The Analgesic Effects of (5R,6R)6-(3-Propylthio-1,2,5-thiadiazol-4-yl)-1-azabicyclo[3.2.1] Octane on a Mouse Model of Neuropathic Pain.

BACKGROUND: Both pharmacologic and genetic approaches have been used to study the involvement of the muscarinic acetylcholine system in the regulation of chronic pain. Previous studies suggest that the M2 and M4 subtypes of muscarinic acetylcholine receptors (mAChRs) are important targets for the development of chronic pain. (5R,6R)6-(3-Propylthio-1,2,5-thiadiazol-4-yl)-1-azabicyclo[3.2.1] octane (PTAC) has agonist effects on muscarinic M2 and M4 receptors and antagonist effects on muscarinic M1, M3, and M5 receptors. However, its analgesic effects have been less studied. METHODS: Male C57B L/6 mice were anesthetized, and left common peroneal nerve (CPN) ligation was performed to induce neuropathic pain. Before and after the application of PTAC systemically or specifically to the anterior cingulate cortex (ACC), the withdrawal thresholds to mechanical stimulation and static weight balance were measured, and the effects of PTAC on the conditioned place preference (CPP) were further evaluated. Western blotting was used to examine the expression of M1 and M2 in the striatum, ACC, and ventral tegmental area. RESULTS: The application of PTAC ([i.p.] intraperitoneal injection) increased the paw withdraw threshold in both the early (0.05 mg/kg, mean difference [95% confidence interval, CI]: 0.19 [0.05-0.32]; 0.10 mg/kg: mean difference [95% CI]: 0.34 [0.22-0.46]) and the late phases (0.05 mg/kg: mean difference [95% CI]: 0.45 [0.39-0.50]; 0.1 mg/kg: mean difference [95% CI]: 0.44 [0.37-0.51]) after nerve injury and rebalanced the weight distribution on the hind paws of mice (L/R ratio: before, 0.56 +/- 0.03. 0.05 mg/kg, 1.00 +/- 0.04, 0.10 mg/kg, 0.99 +/- 0.03); however, it failed to induce place preference in the CPP (0.05 mg/kg, 2-way analysis of variance, P > .05; 0.2 mg/kg, 2-way analysis of variance, P > .05,). At the same doses, the analgesic effects at D3-5 lasted longer than the effects at D14-16. This may be due to the down-regulation of the M2 and M1 in tested brain regions. CONCLUSIONS: These observations suggested that PTAC has analgesic effects on the neuropathic pain induced by nerve injury. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. (C) 2016 International Anesthesia Research Society

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Haloperidol Versus Ondansetron for Treatment of Established Nausea and Vomiting Following General Anesthesia: A Randomized Clinical Trial.

BACKGROUND: Haloperidol is an antipsychotic. At low doses, it is a useful agent for the prophylaxis of postoperative nausea and vomiting (PONV). However, its use for treating established PONV has not been well studied. METHODS: This randomized double-blinded trial tested whether haloperidol is noninferior to ondansetron for the early treatment of established PONV in adult patients undergoing general anesthesia. The primary outcome is whether patients were PONV free during the first 4 hours. The noninferiority margin was set at 15%. One hundred twenty patients with PONV received either haloperidol 1 mg intravenously (n = 60) or ondansetron 4 mg intravenously (n = 60). RESULTS: Data from 112 patients (59 in the haloperidol group and 53 in the ondansetron group) were analyzed. Thirty-five patients (52%) in the haloperidol group received 1 or 2 prophylactic antiemetics compared with 42 (79%) in the ondansetron group. Haloperidol was noninferior to ondansetron for the end point of complete response to treatment (defined as the rate of PONV-free patients) for the early (0-4 hour) and the 0- to 24-hour postoperative periods by both the per-protocol and intention-to-treat analyses. In the per-protocol analysis, complete responses in the early period were noted in 35 of 59 patients (59%) and 29 of 53 patients (55%) for the haloperidol and ondansetron groups, respectively (difference 5%; 95% confidence interval [CI]: -13% to 22 %), and in the 0- to 24-hour period in 31 of 59 patients (53%) and 26 of 53 patients (49%) for the haloperidol and ondansetron groups, respectively (difference 4%; 95% CI of the difference: -15% to 21%). In the intention-to-treat analysis, complete responses in the early period were noted in 35 of 60 patients (58%) and 29 of 60 patients (48%) for the haloperidol and ondansetron groups, respectively (difference 10%; 95% CI of difference: -8% to 27%) and in the 0- to 24-hour period in 31 of 60 patients (52%) and 26 of 60 patients (43%) for the haloperidol and ondansetron groups, respectively (difference 8%; 95% CI of the difference: -9% to 25%). All other PONV secondary outcomes were comparable. Twenty-five percent of patients in the haloperidol group were sedated versus 2% in the ondansetron group (P

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Nitrous Oxide During Labor: Maternal Satisfaction Does Not Depend Exclusively on Analgesic Effectiveness.

BACKGROUND: Evidence on the analgesic effectiveness of nitrous oxide for labor pain is limited. Even fewer studies have looked at patient satisfaction. Although nitrous oxide appears less effective than neuraxial analgesia, it is unclear whether labor analgesic effectiveness is the most important factor in patient satisfaction. We sought to compare the relationship between analgesic effectiveness and patient satisfaction with analgesia in women who delivered vaginally using nitrous oxide, neuraxial analgesia (epidural or combined spinal-epidural [CSE]), or both (neuraxial after a trial of nitrous oxide). METHODS: A standardized survey was recorded on the first postpartum day for all women who received anesthetic care for labor and delivery. Data were queried for women who delivered vaginally with nitrous oxide and/or neuraxial labor analgesia over a 34-month period in 2011 to 2014. Parturients with complete data for analgesia quality and patient satisfaction were included. Analgesia and satisfaction scores were grouped into 8 to 10 high, 5 to 7 intermediate, and 0 to 4 low. These scores were compared with the use of ordinal logistic regression across 3 groups: nitrous oxide alone, epidural or CSE alone, or nitrous oxide followed by neuraxial (epidural or CSE) analgesia. RESULTS: A total of 6507 women received anesthesia care and delivered vaginally. Complete data were available for 6242 (96%) women; 5261 (81%) chose neuraxial analgesia and 1246 (19%) chose nitrous oxide. Of the latter, 753 (60%) went on to deliver with nitrous oxide alone, and 493 (40%) switched to neuraxial analgesia. Most parturients who received neuraxial analgesia (>90%) reported high analgesic effectiveness. Those who used nitrous oxide alone experienced variable analgesic effectiveness, with only one-half reporting high effectiveness. Among all women who reported poor analgesia effectiveness (0-4; n = 257), those who received nitrous oxide alone were more likely to report high satisfaction (8-10) than women who received epidural analgesia alone (OR 2.5; 95% CI 1.4-4.5; P = .002). Women who reported moderate analgesia (5-7) and received nitrous oxide only were more likely to report high satisfaction compared with the other groups. Among women who reported a high level of analgesic effectiveness, satisfaction with anesthesia was high and not different among groups. CONCLUSIONS: Patients who received nitrous oxide alone were as likely to express satisfaction with anesthesia care as those who received neuraxial analgesia, even though they were less likely to report excellent analgesia. Although pain relief contributes to the satisfaction with labor analgesia care, our results suggest that analgesia is not the only contributor to maternal satisfaction. (C) 2016 International Anesthesia Research Society

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Fluoroscopic-Guided Lumbar Spinal Drain Insertion for Thoracic Aortic Aneurysm Surgery.

We retrospectively reviewed the medical records of 11 patients who were referred by anesthesiologists to an interventional neuroradiologist for fluoroscopy-guided lumbar spinal drain insertion for thoracic aortic aneurysm repair between January 2010 and June 2015. Successful drain insertion was achieved in all patients. Three (27.3%) patients developed drain-related complications. Fluoroscopy-guided spinal drain insertion is an alternative to the conventional, nonimage-guided, blind technique used by anesthesiologists when they expect to encounter difficulty with insertion or in cases of failed insertion. (C) 2016 International Anesthesia Research Society

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Improving Prediction of Postoperative Myocardial Infarction With High-Sensitivity Cardiac Troponin T and NT-proBNP.

BACKGROUND: This study sought to determine whether preoperatively measured high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) improve cardiac risk prediction in patients undergoing major noncardiac surgery compared with the standard risk indices. METHODS: In this ancillary study to the Vitamins in Nitrous Oxide trial, patients were included who had preoperative hs-cTnT and NT-proBNP measured (n = 572). Study outcome was the incidence of postoperative myocardial infarction (MI) within the first 3 postoperative days. hs-cTnT was considered elevated if >14 ng/L and NT-proBNP if >300 ng/L. Additional cutoff values were investigated on the basis of receiver operating characteristic statistics. Biomarker risk prediction was compared with Lee's Revised Cardiac Risk Index (RCRI) with the use of standard methods and net reclassification index. RESULTS: The addition of hs-cTnT (>14 ng/L) and NT-proBNP (>300 ng/L) to RCRI significantly improved the prediction of postoperative MI (event rate 30/572 [5.2%], Area under the receiver operating characteristic curve increased from 0.590 to 0.716 with a 0.66 net reclassification index [95% confidence interval 0.32-0.99], P

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Pediatric trans-oral submandibular gland excision: A safe and effective technique

Publication date: February 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 93
Author(s): C.A. Hughes, J. Brown
IntroductionIn the pediatric population the submandibular gland requires removal in a number of conditions including, refractory recurrent sialoadenitis, sialolithiasis, salivary gland neoplasms and debilitating sialorrhea. In comparison to the traditional trans-cervical approach, the trans-oral route avoids a cervical scar, potential keloid formation and decreased risk of injury to the marginal mandibular branch of the facial nerve. This approach also eliminates the potentiality of remnant duct disease since the entire duct and papillae are removed. The article demonstrates the appropriateness of this method in the pediatric population and discusses the anatomy and technique.MethodsRetrospective review of ten pediatric patients who underwent trans-oral submandibular gland excision, the series was analyzed for age, gender, indication for procedure, complications, length of hospitalization, and postoperative pathology. Patients were followed for a minimum of 12 months.Results7 females and 3 males aged 9 to 17 underwent the procedure. Recurrent sialoadenitis, and sialolithiasis, accounted for 6 cases while salivary neoplasms (pleomorphic adenoma) accounted for 4 cases. No patient suffered vessel or nerve injury and no patient showed recurrent disease at 12 months follow-up. All glands were completely removed and no patient required conversion to the trans-cervical approach.ConclusionsTrans-oral submandibular gland excision is safe and effective in the pediatric population. This method avoids a cervical scar, avoids injury to the marginal mandibular branch of the facial nerve, and completely removes the duct, eliminating the potentiality of remnant duct disease. The authors have performed ten trans-oral submandibular gland excisions in pediatric patients without complications.



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Sinonasal adenocarcinoma: clinical outcomes and predictive factors

Publication date: Available online 21 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J. Michel, T. Radulesco, M. Penicaud, J. Mancini, P. Dessi
A retrospective study of 39 patients treated for sinonasal adenocarcinoma between 1995 and 2010 was performed. Epidemiological, clinical, histological, and therapeutic aspects of this series of patients were analyzed statistically and their impact in terms of overall and disease-free survival established using the Kaplan–Meier method. A search for prognostic factors was made using a log-rank test. The male to female sex ratio was 6.8 to 1. The average age at diagnosis was 65.7 years (range 40.2–85.6 years). An occupational risk factor (wood dust, leather) was found for 19 patients (48.7%). The median patient follow-up was 51.9 months (range 8–180 months). Tumours were classified as T1 in 20.5%, T2 in 25.6%, T3 in 23.1%, and T4 in 30.8% of cases. Disease-free survival rates at 1, 5, and 10 years were 87.9%, 44.8%, and 39.2%, respectively; overall survival rates were 86.1%, 72.2%, and 50.3%, respectively. Overall survival was correlated with tumour status (TNM, American Joint Committee on Cancer) (P=0.004). Surgery followed by radiotherapy improved overall survival (P=0.012) and disease-free survival (P=0.028) when compared to other treatment modalities. When compared to surgery alone, surgery followed by radiotherapy improved disease-free survival regardless of tumour stage (P=0.049).



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3-Iodothyronamine Decreases Expression of Genes Involved in Iodide Metabolism in Mouse Thyroids and Inhibits Iodide Uptake in PCCL3 Thyrocytes

Thyroid , Vol. 0, No. 0.


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Low Elasticity of Thyroid Nodules on Ultrasound Elastography Is Correlated with Malignancy, Degree of Fibrosis, and High Expression of Galectin-3 and Fibronectin-1

Thyroid , Vol. 0, No. 0.


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Hyperinsulinemic normoglycemia decreases glucose variability during cardiac surgery

Abstract

Purpose

Increased glucose variability may be associated with worse outcomes in critically ill patients. Hyperinsulinemic normoglycemia provides intensive glucose control during surgery and may reduce glucose variability. Our objective was to compare glycemic variability between two methods of glucose control in cardiac surgical patients: hyperinsulinemic normoglycemia vs standard insulin infusion. We also assessed whether the effect differed between patients with and without diabetes mellitus.

Methods

We compared measures of glycemic variability, including the primary outcome, average real variability (ARV), and secondary outcomes, within-patient standard deviation (SD) and glucose lability index (GLI), in 252 patients who received hyperinsulinemic normoglycemia and 266 patients who received standard therapy. Data was randomly sampled from each patient treated with hyperinsulinemic normoglycemia, so patients in each group had a similar number of glucose measurements. The significance level for each hypothesis was 0.05, and 0.025 within diabetic status.

Results

For nondiabetic patients, hyperinsulinemic normoglycemia reduced mean glucose measure-to-measure variability for ARV by an estimated −0.23 (97.5% CI −0.30, −0.16) mg/dl/min (P < 0.001) versus standard care. There was no difference in glycemic variability between groups for diabetic patients, with difference in means (97.5% CI) of −0.10 (−0.20, 0.02) mg/dl/min, P = 0.07. Mean SD was lower for hyperinsulinemic normoglycemia patients overall, with difference in means (95% CI) of −19 (−22, −16), P < 0.001, with a stronger effect in nondiabetics (interaction P = 0.042). GLI was also lower with hyperinsulinemic normoglycemia.

Conclusion

Hyperinsulinemic normoglycemia decreases glucose variability for cardiac surgical patients with a stronger effect in nondiabetic patients.

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The effect of esophagogastroduodenoscopy probe insertion on the intracuff pressure of airway devices in children during general anesthesia

Abstract

Given the size of the esophagogastroduodenoscopy (EGD) probe and the compressibility of the pediatric airway, the EGD probe may increase the intracuff pressure (IP) of an airway device. The current study evaluated IP changes during EGD examination under general anesthesia in pediatric patients. Following the induction of anesthesia, a laryngeal mask airway (LMA) or endotracheal tube (ETT) was placed without neuromuscular blockade. The IP was measured at baseline, during EGD probe insertion, while the EGD probe was in place, and after probe removal. The study cohort included 101 patients (mean age 11.3 years). The airway was secured with an LMA and an ETT in 88 and 13 patients, respectively. The IP increased from 27 ± 15 cmH₂O at baseline to 34 ± 17 cmH₂O during probe insertion (p < 0.001), remained at 33 ± 16 cmH₂O while the probe was in place, and decreased to 26 ± 14 cmH₂O after probe removal. The IP of the LMA or ETT increased during EGD probe insertion and remained elevated while the probe was in place. High IP may compromise mucosal perfusion resulting in a sore throat when using an LMA or the potential for airway damage if an ETT is used. Removal of air from the cuff and titration of the IP should be considered after EGD insertion.

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Quantitative Analysis of Aquaporin Expression Levels during the Development and Maturation of the Inner Ear

Abstract

Aquaporins (AQPs) are a family of small membrane proteins that transport water molecules across the plasma membrane along the osmotic gradient. Mammals express 13 subtypes of AQPs, including the recently reported "subcellular AQPs", AQP11 and 12. Each organ expresses specific subsets of AQP subtypes, and in the inner ear, AQPs are essential for the establishment and maintenance of two distinct fluids, endolymph and perilymph. To evaluate the contribution of AQPs during the establishment of inner ear function, we used quantitative reverse transcription polymerase chain reaction to quantify the expression levels of all known AQPs during the entire development and maturation of the inner ear. Using systematic and longitudinal quantification, we found that AQP11 was majorly and constantly expressed in the inner ear, and that the expression levels of several AQPs follow characteristic longitudinal patterns: increasing (Aqp0, 1, and 9), decreasing (Aqp6, 8, and 12), and peak of expression on E18 (Aqp2, 5, and 7). In particular, the expression level of Aqp9 increased by 70-fold during P3–P21. We also performed in situ hybridization of Aqp11, and determined the unique localization of Aqp11 in the outer hair cells. Immunohistochemistry of AQP9 revealed its localization in the supporting cells inside the organ of Corti, and in the root cells. The emergence of AQP9 expression in these cells was during P3–P21, which was coincident with the marked increase of its expression level. Combining these quantification and localization data, we discuss the possible contributions of these AQPs to inner ear function.

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Vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association with Mayer-Rokitansky-Küster-Hauser syndrome in co-occurrence: two case reports and a review of the literature

The vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association and Mayer-Rokitansky-Küster-Hauser syndrome are rare conditions. We a...

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Prostatic urethra malformation associated with retrograde ejaculation: a case report

Retrograde ejaculation can have anatomical, neurogenic, or pharmacological causes. Among these factors, malformation of the prostatic urethra is an uncommon cause.

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Pyomyositis is not only a tropical pathology: a case series

Pyomyositis is an acute bacterial infection of skeletal muscle that results in localized abscess formation. This infection was thought to be endemic to tropical countries, and is also known as "tropical pyomyo...

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Worsening cholestasis and possible cefuroxime-induced liver injury following “successful” therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone: a case report

Cefuroxime very rarely causes drug-induced liver injury. We present a case of a patient with paradoxical worsening of jaundice caused by cefuroxime-induced cholestasis following therapeutic endoscopic retrogra...

http://ift.tt/2hV55s4

Statistische Methoden für Krebsregister

Zusammenfassung

Hintergrund und Fragestellung

Dieser Artikel gibt einen Überblick zu wichtigen Kenngrößen der Krebsregistrierung, welche vom Zentrum für Krebsregisterdaten (ZfKD) und von Krebsregistern der Bundesländer regelmäßig publiziert werden.

Methoden und Ergebnisse

Am Beispiel von Darmkrebs werden Inzidenz- und Mortalitätsraten, standardisierte Inzidenz- und Mortalitätsquotienten (SIR und SMR), Prävalenz, Erkrankungs- und Sterberisiken, Überlebenswahrscheinlichkeiten und Vollzähligkeit definiert und interpretiert.

Schlussfolgerung

Die dargestellten Methoden sollen den Leser bei der Interpretation von Routineberichten der Krebsregister unterstützen.

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Operative Therapie des Endometriumkarzinoms

Zusammenfassung

Die Übersicht erfasst den aktuellen Stand der operativen Therapie des primären Endometriumkarzinoms und basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zu diesem Thema bis Juli 2016. Relevante Kontroversen sind aufgenommen. Die präoperative Diagnostik erfasst klinisch die funktionelle Fitness der Patientin in Bezug auf das therapeutische Vorgehen. Transvaginalsonographie sowie CT-Thorax und -Abdomen geben präoperativ Hinweise auf das vorliegende Stadium. Erhöhtes CA-125 kann mit Lymphknoten(LK)-Metastasen und höherem Stadium assoziiert sein. Die Standardtherapie des Typ-I-Endometriumkarzinoms, des endometroiden Endometriumkarzinoms, pT1a G1/G2, ist die minimalinvasive totale Hysterektomie (TH) mit beidseitiger Salpingoovarektomie (BSO); prämenopausal ist ein Ovarerhalt außer bei BRCA-Mutation oder Lynch-Syndrom möglich. Bei mittlerem Risiko (pT1a G3 L0/L1 oder pT1b) ist zusätzlich die systematische Lymphonodektomie (LNE) pelvin und paraaortal bis infrarenal zu empfehlen; die alleinige Wächterlymphknotenentfernung wird derzeit in Studien geprüft. Bei Hochrisiko-Typ-I-Endometriumkarzinom im Stadium FIGO II (Zervixstromabefall ohne Anhalt für Parametriumbefall) ist die TH plus BSO mit operativem Staging und systematischer pelviner und paraaortaler LNE ausreichend, bei Typ II FIGO I (nichtendometroides Endometriumkarzinom) TH, BSO, operatives Staging, makroskopische Komplettresektion, systematische pelvine und paraaortale LNE (bis infrarenal), Omentektomie (falls serös oder seröse Anteile). Bei FIGO III und IV ist die Parametrienresektion notwendig, falls dadurch R0 erreicht wird, zusätzlich operatives Staging, makroskopische Komplettresektion, systematische pelvine und paraaortale LNE.

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Use of extracapsular dissection for benign, minor palatal tumours of the salivary gland – a technical note

Publication date: Available online 20 December 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Shiva Subramaniam, Peter A. Brennan, Rajiv Anand




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Reproducibility of three-dimensional posterior cranial base angles using low-dose computed tomography

Abstract

Objectives

One of the key aspects of three-dimensional (3D) craniofacial cephalometry is the measurement of posterior cranial base angle as this area is deeply involved in craniofacial development. The purpose of our retrospective study was to define the best reproducible 3D posterior cranial base angles among five 3D angles transposed from 2D cephalometry (Cousin, BL1 of Ross and Ravosa, Bjork, Delaire, CBA4 of Liberman) and seven 3D angles based on physical anthropology studies and on new concepts (R1 to R7). The null hypothesis was that all 3D posterior cranial base angles were equally reproducible.

Material and methods

We used a preoperative low-dose computed tomography (CT) data from 20 adult patients undergoing orthognathic surgery after approval by local ethical committee. Two independent observers performed two series of 23 3D landmark identifications on 3D CT surface rendering of each patient using Maxilim software. Then, the same observers performed twice 3D cephalometric analyses (23 landmarks, 4 midpoints, 19 planes) that provided the automatic measurement of 12 posterior cranial base angles.

Results

Inter-observer correlation coefficient varied from 0.545 (Cousin) to 0.695 (CBA4 of Liberman) and from −0.177 (R2) to 0.827 (R4).

Conclusions

The null hypothesis was rejected. The most reproducible angle was 3D angle R4 based on "basion," "superior optic" (right, left), and "crista galli inferior" landmarks.

Clinical relevance

R4 angle might be used as reference 3D posterior cranial base angle in further clinical studies involving 3D cephalometry as a diagnostic tool for orthodontics and for orthognathic surgery.

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Efficacy of desensitizing products containing 8% arginine and calcium carbonate for hypersensitivity relief in MIH-affected molars: an 8-week clinical study

Abstract

Objectives

The objective of this study was to compare the efficacy in reducing hypersensitivity in molar incisor hypomineralization (MIH)-affected molars immediately and over 8 weeks combining a single in-office application and a homed-based program with desensitizing products containing 8% arginine and calcium carbonate.

Materials and methods

Nineteen children with at least one MIH-affected molar with hypersensitivity were included. Hypersensitivity was assessed with an evaporative (air) stimulus and a tactile stimulus. Each child received a single in-office treatment with a desensitizing paste containing 8% arginine and calcium carbonate (elmex Sensitive Professional desensitizing paste), followed by 8 weeks of brushing twice daily with a desensitizing toothpaste containing 8% arginine, calcium carbonate with 1450 ppm fluoride (elmex Sensitive Professional toothpaste), using the elmex Sensitive Professional toothbrush. Additionally, the corresponding mouthwash (elmex Sensitive Professional mouthwash) was used. Clinical assessments were made at baseline, immediately after the in-office treatment and after 1, 2, 4 and 8 weeks of brushing twice daily.

Results

Fifty-six molars with an air blast hypersensitivity score of 2 or 3 (Schiff Cold Air Sensitivity Scale) were included. Application of the desensitizing paste decreased hypersensitivity significantly immediately and throughout the 8 weeks recalls (p < 0.001).

Conclusions

In conclusion, 8% arginine and calcium carbonate were able to reduce hypersensitivity successfully during this 8-week trial.

Clinical relevance

Hypersensitivity is a major complaint in patients with MIH. This is the first study evaluating the desensitizing effect of a desensitizing paste containing 8% arginine and calcium carbonate in patients with MIH.

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Clinical performance of a glass ionomer restorative system: a 6-year evaluation

Abstract

Objectives

The aim of this study is to evaluate the long-term clinical performance of a glass ionomer (GI) restorative system in the restoration of posterior teeth compared with a micro-filled hybrid posterior composite.

Materials and methods

A total of 140 (80 Cl1 and 60 Cl2) lesions in 59 patients were restored with a GI system (Equia) or a micro hybrid composite (Gradia Direct). Restorations were evaluated at baseline and yearly during 6 years according to the modified-USPHS criteria. Negative replicas at each recall were observed under SEM to evaluate surface characteristics. Data were analyzed with Cohcran's Q and McNemar's tests (p < 0.05).

Results

One hundred fifteen (70 Cl1 and 45 Cl2) restorations were evaluated in 47 patients with a recall rate of 79.6% at 6 years. Significant differences were found in marginal adaptation and marginal discoloration for both restorative materials for Cl1 and Cl2 restorations (p < 0.05). However, none of the materials were superior to the other (p > 0.05). A significant decrease in color match was observed in Equia restorations (p < 0.05). Only one Cl2 Equia restoration was missing at 3 years and another one at 4 years. No failures were observed at 5 and 6 years. Both materials exhibited clinically successful performance after 6 years. SEM evaluations were in accordance with the clinical findings.

Conclusions

Both materials showed a good clinical performance for the restoration of posterior teeth during the 6-year evaluation.

Clinical relevance

The clinical effectiveness of Equia and Gradia Direct Posterior was acceptable in Cl1 and Cl2 cavities subsequent to 6-year evaluation.

http://ift.tt/2hSXmux

Cutaneous Side Effects and Transepidermal Water Loss To Gefitinib: A Study of 11 Patients

Abstract

Introduction

Cutaneous side effects caused by epidermal growth factor receptor (EGFR) inhibitors occurred in 45–100% of patients which may lead to therapy modification or interruption. This study aimed to evaluate cutaneous side effects and transepidermal water loss (TEWL) values in non-small cell lung carcinoma (NSCLC) patients who received gefitinib EGFR inhibitor.

Methods

A descriptive observational study with cross-sectional design and a consecutive sampling method was conducted from 1 February to 4 March 2016. Eleven NSCLC patients with EGFR mutation who visited the Hemato-Oncology Clinic/Internal Medicine Department, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, were assessed through history taking, physical examination, and TEWL examination using Tewameter.

Results

Ten of the eleven patients experienced cutaneous side effects. The most frequently observed was xerosis cutis (8/10 patients), followed by acneiform eruptions (7/10 patients), and paronychia (3/10 patients). None of these patients experienced hair changes, mucositis, or drug hypersensitivity. Mean TEWL value of these patients was higher than normal (11.205 ± 1.881 g/m²/h).

Conclusions

Patients who received gefitinib EGFR inhibitor experienced cutaneous side effects including xerosis cutis, acneiform eruptions, and paronychia, and have mean TEWL values higher than normal. Therefore, it might affect the skin barrier function.

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Biomarkers associated with disease severity in allergic and nonallergic asthma

Publication date: February 2017
Source:Molecular Immunology, Volume 82
Author(s): Selene Baos, David Calzada, Lucía Cremades, Joaquín Sastre, Joaquín Quiralte, Fernando Florido, Carlos Lahoz, Blanca Cárdaba
Asthma is a complex, chronic respiratory disease with a wide clinical spectrum. Use of high-throughput technologies has generated a great deal of data that require validation. In this work the objective was to validate molecular biomarkers related to asthmatic disease types in peripheral blood samples and define their relationship with disease severity. With this purpose, ninety-four previously described genes were analyzed by qRT-PCR in 30 healthy control (HC) subjects, 30 patients with nonallergic asthma (NA), 30 with allergic asthma (AA), and 14 patients with allergy (rhinitis) but without asthma (AR). RNA was extracted from peripheral blood mononuclear cells (PBMCs) using the TRIzol method. After data normalization, principal component analysis (PCA) was performed, and multiple approaches were used to test for differential gene expression. Relevance was defined by RQ (relative quantification) and corrected P value (<0.05). Protein levels of IL-8 and MSR1 were determined by ELISA and Western blot, respectively.PCA showed 4 gene expression clusters that correlated with the 4 clinical phenotypes. Analysis of differential gene expression between clinical groups and HCs revealed 26 statistically relevant genes in NA and 69 in AA. Protein interaction analysis revealed IL-8 to be a central protein. Average levels of IL-8 were higher in the asthma patients' sera (NA: 452.28±357.72, AA: 327.46±377pg/ml) than in HCs (286.09±179.10), but without reaching statistical significance. Nine genes, especially MSR1, were strongly associated with severe NA.In conclusion, several molecular biomarkers of asthma have been defined, some of which could be useful for the diagnosis or prognosis of disease severity.



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Treatment of lupus erythematosus of the eyelids with pulsed dye laser

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Vascular alterations after photodynamic therapy mediated by 5-aminolevulinic acid in oral leukoplakia

Abstract

Impairment of vascular functions after photodynamic therapy (PDT) is frequently associated with tumor remission and is considered one of the main antineoplastic PDT effects. Vascular alterations in oral leukoplakia (OL) treated with PDT have not yet been described. The aim of this study was to evaluate the effect of topical 5-ALA-mediated PDT on the vascular network of 4NQO-induced OL in rats. After applying 4NQO topically on the tongue during 16 weeks, there was induction of dysplastic lesions, which were treated with two PDT sessions (with an interval of 72 h between them), using topical application of 5-ALA and posterior irradiation with a laser (90 J/cm² fluency). Histological sections of the tongues were obtained and analyzed concerning plasmatic exudation and microvessel density after immunolabeling with CD31 and CD34 vessel markers. There was intense plasmatic exudation after 6 h of the first PDT session; at 6 h of the second PDT session, there was a significant reduction in the density of CD31- and CD34-positive microvessels in comparison to controls (p < 0.05). In the PDT intervals, there was an increase in the density of CD31 and CD34 microvessels, suggesting angiogenesis. Topical application of 5-ALA-mediated PDT caused an immediate deleterious effect on the vascular network, increasing vessel permeability and reducing vessel density, mainly after two sessions of the treatment. However, secondary angiogenesis emerged in these lesions during intervals of the PDT session. This fact may be considered during the adoption of a PDT protocol, to avoid OL resistance and recurrence after the treatment.

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The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia

Abstract

Objective

In total laryngectomy, the neopharynx can be closed in several ways. It is suggested that a pseudo-diverticulum is seen more frequently in patients closed with vertical closure than with "T"-shaped closure, causing postoperative dysphagia. We report the results of patients treated with vertical closure and "T"-shaped closure with regard to the formation of a pseudo-diverticulum and postoperative dysphagia.

Methods

In our retrospective cohort study, we identified 117 consecutive laryngectomized patients treated in the VU University Medical Center of Amsterdam between March 2009 and December 2013. Evaluations with statistical analysis of postoperative outcome measures (the formation of a pseudo-diverticulum and dysphagia), qualitative and quantitative variables were conducted.

Results

Patient demographics were similar between the vertical-shaped closure and the "T"-shaped closure groups. In 84.6% of patients with vertical closure, a pseudo-diverticulum was seen compared to 18.5% with "T"-shaped closure (p < 0.001). Dysphagia was increasingly seen in patients with a pseudo-diverticulum (60.5%) compared to patients without a pseudo-diverticulum (39.5%) (p = 0.090).

Conclusion

Formation of a pseudo-diverticulum is more frequently seen in laryngectomy patients closed with vertical closure than in patients closed with "T"-shaped closure of the neopharynx. It is favorable to implement "T"-shaped closure in laryngectomy.

http://ift.tt/2hU17jp

Diagnostic accuracy of tubomanometry R value in detecting the Eustachian tube pressure equalizing function

Abstract

Tubomanometry is a relatively novel Eustachian tube (ET) function testing method. A number of recent studies have utilized the R value of Tubomanometry as the main objective measure in reporting their outcome in balloon dilation of ET. There is, however, a lack of evidence concerning the reliability or validity of Tubomanometry measurements. The objectives of this study are to determine the accuracy of Tubomanometry for detecting ET opening as compared to tympanometry and determine its usefulness as a measure of ET function. Healthy subjects between ages 8 and 76 years with an intact tympanic membrane and no middle ear (ME) effusion were prospectively tested. Primary outcomes were the ET opening as determined by the Tubomanometry R value and the increase in ME pressure with tympanometry-measured in relation to a swallow at a nasopharyngeal pressure of 300 daPa. The accuracy of the tubomanometry R value for identifying a successful ET opening was made in reference to the change of ME pressure. A total of 280 measurements were available from 258 ears in 137 subjects. The presence of tubomanometry R value showed high sensitivity of detecting ET opening for the criteria of >5 daPa ME pressure increase (187/202) but low specificity for detecting ET non-opening (34/78). The R value criterion described in the original manuscripts on Tubomanometry is sensitive but not specific for ET opening. The need for validation of the tubomanometry test obviates its use as the main objective outcome measure for the balloon dilation of ET procedure.

http://ift.tt/2hIpGlo

The therapy with ethosomes containing 5-fluorouracil for laryngotracheal stenosis in rabbit models

Abstract

The aim of this study is to evaluate the efficacy of ethosomes encapsulated with 5-fluorouracil (5-FU) in treatment of laryngotracheal stenosis in rabbit models. The 5-FU ethosome was prepared by the thin film hydration method, and the amorphous, size distribution and the encapsulation efficiency was investigated. The tracheal mucosa were scraped about 0.5 cm with a nylon brush to induce the scar in airway grow, then models were divided into three groups: 5-FU ethosome group, 5-FU group and saline group, drug were injected into scar of every group by paracentesis guided under endoscope, respectively. The stenosis states were observed under laryngo fiberscope immediate, 7, 14 and 21 days after administrated. Airway stenosis of 5-FU ethosome group has no significant difference when compared with 5-FU group at 7 days after administration, but 5-FU ethosome significantly reduced the airway stenosis after 21-day administration when compared with 5-FU group again and has no restenosis during the period under observation. The fact that ethosomes encapsulated with 5-FU were effective for laryngotracheal stenosis suggests that it has potential as a new method for ameliorating airway stenosis originating from granulation tissue.

http://ift.tt/2hVTf37

Bullae and Atypical Target Lesions in a Young Woman

A young woman with a history of systemic lupus erythematosus was readmitted with fever and a generalized eruption; 6 days prior she had been hospitalized for a photo-induced flare of acute cutaneous lupus erythematosus; at readmission, she had a worsening, tender rash with several blisters across her right arm. What is your diagnosis?

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Optimizing Outcomes for Cutaneous Head and Neck Melanoma

In this issue, Moyer and colleagues report long-term follow-up of a large cohort of patients with head and neck melanoma treated with a "square" staged excision technique using permanent sections for comprehensive margin assessment. The median follow-up of 9.3 years demonstrated excellent long-term disease control of 834 lesions with projected local recurrence rate of 2.2% at 10 years. The mean margin required for histologic clearance of tumor was 9.3 mm for melanoma in situ and 13.7 mm for invasive melanoma. The authors demonstrated that lesion size, presence of invasion, and prior incomplete excision were associated with larger surgical margins required for histologic clearance.

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Trends in US Melanoma Incidence and Mortality

This study examines trends in melanoma incidence and mortality in the United States.

http://ift.tt/2i1fdPB

Black Dermographism

This case report describes a patient with black dermographism.

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Staged Excision With Permanent Section Margin Control for Melanoma

This cohort study of patients with melanoma on the head and neck investigates the local recurrence rates and margin to clearance end points using staged excision with comprehensive hematoxylin-eosin–stained permanent section margin control.

http://ift.tt/2i1odEu

Maladie de Hailey-Hailey : efficacité de l’association doxycycline et vitamine PP

Publication date: Available online 20 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F.Z. Elfatoifi, F. Fanian, S. Chiheb, P. Humbert




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Recommandations pour la prise en charge buccodentaire des patients atteints de maladies bulleuses auto-immunes avec atteinte buccale

Publication date: Available online 20 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): V. Sobocinski, S.-M. Dridi, C. Bisson, S. Jeanne, F. Gaultier, C. Prost-Squarcioni, P. Bernard, F. Pascal, B. Lefevre, P. Weber, C. Abasq, S. Agbo-Godeau, P. Joly, S. Ingen-Housz-Oro, S. Duvert-Lehembre
IntroductionLes maladies bulleuses auto-immunes (MBAI) peuvent occasionner des lésions buccales d'évolution chronique et insidieuse.ObjectifÉlaborer des recommandations permettant une prise en charge buccodentaire optimale des patients atteints de MBAI avec atteinte buccale.MéthodesEn l'absence d'études scientifiques de niveau de preuve élevé, ces recommandations ont été élaborées lors de deux réunions par un comité d'experts en MBAI composé de 7 dermatologues, 1 stomatologue, 1 chirurgien maxillo-facial, 2 odontologistes et 4 parodontologistes.RésultatsLes lésions buccales des MBAI peuvent être classées en trois grades de sévérité : atteinte sévère (gingivite érosive généralisée touchant au minimum 30 % des sites dentaires), atteinte modérée (gingivite érosive localisée touchant moins de 30 % des sites dentaires), ou maladie contrôlée (absence de lésion érosive buccale). Une bonne hygiène buccodentaire, adaptée à la sévérité des lésions buccales, doit absolument être maintenue chez ces patients, afin d'éviter la formation de plaque dentaire aggravant la symptomatologie. La réalisation de soins dentaires et parodontaux doit être discutée en fonction du grade de sévérité des lésions buccales : en cas d'atteinte sévère, la plaque dentaire doit être éliminée manuellement à la curette, mais plusieurs soins (détartrage, traitement des caries, extractions dentaires non urgentes…) doivent être proscrits jusqu'à ce que l'atteinte buccale soit modérée ou que la maladie soit stabilisée.ConclusionLes dermatologues, médecins référents des patients atteints de MBAI, doivent donner à leurs patients des conseils d'hygiène buccodentaire adaptés en cas de lésions buccales, et collaborer étroitement avec les odontologistes et stomatologues pour ces patients.BackgroundAutoimmune bullous diseases (AIBD) may cause chronic oral lesions that progress insidiously.AimsTo provide recommendations for optimal oral-dental management of patients presenting AIBD with oral involvement.Patients and methodsIn the absence of scientific studies with high levels of proof, these recommendations have been drawn up at two meetings by a committee of experts on AIBD comprising 7 dermatologists, 1 stomatologist, 1 maxillofacial surgeon, 2 odontologists and 4 parodontologists.ResultsThe oral lesions associated with AIBD may be classified into three grades of severity: severe (generalised erosive gingivitis affecting at least 30% of dental sites), moderate (localised erosive gingivitis affecting less than 30% of dental sites) and controlled (no erosive oral lesions). Good oral-dental hygiene suited to the severity of the oral lesions, must be practised continually by these patients so as to avoid the formation of dental plaque, which aggravates symptoms. Dental and parodontal care must be considered in accordance with the severity grade of the oral lesions: in severe cases, the dental plaque must be eliminated manually with a curette, but several types of care (descaling, treatment for tooth decay, non-urgent extractions, etc.) must be suspended until the grade of severity is moderate or until the disease is stabilised.



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Syndrome de Lyell aux anti-PD1 d’évolution fatale

Publication date: Available online 20 December 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Demirtas, L. El Aridi, M. Acquitter, C. Fleuret, P. Plantin




http://ift.tt/2hVlHT4

Perspectives on the International Classification of Diseases, 11th Revision, developments in allergy clinical practice in the United States

Publication date: Available online 20 December 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Luciana Kase Tanno, James L. Sublett, J. Allen Meadows, Moises Calderon, Garry N. Gross, Thomas Casale, Pascal Demoly




http://ift.tt/2h23m1X

Inter-platform concordance of gene expression data for the prediction of chemical mode of action

It is interesting to study the consistency of outcomes arising from two genomic platforms: Microarray and RNAseq, which are established on fundamentally different technologies. This topic has been frequently d...

http://ift.tt/2i0Z7W4

Sensitivity, specificity, and reproducibility of RNA-Seq differential expression calls

The MAQC/SEQC consortium has recently compiled a key benchmark that can serve for testing the latest developments in analysis tools for microarray and RNA-seq expression profiling. Such objective benchmarks ar...

http://ift.tt/2hV9Nsm

Exploring the importance of cancer pathways by meta-analysis of differential protein expression networks in three different cancers

It is believed that all cancers occur due to the mutation or change in one or more genes. In order to investigate the significance of the biological pathways which are interrupted by these genetic mutations, w...

http://ift.tt/2i18ipt

Prognostic value of cross-omics screening for kidney clear cell renal cancer survival

Kidney renal clear cell carcinoma (KIRC) is a type of cancer that is resistant to chemotherapy and radiotherapy and has limited treatment possibilities. Large-scale molecular profiling of KIRC tumors offers a ...

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The role of the backbone torsion in protein folding

The set of forces and sequence of events that govern the transition from an unfolded polypeptide chain to a functional protein with correct spatial structure remain incompletely known, despite the importance o...

http://ift.tt/2i0QZVK

Primary omental pregnancy

We present a case of primary omental ectopic pregnancy in a 31-year-old woman which was discovered intraoperatively during a diagnostic laparoscopy and subsequently removed via mini-laparotomy. We emphasise the rarity of this diagnosis, and the importance of careful inspection of the abdominal cavity including the omentum should an ectopic pregnancy be suspected when bilateral fallopian tubes and ovaries appear normal during surgical exploration.

http://ift.tt/2hTDXte

Large bowel perforation secondary to CMV colitis: an unusual primary presentation of HIV infection

We report a case of HIV-associated Cytomegalovirus colitis complicated by large bowel perforation. A 62-year-old man of same-sex relationship was not known to have HIV, but a diagnosis of inflammatory bowel disease was made early in his admission, with steroid treatment initiated. He was later confirmed to be HIV positive, and found to have multiple microperforations of the bowel necessitating ileocecectomy and Hartmann's procedures.

http://ift.tt/2hHN8PM

Missing the point: self-inflicted traumatic brain injury in psychosis

A 36-year-old man was brought to the emergency department by emergency medical services after being found acting unusually at a gas station with blood on his head and clothing. He presented acutely psychotic and reported that he had a pen in his head. Medical evaluation was notable for a superficial puncture wound to the right temple, and he was medically cleared for psychiatric evaluation. After he developed nausea and headache later that evening, the CT scan revealed a temporal bone fracture, pneumocephalus, intraparenchymal haemorrhage and the presence of a metal pen tip lodged in the brain parenchyma. The full nature of the injury went undiscovered in the emergency department for 16 hours due to the superficial appearance of the injury and his acute psychosis with prominent delusional thought content and disorganisation. He underwent craniotomy with removal of the pen and subsequent hospitalisation for intravenous antibiotics, followed by a prolonged psychiatric hospitalisation for psychosis.

http://ift.tt/2hTEyLw

Prenatal intestinal volvulus: look for cystic fibrosis

Intestinal volvulus is a life-threatening emergency requiring prompt surgical management. Prenatal intestinal volvulus is rare, and most are secondary to intestinal atresia, mesenteric defect or without any underlying cause. Cystic fibrosis (CF) is known to cause digestive tract disorders. After birth, 10–15% of newborns with CF may develop intestinal obstruction within a few days of birth because of meconial ileus.¹ This obstruction is a result of dehydrated thickened meconium obstructing the intestinal lumen. We report two cases of fetuses with prenatal diagnosis of segmental volvulus in whom CF was diagnosed.

http://ift.tt/2hHOda6

Case of coeliac disease presenting in the psychiatry ward

We describe a case of coeliac disease that was diagnosed in the psychiatry inpatient unit of a general hospital. The patient was admitted due to suicidal behaviours and developed an agitated catatonic state while in the inpatient psychiatry unit. An extensive diagnostic study allowed for the diagnosis of coeliac disease and while her state was unresponsive to antidepressants, anxiolytics, antipsychotics and electroconvulsive therapy, the patient improved significantly when a gluten-free diet was started. While it is well known that, occasionally, gluten sensitivity and coeliac disease can present as brain gluten sensitivity, such cases are typically characterised by motor and/or cognitive symptoms and by white matter abnormalities. Psychiatric presentations of these conditions have only rarely been reported.

http://ift.tt/2hTDbwA

Anaplastic large cell lymphoma masquerading as osteomyelitis of the shoulder: an uncommon presentation

The presentation of anaplastic lymphoma kinase protein (ALK)-negative anaplastic large cell lymphoma (ALCL) in bone is rare. We describe a patient with ALK-negative ALCL presenting with clinical and radiographic findings suggesting osteomyelitis 6 months after left rotator cuff repair surgery. A review of the characteristics of ALK-negative ALCL with primary bone involvement is presented. ALCL should be considered in patients not responding to therapies for osteomyelitis.

http://ift.tt/2hHJqoX

Fingolimod (Gilenya) and melanoma

The Food and Drug Administration (FDA) had approved fingolimod usage for multiple sclerosis in 2010. Melanoma after the usage of fingolimod immunomodulation was reported rarely in clinical trials, and only two case reports exist in the published literature, both occurring in Europe. Most of the incidences reported in clinical trials were in-situ, whereas both case reports were of malignant melanoma. Fingolimod has been found to inhibit metastatic melanoma growth in a mouse model that depends on vascular endothelial growth factor (VEGF)-induced angiogenesis for metastasis. However, there are numerous pathways of angiogenesis and tumour growth found in vivo by which melanoma can expand that do not mandate VEGF. We report a case of superficial spreading malignant melanoma occurring after fingolimod therapy in the USA.

http://ift.tt/2hVcD0i

Peripheral osteoma in an unusual location on the mandible

Osteoma is a benign, slow-growing, painless, discrete lesion which is characterised with the proliferation of a compact or cancellous bone. Osteomas are rare on the jaws. Lesions of the mandible developed most often in the condyle, angle and margin. Osteoma developed on the genial tubercle area had only been reported in one case. A 50-year-old female patient has been admitted to our department with the symptom of a hard mass under the chin area. In extra-oral and radiographic examinations, a 1x1 cm size, round, palpable, immobile, radiopaque mass has been determined on the genial tubercle area. The lesion has been completely removed under local anaesthesia by extra-oral approach. Her recovery period was uneventful. Osteoma diagnosis was confirmed with histopathological examination. There is no recurrence at 3-year follow-up. The purpose of this case report is to present a peripheral osteoma case that occurred in the genial tubercle area which is an unusual place.

http://ift.tt/2hTw4nI

A powered prosthetic ankle joint for walking and running

Current prosthetic ankle joints are designed either for walking or for running. In order to mimic the capabilities of an able-bodied, a powered prosthetic ankle for walking and running was designed. A powered ...

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Assessment of transfemoral amputees using a passive microprocessor-controlled knee versus an active powered microprocessor-controlled knee for level walking

In transfemoral (TF) amputees, the forward propulsion of the prosthetic leg in swing has to be mainly carried out by hip muscles. With hip strength being the strongest predictor to ambulation ability, an activ...

http://ift.tt/2i2WPsY

Towards active lower limb prosthetic systems: design issues and solutions

http://ift.tt/2gVqleV

Theoretical implementation of prior knowledge in the design of a multi-scale prosthesis satisfaction questionnaire

In product development for lower limb prosthetic devices, a set of special criteria needs to be met. Prosthetic devices have a direct impact on the rehabilitation process after an amputation with both perceive...

http://ift.tt/2i2UDBR

Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review

Virtual reality (VR) based applications play an increasing role in motor rehabilitation. They provide an interactive and individualized environment in addition to increased motivation during motor tasks as wel...

http://ift.tt/2gVo57O

Pathological changes of adipose tissue in secondary lymphedema

Abstract

Background

The pathophysiology of lymphedema is poorly understood. Current treatment options include compression therapy, resection, liposuction, and lymphatic microsurgery, but determining the optimal treatment approach for each patient remains challenging.

Objectives

We characterized skin and adipose tissue alterations in the setting of secondary lymphedema.

Methods

Morphologic and histopathologic evaluations were conducted for 70 specimens collected from 26 female patients with lower extremity secondary lymphedema following surgical intervention for gynecologic cancers. Indocyanine green lymphography was performed for each patient to assess lymphedema severity.

Results

Macroscopic and ultrasound findings revealed that lymphedema adipose tissue had larger lobules of adipose tissue, with these lobules surrounded by thick collagen fibers and interstitial lymphatic fluid. In lymphedema specimens, adipocytes displayed hypertrophic changes and more collagen fiber deposits when examined using electromicroscopy, whole mount staining, and immunohistochemistry. The number of capillary lymphatic channels was also found to be increased in the dermis of lymphedema limbs. Crown-like structures (dead adipocytes surrounded by M1 macrophages) were less frequently seen in lymphedema samples. Flow cytometry revealed that, among the cellular components of adipose tissue, adipose-derived stem/stromal cells (ASCs) and M2 macrophages were decreased in number in lymphedema adipose tissue compared to normal controls.

Conclusions

These findings suggest that long-term lymphatic volume overload can induce chronic tissue inflammation, progressive fibrosis, impaired homeostasis, altered remodeling of adipose tissue, impaired regenerative capacity, and immunologic dysfunction. Further elucidation of the pathophysiologic mechanisms underlying lymphedema will lead to more reliable therapeutic strategies.

This article is protected by copyright. All rights reserved.

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IL-3 Up-regulates and Activates Human Eosinophil CD32 and αMß2 Integrin Causing Degranulation

Abstract

Background

Eosinophils contribute to the pathogenesis of multiple diseases, including asthma. Treatment with antibodies targeting IL-5 or IL-5 receptor α reduces the frequency of asthma exacerbations. Eosinophil receptors for IL-5 share a common ß-chain with IL-3 and GM-CSF receptors. We recently reported that IL-3 is more potent than IL-5 or GM-CSF in maintaining the ERK/p90S6K/RPS6 ribosome-directed signaling pathway, leading to increased protein translation.

Objective

We aimed to determine disease-relevant consequences of prolonged eosinophil stimulation with IL-3.

Methods

Human blood eosinophils were used to establish the impact of activation with IL-3 on IgG-driven eosinophil degranulation, which was then compared to IgG-mediated degranulation of freshly isolated (unstimulated) airway eosinophils activated in vivo by segmental allergen challenge.

Results

When compared to IL-5, continuing exposure to IL-3 further induced degranulation of eosinophils on aggregated IgG via increased production and activation of both CD32 (low affinity IgG receptor) and αMß2 integrin. In addition, unlike IL-5 or GM-CSF, IL-3 induced expression of CD32B/C (FCGRIIB/C) subtype proteins, without changing CD32A (FCGRIIA) protein and CD32B/C mRNA expression levels. Importantly, these in vitro IL-3-induced modifications were recapitulated in vivo on airway eosinophils.

Conclusions

We observed for the first time upregulation of CD32B/C on eosinophils, and identified IL-3 as a potent inducer of CD32- and αMß2-mediated eosinophil degranulation.

This article is protected by copyright. All rights reserved.

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Chronic Airway Inflammation Provides a Unique Environment for B Cell Activation and Antibody Production

Abstract

Background

B cells play many roles in health and disease. However, little is known about the mechanisms that drive B cell responses in the airways, especially in humans. Chronic rhinosinusitis (CRS) is an inflammatory disease of the upper airways that affects 10% of Europeans and Americans. A subset of CRS patients develop nasal polyps (NP), which are characterized by type 2 inflammation, eosinophils and group 2 innate lymphoid cells (ILC2). We have reported that NP contain elevated levels of B cells and antibodies, making NP an ideal system for studying B cells in the airways.

Objective

We sought to determine the mechanisms that drive B cell activation and antibody production during chronic airway inflammation.

Methods

We analyzed B cells from NP or tonsil, or after ILC2 co-culture, by flow cytometry. Antibody production from tissue was measured using Luminex assays, and the frequency of antibody-secreting cells by ELISpot. Formation of B cell clusters was assessed using immunohistochemistry. Expression of genes associated with B cell activation and class switch recombination was measured by qRT-PCR.

Results

NP contained significantly elevated frequencies of plasmablasts, especially those that expressed the extra follicular marker Epstein-Barr virus-induced protein 2 (EBI2), but significantly fewer germinal center (GC) B cells compared to tonsil. Antibody production and the frequency of antibody-secreting cells were significantly elevated in NP, and there was evidence for local class switch recombination in NP. Finally, ILC2s directly induced EBI2 expression on B cells in vitro.

Conclusions and Clinical Relevance

Our data suggest there is a unique B cell activation environment within NP that is distinct from classic GC-mediated mechanisms. We show for the first time that ILC2s directly induce EBI2 expression on B cells, indicating that ILC2s may play an important role in B cell responses. B cell-targeted therapies may provide new treatment options for CRSwNP.

This article is protected by copyright. All rights reserved.

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Hypoxia causes IL-8 secretion, Charcot Leyden crystal formation, and suppression of corticosteroid-induced apoptosis in human eosinophils

Abstract

Background

Inflamed environments are typically hypercellular, rich in pro-inflammatory cytokines, and profoundly hypoxic. While the effects of hypoxia on neutrophil longevity and function have been widely studied, little is known about the consequences of this stimulus on eosinophils.

Objective

We sought to investigate the effects of hypoxia on several key aspects of eosinophil biology; namely secretion, survival, and their sensitivity to glucocorticosteroids (GCS), agents which normally induce eosinophil apoptosis.

Methods

Eosinophils derived from patients with asthma/atopy or healthy controls were incubated under normoxia and hypoxia, with or without glucocorticoids. Activation was measured by flow cytometry, ELISA of cultured supernatants and F-actin staining; apoptosis and efferocytosis by morphology and flow cytometry, and GCS efficacy by apoptosis assays and qPCR.

Results

Hypoxic incubation (3 kPa) caused: (i) stabilisation of HIF-2α and up-regulation of hypoxia regulated genes including BNIP3 (BCL2/adenovirus E1B 19 kDa protein-interacting protein 3) and GLUT1 (glucose transporter 1), (ii) secretion of pre-formed IL-8, and Charcot Leyden crystal (CLC) formation, that was most evident in eosinophils derived from atopic and asthmatic donors, (iii) enhanced F-actin formation, (iv) marked prolongation of eosinophil lifespan (via a NF-κB and Class I PI3-kinase-dependent mechanism), and (v) complete abrogation of the normal pro-apoptotic effect of dexamethasone and fluticasone furoate. This latter effect was evident despite preservation of GCS-mediated gene transactivation under hypoxia.

Conclusion and Clinical Relevance

These data indicate that hypoxia promotes an eosinophil pro-inflammatory phenotype by enhancing eosinophil secretory function, delaying constitutive apoptosis and importantly, antagonising the normal pro-apoptotic effect of GCS. Since eosinophils typically accumulate at sites that are relatively hypoxic, particularly during periods of inflammation, these findings may have important implications to understanding the behaviour these cells in vivo.

This article is protected by copyright. All rights reserved.

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Human Basophils are Differentially Activated by and are a Source of IL-31

Abstract

Background

Basophils are important effector cells involved in the pathogenesis of inflammatory skin diseases including chronic urticaria which is associated by increased IL-31 serum levels. So far the effects of IL-31 on human basophils are unknown.

Objective

To analyse the functional role of IL-31 in basophil biology.

Methods

IL-31 expression was evaluated in skin samples derived from chronic spontaneous urticaria patients. Oncostatin M receptor (OSMR), IL-31 receptor A (RA) and IL-31 protein expressions were analysed on human basophils from healthy donors. Basophil responses to IL-31 were assessed for chemotaxis, externalization of CD63 and CD203c as well as the release of histamine, IL-4 and IL-13.

Results

IL-31RA and OSMR were expressed on human basophils. IL-31 was strongly expressed in the skin of patients with chronic spontaneous urticaria and was released from isolated basophils following either anti-IgE, IL-3 or fMLP stimulation. IL-31 induced chemotaxis and the release of IL-4 and IL-13 which was specifically inhibited by anti-IL-31RA and anti-OSMR. Conversely, IL-31 had no effect on CD63 and CD203c externalization or histamine release.

Conclusions and clinical relevance

Human basophils are a source of -and are activated by- IL-31 with the release of pro-inflammatory cytokines and the induction of chemotaxis indicating an important novel function of IL-31 in basophil biology.

This article is protected by copyright. All rights reserved.

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Sub-pollen particles are rich carriers of major short ragweed allergens and NADH dehydrogenases: quantitative proteomic and allergomic study

Abstract

Background

Short ragweed (Ambrosia artemisiifolia) allergies affect more than 36 million people annually. Ragweed pollen grains release sub-pollen particles (SPP) of respirable size upon hydration or a change in air electrical conditions. The aim of this study was to characterise the proteomes and allergomes of short ragweed SPP and total pollen protein extract (TOT), and compare their effects with those of standard aqueous pollen protein extract (APE) using sera from short ragweed pollen-sensitized patients.

Methods

Quantitative 2D gel-based and shotgun proteomics, 1D and 2D immunoblotting, and quantitative ELISA were applied. Novel SPP extraction and preparation protocols enabled appropriate sample preparation and further downstream analysis by quantitative proteomics.

Results

The SPP fraction contained the highest proportion (94%) of the allergome, with the largest quantities of the minor Amb a 4 and major Amb a 1 allergens, and as unique, NADH dehydrogenases. APE was the richest in Amb a 6, Amb 5, and Amb a 3, and TOT fraction was the richest in the Amb a 8 allergens (83% and 89% of allergome, respectively). Allergenic potency correlated well among the three fractions tested, with 1D immunoblots demonstrating a slight predominance of IgE-reactivity to SPP compared to TOT and APE. However, the strongest IgE binding in ELISA was noted against APE. New allergenic candidates, phosphoglycerate mutase and phosphoglucomutase, were identified in all the three pollen fractions. Enolase, UTP-glucose-1-phosphate uridylyltransferase, and polygalacturonase were observed in SPP and TOT fractions as novel allergens of the short ragweed pollen, as previously described.

Conclusion and Clinical Relevance

We demonstrated that the complete major (Amb a 1 and 11) and almost all minor (Amb a 3, 4, 5, 6, 8, and 9) short ragweed pollen allergen repertoire as well as NADH oxidases are present in SPP, highlighting an important role for SPP in allergic sensitization to short ragweed.

This article is protected by copyright. All rights reserved.

http://ift.tt/2i0zbd6

Personalized and Cell-based Antitumor Immunization MVX-ONCO-1 in Advanced HNSCC

Condition:   Head and Neck Squamous Cell Carcinoma
Intervention:   Other: MVX-ONCO-1
Sponsor:   Swiss Group for Clinical Cancer Research
Not yet recruiting - verified December 2016

http://ift.tt/2hHzPP1

Randomized Trial of Avelumab-cetuximab-radiotherapy Versus SOCs in LA SCCHN (REACH)

Condition:   HNSCC
Interventions:   Drug: Cetuximab;   Drug: avelumab;   Drug: Cisplatin;   Radiation: IMRT
Sponsors:   Groupe Oncologie Radiotherapie Tete et Cou;   Merck Sharp & Dohme Corp.;   Pfizer
Not yet recruiting - verified December 2016

http://ift.tt/2hTfzrQ

A Study of APR-246 in Oesophageal Cancer

Condition:   Oesophageal Carcinoma
Intervention:   Drug: APR-246
Sponsor:   Peter MacCallum Cancer Centre, Australia
Not yet recruiting - verified November 2016

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Erratum to “Undifferentiated round cell sarcoma with BCOR-CCNB3 translocation in the jaw of a child” [2016; Vol 122, No 5, Page e174]

Publication date: Available online 20 December 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology





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Alanine-scanning mutagenesis of human signal transducer and activator of transcription 1 to estimate loss- or gain-of-function variants

Publication date: Available online 20 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Reiko Kagawa, Ryoji Fujiki, Miyuki Tsumura, Sonoko Sakata, Shiho Nishimura, Yuval Itan, Xiao-Fei Kong, Zenichiro Kato, Hidenori Ohnishi, Osamu Hirata, Satoshi Saito, Maiko Ikeda, Jamila El Baghdadi, Aziz Bousfiha, Kaori Fujiwara, Matias Oleastro, Judith Yancoski, Laura Perez, Silvia Danielian, Fatima Ailal, Hidetoshi Takada, Toshiro Hara, Anne Puel, Stéphanie Boisson-Dupuis, Jacinta Bustamante, Jean-Laurent Casanova, Osamu Ohara, Satoshi Okada, Masao Kobayashi
BackgroundGermline heterozygous mutations in human signal transducer and activator of transcription 1 (STAT1) can cause loss of function (LOF), as in patients with Mendelian susceptibility to mycobacterial diseases, or gain of function (GOF), as in patients with chronic mucocutaneous candidiasis. LOF and GOF mutations are equally rare and can affect the same domains of STAT1, especially the coiled-coil domain (CCD) and DNA-binding domain (DBD). Moreover, 6% of patients with chronic mucocutaneous candidiasis with a GOF STAT1 mutation have mycobacterial disease, obscuring the functional significance of the identified STAT1 mutations. Current computational approaches, such as combined annotation-dependent depletion, do not distinguish LOF and GOF variants.ObjectiveWe estimated variations in the CCD/DBD of STAT1.MethodsWe mutagenized 342 individual wild-type amino acids in the CCD/DBD (45.6% of full-length STAT1) to alanine and tested the mutants for STAT1 transcriptional activity.ResultsOf these 342 mutants, 201 were neutral, 30 were LOF, and 111 were GOF mutations in a luciferase assay. This assay system correctly estimated all previously reported LOF mutations (100%) and slightly fewer GOF mutations (78.1%) in the CCD/DBD of STAT1. We found that GOF alanine mutants occurred at the interface of the antiparallel STAT1 dimer, suggesting that they destabilize this dimer. This assay also precisely predicted the effect of 2 hypomorphic and dominant negative mutations, E157K and G250E, in the CCD of STAT1 that we found in 2 unrelated patients with Mendelian susceptibility to mycobacterial diseases.ConclusionThe systematic alanine-scanning assay is a useful tool to estimate the GOF or LOF status and the effect of heterozygous missense mutations in STAT1 identified in patients with severe infectious diseases, including mycobacterial and fungal diseases.



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Epigenome-wide Analysis Links SMAD3 Methylation at Birth to Asthma in Children of Asthmatic Mothers

Publication date: Available online 21 December 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Avery DeVries, Gabriela Wlasiuk, Susan J. Miller, Anthony Bosco, Debra A. Stern, I. Carla Lohman, Janet Rothers, Anya C. Jones, Jessie Nicodemus-Johnson, Monica M. Vasquez, John A. Curtin, Angela Simpson, Adnan Custovic, Daniel J. Jackson, James E. Gern, Robert F. Lemanske, Stefano Guerra, Anne L. Wright, Carole Ober, Marilyn Halonen, Donata Vercelli
BackgroundThe timing and mechanisms of asthma inception remain imprecisely defined. Although epigenetic mechanisms likely contribute to asthma pathogenesis, little is known about their role in asthma inception.ObjectiveTo assess whether the trajectory to asthma begins already at birth and epigenetic mechanisms, specifically DNA methylation, contribute to asthma inception.MethodsWe used Methylated CpG Island Recovery Assay (MIRA)-chip to survey DNA methylation in cord blood mononuclear cells (CBMC) from 36 children (18 non-asthmatic, 18 asthmatic by age 9) from the Infant Immune Study (IIS), an unselected birth cohort closely monitored for asthma for a decade. SMAD3 methylation in IIS (n=60) and in two replication cohorts (The Manchester Asthma and Allergy Study, n=30, and the Childhood Origins of ASThma Study, n=28) was analyzed by bisulfite sequencing or Illumina 450K arrays. CBMC-derived IL-1β was measured by ELISA.ResultsNeonatal immune cells harbored 589 differentially methylated regions (DMRs) that distinguished IIS children who did and did not develop asthma by age 9. In all three cohorts, methylation in SMAD3, the most connected node within the network of asthma-associated DMRs, was selectively increased in asthmatic children of asthmatic mothers and was associated with childhood asthma risk. Moreover, SMAD3 methylation in IIS neonates with maternal asthma was strongly and positively associated with neonatal production of IL-1β, an innate inflammatory mediator.ConclusionsThe trajectory to childhood asthma begins at birth and involves epigenetic modifications in immunoregulatory and pro-inflammatory pathways. Maternal asthma influences epigenetic mechanisms that contribute to the inception of this trajectory.

Graphical abstract

Teaser

CAPSULE SUMMARY: The trajectory to childhood asthma begins at birth and involves epigenetic (DNA methylation) modifications in innate pro-inflammatory and immunoregulatory pathways. Maternal asthma appears to strongly influence this trajectory.


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Are there risk factors for osseous mandibular inferior border defects after bilateral sagittal split osteotomy?

Publication date: Available online 21 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): J.P. Verweij, J.G. van Rijssel, M. Fiocco, G. Mensink, P.J.J. Gooris, J.P.R. van Merkesteyn
PurposeBone defects of the inferior mandibular border (osseous inferior border defects) can cause unesthetic postoperative outcomes after bilateral sagittal split osteotomy (BSSO). The aim of this study was to estimate the frequency of osseous inferior border defects after BSSO and to identify risk factors for this complication.Materials and MethodsThis retrospective study included consecutive patients who underwent BSSO for mandibular retrognathia. The primary outcome was the presence/absence of osseous inferior border defects. Predictors included the mandibular movement, rotation of the occlusal plane, postoperative proximal segment position, pattern of lingual fracture, occurrence of bad split, and presence of third molars.ResultsThe study sample consisted of 200 patients and had a mean follow-up of 13 months. The mean mandibular advancement and rotation was respectively 5.8 mm and 5.4 degrees clockwise. Osseous inferior border defects were present in 7.0% of splits and in 12.5% of patients. Significant risk factors for inferior border defects included increased advancement, increased clockwise rotation, cranial rotation of the proximal segment, and a split originating in the lingual cortex.ConclusionIn conclusion, osseous inferior border defects occur significantly more often in cases with large mandibular advancement, increased clockwise rotation of the occlusal plane, malpositioning of the proximal segment, and a split originating in the lingual cortex.



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Levator alae nasi muscle v-y island flap for nasal tip reconstruction

Publication date: Available online 21 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Simone La Padula, Vincenzo Abbate, Gianluca Di Monta, Fabrizio Schonauer
Nasal tip reconstruction can be very challenging. It requires close attention to skin texture, colour and thickness matching, with the respect of the nasal aesthetic units and symmetry. Flaps are usually preferred to skin grafts where possible. Based on different donor areas, various flaps have been described for reconstruction of this region. Here we present a new V-Y myocutaneous island flap based on the levator alae nasi muscle (LAN muscle) blood supply. This flap may represent an alternative to the nasalis myocutaneous sliding V-Y flap previously described by Rybka. As its pivot point it is located more cranially than the nasalis flap, and it can advance more medially than the Rybka flap, with the possibility of covering larger defects of the nasal tip area, up to 1.8 cm in diameter. Over the past 5 years, 24 patients received nasal tip reconstruction with this flap following the resection of basal cell carcinomas. Good tip projection was maintained, and the aesthetic outcome was satisfactory, with well healed scars. We recommend this technique as an alternative to other flaps for nasal tip defects, especially if paramedian.



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Effect of hypoxia on the proliferation of porcine bone marrow−derived mesenchymal stem cells and adipose-derived mesenchymal stem cells in 2- and 3-dimensional culture

Publication date: Available online 20 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Egon Burian, Florian Probst, Benjamin Palla, Christina Riedel, Matthias Cornelsen, Florian König, Matthias Schieker, Sven Otto
ObjectiveBone marrow-derived mesenchymal stem cells (MSCs) and adipose-derived mesenchymal stem cells (ASCs) currently represent a promising tool for the regeneration of large bony defects. Therefore, it is pivotal to find the best cell source within the body and the best conditions for in vitro cellular expansion. This study compared cellular response of MSCs and ASCs from a porcine animal in normoxic (21% O2) and hypoxic (2% O2) cell culture conditions via 2D and 3D experimental settings.Materials and methodsThe effect of constant exposure to hypoxia on primary pig stem cells was evaluated by two methods. First, a cumulative population doublings (cumPD) over a period of 40 days, a metabolic activity assay in both 2D and 3D beta-TCP-PHB scaffolds, followed by analysis of osteogenic differentiation potential in cell monolayers.ResultsOur results displayed enhanced cell culture proliferation in 2% O2 for both MSCs and ASCs, with impaired osteogenic differentiation of MSCs. The impact of constant hypoxia on porcine MSCs and ASCs exhibited a statistically significant decrease in osteogenic differentiation under hypoxic conditions with the MSCs.ConclusionsOur data suggest that MSCs and ASCs expanded in hypoxic culture conditions, might be more suitable for use in the clinical setting where large cell numbers are required. When differentiated in normoxic conditions, MSCs showed the highest osteogenic differentiation potential and might be the best choice of cells with consideration to bone repair.



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Effect of an evidence-based guideline on the treatment of maxillofacial cancer: A prospective analysis

Publication date: Available online 20 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Klaus-Dietrich Wolff, Andrea Rau, Julia Ferencz, Thomas Langer, Marco Kesting, Markus Nieberler, Simone Wesselmann
BackgroundIn 2012, a guideline for the diagnosis and treatment of oral cavity cancer based on the best available evidence was implemented at certified German cancer centres for head and neck carcinomas. The present analysis was performed to determine whether the implementation of the guideline via certification improved the level of care, leading to a benefit for the patients.MethodsA prospective observational study was performed based on the annual operating figures at 31 certified head and neck cancer centres. From 76 statements and recommendations, 9 indicators were derived defining important steps during treatment. The annual shift of the figures was documented for each indicator and was used to measure the impact of the guideline. This was achieved by determining the number of patients having received the recommended treatment related to the total number in each centre over a period of 3 years.ResultsIn 2014, 1,570 primary cases with an oral cavity carcinoma were treated at our centres, 31.2% representing stage IVA. Except for two, all indicators showed increasing numbers of achievement from 2012 to 2014, reaching median values between 91% and 100% in 2014. In particular, median values for imaging and interdisciplinary treatment to evaluate the presence of second primaries and metastases increased by 20% and 30%, respectively. Median values decreased by 14% for recommended adjuvant radiation, because of non-acceptance by the patients. Moreover, elective neck dissection was performed less frequently in cN0 categories.ConclusionsImplementation of the national cancer guideline by means of certification evidently had a positive impact on patients suffering from oral squamous cell carcinoma and led to the improved achievement of most evidence-based treatment recommendations over time. Further research involving high-level clinical studies is needed to cover all aspects of this specific tumour entity.



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Preoperative ultrasonography for evaluation of clinically N0 neck in oral cavity carcinoma

Publication date: Available online 21 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Angel Rollon-Mayordomo, Teresa Creo-Martinez, Yolanda Marin-Lapeira, Juan-Andres Rodriguez-Ruiz, Pedro Infante-Cossio
The aim of this study was to evaluate preoperative ultrasound criteria to detect lymph node (LN) cervical metastasis in patients with clinically node-negative neck (cN0) oral cavity squamous cell carcinoma (OCSCC). A prospective, single-center, observational study was conducted in 90 patients undergoing cancer excision with or without elective neck dissection (END) between 2005 and 2012. A surgeon and an experienced radiologist performed preoperative cervical ultrasonography in all cases. The primary objective was to obtain an a priori sensitivity of 90% and specificity >50% in cN0 OCSCC staging. The sonographic criteria for LN assessment were as follows: number; neck levels; clusters; aspect; heterogeneity; longitudinal diameter (L); transverse diameter (T); L/T ratio; and combination in series or in parallel of T and L/T ratio. The gold standard for comparison was the LN histological identification of metastasis after END or the occurrence in the follow-up at least 36 months. Statistically significant sonographic criteria in univariate analysis (P<0.05) were as follows: multilevel lymph nodes, T diameter >6.5 mm, and the combination T>6.5 mm or L/T<1.3 ratio; and in multivariate logistic regression analysis were (P<0.05): combination T>6.5 mm and L/T<1.3 ratio, LN in level II, and moderately-poorly differentiated OCSCC. By using selected sonographic criteria, ultrasound can be a valid preoperative diagnostic method to optimize staging cervical metastasis and to help decide about neck dissection.



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Masthead

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The State of The Laryngoscope: 2017

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Table of contents

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Use of extracapsular dissection for benign, minor palatal tumours of the salivary gland – a technical note

Extracapsular dissection for benign parotid tumours such as pleomorphic adenomas is an increasingly-promoted alternative to superficial parotidectomy, with a safe outcome and a low risk of damage to the facial nerve.

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Heralding Extramedullary Blast Crisis: Horner’s Syndrome with Brachial Plexopathy in a Patient with Chronic Myelogenous Leukemia

Chronic myelogenous leukemia (CML) blast crisis is an ominous clinical event that is challenging to treat. This can develop at extramedullary sites rarely and is defined as the infiltration of blasts outside the bone marrow irrespective of proliferation of blasts within the bone marrow. We aim to report an unusual clinical presentation characterized by Horner's syndrome, ipsilateral arm weakness, and cervical lymphadenopathy as the first signs of extramedullary blast crisis in a CML patient. To the best of our knowledge, the extramedullary locations involving the brachial plexus along with cervicothoracic paraspinal chloroma have not been previously reported in the literature.

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Hair pull test: Evidence-based update and revision of guidelines

The hair pull test lacks validation and has unclear pretest guidelines.

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Nail involvement in systemic sclerosis

Nail involvement has rarely been recognized in systemic sclerosis (SSc). Indeed, only a few small series have assessed nail changes in SSc, most of which are case reports.

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Perspectives on the International Classification of Diseases, 11th Revision, developments in allergy clinical practice in the United States

The International Classification of Diseases (ICD) has been in use as a recognized global classification system since 1900, when the first version was launched.1 Its development and continuing evolution reflect the untiring efforts of many experts and contributors. The ICD is revised periodically, and respective updates are gradually adopted and implemented in participating countries. Currently, the International Classification of Diseases, Tenth Revision (ICD-10) is in use in more than 100 countries worldwide, translated in 43 different languages, and used as a common language for reporting and monitoring diseases to achieve the standard of being a universal classification.

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Use of free tissue transfer in head and neck cancer surgery and risk of overall and serious complication(s): An American College of Surgeons–National Surgical Quality Improvement Project analysis of free tissue transfer to the head and neck

ABSTRACT

Background

The purpose of this article was to assess the rates of head and neck free tissue transfer and variables available in the American College of Surgeons – National Surgical Quality Improvement Project (ACS–NSQIP) dataset to predict overall and serious complications.

Methods

We conducted a data analysis from 2005 to 2014 on free tissue cases in the head and neck with descriptive and cross-sectional analysis to examine correlation of NSQIP variables with complications (p < .05).

Results

Of 1643 flaps, 906 complications occurred, such as blood transfusion, return to the operating room, extended ventilator support, pneumonia, and superficial surgical site infection. Insulin-dependent diabetes, operative time, age, white blood cell (WBC) count, and smoking correlated with overall complications. Five hundred one patients experienced 859 serious complications: return to the operating room, pneumonia, deep surgical site infection, sepsis, and unplanned intubation. Operative time, clean contaminated wound status, dirty wound classification, and history of congestive heart failure were predictive.

Conclusion

Identification of risks for complications is an opportunity for improvement. Extended operative time consistently predicts for both overall and serious complications, suggesting long surgery within contaminated sites risks complication. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Prevalence and clinical significance of cancer cachexia based on time from treatment in advanced-stage head and neck squamous cell carcinoma

Abstract

Background

The purpose of this study was to identify the prevalence of cancer cachexia and its prognostic impact in patients with advanced head and neck squamous cell carcinoma (HNSCC).

Methods

The prevalence of cancer cachexia was analyzed according to the follow-up periods during the first year after curative initial treatment. Recurrences, noncancer health events (NCHEs), and cause-specific survival outcomes were also analyzed according to the incidence of cancer cachexia during follow-up.

Results

Cancer cachexia was identified in 22 (6.1%), 148 (41%), 66 (18.4%), and 65 (18.7%) of 361 enrolled patients at pretreatment, immediately after treatment, 6-months after treatment, and 12-months after treatment, respectively. Sustained or newly developed cachexia at 6 and 12 months showed a significant association with recurrence and NCHE occurrence (p < .05). In cause-specific survival analysis, patients with cachexia had a higher probability of cancer-specific death, noncancerous death, and overall death (p < .05).

Conclusion

Cachexia prevalence at 6 and 12 months after treatment for HNSCC indicates a higher chance of recurrence, NCHE, and death. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Parotidectomy under sedation and locoregional anesthesia with monitoring of brain activity

ABSTRACT

Background

Parotidectomy is usually performed while the patient is under general anesthesia, however, sedation with locoregional anesthesia could be an alternative.

Methods

Fifteen adult patients with parotid tumors of the superficial lobe were included in this study. Anesthetic procedure consisted of sedation associated with cervical plexus and auriculotemporal nerve block. Sedation was managed based on the bispectral index.

Results

Superficial parotidectomies were performed in 13 patients, and combined partial resections were performed in 2 patients. The mean operative time was 118.2 ± 16.4 minutes. Conversion to general anesthesia was necessary in only 1 patient. Ten surgeries were performed on an outpatient basis. Definitive facial paralysis occurred in 1 patient. All patients reported total satisfaction with the procedure.

Conclusion

In selected cases, parotidectomy under sedation plus locoregional anesthesia is feasible and safe. The careful selection of patients and the close collaboration with an anesthesiologist is the key to a successful procedure. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

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Defining the Location of the Adductor Canal Using Ultrasound.

Background and Objectives: The precise location of the adductor canal remains controversial among anesthesiologists. In numerous studies of the analgesic effect of the so-called adductor canal block for total knee arthroplasty, the needle insertion point has been the midpoint of the thigh, determined as the midpoint between the anterior superior iliac spine and base of patella. "Adductor canal block" may be a misnomer for an approach that is actually an injection into the femoral triangle, a "femoral triangle block." This block probably has a different analgesic effect compared with an injection into the adductor canal. We sought to determine the exact location of the adductor canal using ultrasound and relate it to the midpoint of the thigh. Methods: Twenty-two volunteers were examined using ultrasound. The proximal end of the adductor canal was identified where the medial border of the sartorius muscle intersects the medial border of the adductor longus muscle. The distal end of the adductor canal is the adductor hiatus, which was also visualized ultrasonographically. Results: The mean distance from the anterior superior iliac spine to the midpoint of the thigh was 22.9 cm (range, 20.3-24.9 cm). The mean distance from the anterior superior iliac spine to the proximal end of the adductor canal was 27.4 cm (range, 24.0-31.4 cm). Consequently, the mean distance from the midpoint of the thigh to the proximal end of the adductor canal was 4.6 cm (range, 2.3-7.0 cm). Conclusions: In all volunteers, the midpoint of the thigh was proximal to the beginning of the adductor canal, suggesting that an injection performed at this level is in fact a femoral triangle block. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2016 by American Society of Regional Anesthesia and Pain Medicine.

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Evaluation of Ultrasound-Assisted Thoracic Epidural Placement in Patients Undergoing Upper Abdominal and Thoracic Surgery: A Randomized, Double-Blind Study.

Background and Objectives: The placement of thoracic epidurals can be technically challenging and requires a thorough understanding of neuraxial anatomy. Although ultrasound imaging of the thoracic spine has been described, no outcome studies on the use of this imaging have been performed. We evaluated whether preprocedural ultrasound of the thoracic spine would facilitate the process of epidural catheterization. Methods: Subjects undergoing thoracic or upper abdominal surgery with planned thoracic epidural placement at T10 or higher were enrolled in this randomized double-blind study. Subjects were allocated into 1 of 2 groups for preoperative epidural placement: ultrasound guidance (group US) or palpation (group Palp). Subjects randomized to group US had a preprocedural ultrasound examination to identify pertinent spinal anatomy and make appropriate marks on the skin identifying midline and interlaminar spaces for targeted Tuohy needle insertion. Subjects in group Palp had a skin marking performed by palpation alone. Using the skin markings, all epidurals were performed using a loss of resistance to saline technique. Block levels were assessed with ice and pain scores obtained by a blinded nurse in the postanesthesia care unit. The primary outcome was procedural time from needle insertion to loss of resistance in the epidural space. Results: Seventy subjects were recruited and completed the study protocol. The median time for epidural needle placement to achieve loss of resistance in group US and group Palp was 188.5 seconds (interquartile range [IQR], 79.0-515.0) and 242.0 seconds (IQR, 87.0-627.0), respectively (P = 0.188). Using ultrasound to mark the skin overlying the targeted epidural space took a median time of 85 seconds (IQR, 69-113) for group US and 35 seconds (IQR, 27-51) for group Palp (P

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Neck dissection with harmonic scalpel and electrocautery? A randomised study

Is the use of harmonic scalpel for neck dissection useful? Literature search did not show a single, prospective, randomised control trial. We intended to study the role of harmonic scalpel in neck dissection and compare it with conventional electrocautery technique for oral cavity carcinoma.

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The temporalis muscle flap for reconstruction of soft palate and lateral oropharyngeal wall after transoral robotic surgery

Trans Oral Robotic Surgery (TORS) is a prominent surgical approach for the resection of oropharyngeal tumors without division of the lip and mandible. Some defects following TORS are large and complex enough to benefit soft-tissue coverage. The pedicled temporalis muscle flap is a versatile and reliable flap and may be a valid option to reconstruct defects of the lateral pharyngeal wall and partial soft palate.

http://ift.tt/2hqh9R6

Syndrome of inappropriate antidiuretic hormone secretion in a case of olfactory neuroblastoma without anti-diuretic hormone immunoreactivity: A case report and review of the literature

Olfactory neuroblastoma (ONB) is a relatively rare nasal or paranasal malignant tumor. This tumor is rarely accompanied by paraneoplastic syndromes such as syndrome of inappropriate antidiuretic hormone secretion (SIADH). Here, we report a 31-year-old female with histologically confirmed ONB who had been diagnosed with SIADH three years prior. She was treated with surgery followed by concurrent chemoradiotherapy. SIADH resolved immediately after surgical tumor resection. Immunohistochemically, both biopsy and resected specimens from the nasal cavity had been negative for ADH.

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Islanded facial artery musculomucosal flap for tongue reconstruction

Reconstruction of the tongue can be achieved by means of various local, regional, and microvascular free flaps. Local flaps commonly used for tongue reconstruction include the nasolabial flap, submental flap, infrahyoid flap, and pedicled facial artery musculomucosal (FAMM) flap. The purpose of this article is to propose a technical modification to the FAMM flap for the reconstruction of small to medium-sized tongue defects post tumour excision: islanding the flap and tunnelling it from the lingual aspect of the mandible in a single-stage procedure.

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Sinonasal adenocarcinoma: clinical outcomes and predictive factors

A retrospective study of 39 patients treated for sinonasal adenocarcinoma between 1995 and 2010 was performed. Epidemiological, clinical, histological, and therapeutic aspects of this series of patients were analyzed statistically and their impact in terms of overall and disease-free survival established using the Kaplan–Meier method. A search for prognostic factors was made using a log-rank test. The male to female sex ratio was 6.8 to 1. The average age at diagnosis was 65.7 years (range 40.2–85.6 years).

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Thiol/disulfide homeostasis as a novel indicator of oxidative stress in obstructive sleep apnea patients

Objectives

The aim of the present study was to assess thiol/disulfide (SS) homeostasis as a novel indicator of oxidative stress in patients with obstructive sleep apnea (OSA) and to investigate the effect of continuous positive airway pressure (CPAP) therapy on oxidative parameters.

Study Design

Prospective clinical study.

Methods

A total of 104 subjects, 44 in an OSA group and 60 in two control groups (control simple snoring group, control OSA group) were included. The levels of parameters were measured using the Erel and Neselioglu method in patients with moderate or severe OSA before and after CPAP therapy.

Results

The serum native thiol (SH) and total SH levels as well as the %SH/total SH ratio were significantly lower (P < 0.05) in OSA patients compared to controls, and the SS level and %SS/SH and %SS/total SH ratios were significantly higher (P < 0.05). After CPAP therapy, the native SH level and %SH/total SH ratio were significantly higher (P < 0.05) than before CPAP therapy, and the SS level and %SS/SH and %SS/total SH ratios were significantly lower (P < 0.05). Significant negative correlations were evident between the apnea/hypopnea index (AHI) and the native SH level and %SH/total SH ratio (P < 0.05) before CPAP therapy; and significant positive correlations were seen between the AHI and the %SS/SH and %SS/total SH ratios but not with the SS level.

Conclusion

We found that oxidative stress was increased and CPAP therapy had a positive effect in patients with moderate or severe OSA.

Level of Evidence

3b. Laryngoscope, 2016

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Fabrication and validation of a low-cost, medium-fidelity silicone injection molded endoscopic sinus surgery simulation model

Objectives/Hypothesis

Develop a low-cost, medium-fidelity model for education in endoscopic sinus surgery techniques. Establish face and content validity of the model based on the feedback of otolaryngology faculty including fellowship-trained rhinologists.

Study Design

Survey.

Methods

A novel silicone injection molded sinus model was constructed. Three fellowship-trained rhinologists and four general otolaryngologists were recruited to perform seven tasks and provide feedback of the model's performance via a 22-question Likert survey.

Results

Those surveyed strongly agreed the sinus model is useful for basic endoscopic skill acquisition such as camera skills (86%), hand-eye coordination (100%), nasal endoscopy skills (100%). Ratings of the model for training the specific tasks were consistently high. Neutral or lower were received for inferior turbinoplasty (14%), frontal balloon task (14%), understanding the ethmoid bulla (29%), and advanced sinus techniques (57%). All faculty strongly agreed they would be interested in using the model to train residents.

Conclusions

Simulation models have proven efficacy in endoscopic skill and procedural training. The group developed a novel low-cost, medium-fidelity sinus training model utilizing three-dimensional modeling and printing. Testing of this model revealed high ratings for both face and construct validity for a range of endoscopic procedures. Strong interest in using this model for resident training was unanimous among all survey participants.

Level of Evidence

NA Laryngoscope, 2016

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Duty hour restrictions and surgical complications for head and neck key indicator procedures

Objectives/Hypothesis

Graduate medical education has traditionally required long work hours, allowing trainees little time for adequate rest. Based on concerns over performance deterioration with sleep deprivation and its effect on patient outcomes, duty hour restrictions have been mandated. We sought to characterize complications from otolaryngology key indicator procedures performed before and after duty hour reform.

Study Design

Retrospective cross-sectional analysis of National Inpatient Sample (NIS).

Methods

The NIS was queried for procedure codes associated with head and neck key indicator groupings for the years 2000–2002 (45,363 procedures) and 2006–2008 (51,144 procedures). Hospitals were divided into three groups: nonteaching hospitals (NTH), teaching hospitals without otolaryngology programs (TH), and teaching hospitals with otolaryngology programs (TH-OTO). Surgical complication rates, length of stay, and mortality rates were analyzed using logistic and linear regression.

Results

The number of procedures increased (12.7%), with TH-OTO contributing more in postrestriction years (21% to 30%). Overall complication rates between the two periods revealed no difference, regardless of hospital setting. Subset analysis showed some variation within each complication within each grouping. Length of stay increased at TH-OTO (2.75 to 2.78 days) and decreased at NTH (2.28 to 2.24 days) and TH (2.39 to 2.36 days). Mortality did not increase among the three hospital types (NTH, P < .58; TH, P < .96; TH-OTO, P < .06). During the latter period, TH-OTO procedures showed lower mortality (P < .0038, odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.27-0.77). Increasing Charlson comorbidity index increased overall mortality rate (P < .0001, OR = 2.63, 95% CI = 2.4-2.89).

Conclusions

Overall complication rates did not change for head and neck key indicator procedures. Moreover, concerns about reduced surgical case numbers appear unfounded, especially for otolaryngology programs.

Level of Evidence

2c Laryngoscope, 2016

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