Head and Neck Medicine by Alexandros G.Sfakianakis: 12/05/16

Δευτέρα 5 Δεκεμβρίου 2016

Effects of green tea and bisphosphonate association on dental socket repair of rats

Publication date: March 2017
Source:Archives of Oral Biology, Volume 75
Author(s): Edson Yoshihiro Mada, Alana Claro Cunha Santos, Angelica Cristina Fonseca, Claudia Cristina Biguetti, Fernando Tozze Alves Neves, Patrícia Pinto Saraiva, Mariza Akemi Matsumoto
ObjectivesTo evaluate the effects of green tea intake and zoledronic acid intravenous therapy on teeth socket repair.DesignSixty male albinus Wistar rats were divided into 4 groups: C—Control, intravenous (IV) 0.9% saline solution (SS), GT—1% green tea in drinking water and IV SS, BP—IV zoledronic acid (BP), and BP+GT—IV BP and 1% green tea. 0.035mg/kg of BP was administered every two weeks. After ten weeks, right upper molars were extracted and the green tea started to be offered for GT and BP+GT. After 7, 14, and 28days the animals were euthanized.ResultsHistopathology analysis revealed lack of socket repair in BP and BP+GT groups, which presented significant increased number of polimorphonuclear leukocytes at day 28, in comparison with C (p<0.05). No significant differences were detected between C and the experimental groups at the same period (p<0.05) when considering mononuclear leukocytes. Immunolabeling revealed that the association of BP and GT caused a slight disturbance in OPG/RANKL system and retarded Runx-2 labeling. Although strong TRAP labeling was observed, most of the positive cells in BP and BP+GT groups were not located on bone surface.ConclusionsSocket healing of rats treated with BP and regular drinking green tea presented no relevant differences in comparison to those treated with BP alone.

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Production of endogenous hydrogen sulfide in human gingival tissue

Publication date: February 2017
Source:Archives of Oral Biology, Volume 74
Author(s): Jiang Chun-Mei, Chen Wu, Meng Guo-Liang, Gu Yue, Chen Ning, Yong Ji
ObjectiveEndogenous hydrogen sulfide (H2S) has recently been shown to play an important role in inflammation, but the role of endogenous H2S in the human gingival tissue is unknown. The aim of this study was to investigate whether gingiva had enzymes for H2S synthesis, and whether the effect of these enzymes for H2S production changed with periodontal inflammation.DesignGingival tissues were collected from patients undergoing periodontal operation including gingivitis, moderate chronic periodontitis, severe chronic periodontitis and normal controls. RT-PCR and western blotting were performed to measure mRNA and protein levels of cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE) for H2S production. Immunohistochemistry was carried out to detect the location of the enzymes. H2S levels and synthesis in gingival tissue were evaluated with modified methylene blue method.ResultsThe mRNA and protein of CBS and CSE were both expressed in human gingiva and raised significantly in moderate and severe periodontitis compared of that in healthy control. CBS, but not CSE, increased in gingivitis (p<0.05). However, there was no significant difference of H2S level and synthesis among these groups (p>0.05).ConclusionsBoth CBS and CSE were expressed in human gingival tissue. The mRNA and protein levels of CBS and CSE were up-regulated in periodontitis.

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Calcitonin induces collagen synthesis and osteoblastic differentiation in human periodontal ligament fibroblasts

Publication date: February 2017
Source:Archives of Oral Biology, Volume 74
Author(s): Yibo Wei, Qing Ye, Zhen Tang, Gang Tian, Qiang Zhu, Haocheng Gao, Dalin Wang, Zhizhong Cao
BackgroundExtracellular matrix (ECM) secretion and osteogenic differentiation in periodontal ligament fibroblasts (PDLF) facilitate the neogenesis of alveolar bone, which is the cellular basis for alveolar bone repair. Calcitonin (CT) has been reported to play an important role in promoting ECM expression and inducing osteogenic differentiation in osteoblast, but its effects on PDLFs remain obscure.MethodsThe expression of CT, transforming growth factor-beta 1(TGF-β1) and bone morphogenetic protein (BMP) in gingival crevicular fluid (GCF) was measured by ELISA. The effects of CT on collagen synthesis and osteogenic differentiation in hPDLFs were investigated by using the primarily cultured hPDLFs infected with adenovirus carrying the CT gene. Gene expression was measured by quantitative PCR and western blot.ResultsThe expression of CT in gingival crevicular fluid (GCF) of patients with periodontitis was significantly higher than that of healthy subjects. In addition, CT expression correlated with the clinical indexes including probing pocket depth (PPD), clinical attachment level (CAL), and gingival index (GI). The in vitro study demonstrated that overexpression of CT by adenovirus infection increased the expression of TGF-β1, collagen type I and III, and osteoblastic markers including BMP-2/-4, alkaline phosphatase and osteocalcin in human PDLFs. Moreover, CT-enhanced collagen synthesis was abrogated in hPDLFs transfected with TGF-β1 siRNA, and CT-induced osteoblastic differentiation was blocked in hPDLFs by BMPs inhibitor noggin.ConclusionsThese results suggest that CT promotes collagen synthesis and osteogenic differentiation in hPDLFs via the TGF-β1 and BMPs signaling pathways, respectively.

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Effects of green tea and bisphosphonate association on dental socket repair of rats

Calcitonin induces collagen synthesis and osteoblastic differentiation in human periodontal ligament fibroblasts

Metabolites: deciphering the molecular language between DCs and their environment

Abstract

Dendritic cells (DCs) determine the outcome of the immune response based on signals they receive from the environment. Presentation of antigen under various contexts can lead to activation and differentiation of T cells for immunity or dampening of immune responses by establishing tolerance, primarily through the priming of regulatory T cells. Infections, inflammation and normal cellular interactions shape DC responses through direct contact or via cytokine signaling. Although it is widely accepted that DCs sense microbial components through pattern recognition receptors (PRRs), increasing evidence advocates for the existence of a set of signals that can profoundly shape DC function via PRR-independent pathways. This diverse group of host- or commensal-derived metabolites represents a newly appreciated code from which DCs can interpret environmental cues. In this review, we discuss the existing information on the effect of some of the most studied metabolites on DC function, together with the implications this may have in immune-mediated diseases.

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Computed tomography and magnetic resonance fusion imaging in cholesteatoma preoperative assessment

Abstract

The purpose of this study is to describe a method for developing fusion imaging for the preoperative evaluation of cholesteatoma. In 33 patients diagnosed with cholesteatoma, a high-resolution temporal bone computed tomography (CT) scan without intravenous contrast and propeller diffusion-weighted magnetic resonance imaging (MRI) were performed. Both studies were then sent to the BrainLAB work station, where the images were fused to obtain a morphological and color map. Intraoperative findings coincided with fusion CT–MRI imaging in all but two patients. In addition, one false positive and one false negative case were observed. CT and diffusion-weighted MRI are complementary techniques that should be employed to assess a cholesteatoma prior to surgery in many cases. Hence, to combine the advantages of each technique, we developed a fusion image technique similar to those that are routinely employed for radiotherapy planning and positron emission tomography–CT imaging. Fusion images can prove useful in selected cases.

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The utility of vacuum-assisted closure therapy for skin necrosis secondary to cervical abscess in the elderly

Vacuum-assisted closure (VAC) systems have been used as negative-pressure dressings in various fields, including decubitus ulcer, trauma, and wound dehiscence. To the best of our knowledge, few reports have examined the utility of VAC therapy for neck abscess in an oldest-old patient. We present here a rare case of neck abscess secondary to parotid abscess, resulting in extensive skin necrosis. Successful management included emergency drainage following epithelial induction through a VAC system without using skin grafting.

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Effect of basal insulin dosage on blood glucose concentration in ambulatory surgery patients with type 2 diabetes

Among patients with type 2 diabetes treated with insulin, perioperative hyperglycemia and hypoglycemia may cause undesirable symptoms, surgery delay or cancellation, or unexpected hospitalization. Our objective was to compare preoperative glargine dosing regimens on perioperative glycemic control in patients undergoing ambulatory surgery.

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The effect of tramadol plus paracetamol on consumption of morphine after coronary artery bypass grafting

To compare the effects of oral tramadol+paracetamol combination on morphine consumption following coronary artery bypass grafting (CABG) in the patient-controlled analgesia (PCA) protocol.

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Minimum effective fluid volume of colloid to prevent hypotension during caesarean section under spinal anesthesia using a prophylactic phenylephrine infusion: An up-down sequential allocation study

The aim of this study was to de termine the minimum effective fluid volume (MEFV) of hydroxyethyl starch 130/0.4 (HES) infused in a preload fashion which would prevent hypotension in 50% of parturients undergoing caesarean section. A secondary objective was to measure the hemodynamic effect of fluid loading on the subjects.

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Mandibular stability using sliding or conventional four-hole plates for fixation after bilateral sagittal split ramus osteotomy for mandibular setback

Our aim was to compare the postoperative stability of the mandible when two different fixation methods had been used after bilateral sagittal split ramus osteotomy (BSSRO) for mandibular setback. The study included 23 patients who had two-jaw BSSRO mandibular setback at the Department of Oromaxillofacial Surgery, Korea University Guro Hospital, between January 2011 and June 2014. The first group (four-hole (control) group, n=13) comprised patients whose bony segments were fixed with conventional four-hole plates, and the second (sliding plate (experimental) group, n=10) included patients whose bone segments were fixed with sliding plates.

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BAOMS Surgery Prize Oration2016 for Bhavin Gordhan Visavadia

Bhavin Visavadia was born in the Great Rift Valley town of Nakuru, Kenya, on the 23rd February 1968. As you can see from the photograph, the young Bhavin did not have much going for him, and if he were to make anything of himself in life it would have to be by sheer endeavour and intellect.

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Variation in the site of the lateral femoral cutaneous nerve during harvest of a deep circumflex iliac artery free flap

Publication date: Available online 4 December 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Mattine, K.F.B. Payne

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Medication-related osteonecrosis of the jaw associated with aflibercept

Publication date: Available online 4 December 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P. Zarringhalam, E. Brizman, K. Shakib

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Mandibular stability using sliding or conventional four-hole plates for fixation after bilateral sagittal split ramus osteotomy for mandibular setback

Publication date: Available online 5 December 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H.G. Lee, K.J. Agpoon, A.N. Besana, H.K. Lim, H.S. Jang, E.S. Lee
Our aim was to compare the postoperative stability of the mandible when two different fixation methods had been used after bilateral sagittal split ramus osteotomy (BSSRO) for mandibular setback. The study included 23 patients who had two-jaw BSSRO mandibular setback at the Department of Oromaxillofacial Surgery, Korea University Guro Hospital, between January 2011 and June 2014. The first group (four-hole (control) group, n=13) comprised patients whose bony segments were fixed with conventional four-hole plates, and the second (sliding plate (experimental) group, n=10) included patients whose bone segments were fixed with sliding plates. Lateral cephalograms were taken and analysed at three time points: preoperatively (T1), and one week (T2), and 1year (T3) postoperatively. The Mann–Whitney U test was used to compare the postoperative stability of the mandible in each group. There were no significant differences between the two groups in changes in the horizontal and vertical positions of point B and pogonion postoperatively, nor were there any significant differences between them in ramal inclination and inclination of the SN plane with point B at the given time points (p=>0.05 in surgical changes in the mandible immediately after surgery and 0.397, 0.616, 0.082, 0.951, 0.901, 0.476 in postoperative changes in the madible 1 week to 1 year after surgery). Like the conventional four-hole plate, the sliding plate can also be used to achieve stability in the fixation of mandibular bone segments after BSSRO.

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Impact of Sonic Hedgehog Pathway Expression on Outcome in HPV Negative Head and Neck Carcinoma Patients after Surgery and Adjuvant Radiotherapy

by Elisabeth Enzenhofer, Thomas Parzefall, Georg Haymerle, Sven Schneider, Lorenz Kadletz, Gregor Heiduschka, Johannes Pammer, Felicitas Oberndorfer, Fritz Wrba, Benjamin Loader, Matthäus Christoph Grasl, Christos Perisanidis, Boban M. Erovic

Introduction

HPV positive patients suffering from head and neck cancer benefit from intensified radiotherapy when applied as a primary as well as an adjuvant treatment strategy. However, HPV negative patients treated with surgery and adjuvant radiotherapy lack validated prognostic biomarkers. It is therefore important to define prognostic biomarkers in this particular patient population. Especially, ´high-risk groups´ need to be defined in order to adapt treatment protocols. Since dysregulation of the sonic hedgehog pathway plays an important role in carcinogenesis, we aimed to assess whether members of the sonic hedgehog-signaling pathway may act as prognostic factors in patients with HPV negative head and neck squamous cell carcinoma.

Materials and Methods

In this prospective study, pretreatment tumor biopsies of patients with head and neck squamous cell carcinoma were taken during panendoscopy (2005 to 2008). All patients were treated with surgery and postoperative radiotherapy. After assessment of HPV and p16 status, protein expression profiles of the Sonic hedgehog-signaling pathway were determined by immunohistochemistry and tissue microarray analyses in 36 HPV negative tumor biopsies. Expression profiles of Sonic hedgehog, Indian hedgehog, Patched, Smoothened, Gli-1, Gli-2 and Gli-3 were correlated with patients´ clinical data, local-control rate, disease-free as well as overall survival. Data from The Cancer Genome Atlas databank were used for external validation of our results.

Results

Gli-1 (p = 0.04) and Gli-2 (p = 0.02) overexpression was significantly linked to improved overall survival of HPV negative patients. Gli-2 (p = 0.04) overexpression correlated significantly with prolonged disease-free survival. Cox-multivariate analysis showed that overexpression of Gli-2 correlated independently (HR 0.40, 95% CI 0.16–0.95, p = 0.03) with increased overall survival.

Discussion

Gli-1 and Gli-2 overexpression represents a substantial prognostic factor for overall and disease-free survival in patients with locally advanced HPV negative head and neck cancer undergoing surgery and postoperative radiotherapy.

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Evaluation of Immunostimulatory Effects of N-(2-Hydroxy) Propyl-3-Trimethylammonium Chitosan Chloride for Improving Live Attenuated Hepatitis A Virus Vaccine Efficacy

Viral Immunology , Vol. 0, No. 0.

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Tofacitinib Shows Promise for Treating Severe Alopecia Areata

The Janus kinase (JAK) inhibitor tofacitinib shows promise for treating severe alopecia areata and its variants in adults and adolescents, according to two retrospective studies.
Reuters Health Information

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Épidermolyses bulleuses héréditaires : protocole national de diagnostic et de soins (PNDS)

Publication date: Available online 5 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Chiaverini, E. Bourrat, J. Mazereeuw-Hautier, S. Hadj-Rabia, C. Bodemer, J.-P. Lacour
Les épidermolyses bulleuses héréditaires (EBH) sont un groupe hétérogène de maladies génétiques rares caractérisées par une fragilité cutanée et/ou muqueuse, localisée ou généralisée. Elles sont dues à des mutations de gènes codant pour des protéines impliquées pour la plupart dans la structure et la fonction de la jonction dermo-épidermique. Dix-neuf gènes sont actuellement identifiés. On distingue, en fonction du niveau de clivage dans la peau (du haut vers le bas), les formes simples, jonctionnelles et dystrophiques, auxquelles s'ajoute le syndrome de Kindler. Le diagnostic suspecté cliniquement est confirmé en centre spécialisé par la biopsie cutanée pour examen immuno-histologique permettant de déterminer le niveau de clivage et la protéine déficiente. Cet examen est éventuellement suivi d'une analyse génétique. La sévérité de la pathologie est très variable, allant de formes localisées permettant une vie quasi normale à des formes rapidement létales. Dans les formes sévères généralisées, l'étendue des plaies, l'atteinte muqueuse, les cicatrisations à répétition sont sources de complications systémiques multiples : dénutrition, douleur, rétractions articulaires, syndrome inflammatoire chronique, amylose, carcinomes épidermoïdes cutanés. Certaines formes particulières s'associent à d'autres signes cutanés (atteinte unguéale, alopécie, hyperpigmentation, kératodermie palmoplantaire) ou extracutanés (dystrophie musculaire ou atrésie du pylore). Aucun traitement curatif des EBH n'est disponible à ce jour. Ces maladies nécessitent une prise en charge médicale pluridisciplinaire, mais aussi infirmière, psychologique et sociale, assurée au sein d'un réseau ville–hôpital impliquant les centres de référence, les centres de compétence et les soignants de proximité du lieu de vie. Les soins consistent à prévenir et traiter les plaies avec des pansements spécifiques non adhérents et prévenir, dépister et traiter les complications. Il est essentiel de ne pas traumatiser la peau (pansement, frottement, etc.). Les thérapies de substitution protéique, cellulaire ou génique, les greffes de moelle osseuse allogénique, de sang de cordon ou de cellules souches pluripotentes induites sont en cours d'évaluation. L'objectif de ce protocole national de diagnostic et de soins (PNDS) est d'expliciter, pour les professionnels de la santé, la prise en charge optimale et le parcours de soins d'un malade atteint d'EBH.Hereditary epidermolysis bullosa (EB) is a heterogeneous group of rare genetic diseases characterized by fragile skin and/or mucous membrane, and it may be either local or generalized. It is caused by mutations in genes encoding different proteins involved mainly in the structure and function of the dermal-epidermal junction. Nineteen genes have so far been identified. They are classified by level of skin cleavage (from top to bottom) into four groups: EB simplex, junctional EB, dystrophic EB and Kindler syndrome. Clinically suspected diagnosis is confirmed by immunohistochemical examination of a skin biopsy at specialized centres in order to determine the level of cleavage and the deficient protein. This first step may be followed by genetic analysis. The severity of the disease is highly variable, ranging from localized forms with little effect on quality of life to rapidly lethal forms. In generalized severe forms, the extent and chronicity of lesions, as well as mucosal involvement, can lead to systemic complications: malnutrition, pain, joint contractures, chronic inflammation, amyloidosis, cutaneous squamous cell carcinoma. Some specific forms are associated with other cutaneous signs (nail involvement, alopecia, hyperpigmentation, palmoplantar keratoderma) or extracutaneous involvement (muscular dystrophy or pyloric atresia). No curative treatment of EB is available today. EB requires multidisciplinary medical care, nursing, psychological and social management. This is best provided by a specialized network, involving reference centres, centres of expertise and daily caregivers. The goal of treatment is the prevention and treatment of lesions with specific non-adherent dressings and the prevention, detection and treatment of complications. It is essential not to traumatize the skin (bandaging, friction, etc.). Protein, gene or cell replacement therapy, and allogeneic bone marrow, cord blood or pluripotent stem-cell transplantation are currently being assessed. The aim of these French recommendations (national diagnostic and treatment protocol [PNDS]) is to provide healthcare professionals with guidance on the course of EB and on optimal patient management.

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Complement and sepsis-induced heart dysfunction

Publication date: Available online 5 December 2016
Source:Molecular Immunology
Author(s): Fatemeh Fattahi, Peter A. Ward
It is well known that cardiac dysfunction develops during sepsis in both humans and in rodents (rats, mice). These defects appear to be reversible, since after "recovery" from sepsis, cardiac dysfunction disappears and the heart returns to its function that was present before the onset of sepsis. Our studies, using in vivo and in vitro models, have demonstrated that C5a and its receptors (C5aR1 and C5aR2) play key roles in cardiac dysfunction developing during sepsis. Use of a neutralizing antibody to C5a largely attenuates cardiac dysfunction and other adverse events developing during sepsis. The molecular basis for cardiac dysfunctions is linked to generation of C5a and its interaction with C5a receptors present on surfaces of cardiomyocytes (CMs). It is established that C5a interactions with C5a receptors leads to significant reductions involving faulty contractility and relaxation in CMs. In addition, C5a interactions with C5a receptors on CMs results in reductions in Na⁺/K⁺-ATPase in CMs. This ATPase is essential for intact action potentials in CMs. The enzymatic activity and protein for this ATPase were strikingly reduced in CMs during sepsis by unknown mechanisms. In addition, C5a interactions with C5aRs also caused reductions in CM homeostatic proteins that regulate cytosolic [Ca²⁺]i in CMs: sarco/endoplasmic reticulum Ca²⁺-ATPase2 (SERCA2) and Na⁺/Ca²⁺ exchanger (NCX). In the absence of C5a receptors, defects in SERCA2 and NCX in CMs after sepsis are strikingly attenuated. These observations suggest new strategies to protect the heart from dysfunction developing during sepsis.

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Editorial Board/ Publication Information

Publication date: December 2016
Source:Molecular Immunology, Volume 80

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A Possible Association of Diindolylmethane with Pulmonary Embolism and Deep Venous Thrombosis

Introduction. 3,3′-Diindolylmethane is available as a supplement in the United States for "cancer prevention" and "augmentation of physical fitness." A derivative of indole-3-carbinol found in plants, diindolylmethane, binds to receptors associated with the sex steroid pathways and has unclear effects on estrogen and androgen physiology. We present a patient who had been taking diindolylmethane and developed right lower extremity deep venous thrombosis and bilateral pulmonary embolism. Case Presentation. A 65-year-old man presented with swelling, erythema, and warmth of his right lower extremity for three to four weeks. He had been taking diindolylmethane one tablet daily for three to four months. Risk factors for venous thromboembolism included tobacco use, personal history of possible pulmonary embolism, body mass index, and age. Imaging studies found extensive deep venous thrombosis in his right lower extremity and bilateral pulmonary embolism with probable right middle lobe infarction. Follow-up imaging showed chronic deep venous thrombosis in his right lower extremity. Discussion. As suggested in this single case, patients who take diindolylmethane may be at greater risk for venous thromboembolism. Further reports and studies are necessary in order to elucidate this possible association. Clinicians should question patients about supplements in the setting of venous thromboembolism.

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Assessing the value of mepolizumab for severe eosinophilic asthma: a cost-effectiveness analysis

Publication date: Available online 4 December 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Melanie D. Whittington, R. Brett McQueen, Daniel A. Ollendorf, Jeffrey A. Tice, Richard H. Chapman, Steven D. Pearson, Jonathan D. Campbell
BackgroundAdding mepolizumab to standard treatment with inhaled corticosteroids and controller medications could decrease asthma exacerbations and use of long-term oral steroids in patients with severe disease and increased eosinophils; however, mepolizumab is costly and its cost effectiveness is unknown.ObjectiveTo estimate the cost effectiveness of mepolizumab.MethodsA Markov model was used to determine the incremental cost per quality-adjusted life year (QALY) gained for mepolizumab plus standard of care (SoC) and for SoC alone. The population, adults with severe eosinophilic asthma, was modeled for a lifetime time horizon. A responder scenario analysis was conducted to determine the cost effectiveness for a cohort able to achieve and maintain asthma control.ResultsOver a lifetime treatment horizon, 23.96 exacerbations were averted per patient receiving mepolizumab plus SoC. Avoidance of exacerbations and decrease in long-term oral steroid use resulted in more than $18,000 in cost offsets among those receiving mepolizumab, but treatment costs increased by more than $600,000. Treatment with mepolizumab plus SoC vs SoC alone resulted in a cost-effectiveness estimate of $386,000 per QALY. To achieve cost effectiveness of approximately $150,000 per QALY, mepolizumab would require a more than 60% price discount. At current pricing, treating a responder cohort yielded cost-effectiveness estimates near $160,000 per QALY.ConclusionThe estimated cost effectiveness of mepolizumab exceeds value thresholds. Achieving these thresholds would require significant discounts from the current list price. Alternatively, treatment limited to responders improves the cost effectiveness toward, but remains still slightly above, these thresholds. Payers interested in improving the efficiency of health care resources should consider negotiations of the mepolizumab price and ways to predict and assess the response to mepolizumab.

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Preoperative neutrophil-to-lymphocyte ratio predicts the prognosis of oral squamous cell carcinoma: a large-sample prospective study

Publication date: Available online 5 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Fa Chen, Lisong Lin, Lingjun Yan, Yu Qiu, Lin Cai, Baochang He
PurposeTo access and determine the prognostic value of preoperative the neutrophil to lymphocyte ratio (NLR) in patients with oral squamous cell carcinoma (OSCC).Patients and MethodsThe prospective study involving 1202 OSCC patients with surgical resection was carried out in Fujian, China. We performed two-stage analyses through randomly dividing all patients into 800 discovery and 402 replication sets. The optimal cutoff points of NLR were identified by X-tile program with the minimum P values. Prognostic factors were evaluated using univariate and multivariate Cox regression model.ResultsWe categorized the discovery set into low, middle and high risk groups based on optimal cutoff points of NLR (the NLR number were <1.94, 1.94-3.66, >3.66, respectively). High NLR was significantly associated with an increased risk of death on survival: the HRs were 1.51 (95% CI: 1.09-2.08) for patients with 1.99-3.66 NLR and 1.76 (95% CI: 1.21-2.55) for patients with >3.66 NLR. In the replication phase, we still found that patients in the high NLR values showed significantly worse overall survival compared with those with low NLR values(NLR number 1.94-3.66, HR: 1.61, 95%CI: 1.02-2.55; NLR >3.66, HR: 1.94, 95%CI: 1.16-3.27). Additionally, the better overall survival was observed in higher NLR patients who had received postoperative chemoradiotherapy (HR: 0.49, 95% CI: 0.26-0.92).ConclusionPreoperative NLR is an independent factor in predicting the prognosis of OSCC especially for patients with chemoradiotherapy, which may serve as a potential target for improving patients' prognosis.

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Bioactive peptides hidden in human salivary proteins

Publication date: Available online 5 December 2016
Source:Journal of Oral Biosciences
Author(s): Eiichi Saitoh, Masayuki Taniguchi, Akihito Ochiai, Tetsuo Kato, Akane Imai, Satoko Isemura
BackgroundExtensive peptidomic studies of human saliva have resulted in considerable advances in the field of proteomics. As the next generation in salivary research, a comprehensive understanding of the biological functions of in vivo peptides generated by proteolysis in the oral cavity has been long awaited. A cyclopedic functional analysis of salivary peptides may bring promising therapeutic agents and novel clinical applications.ConclusionHuman salivary proteins have the ability to generate bioactive peptides upon proteolytic cleavage.

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Involvement of microglia and astroglia in modulation of the orofacial motor functions in rats with neuropathic pain

Publication date: Available online 5 December 2016
Source:Journal of Oral Biosciences
Author(s): Mohammad Zakir Hossain, Masamichi Shinoda, Shumpei Unno, Hiroshi Ando, Yuji Masuda, Koichi Iwata, Junichi Kitagawa
BackgroundOrofacial motor functions have been reported to be altered under neuropathic pain conditions. Recently, microglia and astroglia of the central nervous system have been implicated in the initiation and maintenance of orofacial pain.HighlightsIn this review, we focus on the involvement of microglia and astroglia in the modulation of orofacial motor activity during neuropathic pain induced by nerve injury, findings that we have recently demonstrated in our research. Activation of microglia and astroglia modulated orofacial nocifensive behavior and motor functions following trigeminal nerve injury. Minocycline, a microglial blocker, attenuated nocifensive behavior as well as activated microglia and restored masticatory functions. Astroglial activation, nocifensive behavior, and altered jaw opening reflex after nerve injury were reversed by application of methionine sulfoximine, a blocker of glutamine synthetase involved in synthesis of glutamine, a precursor of glutamate, suggesting involvement of astroglial glutamate-glutamine shuttle in neuropathic pain conditions.ConclusionThe results observed in our studies suggest the involvement of microglia and astroglia in the alteration of orofacial motor activity during neuropathic pain.

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Biological application of focus ion beam-scanning electron microscopy (FIB-SEM) to the imaging of cartilaginous fibrils and osteoblastic cytoplasmic processes

Publication date: Available online 5 December 2016
Source:Journal of Oral Biosciences
Author(s): Tomoka Hasegawa, Takashi Endo, Erika Tsuchiya, Ai Kudo, Zhao Shen, Yasuhito Moritani, Miki Abe, Tomomaya Yamamoto, Hiromi Hongo, Kanako Tsuboi, Taiji Yoshida, Tomoya Nagai, Naznin Khadiza, Ayako Yokoyama, Paulo Henrique Luiz de Freitas, Minqi Li, Norio Amizuka
ObjectivesThe aim of this study was the biological application of focused ion beam-scanning electron microscopy (FIB-SEM) to obtain serial sectional images of skeletal tissues that showed the ultrastructure of 1) cartilaginous extracellular fibrils and 2) osteoblastic cytoplasmic processes.MethodsSeven-week-old female wild-type mice were fixed with half-Karnovsky solution and then OsO4, and tibiae were extracted for block staining prior to observation under transmission electron microscope (TEM) and FIB-SEM.ResultsTEM showed the fine fibrillar but somewhat amorphous ultrastructure of the intercolumnar septa in the growth plate cartilage. In contrast, FIB-SEM revealed bundles of stout fibrils at regular intervals paralleling the septa's longitudinal axis, as well as vesicular structures embedded in the cartilaginous matrix of the proliferative zone. In the primary trabeculae, both TEM and FIB-SEM showed several osteoblastic cytoplasmic processes on the osteoid, in greater numbers than those seen in the bone matrix. FIB-SEM revealed the agglomeration of cytoplasmic processes beneath osteoblasts that formed a tubular continuum extending from those cells. Based on these findings, we postulated that osteoblasts not only extend their cytoplasmic processes to the bone matrix, but also stack these cell processes on the osteoid of the primary trabeculae.ConclusionTaken together, these data suggest that FIB-SEM imaging of serial bone sections may facilitate new insights on the ultrastructure of cartilage and bone tissues.

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A Rare Case of Clavicle Osteomyelitis in a Child and Literature Review

Acute clavicle osteomyelitis in children is rare representing

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Validation of the Method "CaptHPV" for the Diagnosis of Human Papillomavirus Associated Infiltrating Carcinomas

Conditions: Cervical Cancer; Vulvar Cancer; Anal Cancer; Oropharynx Cancer
Intervention: Other: CaptHPV method
Sponsor: Institut de Cancérologie de Lorraine
Not yet recruiting - verified November 2016

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Enlargement of Meckel's cave in patients with spontaneous cerebrospinal fluid leaks

Background

Spontaneous cerebrospinal fluid (CSF) leaks have imaging findings consistent with chronically elevated intracranial pressure, such as empty sella. Meckel's cave is a CSF-filled space that houses the trigeminal ganglion at the cranial base. Our objective in this study was to evaluate "dilated" Meckel's cave as a radiologic sign in patients with elevated intracranial pressure spontaneous CSF leaks and compare the dimensions with those from a control cohort.

Methods

Meckel's cave dimensions were measured in patients with spontaneous CSF leaks and documented elevated intracranial pressure. A control group of subjects who underwent magnetic resonance imagine (MRI) scans for unrelated diagnoses were also evaluated. Subjects were included only if suitable MRIs with T2-weighted sequences in the axial plane were available.

Results

Sixty-three patients with spontaneous CSF leaks and 91 normal control patients were included in the study. There was significant (p < 0.05) enlargement in all measured dimensions (length and width) for the spontaneous CSF leak group. When evaluating area, spontaneous CSF leak subjects again showed significant enlargement compared with controls (0.81 ± 0.35 cm² vs 0.52 ± 0.15 cm²; p < 0.0001). Average intracranial pressure measurements were 25.9 ± 9.0 cmH₂O.

Conclusion

Patients with spontaneous CSF leaks have evidence of enlarged Meckel's caves. Evaluation of Meckel's cave dimensions should be included in preoperative imaging assessment as an additional indicator of chronically elevated intracranial pressure.

http://ift.tt/2gYmFgw

The International Classification of the radiological Complexity (ICC) of frontal recess and frontal sinus

Background

The frontal sinus is considered the most challenging sinus to address surgically. There are no current classifications of the degree of surgical complexity of different frontal sinus configurations. The aim of this study is to develop a classification system of the degree of complexity of frontal recess surgery based on preoperative computed tomography (CT) scans.

Methods

Authors were asked to submit a classification system. These were circulated to all authors. Selection of the final 3 classifications was based on a majority consensus. These classifications were compared further for time-taken, ease-of-use, and interrater agreement. These were assessed by the authors on 10 CT scans representing a range of anticipated surgical difficulty.

Results

Out of 3 compared classifications, classification A was the quickest to score (1.44 minutes vs 1.57 minutes and 2.25 minutes), subjectively easiest (3.23 vs 4.07 and 5 on a visual analogue scale [VAS]), and had a moderate interrater agreement (0.52 vs 0.42 and 0.79). In addition, the grading of complexity was as good whether measurements were taken on the CT scans or whether size of the frontal ostium was visually estimated.

Conclusion

We propose a fast, easy classification to anticipate the complexity of surgery in the frontal sinus and recess, for patients undergoing primary surgery.

http://ift.tt/2g20ce6

Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management

Abstract

Worldwide, more than 1.9 billion adults are overweight, and around 600 million people suffer from obesity. Similarly, ~382 million individuals live with diabetes, and 40–50% of the global population is labeled at "high risk" (i.e., prediabetes). The impact of these two chronic conditions relies not only on the burden of illnesses per se (i.e., associated increased morbidity and mortality), but also on their increased cost, burden of treatment, and decreased health-related quality of life. For this review a comprehensive search in several databases including PubMed (MEDLINE), Ovid EMBASE, Web of Science, and Scopus was conducted. In both diabetes and obesity, genetic, epigenetic, and environmental factors overlap and are inclusive rather than exclusive. De facto, 70–80% of the patients with obesity and virtually every patient with type 2 diabetes have insulin resistance. Insulin resistance is a well-known pathophysiologic factor in the development of type 2 diabetes, characteristically appearing years before its diagnosis. The gold standard for insulin resistance diagnosis (the euglycemic insulin clamp) is a complex, invasive, costly, and hence unfeasible test to implement in clinical practice. Likewise, laboratory measures and derived indexes [e.g., homeostasis model assessment of insulin resistance (HOMA-IR-)] are indirect, imprecise, and not highly accurate and reproducible tests. However, skin manifestations of insulin resistance (e.g., acrochordons, acanthosis nigricans, androgenetic alopecia, acne, hirsutism) offer a reliable, straightforward, and real-time way to detect insulin resistance. The objective of this review is to aid clinicians in recognizing skin manifestations of insulin resistance. Diagnosing these skin manifestations accurately may cascade positively in the patient's health by triggering an adequate metabolic evaluation, a timely treatment or referral with the ultimate objective of decreasing diabetes and obesity burden, and improving the health and the quality of care for these patients.

http://ift.tt/2gb78sC

A reddish pulsatile mass beyond tympanic membrane: think before act

We report a case of a 76-year-old man that referred to our hospital because of progressive mixed right hearing loss, aural fullness and pulsatile tinnitus synchronized with heart beats. Otoscopic examination revealed a reddish pulsatile mass beyond tympanic membrane. CT and MRI scans showed a class C glomus tumor. Anamnesis and a complete physical examination, with careful differential diagnosis, should be obtained to rule out highly vascularized middle ear lesion before any invasive procedure.

L'articolo A reddish pulsatile mass beyond tympanic membrane: think before act sembra essere il primo su European Review.

http://ift.tt/2gsH0r3

Repeated failed non-invasive prenatal testing in a woman with immune thrombocytopenia and antiphospholipid syndrome: lessons learnt

We present a case of a 37-year-old Chinese woman (gravida 4 para 0) with a history of immune thrombocytopenia and type IIb antiphospholipid syndrome. She was started on 100 mg of aspirin, 20 mg of prednisolone and 20 mg of subcutaneous low-molecular-weight heparin daily for her fourth pregnancy. She opted for non-invasive prenatal testing for aneuploidy screening but had failed results three times consecutively from insufficient fetal cfDNA initially or high variance in cfDNA counts on redraws. She declined invasive karyotyping. Her pregnancy was complicated by severe pre-eclampsia and fetal growth restriction at 19+6 weeks of gestation and was terminated. Subsequent fetal karyotyping revealed a normal karyotype of 46XY with no apparent abnormalities.

http://ift.tt/2h5v2n7

Venous and arterial air embolism: a rare phenomenon with fatal consequences

Air embolism is often an iatrogenic complication which may occur in venous or arterial circulation depending on the port of entry. We present two cases in which air embolism occurred in venous and arterial circulation after contrast medium injection (CMI) and coronary artery bypass graft (CABG) surgery, respectively. In one case, accumulation of air bubbles was observed in the pulmonary artery after CMI. This was attributed to inadvertent injection of air owing to improper connection of the injector and the catheter. The patient was managed with 100% oxygen in the Trendelenburg and left lateral decubitus position. Repeat imaging demonstrated resorption of the emboli. In another case, air was introduced during CABG in the left atrium and ventricle. Immediate suction of air was attempted however, the patient developed cardiogenic shock requiring vasopressors, and subsequently seizures and coma due to diffuse ischaemic stroke. The patient eventually expired.

http://ift.tt/2fZyjs6

Adult ileocolic intussusception caused by Burkitt lymphoma

Ileocolic intussusception due to Burkitt lymphoma is extremely rare in adults. A man aged 17 years presented with a history of recurrent abdominal pain over the past 3 weeks. The abdomen was distended with diffuse tenderness, and bowel sounds were present. Abdominal ultrasound and CT scans showed evidence of small bowel obstruction with marked wall thickening in the ileocecal region and 'target' signs suggestive for intussusception. At laparoscopy, a mass involving the caecum and the terminal ileum was found, along with multiple locoregional nodes, which was highly suggestive of malignancy. A typical en bloc right colectomy with intracorporeal ileocolic anastomosis was performed. Histopathological examination showed a high-grade B-cell Burkitt lymphoma that was confirmed by immunohistochemistry. The patient was subsequently treated with adjuvant combination chemotherapy and is alive and disease-free at the 3-year follow-up.

http://ift.tt/2h5uihH

Novel technique for repigmentation of senescence grey hair

http://ift.tt/2gaWNNl

Efficacy and tolerability of a new topical nitric-zinc preparation for “difficult-to-treat” warts

Abstract

Treating plantar, periungual, and external genital warts can be challenging. A prospective study from four centers in Italy evaluated 37 immunocompetent patients with single or multiple warts and treated each lesion with a nitric-zinc topical solution composed of organic and inorganic acids meant to devitalize tissue and destroy HPV DNA in infected keratinocytes. Thirty of the 37 patients had external genital warts, two had plantar warts, two had palm and finger warts, and three had subungual warts for a total of 55 lesions treated. Nitric-zinc aqueous solution was applied over each wart utilizing a 30 µL capillary tube until a whitening response was observed. Additional applications as needed were accomplished at 2-week intervals until the wart was gone. In those with hand, plantar, and subungual warts, there was a 100% clearance after two to three sessions. Three with external genital warts had only a partial response and one no benefit after four applications. Thus, this approach was effective in external genital and other "difficult-to-treat" warts in 90% of patients after one to four applications. It also was easy to use with no adverse events noted.

http://ift.tt/2gTqLUr

Human newborn B cells mount an IFNAR-dependent humoral response to RSV

Publication date: Available online 5 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Jop Jans, Matthew Pettengill, Dhohyung Kim, Cas van der Made, Ronald de Groot, Stefanie Henriet, Marien I. de Jonge, Gerben Ferwerda, Ofer Levy

Teaser

This study provides evidence of a first line of human humoral defense against RSV infection in early life including the presence of natural neutralizing anti-RSV IgM as well as an IFN-β-mediated newborn B cell activation.

http://ift.tt/2gaU5aH

Effect of probiotics in prevention of atopic dermatitis is dependent on the intrinsic microbiota at early infancy

Publication date: Available online 5 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Ekaterina Avershina, Raul Cabrera-Rubio, Krister Lundgård, Gaspar Perez-Martinez, Maria Carmen Collado, Ola Storrø, Torbjørn Øien, Christian Kvikne Dotterud, Roar Johnsen, Knut Rudi
Although a link between probiotic intervention and reduction in atopic disease has been documented, no consistent associations with microbiota has yet been established. Here we have conducted an extensive analysis of the microbiota from more than 250 mother child pairs from a probiotic intervention cohort, where we previously have shown 40 % reduction in atopic dermatitis. Within the probiotic intervention group at the age of 10 days we found that the atopic children had a deviating microbiota (p = 0.028, BH-FDR corrected Kruskal Wallis) with high levels (> 10 %) of a bacterium related to Bifidobacterium dentium (p=0.039, BH-FDR corrected Chi-square). Based on these findings, we propose a model with two groups of children where the group responding to probiotic intervention, has gut microbiota related to that of non-atopic children; while the non-responding group has a divergent microbiota at the age of 10 days with overrepresented amounts of B. dentium. In conclusion, our results support the importance of early colonization for prevention of diseases developing later in life, with potential intervention effects being dependent on the intrinsic microbiota.

Teaser

Here we report a study suggesting that effect of probiotic intervention is dependent on intrinsic microbiota. Specifically, children who developed AD regardless of probiotic intake had divergent microbiota and characteristically higher levels of B. dentium at 10 days of age.

http://ift.tt/2gTi8cJ

Molecular engineering of a therapeutic antibody for Blo t 5-induced allergic asthma

Publication date: Available online 5 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): J. H. Sherlynn Chan, Yen Leong Chua, Hong Yong Peh, Vojislav Jovanovic, Nicholas R.J. Gascoigne, W. S. Fred Wong, Fook Tim Chew, Brendon J. Hanson, David M. Kemeny, Paul A. MacAry

http://ift.tt/2gTmX5B

Identification of IL-17F/frequent exacerbator endotype in asthma

Publication date: Available online 5 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Fabio L.M. Ricciardolo, Valentina Sorbello, Anna Folino, Fabio Gallo, Gian Mario Massaglia, Gabriella Favatà, Salvatore Conticello, Davide Vallese, Federica Gani, Mario Malerba, Gert Folkerts, Giovanni Rolla, Mirella Profita, Thais Mauad, Antonino Di Stefano, Giorgio Ciprandi
BackgroundSevere asthma might be associated with neutrophil recruitment and Th17 cytokines over-expression in bronchial biopsies.ObjectiveTo study IL-17-related cytokines in nasal/bronchial biopsies from controls and mild (MA)-to-severe (SA) asthmatics in relation to exacerbation rate.MethodsInflammatory cells and IL-17A⁺, IL-17F⁺, IL-21⁺, IL-22⁺ and IL-23⁺ cells were examined by immunohistochemistry (IHC) in cryostat sections of bronchial/nasal biopsies obtained from 33 SA (21 frequent exacerbators (FE)), 31 MA (3 FE) and 14 controls. IL-17F protein was also measured by ELISA in bronchial/nasal lysates and by IHC in bronchial tissue obtained from subjects died for fatal asthma. Immunofluorescence/confocal microscopy was used for IL-17F co-localization.ResultsHigher number (p<0.05) of neutrophils, IL-17A⁺, IL-17F⁺ and IL-21⁺ cells in bronchial biopsies and higher number (p<0.01) of IL-17F⁺ and IL-21⁺ cells in nasal biopsies were observed in SA compared to MA. Bronchial IL-17F⁺ cells correlated with bronchial neutrophils (r=0.54), exacerbation rate (r=0.41) and FEV1 (r=-0.46). Nasal IL-17F⁺ cells correlated with bronchial IL-17F (r=0.35), exacerbation rate (r=0.47) and FEV1 (r=-0.61). FE showed increased number of bronchial neutrophils/eosinophils/CD4⁺/CD8⁺ cells and bronchial/nasal IL-17F⁺ cells. ROC curve analysis evidenced predictive cut-off values of bronchial neutrophils and nasal/bronchial IL-17F for discriminating between asthmatics and controls, between MA and SA and between FE and non-FE. IL-17F protein increased in bronchial/nasal lysates of SA and FE and in bronchial tissue of fatal asthma. IL-17F co-localized in CD4⁺/CD8⁺ cells.ConclusionsIL-17-related cytokines expression was amplified in bronchial/nasal mucosa of neutrophilic asthma prone to exacerbation suggesting a pathogenic role of IL-17F in frequent exacerbators.

Teaser

Overexpression of nasal/bronchial IL-17F is a feature of severe asthma in relation to neutrophils, airway obstruction and exacerbation rate and it is also able to recognize frequent exacerbator phenotype potentially at risk of asthma death.

http://ift.tt/2gaPVj4

Acute septic arthritis of the temporomandibular joint derived from otitis media: a report and review of the English and Japanese literature

Abstract

Septic arthritis of the temporomandibular joint (SATMJ) is an extremely rare disease with characteristic features of preauricular pain, swelling, redness, and malocclusion. The present report describes a case of SATMJ derived from otitis media, which resulted in a good outcome. We also reviewed the English and Japanese literature with special interest in etiology. It is generally agreed that contiguous or distant infection and trauma are common etiological factors of SATMJ. So far, these etiological factors are mainly discussed based on hypotheses rather than sufficient evidence. Therefore, in many past cases, accurate causes were not identified. To our knowledge, our case is the third report of SATMJ following otitis media. In addition, this is the first case in which the pathogenic bacterium responsible for the otitis media was the definite cause of the SATMJ. Cases of SATMJ are sometimes misdiagnosed with otitis media, and SATMJ derived from otitis media is extremely rare. Dentists and otolaryngologists should collaborate for the management of this disease as needed.

http://ift.tt/2gGvQ4N

Αρχειοθήκη ιστολογίου

Δευτέρα 5 Δεκεμβρίου 2016

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