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
Σάββατο 29 Οκτωβρίου 2016
Implications of cancer stem cells in developing therapeutic resistance in oral cancer
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 BRAFV600E in papillary thyroid cancer (PTC). We investigated the associations between the extent of BRAFV600E alleles and both clinico-pathological features and recurrence of PTC.Materials and methodsCarcinoma tissues from 60 patients with PTC were genotyped for BRAFV600E 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 BRAFV600E mutation was detected in 66.7% (40/60) of our PTC patients. When we defined four groups on the basis of the extent of BRAFV600E 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 BRAFV600E 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.
http://ift.tt/2frUoih
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.
http://ift.tt/2dHCPbK
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.
http://ift.tt/2dZiBY2
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.
http://ift.tt/2dZfPSy
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.
http://ift.tt/2dZe0VW
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
http://ift.tt/2frWw9P
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
http://ift.tt/2dZgfIv
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.
http://ift.tt/2frXAdC
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
http://ift.tt/2dZfTlr
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.
http://ift.tt/2f1bn85
Host and clinical aspects in patients with benign migratory glossitis
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
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
Editorial Board
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 133, Issue 5
http://ift.tt/2f12bjU
An unusual case of focal segmental glomerulosclerosis presenting with retropharyngeal edema
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.
http://ift.tt/2fik5T3
Neck tumour
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 133, Issue 5
Author(s): C.A. Righini, A. Bally, L. Giraud
http://ift.tt/2f170cU
Primary epidermoid carcinoma of the lacrimal sac
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 133, Issue 5
Author(s): A. El Bousaadani, R. Abada, M. Belhadji, M. Mahtar
http://ift.tt/2fihCIr
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]
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
http://ift.tt/2f16BYc
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.
http://ift.tt/2figB32
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.
http://ift.tt/2f18OCP
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.
http://ift.tt/2fibQ9A
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.
http://ift.tt/2f12ATK
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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Chondrosarcoma of the hyoid bone – Report of a case and a literature review of the suitable treatment strategy
Publication date: Available online 18 October 2016
Source:Auris Nasus Larynx
Author(s): Daisuke Maki, Taisuke Mori, Masanori Teshima, Kenya Kobayashi, Fumihiko Matsumoto, Akihiro Sakai, Kenji Okami, Seiichi Yoshimoto
Chondrosarcoma is a rare malignant tumor occurring in the trunk and long bones. We present an extremely rare case of chondrosarcoma of the hyoid bone with clinical and pathological correlation and a literature review. We searched all cases of the hyoid chondrosarcoma in PubMed (MEDLINE) between 1990 and 2015. Eighteen cases were analyzed, including the present case. Most of them were low grade type. In 12 cases where intraoperative findings were recorded, no adhesion to the surrounding tissue was observed. Chondrosarcoma of the hyoid bone is usually low grade type, and there may be no invasion to the adjacent structures even if invasion is suspected by imaging findings. In order to preserve swallowing and laryngeal function, total hyoidectomy without laryngectomy should be indicated according to the intraoperative findings. Needle biopsy is an effective diagnostic technique, but open biopsy should be avoided to prevent the dissemination. To the best of our knowledge, this is the first presentation of hyoid bone chondrosarcoma with the investigation of intraoperative findings and pre-operative diagnostic modality.
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Congenital nasal cavity stenosis in children with craniosyntosis: A report of 4 rare cases
Publication date: Available online 25 October 2016
Source:Auris Nasus Larynx
Author(s): Yew Toong Liew, Siew Shuin Soo, Anna Marie Nathan, Anura Michelle Manuel
Congenital bony nasal stenosis (CBNS) is a very rare but life-threatening cause of airway obstruction in neonates and infants. This review aims to assess the presentation and early airway management of 4 new cases of craniosynostosis with bilateral nasal cavity stenosis. Patients were treated with endoscopic endonasal widening of the nasal cavity and stenting. All patients were extubated well post-operatively with resolution of symptoms. They remained asymptomatic with stents in situ for at least 6 months with no complications reported.Minimally invasive endoscopic endonasal widening of the nasal cavity with stenting is an effective and safe way of addressing nasal cavity stenosis.
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Editorial Board
Publication date: November 2016
Source:Journal of Oral Biosciences, Volume 58, Issue 4
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Evaluation of a new mouse model for studying dental pulpal responses to GaAlAs laser irradiation
Publication date: Available online 27 October 2016
Source:Journal of Oral Biosciences
Author(s): Shiori Sugawara, Yoshimi Shigetani, Shinichi Kenmotsu, Takashi Okiji, Hayato Ohshima
ObjectivesThe molecular mechanisms regulating pulpal responses to GaAlAs laser irradiation remain to be clarified. This study aimed to assess the feasibility of a mouse model for studying pulpal responses to GaAlAs laser irradiation.MethodsMaxillary first molars of 5-week-old ICR mice were irradiated at an output power of 1.0W for 180s, and samples were collected at intervals of 0, 1, 3, 5, 7, 10, and 14 days. The demineralized paraffin sections were processed for hematoxylin and eosin staining, immunohistochemistry for nestin (a marker for odontoblast differentiation) and Ki67 (a marker for cell proliferation), and a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay.ResultsThe intense nestin immunoreactivity in the odontoblast layer of the mesial pulp was weakened immediately after irradiation and was almost lost on Days 1–3, although the extent of pulpal damage was variable among individual animals. At around Day 1, numerous TUNEL-positive cells appeared in the degenerative zone and gradually decreased in number by Day 14. Active cell proliferation occurred in the mesial pulp during Days 5–10. Nestin-positive odontoblast-like cells appeared along the pulp-dentin border by Day 10, resulting in tertiary dentin formation on Day 14.ConclusionsThe current output energy induced apoptosis in the affected dental pulp, followed by active cell proliferation, resulting in tertiary dentin formation. This is the first report regarding laser irradiation of teeth in an in vivo mouse model. This model could enable further understanding of the function of certain proteins, including transcriptional factors.
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Comparing performance of Bonfils fiberscope and GlideScope videolaryngoscope for awake intubation
The recent article by Nassar et al [1] comparing performance of Bonfils fiberscope and GlideScope videolaryngoscope for awake intubation in the morbidly obese patients with expected difficult airways was of great interest to us. They showed that Bonfils fiberscope was more tolerated by patients with statistical difference, whereas GlideScope videolaryngoscope provided shorter intubation time and less intubation attempts but without statistical significance. Given that the airway management of morbidly obese patients often presents a unique challenge to the anesthesiologists, their findings have potential implications.
http://ift.tt/2eZ1nMK
Sudden cardiorespiratory collapse associated with Takotsubo cardiomyopathy upon transferring a patient to the operation bed
Here, we report a case of cardiopulmonary collapse associated with Takotsubo cardiomyopathy after moving a patient to the operation bed.
http://ift.tt/2eH5ChP
Rapid-sequence intubation of a patient with difficult airway using a double-lumen endotracheal tube with the Pentax-AWS Airwayscope and a soft-tipped tube exchanger
Rapid-sequence intubation of a double-lumen tube is difficult, especially in patients with difficult airway [1]. Here we report successful rapid-sequence intubation of a patient with difficult airway using a double-lumen endotracheal tube (DLT) with the Pentax-AWS Airwayscope (AWS) (HOYA, Tokyo, Japan) videolaryngoscope equipped with a newly developed Intlock for DLT (ITL-LL) (HOYA), combined with a soft-tipped tube exchange catheter (TE-Soft) (Cook Medical, IN, USA).
http://ift.tt/2eYUpaM
A distinct microbiota composition is associated with protection from food allergy in an oral mouse immunization model
Publication date: December 2016
Source:Clinical Immunology, Volume 173
Author(s): Susanne C. Diesner, Cornelia Bergmayr, Barbara Pfitzner, Vera Assmann, Durga Krishnamurthy, Philipp Starkl, David Endesfelder, Michael Rothballer, Gerhard Welzl, Thomas Rattei, Thomas Eiwegger, Zsolt Szépfalusi, Heinz Fehrenbach, Erika Jensen-Jarolim, Anton Hartmann, Isabella Pali-Schöll, Eva Untersmayr
In our mouse model, gastric acid-suppression is associated with antigen-specific IgE and anaphylaxis development. We repeatedly observed non-responder animals protected from food allergy. Here, we aimed to analyse reasons for this protection. Ten out of 64 mice, subjected to oral ovalbumin (OVA) immunizations under gastric acid-suppression, were non-responders without OVA-specific IgE or IgG1 elevation, indicating protection from allergy. In these non-responders, allergen challenges confirmed reduced antigen uptake and lack of anaphylactic symptoms, while in allergic mice high levels of mouse mast-cell protease-1 and a body temperature reduction, indicative for anaphylaxis, were determined. Upon OVA stimulation, significantly lower IL-4, IL-5, IL-10 and IL-13 levels were detected in non-responders, while IL-22 was significantly higher. Comparison of fecal microbiota revealed differences of bacterial communities on single bacterial Operational-Taxonomic-Unit level between the groups, indicating protection from food allergy being associated with a distinct microbiota composition in a non-responding phenotype in this mouse model.
Graphical abstract
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Intraperitoneal injection of IDO-expressing dermal fibroblasts improves the allograft survival
Publication date: Available online 29 October 2016
Source:Clinical Immunology
Author(s): Mohsen Khosravi-Maharlooei, MohammadReza Pakyari, Reza B. Jalili, Ruhangiz T. Kilani, Aziz Ghahary
Indoleamine 2,3-dioxygenase (IDO) is an immunosuppressive enzyme with tolerogenic effects on different immune cells. Our group has previously shown that co-transplantation of IDO-expressing fibroblasts with donor tissues can delay immune rejection by inducing local immunosuppression. In this study, we have employed a systemic approach to improve allograft survival without using any immunosuppressive medication. To achieve this, 10 million lentiviral transduced IDO-expressing donor derived fibroblasts were injected into the peritoneal cavity of allograft recipients. We showed that IDO-fibroblast therapy increases the survival of both islets and skin allografts and decreases the infiltration of immune cells in subcutaneous transplanted skins. Indirect pathway of allo-reactive T cell activation was suppressed more than the direct pathway. Injected IDO-fibroblasts were found in peritoneal cavity and mesenteric lymph nodes of the recipient mice. In conclusion, IDO-expressing fibroblast therapy proved to be a novel approach in improving the allogeneic graft survival.
http://ift.tt/2dYzS3A
Phenotypic changes of peripheral blood mononuclear cells upon corticosteroid treatment in idiopathic intermediate uveitis
Publication date: Available online 29 October 2016
Source:Clinical Immunology
Author(s): Karoline Walscheid, Toni Weinhage, Dirk Foell, Carsten Heinz, Maren Kasper, Arnd Heiligenhaus
We analyzed phenotype and function of peripheral blood mononuclear cells in 9 patients with active idiopathic intermediate uveitis (IIU) before and after 6 and 12weeks of systemic corticosteroid (CS) treatment and compared to 28 healthy individuals. Monocytes from IIU patients showed increased MHCII expression compared with controls (p=0.09). Treatment reduced expression of MHCII, CD86, CD39 and CD124 (all p<0.05), whereas the percentage of CD121b-expressing monocytes was increased by week 6 (p=0.039). Patients showed alterations in T cell polarization (Th1/Th2 ratio: patients 5.2 versus controls 3.1, p=0.054; Th17/Treg ratio: 3.0 versus 1.7, p=0.027). S100A12 serum levels were higher in active IIU (p=0.057). Phagocytosis, oxidative burst and serum cytokine levels did not differ between patients and controls, and were not altered by treatment. In conclusion, monocytes from patients with active IIU show increased co-stimulatory capacities, which are modulated by systemic CS treatment, whereas innate immune cell functions are not altered.
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Estrogen receptor alpha promotes lupus in (NZB×NZW)F1 mice in a B cell intrinsic manner
Publication date: Available online 29 October 2016
Source:Clinical Immunology
Author(s): Dana E. Tabor, Karen A. Gould
Lupus is a systemic autoimmune disease characterized by the production of autoreactive antibodies against nuclear antigens. Women are disproportionately affected by lupus, and this sex bias is thought to be due, in large part, to the ability of estrogens to promote lupus pathogenesis. Previously, we have shown that global deletion of estrogen receptor alpha (ERα) significantly attenuated loss of tolerance, immune cell activation, autoantibody production, and the development of lupus nephritis. Here we show that targeted deletion of ERα specifically in B cells retards production of pathogenic autoantibodies and the development of nephritis in lupus-prone (NZB×NZW)F1 mice. Furthermore, we observed that ERα deletion in B cells was associated with decreased B cell activation in young, pre-autoimmune (NZB×NZW)F1 females. Altogether, these data suggest that ERα acts in a B cell-intrinsic manner to control B cell activation, autoantibody production, and lupus nephritis.
http://ift.tt/2dYvuRY
Inflammation elevated IL-33 originating from the lung mediates inflammation in acute lung injury
Publication date: Available online 29 October 2016
Source:Clinical Immunology
Author(s): Shi-hui Lin, Juan Fu, Chuan-jiang Wang, Feng Gao, Xuan-yun Feng, Qiong Liu, Ju Cao, Fang Xu
Excessive inflammatory reactions occur with acute respiratory distress syndrome (ARDS), however, the underlying mechanisms of ARDS remain incompletely understood. Here we investigated whether interleukin (IL)-33 was elevated in ARDS patients. Serum samples were obtained from 14 ARDS patients and 24 control healthy volunteers. ELISA was used to measure the concentrations of IL-33. Besides, we established pulmonary ARDS and extrapulmonary ARDS models in mice, and serum and lung tissue samples were collected for analyses. The results showed that serum IL-33 concentrations were significantly higher in pulmonary ARDS patients compared to controls. Also, the levels of IFN-γ and IL-2 were positively correlated with IL-33 levels. We also showed that there were increased IL-33 levels in both the serum and lungs in the pulmonary ARDS model. This was not the case, however, in the extrapulmonary ARDS model. Pulmonary inflammation and injury in the pulmonary ARDS model was reduced with IL-33 neutralizing antibody treatment.
http://ift.tt/2frfbCn
An overview of the necessary thymic contributions to tolerance in transplantation
Publication date: December 2016
Source:Clinical Immunology, Volume 173
Author(s): Joseph R. Scalea, John B. Hickman, Daniel J. Moore, Kenneth L. Brayman
The thymus is important for the development of the immune system. However, aging leads to predictable involution of the thymus and immunodeficiency. These immunodeficiencies may be rectified with thymic rejuvenation. Atrophy of the thymus is governed by a complex interplay of molecular, cytokine and hormonal factors. Herein we review the interaction of these factors across age and how they may be targeted for thymic rejuvenation. We further discuss the growing pre-clinical evidence defining the necessary and sufficient contributions of the thymus to successful tolerance induction in transplantation.
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Ebola virus vaccines: Where do we stand?
Publication date: Available online 28 October 2016
Source:Clinical Immunology
Author(s): Vincent Pavot
The recent outbreak of Ebola virus disease in West Africa has led to more than 11,000 deaths, with a peak in mortality from August through December of 2014. A meeting convened by the World Health Organization (WHO) in September 2014, concluded that an urgent unmet need exists for efficacy and safety testing of the Ebola virus vaccine candidates and that clinical trials should be expedited. These vaccines could be used both in an outbreak setting and to provide long-term protection in populations at risk of sporadic outbreaks.A number of vaccines have been evaluated in phase 1 trials, but the two most advanced first-generation Ebola vaccine candidates are the live replicating vesicular stomatitis virus (rVSV) and the replication-defective chimpanzee adenovirus 3 (ChAd3).This review focuses on these two vaccines in clinical development and discusses the future opportunities and challenges faced in the licensure and deployment of Ebola virus vaccines.
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The contribution of the programmed cell death machinery in innate immune cells to lupus nephritis
Publication date: Available online 22 October 2016
Source:Clinical Immunology
Author(s): FuNien Tsai, Harris Perlman, Carla M. Cuda
Systemic lupus erythematosus (SLE) is a chronic multi-factorial autoimmune disease initiated by genetic and environmental factors, which in combination trigger disease onset in susceptible individuals. Damage to the kidney as a consequence of lupus nephritis (LN) is one of the most prevalent and severe outcomes, as LN affects up to 60% of SLE patients and accounts for much of SLE-associated morbidity and mortality. As remarkable strides have been made in unlocking new inflammatory mechanisms associated with signaling molecules of programmed cell death pathways, this review explores the available evidence implicating the action of these pathways specifically within dendritic cells and macrophages in the control of kidney disease. Although advancements into the underlying mechanisms responsible for inducing cell death inflammatory pathways have been made, there still exist areas of unmet need. By understanding the molecular mechanisms by which dendritic cells and macrophages contribute to LN pathogenesis, we can improve their viability as potential therapeutic targets to promote remission.
http://ift.tt/2dYuQnA
Immature myeloid cells in the tumor microenvironment: Implications for immunotherapy
Publication date: Available online 21 October 2016
Source:Clinical Immunology
Author(s): Neha Kamran, Mayuri Chandran, Pedro R Lowenstein, Maria G Castro
Various preclinical studies have demonstrated that the success of immunotherapeutic strategies in inhibiting tumor progression in animal models of Glioblastoma multiforme (GBM). It is also evident that tumor-induced immune suppression drastically impacts the efficacy of immune based therapies. Among the mechanisms employed by GBM to induce immunosuppression is the accumulation of regulatory T cells (Tregs) and Myeloid derived suppressor cells (MDSCs). Advancing our understanding about the pathways regulating the expansion, accumulation and activity of MDSCs will allow for the development of therapies aimed at abolishing the inhibitory effect of these cells on immunotherapeutic approaches. In this review, we have focused on the origin, expansion and immunosuppressive mechanisms of MDSCs in animal models and human cancer, in particular GBM.
http://ift.tt/2fre4mu
Crosstalk between the gut and the liver via susceptibility loci: Novel advances in inflammatory bowel disease and autoimmune liver disease
Publication date: Available online 21 October 2016
Source:Clinical Immunology
Author(s): Xinyang Li, Jun Shen, Zhihua Ran
Inflammatory bowel disease (IBD) is an autoimmune disorder characterized by chronic, relapsing intestinal inflammation. Autoimmune liver disease (AILD) may be involved in IBD as an extra-intestinal manifestation (EIM). Epidemiologic and anatomic evidence have demonstrated an intimate crosstalk between the gut and the liver. In this review, we briefly introduced nine groups of susceptibility loci shared by inflammatory bowel and autoimmune liver disease for the first time. The genome-wide association studies (GWAS) evidence of pathways involving crosstalk between the gut and the liver is clarified and explained. It has been found that HNF4-α, GPR35, MST1R, CARD9, IL2/IL21/IL2R, BACH2, TNFRSF14, MAdCAM-1, and FUT2 are the genes involved in tight junction formation, macrophage function, T helper cell or Treg cell cycle and function, TNF secretion, lymphocyte homing or intestinal dysbiosis, respectively. The intimate crosstalk between the gut and liver in immunity is also highlighted and discussed in this review.
http://ift.tt/2dYvvpn
Adult atopic dermatitis and the risk of type 2 diabetes
Source:Journal of Allergy and Clinical Immunology
Author(s): Yuki M.F. Andersen, Alexander Egeberg, Gunnar H. Gislason, Lone Skov, Filip K. Knop, Jacob P. Thyssen
Teaser
While AD is not an independent risk factor for T2D in adjusted analysis, age, smoking, alcohol abuse and use of systemic and topical corticosteroids may increase the risk of T2D in adults with AD.http://ift.tt/2e7DWle
Latent class analysis reveals clinically relevant atopy phenotypes in two birth cohorts
Publication date: Available online 19 October 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Alexander J. Hose, Martin Depner, Sabina Illi, Susanne Lau, Thomas Keil, Ulrich Wahn, Oliver Fuchs, Petra Ina Pfefferle, Elisabeth Schmaußer-Hechfellner, Jon Genuneit, Roger Lauener, Anne M. Karvonen, Caroline Roduit, Jean-Charles Dalphin, Josef Riedler, Juha Pekkanen, Erika von Mutius, Markus J. Ege, Carl Peter Bauer, Johannes Forster, Fred Zepp, Volker Wahn, Antje Schuster, Renate L. Bergmann, Karl E. Bergmann, Andreas Reich, Linus Grabenhenrich, Bianca Schaub, Georg J. Loss, Harald Renz, Michael Kabesch, Marjut Roponen, Anne Hyvärinen, Pekka Tiittanen, Sami Remes, Charlotte Braun-Fahrländer, Remo Frei, Vincent Kaulek, Marie-Laure Dalphin, Gert Doekes, Nicole Blümer, Urs Frey
BackgroundPhenotypes of childhood-onset asthma are characterized by distinct trajectories and functional features. For atopy, definition of phenotypes during childhood is less clear.ObjectiveTo define phenotypes of atopic sensitization over the first 6 years of life by a latent class analysis (LCA) integrating three dimensions of atopy: allergen specificity, time course, and levels of specific IgE.MethodsPhenotypes were defined by LCA in 680 children of the MAS and 766 of the PASTURE birth cohorts and compared to classical non-disjunctive definitions of seasonal, perennial, and food sensitization with respect to atopic diseases and lung function. Cytokine levels were measured in PASTURE.ResultsThe LCA classified predominantly by type and multiplicity of sensitization (food versus inhalant), allergen combinations, and sIgE levels. Latent classes were related to atopic disease manifestations with higher sensitivity and specificity than the classical definitions. LCA detected in both cohorts consistently a distinct group of children with severe atopy characterized by high seasonal sIgE and a strong propensity for asthma, hay fever, eczema and impaired lung function even in children without an established asthma diagnosis. Severe atopy was associated with an elevated interleukin-5/interferon-gamma ratio. A path analysis among sensitized children revealed that among all features of severe atopy only excessive sIgE production early in life impacted on asthma risk.ConclusionsLCA revealed a set of benign, symptomatic, and severe atopy phenotypes. The severe phenotype emerged as a latent condition with signs of a dysbalanced immune response. It determined high asthma risk via excessive sIgE production and directly impacted on impaired lung function.
Graphical abstract
Teaser
Atopic sensitization was classified with respect to disease relevance in three phenotypes of benign, symptomatic, and severe atopy, which impacted on asthma risk via excessive production of specific IgE early in life and on poor lung function.http://ift.tt/2f2cSBv
Cross-Talk between Human Mast Cells and Epithelial Cells by IgE-mediated Periostin Production in Eosinophilic Nasal Polyps
Source:Journal of Allergy and Clinical Immunology
Author(s): Dae Woo Kim, Marianna Kulka, Ara Jo, Kyoung Mi Eun, Narcy Arizmendi, Brian P. Tancowny, Seung-No Hong, Jung Pyo Lee, Hong Ryul Jin, Richard F. Lockey, Dong-Kyu Kim, Seong H. Cho
Teaser
Periostin is up-regulated in E-NP and is associated with disease severity and Th2 inflammatory markers. Periostin was produced by IgE-stimulated mast cells. Secreted periostin binds to integrin αV on the epithelial cell surface and induces TSLP release from epithelial cells in E-NP.http://ift.tt/2f2cSS1
Estimation of Round-Trip Outer-Middle Ear Gain Using DPOAEs
Abstract
The reported research introduces a noninvasive approach to estimate round-trip outer-middle ear pressure gain using distortion product otoacoustic emissions (DPOAEs). Our ability to hear depends primarily on sound waves traveling through the outer and middle ear toward the inner ear. The role of the outer and middle ear in sound transmission is particularly important for otoacoustic emissions (OAEs), which are sound signals generated in a healthy cochlea and recorded by a sensitive microphone placed in the ear canal. OAEs are used to evaluate the health and function of the cochlea; however, they are also affected by outer and middle ear characteristics. To better assess cochlear health using OAEs, it is critical to quantify the effect of the outer and middle ear on sound transmission. DPOAEs were obtained in two conditions: (i) two-tone and (ii) three-tone. In the two-tone condition, DPOAEs were generated by presenting two primary tones in the ear canal. In the three-tone condition, DPOAEs at the same frequencies (as in the two-tone condition) were generated by the interaction of the lower frequency primary tone in the two-tone condition with a distortion product generated by the interaction of two other external tones. Considering how the primary tones and DPOAEs of the aforementioned conditions were affected by the forward and reverse outer-middle ear transmission, an estimate of the round-trip outer-middle ear pressure gain was obtained. The round-trip outer-middle ear gain estimates ranged from −39 to −17 dB between 1 and 3.3 kHz.
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Extracorporeal lung support.
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Obesity hypoventilation syndrome, sleep apnea, overlap syndrome: perioperative management to prevent complications.
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Sleep, sleep studies and sleep-disordered breathing: basic knowledge for the anesthesiologist.
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Letter to the editor in response to the article “Clinical characteristics and risk factors for low dose methotrexate toxicity: a cohort of 28 patients” by Kivity S, Zafrir Y, Loebstein R, Pauzner R, Mouallem M, Mayan H, Autoimmun Rev. 2014 Nov.;13(11):1109–13
Source:Autoimmunity Reviews, Volume 15, Issue 11
Author(s): Sophie Wassenaar, Ethan den Boer, Elsbeth M. Westerman, Johanna M. Hazes, Robert de Jonge
http://ift.tt/2el3IAl
Pyoderma gangraenosum und Sweet-Syndrom
Zusammenfassung
Das Pyoderma gangraenosum und das Sweet-Syndrom sind seltene Erkrankungen aus der Gruppe der neutrophilen Dermatosen und teilen eine Vielzahl an Charakteristika. Zwar unterscheiden sich die beiden Erkrankungen klinisch deutlich voneinander, jedoch zeigen beide in der Histologie ausgeprägte dermale Infiltrate mit neutrophilen Granulozyten ohne Hinweis auf eine primäre Vaskulitis und sprechen gut auf immunsuppressive Medikamente an. Zudem sind beide Krankheiten häufig assoziiert mit anderen systemischen und hämatologischen Erkrankungen. Neueste Erkenntnisse zeigen, dass die neutrophilen Dermatosen als kutane Manifestation von Autoinflammation betrachtet werden können, was einen interessanten neuen Aspekt bei der Entstehung der beiden Erkrankungen und neue Therapieansätze aufzeigt.
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Sinus Disventilation and Atrophy of the Upper Maxilla: A Combined Surgical Approach Is Possible?.
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Indications for Elective Tracheostomy in Reconstructive Surgery in Patients With Oral Cancer.
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The Effect of the Angle and Length of the Eustachian Tube on the Success Rate of Cartilage Type 1 Tympanoplasty.
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A Craniomaxillofacial Surgical Assistance Workstation for Enhanced Single-Stage Reconstruction Using Patient-Specific Implants.
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Pituitary Colloid Cyst.
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Intracranial Nasal Dermoid Sinus Cyst: Transnasal Endoscopic Resection by Open Rhinoplasty Approach, With Intraoperative Video.
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Neurocutaneous Melanosis Presenting as Cavernous Hemangioma Persistent Abdominal Pain.
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Cleft Lip Repair: Through the Looking Glass.
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Reconstruction of tooth-bearing portion of mandible using polyglactin 910 sutures for internal fixation in the third-world: functional and cosmetic outcome
Abstract
Background
This study analyzed the cosmetic and functional outcome of cases involving reconstruction of tooth-bearing portion of the lower jaw, using a polyglactin 910 suture for fixation.
Patients and method
This prospective intervention study documented the treatment outcome in 25 consecutive adult patients, who underwent immediate mandibular reconstruction following segmental resection of tooth-bearing portion of mandible. Cortico-cancellous bone graft was taken from the inner table of iliac bone, sparing the crest. Use of post-surgical inter-maxillary fixation was avoided.
Results
Twenty-five patients were recruited for the study. Seventeen were males and eight were females. Their ages ranged from 18 to 50 years, with a mean of 30.0 years. Average length of grafted bone was 9.8 cm. Following surgery, all 25 (100%) patients were judged to have satisfactory facial symmetry. One (4.0 %) had altered dental occlusion. Twenty-five (100%) had satisfactory bone union. All of the patients claimed to masticate satisfactorily. Assessment was carried out at the last post-operative follow-up visit for each patient who ranged between 22 and 83 months.
Conclusion
Use of polyglactin 910 suture material for fixation in mandibular reconstruction following segmental resection of tooth-bearing portion has proven to be a cosmetic and functional success. It may serve as alternative for those among whom conventional treatment methods may be contraindicated. This method of bone fixation may serve as a reliable and much cheaper alternative in low-income countries.
Level of evidence
Level IV, therapeutic study.
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