st, 1990 and March 31st, 2015, were identified. Epidemiological studies that showed an association between dietary factors and thyroid diseases were selected, yielding a total of 21 articles. RESULTS: Due to a sudden increase in iodine supplementation (i.e., via salt iodization), regions such as Denmark and China, where insufficient iodine intake previously existed, showed a significant increase in the occurrence of hypothyroidism compared with that of hyperthyroidism. Other dietary factors, such as nitrate intake, may increase the risk of the diseases, whereas a vegan diet and alcohol intake may lower the risk. CONCLUSION: The level of iodine intake is quite variable between individuals in different geographic regions, and the risk of thyroid diseases may also vary by age and gender. Therefore, monitoring of safe levels of iodine intake should be performed to prevent iodine-induced thyroid diseases.

Green Chemistry at the present in Korea

OBJECTIVES: Despite the great contribution made by chemical substances to the development of modern civilization, their indiscriminate use has caused various kinds of damage to the global environment and human beings. Accordingly, the major developed countries and international society have tried to ensure the safe use of chemicals and a reduction in the use of hazardous chemicals through the establishment of the United Nations Environment Programme and various international agreements. In this reason, we tried to introduce about Green Chemistry progress at the present in worldwide and Korea. METHODS: We checked and analyzed relative journals, reports using keyword as like Green Chemistry, alternative chemicals, eco-friendly etc. and major country's government homepage search. RESULTS: Green Chemistry theory, which argues for the reduction or removal of harmfulness in chemicals throughout their entire life-cycle, has been spreading, and major developed countries, such as the US and Denmark, have developed and operate programs to provide reliable chemical information to help replace hazardous chemicals. Korea has also been conducting studies as like eco-innovation project. Through this project the "Alternative Chemical Search program," has been developed, distributed, and operated since 2011 to provide reliable information to small and medium-sized businesses that have difficulties collecting information to ensure conformity to international regulations. The program provides information that includes the regulations of major countries and Korea, information on 340 alternative chemicals, 70 application cases, and 1:1 consulting. CONCLUSIONS: The Alternative Chemical Search program is expected to contribute to the establishment of response systems for regulation of Korean small and medium-sized businesses, and it also will be used to provide basic data for Korean hazardous chemical regulation, together with the Act on the Registration and Evaluation, etc. of Chemical Substances and the Chemical Control act, making it possible to establish an infrastructure for Green Chemistry in Korea and to increase national competitiveness.

Green Chemistry at the present in Korea

OBJECTIVES: Despite the great contribution made by chemical substances to the development of modern civilization, their indiscriminate use has caused various kinds of damage to the global environment and human beings. Accordingly, the major developed countries and international society have tried to ensure the safe use of chemicals and a reduction in the use of hazardous chemicals through the establishment of the United Nations Environment Programme and various international agreements. In this reason, we tried to introduce about Green Chemistry progress at the present in worldwide and Korea. METHODS: We checked and analyzed relative journals, reports using keyword as like Green Chemistry, alternative chemicals, eco-friendly etc. and major country's government homepage search. RESULTS: Green Chemistry theory, which argues for the reduction or removal of harmfulness in chemicals throughout their entire life-cycle, has been spreading, and major developed countries, such as the US and Denmark, have developed and operate programs to provide reliable chemical information to help replace hazardous chemicals. Korea has also been conducting studies as like eco-innovation project. Through this project the "Alternative Chemical Search program," has been developed, distributed, and operated since 2011 to provide reliable information to small and medium-sized businesses that have difficulties collecting information to ensure conformity to international regulations. The program provides information that includes the regulations of major countries and Korea, information on 340 alternative chemicals, 70 application cases, and 1:1 consulting. CONCLUSIONS: The Alternative Chemical Search program is expected to contribute to the establishment of response systems for regulation of Korean small and medium-sized businesses, and it also will be used to provide basic data for Korean hazardous chemical regulation, together with the Act on the Registration and Evaluation, etc. of Chemical Substances and the Chemical Control act, making it possible to establish an infrastructure for Green Chemistry in Korea and to increase national competitiveness.

A saint in the history of Cardiology / Un santo en la historia de la Cardiología

Niels Stensen (1638-1686) was born in Copenhagen. He took courses in medicine at the local university under the guidance of Professor Thomas Bartholin and later at Leiden under the tutelage of Franz de la Boé (Sylvius). While in Holland, he discovered the existence of the parotid duct, which was named Stensen's duct or stenonian duct (after his Latinized name Nicolaus Stenon). He also described the structural and functional characteristics of peripheral muscles and myocardium. He demonstrated that muscular contraction could be elicited by appropriate nerve stimulation and by direct stimulation of the muscle itself and that during contraction the latter does not increase in volume. Toward the end of 1664, the Academic Senate of the University of Leiden awarded him the doctor in medicine title. Later, in Florence, he was admitted as a corresponding member in the Academia del Cimento (Experimental Academy) and collaborated with the Tuscan physician Francesco Redi in studies relating to viviparous development. In the Tuscan capital, he converted from Lutheranism to Catholicism and was shortly afterwards ordained in the clergy. After a few years, he was appointed apostolic vicar in northern Germany and died in the small town of Schwerin, capital of the Duchy of Mecklenburg-Schwerin on November 25, 1686.

Niels Stensen (1638-1686) nació en Copenhague, siguió cursos de medicina en la universidad local bajo la tutoría del profesor Thomas Bartholin y, más tarde, en Leyden con Franz de la Boé (Sylvius). En Holanda descubrió la existencia del conducto parotideo, al que los catedráticos de la universidad mencionada dieron el nombre de conducto stenoniano (de su nombre latinizado: Nicolaus Steno). Demostró asimismo las características estructurales y funcionales de los músculos periféricos y del miocardio. Comprobó que la contracción muscular puede reproducirse no solo por estimulación del nervio correspondiente, sino también por estimulación directa del mismo músculo y que, durante la contracción, este último no aumenta de volumen. Hacia fines del ano 1664, le fue otorgado el título de doctor en medicina por el Senado Académico de la Universidad de Leyden. Más tarde, en Florencia, fue admitido como miembro correspondiente en la <

Evaluation of different approaches for using a laser scanner in digitization of dental impressions

PURPOSE: This study aimed to investigate the potential clinical application of digitized silicone rubber impressions by comparing the accuracy of zirconia 3-unit fixed partial dentures (FPDs) fabricated from 2 types of data (working model and impression) obtained from a laser scanner. MATERIALS AND METHODS: Ten working models and impressions were prepared with epoxy resin and vinyl polysiloxane, respectively. Based on the data obtained from the laser scanner (D-700; 3Shape A/S, Copenhagen, Denmark), a total of 20 zirconia frameworks were prepared using a dental CAD/CAM system (DentalDesigner; 3shape A/S, Copenhagen, Denmark / Ener-mill, Dentaim, Seoul, Korea). The silicone replicas were sectioned into four pieces to evaluate the framework fit. The replicas were imaged using a digital microscope, and the fit of the reference points (P1, P2, P3, P4, P5, P6, and P7) were measured using the program in the device. Measured discrepancies were divided into 5 categories of gaps (MG, CG, AWG, AOTG, OG). Data were analyzed with Student's t-test (alpha=0.05), repeated measures ANOVA and two-way ANOVA (alpha=0.05). RESULTS: The mean gap of the zirconia framework prepared from the working models presented a narrower discrepancy than the frameworks fabricated from the impression bodies. The mean of the total gap in premolars (P=.003) and molars (P=.002) exhibited a statistical difference between two groups. CONCLUSION: The mean gap dimensions of each category showed statistically significant difference. Nonetheless, the digitized impression bodies obtained with a laser scanner were applicable to clinical settings, considering the clinically acceptable marginal fit (120 microm).

Niels Stensen and the discovery of the parotid duct / Niels Stensen y el descubrimiento del conducto parotídeo

Niels Stensen was a renowned Danish scientist, theologian and Catholic bishop. Stensen's early career was devoted to anatomy and it is in this discipline that he made many important contributions. His method in anatomy was rooted in systematic observations based on meticulously executed dissections of human and animal cadavers, as well as experiments on animals. His first important discovery in the field of anatomy, which is the main focus of this paper, was the discovery of the parotid duct. The discovery brought Stensen recognition and fame but only after a controversy in which he was accused of plagiarism by his mentor Gerard Blaes. Although still in an early stage of his career Stensen dealt with the accusation masterfully, producing further research which confirmed him as the discoverer of the parotid duct.

Niels Stensen fue un renombrado científico danés, obispo y teólogo católico. A principios de su carrera Stensen se dedicó a la anatomía, disciplina en la cual logró muchas contribuciones importantes. Su método de anatomía se fundamentaba en observaciones sistemáticas basadas en disecciones de cadáveres humanos y de animales ejecutadas meticulosamente, así como los experimentos con animales. Su primer descubrimiento importante en el campo de la anatomía, que constituye el tema principal de este trabajo, fue el descubrimiento del conducto parotídeo. El descubrimiento le trajo el reconocimiento y fama a Stensen, pero sólo después de una polémica en la que se le acusaba de plagio por su mentor Gerard Blaes. A pesar de haber estado en una etapa temprana de su carrera, Stensen se hizo cargo de la acusación con maestría, produciendo una mayor investigación que lo confirma como el descubridor del conducto parotídeo.