Intramuscular granular cell tumor of the gluteal region

Abstract

Granular cell tumors are uncommon, usually benign neoplasms, mainly observed in the head and neck region, chest wall and upper extremities. These tumors account for ~0.5% of all soft-tissue tumors. Less than 2% are malignant. These are associated with poor prognosis. Clinical signs suspicious for malignancy are large size, rapid growth, invasion, recurrence and metastasis. Malignancy is confirmed by histological examination. We present the case of a 79-year-old patient with a 6-month history of a rapidly growing mass in the left gluteal region giving the clinical impression of a malignant tumor. The patient underwent surgical excision of the tumor and the pathology report revealed a granular cell tumor. In difficult cases, multidisciplinary approach is necessary for appropriate diagnosis and management.

http://ift.tt/2DZ84Ou

A rare case of massive lower gastrointestinal bleeding from a ruptured splenic artery aneurysm

Abstract

Splenic artery aneurysms (SAAs) are an extremely rare cause of asymptomatic massive lower gastrointestinal bleeding with less than a handful of patients surviving such a presentation. A 24-year-old female presented in shock after multiple episodes of massive rectal bleeding. Imaging revealed a heterogeneous mass arising from the tail of the pancreas eroding into the splenic flexure of the colon. Further episodes of bleeding led to an exploratory laparotomy. Intraoperatively, a suspected neoplastic process arising from the tail of the pancreas with contiguous involvement of the splenic flexure of the colon and the greater curvature of the stomach was noted. Distal pancreaticosplenectomy, gastric wedge resection with segmental colectomy and primary anastomosis were performed. Histology revealed a SAA with rupture into the colon. This case report shows that en-bloc resection of a ruptured SAA can be performed with success in the emergency setting.

http://ift.tt/2nFXTmL

A rare case of spinal cord compression due to cervical spine metastases from paraganglioma of the jugular foramen—how should it be treated?

Abstract

Paragangliomas are benign neoplasms that arise from the autonomic nervous system and the associated paraganglia. Although benign, they have been shown to possess metastatic potential. Involvement of the spine is rare. Even rarer is considered the involvement of the cervical spine. We report a case of a patient with a history of an extra-adrenal non-functional paraganglioma of the jugular foramen which was initially treated with intra-arterial embolization. After a 3-year disease-free follow-up, the patient was presented with symptoms of spinal cord compression due to spinal metastases in C2 and C3 vertebrae. The patient was then treated with surgical decompression and external beam radiation. Therapeutic management with additional treatment options is now under discussion by a multidisciplinary team. Paraganglioma of the jugular foramen with spinal metastasis is an uncommon presentation where increased physician awareness and long-term follow-up are mandatory for all patients with history of paraganglioma.

http://ift.tt/2DWqzTu

In This Issue

http://ift.tt/2FHT0Rt

TcR-α recombinations in renal cell carcinoma exome files correlate with an intermediate level of T-cell exhaustion biomarkers

Abstract

Renal cell carcinoma exome-derived, V(D)J recombination reads had an elevated presence and variability, for both TcR-α and -β, when compared to marginal tissue, reflecting an opportunity to assess tumor immunogenicity by comparison with marginal tissue T cells. PD-1, PD-L2, CTLA4 and FOXP3, all of which are implicated in the evasion of an anti-tumor immune response, had a significantly higher expression for samples representing co-detection of productive TcR-α and -β recombination reads. Samples representing tumors with productive TcR-α recombination reads but no detectable, productive TcR-β recombination reads, reflected a 20% survival advantage, and RNASeq data indicated an intermediate level of immune checkpoint gene expression for those samples. These results raise the question of whether relatively high levels of detection of productive TcR-α recombination reads, in comparison with detection of reads representing the TcR-β gene, identify a microenvironment that has not yet entered a T-cell exhaustion phase and may thereby represent conditions for immune enhancements that do not require anti-immune checkpoint therapies.

http://ift.tt/2E9D2Tc

Rapid immunosurveillance by recirculating lymphocytes in the rat intestine: critical role of unsulfated sialyl-Lewis X on high endothelial venules of the Peyer’s patches

Abstract

Naive lymphocytes systemically recirculate for immunosurveillance inspecting foreign antigens and pathogens in the body. Trafficking behavior such as the migration pathway and transit time within the gastrointestinal tract, however, remains to be elucidated. Rat thoracic duct lymphocytes (TDLs) were transferred to a congeneic host that had undergone mesenteric lymphadenectomy. The migration pathway was investigated using newly developed four-color immunohistochemistry and immunofluorescence. Donor TDLs showed rapid transition in gut tissues from which they emerged in mesenteric lymph around 4 h after intravenous injection. Immunohistochemistry showed that donor TDLs predominantly transmigrated across high endothelial venules (HEVs) at the interfollicular area of the Peyer's patches (PPs), then exited into the LYVE-1⁺ efferent lymphatics, that were close to the venules. The rapid recirculation depended largely on the local expression of unsulfated sialyl-Lewis X on these venules where putative dendritic cells (DCs) were associated underneath. Recruited naive T cells briefly made contact with resident DCs before exiting to the lymphatics in the steady state. In some transplant settings, however, the T cells retained contact with DCs and were sensitized and differentiated into activated T cells. In conclusion, we directly demonstrated that lymphocyte recirculation within the gut is a very rapid process. The interfollicular area of PPs functions as a strategically central site for rapid immunosurveillance where HEVs, efferent lymphatics and resident DCs converge. PPs can, however, generate alloreactive T cells, leading to exacerbation of graft-versus-host disease or gut allograft rejection.

http://ift.tt/2FHrBzj

Clinical response to PD-1 blockade correlates with a sub-fraction of peripheral central memory CD4+ T cells in patients with malignant melanoma

Abstract

Cancer immunotherapy that blocks immune checkpoint molecules, such as PD-1/PD-L1, unleashes dysfunctional antitumor T-cell responses and has durable clinical benefits in various types of cancers. Yet its clinical efficacy is limited to a small proportion of patients, highlighting the need for identifying biomarkers that can predict the clinical response by exploring antitumor responses crucial for tumor regression. Here, we explored comprehensive immune-cell responses associated with clinical benefits using PBMCs from patients with malignant melanoma treated with anti-PD-1 monoclonal antibody. Pre- and post-treatment samples were collected from two different cohorts (discovery set and validation set) and subjected to mass cytometry assays that measured the expression levels of 35 proteins. Screening by high dimensional clustering in the discovery set identified increases in three micro-clusters of CD4⁺ T cells, a subset of central memory CD4⁺ T cells harboring the CD27⁺FAS⁻CD45RA⁻CCR7⁺ phenotype, after treatment in long-term survivors, but not in non-responders. The same increase was also observed in clinical responders in the validation set. We propose that increases in this subset of central memory CD4⁺ T cells in peripheral blood can be potentially used as a predictor of clinical response to PD-1 blockade therapy in patients with malignant melanoma.

http://ift.tt/2E9CX1Q

The immune checkpoint molecule VISTA regulates allergen-specific Th2-mediated immune responses

Abstract

V-domain immunoglobulin suppressor of T-cell activation (VISTA) is a novel immune checkpoint receptor and ligand that regulates T-cell activation. We investigated the functional involvement of VISTA in T_h2 cell-mediated immune responses using an ovalbumin (OVA)-induced allergic asthma model. Treatment with an anti-VISTA monoclonal antibody (mAb) during allergen sensitization increased the production of antibodies, including total IgE, OVA-specific IgG1 and IgG2a and allergen-specific IL-5 and IL-13; it also increased the expression of IL-13 by splenic CD4⁺ T cells. However, treatment with the anti-VISTA mAb during sensitization did not accelerate asthmatic responses, including airway hyper-responsiveness (AHR) or the number of eosinophils in bronchoalveolar lavage (BAL) fluid. In contrast, treatment with the anti-VISTA mAb during allergen challenge significantly augmented AHR and BAL fluid eosinophilia. This treatment also increased the production of IL-5 and IL-13 in BAL fluid and the expression of IL-13 by CD4⁺ T cells in draining lymph nodes. These results suggest that VISTA is involved in the regulation of T_h2 cell generation and T_h2 cell-mediated antibody production and regulates asthmatic responses, especially in the effector phase.

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Sweet syndrome associated with ipilimumab in a patient with metastatic melanoma

http://ift.tt/2DUKguW

Use of a novel 1-hour protocol for rapid frozen section immunocytochemistry, in a case of squamous cell carcinoma treated with Mohs micrographic surgery

Summary

For squamous cell carcinoma (SCC) treated using Mohs micrographic surgery (MMS), interpretation of haematoxylin and eosin-stained frozen sections can be challenging. In these situations, ancillary use of immunostaining is a useful tool for the Mohs surgeon. However, use of immunostaining in MMS laboratories is limited, mainly because current manual immunostaining platforms are subject to operator error, and automated immunostaining, albeit accurate, is too slow for inclusion in MMS. In this report, we describe a novel 1-hour protocol for rapid frozen section immunocytochemistry, using the pancytokeratin markers AE1/AE3. This protocol has been specifically designed to integrate the speed of manual techniques and the accuracy of automated platforms, making it a valuable addition to the MMS laboratory. We propose that in selected or histologically challenging cases, there is a role for the use of this novel protocol, allowing the Mohs surgeon to more confidently declare tumour clearance, thus preventing further unnecessary surgery and preserving healthy tissue.

http://ift.tt/2nEGXgv

Epitope Mapping of Monoclonal Antibody PMab-52 Against Cat Podoplanin

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


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Snap, crackle and pop: when sneezing leads to crackling in the neck

Wanding Yang<br />Jan 15, 2018; 2018:bcr-2016-218906-bcr-2016-218906<br />Rare disease

http://ift.tt/2DWxIPU

Successful treatment of postural orthostatic tachycardia and mast cell activation syndromes using naltrexone, immunoglobulin and antibiotic treatment

Leonard B Weinstock<br />Jan 11, 2018; 2018:bcr-2017-221405-bcr-2017-221405<br />Novel treatment (new drug/intervention; established drug/procedure in new situation)

http://ift.tt/2Exc6KN

Combined transoral–transhyoid endoscopic approach for hypopharyngeal cancer

Endoscopic transoral surgery for hypopharyngeal cancer is an effective treatment option to avoid invasive open surgery or chemoradiation. Here we describe the case of a 66-year-old patient with cT2N0M0 pyriform sinus cancer whom we treated using a transoral–transhyoid endoscopic approach. Using this approach, a transhyoid route was created in addition to the transoral route and used to extirpate the tumor. En bloc resection of the tumor was completed without difficulty. A combined transoral–transhyoid approach is a useful surgical option for treatment of selected patients with hypopharyngeal cancer.

http://ift.tt/2nzI4Pr

Prognostic value of the blink reflex test in Bell’s palsy and Ramsay-Hunt syndrome

This study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell's palsy (BP) or Ramsay Hunt syndrome (RHS).

http://ift.tt/2BQK7mu

Conservative treatment for cutaneous fistula resulted from abscess formation in patients with tuberculous cervical lymphadenitis

This study describes the clinical characteristics and course of conservative treatment using anti-Tb medication and dressing in patients with tuberculous cervical fistula resulting from abscess formation, and to investigate factors prognostic of dressing and treatment duration.

http://ift.tt/2nugLpO

Instrumental head impulse test changes after intratympanic gentamicin for unilateral definite Ménière’s disease: A systematic review and meta-analysis

To estimate how much could intratympanic gentamicin (ITG) interfere with the vestibular-ocular reflex (VOR) parameters on instrumental head impulse test (HIT), either with scleral search coil or video head impulse test and, eventually, foresee the control of vertigo crisis in unilateral intractable Ménière's disease (MD).

http://ift.tt/2BQQXIy

Anatomical anomalies of the Eustachian tube and chronic otitis media

I read with great interest the excellent article titled "Eustachian tube diameter: Is it associated with chronic otitis media development?" by Paltura et al. [1]. The authors measured the Eustachian tube (ET) diameter (ETd) on the diseased and healthy sides of the head in patients with unilateral chronic otitis media (COM) (a tympanic membrane perforation with or without purulent discharge), and found that anatomical anomalies of the ET were correlated with the incidence of COM. We recommend measuring the bony diameter of the ET during routine temporal computed tomography.

http://ift.tt/2DZnHFL

A rare primary leiomyosarcoma of the parotid gland: A case report and literature review

Leiomyosarcoma of the head and neck region is very rare. Primary parotid leiomyosarcoma has only been reported nine times in the medical literature.

http://ift.tt/2nCLn7O

Salvage of recurrence after surgery and adjuvant therapy: A systematic review

To determine the oncologic and functional outcomes of patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma after initial management with surgery and adjuvant therapy.

http://ift.tt/2DX0uDY

Renal protective effect of a hydration supplemented with magnesium in patients receiving cisplatin for head and neck cancer

Our study analyzes the effect of magnesium supplementation on nephrotoxicity in patients receiving cisplatin for head and neck cancer.

http://ift.tt/2s3xuF4

FAMI Screws for Mandibulo-Maxillary Fixation in Mandibular Fracture Treatment – Clinico-radiological Evaluation

Mandibulo-maxillary fixation (MMF) is indispensable for mandibular fracture treatment. Various means for MMF have been proposed, of which arch bars are widely considered to be the mainstay. However, disadvantages to this method have initiated a quest for an alternative, leading to to the introduction of MMF screws. MMF screws have frequently been criticized for poor stability of fracture sites, root damage, hardware failure, and nerve damage. We retrospectively evaluate the FAMI (Fixation and Adaptation in Mandibular Injuries) screw in mandibular fracture treatment by scanning for clinically and radiologically visible complications.

http://ift.tt/2DXEd4S

Establishment of a Finite Element Model of a neonate´s skull to evaluate the stress pattern distribution resulting during Nasoalveolar Molding therapy of cleft lip and palate patients

Nasoalveolar Molding (NAM) is associated with ambivalent acceptance regarding effectiveness and unknown long-term results. Our purpose was to analyze the stress distribution patterns within the viscero- and neurocranium of neonates during the first phase of NAM therapy.A finite element (FE) model of a healthy four-week-old neonate was generated, derived from a computed tomography scan allowing the implementation of a bone-density-dependent material model. The influence of dental germs with variable material properties, the cleft width and area of expected force application were analyzed in a worst-case scenario.

http://ift.tt/2ECALxu

Squamous cell carcinoma of the maxilla: Analysis of clinicopathological predictors for disease recurrence and metastatic behavior

Squamous cell carcinoma of the head and neck (HNSCC) is the sixth most common cancer in the world, accounting for approximately 5% of all malignant tumors (with regional differences) (Torre et al. 2015). Cancer of the maxilla, however, is relatively rare and accounts for only 0.5–5% of oral cancers in general, depending on anatomical classification (Brown et al. 2000, Pathak et al. 2007, Binahmed et al. 2008, Sagheb et al. 2014). While the available literature can point to a large number of epidemiological studies that investigate cancers of the head and neck or the oral cavity in general, few authors have examined maxillary carcinoma exclusively.

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Mechanical stress in plates for bridging reconstruction mandibular defects and purposes of double plate reinforcement

To evaluate the biomechanical performance of a commercially available bridging plate (2.4) as well as screws and bone simulating the reconstruction of hemimandibular defects and to indicate alternatives of reinforcement to prevent plate fractures either by strength or fatigue.

http://ift.tt/2EB6PSq

Evaluation of the safety of a protocol for switching venom immunotherapy products

Venom immunotherapy (VIT) in patients allergic to hymenoptera stings is clearly acknowledged as effective and safe. Safety, in particular, is a pivotal issue that requires the use of standardized products and well-established protocols for the build-up and maintenance phases of VIT1.

http://ift.tt/2EBnBkC

Brain abscess as an initial presentation in a patient of hereditary haemorrhagic telangiectasia caused by a novel ENG mutation

Kai-Hsiang Chen<br />Feb 25, 2013; 2013:bcr2013008802-bcr2013008802<br />case-report

http://ift.tt/2EcWH4H

Marijuana and stoned fruit

The Cannabis sativa plant has various uses depending on the preparation. The flowering tops and leaves from C. sativa, called marijuana, are high in psychoactive compounds and typically smoked. Hemp is the fibrous component of the plant used in the clothing industry, while hemp seeds are a commercial food growing in popularity. C. sativa components can, reportedly, cause various allergic symptoms, including rhinoconjunctivitis, contact urticaria, and anaphylaxis.1,2 The mode of sensitization and role of cross-sensitivity remains unclear.

http://ift.tt/2EBd212

Cytokine-targeting biologics for allergic diseases

Asthma and allergic diseases continue to increase in prevalence, creating a financial burden on the health care system and impacting the quality of life for those who suffer from these diseases. Many intrinsic and extrinsic factors are involved in the initiation and maintenance of the allergic response. Cytokines are proteins with growth, differentiation, and activation functions that regulate and direct the nature of immune responses.

http://ift.tt/2DYvVtH

Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions

Assessment of asthma using clinical measures alone often fails to detect underlying airway inflammation. Fractional exhaled nitric oxide (FeNO) is a recognized biomarker of type 2 airway inflammation in asthma. Measurement of FeNO is instrumental in the assessment and management of patients with corticosteroid-sensitive asthma.

http://ift.tt/2Ezs9I6

Subcutaneous immunoglobulin treatment and thromboembolic risk

Treatment with intravenous immunoglobulin (IVIg) has commonly been used with good results since 1987 in patients with autoimmune neuropathy.

http://ift.tt/2DXNCt7

Occupational asthma caused by high and low-molecular weight agents in an auto body worker

We report the case of a 35-year-old Ecuadorian male, who presented at our center with shortness of breath on moderate exertion, wheezing, dry cough and thoracic oppression. The symptoms worsened at the end of the work day and had been progressing for two years. He had been hospitalized for an asthma exacerbation one year prior and was since treated with on-demand Salbutamol, which he used 3 times weekly, usually at night. He also presented rhinoconjunctivitis symptoms in the spring, was asymptomatic during his summer vacation in Ecuador, smoked occasionally and had no prior diagnosis of asthma.

http://ift.tt/2DXNqKp

From the pages of allergywatch recent advances in food allergy prevention and treatment

Oral immunotherapy to peanut shows promise under age 3

http://ift.tt/2Ey4MyB

Sex hormones, gender and asthma

Asthma is a chronic, heterogeneous disease that ranges from mild, intermittent asthma to severe asthma. In 2015, asthma affected approximately 18 million adults and 6 million children in the United States.1 Asthma is characterized by coughing, wheezing, shortness of breath and/or chest tightness driven by increased airway reactivity, inflammation, and/or mucus production. The majority of patients with asthma have allergic airway inflammation characterized by type 2-mediated airway inflammation.2 However, some patients with asthma have low (or no) type 2-mediated airway inflammation but have increased neutrophils driven by type 1 or IL17-mediated airway inflammation.

http://ift.tt/2DXNgCN

Allergy skin testing: methodological issues on reliability and validity

Sir, I was interested to read the paper by Shtessel M and colleagues published in the Jan 2018 issue of Ann Allergy Asthma Immunol.1 Percutaneous allergen skin testing remains an established benchmark for diagnosing atopic disease. The reliability of skin testing depends greatly on the performance of allergen extracts used, methods used, and the presence of antihistamine medications. The authors aimed to determine the differential effect of cetirizine on 2 different concentrations of histamine control solution and 5 common allergens used for percutaneous skin testing.

http://ift.tt/2EBY8HI

The environment and food allergy

Food allergy (FA) is an immune-mediated adverse reaction to food, which has become an important global public health problem affecting up to 8% of the children and up to 5% of the adults in the USA, UK, Canada, and Australia. 1 Peanut allergy alone affects up to 1.4-4.5% of infants and young children in these countries, reaching epidemic proportions. The prevalence of food-induced anaphylaxis is presumed to have increased significantly.

http://ift.tt/2DVBsB1

Novel oral anticoagulants and HIV: dabigatran use with antiretrovirals

Jacinta Perram<br />Nov 20, 2015; 2015:bcr2015211651-bcr2015211651<br />case-report

http://ift.tt/2FEWS5N

Jellyfish collagen: a new allergen in the beach.

Jellyfish stings are a common event in seas worldwide with an estimated 150 million envenomations annually, usually results in acute cutaneous inflammation but some allergic reactions are also documented.1 Usually the allergy manifests with rashes, erythema, and pruritus and in some cases with even more severe reactions as anaphylasis. Among jellyfish (considering Scyphozoa, Cubozoa and the siphonophore Portuguese man o'war) there are different species, some of them very dangerous; their sting can lead to severe injuries and even death of the individual, mainly from Cubozoa and Siphonophora.

http://ift.tt/2EzXVEV

Global perspectives on food allergy

The prevalence of childhood food allergy has increassed sharply during the past 2 decades. Up to 8% of children in the United States and 11% of Australian infants are food allergic, and the prevalence of peanut allergy is between 1% and 3% in these countries.1 Allergy research has shifted its focus in recent years toward measures aimed at the primary prevention of food allergy in children, such as through dietary interventions in early life. The Learning Early About Peanut Allergy (LEAP) randomized clinical trial enrolled 640 high-risk infants between the ages of 4 and 11 months in the United Kingdom who had severe atopic dermatitis (AD) and/or egg allergy and peanut skin prick test (SPT) responses of 1 to -4 mm.

http://ift.tt/2DWbA7X

Differential diagnosis of soft scalp lumps

Lawrence K Leung<br />Nov 15, 2011; 2011:bcr0720114492-bcr0720114492<br />case-report

http://ift.tt/2FFqU9y

Standard morphology of the oral commissure and changes resulting from reconstruction for defects involving the commissure

The aim of this study was to characterize the standard morphology of the oral commissure and to describe the changes after reconstruction in patients with through-and-through cheek defects involving the oral commissure. Indices for the morphological analyses of the commissure were derived from examinations of 50 normal Japanese volunteers. Ten patients with full-thickness cheek defects involving the commissure were then evaluated. All of these patients underwent free flap reconstruction with vermilion advancement flaps from the remaining vermilion.

http://ift.tt/2FHJiim

Does platelet-rich fibrin have a role in osseointegration of immediate implants? A randomized, single-blind, controlled clinical trial

Immediate implants are a valuable treatment option to replace natural teeth in the aesthetic region. The hypothesis of this randomized controlled clinical trial was that immediate implants grafted with autologous platelet-rich fibrin (PRF) have better clinical and radiographic outcomes than non-grafted controls. Forty-one implants were placed in 31 subjects with one or more non-restorable single-rooted teeth. Autologous PRF was placed in the peri-implant region of the study group (n=21) and no augmentation was done in the control group (n=20).

http://ift.tt/2EcZ4V9

Dynamic analysis of maxillary perfusion during Le Fort I osteotomy using indocyanine green

The aim of this study was to evaluate the dynamic perfusion of the maxilla during various stages of a Le Fort I osteotomy using indocyanine green (ICG) dye angiography. This was a retrospective evaluation of patients who underwent a Le Fort I osteotomy. ICG was used to assess perfusion at specific time points during the procedure. Twenty-four patients underwent a Le Fort I osteotomy with dynamic perfusion ICG angiography. Statistically significant differences in perfusion were noted at all three locations assessed between preoperative (T0), post down-fracture (T1), and postoperative (T2) time points.

http://ift.tt/2FHMw5p

A Systematic Review and Meta-Analysis of the Effects of Topical Nitrates in the Treatment of Primary and Secondary Raynaud’s Phenomenon

Multiple placebo controlled trials have assessed locally applied topical nitrate preparations in treating Raynaud's phenomenon (RP).

http://ift.tt/2ECrwxi

Diacerein Orphan Drug Development for Epidermolysis Bullosa Simplex: A Phase 2/3 Randomized, Placebo-Controlled, Double-Blind Clinical Trial

EBS is a rare genetic, blistering skin disease for which there is no cure. Treatments that address the pathophysiology of EBS are needed.

http://ift.tt/2DWX1RR

Baricitinib in adult patients with moderate-to-severe atopic dermatitis: a phase 2 parallel, double-blinded, randomized placebo-controlled multiple-dose study

Baricitinib, an oral selective inhibitor of Janus kinase (JAK)1 and JAK2, modulates pro-inflammatory cytokine signaling.

http://ift.tt/2EzlZHY

Biocompatibility and efficiency of biodegradable magnesium-based plates and screws in the facial fracture model of beagles

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Byung Jun Kim, Yinglan Piao, Maierdanjiang Wufuer, Woo-Chan Son, Tae Hyun Choi
PurposeA biodegradable magnesium alloy system has been developed as a substitute for conventional plates and screws made of titanium or absorbable polymer. However, previous studies were limited to small animal experiments using screws or wires. In the present study, we preliminarily evaluated the biocompatibility and effectiveness of human standard-sized biodegradable magnesium-based plates and screws in facial fractures of beagles.MethodsFracture lines were created bilaterally in the zygomatic arches of six beagles. They were fixed in situ with plates and screws made of magnesium alloy mixed with calcium and zinc (experimental group) or absorbable polymer (control group). Laboratory testing, radiologic imaging, histological analysis, and mechanical testing were performed 4 weeks postoperatively.ResultsInflammatory reactions were not significantly increased in any animal. Mechanical testing showed higher ultimate load and structural stiffness values in the experimental group. In the histologic analysis, the void area and bone regeneration area were increased in the experimental group, while the implant area and soft tissue area were increased in the control group. Radiologically, three-dimensional micro-computed tomography showed no difference in the bone gap area between the two groups. A temporary increase in hydrogen gas around the magnesium implants regressed spontaneously and did not affect bone healing significantly.ConclusionMagnesium-based biodegradable plates and screws showed good biocompatibility and offered considerable stability for fixating facial bone fractures in the early bone-healing process. These results show the possibilities for the future development of magnesium alloy plates and screws for craniomaxillofacial fixation in humans.



http://ift.tt/2GISMuH

Rhabdomyolysis after Prolonged Surgery: Report of Two Cases and Review of Literature

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rebecca Grammer, Jingping Wang, Edward Lahey
Rhabdomyolysis is a condition in which damaged muscle tissue breaks down and intracellular contents, including myoglobin, are released into circulation. This produces a non-specific clinical syndrome including electrolyte disturbances, hypovolemia, metabolic acidosis, coagulopathies, and risk for acute kidney injury. Rhabdomyolysis has been reported as a complication of prolonged surgical procedures but has rarely been reported in the oral and maxillofacial surgery literature. Early diagnosis and treatment of rhabdomyolysis are important to avoid long-term complications such as renal failure. We present two cases of postoperative rhabdomyolysis following prolonged maxillofacial surgical procedures in which the patients were managed without long-term sequelae. The pathophysiology, risk factors, diagnosis and treatment for postoperative rhabdomyolysis are discussed here with a brief review of the literature.



http://ift.tt/2s5VS8U

Idiopathic isolated unilateral hypoglossal nerve palsy: a report of two cases and review of the literature

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Akio Shibata, Masashi Kimura, Kenichiro Ishiabashi, Masahiro Umemura
Hypoglossal nerve palsy (HNP) is a common finding in neurological diseases when associated with other cranial nerve palsies or further pathology and exhibits characteristic clinical manifestations, including unilateral atrophy of the musculature of the tongue. It occasionally appears as the initial or solitary sign of an intracranial or extracranial space-occupying lesion, head/neck injury, or vascular abnormality of the internal carotid artery. There are few cases of idiopathic isolated unilateral HNP, which should be diagnosed through exclusion. Here, we describe two patients who experienced different outcomes and present a literature review of idiopathic isolated unilateral HNP. Case 1 was a 71-year-old man who was referred with a 1-month history of dysphagia and speech impairment. Intraoral examination revealed marked left-sided hemiatrophy of the tongue and deviation toward the left on protrusion. On coronal Tl-weighted magnetic resonance imaging (MRI), left-sided hemiatrophy of the tongue was clearly visible through the deviation of the median septum to the left. The patient was diagnosed with idiopathic isolated unilateral HNP through exclusion, and was treated with steroids and mecobalamin, but he did not recover. Case 2 was a 32-year-old man complaining of tongue weakness since 2 days. On examination, left HNP was evident, with deviation of the tongue to the left on protrusion. He was diagnosed with idiopathic isolated unilateral HNP through exclusion, and was treated with steroids. After 3 weeks, the patient had completely recovered. To the best of our knowledge, this is the first detailed literature review on idiopathic isolated unilateral HNP. This condition is very rare but should be considered for diagnosis. It warrants a thorough and stepwise approach for etiological diagnosis.



http://ift.tt/2GJDLsT

Syngnathia - Congenital maxillo-mandibular fusion: Case Report and Literature Review.

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Amit Mohan
Congenital maxillo-mandibular fusion is a rare disorder of the craniofacial region. Maintenance of the airway and difficulty in feeding are the main concerns in such patients. We performed a PUBMED search to identify reported cases of syngnathia. In reference to the site of fusion and corresponding anomalies, the available articles were reviewed. The maxillo-mandibular fusion can be anterior fusion, unilateral or bilateral fusion and complete fusion. The condition can be seen as an isolated problem or associated with a syndrome. The condition may require an immediate attention as it can be fatal. A case of isolated unilateral syngnathia has been discussed in this manuscript along with the detailed review of the literature.



http://ift.tt/2s3JMx6

Open reduction and internal fixation of mandibular condylar base and neck fractures using strut plates

Publication date: Available online 2 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Carolin Lechler, Florian Probst, Carl-Peter Cornelius, Wenko Smolka
PurposeEvaluation of the clinical, radiological and functional outcomes of patients with condylar neck or base fractures treated with open reduction and internal fixation using strut plates.Patients and MethodThirty patients with a total of 34 condylar neck and base fractures were included in the study. Transoral endoscopically assisted, submandibular or transparotid approaches were performed. Clinical and radiological outcomes were evaluated. Functional outcomes were assessed with the Helkimo index in a subgroup of 15 patients.ResultsStrut plates were successfully placed through all surgical approaches used in this study. Fracture healing was without complications in 33 condylar processes. One plate fracture occurred. In the subgroup, 7 patients had good functional outcome, 7 had slightly impaired and one patient had moderately impaired functional outcome.ConclusionStrut plates are appropriate for retromandibular transparotid, endoscopic assisted transoral or submandibular approaches in the management of condylar neck or base fractures. Intraoperative handling and fitting accuracy of the strut plates are good. Good to slightly impaired functional outcome was observed in a subgroup of patients.



http://ift.tt/2GHYqNT

Streptococcus anginosus dental implant-related osteomyelitis of the jaws: An insidious and calamitous entity

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sybille Chatelain, Tommaso Lombardi, Paolo Scolozzi
PurposeTo analyze a series of patients with dental implant-related suppurative osteomyelitis of the jaws (DIOMJ) due to Streptococcus anginosus.Patients and MethodsThe charts of all patients seen for osteomyelitis of the jaws between 2011 and 2016 were reviewed. The primary outcome variable was Streptococcus anginosus DIOMJ. Other variables included age, gender, smoking habits, associated co-morbidities, dental implant localization, type of osteomyelitis, delay between dental implant placement and DIOMJ, microbiological examination and antibiogram, antibiotherapy, type of surgery and final outcome.Cases from previous reports of DIOMJ in the literature were also analyzed for comparison.Descriptive statistics were computed.Results26 patients had jaw osteomyelitis, of whom 6 (26%) occurred after dental implant placement. S. anginosus was found in 5 patients and Escherichia coli in one. The osteomyelitis was located in the mandible and associated with a deep neck abscess in all cases. All of the patients were women and were either smokers or had co-morbidities affecting bone metabolism. In all of the cases, dental implants were removed and several surgical debridement procedures (at least two) and prolonged antibiotherapy (6 months on average) were needed. Half of the patients needed a radical surgical reconstructive procedure with partial resection and bone graft.ConclusionThis study demonstrated that Streptococcus anginosus DIOMJ is a particularly aggressive form of osteomyelitis, which has a propensity to develop in the mandible in women in their 60s who are either smokers or have co-morbidities.



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Management of Bilateral Edentulous Mandible Fractures through an Intraoral Approach Using CAD/CAM Technology: A Case Report

Publication date: Available online 31 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Howard D. Wang, Christopher Frost, Alessandro Cusano, Amir H. Dorafshar
Surgical management of edentulous mandible fractures presents unique challenges secondary to poor bone stock and the absence of dentition to assist with fracture reduction. In complex injury patterns, such as bilateral edentulous mandible fractures, an external approach is often necessary to achieve adequate reduction and adaptation of a load-bearing reconstruction plate. We report a case in which computer-assisted design/computer-assisted manufacturing (CAD/CAM) was applied as an adjunct for the acute management of a 58-year-old man with bilateral edentulous mandible fractures. CAD/CAM technology was used to fabricate a patient-specific reconstruction plate and a maxillomandibular splint, which facilitated the successful treatment of this complex injury through an intraoral approach. This case highlights the potential of CAD/CAM technology to improve operative efficiency and clinical outcomes in the acute management of complex edentulous mandible fractures.



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Significant association of increased PD-L1 and PD-1 expression with nodal metastasis and a poor prognosis in oral squamous cell carcinoma

Publication date: Available online 1 February 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Y. Maruse, S. Kawano, T. Jinno, R. Matsubara, Y. Goto, N. Kaneko, T. Sakamoto, Y. Hashiguchi, M. Moriyama, T. Toyoshima, R. Kitamura, H. Tanaka, K. Oobu, T. Kiyoshima, S. Nakamura
Programmed cell death ligand 1 (PD-L1) and its receptor PD-1 are immune checkpoint molecules that attenuate the immune response. Blockade of PD-L1 enhances the immune response in a variety of tumours and thus serves as an effective anti-cancer treatment. However, the biological and prognostic roles of PD-L1/PD-1 signalling in oral squamous cell carcinoma (OSCC) remain to be elucidated. The purpose of this study was to examine the correlation of PD-L1/PD-1 signalling with the prognosis of OSCC patients to assess its potential therapeutic relevance. The expression of PD-L1 and of PD-1 was determined immunohistochemically in 97 patients with OSCC and the association of this expression with clinicopathological characteristics was examined. Increased expression of PD-L1 was found in 64.9% of OSCC cases and increased expression of PD-1 was found in 61.9%. Univariate and multivariate analysis revealed that increased expression of PD-L1 and PD-1 positively correlated with cervical lymph node metastasis. The expression of CD25, an activated T-cell marker, was negatively correlated with the labelling index of PD-L1 and PD-1. Moreover, the patient group with PD-L1-positive and PD-1-positive expression showed a more unfavourable prognosis than the group with PD-L1-negative and PD-1-negative expression. These data suggest that increased PD-L1 and PD-1 expression is predictive of nodal metastasis and a poor prognosis and is possibly involved in cancer progression via attenuating the immune response.



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Otosclerosis

Otosclerosis is pathologically characterized by abnormal bony remodeling, which includes bone resorption, new bone deposition, and vascular proliferation in the temporal bone. Sensorineural hearing loss in otosclerosis is associated with extension of otosclerosis to the cochlear endosteum and deposition of collagen throughout the spiral ligament. Persistent or recurrent conductive hearing loss after stapedectomy has been associated with incomplete footplate fenestration, poor incus-prosthesis connection, and incus resorption in temporal bone specimens. Human temporal bone pathology has helped to define the role of computed tomography imaging for otosclerosis, confirming that computed tomography is highly sensitive for diagnosis, yet limited in assessing cochlear endosteal involvement.

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International consensus (ICON) on comprehensive management of the laryngeal nerves risks during thyroid surgery

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Périé, J. Santini, H.Y. Kim, H. Dralle, G.W. Randolph
The laryngeal monitoring of the inferior and superior laryngeal nerves, and the vagus nerve, has advanced for last years, in practice of thyroid and parathyroid surgery. Different methods are used, using direct or indirect laryngeal stimulation and also intermittent or continuous nerve registration. At present time, various recommendations of it in the world use are reported, and availability of the tool used remains a limit in some countries. The aim of this Icon during Ifos 2017 was to share knowledge about laryngeal intraoperative nerve monitoring (LIONM) procedures and to evaluate current practices used to improve the quality of thyroid and parathyroid surgery. Benefits of LIONM were discussed with three experts (Pr G. Randolph from Boston, Pr Henning Dralle from Halle in Germany, Pr Hoon Yub KIM from Seoul). All of them have been actively involved in the development and use of laryngeal nerve monitoring during thyroid and parathyroid surgery.



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International consensus (ICON) on assessment of oropharyngeal dysphagia

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): F. Espitalier, A. Fanous, J. Aviv, S. Bassiouny, G. Desuter, N. Nerurkar, G. Postma, L. Crevier-Buchman
ObjectiveTo present international recommendations regarding the proper evaluation of oropharyngeal dysphagia (OD), both objectively and subjectively (self-evaluation).MethodsFollowing a thorough review of the literature, 5 experts in the field from 4 different continents answered separately a questionnaire regarding the work-up of OD. Individual answers were presented and discussed during the world ENT conference that was held in Paris in June 2017. This article will present the recommendations issued from that meeting.ResultsFor the initial objective assessment of OD, it is recommended to perform either a functional endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallowing study (VFSS). FEES is the more popular investigation given its increased ease of use and accessibility. When evaluating for the presence of aspiration during the objective evaluation of OD, it is recommended to perform either a FEES or a VFSS. In this case, FEES is the favored investigation given its likely increased sensitivity. In order to highlight the presence of oropharyngeal food residue following the deglutition process, it is recommended to perform either a FEES or a VFSS; FEES likely being the more sensitive investigation while VFSS allows a better quantification of the amount of pharyngeal residue. Is it also recommended to objectify the quality of the deglutition process by means of a score during the objective evaluation of OD. Finally, it is recommended to utilize a self-evaluation questionnaire during research studies exploring the deglutition process.



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International consensus (ICON) on audiological assessment of hearing loss in children

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Farinetti, A. Raji, H. Wu, B. Wanna, C. Vincent
The prevalence of hearing loss in newborns and infants is estimated between 1 to 3.47 cases per 1000 live births. Early diagnosis and rehabilitation of congenital hearing loss are mandatory in order to achieve a satisfactory linguistic and cognitive development. Without appropriate opportunities to learn language, these children will fall behind their normal hearing peers in communication, cognition, reading and socio-emotional development. After promising results, neonatal screening for hearing loss and audiological evaluation are becoming more extensively carried out. In planning universal neonatal hearing screening programs, transient evoked otoacoustic emissions and auditory brainstem responses are the gold standard for the screening and diagnosis program. However, there is no consensus regarding the use of audiometry and other electrophysiological tests (such as auditory steady-state responses) in current practices. Several screening and audiological assessment procedures have been described and advocated all around the world. But, a systematic scheme of performing diagnosis in the pediatric audiology population is lacking. A consensus conference was held at the International Federation of Oto-rhino-laryngological Societies Congress, in June 2017, to discuss the different current practices and to identify the best neonatal hearing screening and audiological assessment management. This article is intended to provide professionals with recommendations about the "best practice" based on consensus opinion of the session's speakers, and a review of the literature on the efficacy of various assessment options for children with hearing loss.



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Forestier syndrome and obstructive sleep apnea: Surgical treatment

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D.K. Ribeiro, J.A. Pinto, G.S. Freitas
IntroductionWe report a case of obstructive sleep apnea that occurred as a result of Forestier disease and describe the surgical treatment that was performed.SummaryThe patient is a 56-year-old man who presented dysphagia for solids and liquids, snoring (score 10) and excessive daytime sleepiness for 5 years. On fiber optic laryngoscopy examination, there was interarytenoid edema and protrusion of the posterior wall of the larynx. The cervical X-Ray showed protrusion of intervertebral disc between C3–C5 (skeletal hyperostosis) and the polysomnography revealed apnea-hypopnea index (AHI) of 56 events/h. Surgery was performed by the otorhinolaryngology and orthopedic teams. The patient evolved with complete symptom resolution and an AHI of 3,9 events/h on the control polysomnography.DiscussionsThis is the first reported case of Forestier Syndrome (FS) associated with Obstructive Sleep Apnea (OSA) that was proposed surgical treatment and the patient evolved with complete symptom improvement.



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International consensus (ICON) on treatment of sudden sensorineural hearing loss

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Marx, E. Younes, S.S. Chandrasekhar, J. Ito, S. Plontke, S. O'Leary, O. Sterkers
Sudden sensorineural hearing loss (SSNHL) is a common and alarming symptom that often prompts an urgent visit to an ENT specialist. Treatment of SSNHL remains one of the most problematic issues for contemporary otorhinolaryngology: although many meta-analyses and national guidelines have been issued, management is not standardized in terms of medical treatment, and duration and route of administration. We present several methodological suggestions for the study of treatments for SSNHL. These were developed from the existing level of evidence of the main treatments used in SSNHL by experts who convened at the IFOS 2017 ENT World Congress in Paris, France. All panelists agreed that one of the main limitations present in studies on SSNHL is related to the wide heterogeneity, which characterizes both the initial hearing deficit and the amount of hearing recovery. Although evidence of the efficacy of systemic steroids cannot be considered as strong enough to recommend their use, it is still the most widespread primary therapy and can be considered as the current standard of care. Therefore, systemic steroids stand as an adequate control for any innovative treatment. To reduce the number of subjects we suggest that the inclusion criteria should be restricted to moderate to profound levels of hearing loss. The efficacy of trans-tympanic steroids as a salvage therapy was suggested in several reports on small populations and needs to be confirmed with larger randomized controlled trials.



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International consensus (ICON) on functional and aesthetic rhinoplasty

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Albert, F. Simon, A.-J. Tasman, D. Chua, R. Grigg, A. Jaklis, T. Wang, F. Disant
During the 2017 IFOS international congress in Paris, a roundtable discussion on the topic of functional and aesthetic rhinoplasty was organised. Five experts, from the five continents and renown in the field of rhinoplasty, were brought together to discuss the issue from an international perspective and to put forward a consensus or on the contrary practical differences. Five questions were put to the experts beforehand to guarantee independent answers, which were then discussed during the roundtable. The questions were the following:– What are the age limits for achieving a rhinoplasty?– Do you use objective measurements before, during and after surgery? (facial landmarks, airflow, peroperative measurements)– How do you manage the preoperative general information and computer imaging of the patient?– What are the indications in your practice to perform a CT-scan or endoscopic examination before doing a rhinoplasty?– What kind of graft or prosthesis do you use for an augmentation rhinoplasty? This paper offers a synthesis of the roundtable based on the experts' answers to the different questions.



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An unusual neck tumor

Publication date: Available online 1 February 2018
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Gaudreau, A. Belisle, T. Ayad




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Patient Concerns Inventory (at diagnosis) and intention to treat

Treatment of head and neck cancer is often radical, with patients going through considerable emotional distress at some point before, during, or after treatment.1 Both disease and treatment can adversely affect the health-related quality of life.2 For patients to be involved with making decisions about their care, it is crucial that they are able to communicate their needs and concerns effectively.3 Care can be improved by screening problems, thereby facilitating effective management of resources and provision of appropriate interventions.

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Transdermal scopolamine for the prevention of a salivary fistula after parotidectomy

Our aim was to investigate whether perioperative transdermal application of scopolamine could help to prevent fistulas after parotidectomy, and to this end we retrospectively studied the records of all patients (n=645) who had benign parotid tumours treated by partial parotidectomy between 2011 and 2016. We found that scopolamine led to a significant decrease in the incidence of salivary fistulas from 54/371(15%) in the group not given it to 10/274 (4%) in the group given it (p<0.0001). The "number needed to treat" was 9.17.

http://ift.tt/2DU9Foy

Pink1 attenuates propofol-induced apoptosis and oxidative stress in developing neurons

Abstract

Background

The underlying mechanisms of propofol-induced neurotoxicity in developing neurons are still not completely understood. We examined the role of PTEN-induced kinase 1 (Pink1), an antioxidant protein, in propofol-induced apoptosis in developing neurons.

Materials and methods

Primary hippocampal neurons isolated from neonatal Sprague–Dawley rats were exposed to propofol 20 μM for 2, 4, 6 and 12 h. Subsequently, neurons underwent overexpression and knockdown of Pink1, followed by propofol exposure (20 μM, 6 h). Neuron apoptosis was detected by terminal transferase deoxyuridine triphosphate-biotin nick-end labeling (TUNEL). Reactive oxygen species (ROS) production in neurons was detected by using a 2,7-dichlorodihydro-fluorescein diacetate probe and target protein or mRNA levels were analyzed by Western blotting or real-time polymerase chain reaction.

Results

Propofol treatment time-dependently increased the number of TUNEL-positive neurons and the expression levels of cleaved caspase-3 and B-cell lymphoma 2 (BcL-2) associated X protein, but decreased expression levels of BcL-2. Furthermore, propofol treatment time-dependently reduced the expression levels of Pink1 mRNA and protein. ROS production and the markers of oxidative stress, 2,4-dinitrophenol and 4-hydroxynonenal, were increased by propofol treatment. However, these propofol-induced changes were significantly restored by Pink1 overexpression.

Conclusions

Pink1 plays an important role in neuronal apoptosis induced by propofol. Our results may provide some new insights in propofol-induced neurotoxicity in developing neurons.

http://ift.tt/2EdX7YN

Quick reference tidal volume cards reduce the incidence of large tidal volumes during surgery

Abstract

Ventilation with large tidal volumes (V _T), greater than 10 ml/kg of predicted body weight (PBW), is associated with worse outcomes in critically ill and surgical patients. We hypothesized that the availability of quick reference cards with proposed V _T ranges specific to gender and different heights would reduce the intraoperative use of large V _T during prolonged abdominal surgery. We compared retrospectively the incidence of median V _T used during prolonged (≥4-h-long) abdominal surgery before ("before") and after ("after") the quick reference V _T cards were made available in all anesthesia machines in operating rooms of a single academic US medical center. We evaluated the effect of the intervention on the primary outcome while adjusting for previously identified risk factors of large V _T use: female gender, obesity (body mass index, BMI > 30), and short height (< 165 cm). The frequency of V _T > 10 ml/kg PBW was 15.1% in the before group and 4.3% in the after group (p < 0.001). The frequency of large V _T used during abdominal surgery was significantly decreased after the intervention even after adjusting for female gender, obesity or short height [adjOR 0.11 (95% CI 0.04–0.30)]. Our quick reference V _T cards significantly reduced the frequency of large V _T use during abdominal surgery.

http://ift.tt/2FEPYOd

HANP on renal damage during cardiac surgery

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Central noradrenergic activity affects analgesic effect of Neuropeptide S

Abstract

Background

Neuropeptide S (NPS) is an endogenous neuropeptide controlling anxiolysis, wakefulness, and analgesia. NPS containing neurons exist near to the locus coeruleus (LC) involved in the descending anti-nociceptive system. NPS interacts with central noradrenergic neurons; thus brain noradrenergic signaling may be involved in NPS-induced analgesia. We tested NPS analgesia in noradrenergic neuron-lesioned rats using a selective LC noradrenergic neurotoxin, N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4).

Methods

A total 66 male Sprague–Dawley rats weighing 350–450 g were used. Analgesic effects of NPS were evaluated using hot-plate and tail-flick test with or without DSP-4. The animal allocated into 3 groups; hot-plate with NPS alone intracerebroventricular (icv) (0.0, 1.0, 3.3, and 10.0 nmol), tail-flick NPS alone icv (0.0 and 10.0 nmol), and hot-plate with NPS and DSP-4 (0 or 50 mg/kg ip). In hot-plate with NPS and DSP-4 group, noradrenaline content in the cerebral cortex, pons, hypothalamus, were measured.

Results

NPS 10 nmol icv prolonged hot plate (%MPE) but not tail flick latency at 30 and 40 min after administration. DSP-4 50 mg/kg decreased noradrenaline content in the all 3 regions. The NA depletion inhibited NPS analgesic effect in the hot plate test but not tail flick test. There was a significant correlation between hot plate latency (percentage of maximum possible effect: %MPE) with NPS 10 nmol and NA content in the cerebral cortex (p = 0.017, r ² = 0.346) which noradrenergic innervation arisen mainly from the LC. No other regions had the correlation.

Conclusions

NPS analgesia interacts with LC noradrenergic neuronal activity.

http://ift.tt/2FDB9LA

Effect of dexmedetomidine for attenuation of propofol injection pain in electroconvulsive therapy: a randomized controlled study

Abstract

Purpose

Current analgesic strategies for propofol injection pain may cause adverse reactions during electroconvulsive therapy (ECT), such as shortening seizure duration. This study investigated whether dexmedetomidine could attenuate propofol injection pain in ECT.

Methods

Participants were randomly allocated to receive 0.2 μg/kg dexmedetomidine (Dex-0.2 group), 0.5 μg/kg dexmedetomidine (Dex-0.5 group) or saline (control group) prior to ECT. The composite pain scale and objective Surgical Pleth Index (SPI) were used to measure the intensity of injection pain, and the percentage of patients with pain score > 2 was the primary outcome.

Results

Of 137 patients recruited, 46 were assigned to each of the Dex-0.2 or Dex-0.5 groups, while 45 were in the control group. The percentage of pain score > 2 was reduced from 68.9% (31/45) in the control group to 34.8% (16/46) in the Dex-0.2 group (P < 0.001) and 15.2% (7/46) in the Dex-0.5 group (P < 0.001). The pain score and SPI at 5 s after propofol injection were greater in the control group than in the Dex-0.2 [pain scores 3 (2–4) vs. 1 (1–3), P < 0.001, SPI 76.6 ± 10.0 vs. 58.0 ± 11.0, P < 0.001] and Dex-0.5 groups [pain scores 3 (2–4) vs. 1 (0–1), P < 0.001, SPI 76.6 ± 10.0 vs. 51.2 ± 12.3, P < 0.001]. There were no significant differences in seizure duration between the three groups. No patients developed bradycardia and hypotension.

Conclusions

Pretreatment with dexmedetomidine was able to reduce the propofol injection pain in ECT without interfering with the seizure duration and causing adverse effects such as bradycardia and hypotension. In addition, close monitoring of hemodynamic variables and preparation of a treatment plan and drugs for bradycardia are essential.

http://ift.tt/2E7vBfr

Association between fentanyl test results and rescue morphine requirements in children after adenotonsillectomy

Abstract

Purpose

Preoperative sleep study helps to predict post-adenotonsillectomy morphine requirements. However, in some institutions, many suspected children with obstructive sleep apnoea syndrome have an adenotonsillectomy without polysomnography assessments. This study investigated the relationship between the results of a fentanyl test performed before extubation and the postoperative morphine requirements in children after adenotonsillectomy.

Methods

Intravenous fentanyl (1 µg/kg) was given as a test before extubation when spontaneous ventilation was restored in 80 children aged 3–7 years who underwent adenotonsillectomy. The result was considered positive if the patient's respiratory rate decreased >50% after the test. In the recovery room, pain was assessed every 10 min using the Children's Hospital of Eastern Ontario Pain Scale. Rescue morphine (10 µg/kg) was given when the score was ≥6.

Results

The median [IQR (range)] cumulative morphine consumption rates for children with a positive result (n = 25) and a negative result (n = 52) were 30 (20, 40) and 50 (40, 50) µg/kg, respectively (P = 0.002). Eighty-eight percent of the positive-result patients and 48% of the negative-result patients were light consumers of morphine (cumulative dose <50 µg/kg) (P = 0.001).

Conclusions

We conclude that children with a positive result after a fentanyl test require less morphine to achieve comfort than those with a negative result.

ClinicalTrials.gov ID

NCT02484222.

http://ift.tt/2FHwxnL

Perioperative respiratory complications: current evidence and strategy discussed in 2017 JA symposium

Abstract

Respiratory management during general anesthesia aims to safely secure the airway and maintain adequate ventilation to deliver oxygen to the vital organs, maintaining homeostasis even during surgery. Despite its clinical importance, anesthesiologists often encounter difficulties in properly managing respiration during the perioperative period, leading to severe respiratory complications. In this year's JA symposium, 5 editorial board members of Journal of Anesthesia (JA) who are experts in the field of respiratory management in anesthesia discussed the following topics: quitting smoking before surgery: exposure to passive smoke is damaging to children, ventilator-associated pneumonia, high inspiratory oxygen concentration and lung injury, aspiration pneumonia, and postoperative respiratory management strategy in patients with obstructive sleep apnea. We hope that this special article regarding this year's JA symposium may be useful for JA readers to manage clinical anesthesia on a daily basis.

http://ift.tt/2EaCVXn

Performance of the 2012 systemic lupus international collaborating clinics classification criteria versus the 1997 American College of Rheumatology Classification Criteria in adult and juvenile systemic lupus Erythematosus. A systematic review and meta-analysis

Publication date: Available online 31 January 2018
Source:Autoimmunity Reviews
Author(s): Esther A.R. Hartman, Annet van Royen-Kerkhof, Johannes W.G. Jacobs, Paco M.J. Welsing, Ruth D.E. Fritsch-Stork
ObjectiveTo evaluate the performance in classifying systemic lupus erythematosus by the 2012 Systemic Lupus International Collaborating Clinics criteria (SLICC'12), versus the revised American College of Rheumatology criteria from 1997 (ACR'97) in adult and juvenile SLE patients.MethodsA systematic literature search was conducted in PubMed and Embase for studies comparing SLICC'12 and ACR'97 with clinical diagnosis. A meta-analysis was performed to estimate the sensitivity and specificity of SLICC'12 and ACR'97. To assess classification earlier in the disease by either set, sensitivity and specificity were compared for patients with disease duration <5 years. Sensitivity and specificity of individual criteria items were also assessed.ResultsIn adult SLE (nine studies: 5236 patients, 1313 controls), SLICC'12 has higher sensitivity (94.6% vs. 89.6%) and similar specificity (95.5% vs. 98.1%) compared to ACR'97. For juvenile SLE (four studies: 568 patients, 339 controls), SLICC'12 demonstrates higher sensitivity (99.9% vs. 84.3%) than ACR'97, but much lower specificity (82.0% vs. 94.1%). SLICC'12 classifies juvenile SLE patients earlier in disease course. Individual items contributing to diagnostic accuracy are low complement, anti-ds DNA and acute cutaneous lupus in SLICC'12, and the immunologic and hematologic disorder in ACR'97.ConclusionBased on sensitivity and specificity SLICC'12 is best for adult SLE. Following the view that higher specificity, i.e. avoidance of false positives, is preferable, ACR'97 is best for juvenile SLE even if associated with lower sensitivity. Our results on the contribution of the individual items of SLICC'12 and ACR´97 may be of value in future efforts to update classification criteria.



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Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians

Publication date: Available online 31 January 2018
Source:Autoimmunity Reviews
Author(s): Kwang Seob Lee, Andreas Kronbichler, Michael Eisenhut, Keum Hwa Lee, Jae Il Shin
Systemic autoimmune diseases can affect various kinds of organs including the kidney, the skin, soft tissue and the bone. Among others, cardiovascular involvement in rheumatic diseases has been shown to affect myocardium, pericardium, cardiac vessels, conduction system and valves, eventually leading to increased mortality. In general, underlying chronic inflammation leads to premature atherosclerosis, but also other manifestations such as arrhythmia and heart failure may have a 'silent' progress. Traditional cardiovascular risk factors play a secondary role, while disease-specific factors (i.e. disease duration, severity, antibody positivity, persistent disease activity) can directly influence the cardiovascular system. Therefore, early diagnosis is critical to optimize management and to control inflammatory activity and recent data suggest that risk factors (i.e. hypercholesterolemia and hypertension) need intensive treatment as well. With the advent of immunosuppressive agents, most rheumatic diseases are well controlled on treatment, but information related to their cardioprotective efficacy is not well-defined. In this review, we focus on cardiovascular involvement in rheumatic diseases and highlight current evidence which should be of help for the treating physicians. Moreover, cardiotoxicity of immunosuppressive drugs is a rare issue and such potential adverse events will be briefly discussed.



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The anti-inflammatory effects of statins on patients with rheumatoid arthritis: A systemic review and meta-analysis of 15 randomized controlled trials

Publication date: Available online 31 January 2018
Source:Autoimmunity Reviews
Author(s): Guo-min Li, Jie Zhao, Bing Li, Xiao-fei Zhang, Jian-xiong Ma, Xin-long Ma, Jun Liu
BackgroundOver the past several years, numerous studies investigated the anti-inflammatory effects of statin on patients with RA. However, the findings of the individual studies were often inconsistent or conflicting.Materials and methodsThe Pubmed, Web of Science, Embase, Cochrane Library and CNKI literature databases were searched in order to identify randomized controlled clinical trials where the association between the anti-inflammatory effect of statin and RA was investigated. Two researchers performed data extraction from eligible independently. Quality parameters and risk of bias in the included studies were assessed according to Cochrane's guidelines. The pooled Standardized Mean Difference (SMD) with a 95%CI was used to assess the anti-inflammatory effect of statin in patients with RA.ResultsFifteen randomized controlled clinical, classified as "high quality" and with a relatively low risk of selection bias, were included in the meta-analysis. Of these, eight reported that there was no difference in the level of serum total lipids between the atorvastatin-treated and the conventional treatment group. However, the pooled analysis showed that atorvastatin could increase the level of serum amount of high-density lipoprotein (HDL) in RA patients by approximately x ± SD95% [HDL: SMD = 0.807, 95%CI = (0.187, 1.426), p = .011]. Meanwhile atorvastatin could reduce the level of serum low-density lipoprotein (LDL), total cholesterol (TC), and triglyceride (TG) in RA patient by x ± SD95% [LDL: SMD = −4.015, 95%CI = (−5.848, −2.183), p = .000; TC: SMD = −4.497, 95%CI = (−6.457, −2.537), p = .000; TG: SMD = −1.475, 95%CI = (−2.352, −0.599), p = .001]. Nine studies reported a change in C-Reactive Protein (CRP) after atorvastatin treatment, and the pooled analysis showed that atorvastatin decreased CRP in RA patients by x ± SD95% [SMD = −3.033, 95%CI = (−4.460, −1.606), p = .000]. Seven studies investigated the change of Erythrocyte Sedimentation Rate (ESR), and the pooled analysis showed that atorvastatin decreased ESR by x ± SD95% [SMD = −2.097, 95%CI = (−3.408, −0.786), p = .002]. Nine studies reported the improvement of disease activity score in RA patients after taking atorvastatin for 12 weeks, and the pooled analysis showed atorvastatin could decrease the DAS28 score in RA patients by x ± SD95% [SMD = −2.001, 95%CI = (−3.191, −0.811), p = .001].ConclusionsStatins have a significant anti-inflammatory effect in RA patients. However, atorvastatin was superior to simvastatin both in terms of its anti-inflammatory and lipid-lowering activities.



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Vitamin D and juvenile systemic lupus erythematosus: Lights, shadows and still unresolved issues

Publication date: Available online 31 January 2018
Source:Autoimmunity Reviews
Author(s): Stefano Stagi, Donato Rigante
Systemic lupus erythematosus (SLE) and juvenile SLE (jSLE) are autoimmune disorders naturally associated with several genetic, environmental, hormonal, and immunological contributing factors. It has been assumed that vitamin D deficiency may have a role in the immune activation of patients with SLE and play an active part in many comorbidities and even complications. A host of clinical studies suggested that vitamin D exerts inhibitory effects on many immunological abnormalities associated with SLE, also in children and adolescents, while different reports have hypothesized that vitamin D may be associated with accelerated cardiovascular disease in SLE. This review updates and summarizes the information related to the immunoregulatory effects of vitamin D and its importance in jSLE, discusses the innumerable correlations between vitamin D and disease activity, including clinical expression and gene polymorphisms of vitamin D receptor as well as the recommendations for vitamin D supplementation in these patients. Despite the excitement raised by many data obtained about vitamin D and its influence on several aspects of the disease, further well-designed perspective trials are required to define the exact role that vitamin D may have in the management of both SLE and jSLE.



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Genetic risk factors in thrombotic primary antiphospholipid syndrome: A systematic review with bioinformatic analyses

Publication date: Available online 19 January 2018
Source:Autoimmunity Reviews
Author(s): Md. Asiful Islam, Shahad Saif Khandker, Fahmida Alam, Mohammad Amjad Kamal, Siew Hua Gan
BackgroundAntiphospholipid Syndrome (APS) is an autoimmune multifactorial disorder. Genetics is believed to play a contributory role in the pathogenesis of APS, especially in thrombosis development and pregnancy morbidity. In the last 20 years, extensive research on genetic contribution on APS indicates that APS is a polygenic disorder, where a number of genes are involved in the development of its clinical manifestations.AimsThe aim of this systematic review is to evaluate the genetic risk factors in thrombotic primary APS. Additionally, to assess the common molecular functions, biological processes, pathways, interrelations with the gene encoded proteins and RNA-Seq-derived expression patterns over different organs of the associated genes via bioinformatic analyses.MethodsWithout restricting the year, a systematic search of English articles was conducted (up to 4th September 2017) using Web of Science, PubMed, Scopus, ScienceDirect and Google Scholar databases. Eligible studies were selected based on the inclusion criteria. Two researchers independently extracted the data from the included studies. Quality assessment of the included studies was carried out using a modified New-Castle Ottawa scale (NOS).ResultsFrom an initial search result of 2673 articles, 22 studies were included (1268 primary APS patients and 1649 healthy controls). Twenty-two genes were identified in which 16 were significantly associated with thrombosis in primary APS whereas six genes showed no significant association with thrombosis. Based on the NOS, 14 studies were of high quality while 6 were low quality studies. From the bioinformatic analyses, thrombin-activated receptor activity (q = 6.77 × 10⁻⁷), blood coagulation (q = 2.63 × 10⁻¹⁵), formation of fibrin clot (q = 9.76 × 10⁻¹⁰) were the top hit for molecular function, biological process and pathway categories, respectively. With the highest confidence interaction score of 0.900, all of the thrombosis-associated gene encoded proteins of APS were found to be interconnected except for two. Based on the pathway analysis, cumulatively all the genes affect haemostasis [false discovery rate (FDR) = 1.01 × 10⁻⁸] and the immune system [FDR = 9.93 × 10⁻²]. Gene expression analysis from RNA-Seq data revealed that almost all the genes were expressed in 32 different tissues in the human body.ConclusionAccording to our systematic review, 16 genes contribute significantly in patients with thrombotic primary APS when compared with controls. Bioinformatic analyses of these genes revealed their molecular interconnectivity in protein levels largely by affecting blood coagulation and immune system. These genes are expressed in 32 different organs and may pose higher risk of developing thrombosis anywhere in the body of primary APS patients.



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Bicaudal D2 is a novel autoantibody target in systemic sclerosis that shares a key epitope with CENP-A but has a distinct clinical phenotype

Publication date: Available online 31 January 2018
Source:Autoimmunity Reviews
Author(s): Marvin J. Fritzler, Marie Hudson, May Y. Choi, Michael Mahler, Mianbo Wang, Chelsea Bentow, Jay Milo, Murray Baron
We studied the clinical correlations and epitopes of autoantibodies directed to a novel autoantigen, Bicaudal D (BICD2), in systemic sclerosis (SSc) and reviewed its relationship to centromere protein A (CENP-A). 451 SSc sera were tested for anti-BICD2 using a paramagnetic bead immunoassay and then univariate and multivariate logistic regression was used to study the association between anti-BICD2 and demographic and clinical parameters as well as other SSc-related autoantibodies. Epitope mapping was performed on solid phase matrices. 25.7% (116/451) SSc sera were anti-BICD2 positive, of which 19.0% had single specificity anti-BICD2 and 81.0% had other autoantibodies, notably anti-CENP (83/94; 88.3%). Compared to anti-BICD2 negative subjects (335/451), single specificity anti-BICD2 subjects were more likely to have an inflammatory myopathy (IM; 31.8% vs. 9.6%, p = .004) and interstitial lung disease (ILD; 52.4% vs. 29.0%, p = .024). Epitope mapping revealed a serine- and proline-rich nonapeptide SPSPGSSLP comprising amino acids 606–614 of BICD2, shared with CENP-A but not CENP-B. We observed that autoantibodies to BICD2 represent a new biomarker as they were detected in patients without other SSc-specific autoantibodies and were the second most common autoantibody identified in this SSc cohort. Our data indicate that the major cross-reactive epitope is associated with anti-CENP-A but, unlike anti-CENP, single specificity anti-BICD2 antibodies associate with ILD and IM.



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Genetics of immunoglobulin-A vasculitis (Henoch-Schönlein purpura): An updated review

Publication date: Available online 17 January 2018
Source:Autoimmunity Reviews
Author(s): Raquel López-Mejías, Santos Castañeda, Fernanda Genre, Sara Remuzgo-Martínez, F. David Carmona, Javier Llorca, Ricardo Blanco, Javier Martín, Miguel A. González-Gay
Immunoglobulin-A vasculitis (IgAV) is classically a childhood small-sized blood vessel vasculitis with predominant involvement of the skin. Gastrointestinal and joint manifestations are common in patients diagnosed with this condition. Nephritis, which is more severe in adults, constitutes the most feared complication of this vasculitis. The molecular bases underlying the origin of IgAV have not been completely elucidated. Nevertheless, several pieces of evidence support the claim that genes play a crucial role in the pathogenesis of this disease. The human leukocyte antigen (HLA) region is, until now, the main genetic factor associated with IgAV pathogenesis. Besides a strong association with HLA class II alleles, specifically HLA-DRB1 alleles, HLA class I alleles also seem to influence on the predisposition of this disease. Other gene polymorphisms located outside the HLA region, including those coding cytokines, chemokines, adhesion molecules as well as those related to T-cells, aberrant glycosylation of IgA1, nitric oxide production, neoangiogenesis, renin-angiotensin system and lipid, Pyrin and homocysteine metabolism, may be implicated not only in the predisposition to IgAV but also in its severity. An update of the current knowledge of the genetic component associated with the pathogenesis of IgAV is detailed in this review.



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Altered B lymphocyte homeostasis and functions in systemic sclerosis

Publication date: Available online 16 January 2018
Source:Autoimmunity Reviews
Author(s): Alexandra Forestier, Thomas Guerrier, Mathieu Jouvray, Jonathan Giovannelli, Guillaume Lefèvre, Vincent Sobanski, Carine Hauspie, Eric Hachulla, Pierre-Yves Hatron, Hélène Zéphir, Patrick Vermersch, Myriam Labalette, David Launay, Sylvain Dubucquoi
Beyond the production of autoantibodies, B-cells are thought to play a role in systemic sclerosis (SSc) by secreting proinflammatory/profibrotic cytokines. B-cells are a heterogeneous population with different subsets distinguished by their phenotypes and cytokine production. Data about B-cell subsets, cytokine production and intracellular pathways leading to this production are scarce in SSc. The aim of our study was to describe B-cell homeostasis, activation, proliferation, cytokine production in B-cells and serum and B-cell intracellular signaling pathways in SSc. We hypothezided that B-cell homeostasis and cytokine production were altered in SSc and could be explained by serum cytokine as well as by intracellular signaling pathway abnormalities.Forty SSc patients and 20 healthy controls (HC) were prospectively included. B-cell subsets were determined by flow cytometry using CD19, CD21, CD24, CD38, CD27, IgM and IgD. CD25, CD80, CD95, HLA-DR were used to assess B-cell activation. Intracellular production of IL-10 and IL-6 were assessed by flow cytometry after TLR9 and CD40 stimulation. IL-6, IL-10, Ki67, Bcl2 mRNA were quantified in B-cells. Cytokine production was also assessed in sera and supernatants of B-cell culture, using a multiplex approach. Signaling pathways were studied through phosphorylation of mTOR, ERK, STAT3, STAT5 using a flow cytometry approach.We found that SSc patients exhibited an altered peripheral blood B-cell subset distribution, with decreased memory B-cells but increased proportion of naive and CD21^LoCD38^Lo B-cell subsets. We observed an increased expression of activation markers (CD80, CD95, HLA-DR) on some B-cell subsets, mainly the memory B-cells. Secretion of IL-6, BAFF and CXCL13 were increased in SSc sera. There was no correlation between the peripheral blood B-cell subsets and the serum concentrations of these cytokines. After stimulation, we observed a lower proportion of IL-10 and IL-6 producing B–cells in SSc. Finally, we observed a significant decrease of mTOR phosphorylation in SSc patient B-cells.In conclusion, we observed an altered B-cell homeostasis in SSc patients compared to HC. Memory B-cells were both decreased and activated in patients. IL-10 producing B-cells were decreased in SSc. This decrease was associated with an alteration of mTOR phosphorylation in B-cells. Conversely, there was no correlation between serum cytokine profile and B-cell homeostasis alterations.



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Systemic Sclerosis: Small mouth, big burden?

Publication date: Available online 16 January 2018
Source:Autoimmunity Reviews
Author(s): Gaetano Isola, Marco Migliorati, Domenico Dalessandri, Giovanni Matarese




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Arterial stenosis in antiphospholipid syndrome: Update on the unrevealed mechanisms of an endothelial disease

Publication date: Available online 16 January 2018
Source:Autoimmunity Reviews
Author(s): Ghita Harifi, Wared Nour-Eldine, Mohammad Hassan A. Noureldine, Mohammad Baker Berjaoui, Romy Kallas, Rita Khoury, Imad Uthman, Jamal Al-Saleh, Munther A. Khamashta
First described in 1983, antiphospholipid syndrome (APS) is an autoimmune condition characterized by the occurrence of recurrent arterial and/or venous thrombosis, and/or pregnancy morbidity, in the setting of persistent presence of antiphospholipid antibodies (aPL). While thrombosis is the most well-known pathogenic mechanism in this disorder, the relevance of some other mechanisms such as arterial stenosis is being increasingly recognized. Arterial stenosis has been first described in the renal arteries in patients with APS, however intracranial and coeliac arteries can also be involved with various and treatable clinical manifestations. The underlying pathophysiology of this stenotic arterial vasculopathy is not fully understood but some recent studies revealed new insights into the molecular mechanism behind this endothelial cell activation in APS. In this review, we discuss these newly discovered mechanisms and highlight the diagnostic and therapeutic modalities of the APS related arterial stenosis.



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Rheumatic manifestations among cancer patients treated with immune checkpoint inhibitors

Publication date: Available online 16 January 2018
Source:Autoimmunity Reviews
Author(s): Merav Lidar, Eitan Giat, Daniela Garelick, Yuval Horowitz, Howard Amital, Yael Steinberg-Silman, Jacob Shachter, Ronnie Shapira-Frommer, Gal Markel
BackgroundThe use of immune checkpoint inhibitors (ICI) has grown incessantly since they were first approved in 2014. These monoclonal antibodies inhibit T cell activation, yielding a dramatic tumor response with improved survival. However, immunotherapy is frequently hampered by immune adverse events (iAE) such as hypophysitis, colitis, hepatitis, pneumonitis and rash. Until recently, rheumatic side effects were only infrequently reported.AimTo describe the rheumatic manifestations encountered among patients treated with ICIs in a large tertiary cancer center in IsraelMethodsThe cancer center's patient registry was screened for patients who had ever been treated with ipilimumab, pembrolizumab and/or nivolumab with relevant data gathered from clinical charts.ResultsRheumatic manifestations were encountered in 14 of 400 patients (3.5%) who had received immunotherapy between January 1st 2013 and April 30th, 2017. The most common rheumatic manifestation was inflammatory arthritis (85%) for which a third (4/11) had a clear cut predisposing factor such as a personal or family history of psoriasis, a prior episode of uveitis or ACPA positivity. Pulmonary sarcoidosis and biopsy-proven eosinophilc fasciitis were diagnosed in two additional patients. Treatment with NSAIDS was mostly unsuccessful while steroid therapy was beneficial in doses ≥20 mg/d. Methotrexate enabled steroid tapering without an excess of side effects or tumor progression in the short follow-up available. Overall, rheumatic manifestations tended to occur later in the course of immunotherapy as compared to other iAE.ConclusionsOur findings underscore that rheumatic iAE are part of the side effect profile of ICIs and require heightened awareness as these therapies are becoming the standard of care for various malignancies. We show that these appear later in the course of iAEs and respond preferentially to high dose steroids. MTX appears effective as a steroid sparing agent.



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Diagnosis and management of neuromyelitis optica spectrum disorders - an update

Publication date: Available online 13 January 2018
Source:Autoimmunity Reviews
Author(s): Alice Bruscolini, Marta Sacchetti, Maurizio La Cava, Magda Gharbiya, Massimo Ralli, Alessandro Lambiase, Armando de Virgilio, Antonio Greco
Neuromyelitis optica (NMO) and Neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune conditions characterized by inflammatory involvement of the optic nerve, spinal cord and central nervous system. Novel evidence showed a key role of autoantibodies against aquaporin-4 immunoglobulin G (AQP4 IgG) in the pathogenesis of NMOSD and, recently, new classification and diagnostic criteria have been adopted to facilitate an earlier identification and improve the management of these conditions. Diagnosis of NMOSD is currently based on clinical, neuroimaging and laboratory features. Standard treatment is based on the use of steroids and immunosuppressive drugs and aims to control the severity of acute attacks and to prevent relapses of the disease. This review gives an update of latest knowledge of NMOSD and NMO, emphasizing the novel diagnostic criteria and both current and future therapeutic approaches.



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Postoperative pain after removal of gutta-percha from root canals in endodontic retreatment using rotary or reciprocating instruments: a prospective clinical study

Abstract

Objectives

The aim of this clinical study was to evaluate and compare the incidence and intensity of postoperative pain following removal of gutta-percha from root canals using rotary and reciprocating instruments.

Materials and methods

One hundred and sixty patients scheduled for a non-surgical endodontic retreatment were included for evaluation. Preoperative pain was recorded with using a questionnaire with a 10-cm visual analogical scale (VAS). Endodontic filling material was removed with Reciproc (VDW, Munich, Germany) or ProFile (Dentsply Tulsa Dental Specialties, Tulsa, OK) instruments. Patients then recorded their postoperative pain in a VAS pain scale at 4, 8, 16, 24, 48, and 72 h post-treatment. Results were analyzed using the Mann-Whitney U, Kruskal-Wallis, and Chi-square tests. Multivariate logistic and a multiple regression analysis were used to detect the effect of confounding factors.

Results

Results showed a direct relation between the intensity of pre-operative pain and that of postoperative pain (P < .05). No significant differences were observed between the two groups regarding postoperative pain (P > .05) as a qualitative variable. As numerical values, statistically significant differences were found regarding sex and the system used (P < .05).

Conclusions

The method for pain evaluation was determinant in postoperative pain findings. Endodontic retreatment preparation with Reciproc results in lower values of postoperative pain compared with ProFile. Women are more susceptible to postoperative pain than are men.

Clinical relevance

One of the most significant contributions of this research is the importance given to the method used for pain evaluation. The present study analyzed postoperative pain resulting from the use of reciprocating or continuous rotary instruments during removal of gutta-percha in retreatment procedures.

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Influence of the location of nasal polyps on olfactory airflow and olfaction

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) often results in decreased olfaction. In this study, we examined the relationship between nasal polyp location and olfactory airflow and odorant transport changes using virtual nasal polyp models at different locations and computational fluid dynamics (CFD) analysis. We also compared olfactory airflow and olfaction between patients with nasal polyps at different locations using CFD analysis and an olfactory test.

Methods

Nasal computed tomography images were used to generate a normal model and 4 virtual nasal polyp models based on polyp locations, including the olfactory region (all-olfactory model), the region anterior to the olfactory region (preolfactory model), the middle meatus (middle-meatus model), and the superior meatus (superior-meatus model). Various airflow parameters were compared between these models and a normal model without polyps. We then performed a similar comparison between the 3-dimensional (3D) reconstruction models of patients with nasal polyps, and retrospectively investigated the correlation between olfaction and nasal polyp location in those patients.

Results

Virtual nasal polyp analysis revealed dispersion of olfactory airflow in the all-olfactory model. Olfactory airflow and odorant transport showed maximum decrease in the preolfactory model and a slight decrease in the superior-meatus model. Olfactory airflow by polyps was further decreased by blockade of the olfactory airflow inlet than of the outlet. The findings obtained by patients corresponded well to those of the virtual polyp analysis.

Conclusion

Olfactory airflow and olfaction are differentially affected by nasal polyp location. This finding is important for planning polyp-removal surgeries from the perspective of improving patient olfaction.

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Corticosteroid nasal irrigations are more effective than simple sprays in a randomized double-blinded placebo-controlled trial for chronic rhinosinusitis after sinus surgery

Background

Persistent mucosal inflammation in patients with chronic rhinosinusitis (CRS) often results in ongoing symptoms, recurrence of polypoid mucosa, infective exacerbations, and further systemic medication despite surgical intervention. Debate exists as to the most effective topical therapy in CRS.

Methods

The objective was to determine if corticosteroid delivered via a nasal irrigation or via a simple nasal spray would be more effective in controlling the symptoms and signs of CRS. A double-blind placebo-controlled randomized trial over 12 months was performed between 3 tertiary rhinologic clinics. After sinus surgery, all patients performed a nasal irrigation followed by a nasal spray once a day for 12 months. Groups were defined by corticosteroid (2 mg mometasone) delivered by either spray or irrigation. The primary outcomes were patient-reported symptoms: visual analogue score (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22), a global rating of sinonasal function. Secondary outcomes were also recorded from radiology (Lund-Mackay score [LMS]) and endoscopic (Modified Lund-Kennedy score [mLKS]) assessments.

Results

A total of 44 patients were randomized (age 50.3 ± 13.0 years; 40.9% female). Overall, patients improved significantly from either intervention. However, the corticosteroid nasal irrigation group had greater improvement in nasal blockage (−69.91 ± 29.37 vs −36.12 ± 42.94; p = 0.029), a greater improvement on LMS (−12.07 ± 4.43 vs −7.39 ± 6.94; p = 0.031) and less inflammation on mLKS at 12 months (7.33 ± 11.55 vs 21.78 ± 23.37; p = 0.018). One-year posttreatment blockage, drainage, fever, and total VAS scores were all lower in the corticosteroid irrigation group.

Conclusion

In the setting of diffuse or patchy CRS disease, the use of corticosteroid delivered by nasal irrigation is superior to simple nasal spray in postsurgical patients.

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Medical treatment of epistaxis in hereditary hemorrhagic telangiectasia: an evidence-based review

Background

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant hereditary disorder resulting in vascular dysplasia and formation of arteriovenous malformations. Recurrent epistaxis is a hallmark of the disease. An array of medical therapies are used in this patient population, but robust evidence-based recommendations regarding the medical treatment of epistaxis are lacking. This systematic review was performed to look at the current literature and make meaningful evidence-based recommendations.

Methods

A search of the Ovid MEDLINE, Embase, and Cochrane databases was conducted by a research librarian. Abstracts in the English language and published in a peer-review journal were reviewed for relevance and inclusion. PRISMA guidelines were followed.

Results

Eighteen studies met the inclusion criteria. In a few small studies, thalidomide was shown to consistently improve severity and frequency of epistaxis and improve hemoglobin concentrations while decreasing the need for transfusion. Tranexamic acid appeared to only impact the epistaxis severity score and not other clinical outcomes. Selective estrogen modulators (SERMs), propranolol, rose geranium oil, and N-acetylcysteine, have demonstrated promising efficacy in small trials.

Conclusion

Appropriate medical therapies for epistaxis outcomes in HHT remain undefined, and there is no "gold standard." Many of the studies are small and the data reported are heterogeneous, and therefore the ability to make strong evidence-based recommendations is limited. However, many different medications appear to be promising options.

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National disparities in treatment package time for resected locally advanced head and neck cancer and impact on overall survival

Abstract

Background

The purpose of this study was to determine national disparities in head and neck cancer treatment package time (the time interval from surgery through the completion of radiation) and the associated impact on survival.

Methods

We conducted an observational cohort study using the National Cancer Database of 15 234 patients with resected head and neck cancer who underwent adjuvant radiotherapy from 2004-2012. Predictors of prolonged package time were identified by multivariable linear regression. Survival outcomes were assessed using a multivariable Cox model.

Results

Mean package time was 100 days (SD 23). Package time was 7.52 days (95% confidence interval [CI] 6.23-8.81; P < .001) longer with Medicaid versus commercial insurance. Low income and African American race also predicted for longer package times. All-cause mortality increased an average of 4% with each 1 week increase in treatment package time (hazard ratio [HR] 1.04; 95% CI 1.03-1.05; P < .001).

Conclusion

Significant national socioeconomic disparities exist in treatment package time. Treatment delays in this setting may contribute to worse survival outcomes.

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Primary orbital melanoma treated with orbital exenteration and postoperative radiotherapy: A case report and review of the literature

Abstract

Background

We report on a patient with human immunodeficiency virus (HIV)-positive disease with a primary orbital melanoma treated with surgery and adjuvant radiation.

Methods

A 53-year-old woman with HIV-positive disease presented with left-sided progressive ipsilateral vision loss and proptosis. An MRI scan revealed a mass-enhancing lesion measuring 2.1 × 2.6 × 2.5 cm abutting the optic nerve. The patient underwent left orbital exenteration with temporalis flap reconstruction, pathology revealing malignant melanoma, stage T1N0M0. Posterior margins were positive and lymphovascular invasion was present; therefore, the patient received adjuvant radiation to a total dose of 70 Gy in 35 fractions.

Results

The patient remains with no evidence of disease (NED) at a follow-up time of 3.5 years.

Conclusion

Surgery remains the mainstay of treatment in patients with primary orbital melanomas, and adjuvant radiotherapy should be considered for those with positive margins or other risk factors for recurrence. We present a patient with significant risk factors with NED at 3.5-year follow-up.

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Prognostic value of lymph node ratio in head and neck squamous cell carcinoma

Abstract

Background

Lymph node ratio (LNR) is increasingly reported as a potential prognostic tool. The purpose of this review was to analyze the available literature on the prognostic significance of LNR in head and neck squamous cell carcinoma (HNSCC).

Methods

A PubMed internet search was performed and articles meeting selection criteria were reviewed.

Results

Twenty-eight studies were identified in the literature dealing with the prognostic value of LNR. The published results are variable with a range of cutoff values of LNR associated with prognosis (overall survival [OS] and/or disease-specific survival [DSS]) between 0.02 and 0.20, with an average of 0.09.

Conclusion

The LNR is reported to be of value in assessing prognosis in the patients with HNSCC. Although it is easy to calculate and could be considered in the staging of these patients, the currently available evidence in the literature does not yet provide a solid base for implementation.

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