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.

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.

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 <

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.

Legalizar a eutanásia? Uma perspectiva dinamarquesa / Should euthanasia be legalized? A Danish perspective

Apresenta a situaçäo atual da discussäo da eutanásia na Dinamarca. Analisa a questäo numa perspectiva histórico-evolutiva. Inicia falando da interrupçäo do tratamento fútil, emergência da legislaçäo em torno do testamento em vida(living will) e finaliza comentando a publicaçäo do Comitê Dinamarquês de Ética (1996), que diz näo à legalizaçäo da eutanásia ativa e recomenda o incremento dos cuidados paliativos na área da pesquisa e educaçäo dos profissionais de saúde

Os comitês de ética na Dinamarca / Ethical committees in Denmark

A Dinamarca possui diversos tipos de comitês de ética. Apresenta uma breve visäo do sistema dinamarquês, seguida por uma análise mais profunda do funcionamento do sistema do comitê de ética em pesquisa, com ênfase nas características que o distinguem de outros sistemas da Europa e dos Estados Unidos

Um olhar sobre as agências / A look about the agencies

Traz informaçöes básicas sobre sete agências de cooperaçäo de cinco países europeus. Acha importante abordar a questäo das agências pela relevância do seu relacionamento com as ONGs do Brasil e também devido às mudanças pelas quais elas estäo passando nos últimos anos. Relata que as agências têm buscado democratizar a formulaçäo de suas políticas e a definiçäo de suas prioridades, construindo mecanismos coletivos de consulta. Busca contribuir para explicitar as discussöes travadas no interior das agências sobre as tendências atuais da cooperaçäo internacional na Europa, e especialmente nos seis países das agências; os reflexos dessas tendências sobre as suas relaçöes com as entidades parceiras, em especial as do Brasil; a questäo do "impacto" e dos resultados do trabalho das agências e das entidades parceiras; expectativas e propostas para o futuro. Faz um resumo da política de cooperaçäo internacional e sua organizaçäo. Aborda as agências ecumênicas e a política da agências em relaçäo ao Brasil.

O difícil caminho para a justiça social / The hard way to the social justice

Trabalhos da Cúpula Mundial para o Desenvolvimento Social, com avaliaçäo e implicaçöes futuras para as políticas sociais no Brasil e na Alemanha

El papel del estado en la elaboración de un plan nacional de amplios alcances para la atención del anciano: la experiencia danesa

En el presente trabajo se exponen los antecedentes historicos del sistema de atención de salud de Dinamarca, se analizan los problemas de establecer una politica coherente y se formulan algunas consideraciones sobre eleboracion de políticas que puedan revestir interes mas alla de Dinamarca y resultar aplicabels en alguna medida en América Latina y el Caribe