Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery

The aim of this study was to evaluate the diagnostic accuracies of cone beam computed tomography (CBCT) and panoramic techniques in predicting inferior alveolar nerve (IAN) exposure. The sample size was determined based on a pilot study. This prospective clinical series study included 59 third molar extraction sites with any of seven previously suggested panoramic signs of IAN exposure. The diagnosis of nerve exposure was done on panoramic and CBCT images. Molars were extracted and nerve exposure was evaluated clinically.

http://ift.tt/2f6IeIA

Expression and clinical significance of TrkB in sinonasal squamous cell carcinoma: a pilot study

Previous studies have confirmed that tropomyosin-related kinase B (TrkB) plays a critical role in the occurrence, development, and metastasis of many kinds of malignant tumour. More recently, TrkB was found to be overexpressed in head and neck squamous cell carcinoma (SCC) and to be involved in multistep tumour progression. In this study, the expression of TrkB was investigated in 27 cases of sinonasal SCC using an immunohistochemical method. The clinical significance and possible role of TrkB as a prognostic marker in these tumours was also explored.

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Oral mucosal epithelial cells express the membrane anchored mucin MUC1

Publication date: January 2017
Source:Archives of Oral Biology, Volume 73
Author(s): Helena Ukkonen, Paula Pirhonen, Maria Herrala, Jopi J.W. Mikkonen, Surya P. Singh, Raija Sormunen, Arja M. Kullaa
ObjectiveThe presence of a stable salivary pellicle (SP) is essential to provide a wet surface for the oral mucosal epithelia. The oral mucosa is covered by the SP which is suggested to be a mixed film of both salivary and epithelial components. Our aim was to analyse the presence of membrane-anchored mucin MUC1 in the oral mucosal epithelia.DesingThe presence of MUC1 was studied by immunohistochemical and immunoelectron microscopical methods in 19 buccal mucosal specimens. The localization and intensity of the epithelial expression were analyzed.ResultsStrong staining of MUC1 was found in the epithelial cells of intermediate and superficial layers. Some basal cells were shown faint expression. In the intermediate and superficial layers, the MUC1 expression was seen mainly on the upper cell surface. Furthermore, the expression of MUC1 was noted in the cytoplasm near the nucleus and in the rough granules. By electron microscopy, extracellular domain of membrane-anchored molecules extruded about 15–30nm above the cell surface in the apical cells of the oral epithelium. Immunoelectron microscopic examination shows that MUC1 is mainly localized in the plasma membrane of epithelial cells and also in small vesicles (75–100nm) just below the plasma membrane.ConclusionThe membrane-anchored MUC1 is expressed in the superficial layer of the oral mucosal epithelium, especially on the upper surface of epithelial cells. MUCI may be the anchoring protein of the salivary pellicle stabilization.



http://ift.tt/2eVoEyr

Oral mucosal epithelial cells express the membrane anchored mucin MUC1

Publication date: January 2017
Source:Archives of Oral Biology, Volume 73
Author(s): Helena Ukkonen, Paula Pirhonen, Maria Herrala, Jopi J.W. Mikkonen, Surya P. Singh, Raija Sormunen, Arja M. Kullaa
ObjectiveThe presence of a stable salivary pellicle (SP) is essential to provide a wet surface for the oral mucosal epithelia. The oral mucosa is covered by the SP which is suggested to be a mixed film of both salivary and epithelial components. Our aim was to analyse the presence of membrane-anchored mucin MUC1 in the oral mucosal epithelia.DesingThe presence of MUC1 was studied by immunohistochemical and immunoelectron microscopical methods in 19 buccal mucosal specimens. The localization and intensity of the epithelial expression were analyzed.ResultsStrong staining of MUC1 was found in the epithelial cells of intermediate and superficial layers. Some basal cells were shown faint expression. In the intermediate and superficial layers, the MUC1 expression was seen mainly on the upper cell surface. Furthermore, the expression of MUC1 was noted in the cytoplasm near the nucleus and in the rough granules. By electron microscopy, extracellular domain of membrane-anchored molecules extruded about 15–30nm above the cell surface in the apical cells of the oral epithelium. Immunoelectron microscopic examination shows that MUC1 is mainly localized in the plasma membrane of epithelial cells and also in small vesicles (75–100nm) just below the plasma membrane.ConclusionThe membrane-anchored MUC1 is expressed in the superficial layer of the oral mucosal epithelium, especially on the upper surface of epithelial cells. MUCI may be the anchoring protein of the salivary pellicle stabilization.



http://ift.tt/2eVoEyr

Immunoglobulin Glycosylation Effects in Allergy and Immunity

Abstract

Purpose of Review

The aim of this review will be to familiarize the reader with the general area of antibody (Ab) glycosylation and to summarize the known functional roles of glycosylation and how glycan structure can contribute to various disease states with emphasis on allergic disease.

Recent Findings

Both immunoglobulin (Ig) isotype and conserved Fc glycosylation sites often dictate the downstream activity of an Ab where complexity and degree of glycosylation contribute to its ability to bind Fc receptors (FcRs) and activate complement. Most information on the effects of glycosylation center on IgG in cancer therapy and autoimmunity. In cancer therapy, glycosylation modifications that enhance affinity for activating FcRs are utilized to facilitate immune-mediated tumor cell killing. In autoimmunity, disease severity has been linked to alterations in the presence, location, and composition of Fc glycans. Significantly less is understood about the role of glycosylation in the setting of allergy and asthma. However, recent data demonstrate that glycosylation of IgE at the asparagine-394 site of Cε3 is necessary for IgE interaction with the high affinity IgE receptor but, surprisingly, glycosylation has no effect on IgE interaction with its low-affinity lectin receptor, CD23.

Summary

Variations in the specific glycoform may modulate the interaction of an Ig with its receptors. Significantly more is known about the functional effects of glycosylation of IgG than for other Ig isotypes. Thus, the role of glycosylation is much better understood in the areas of autoimmunity and cancer therapy, where IgG is the dominant isotype, than in the field of allergy, where IgE predominates. Further work is needed to fully understand the role of glycan variation in IgE and other Ig isotypes with regard to the inhibition or mediation of allergic disease.

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Interleukin-5 Antagonists Usher in a New Generation of Asthma Therapy

Abstract

Asthma is the most common chronic respiratory disease in the USA. A subset of patients with asthma have refractory symptoms, persistent eosinophilic inflammation, and recurrent exacerbations despite maximal medical therapy. The monoclonal antibodies targeting the IL-5 pathway are a new class of medications designed to target severe eosinophilic asthma. There are two medications clinically available: mepolizumab and reslizumab, both of which target IL-5. A third medication, benralizumab, is currently under development and targets the IL-5 receptor. Clinical data suggest these medications can reduce asthma exacerbations and improve lung function in patients with peripheral eosinophilia and poorly controlled asthma despite maximal medical therapy. The anti-IL-5 medications are among the first targeted molecular therapies for asthma and will usher in an exciting new era in the treatment of severe asthma.

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The Reemergence of the Asthma-COPD Overlap Syndrome: Characterizing a Syndrome in the Precision Medicine Era

Abstract

Purpose of Review

The asthma-COPD overlap syndrome (ACOS) has reemerged in the medical literature. This review addresses our current understanding of ACOS as a clinical and biological entity and how new and existing therapies may be targeted to this group.

Recent Findings

Many studies suggest that ACOS is common and associated with more morbidity than asthma and COPD in general. However, there is no consensus on an ACOS definition, likely due to the heterogeneity of the disease. Variable definitions have led to variable results in ACOS studies. Given this clinical variability, biomarkers (e.g., eosinophils and type 2 inflammatory markers) are increasingly being used to identify an ACOS molecular phenotype which appears to be more responsive to inhaled corticosteroids.

Summary

Although ACOS has become a popular diagnosis, it is unclear whether identifying ACOS as a separate disease entity is clinically useful. Future studies should focus on identifying key clinical features and biomarkers that characterize vulnerable and treatment-responsive patients.

http://ift.tt/2eTc42V

Erratum to “The effect of human papillomavirus on DNA repair in head and neck squamous cell carcinoma” [Oral Oncol. 61 (2016) 27–30]

The publisher regrets that Vicky Yamamoto's forename appeared incorrectly in the original article. It appears correctly above.

http://ift.tt/2faUN4r

Erratum to “Neoadjuvant radiotherapy plus radical surgery for locally advanced stage III/IV oral cancer: Analysis of prognostic factors affecting overall survival” [Oral Oncol. 60 (2016) 1–7]

The publisher regrets that the author's forename and surnames were displayed in an incorrect order in the original article. They appear correctly above.

http://ift.tt/2egjAX8

Modern Management of Familial Hypercholesterolemia

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


http://ift.tt/2f2pqN3

Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study

In this study we investigated and compared the predictive values of different airway assessments tests including thyromental height measurement test, which has been recently suggested, in difficult laryngoscopy (Cormack and Lehane [C-L] scores 3 and 4). In addition, we compared the effectiveness of methods and C-L scores, by IDS, in terms of predicting difficult intubation.

http://ift.tt/2eV88yE

Typology of Perceived Causes of Intimate Partner Violence Perpetration in Young Adults

Violence and Gender , Vol. 0, No. 0.


http://ift.tt/2esHcW0

A Novel Thyroid Hormone Receptor Beta Gene Mutation (G251V) in a Thai Patient with Resistance to Thyroid Hormone Coexisting with Pituitary Incidentaloma

Thyroid , Vol. 0, No. 0.


http://ift.tt/2e6nj6j

Assessment of Nutritional Status of Iodine Through Urinary Iodine Screening Among Local Children and Adolescents After the Fukushima Daiichi Nuclear Power Plant Accident

Thyroid , Vol. 0, No. 0.


http://ift.tt/2e6u7Rf

Identification of Specific Long Non-Coding RNA Expression: Profile and Analysis of Association with Clinicopathologic Characteristics and BRAF Mutation in Papillary Thyroid Cancer

Thyroid , Vol. 0, No. 0.


http://ift.tt/2fxPwrR

Systemische Therapie des metastasierten Prostatakarzinoms

Zusammenfassung

Zur Behandlung von Patienten mit metastasiertem kastrationssensitivem (mCSPC) und kastrationsresistentem Prostatakarzinom (mCRPC) stehen aktuell verschiedene therapeutische Optionen mit unterschiedlichen Wirkprinzipien zur Wahl. Beim mCSPC konnte in verschiedenen Studien gezeigt werden, dass neben der Standardtherapie mittels Androgendeprivation (ADT-Therapie) der frühzeitige Einsatz einer Chemotherapie mit Docetaxel eine signifikante Verlängerung des Gesamtüberlebens erzielen kann. Besonders Patienten mit hoher Tumorlast profitieren dabei. Basierend auf den Ergebnissen wird daher der Einsatz der Chemotherapie bereits beim mCSPC, insbesondere bei Patienten mit hoher Tumorlast empfohlen. Durch die Entwicklung neuerer Substanzen wie Abirateron und Enzalutamid, den α-Strahler Radium-223, einsetzbar bei Patienten mit ausschließlich ossärer Metastasierung und den klassischen Chemotherapeutika Docetaxel in der Erst- und Cabazitaxel in der Zweitlinie ist es gelungen, die Prognose des mCRPC deutlich zu verbessern und die Überlebenszeit signifikant zu verlängern. Die optimale Therapiesequenz bleibt dabei weiter unklar; es liegen bislang nur wenige, meist retrospektive Daten an kleinen Fallzahlen vor. Weitere prospektive Studien sind erforderlich, um neue Erkenntnisse über sinnvolle Sequenzen zu gewinnen. Eine Kreuzresistenz zwischen Enzalutamid und Abirateron, vermittelt z. B. durch die Androgen-Rezeptor Splicevariante 7, ist eine mögliche Ursache einer reduzierten Effektivität in nachfolgenden Therapielinien. Neben den bereits zugelassenen Medikamenten befinden sich weitere Substanzen in der klinischen und vorklinischen Entwicklung.

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Synchronous perforations of the oesophagus and stomach by air insufflation: an uncommon complication of endoscopic dilation

A 72-year-old woman had a history of carcinoma of the hypopharynx treated by total laryngectomy, circumferential pharyngectomy and free jejunal graft. Endoscopic dilation of the pharyngojejunal anastomotic stricture resulted in synchronous perforations of the oesophagus and stomach. We postulate that the perforations were caused by high intraoesophageal and intragastric pressure resulted from air insufflation during the procedure; in a situation simulating closed-loop obstruction, because of proximal obstruction by the endoscope at the stricture site and distal obstruction by pylorospasm. The sites of perforations were inherent points of weakness at the left side of the distal oesophagus and at the high lesser curve of stomach. Satisfactory outcome of our patient was attributed to prompt diagnosis and surgical repair. Endoscopists should be aware of this possibility during oesophagogastroduodenoscopy and dilation. Rapid and over insufflation of air should be avoided.

http://ift.tt/2e5GWeM

Prolonged unassisted survival in an infant with anencephaly

Anencephaly is one of the most lethal congenital defects. This case report is of an anencephalic infant who lived to 28 months of life and defies current literature. She is the longest surviving anencephalic infant who did not require life-sustaining interventions. This case presents the obstacles that arose from this infant's prolonged life and recommendations based on these findings.

http://ift.tt/2fx8NJW

Metastatic prostate adenocarcinoma presenting as a large right supraclavicular and anterior chest wall mass

Left-sided cervical lymphadenopathy as first presentation of metastatic prostate carcinoma is not a novel observation. Here, we discuss a case of metastatic prostate primary carcinoma with an initial presentation of a right supraclavicular mass with extension into the anterior chest wall, which on radiological investigation was suggestive of a sarcomatous tumour; however, was confirmed to be pervasive metastatic prostatic adenocarcinoma. This is the second case in literature, which reports a prostatic primary cancer presenting as a right-sided supraclavicular and anterior chest wall mass.

http://ift.tt/2e5FyIW

Disseminated Mycobacterium haemophilum infection in a renal transplant recipient

Opportunistic infections are a major concern in renal and transplant medicine. We present the case of a renal transplant recipient with a generalised Mycobacterium haemophilum infection after an increase in immunosuppressive therapy and treatment with a tumour necrosis factor-α (TNF-α) inhibitor. Infection involved skin and soft tissue, joints and bones, as well as the renal transplant with an interstitial nephritis. Rapid diagnosis using PCR and DNA sequencing allowed early appropriate treatment. Triple antibiotic therapy and reduction in immunosuppression resulted in a slow but sustained recovery. Immunosuppression causes severe opportunistic infections. TNF-α inhibitors are very effective and well tolerated but have an increased susceptibility to infections with mycobacteria. Mycobacterial infections represent a significant clinical risk to transplant recipients because of their aggressive clinical course and the need for complex toxic antibiotic treatments. In these patients, M. haemophilum is a cause of skin infections.

http://ift.tt/2fx8Mpm

Severe metallosis following oxidised zirconium wear in total hip arthroplasty

Description

We present a case of a man aged 81 years who underwent a primary cementless total hip arthroplasty. Eight years after the index surgery, failure of the arthroplasty was revealed by the presence of the radiographic 'cloud sign' (figure 1). The original components used were the R3 acetabular cup with a Synergy femoral stem, highly crossed linked polyethylene liner and an oxidised zirconium (Oxinium) femoral head (Smith & Nephew Synergy, Memphis, Tennessee, USA). The initial investigation included a CT scan, full blood tests and a tissue biopsy which revealed no malignancy. Subsequently, during revision surgery, there was extensive osteolysis with metallosis. There was black staining of the periprosthetic soft tissues and the hip pseudocapsule was filled with thick black fluid (figure 2). There was severe wear of the femoral head and the polyethylene liner. Following debridement and removal of the components, a revision...

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Putting T cells to work – outsourcing neoantigen detection in head and neck cancer?

The recent genomic characterization of head and neck squamous cell carcinomas by The Cancer Genome Atlas demonstrated the high frequency of mutations affecting these cancers (Cancer Genome Atlas Network, 2015). This high rate of genomic alterations allows head and neck cancers to be highly immunogenic, thus promoting responses to immune therapies (Allen et al, 2015; Ferris, 2015). For instance, inhibitors of immune checkpoints like the anti-PD-1 monoclonal antibodies nivolumab and pembrolizumab have demonstrated promising results in head and neck cancer (Ferris et al, 2016; Chow et al, 2016), both recently receiving FDA approval in the setting of recurrent or metastatic disease.

This article is protected by copyright. All rights reserved.

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Stage-specific Embryonic Antigen-4 (SSEA-4) as a novel marker of ductal cells of human eccrine sweat glands

Summary

Background

Different populations of unipotent or multipotent stem cells were identified in human epidermis and its appendages. It is well documented that these cells maintain tissue homeostasis and actively participate in epidermal regeneration after injury. However, there is no evidence of the presence of pluripotent stem cells in human epidermis.

Objective

In this study, we investigated whether cells positive for embryonic stem cell marker SSEA-4 are present in adult human epidermis and if so, whether they are pluripotent and may correspond to the population of primitive stem cells.

Methods

The expression of SSEA-4 antigen and pluripotency transcription factors were analysed using flow cytometry. By means of immunohistochemical staining, we studied the exact localization of these cells in human skin sections.

Results

We show that a population of SSEA-4⁺ cells is present in human epidermis. In contrast to a commonly accepted belief, the expression of SSEA-4 antigen is not connected with the pluripotent character of the isolated cells. We found that these SSEA-4⁺ cells are localized in the ducts of eccrine sweat glands.

Conclusion

Our results indicate that the SSEA-4 antigen is a novel marker identifying the ductal cells of human sweat glands. The surface character of the antigen provides for simple method of isolation of this cell population and suggests the application of SSEA-4 for future cell therapy research.

This article is protected by copyright. All rights reserved.

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DOMINO, doxycycline 40mg vs minocycline 100mg in the treatment of rosacea: a randomised, single blinded, non-inferiority trial, comparing efficacy and safety

Summary

Background

There is lack of evidence for minocycline in the treatment of rosacea.

Objectives

To compare the efficacy and safety of doxycycline 40mg versus minocycline 100mg in papulopustular rosacea.

Methods

In this randomised single centre, 1:1 allocation, assessor blinded, non-inferiority trial, patients with a mild to severe papulopustular rosacea, were randomly allocated to either oral doxycycline 40mg or minocycline 100mg for a 16-week period with 12 weeks of follow up.

Our primary outcomes were the change in lesion count and change in patient's Health Related Quality of Life (HRQoL): RosaQoL scores.

Our secondary outcomes were: Patient's Global Assessment (PaGA) success ("excellent" or "good" improvement), Investigator Global Assessment (IGA) success ("clear" or "near clear"), Clinicians Erythema Assessment (CEA) success (at least one point decrease), the relapse rate at follow up and safety profile of the treatment drugs.

Intention to treat (ITT) and per protocol analyses (PPA) were performed.

Results

Of the 80 patients randomised, (40 for minocycline and 40 for doxycycline) 71 patients were treated for 16 weeks. 68 patients completed the study.

At week 16, the median change in lesion count was comparable in both groups: doxycycline versus minocycline respectively 13 versus 14 lesions less. (Non-inferiority difference 3, 90% Confidence interval (CI) -2 to 8). The RosaQoL scores were decreased for both doxycycline and minocycline, respectively 0.62 and 0.86. (Non-inferiority difference 0.15, 90% CI -0.09 to 0.42).

Secondary outcomes were comparable except for IGA success, which was assessed significantly more often in the minocycline group than in the doxycycline group (respectively 60% and 17.5%; p<0.001).

At week 28, outcomes were comparable, except for RosaQoL scores and PaGA, which were significantly different in favour of minocycline (P=0.005 and P=0.043 respectively), and less relapses were recorded in the minocycline group than in the doxycycline group (respectively 6.7% and 48%; p<0.001). In this study no serious adverse reactions (SAEs) were reported.

Conclusions

Minocycline 100mg is non-inferior to doxycycline 40mg in efficacy over a 16- week treatment period. Furthermore, at follow up, RosaQoL scores and PaGA were statistically significantly more improved in the minocycline group than in the doxycycline group, and minocycline 100mg gives longer remission than doxycycline 40mg. In this study there was no significant difference in safety between these treatments, however, based on previous literature minocycline has a lower risk/benefit ratio than doxycycline. Minocycline 100mg may be a good alternative treatment for those patients who, for any reason, are unable or unwilling to take doxycycline 40mg.

This article is protected by copyright. All rights reserved.

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The expression of serine protease inhibitors in epidermal keratinocytes is increased by calcium, but not 1,25(OH)2 vitamin D3 or retinoic acid

Summary

Background

In the human skin, the serine proteases kallikrein-related peptidases (KLK) 5 and KLK7 degrade corneodesmosome proteins, which leads to desquamation. The serine protease activity of the skin is tightly regulated by the interplay between such proteases and serine protease inhibitors, which include lympho-epithelial Kazal-type related inhibitor (LEKTI) encoded by SPINK5, secretory leukocyte peptidase inhibitor (SLPI), and elafin. The expression of KLK5 and KLK7 is controlled and up-regulated by stimulants such as calcium, 1,25(OH)₂ vitamin D₃ (1,25(OH)₂VD₃), and retinoic acid (RA).

Objectives

To understand the effect of calcium, 1,25(OH)₂VD₃, and RA on the expression of serine protease inhibitors in epidermal keratinocytes.

Methods

We stimulated normal human epidermal keratinocytes (NHEKs) with high calcium, 1,25(OH)₂VD₃, or RA and then analysed the expression of serine protease inhibitors using quantitative real-time-PCR, ELISA, and immunocytofluorescence. We also analysed trypsin- and chymotrypsin-like serine protease activities in stimulated NHEKs.

Results

High calcium, but not 1,25(OH)₂VD₃ or RA, significantly induced the expression of LEKTI, SLPI, and elafin at both transcript and protein levels in NHEKs. These inductions were time- and dose-dependent. The activities of trypsin- and chymotrypsin-like serine proteases were significantly up- and down-regulated by high calcium, respectively, in NHEKs.

Conclusions

High calcium, but not 1,25(OH)₂VD₃ or RA, increases the expression of serine protease inhibitors in epidermal keratinocytes. Our findings contribute to the understanding of the mechanisms by which serine protease activities are regulated by serine proteases and related inhibitors in epidermal keratinocytes.

This article is protected by copyright. All rights reserved.

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Re: The effects of Air Pollution on asthma Hospital admissions in Adelaide, South Australia, 2003-2013: time series and case-crossover analysis

Abstract

We read with great interest the recent study by Chen K and colleagues [1] which showed an increase risk of asthma hospital admissions in all age groups with total pollen. However, there are numerous issues that have been overlooked in the analysis of the pollen variable. If these issues were considered, the authors may have observed stronger species-specific effects thereby contributing to the evidence base on which pollen species is the major trigger of asthma exacerbations requiring hospitalization.

This article is protected by copyright. All rights reserved.

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Can routine office-based audiometry predict cochlear implant evaluation results?

Objectives/Hypothesis

Determining cochlear implant candidacy requires a specific sentence-level testing paradigm in best-aided conditions. Our objective was to determine if findings on routine audiometry could predict the results of a formal cochlear implant candidacy evaluation. We hypothesize that findings on routine audiometry will accurately predict cochlear implant evaluation results in the majority of candidates.

Study Design

Retrospective, observational, diagnostic study.

Methods

The charts of all adult patients who were evaluated for implant candidacy at a tertiary care center from June 2008 through June 2013 were included. Routine, unaided audiologic measures (pure-tone hearing thresholds and recorded monosyllabic word recognition testing) were then correlated with best-aided sentence-level discrimination testing (using either the Hearing in Noise Test or AzBio sentences test).

Results

The degree of hearing loss at 250 to 4,000 Hz and monosyllabic word recognition scores significantly correlated with sentence-level word discrimination test results. Extrapolating from this association, we found that 86% of patients with monosyllabic word recognition scores at or below 32% (or 44% for patients with private insurance) would meet candidacy requirements for cochlear implantation.

Conclusions

Routine audiometric findings can be used to identify patients who are likely to meet cochlear implant candidacy upon formal testing. For example, patients with pure-tone thresholds (250, 500, 1,000 Hz) of ≥75 dB and/or a monosyllabic word recognition test score of ≤40% have a high likelihood of meeting candidacy criteria. Utilization of these predictive patterns during routine audiometric evaluation may assist hearing health professionals in deciding when to refer patients for a formal cochlear implant evaluation.

Level of Evidence

4 Laryngoscope, 2016

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Multimodality Cardiac Imaging in a Patient with Kawasaki Disease and Giant Aneurysms

Kawasaki disease is a well-known cause of acquired cardiac disease in the pediatric and adult population, most prevalent in Japan but also seen commonly in the United States. In the era of intravenous immunoglobulin (IVIG) treatment, the morbidity associated with this disease has decreased, but it remains a serious illness. Here we present the case of an adolescent, initially diagnosed with Kawasaki disease as an infant, that progressed to giant aneurysm formation and calcification of the coronary arteries. We review his case and the literature, focusing on the integral role of multimodality imaging in managing Kawasaki disease.

http://ift.tt/2eTLOW9

Mercury Vapour Long-Lasting Exposure: Lymphocyte Muscarinic Receptors as Neurochemical Markers of Accidental Intoxication

Introduction. Chronic poisoning may result in home setting after mercury (Hg) vapours inhalation from damaged devices. We report a chronic, nonoccupational Hg poisoning due to 10-year indoor exposure to mercury spillage. Case Report. A 72-year-old man with polyneuropathy of suspected toxic origin. At hospitalization, toxicological clinical evaluations confirmed the altered neurological picture documented across the last decade. Periodic blood and urine Hg levels (BHg, UHg) monitoring were performed from admission (), until 1 year later (), paralleled by blood neurochemical markers assessment, that is, lymphocytes muscarinic receptors (l-MRs). At : BHg and UHg were 27 and 1.4 microg/L, respectively (normal values: BHg 1–4.5; UHg 0.1–4.5), associated with l-MRs increase, 185.82 femtomoL/million lymphocytes (normal range: 8.0–16.0). At (two days after DMSA-mobilization test), BHg weak reduction, paralleled by UHg 3.7-fold increase, was measured together with further l-MRs enhancement (205.43 femtomoL/million lymphocytes). At (eight months after two cycles of DMSA chelating therapy ending), gradual improving of clinical manifestations was accompanied by progressive decrease of BHg and UHg (4.0 and 2.8 microg/L, resp.) and peripheral l-MRs neurochemical marker (24.89 femtomoL/million lymphocytes). Conclusion. l-MRs modulatory effect supports their use as peripheral neurochemical marker in Hg poisoning diagnosis and chelation therapy monitoring.

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Phase I/II Study OF Metformin in Combination With Cisplatin and Radiation in Head and Neck Squamous Cell Carcinoma

Condition:   Head and Neck Squamous Cell Carcinoma
Intervention:   Drug: Metformin
Sponsor:   Baylor College of Medicine
Not yet recruiting - verified October 2016

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A Study of Laparoscopic Right Hemicolectomy Using the Caudal-to-cranial Approach

Conditions:   Ascending Colon Cancer;   Ileocaecal Valve Carcinoma;   Cancer Flexure Hepatic;   Adenocarcinoma of Hepatic Flexure (Diagnosis)
Interventions:   Procedure: the caudal-to-cranial approach;   Procedure: the medial-to-lateral approach
Sponsor:   Guangdong Provincial Hospital of Traditional Chinese Medicine
Recruiting - verified October 2016

http://ift.tt/2f0PnwD

The Efficacy of Vocal Function Exercises for Laryngeal Cancers

Condition:   Vocal Folds
Interventions:   Procedure: Vocal Function Exercises;   Procedure: Vocal Hygiene
Sponsor:   Vrushali Angadi
Recruiting - verified October 2016

http://ift.tt/2eTSdjV

Test

Test thyroid system post

The post Test appeared first on American Thyroid Association.

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New insights into Mesolithic human diet in the Mediterranean from stable isotope analysis: The sites of Campu Stefanu and Torre d'Aquila, Corsica

Abstract

Mesolithic human remains are rare in the archaeological record of the French Mediterranean. Only the island of Corsica has so far produced relatively well preserved burials, and recent archaeological excavations have brought to light new Mesolithic human remains. The site of Campu Stefanu, located in Sollacaro in the southeast of the island, contained a collective burial of 7-8 individuals in a previously unobserved funerary context. A re-evaluation of collections in regional museums yielded the remains from another Mesolithic individual from the site of Torre d'Aquila, excavated at Pietracorbara, in the northern part of the island, at the beginning of the 1990s. These two discoveries presented the rare opportunity to obtain new radiocarbon dates and paleodietary insights from this crucial time period using stable isotope analysis (δ¹³C, δ¹⁵N) on collagen. From Campu Stefanu one individual had sufficient collagen preserved for radiocarbon dating, revealing that it is the oldest Mesolithic human known on the island, dated to 10216-9920 cal. BP. At Torre d'Aquila, radiocarbon dates indicate that the individual belonged to a younger Mesolithic phase than Campu Stefanu, dated to 9903-9596 cal. BP. δ¹³C and δ¹⁵N isotope ratios are similar between the Campu Stefanu and Torre d'Aquila individuals and indicate a diet dominated by the consumption of terrestrial animal protein, and a lack of marine resources. These findings are in contrast with the previous results from two other Mesolithic individuals from Corsica from the sites of Araguina Sennola and Monte Leone, for which about 25-30% of the consumed proteins came from a marine diet. The dietary variability recorded in Corsica is consistent with results obtained from Mesolithic human remains of Sicily and the Iberian Peninsula. We can hypothesize, that despite the nomadic lifestyle, the distance to the sea played a major role in Mesolithic food choices in Corsica. This article is protected by copyright. All rights reserved.

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Morphometry of a Pre-Hispanic Dog From Northwestern Argentina (Ad 800-1200)

Abstract

A detailed morphometric description of a dog skull from the pre- Hispanic archaeological site La Isla de Tilcara (northwestern Argentina, ca. AD 800-1200) is presented. The resulting data were compared with those of dog skulls from other South American archaeological sites to establish dog morphotype. The examined skull belonged to a small, long-snouted dog, similar to the smallest morphotypes from the Central Andes.

http://ift.tt/2eqH7T0

BRAF V600D mutation in a paediatric high-grade glioma

The authors report a case of high-grade glioma with unusual pathology that has not previously been reported in glioma pathology. The 5-year-old patient presented to the emergency department with a 1-day history of a right temporal swelling on a background history of increasing nausea and vomiting for the preceding 5 months. A computed tomography brain was performed, which showed a large right-sided temporoparietal lesion. The patient underwent surgery to remove the mass and pathology confirmed anaplastic astrocytoma (WHO Grade 3). This report focuses on prognostic factors in high-grade glioma, particularly on pathological indicators, namely epidermal growth factor receptor, O6-methylguanine-DNA-methyltransferase expression and BRAF V600D mutation.

http://ift.tt/2ee67yY

Spontaneous resolution of symptomatic lumbar synovial cyst

Lumbar synovial cyst arises from the facet joint and can lead to back pain, radiculopathy, neurogenic claudication or even cauda equina syndrome. Although most surgeons would consider surgery to be the treatment of choice, the natural history of the disease process remains unknown and uncertainty still exists regarding optimal management of this controversial entity. We illustrate a case of large L5/S1 synovial cyst for which surgery was initially planned. However, it resolved spontaneously without any treatment. We also provide a brief literature review regarding conservative, surgical and minimally invasive management of symptomatic lumbar synovial cyst with special reference to patient outcome.

http://ift.tt/2eebaj3

Extensive upper extremity deep venous thrombosis following brief application of an operative arm tourniquet

Extensive upper extremity deep venous thrombosis and compartment syndrome secondary to operative tourniquet application are rare outcomes of established practice. We present the case of a 54-year-old female who underwent elective removal of a right olecranon plate under general anaesthetic with brief application of a tourniquet. In recovery, she developed a swollen and erythematous forearm, without significant pain and paraesthesia. An urgent dual-phase computed tomography angiogram identified no venous outflow proximal to the axillary vein. Concern for early compartment syndrome necessitated emergency fasciotomies of the right forearm and hand, precluding thrombolysis. Thrombosis was found in the superficial and deep veins throughout the forearm, but the muscles were healthy. The patient commenced anticoagulation therapy early and made good recovery. Further haematology review concluded that she had a 'provoked thrombosis' and no need for long-term anticoagulation.

http://ift.tt/2f8QKFB

Rosai-Dorfman Disease Involving Multiple Organs: An Unusual Case with Poor Prognosis

Rosai-Dorfman disease is a rare, benign histiocytic proliferative disorder that usually affects the lymph nodes. Although extranodal involvement has been reported in diverse sites, manifestation in the cardiovascular system is extremely rare. Specifically, cardiac involvement in Rosai-Dorfman disease is an extraordinarily infrequent event. We describe a case of a 36-year-old female who presented Rosai-Dorfman disease of multiple organs including the heart, with poor prognosis.

http://ift.tt/2dUxAY6

Immunoglobulin Glycosylation Effects in Allergy and Immunity

Abstract

Purpose of Review

The aim of this review will be to familiarize the reader with the general area of antibody (Ab) glycosylation and to summarize the known functional roles of glycosylation and how glycan structure can contribute to various disease states with emphasis on allergic disease.

Recent Findings

Both immunoglobulin (Ig) isotype and conserved Fc glycosylation sites often dictate the downstream activity of an Ab where complexity and degree of glycosylation contribute to its ability to bind Fc receptors (FcRs) and activate complement. Most information on the effects of glycosylation center on IgG in cancer therapy and autoimmunity. In cancer therapy, glycosylation modifications that enhance affinity for activating FcRs are utilized to facilitate immune-mediated tumor cell killing. In autoimmunity, disease severity has been linked to alterations in the presence, location, and composition of Fc glycans. Significantly less is understood about the role of glycosylation in the setting of allergy and asthma. However, recent data demonstrate that glycosylation of IgE at the asparagine-394 site of Cε3 is necessary for IgE interaction with the high affinity IgE receptor but, surprisingly, glycosylation has no effect on IgE interaction with its low-affinity lectin receptor, CD23.

Summary

Variations in the specific glycoform may modulate the interaction of an Ig with its receptors. Significantly more is known about the functional effects of glycosylation of IgG than for other Ig isotypes. Thus, the role of glycosylation is much better understood in the areas of autoimmunity and cancer therapy, where IgG is the dominant isotype, than in the field of allergy, where IgE predominates. Further work is needed to fully understand the role of glycan variation in IgE and other Ig isotypes with regard to the inhibition or mediation of allergic disease.

http://ift.tt/2eTePRL

Interleukin-5 Antagonists Usher in a New Generation of Asthma Therapy

Abstract

Asthma is the most common chronic respiratory disease in the USA. A subset of patients with asthma have refractory symptoms, persistent eosinophilic inflammation, and recurrent exacerbations despite maximal medical therapy. The monoclonal antibodies targeting the IL-5 pathway are a new class of medications designed to target severe eosinophilic asthma. There are two medications clinically available: mepolizumab and reslizumab, both of which target IL-5. A third medication, benralizumab, is currently under development and targets the IL-5 receptor. Clinical data suggest these medications can reduce asthma exacerbations and improve lung function in patients with peripheral eosinophilia and poorly controlled asthma despite maximal medical therapy. The anti-IL-5 medications are among the first targeted molecular therapies for asthma and will usher in an exciting new era in the treatment of severe asthma.

http://ift.tt/2eZPMPR

The Reemergence of the Asthma-COPD Overlap Syndrome: Characterizing a Syndrome in the Precision Medicine Era

Abstract

Purpose of Review

The asthma-COPD overlap syndrome (ACOS) has reemerged in the medical literature. This review addresses our current understanding of ACOS as a clinical and biological entity and how new and existing therapies may be targeted to this group.

Recent Findings

Many studies suggest that ACOS is common and associated with more morbidity than asthma and COPD in general. However, there is no consensus on an ACOS definition, likely due to the heterogeneity of the disease. Variable definitions have led to variable results in ACOS studies. Given this clinical variability, biomarkers (e.g., eosinophils and type 2 inflammatory markers) are increasingly being used to identify an ACOS molecular phenotype which appears to be more responsive to inhaled corticosteroids.

Summary

Although ACOS has become a popular diagnosis, it is unclear whether identifying ACOS as a separate disease entity is clinically useful. Future studies should focus on identifying key clinical features and biomarkers that characterize vulnerable and treatment-responsive patients.

http://ift.tt/2eTc42V

Biocompatibility of “On-command” dissolvable tympanostomy tube in the rat model

Objectives/Hypothesis

A prototype tympanostomy tube, composed of polybutyl/methyl methacrylate-co-dimethyl amino ethyl methacrylate (PBM), was tested to 1) evaluate the effect of PBM tubes on rat dermis as a corollary for biocompatibility and (2) to observe the efficacy of dissolution with isopropyl alcohol (iPrOH) and ethanol (EtOH).

Study Design

Original animal experiment and bench testing.

Methods

A two-part study was conducted to assess biocompatible substance with inducible dissolvability as a critical characteristic for a newly engineered tympanostomy tube. First, tympanostomy tubes were inserted subcutaneously in 10 rats, which served as an animal model for biosafety, and compared to traditional tubes with respect to histologic reaction. Tissue surrounding the PBM prototype tubes was submitted for histopathology and demonstrated no tissue reactivity or signs of major inflammation. In the second part, we evaluated the dissolvability of the tube with either isopropyl alcohol, ethanol, ofloxacin, ciprodex, water, and soapy water. PBM tubes were exposed to decreasing concentrations of iPrOH and EtOH with interval qualitative assessment of dissolution.

Results

Histologic examination did not reveal pathology with PBM tubes. Concentrations of at least 50% iPrOH and EtOH dissolve PBM tubes within 48 hours, whereas concentrations of at least 75% iPrOH and EtOH were required for dissolution when exposure was limited to four 20-minute intervals.

Conclusions

PBM is biocompatible in the rat model. Additionally, PBM demonstrates rapid dissolution upon alcohol-based stimuli, validating the proof-of-concept of dissolvable on-command or biocommandible ear tubes. Further testing of PBM is needed with a less ototoxic dissolver and in a better simulated middle ear environment before testing can be performed in humans.

Level of Evidence

NA Laryngoscope, 2016

http://ift.tt/2eLq4y2

Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis

Objectives/Hypothesis

To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA).

Data Sources

PubMed/MEDLINE and eight additional databases.

Review Methods

Three authors independently and systematically reviewed the international literature through February 21, 2016.

Results

Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea–hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is −1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73–95% reduction) than in children with large tonsils (61% reduction). For >3-year follow-up (range = 6.5–12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction).

Conclusions

Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up). Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope, 2016

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Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital

Objectives/Hypothesis

To describe the presentation and management of acute complicated mastoiditis in children.

Study Design

Retrospective case series.

Methods

An analysis of pediatric patients with acute complicated mastoiditis treated at an urban, tertiary care children's hospital from 2007 to 2014 was performed.

Results

Forty-eight patients presented with a total of 67 complications of acute mastoiditis. Mean age at presentation was 4.8 years (range = 0.1–15.3 years). The most common complications were subperiosteal abscess (n = 22, 45.8%), epidural abscess (n = 16, 33.3%), and sigmoid sinus thrombosis (n = 14, 29.2%). The most common pathogens isolated included Streptococcus pneumoniae (n = 14, 29.2%) and group A streptococcus (n = 10, 20.8%). Multidrug resistance was not associated with complication type. Surgical management included myringotomy ± tympanostomy tube placement in 46 (95.8%) patients (the only surgery in 10), drainage of subperiosteal abscess without mastoidectomy in 18 (37.5%) patients, and mastoidectomy in 21 (43.8%) total patients. Patients presenting with intracranial complications were the most likely to undergo a mastoidectomy. Anticoagulation was used in the management of nine of 14 (64.3%) patients presenting with sigmoid sinus thrombosis. Neurosurgical interventions (n = 7, 14.6% patients) were primarily performed to manage increased intracranial pressure.

Conclusions

Subperiosteal abscess was the most common complication of acute mastoiditis, and when occurring as the sole complication was successfully managed with antibiotics and surgical intervention that did not include mastoidectomy. Epidural abscess and sigmoid sinus thrombosis were more prevalent than reported in prior series and were managed more aggressively. These patients were more likely to need neurosurgical interventions.

Level of Evidence

4. Laryngoscope, 2016

http://ift.tt/2eLp1Oj

Does drug-induced sleep endoscopy predict surgical success in transoral robotic multilevel surgery in obstructive sleep apnea?

Objectives/Hypothesis

The aim of this study was to determine if drug-induced sleep endoscopy (DISE) was predictive of success for patients undergoing transoral robotic surgery (TORS) and multilevel procedures for sleep apnea.

Study Design

Retrospective case series of patients who underwent TORS surgery for sleep apnea

Methods

Before and after polysomnograms were analyzed to assess improvement, success, and cure. Improvement was defined as any decrease in apnea-hypopnea index (AHI), success as an AHI <20 with a decrease >50%, and cure as an AHI <5. DISE videos were scored using the NOHL (nose, oropharynx, hypopharynx, larynx) and VOTE (velum, oropharynx, tongue, epiglottis) classification systems.

Results

One hundred one patients were available for analysis. Eighty-seven percent of patients had an improvement in their AHI. Fifty-one percent met criteria for success, whereas 17% were cured. The degree of collapse at individual NOHL and VOTE subsites as well as total additive scores did not predict improvement, success, or cure. Patients with no oropharyngeal lateral collapse in the VOTE classification system were more likely to improve following surgery (P = .001); however, this effect did not hold for success or cure. Multivariate analysis of DISE variables was not predictive of success.

Conclusions

In obstructive sleep apnea patients, there is a 51% success rate and a 17% cure rate. DISE, as scored by the NOHL and VOTE system, did not readily identify patients who would benefit most from surgery. Patients with lateral oropharyngeal collapse may be poorer candidates. Prospective, larger studies are required to further evaluate the use of DISE in predicting success following TORS.

Level of Evidence

4 Laryngoscope, 2016

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Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery

Objectives/Hypothesis

Laser microlaryngeal surgery (LMS) is a short operation requiring brief and intense paralysis. Adequate muscle relaxation and rapid recovery of neuromuscular function are essential for improving surgical conditions and reducing the incidence of complications during LMS. However, the ideal muscle relaxant with a rapid onset and short duration of action is not yet available. Rocuronium has rapid onset at higher doses, but with a prolonged duration of action. Sugammadex is a selective relaxant-binding agent that allows for rapid reversal of rocuronium-induced neuromuscular blockade. This study aimed to compare the surgical conditions and anesthesia time between two combinations of neuromuscular blocker and reversal agent, rocuronium-sugammadex (R-S) and succinylcholine-cisatracurium-pyridostigmine (S-C-P), and propose an optimal anesthetic regimen for improving the surgical conditions in LMS patients.

Study Design

Prospective, randomized, double-blinded clinical study.

Methods

Patients in the R-S group received 1 mg/kg rocuronium bromide, whereas those in the S-C-P group received 1 mg/kg succinylcholine. After endotracheal intubation, 0.08 mg/kg cisatracurium was injected in S-C-P patients. After the procedure, R-S patients received 2 mg/kg sugammedex, whereas S-C-P patients received 0.2 mg/kg pyridostigmine plus 10 μg/kg atropine.

Results

In the R-S group, surgical condition scores were significantly higher and anesthesia time was significantly shorter. The use of additive neuromuscular blocking agents was significantly higher in the S-C-P group.

Conclusions

Muscle relaxation with rocuronium and reversal with sugammadex resulted in better surgical conditions and a shorter anesthesia time in patients undergoing LMS when compared to the S-C-P regimen.

Level of Evidence

1b Laryngoscope, 2016

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Is bevacizumab effective for reducing epistaxis in hereditary hemorrhagic telangiectasia?

http://ift.tt/2f3GrnV

In reference to “Review of videolaryngoscopy pharyngeal wall injuries”

http://ift.tt/2eLrcSf

Oral Swirl (OS) samples – A robust source of microRNA protected by extracellular vesicles

Abstract

MicroRNAs are small non-coding RNAs which are dysregulated in disease states, such as oral cancer. Extracellular vesicles, a potential source of microRNA, are found in saliva.

Objective

To demonstrate that a quantifiable amount of microRNA can be isolated from oral swirl samples. Additionally, we hypothesized that extracellular vesicles may protect contained microRNA from degradation in these samples.

Method

A polyethylene glycol based precipitation was used for extracellular vesicle enrichment of oral swirl samples. Comparison was made between samples treated with and without RNase. Further, samples from 3 subjects were submitted to a range of conditions over 7 days and assessed for presence of microRNA by reverse transcription quantitative PCR. Extracellular vesicles from samples were identified under transmission electron microscopy.

Results

An adequate quantity of microRNA for qPCR analysis was extractable from samples despite exposure to conditions under which degradation of RNA would be expected.

Conclusion

A technique was developed to isolate an adequate quantity of microRNA for analysis from oral swirl samples. Extracellular vesicle associated microRNA may be protected from degradation. This technique moves towards chairside application of translational microRNA research in the field of oral cancer prognostics.

This article is protected by copyright. All rights reserved.

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Implications of cancer stem cells in developing therapeutic resistance in oral cancer

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Prajna Paramita Naik, Durgesh Nandini Das, Prashanta Kumar Panda, Subhadip Mukhopadhyay, Niharika Sinha, Prakash Priyadarshi Praharaj, Rajesh Agarwal, Sujit Kumar Bhutia
Conventional therapeutics are often frequented with recurrences, refraction and regimen resistance in oral cavity cancers which are predominantly manifested by cancer stem cells (CSCs). During oncoevolution, cancer cells may undergo structural and functional reprogramming wherein they evolve as highly tolerant CSC phenotypes with greater survival advantages. The CSCs possess inherent and exclusive properties including self-renewal, hierarchical differentiation, and tumorigenicity that serve as the basis of chemo-radio-resistance in oral cancer. However, the key mechanisms underlying the CSC-mediated therapy resistance need to be further elucidated. A spectrum of dysfunctional cellular pathways including the developmental signaling, apoptosis, autophagy, cell cycle regulation, DNA damage responses and epigenetic regulations protect the CSCs from conventional therapies. Moreover, tumor niche shelters CSCs and creates an immunosuppressive environment favoring the survival of CSCs. Maintenance of lower redox status, epithelial-to-mesenchymal transition (EMT), metabolic reprogramming and altered drug responses are the accessory features that aid in the process of chemo-radio-resistance in oral CSCs. This review deals with the functional and molecular basis of cancer cell pluripotency-associated resistance highlighting the abrupt fundamental cellular processes; targeting these events may hold a great promise in the successful treatment of oral cancer.



http://ift.tt/2dZgfZ1

Clinical implications of the extent of BRAFV600E alleles in patients with papillary thyroid carcinoma

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Lihua Liu, Jae Won Chang, Seung-Nam Jung, Hee Sung Park, Taejeong Oh, Young Chang Lim, Bon Seok Koo
ObjectiveThere are many conflicting reports about the clinical implications of BRAF^V600E in papillary thyroid cancer (PTC). We investigated the associations between the extent of BRAF^V600E alleles and both clinico-pathological features and recurrence of PTC.Materials and methodsCarcinoma tissues from 60 patients with PTC were genotyped for BRAF^V600E using pyrosequencing, and the clinico-pathological factors and disease outcomes of the patients were examined. The associations between the extent of mutant BRAF alleles and both clinico-pathological parameters and recurrence-free survival (RFS) were analyzed.ResultsThe BRAF^V600E mutation was detected in 66.7% (40/60) of our PTC patients. When we defined four groups on the basis of the extent of BRAF^V600E alleles by pyrosequencing—negative (less than 5%), low (5 – less than 15%), intermediate (15 – less than 25%), and high (25% or greater)— the four groups showed statistically significant differences regarding lymph node (LN) metastasis and recurrence (P<0.05). However, age, gender, tumor size, multicentricity, capsular invasion, and lymphovascular invasion were not significantly different among the groups. The 10-year RFS rates in PTC patients with greater than 25% and less than 25% mutated BRAF alleles were 74% and 100%, respectively. This difference was significant (P=0.043).ConclusionsA high extent more than 25% of BRAF^V600E alleles may be associated with disease outcome in PTC patients. We need more data to verify a hypothesis that the extent of BRAF mutations may be clinically informative in the management of PTC, such as by tailoring proper surgical and radioactive iodine treatments and determining appropriate management during follow-up.



http://ift.tt/2frZfA0

Optimize the cycle of neoadjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy: A propensity score matching analysis

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Hao Peng, Lei Chen, Wen-Fei Li, Yuan Zhang, Li-Zhi Liu, Li Tian, Ai-Hua Lin, Ying Sun, Jun Ma
ObjectivesThe aim of this study is to optimize the cycle for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) receiving neoadjuvant chemotherapy (NCT) in the era of intensity-modulated radiotherapy (IMRT).Materials and methodsData on 569 locoregionally advanced NPC patients treated with IMRT were retrospectively reviewed. Propensity score matching (PSM) method was adopted to balance prognostic factors and match patients. Survival outcomes of matched patients between different NCT cycle groups were compared.ResultsThe median cycle of NCT was 2 (range, 2–4 cycles) for the whole cohort, and patients were therefore stratified as low cycle (=2) and high cycle (>2) groups. In total, 247 pairs of NPC patients were selected by PSM. Univariate analysis found no significantly prognostic difference between the low cycle and high cycle groups, and multivariate analysis did not establish NCT cycle as an independent factor. However, stratified analysis revealed patients in the low cycle group had better OS than those of patients in the high cycle group (92.4% vs. 80.8%, P=0.029), and NCT was identified as an independent prognostic factor for OS in patients with N2-3 category (HR, 2.252; 95% CI, 1.024–4.953; P=0.043).ConclusionTwo cycles of NCT may be enough and additional more cycles are not associated with improved survival outcomes for patients with locoregionally advanced NPC in the era of IMRT.



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Free flap outcome of salvage surgery compared to primary surgery for head and neck defects: A propensity score analysis

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Chung-Hwan Baek, Woori Park, Nayeon Choi, Seonhye Gu, Insuk Sohn, Man Ki Chung
ObjectivesTo compare free flap outcomes for head and neck defects between primary surgery and salvage surgery and identify factors affecting the outcomes in the two settings.MethodsA total of 225 patients (primary group, n=56; salvage group, n=169) were retrospectively identified. The salvage group was previously treated with radiotherapy, chemoradiation, surgery, or any combination of these treatments. Clinical data were retrieved and analyzed between the two groups to compare the incidence and contributing factors of flap-related complications and flap failure. A propensity score analysis with matching T stage, defect, and flap types was also performed for unbiased comparisons.ResultsFlap-related complication rate was 22.2% in all patients. The salvage group showed higher rates of wound dehiscence than the primary group (3.6% in primary vs. 13.0% in salvage; p=0.04). Flap failures occurred in 10 patients (4.4%), including 3 (5.4%) in the primary group and 7 (4.1%) in the salvage group (p=0.71). Multivariate analysis showed no critical factor that influenced the occurrence of flap-related complications or flap failure, including surgery type (primary or salvage). In propensity score analysis, incidences and types of flap-related complications and flap failure were not statistically different between the two groups (primary and salvage).ConclusionsFree flap reconstruction is a safe and reliable method to restore the ablative defects in previously irradiated or operated head and neck defects.



http://ift.tt/2exERJ2

Risk factors for radiation failure in early-stage glottic carcinoma: A systematic review and meta-analysis

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Görkem Eskiizmir, Yasemin Baskın, Femin Yalçın, Hülya Ellidokuz, Robert L. Ferris
BackgroundRadiotherapy is one of the main treatment modalities for early-stage glottic carcinoma. Unfortunately, local failure may occur in a group of cases with T1-T2 glottic carcinoma. This meta-analysis sought to determine risk factors for radiation failure in patients with early-stage glottic carcinoma.MethodsA systematic and comprehensive search was performed for related studies published between 1995 and 2014. The primary end-point was 5-year local control. Data extraction and analysis were performed using the software STATA/SE 13.1 for Windows.ResultsTwenty-seven studies were eligible. A higher risk of radiation failure was demonstrated in male patients [relative risk (RR): 0.927, p<0.001] and those with low hemoglobin level (RR: 0.891, p<0.001) with a high agreement between studies (I-squared=0.0%). Moreover, T2 tumors (RR: 0.795, p<0.001), tumors with anterior commissure involvement (RR: 0.904, p<0.001), tobacco use during/after therapy (RR: 0.824, p<0.001), and "bulky" tumors (RR: 1.270, p<0.001] or tumors bigger in size (RR: 1.332, p<0.001]. Poorly differentiated tumors had a questionable risk of local failure, although a moderate to high interstudy heterogeneity was determined. A statistically significant contribution was not detected for age, presence of comorbidity, alcohol use or subglottic extension.ConclusionThis is the first meta-analysis which assessed the potential risk factors for radiation failure in patients with early-stage glottic carcinoma. Gender and pretreatment hemoglobin level are major influential factors associated with radiation failure in patients with early-stage glottic carcinoma. However, prospective, randomized clinical trials may permit better stratification of their relative contributions, and those who may benefit more from upfront surgery.



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Diagnosis of HPV driven oropharyngeal cancers: Comparing p16 based algorithms with the RNAscope HPV-test

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Haïtham Mirghani, Odile Casiraghi, Joanne Guerlain, Furrat Amen, Ming-Xiao He, Xiao-Jun Ma, Yuling Luo, Céline Mourareau, Françoise Drusch, Aïcha Ben Lakdhar, Antoine Melkane, Lacau St Guily, Cécile Badoual, Jean Yves Scoazec, Isabelle Borget, Anne Aupérin, Veronique Dalstein, Philippe Vielh
BackgroundAccurate identification of HPV-driven oropharyngeal cancer (OPC) is a major issue and none of the current diagnostic approaches is ideal. An in situ hybridization (ISH) assay that detects high-risk HPV E6/E7 mRNA, called the RNAscope HPV-test, has been recently developed. Studies have suggested that this assay may become a standard to define HPV-status.MethodsTo further assess this test, we compared its performance against the strategies that are used in routine clinical practice: p16 immunohistochemistry (IHC) as a single test and algorithms combining p16-IHC with HPV-DNA identification by PCR (algorithm-1) or ISH (algorithm-2).Results105 OPC specimens were analyzed. The prevalence of HPV-positive samples varied considerably: 67% for p16-IHC, 54% for algorithm-1, 61% for algorithm-2 and 59% for the RNAscope HPV-test. Discrepancies between the RNAscope HPV-test and p16-IHC, algorithm-1 and 2 were noted in respectively 13.3%, 13.1%, and 8.6%.The 4 diagnostic strategies were able to identify 2 groups with different prognosis according to HPV-status, as expected. However, the greater survival differential was observed with the RNAscope HPV-test [HR: 0.19, 95% confidence interval (CI), 0.07–0.51, p=0.001] closely followed by algorithm-1 (HR: 0.23, 95% CI, 0.08–0.66, p=0.006) and algorithm-2 (HR: 0.26, 95% CI, 0.1–0.65, p=0.004). In contrast, a weaker association was found when p16-IHC was used as a single test (HR: 0.33, 95% CI, 0.13–0.81, p=0.02).ConclusionsOur findings suggest that the RNAscope HPV-test and p16-based algorithms perform better that p16 alone to identify OPC that are truly driven by HPV-infection. The RNAscope HPV-test has the advantage of being a single test.



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Lateral lymph node recurrence after total thyroidectomy and central neck dissection in patients with papillary thyroid cancer without clinical evidence of lateral neck metastasis

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Young Chang Lim, Lihua Liu, Jae Won Chang, Bon Seok Koo
BackgroundThis study analyzed the incidence, pattern, and predictive factors for lateral lymph node (LN) recurrence in patients with papillary thyroid cancer (PTC) without clinical evidence of lateral LN metastasis.MethodsA retrospective analysis was performed on 246 patients with PTC who underwent total thyroidectomy and central neck dissection from 2004 to 2010. None of the patients had clinical evidence of lateral LN metastasis at the time of diagnosis. Predictive factors for lateral LN recurrence were evaluated using the chi-square test. Binary logistic regression was used for the multivariate analysis. Recurrence-free survival rates were estimated by the Kaplan–Meier and Cox regression methods.ResultsOf the 246 patients, 11 (4.5%) developed lateral LN recurrence with a median follow-up of 49months. In the multivariate analysis, tumor size >1cm (odds ratio [OR], 8.14; 95% confidence interval [CI], 1.01–65.68; p=0.049) and central LN metastasis (OR, 10.59; 95% CI, 1.32–85.17; p=0.026) were independent predictive factors of lateral LN recurrence. Especially, extranodal extension of a metastatic central LN (OR, 38.82; 95% CI, 5.71–264.10; p<0.001) was an independent predictor of lateral LN recurrence.ConclusionsTumor size and central LN metastasis were independent predictors of lateral LN recurrence in patients with PTC without initial clinical lateral neck metastasis who underwent total thyroidectomy and central neck dissection. Close surveillance may be necessary for early detection of lateral LN recurrence in PTC patients with tumor size ⩾1cm, and central LN metastasis with extranodal extension.



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Induction chemotherapy with docetaxel, cisplatin and fluorouracil followed by concurrent chemoradiotherapy or chemoradiotherapy alone in locally advanced non-endemic nasopharyngeal carcinoma

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Dan Ou, Pierre Blanchard, Clément El Khoury, Francesca De Felice, Caroline Even, Antonin Levy, France Nguyen, François Janot, Philippe Gorphe, Eric Deutsch, Stephane Temam, Yungan Tao
ObjectivesTo evaluate the efficacy of induction chemotherapy with docetaxel, cisplatin and fluorouracil (TPF) followed by concurrent chemoradiotherapy (IC+CCRT) or CCRT alone in non-endemic locally advanced nasopharyngeal carcinoma (NPC) patients.Materials and methodsData of 106 patients with NPC treated from January 1999 to June 2012 with IC+CCRT (n=58) or CCRT alone (n=48) were retrospectively reviewed.ResultsMedian follow-up was 6.4years. Distribution of age, performance status, stage and concurrent chemotherapy regimen were imbalanced between the two groups. The 5-year overall survival (OS) and progression-free survival (PFS) were not significantly different between IC+CCRT and CCRT groups (OS: 78.3% vs. 82.7%, p=0.77; PFS: 72.5% vs. 68.2%, p=0.81, respectively). There were less total cumulative incidence of grade 3–4 late radiation morbidity in the IC+CCRT group (44.8% vs. 70.8%, p=0.01). Five-year OS for patients with post-IC complete response (CR), partial response (PR) and stable disease (SD) sub-groups were 100%, 79.4% and 60%, respectively.ConclusionCompared with CCRT alone, IC (TPF regimen)+CCRT did not improve OS or PFS in patients with NPC, but less grade 3–4 late toxicities were observed. Responsiveness of IC may provide additional prognostic information.



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Circulating tumor stem like cells in oral squamous cell carcinoma: An unresolved paradox

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Shanaya Patel, Kavan Shah, Sheefa Mirza, Kanisha Shah, Rakesh Rawal
ObjectiveCirculating tumor cells (CTCs) are increasingly gaining importance due to their immense potential in enhancing diagnosis, prognosis and response to therapy in solid malignancies. Therefore, we aimed to comprehend the molecular diversity and critical role of this disseminated tumor population in OSCC.MethodologyCD44+ subpopulation was isolated using immuno-magnetic cell separation and their purity was validated using flow cytometry. Characterisation of self renewal potential and resistance to chemotherapy was assessed using tumor sphere forming and cytotoxicity assay. Gene expression profile of pertinent CSC (CD44s, CD44v3, CD44v6) and stemness markers (Bmi1 and Nanog) was carried out in CD44+ cells using Real Time PCR. Predominantly expressed markers and their association with clinico-pathological conditions were substantiated in 30 OSCC patients.ResultFlow cytometry analysis depicted a predominant population of CD44+CD24−CD45− cells suggesting that circulating tumor cells had a subpopulation of CSC like cells in the circulation. These cells demonstrated increased sphere forming capability and intrinsic chemo-resistance compared to non-CSC, thus indicating the CSC features of self-renewal and chemo-resistance. Additionally, CD44+ cells showed significantly increased expression levels of CD44v6 and Nanog compared to CD44− cells. Clinically, expression pattern of CD44v6 and Nanog correlated with different anatomical subsites, loco-regional aggressiveness of the disease and recurrence, thus opening newer avenues that can be explored for better prognostic and therapeutic implications.ConclusionThis study explored the inevitable role of CD44v6 and Nanog as circulating stem like cell markers in assessment of loco-regional aggressiveness, detection of relapse and therapeutic response and resistance.



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Effects of geographic area and socioeconomic status in Taiwan on survival rates of head and neck cancer patients after radiotherapy

Publication date: November 2016
Source:Oral Oncology, Volume 62
Author(s): Tsu-Jen Kuo, Chi-Hsiang Chu, Pei-Ling Tang, Yu-Cheng Lai




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Tumor necrosis factor-α did not enhance α-smooth muscle actin expression in fibroblastic cell cultures derived from healthy donors

Publication date: Available online 27 October 2016
Source:Oral Oncology
Author(s): Lucas Novaes Teixeira, Flávio de Melo Garcia, Victor Ângelo Martins Montalli, Marcelo Sperandio, Elizabeth Ferreira Martinez, Vera Cavalcanti de Araújo




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Lung metastasectomy in adenoid cystic cancer: Is it worth it?

Publication date: Available online 26 October 2016
Source:Oral Oncology
Author(s): Lara Girelli, Laura Locati, Carlotta Galeone, Paolo Scanagatta, Leonardo Duranti, Lisa Licitra, Ugo Pastorino
Background and purposeAdenoid cystic carcinoma (ACC) of salivary glands is characterized by long-term distant metastasis, most commonly in lungs. No agreement has been reached about the role of surgical treatment of pulmonary lesions. We evaluated the long-term results of lung metastasectomy for ACC in order to identify factors that should be taken into account in selecting patients eligible for surgery and treatment planning.Patients and methodsA retrospective study was conducted on 109 patients selected from our institutional experience and from the International Registry of Lung Metastases. Survival was calculated by Kaplan-Meier estimate and prognostic factors endowed with a predictive power for most other metastatic cancers were investigated.ResultsThe cumulative survival was 66.8% at 5years and 40.5% at 10years. In patients with a disease-free interval (DFI) greater than 36months, the overall survival was 76.5% at 5years. Survival in case of complete surgical resection was 69.5% at 5years. Multivariate analysis confirmed DFI and completeness of resection resulted in the best prognostic variables.DiscussionLung metastasectomy should be considered as a therapeutic option to achieve local control of disease when 2 conditions are met: (1) complete surgical resection is feasible and (2) the time to pulmonary relapse after primary tumor treatment is greater than 36months. Symptomatic benefits of an incomplete lung resection in slow-growing tumors such as ACC remain uncertain. The turning point in the management of disseminated cancers will be clarified with biological profiling of ACC and the development of targeted therapies.



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Amidst the excitement: A cautionary tale of immunotherapy, pseudoprogression and head and neck squamous cell carcinoma

Publication date: Available online 21 October 2016
Source:Oral Oncology
Author(s): Shrujal S. Baxi, Lara A. Dunn, Barbara A. Burtness




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Prognosis of oral squamous cell carcinoma patients with level IV/V metastasis: An observational study

Publication date: Available online 29 October 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Takumi Hasegawa, Yasuyuki Shibuya, Daisuke Takeda, Eiji Iwata, Izumi Saito, Yasumasa Kakei, Akiko Sakakibara, Masaya Akashi, Tsutomu Minamikawa, Takahide Komori
PurposeThe objectives of this study were to retrospectively describe the characteristics and outcomes of patients with oral squamous cell carcinoma (OSCC) with level IV/V metastases, and to evaluate the multivariate relationships among potential risk factors for metastasis and prognosis.Materials and MethodsWe evaluated 291 patients (178 men and 113 women; mean age, 65.9 ± 13.5 years). Clinicopathological data, time of development of level IV/V metastases, and clinical course were investigated.ResultsTwenty-three patients (7.9%) developed level IV/V metastases. The 3-year overall survival rates when level IV/V metastasis first developed were 27.3% upon initial treatment, 57.1% when metachronous neck metastasis developed, and 40.0% when the tumor recurred. Oral tongue tumor subsite, high N staging, neck dissection when metachronous neck metastasis developed, as well as recurrence were independent risk factors for level IV/V metastasis.ConclusionWe demonstrate here the multivariate relationships among the risk factors indicated above for level IV/V metastasis and their prognostic significance for patients with OSCC. Oral tongue tumors, high N staging, and neck dissection upon the occurrence of metachronous neck metastasis or recurrence were risk factors for level IV/V metastasis and positive extracapsular spread, presence of multiple lymph metastases, and moderate or poor differentiation were poor prognostic factors.



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Host and clinical aspects in patients with benign migratory glossitis

Publication date: January 2017
Source:Archives of Oral Biology, Volume 73
Author(s): Rafaela Scariot, Thiago Beltrami Dias Batista, Marcia Olandoski, Cleber Machado Souza, Paulo Henrique Couto Souza, Antonio Adilson Soares Lima, Paula Cristina Trevilatto
ObjectiveInvestigate the association of clinical, cytological and genetic characteristics with benign migratory glossitis (BMG).Study designSample consisted of 175 patients, 44 with BMG and 131 control patients. Clinical examination and DMFT index were assessed. Cytological evaluation determined cell morphology and morphometry. Genetic evaluation was performed by analysing IL6 polymorphisms by real-time PCR. Univariate and multivariate analyses were performed (p<0.05).ResultsThere was a higher level of anxiety, DMFT score and a prevalence of fissured tongue in BMG group. A high mean nuclear/cytoplasmic area ratio was observed in patients with BMG. There was predominance of Papanicolaou class II I BMG group. IL6 allele G rs2069843 polymorphism was associated with BMG in the dominant model. In multivariate analysis, DMFT and anxiety scale remained associated with BMG.



http://ift.tt/2eQlY5k

Host and clinical aspects in patients with benign migratory glossitis

Publication date: January 2017
Source:Archives of Oral Biology, Volume 73
Author(s): Rafaela Scariot, Thiago Beltrami Dias Batista, Marcia Olandoski, Cleber Machado Souza, Paulo Henrique Couto Souza, Antonio Adilson Soares Lima, Paula Cristina Trevilatto
ObjectiveInvestigate the association of clinical, cytological and genetic characteristics with benign migratory glossitis (BMG).Study designSample consisted of 175 patients, 44 with BMG and 131 control patients. Clinical examination and DMFT index were assessed. Cytological evaluation determined cell morphology and morphometry. Genetic evaluation was performed by analysing IL6 polymorphisms by real-time PCR. Univariate and multivariate analyses were performed (p<0.05).ResultsThere was a higher level of anxiety, DMFT score and a prevalence of fissured tongue in BMG group. A high mean nuclear/cytoplasmic area ratio was observed in patients with BMG. There was predominance of Papanicolaou class II I BMG group. IL6 allele G rs2069843 polymorphism was associated with BMG in the dominant model. In multivariate analysis, DMFT and anxiety scale remained associated with BMG.



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Editorial Board

Publication date: November 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 133, Issue 5





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An unusual case of focal segmental glomerulosclerosis presenting with retropharyngeal edema

Publication date: November 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 133, Issue 5
Author(s): C.-H. Hsu, M.-Y. Wu, Y.-C. Liu, C.-S. Wong
IntroductionAcute neck swelling with pharyngeal signs often triggers emergency consultation. Treatment and diagnosis are usually multidisciplinary. Failing to find a possible etiology may lead to misdiagnosis.Case presentationA young man presented to the emergency room with a 4-day history of cough, neck swelling and sore throat. Laboratory testing showed a leukocyte count of 9200 without left shift. Mild elevated CRP with 1.7 was noted and computed tomography (CT) showed fluid accumulation in the retropharyngeal space and neck edema down to thyroid region. Antibiotic was prescribed and admitted to infection ward under the impression of deep neck infection. During hospitalization, needle aspiration was performed where water fluid was collected without pus. Investigations showed massive proteinuria, hypoalbuminemia and hypercholesterolemia. The early focal segmental glomerulosclerosis was found by renal biopsy. After prednisolone 60mg daily and albumin supplement, the neck swelling, swallowing pain and general edema had completely resolved.DiscussionThe purpose of this case is to raise awareness of nephrotic syndrome as an unusual but possibly cause of retropharyngeal edema. We highlight the diagnostic features that will allow the physicians to make the correct diagnosis, avoid unnecessary incision and drainage, and commence effective treatment early in the disease course.



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Neck tumour

Publication date: November 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 133, Issue 5
Author(s): C.A. Righini, A. Bally, L. Giraud




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Primary epidermoid carcinoma of the lacrimal sac

Publication date: November 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 133, Issue 5
Author(s): A. El Bousaadani, R. Abada, M. Belhadji, M. Mahtar




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Erratum to “Head and neck adenoid cystic carcinoma: A prospective multicenter REFCOR study of 95 cases” [Eur. Ann. Otorhinolaryngol. Head Neck Dis. 133 (1) (2016) 13–7]

Publication date: Available online 26 October 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): M. Meyers, B. Granger, P. Herman, F. Janot, R. Garrel, N. Fakhry, G. Poissonnet, A.-C. Baglin, M. Lefèvre, B. Baujat




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Ameloblastoma of the jaws: Management and recurrence rate

Publication date: Available online 25 October 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Laborde, R. Nicot, T. Wojcik, J. Ferri, G. Raoul
IntroductionAmeloblastoma is a rare, benign odontogenic tumour associated with a high recurrence rate. It accounts for 1% of all tumours of the jaws. The purpose of this study was to compare the ameloblastoma recurrence rate according to the type of treatment: radical or conservative.Patients and methodsAll patients with a diagnosis of ameloblastoma between 1991 and 2013 were retrospectively identified in order to extract topographic, radiological, and histological data and the type of treatment: conservative (marsupialization, enucleation, curettage) or radical (segmental resection) and to compare the recurrence rate according to the type of treatment.ResultsTwenty-seven patients were included, managed by conservative treatment (CT) in 22 cases and radical treatment (RT) in 14 cases. The recurrence rate was 90.9% in the CT group and 9.1% in the RT group (P=0.025) with a mean follow-up of 56.2 months.DiscussionThe recurrence rate after conservative treatment was higher than that after radical treatment. These results are similar to those reported in the literature. The choice of treatment must be adapted to the macroscopic and histological characteristics of each tumour and to the patient.



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Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults

Publication date: Available online 24 October 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Bequignon, B. Vérillaud, L. Robard, J. Michel, V. Prulière Escabasse, L. Crampette, O. Malard
ObjectivesThe authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (SFORL) on first-line treatment of epistaxis in adults.MethodsA multidisciplinary work-group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work-group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.ResultsIn first-line, clearing out blood-clots and bidigital compression are recommended. In case of persistent bleeding, local anesthesia with a vasoconstrictor is essential before nasal diagnostic and therapeutic procedures. When the origin of bleeding is not anterior, nasal endoscopy is an essential procedure, identifying the bleeding site in most cases. In case of active bleeding, cauterization is recommended but is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.



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Nasal NK/T-cell lymphoma: A tragic case

Publication date: Available online 24 October 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): L. Taali, M. Abou-Elfadl, M. Fassih, M. Mahtar
IntroductionNasal NK/T-cell lymphoma is a rare clinicopathological entity, formerly called midline lethal granuloma. Following progress in histology and the routine use of immunohistochemistry, nasal NK/T-cell lymphoma was recognized as a distinct entity by WHO in 2001.Case reportThe authors report the case of a 22-year-old, insulin-dependent diabetic woman, who presented with mid-facial inflammatory swelling following facial trauma, initially diagnosed and treated as cellulitis of the face. The subsequent course was rapidly progressive and fatal, with the development of midline destructive disease. Histological examinations concluded on NK/T-cell lymphoma.DiscussionThe various differential diagnoses of NK/T-cell lymphoma include gangrenous cellulitis, invasive mycotic rhinosinusitis, Wegener's granulomatosis, actinomycosis, and facial T-cell lymphoma. The clinical presentation of this case was atypical, resulting in delayed diagnosis and treatment. Treatment is based on radiotherapy and chemotherapy, but the prognosis remains very poor even when treatment is rapidly initiated.



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Guidelines of the French Society of Otorhinolaryngology (SFORL). Second-line treatment of epistaxis in adults

Publication date: Available online 17 October 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): B. Verillaud, L. Robard, J. Michel, V. Pruliere Escabasse, E. Béquignon, L. Crampette, O. Malard
ObjectivesThe authors present the guidelines of the French Oto-Rhino-Laryngology – Head and Neck Surgery Society (Société Française d'Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou: SFORL) on second-line treatment of epistaxis in adults, after failure of anterior and/or anterior–posterior nasal packing.MethodsA multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.ResultsArterial embolization should be performed by an experienced interventional neuroradiologist with adequate technical facilities, to reduce the risk of complications. Cerebral and supra-aortic vessel CT angiography should be performed in case of post-traumatic epistaxis with suspected internal carotid injury. In case of persistent bleeding despite endoscopic hemostasis of the sphenopalatine artery, anterior ethmoidal artery hemostasis should be performed via a medial canthal incision, with endoscopic assistance as needed. In case of persistent epistaxis despite the usual surgical and neuroradiological procedures, surgical exploration of the sinonasal cavities should be performed, with elective coagulation in case of bleeding from secondary branches, and/or ethmoidectomy in case of diffuse bleeding. A decision-tree was drawn up for the management of second-line treatment of epistaxis.



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Management of chronic spontaneous urticaria in routine clinical practice: A Delphi-method questionnaire among specialists to test agreement with current European guidelines statements

Publication date: Available online 28 October 2016
Source:Allergologia et Immunopathologia
Author(s): A. Giménez-Arnau, M. Ferrer, J. Bartra, I. Jáuregui, M. Labrador-Horrillo, J. Ortiz de Frutos, J.F. Silvestre, J. Sastre, M. Velasco, A. Valero
BackgroundChronic spontaneous urticaria (CSU) is a frequent clinical entity that often presents a diagnostic and therapeutic challenge.ObjectiveTo explore the degree of agreement that exists among the experts caring for patients with CSU diagnosis, evaluation, and management.MethodsAn online survey was conducted to explore the opinions of experts in CSU, address controversial issues, and provide recommendations regarding its definition, natural history, diagnosis, and treatment. A modified Delphi method was used for the consensus.ResultsThe questionnaire was answered by 68 experts (dermatologists, allergologists, and primary care physicians). A consensus was reached on 54 of the 65 items posed (96.4%). The experts concluded that CSU is a difficult-to-control disease of unpredictable evolution. Diagnostic tests should be limited and based on clinical history and should not be indiscriminate. Autoinflammatory syndromes and urticarial vasculitis must be ruled out in the differential diagnosis. A cutaneous biopsy is only recommended when wheals last more than 24h, to rule out urticarial vasculitis. The use of specific scales to assess the severity of the disease and the quality of life is recommended. In patients with severe and resistant CSU, second-generation H1-antihistamines could be used at doses up to four times the standard dose before giving second-line treatments. Omalizumab is a safe and effective treatment for CSU that is refractory to H1-antihistamines treatment. In general, diagnosis and treatment recommendations given for adults could be extrapolated to children.ConclusionsThis work offers consensus recommendations that may be useful in the management of CSU.



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Prenatal and postnatal exposure to polycyclic aromatic hydrocarbons and allergy symptoms in city children

Publication date: Available online 25 October 2016
Source:Allergologia et Immunopathologia
Author(s): J. Jerzynska, D. Podlecka, K. Polanska, W. Hanke, I. Stelmach, W. Stelmach
BackgroundStudies indicate that exposure to polycyclic aromatic hydrocarbons (PAH) is associated with adverse respiratory and allergy outcomes. Exposure to PAH may impair the immune function of the foetus and, subsequently, be responsible for an increased susceptibility of children to allergic diseases.ObjectivesThe aim of the present study was to assess the association between mother's exposure to PAH during pregnancy and allergy diseases in their infants. We also assessed the above associations using measured PAH exposure in children's urine during the first two years of life.MethodsThe current analysis was restricted to 455 mothers and their children from Lodz district. The women were interviewed three times during the pregnancy in order to collect demographic, socio-economic and medical history data. Children's health status was assessed at the age of 10–18 months and repeated at two years of age. The associations between dependent dichotomous variables and urine concentrations of 1-hydroxypyrene (1-HP) were analysed using logistic regression.ResultsWe showed that higher urine concentrations of 1-HP in mothers at 20–24 weeks of pregnancy increased the risk of more frequent respiratory infections (p=0.02) in children during their first year of life. Higher 1-HP concentrations in children's urine increased the risk of food allergy (p=0.002) in children during their first two years of life.ConclusionsThis study suggests awareness of environmental factors, which may affect children's health since PAH showed to be a risk factor for airway infections and food allergy in children after adjustment for other risk factors.



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Allergenicity of vertebrate tropomyosins: Challenging an immunological dogma

Publication date: Available online 24 October 2016
Source:Allergologia et Immunopathologia
Author(s): J. González-Fernández, A. Daschner, C. Cuéllar
With the exception of tilapia tropomyosin, other anecdotic reports of tropomyosin recognition of vertebrate origin are generally not accompanied by clinical significance and a dogmatic idea is generally accepted about the inexistence of allergenicity of vertebrate tropomyosins, based mainly on sequence similarity evaluations with human tropomyosins. Recently, a specific work-up of a tropomyosin sensitised patient with seafood allergy, demonstrated that the IgE-recognition of tropomyosin from different fish species can be clinically relevant. We hypothesise that some vertebrate tropomyosins could be relevant allergens. The hypothesis is based on the molecular evolution of the proteins and it was tested by in silico methods. Fish, which are primitive vertebrates, could have tropomyosins similar to those of invertebrates. If the hypothesis is confirmed, tropomyosin should be included in different allergy diagnosis tools to improve the medical protocols and management of patients with digestive or cutaneous symptoms after fish intake.



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Knowledge and attitudes among patients with asthma and parents and physicians towards influenza vaccination

Publication date: Available online 24 October 2016
Source:Allergologia et Immunopathologia
Author(s): A. Kaya, N. Altınel, G. Karakaya, F. Çetinkaya
BackgroundInfluenza is an infectious disease, dangerous for all people, especially for some risk groups such as patients with chronic diseases and health care workers. But most of the people under the risk of influenza, including health care workers are not immunised because of misinformation. In this study, we aimed to determine the knowledge, beliefs and attitudes of patients with allergic rhinitis and asthma and parents of such children related to influenza vaccination. Attitudes and beliefs of physicians treating these patients about influenza vaccination were also investigated.MethodsTwo different questionnaires consisting of various items related to influenza vaccine were distributed to physicians and patients and parents of children with asthma and allergic disease.ResultsThe physicians group consisted of 189 physicians from various branches. About one third of physicians from various branches reported that they did not believe the vaccine's effectiveness. Most of the participating physicians did not immunise themselves with influenza vaccination despite the fact that any patient of theirs had died due to influenza infection.Although nearly half of the 183 patients had been vaccinated with influenza vaccine, only 27% of adults and 11.7% of children had been vaccinated annually.ConclusionsAsthmatic patients are not immunised regularly with influenza vaccine due to misperceptions about vaccine effectiveness and fear of adverse effects. Another important reason of this is that most the physicians caring for these patients neither immunise themselves nor recommend the vaccine to their patients.



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Novel AICDA mutation in a case of autosomal recessive hyper-IgM syndrome, growth hormone deficiency and autoimmunity

Publication date: Available online 24 October 2016
Source:Allergologia et Immunopathologia
Author(s): A. Fazel, S. Kashef, S. Aleyasin, S. Harsini, Z. Karamizadeh, S. Zoghi, S.K. Flores, K. Boztug, N. Rezaei
BackgroundThe Hyper-immunoglobulin M syndromes (HIGM) are a heterogeneous group of genetic disorders, which have been rarely reported to be associated with growth hormone deficiency (GHD).Methods and resultsA nine-year-old girl with recurrent urinary tract infections, diarrhoea, sinopulmonary infections, and failure to thrive since the age of six months had normal CD3+, CD4+, CD8+T lymphocytes, and CD19+B lymphocytes and natural killer (NK) cells, but extremely elevated IgM and significantly decreased IgG and IgA. In view of the patient's short stature, growth hormone evaluation was carried out and growth hormone deficiency established. The patient underwent Ig replacement therapy and received growth hormone therapy in addition to antibiotics and responded well. Furthermore, the patient developed benign cervical lymphadenopathy, as well as elevated erythrocyte sedimentation rate, positive autoantibodies to SSA-Ro, and severely dry eyes, which partially responded to both the punctate occlusion and systemic corticosteroids, at the age of seven years. Sequencing analysis of the exons from activation-induced cytidine deaminase (AICDA) gene revealed that the patient was homozygous for a single T to C transversion at position 455 in exon 4, which replaces a Valine with an Alanine.ConclusionsTo our knowledge, this is a new AICDA mutation, which has not been reported previously in HIGM. The mutation analysis could improve diagnosis of HIGM patients and also elaborating on the spectrum of AICDA mutations.



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Gut microbiota and allergy/asthma: From pathogenesis to new therapeutic strategies

Publication date: Available online 28 October 2016
Source:Allergologia et Immunopathologia
Author(s): Y.B. Kang, Y. Cai, H. Zhang
Asthma and atopy, classically associated with hyper-activation of the T helper 2 (Th2) arm of adaptive immunity, are among the most common chronic illnesses worldwide. Emerging evidence relates atopy and asthma to the composition and function of gut microbiota composition. Moreover, certain gut microbial strains have been shown to inhibit or attenuate immune responses associated with chronic inflammation in experimental models. Although still a relatively nascent field of research, evidence to date suggests that the gut microbiome may represent fertile targets for prevention or management of allergic asthma and other diseases in which adaptive immune dysfunction is a prominent feature. The oral probiotics/prebiotic represents a possible therapeutic for improving asthma and allergic disease. Especially, recent technological developments that permit identification of microbes and their products using culture-independent molecular detection techniques. In this review, we literaturely summarise the aggravation or improvement of metabolic diseases by role of gut microbiota, probiotics/prebiotic treatment.



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Variations of B cell subpopulations in peripheral blood of healthy Mexican population according to age: Relevance for diagnosis of primary immunodeficiencies

Publication date: Available online 22 October 2016
Source:Allergologia et Immunopathologia
Author(s): L. Berrón-Ruíz, G. López-Herrera, C.E. Ávalos-Martínez, C. Valenzuela-Ponce, E. Ramírez-SanJuan, G. Santoyo-Sánchez, F. Mújica Guzmán, F.J. Espinosa-Rosales, L. Santos-Argumedo
BackgroundPeripheral blood B cells include lymphocytes at various stages of differentiation, each with a specific function in the immune response. All these stages show variations in percentage and absolute number throughout human life. The numbers and proportions of B subpopulation are influenced by factors such as gender, age, ethnicity, and lifestyle. This study establishes reference values according to age of peripheral blood B cell subtypes in healthy Mexican population.MethodsPeripheral blood from healthy new-borns and adults were analysed for total B cell subpopulations, using surface markers such as CD19, IgM, IgD, CD21, CD24, CD27, and CD38, to identify naïve, memory with and without isotype switch, double-negative, transitional, and plasmablast cells.ResultsWe observed a significant variation in terms of frequency and absolute counts between all groups analysed. Values from each B cell subpopulation show variations according to age.ConclusionsIn order to attempt to elucidate reference values for B cell subpopulation, the present study evaluated a population sample of healthy blood donors from this region. Values reported here can also be used as a tool for diagnosis of diseases in which B cell maturation is affected.



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Evidence in immunotherapy for paediatric respiratory allergy: Advances and recommendations

Publication date: Available online 21 October 2016
Source:Allergologia et Immunopathologia
Author(s): M. Tortajada-Girbés, M. Mesa del Castillo, H. Larramona, J.M. Lucas, M. Álvaro, A.I. Tabar, M.J. Jerez, A. Martínez-Cañavate
Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy (AIT). AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT.



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