Head and Neck Medicine by Alexandros G.Sfakianakis: Δεκεμβρίου 2017

Σάββατο 30 Δεκεμβρίου 2017

Hold your horses: A comparison of human laryngomalacia with analogous equine airway pathology

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Rachael J. Lawrence, Matthew J. Butterell, James D. Constable, Matija Daniel
ObjectivesLaryngomalacia is the most common cause of stridor in infants. Dynamic airway collapse is also a well-recognised entity in horses and an important cause of surgical veterinary intervention. We compare the aetiology, clinical features and management of human laryngomalacia with equine dynamic airway collapse.MethodsA structured review of the PubMed, the Ovid Medline and the Cochrane Collaboration databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Systemic Reviews).ResultsThere are numerous equine conditions that cause dynamic airway collapse defined specifically by the anatomical structures involved. Axial Deviation of the Aryepiglottic Folds (ADAF) is the condition most clinically analogous to laryngomalacia in humans, and is likewise most prevalent in the immature equine airway. Both conditions are managed either conservatively, or if symptoms require it, with surgical intervention. The operative procedures performed for ADAF and laryngomalacia are technically comparable.ConclusionDynamic collapse of the equine larynx, especially ADAF, is clinically similar to human laryngomalacia, and both are treated in a similar fashion.

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Priorities for future research into asthma diagnostic tools: A PAN-EU Consensus exercise from the European asthma research innovation partnership (EARIP)

Abstract

The diagnosis of asthma is currently based on clinical history, physical examination and lung function; and to date there are no accurate objective tests either to confirm the diagnosis or to discriminate between different types of asthma. This consensus exercise reviews the state-of-the-art in asthma diagnosis to identify opportunities for future investment based on the likelihood of their successful development, potential for widespread adoption and their perceived impact on asthma patients.

Using a two-stage e-Delphi process and a summarising workshop, a group of European asthma experts including health professionals, researchers, people with asthma and industry representatives ranked the potential impact of research investment in each technique or tool for asthma diagnosis and monitoring. After a systematic review of the literature, 21 statements were extracted and were subject of the two-stage Delphi process. Eleven statements were scored 3 or more and were further discussed and ranked in a face to face workshop.

The three most important diagnostic/predictive tools ranked were: "New biological markers of asthma (e.g. genomics, proteomics and metabolomics) as a tool for diagnosis and/or monitoring", "Prediction of future asthma in preschool children with reasonable accuracy" and "Tools to measure volatile organic compounds (VOCs) in exhaled breath".

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Effect of different doses and durations of teriparatide therapy on resolution of medication-related osteonecrosis of the jaw: A randomized, controlled preclinical study in rats

To evaluate the effects of different doses and durations of teriparatide therapy on MRONJ resolution in rats.

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Overexpression of sprouty2 in human oral squamous cell carcinogenesis

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Pei-Hsien Liao, Yen-Yun Wang, Wen-Chen Wang, Chung-Ho Chen, Yu-Hsun Kao, Jing-Wei Hsu, Ching-Yi Chen, Ping-Ho Chen, Shyng-Shiou Yuan, Yuk-Kwan Chen
ObjectiveThis study investigated SPRY2 expression in human oral potentially malignant disorders (OPMDs) and oral squamous cell carcinomas (OSCCs).Methods75 OSCCs, 23 OPMDs with malignant transformation (MT), 17 OPMDs without MT, and eight normal oral mucosa (NOM) tissues were used for immunohistochemical staining; three OSCC tissues with normal tissue counterparts were used for western blotting. Three human oral cancer cell lines (OCCLs), an oral precancer cell line (DOK), and a NOM primary culture (NOMPC) were used for western blotting; OCCLs and NOMPC were employed for real-time quantitative reverse transcription-polymerase chain reaction. OCCLs were evaluated in terms of proliferation, migration, invasion and BRAF V600E point mutation assays.ResultsSignificantly increased SPRY2 protein expression was observed in OSCCs as compared with NOM, and SPRY2 expression also differed between OSCC patients with and without lymph-node metastasis. SPRY2 protein and mRNA expressions were significantly enhanced as compared with NOMPC. Increased phospho-ERK expression was observed in OCCLs as compared with NOMPC. Significant decreases in the proliferation rate, degrees of migration and invasion were noted in OCCLs with SPRY2 siRNA transfection as compared with those without SPRY2 siRNA transfection. No BRAF V600E point mutation was observed for OCCLs as compared with NOMPC. A significantly increased SPRY2 protein level was noted in OPMDs with MT as compared to those without MT, and was also found in OPMDs with MT in comparison with NOM, as well as in DOK in comparison with NOMPC.ConclusionsOur results indicated that SPRY2 overexpression is associated with human oral squamous-cell carcinogenesis.

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Superhydrophilic co-polymer coatings on denture surfaces reduce Candida albicans adhesion—An in vitro study

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Masahiro Hirasawa, Chiaki Tsutsumi-Arai, Kensuke Takakusaki, Toyohisa Oya, Kenji Fueki, Noriyuki Wakabayashi
ObjectiveIn this study, we aimed to investigate denture-base-resin coatings prepared with a crosslinkable co-polymer containing sulfobetaine methacrylamide (SBMAm) and the relationship between their surface characteristics and the initial adhesion of Candida albicans (C. albicans).MethodsAcrylic resin discs were coated with co-polymers containing various concentrations of SBMAm and N,N'-(4,7,10-trioxa-1,13-tridecadiamine) diacrylamide (JDA) as crosslinking agent. Uncoated discs were used as controls. An acquired pellicle was formed on each disc using artificial saliva, and the discs were immersed in a suspension of C. albicans (JCM2085) cells. After incubation, tetrazolium salt (XTT-reduction) and colony forming unit (CFU) assays were performed and the morphogenesis of C. albicans was examined using scanning electron microscopy (SEM). The surface roughness, film thickness, and the water contact angle of each disc surface were measured.ResultsAll coating groups showed significantly lower amounts of adhered C. albicans in the XTT-reduction and CFU assays than the control, confirmed by the SEM images. Many wrinkle structures were observed on the surfaces coated with co-polymers containing more than 30% SBMAm. There were no significant differences in surface roughness among all groups. The co-polymer films on the coated discs were less than 5.0 μm in thickness, and these surfaces exhibited significantly lower mean water contact angles than the control.ConclusionCrosslinkable co-polymers containing SBMAm can enhance the hydrophilicity of the surface of denture-base resins and reduce the initial adhesion of C. albicans.

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Immunoexpression of proteins involved in cytoskeleton remodeling in benign odontogenic lesions

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Paula Nascimento Antonio, Natália Galvão Garcia, Agnes Assao, José Roberto Pereira Lauris, Fernando Augusto Soares, Denise Tostes Oliveira
ObjectiveThe present study was designed to analyze the immunolocalization of proteins involved in cytoskeleton remodeling, such as moesin and Rho-A, in benign odontogenic lesions that present with expansive growth and invasive clinical behavior.Materials and methodsExpressions of moesin and Rho-A in odontogenic epithelium were evaluated by immunohistochemical analysis in 45 odontogenic lesions using monoclonal antibodies.ResultsOur results demonstrated strong membranous and cytoplasmic expressions of moesin in the epithelial cells in 66.7% and 44.4% of the odontogenic lesions, respectively. Furthermore, Rho-A expression in odontogenic epithelium was strong in the membrane and cytoplasm of 51.1% and 62.2% of the odontogenic lesions, respectively. A statistically significant correlation was found between the membranous and cytoplasmic expressions of moesin (p = 0.000) and those of Rho-A (p = 0.048) in odontogenic epithelial cells, while no statistically significant correlation was found between moesin and Rho-A expressions (p > 0.05).ConclusionsThe present study confirmed the strong expressions of moesin and Rho-A by odontogenic epithelial cells, suggesting their involvement in the development of benign odontogenic lesions. However, this study has failed to detect the connection between the moesin and Rho-A interaction in expansive growth and local invasiveness of these lesions.

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Overexpression of sprouty2 in human oral squamous cell carcinogenesis

Superhydrophilic co-polymer coatings on denture surfaces reduce Candida albicans adhesion—An in vitro study

Immunoexpression of proteins involved in cytoskeleton remodeling in benign odontogenic lesions

Comparative Evaluation of Clinical Outcomes Using Delta Plates and Conventional Miniplates for Internal Fixation of Mandibular Condylar Fractures In Adults

Publication date: Available online 30 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Suraj Arjun Ahuja, Jyotsna Galinde, Usha Asnani, Yusuf A. Mistry
PurposeIn recent years numerous osteosynthesis devices are available for management of condylar fracture, the aim of this study was to compare and evaluate the clinical outcomes of delta plates and conventional miniplates for internal fixation of mandibular condylar fractures in adults.Material and MethodsA prospective study was performed on 20 patients with subcondylar fracture requiring open reduction and internal fixation for their management. Patients were randomly divided into two groups using computer software, patients under Group A [N=10] were treatment using delta plate while under Group B [N=10] using conventional miniplates via extraoral retromandibular transparotid approach.ResultsThere was no statically difference between delta plates and conventional miniplates for internal fixation of mandibular condylar fractures in adults. However, the time taken for adaptation of the delta plates & ease of adaptation was significantly lower than that required for the two miniplates [p=0.000].ConclusionsThe study results indicated that delta plate and miniplate are equally effective in terms of long-term clinical success in the management of mandibular subcondylar fractures in adults. The delta plates are superior in terms of handling characteristics, such as ease of adaptation and time required for adaptation as only one plate and four screws are required as compared to two plates and eight screws.

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Impact of temporomandibular joint discectomy on condyle morphology: an animal study

Publication date: Available online 30 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Reinaldo Abdala-Júnior, Arthur Rodriguez Gonzalez Cortes, Eduardo Massaharu Aoki, Simone Ferreira, João Gualberto Cerqueira Luz, Emiko Saito Arita, Jefferson Xavier de Oliveira
PurposeTemporomandibular disorders (TMD) lead to parafunctional activity that may alter bone remodeling of mandibular components. This animal study aimed to assess the impact of temporomandibular joint discectomy on condyle bone microarchitecture.Material and MethodsA total of 30 one-month-old Wistar rats were assessed and divided in three equal groups (two tests and one control) of 10. The first test group underwent disc removal (DRm; the second test group underwent disc and condylar cartilage removal (DCR); and the 10 remaining rats were analyzed as sham-operated controls (CTR), following a split-mouth design. Rats were sacrificed two months after surgery, and the respective mandibles were scanned with micro-CT for quantitative morphometric analysis.ResultsThere were significant differences among the three groups analyzed (DR, DCR and CTR) for Bone volume fraction (BV/TV, p=0.044), Structure model index (p<0.001), Fractal Dimension (p=0.024) and porosity (p=0.023). In addition, operated and contralateral non-operated sides significantly differed for all variables in at least one of the test groups (p<0.05), but not in the control group (p>0.05).ConclusionWithin the limitations of this study, the present results suggest that discectomy may lead to alterations of the mandibular condylar morphology.

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Effect of different doses and durations of teriparatide therapy on resolution of medication-related osteonecrosis of the jaw: A randomized, controlled preclinical study in rats

Publication date: Available online 30 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Mohammad Zandi, Arash Dehghan, Najmeh Zandipoor, Payam Amini, Shideh Doulati
ObjectiveTo evaluate the effects of different doses and durations of teriparatide therapy on MRONJ resolution in rats.Subjectsand methods: A total of 120 rats that had been affected with MRONJ (after six weekly zoledronate injections and tooth extraction) were randomly divided into eight subgroups: 2, 10, and 20 μg/kg/day teriparatide were administered to L4, M4, and H4 for 4 weeks, and to L8, M8, and H8 for 8 weeks, respectively. C4 and C8 received saline for 4 and 8 weeks, respectively. One week after the final injection, rats were sacrificed and assessed clinically (bone exposure/fistula) and histologically (number of osteocytes in extraction socket and empty lacunae in alveolar bone).ResultsMRONJ was clinically improved in 72.2%, 61.5%, and 40% of stage I, II, and III experimental rats, respectively. In the control rats, the results were 20.8% for stage I and no improvement for stages II and III. Aside from L4 and L8, the experimental subgroups had a significantly higher rate of clinical and histological improvement compared with their corresponding controls. There was a significantly higher number of osteocytes and lower number of empty lacunae in M4 and H4 compared with C4, in H4 compared with L4, in M8 and H8 compared with C8, and in H8 compared with L8.ConclusionTeriparatide therapy improved clinical and histological features of MRONJ in a dose-dependent manner, but clinically relevant doses of teriparatide might not be sufficient for MRONJ resolution in rats. Extending the duration of teriparatide therapy from 4 to 8 weeks did not affect treatment outcomes.

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Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature

Publication date: Available online 29 December 2017
Source:American Journal of Otolaryngology
Author(s): W.X. Yeo, S.H. Xu, T.Y. Tan, Y.M. Low, H.W. Yuen
IntroductionJugular bulb and sigmoid sinus anomalies are well-known causes of vascular pulsatile tinnitus. Common anomalies reported in the literature include high-riding and/or dehiscent jugular bulb, and sigmoid sinus dehiscence. However, cases of pulsatile tinnitus due to diverticulosis of the jugular bulb or sigmoid sinus are less commonly encountered, with the best management option yet to be established. In particular, reports on surgical management of pulsatile tinnitus caused by jugular bulb diverticulum have been lacking in the literature.ObjectivesTo report two cases of pulsatile tinnitus with jugular bulb and/or sigmoid sinus diverticulum, and their management strategies and outcomes. In this series, we describe the first reported successful case of pulsatile tinnitus due to jugular bulb diverticulum that was surgically-treated.Subjects and methodsTwo patients diagnosed with either jugular bulb and/or sigmoid sinus diverticulum, who had presented to the Otolaryngology clinic with pulsatile tinnitus between 2016 and 2017, were studied. Demographic and clinical data were obtained, including their management details and clinical outcomes.ResultsTwo cases (one with jugular bulb diverticulum and one with both sigmoid sinus and jugular bulb diverticula) underwent surgical intervention, and both had immediate resolution of pulsatile tinnitus post-operatively. This was sustained at subsequent follow-up visits at the outpatient clinic, and there were no major complications encountered for both cases intra- and post-operatively.ConclusionTransmastoid reconstruction/resurfacing of jugular bulb and sigmoid sinus diverticulum with/without obliteration of the diverticulum is a safe and effective approach in the management of bothersome pulsatile tinnitus arising from these causes.

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Introduction: Antibody-Mediated Therapy Special Issue Part 2

Antibodies have been used therapeutically for well over a century but the breadth and depth of their applications are increasing so rapidly and successfully that clinical studies are informing mechanistic questions while basic research continues to interrogate how antibodies are made and function, so their properties can be further refined. The first part of this Special Issue comprised five review articles (1); this second part includes four more reviews. Once again, we thank the authors for their excellent contributions. This issue also includes an original research article that builds on observations from patients with hyper-IgM syndrome to further define the mechanism for antibody class-switch recombination (CSR).

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Cover

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A pro-inflammatory role of Fcα/μR on marginal zone B cells in sepsis

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Abstract

Fc receptors play important roles for a wide array of immune responses. In contrast to the well-defined Fcγ and Fcε receptors, the molecular and functional characteristics of Fc receptors for IgA and IgM have remained incompletely understood for years. Recent progress has unveiled the characteristics of Fc receptors for IgA and IgM, including Fcα/μ receptor (Fcα/μR) (CD351), polymeric immunoglobulin receptor (poly-IgR), Fcα receptor (FcαRI) (CD89) and Fcμ receptor (FcμR). In this review, we summarize the molecular and functional characteristics of Fcα/μR in comparison with poly-IgR, FcμR and FcαRI, and focus particularly on the pro-inflammatory function of Fcα/μR expressed on marginal zone B cells in sepsis.

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Depletion of recombination-specific cofactors by the C-terminal mutant of the activation-induced cytidine deaminase causes the dominant negative effect on class switch recombination

Abstract

Activation-induced cytidine deaminase (AID) is essential for class-switch recombination (CSR) and somatic hypermutation (SHM) of immunoglobulin genes. Studies on in vitro mutagenized AID as well as its mutations in human patients with hyper-IgM (HIGM)-syndrome type II revealed that C-terminal AID mutations were defective in CSR whereas their DNA cleavage and SHM activities remained intact. The C-terminal mutants of AID were speculated to exert the dominant negative effect on wild-type (WT) AID whereas its mechanism remains unknown. We generated the JP41 (R190X) mutation in one allele and a null mutation on the other allele in a mouse B cell line (CH12F3-2A) using CRISPR/Cas9 genome-editing tools and studied the effect of JP41 expression on the function of exogenously introduced WT AID fused with estrogen receptor (AIDER) in AID^JP41/∆/AIDER CH12F3-2A cells. We found that JP41 expression strongly suppressed not only CSR but also Igh/c-Myc chromosomal translocations by AIDER. We showed that the dominant negative effect is not evident at the DNA cleavage step but obvious at both deletional and inversional recombination steps. We also confirmed the dominant negative effect of other C-terminal mutants, JP8Bdel (R183X) and P20 (34-aa insertion at residue 182) in AID-deficient spleen B cells. Finally, we showed that the expression of JP41 reduced the binding of AIDER with its cofactors (hnRNP L, SERBP1 and hnRNP U). Together, these data indicate that dominant negative effect of JP41 on CSR is likely due to the depletion of the CSR-specific RNA-binding proteins from WT AID.

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Targeted antibody therapy and relevant novel biomarkers for precision medicine for rheumatoid arthritis

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Abstract

Over the past two decades, the management of rheumatoid arthritis (RA) has progressed remarkably, encompassing the development of new diagnostic tools and efficacious biological agents, such as monoclonal antibodies against inflammatory cytokines and surface markers on immune cells. In addition to the significant efficacy of these biological agents, biomarkers for RA are under consideration for their potential to classify heterogeneous patients into several groups based on clinical and immunological phenotypes for the prediction of clinical course and prognosis and the facilitation of appropriate and precise treatment with the appropriate therapeutic monoclonal antibodies. Biomarkers, particularly those for the prediction and monitoring of the responses to therapeutic monoclonal antibodies for RA, are in demand, with many approaches examined in recent years. In this article, we have summarized the background research on biomarkers and introduced recent topics in the field that enable the possible clinical applications of biomarkers, especially those related to pathogenic cytokines, to guide the treatment of RA.

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Sweet SIGNs: IgG glycosylation leads the way in IVIG-mediated resolution of inflammation

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Abstract

A hallmark of many chronic inflammatory and autoimmune diseases is that there is an impaired resolution of inflammation and return to the steady state. The infusion of high doses of pooled serum IgG preparations from thousands of donors [intravenous immunoglobulin (IVIG) therapy] has been shown to induce resolution of inflammation in a variety of chronic inflammatory and autoimmune diseases, suggesting that IgG molecules can instruct the immune system to stop inflammatory processes and initiate the return to the steady state. The aim of this review is to discuss how insights into the mechanism of IVIG activity may help to understand the molecular and cellular pathways underlying resolution of inflammation. We will put a special emphasis on pathways dependent on the IgG F_C domain and IgG sialylation, as several recent studies have provided new insights into how this glycosylation-dependent pathway modulates innate and adaptive immune responses through different sets of C-type or I-type lectins.

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IVIG-mediated effector functions in autoimmune and inflammatory diseases

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Abstract

Intravenous immunoglobulin (IVIG) is a pooled preparation of normal IgG obtained from several thousand healthy donors. It is widely used in the immunotherapy of a large number of autoimmune and inflammatory diseases. The mechanisms of action of IVIG are complex and, as discussed in this review, experimental and clinical data provide an indicator that the therapeutic benefit of IVIG therapy is due to several mutually non-exclusive mechanisms affecting soluble mediators as well as cellular components of the immune system. These mechanisms depend on Fc and/or F(ab′)₂ fragments. A better understanding of the effector functions of IVIG should help in identification of biomarkers of responses to IVIG in autoimmune patients.

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Barrier dysfunction in allergy

Publication date: January 2018
Source:Allergology International, Volume 67, Issue 1
Author(s): Kenji Kabashima, Kenji Izuhara

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Food Protein-Induced Proctocolitis. The shadow of allergic disorders

Publication date: January–February 2018
Source:Allergologia et Immunopathologia, Volume 46, Issue 1
Author(s): C.A. Sánchez-Salguero

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Type III interferons are critical host factors that determine susceptibility to Influenza A viral infection in allergic nasal mucosa

Abstract

Background

Allergic respiratory conditions have been associated with increased susceptibility to viral infection due to impaired interferon (IFN)-related immune responses but the mechanisms for reinforcement of mucosal immunity against viral infection in allergic diseases are largely unknown.

Objectives

To determine whether IFN induction would be impaired in allergic nasal mucosa and to identify if higher loads of influenza A virus (IAV) in allergic nasal mucosa could be controlled with IFN treatment.

Methods

IAV mRNA, viral titers and IFN expression were compared in IAV-infected normal human nasal epithelial (NHNE, N=10) and allergic rhinitis nasal epithelial (ARNE, N=10) cells. We used in vivo model of allergic rhinitis (BALB/C mouse, N=10) and human nasal mucosa from healthy volunteers (N=72) and allergic rhinitis patients (N=29) to assess the induction of IFNs after IAV infection.

Results

IAV mRNA levels and viral titers were significantly higher in ARNE compared with NHNE cells. IFN-β and -λs were induced in NHNE and ARNE cells up to 3 days after IAV infection. Interestingly, induction of IFN-λs mRNA levels and the amount of secreted proteins were considerably lower in ARNE cells. The mean IFN-λs mRNA level was also significantly lower in the nasal mucosa of AR patients and we found that recombinant IFN-λ treatment attenuated viral mRNA levels and viral titers in IAV-infected ARNE cells. In vivo AR mouse were exhibited higher viral load after IAV infection but intranasal inoculation of IFN-λ completely decreased IAV protein expression and viral titer in nasal mucosa of IAV-infected AR mouse.

Conclusion

Higher susceptibility of the allergic nasal mucosa to IAV may depend on impairment of type III IFN induction, and type III IFN is a key mechanistic link between higher viral loads and control of IAV infection in allergic nasal mucosa.

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Sex-based differences in CD103+ dendritic cells promote female-predominant Th2 cytokine production during allergic asthma

Abstract

Background

Gender disparities in adult patients with asthma regarding its prevalence and severity are mainly due to enhanced type 2 T-helper (Th2) cytokine production in female patients compared to that in male patients. However, the pathways mediating this effect remain unclear.

Objective

We aimed to determine the roles of two major subsets of dendritic cells (DCs) in females, specifically those displaying CD11b or CD103, during enhanced Th2-priming after allergen exposure, using an ovalbumin-induced asthma mouse model.

Methods

Sex-based differences in the number of DCs at inflamed sites, co-stimulatory molecule expression on DCs, and the ability of DCs to differentiate naïve CD4⁺ T cells into Th2 population were evaluated after allergen exposure in asthmatic mice. In addition, we assessed the role of 17β-estradiol in CD103⁺ DC function during Th2-priming in vitro.

Results

The number of CD11b^high DCs and CD103⁺ DCs in the lung and bronchial lymph node (BLN) were increased to a greater extent in female mice than in male mice at 16 to 20 hours after ovalbumin (OVA) inhalation. In BLNs, CD86 and I-A/I-E expression levels and antigen uptake ability in CD103⁺ DCs, but not in CD11b^high DCs, were greater in female mice than in male mice. Furthermore, CD4⁺ T cells cultured with CD103⁺ DCs from female mice produced higher levels of interleukin (IL)-4, IL-5, and IL-13, compared with CD4⁺ T cells cultured with CD103⁺ DCs from male mice. The 17β-estradiol oriented-enhancement of CD86 expression on CD103⁺ DCs after allergen exposure induced the enhanced IL-5 production from CD4⁺ T cells.

Conclusions & Clinical Relevance

These findings suggest that with regards to asthma, enhanced Th2 cytokine production in females might be attributed to 17β-estradiol-mediated Th2-oriented CD103⁺ DCs in the BLN.

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Different applicabilities of the etch-bleach-seal technique for treating opacities on permanent incisor damage by molar incisor hypomineralisation in three young patients

Enamel opacity on anterior teeth can be prejudicial for the aesthetic appearance of affected patients. Patients with molar incisor hypomineralisation, for example, present opacities that can range from discrete white mottling to extensive yellow-brown discolourations. They can request a treatment to improve their aesthetic conditions. Many techniques have been considered to manage this condition. Wright developed a technique called etch–bleach–seal, which showed promising results for the management of anterior enamel opacities. The aims of this report are to present this technique and to analyse its benefits and inconveniences.

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The effect of flurbiprofen oral spray and ibuprofen versus ibuprofen alone on postoperative tonsillectomy pain: an open randomised controlled trial

Abstract

Objective

This prospective clinical study was carried out to evaluate the analgesic efficacy and safety of oral spray form of flurpiprofen in the treatment of postoperative pain in tonsillectomy patients.

Study Design

Open randomised controlled clinical study.

Setting

Tertiary care training and research hospital.

Participants

One hundred (53 males, 47 females) with an age range of 18-53 years old (mean 27.4 ± 9.3 SD) undergoing tonsillectomy were enrolled to this prospective controlled study.

Main outcome measures

Patients receiving oral ibuprofen and flurbiprofen as spray form were enrolled as study group (53) whereas patients receiving only oral ibuprofen were enrolled as control group (47) in postoperative period. Postoperative pain was evaluated through visual analog scale on 12th hour, first, third and seventh days after surgery.

Results

The mean maximal pain score of patients who have received flurbiprofen spray and ibuprofen was 3.36 ± 1.93 SD that was statistically lower than the mean maximal pain score of patients who were medicated with only ibuprofen which was 4.06 ± 1.29 SD on postoperative seventh day (p=0.013).

Conclusion

This study revealed that addition of flurbiprofen spray to oral ibuprofen is effective in the management of postoperative pain in tonsillectomy patients with no notable complications.

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Cold/Cold vs. Bipolar Dissection Tonsillectomy: A Surgeon-Controlled Study of 400 Cases

Abstract

Surgeon controlled study of 200 cold/cold and 200 hot/hot tonsillectomy cases in one institution

Hot/hot resulted in higher overall rates of early and late post-tonsillectomy haemorrhage and return-to-theatre when compared to cold/cold methods.

Bipolar diathermy tonsillectomy resulted in a statistically significant higher rate of secondary post-tonsillectomy haemorrhage than cold-steel of nearly three times.

Trainee surgeons performed better in bipolar haemostasis than cold-steel dissection with regard to post-operative morbidity.

With continued use of cold-steel tonsillectomy methods in both junior and senior surgeons, it is hoped that the rates of PTH and RTT will continue to improve.

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Double Suspension Sutures: a simple Surgical Technique for Selected Cases of obstructive Sleep Apnea: our experience with twenty two patients

Abstract

This work aimed at presenting a simple modification of expansion pharyngoplasty using bilateral double palatal suspension sutures for the treatment of selected cases of snoring and OSA.

Between Marsh 2013 and August 2017, twenty- two patients underwent the double suspension sutures technique as a treatment for retropalatal collapse of obstructive sleep apnea.

Postoperatively, the mean AHI and the mean lowest oxygen saturation level showed highly significant improvement. Both the retropalatal and interpillar distances were increased significantly.

No persistent postoperative complications were reported. Snoring disappeared in 86.4% of patients.

The procedure is simple, well-tolerated by patients and reversible. It is an economic and less traumatic maneuver. It could be applied as a part of multilevel surgery.

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Autografting in the treatment of large, auricular keloids

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Jet ventilation in obese patients undergoing airway surgery for subglottic and tracheal stenosis

Objectives/Hypothesis

To assess the feasibility of jet ventilation in obese patients and to compare complications of jet ventilation in obese and nonobese patients.

Study Design

Retrospective review of medical records.

Methods

We reviewed 46 patient charts (70 procedures) with the diagnosis of tracheal or subglottic stenosis who underwent endoscopic surgery with jet ventilation between March 2014 and January 2017. Adequacy of jet ventilation was assessed by chest rise, avoidance of endotracheal intubation, and length of case and ventilation. Records were reviewed for demographic details, anesthesia records, and complications.

Results

In 29/70 (41.4%) of cases, patients were obese; in 9/29 (31.0%) of these cases, patients were morbidly obese. Jet ventilation was successful in 28/29 (97%) of obese cases. In 1/29 (3.4%) of cases, the patient required alternative airway management. There were no significant differences between obese and nonobese patients in chest rise, need for endotracheal intubation, and length of surgery or ventilation (P > .05). There were 2/29 (6.9%) cases of intra- and postoperative complications including laryngospasm (1/29, 3.4%) and tachycardia (1/29, 3.4%). Rate of complications did not differ between obese and nonobese patients (P = .178).

Conclusions

Jet ventilation in obese patients can be done successfully, and complications are similar between obese patients and nonobese patients.

Level of Evidence

4. Laryngoscope, 00:000–000, 2017

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Παρασκευή 29 Δεκεμβρίου 2017

Anti-PD-1-induced high-grade hepatitis associated with corticosteroid-resistant T cells: a case report

Abstract

Effective treatment or prevention of immune side effects associated with checkpoint inhibitor therapy of cancer is an important goal in this new era of immunotherapy. Hepatitis due to immunotherapy with antibodies against PD-1 is uncommon and generally of low severity. We present an unusually severe case arising in a melanoma patient after more than 6 months uncomplicated treatment with anti-PD-1 in an adjuvant setting. The hepatitis rapidly developed resistance to high-dose steroids, requiring anti-thymocyte globulin (ATG) to achieve control. Mass cytometry allowed comprehensive phenotyping of circulating lymphocytes and revealed that CD4⁺ T cells were profoundly depleted by ATG, while CD8⁺ T cells, B cells, NK cells and monocytes were relatively spared. Multiple abnormalities in CD4⁺ T cell phenotype were stably present in the patient before disease onset. These included a population of CCR4⁻CCR6⁻ effector/memory CD4⁺ T cells expressing intermediate levels of the Th1-related chemokine receptor CXCR3 and abnormally high multi-drug resistance type 1 transporter (MDR1) activity as assessed by a rhodamine 123 excretion assay. Expression of MDR1 has been implicated in steroid resistance and may have contributed to the severity and lack of a sustained steroid response in this patient. The number of CD4⁺ rhodamine 123-excreting cells was reduced > 3.5-fold after steroid and ATG treatment. This case illustrates the need to consider this form of steroid resistance in patients failing treatment with corticosteroids. It also highlights the need for both better identification of patients at risk and the development of treatments that involve more specific immune suppression.

http://ift.tt/2lkucHJ

Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis

Abstract

Objective

The aim of this prospective study was to evaluate the efficacy of sialendoscopy in the management of adult chronic recurrent parotitis without sialolithiasis. In addition, preliminary results of an initial randomized placebo-controlled trial of single-dose intraductal steroid injection given concurrently with sialendoscopy, are presented.

Methods

Forty-nine adult patients with chronic recurrent parotitis without sialoliths were included in this study. They underwent sialendoscopy and were randomized to receive either a concurrent intraductal injection of isotonic saline solution or 125 mg of hydrocortisone. Symptom severity was evaluated with visual analogue scale (VAS) and by recording symptom frequency and course with a multiple-choice questionnaire completed preoperatively and at 3, 6, and 12 months after the procedure.

Results

The mean VAS score was 5.6 preoperatively and dropped to 2.9 at 3 months, 3.0 at 6 months, and 2.7 at 12 months after the procedure. The VAS score and the frequency of symptoms were significantly lower at 3 (p < 0.001), 6 (p < 0.001) and 12 (p < 0.001) months after the procedure when compared with the preoperative scores indicating that sialendoscopy reduces the symptoms of recurrent parotitis. However, complete permanent resolution of symptoms was rare. Single-dose steroid injection concomitant to sialendoscopy provided no additional benefit, but the current study is not sufficiently powered to determine a clinical difference between the steroid and non-steroid groups.

Conlusion

Sialendoscopy appears to reduce the symptoms of chronic recurrent parotitis. While total permanent symptom remission is rare, sialendoscopy can be considered a safe and relatively efficacious treatment method for this patient group.

http://ift.tt/2Dz1yJH

Reduced frequency of peripheral CD4+CD45RA+CD31+ cells and autoimmunity phenomena in patients affected by Del22q11 syndrome

Publication date: Available online 29 December 2017
Source:Clinical Immunology
Author(s): Silvia Ricci, Marzio Masini, Claudia Valleriani, Arianna Casini, Martina Cortimiglia, Laura Grisotto, Clementina Canessa, Giuseppe Indolfi, Francesca Lippi, Chiara Azzari

http://ift.tt/2zPKaxU

Investigation of autoantibodies to SP-1 in Chinese patients with primary Sjögren's syndrome

Publication date: Available online 29 December 2017
Source:Clinical Immunology
Author(s): Jingxiu Xuan, Ying Wang, Yinglin Xiong, Hongyan Qian, Yan He, Guixiu Shi
In order to evaluate autoantibody to SP-1 as an early biomarker in pSS, we investigated autoantibody to SP-1 in Chinese patients with primary Sjögren's syndrome (pSS). Autoantibodies to SP-1 are significantly increased in pSS patients compared to RA patients, SLE patients, and healthy people without secondary SS. The presence of anti SP-1 antibodies was negatively correlated with the focus score (FS), RF, and salivary gland function. It was positively correlated with FS=0, RF≤20, and normal salivary gland function. In further studies, the autoantigen SP-1 was identified in ductal epithelia of salivary glands in il14α TG mice by IIF. SP-1 mRNAs expression increased with growing age in il14α TG mice. SP-1 mRNA was also identified in labial biopsies of patients with pSS. In conclusion, autoantibody to SP-1 is an early marker in pSS. It is useful to diagnose pSS patients who lack RF or antibodies to Ro/La.

http://ift.tt/2CcsyT3

Characterization of newborn hearing screening failures in multigestational births

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Jonathan Ross Mallen, Jacob B. Hunter, Charles Auerbach, Leslie Wexler, Andrea Vambutas
ObjectiveTo define the rate and characterize the type of newborn hearing screening failures in multigestational births.MethodsRetrospective chart review of all multigestational births that occurred in a 10-year period (2002–2012) in which at least one newborn failed newborn hearing screening at two tertiary care hospitals in the Northwell Health System.ResultsOut of 125,405 total births, we identified 2961 multigestational births, of which 59 (2.0%) newborns failed newborn hearing screening. None of their 66 twin/triplet siblings failed their newborn hearing screens. Of 43 newborns that returned for follow-up, 56.0% (24/43) had confirmed hearing loss, resulting in an overall rate of 0.81% in all multigestational newborns with hearing loss. Of 19 infants that passed repeat testing, two were judged to need myringotomy tube placement. Twenty-four infants had a confirmed hearing loss, 11 of which had sensorineural hearing loss (0.37%), and 13 with a conductive or mixed hearing loss (0.44%).ConclusionsWe identified a greater than expected risk of conductive hearing loss, not attributable to otitis media, than sensorineural hearing loss in this population. These observations are consistent with the increased risk of birth defects in multigestational births.

http://ift.tt/2CqpQ94

Sialoendoscopy for treatment of juvenile recurrent parotitis: The Brescia experience

Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Marco Berlucchi, Vittorio Rampinelli, Marco Ferrari, Paola Grazioli, Luca O. Redaelli De Zinis
ObjectiveTo evaluate the role of sialoendoscopy associated with steroid irrigation for juvenile recurrent parotitis (JRP) at a tertiary referral hospital.MethodsClinical records of patients affected by JRP and treated with operative sialoendoscopy between June 2011 and April 2017 were retrospectively reviewed. Data on demographics, number of acute episodes per year before and after surgery, characteristics of the surgical procedure, hospitalization time, and rate of complications were collected. The outcome of the procedure was measured by comparing the number of episodes of parotid swelling before and after salivary endoscopic treatment.ResultsTwenty-three patients for a total of 34 operative sialoendoscopies were included in the study. Before the surgical endoscopic procedure, the mean number of parotid swelling was 10 episodes per year. At sialoendoscopy, typical endoscopic findings such as mucous plugs, stenosis of the duct, intraductal debris, and pale ductal appearance were evident. All patients were discharged on the first postoperative day. A significant decrease in the number of swelling episodes per year was observed compared to the preoperative rate (p = .0004). Complete resolution of the disorder was obtained in 35% of patients.ConclusionsOperative sialoendoscopy with steroid irrigation can be considered a valid therapeutic treatment for JRP. The technique is conservative, effective, safe, and, potentially repeatable. Short hospitalization time, rapid recovery, absence of peri-operative complications, and a high rate of good outcomes are the main advantages of this treatment.

http://ift.tt/2DwNoII

Oral potentially malignant disorders: risk of progression to malignancy.

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Paul M. Speight, Syed Ali Khurram, Omar Kujan
Oral potentially malignant disorders (OPMD) have a stastically increased risk of progessing to cancer, but the risk varies according to a range of patient or lesion related factors. It is difficult to predict the risk of progression for any individual patient and the clinician must make a judgement based an assessment of each case. The most commonly encountered OPMD is leukoplakia, but others including lichen planus, oral submucous fibrosis and erythroplakia may also be seen. Factors associated with an increased risk of malignant transformation include gender, the site and type of lesion, habits such as smoking and alcohol and the presence of epithelial dysplasia on histologic examination. In this review we attempt to identify the important risk factors, and present a simple algorithm that can be used as a guide for risk assessment at each stage of the clinical evaluation of a patient.

http://ift.tt/2zOs4fx

Clinical complications in the application of polyglycolic acid sheets with fibrin glue after resection of mucosal lesions in oral cavity

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Kohei Okuyama, Souichi Yanamoto, Tomofumi Naruse, Yuki Sakamoto, Satoshi Rokutanda, Seigo Ohba, Izumi Asahina, Masahiro Umeda
Objectives.Covering open wounds with a polyglycolic acid (PGA) sheet using fibrin glue after resection of oral mucosal lesions is reportedly useful. We focused on clinical complications of this procedure: development of marked granuloma-like neoplasm (GLN) and abnormal postoperative bleeding (APB) on the resected region.Study Design.The characteristics of 100 cases with PGA sheet application after the resection of oral mucosal lesion were examined retrospectively by the medical records and/or oral photographs at our department between 2010 and 2016.Results.These included 8 cases of GLN development and 7 cases of APB. There was a significantly higher risk of GLN development when the PGA sheet was applied to the raw surface of the tongue. There were no immediate APBs, but 4 APBs occurred several hours after surgery. All APB cases involved the tongue.ConclusionsBoth GLNs and APBs are minor complications. Although 8 cases of GLNs did not involve the recurrence of a tumor, follow-up with incisional or excisional biopsy should be performed. APB in the oral cavity induced by the PGA sheet peeling due to fluctuating adhesive force of the PGA sheets and fibrin glue can sometimes induce life-threatening events.

http://ift.tt/2CbcgcR

OOOO as required reading in the dental school curriculum: an opportunity to both guide the curriculum and reinforce the relationship between biomedical science education and dental practice?

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Paul C. Edwards

http://ift.tt/2zOQu8M

Radiological correlation between the thickness of the roof of the glenoid fossa and that of the bony covering of the superior semicircular canal

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Rafael Crovetto-Martínez, Carlos Vargas, Iñigo Lecumberri, Amaia Bilbao, Miguel Crovetto-De la Torre, Jaime Whyte-Orozco
ObjectivesDehiscence of the superior semicircular canal (SSC) has been associated with alteration of the temporomandibular joint, although data explaining this association are lacking. The present study examined the correlations between the presence of dehiscences and thickness of the bone covering the SSC and the roof of the glenoid fossa (RGF).Study designComputed tomography was used in a cross-sectional analysis of the presence of dehiscences and thickness of the bone overlying the SCC and RGF in 156 temporal bones of 78 patients. The correlations of the presence of dehiscences in the SSC and ipsilateral RGF and the thickness of bone covering the SSC and RGF were analyzed with the chi-squared or Fisher exact test. The relationship between the thickness of the bone overlying the SCC and RGF was analyzed by the Spearman correlation coefficient and the Kruskal-Wallis test. The relationship of the thickness of the RGF to the covering of the SCC and to age and gender was analyzed with the general linear model.ResultsSignificant correlations were found between the presence of dehiscences and thickness of the bone overlying the SSC and RGF (p<0.001).ConclusionsThere is a morphological relationship between the structure of the SSC and RGF.

http://ift.tt/2CdXpyg

Advantages of submandibular gland preservation surgery over submandibular gland resection for proximal submandibular stones

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jin-Qing Xiao, Hai-Jiang Sun, Qi-Hui Qiao, Xin Bao, Chuan-Bin Wu, Qing Zhou
ObjectivesThis study sought to compare surgical outcomes after the removal of submandibular gland (SMG) stones via two different surgical methods.Materials and MethodsFrom June 2015 to July 2016, a total of 40 patients with SMG stones were selected from the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China), and were randomly assigned to two groups. Twenty patients underwent sialendoscopy-assisted stone removal via extraoral incision with preservation of the SMG, and 20 patients underwent traditional SMG resection. The outcomes of the two surgical procedures were assessed.ResultsThe operation time and hospital stay were shorter in the SMG preservation group than the SMG resection group. There were no significant differences in stone size or location between the groups. The mean visual analog scale (VAS) score was lower in the SMG preservation group than the SMG resection group. All patients in the SMG resection group exhibited varying degrees of scarring and concave deformity on the face and neck, whereas all patients in the SMG preservation group retained intact facial morphology.ConclusionsSialendoscopy-assisted stone removal with preservation of the SMG exhibited many advantages relative to traditional SMG resection.

http://ift.tt/2zPaXu2

Patient morbidity among residents extracting third molars: does experience matter?

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Mohmedvasim Momin, Timothy Albright, Jennie Leikin, Michael Miloro, Michael R. Markiewicz
ObjectiveTo evaluate the complication rates for third molar extractions based upon resident level within an OMFS program, and identify the risk factors associated with postoperative complications following third molar extractions.Study DesignRecords of 1,992 subjects (5,466 third molar extractions) over a 5-year period were reviewed. The data was collected using appropriate CDT codes from July 1, 2011 – June 30, 2016. The cases were analyzed using demographic statistics, Pearson Chi-square test, and regression analysis.Results1,855 patients had sufficient data available for analysis and inclusion in the study. There were 146 adverse outcomes. The common complication was alveolar osteitis. Nerve injuries and retained root tips were encountered less frequently. There was a significant association between the depth of impaction and developing a postoperative complication. There was a direct correlation between the level of resident training and the likelihood of an adverse outcome.ConclusionThe study indicates that there are identifiable risk factors associated with postoperative complications following third molar extraction in an OMFS residency program. These factors include location, depth of impaction, use of a surgical drill, and level of resident training, which are correlated directly with the development of negative outcomes following third molar extractions.

http://ift.tt/2CbfgWW

Historical perspective and nomenclature of potentially malignant or potentially premalignant oral epithelial lesions with emphasis on leukoplakia; some suggestions for modifications

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Isaäc van der Waal
Of the potentially (pre)maligant oral epithelial lesions leukoplakia is the most common one. A brief overview is presented of the various definitions of leukoplakia that have been used in the past. A proposal has been made to adjust the presently existing definition. Clinically, leukoplakias have been subdivided for decades in homogeneous and non-homogeneous leukoplakias, being further divided in different subtypes. A proposal has been made to slightly rearrange these subtypes. Furthermore, attention has been paid to a number of keratotic lesions that have been reported in the literature.In view of the increasing knowledge on carcinogenesis, including the various genetic aspects, it is expected that this knowledge will be reflected in the definition of oral potentially (pre)malignant lesions in the near future.

http://ift.tt/2zObVHa

Mandibular pain, trismus, and weight loss in a 75-year-old man

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hiroshi Yamazaki, Takatsugu Suzuki, Yuya Denda, Yasuhiro Nakanishi, Masahiro Uchibori, Rena Kojima, Yusuke Kondo

http://ift.tt/2CbSBJW

Electromagnetic navigated condylar positioning after high oblique sagittal split osteotomy of the mandible: a guided method to attain pristine temporomandibular joint conditions?

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Moritz Berger, Igor Nova, Sebastian Kallus, Oliver Ristow, Urs Eisenmann, Hartmut Dickhaus, Michael Engel, Christian Freudlsperger, Jürgen Hoffmann, Robin Seeberger
ObjectivesReproduction of the exact preoperative proximal-mandible position after osteotomy in orthognathic surgery is difficult to achieve. This clinical pilot study evaluates an electromagnetic navigation (EM) system for condylar positioning after high oblique sagittal split osteotomy.Study DesignFollowing high oblique sagittal split osteotomy as part of two-jaw surgery, the position of ten condyles was intraoperatively guided by an EM navigation system. As a control, 10 proximal segments were positioned by standard manual replacement. Accuracy was measured by pre- and postoperative cone beam computer tomography imaging.ResultsOverall, EM condyle repositioning was equally accurate compared with manual repositioning (p>0.05). Subdivided into the three axis, significant differences could be identified (p<0.05). Nevertheless, no significantly and clinically relevant dislocations of the proximal segment of either the EM or the manual repositioning method could be shown (p>0.05).ConclusionThis pilot study introduces a guided method for proximal segment positioning, after high oblique sagittal split osteotomy, by applying the intraoperative EM system. The data demonstrate the high accuracy of EM navigation, although manual replacement of the condyles could not be surpassed. However, EM navigation can avoid clinically hidden, severe malpositioning of the condyles.

http://ift.tt/2zOvDTd

Treatment of enucleated odontogenic jaw cysts. a systematic review.

Publication date: Available online 29 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): M. Buchbender, F.W. Neukam, R. Lutz, C. Schmitt
ObjectivesIn this systematic review, we aimed to assess the impact of filling or not filling enucleated odontogenic jaw cysts on bony defect consolidation. In terms of filling we aimed to assess which is the best filling material based on current evidence.Study designAn electronic search was performed using PubMed, Embase, and Medline databases with the logical operators: "odontogenic cysts" AND "jaw cysts" AND "treatment AND therapy".ResultsThirteen studies with primary enucleation (6 with filling and 7 without filling) were included. In terms of filling either synthetic bone substitutes or autologous bone were used. The primary outcome was bony regeneration judged by radiographic follow-up measurements. 2D radiographic follow-up measurements (densitometry) revealed a bone density increase and comparable bone regeneration in both groups.ConclusionsDue to the low number of studies and the heterogeneity of the included data, evidence based treatment recommendations cannot be given at this time. Also outcomes based on 2D measurements should be interpreted with caution. However, the following factors are suggested having an impact on bony defect consolidation: defect size, defect configuration, the preservation of the periosteum and localization (upper or lower jaw). Prospective comparable clinical studies with a 3D follow-up are needed.

http://ift.tt/2CdWVrW

Location of the euryon in scaphocephalic vs. non-scaphocephalic controls: A novel assessment of cranial vault remodeling outcomes

We describe a novel measurement of cranial morphology in pre- and post-operative scaphocephalic patients to complement the cephalic index. This will better describe restoration of normal skull and head shape, further defining the nuances of the corrected skull. In this retrospective comparative study the location of the euryon on the skull was statistically significantly different in preoperative scaphocephalic patients versus non-scaphocephalic controls. This difference was resolved with surgical cranial vault remodeling, indicating restoration of a normal skull profile.

http://ift.tt/2lsaatS

Bioabsorbable plates versus metal miniplate systems for use in endoscope-assisted open reduction and internal fixation of mandibular subcondylar fractures

To compare bioabsorbable plates with metal miniplate systems for use in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondylar fractures.

http://ift.tt/2lmtdqj

Exposure of pregnant sows to deoxynivalenol during 35–70 days of gestation does not affect pathomorphological and immunohistochemical properties of fetal organs

Abstract

In order to evaluate the influence of deoxynivalenol (DON) on histomorphological and immunohistochemical parameters in the development of porcine fetuses, five pregnant sows were fed a control diet (0.15 mg DON/kg diet) and seven sows a contaminated diet (4.42 mg DON/kg diet) between days 35 and 70 of gestation. On day 70, fetuses were delivered by caesarean section and sows and fetuses were euthanized. Tissue samples of three fetuses from each sow were collected, fixed in formalin, and processed routinely for light microscopy and immunohistochemistry. At necropsy, no macroscopic lesions were observed in any organ of the fetuses. Histomorphological, immunohistochemical, and morphometrical parameters of the immune system, liver, and intestinal tract were examined. The following antibodies were used in the liver, spleen, lymph nodes, thymus, gut, and bone marrow to compare control- and DON-treated animals: (I) CD3 and CD79a (T and B lymphocytes differentiation); (II) myeloid/histiocyte antigen 387 (MAC) (identification of macrophages); (III) Ki-67 Antigen (Ki-67) (proliferation marker); (IV) p-p-38 mitogen-activated protein kinases (p-p38 MAPK) as well as caspase-3 (cas3) and caspase-9 (cas9) (enzymes of apoptosis cascade); (V) tumor necrosis factor-alpha (TNFα) (immune-related protein). The results of the study show that exposure of pregnant sows with DON between gestation days 35 and 70 causes no pathomorphologically or immunohistochemically detectable alterations in all fetal organs examined.

http://ift.tt/2Dz2u0G

Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature

Jugular bulb and sigmoid sinus anomalies are well-known causes of vascular pulsatile tinnitus. Common anomalies reported in the literature include high-riding and/or dehiscent jugular bulb, and sigmoid sinus dehiscence. However, cases of pulsatile tinnitus due to diverticulosis of the jugular bulb or sigmoid sinus are less commonly encountered, with the best management option yet to be established. In particular, reports on surgical management of pulsatile tinnitus caused by jugular bulb diverticulum have been lacking in the literature.

http://ift.tt/2pTseTu

Parental decisions for adolescent patients: ethical considerations of information withholding

http://ift.tt/2DxWfdk

Skin cancer in the military: a systematic review of melanoma and non-melanoma skin cancer incidence, prevention, and screening among active duty and veteran personnel

Occupational sun exposure is a well-studied risk factor for skin cancer development, but more work is needed to assess melanoma and non-melanoma skin cancer risk among U.S. military personnel to improve education and screening efforts in this population.

http://ift.tt/2DwUXiF

Cross-sectional assessment of ultraviolet radiation-related behaviors among young people after a diagnosis of melanoma or basal cell carcinoma

http://ift.tt/2CnKqqE

Efficacy of NBUVB, microneedling with triamiconolone acetonide and combination of both modalities in treatment of vitiligo: A comparative study

http://ift.tt/2CpuCnv

Applicability of EULAR/ACR Classification Criteria for Dermatomyositis to Amyopathic Disease

Existing classification systems for idiopathic inflammatory myopathies (IIM) fail to classify and/or diagnose patients with amyopathic dermatomyositis (ADM).

http://ift.tt/2Dy8Vks

Tacking Sutures to Shrink Surgical Defects near Free Margins

http://ift.tt/2Co4GZi

SPF 100+ sunscreen is more protective against sunburn than SPF 50+ in actual-use: Results of a randomized, double-blind, split-face, natural sunlight exposure, clinical trial

The value of additional photoprotection provided by use of high SPF sunscreens is controversial and limited clinical evidence exists.

http://ift.tt/2CoAMEo

MyD88-mediated innate sensing by oral epithelial cells controls periodontal inflammation

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Andrea E. Delitto, Fernanda Rocha, Ann M. Decker, Byron Amador, Heather L. Sorenson, Shannon M. Wallet
Periodontal diseases are a class of non-resolving inflammatory diseases, initiated by a pathogenic subgingival biofilm, in a susceptible host, which if left untreated can result in soft and hard tissue destruction. Oral epithelial cells are the first line of defense against microbial infection within the oral cavity, whereby they can sense the environment through innate immune receptors including toll-like receptors (TLRs). Therefore, oral epithelial cells directly and indirectly contribute to mucosal homeostasis and inflammation, and disruption of this homeostasis or over-activation of innate immunity can result in initiation and/or exacerbation of localized inflammation as observed in periodontal diseases. Dynamics of TLR signaling outcomes are attributable to several factors including the cell type on which it engaged. Indeed, our previously published data indicates that oral epithelial cells respond in a unique manner when compared to canonical immune cells stimulated in a similar fashion. Thus, the objective of this study was to evaluate the role of oral epithelial cell innate sensing on periodontal disease, using a murine poly-microbial model in an epithelial cell specific knockout of the key TLR-signaling molecule MyD88 (B6^{K5Cre.MyD88plox}). Following knockdown of MyD88 in the oral epithelium, mice were infected with Porphorymonas gingivalis and Aggregatibacter actinomycetemcomitans by oral lavage 4 times per week, every other week for 6 weeks. Loss of oral epithelial cell MyD88 expression resulted in exacerbated bone loss, soft tissue morphological changes, soft tissue infiltration, and soft tissue inflammation following polymicrobial oral infection. Most interestingly while less robust, loss of oral epithelial cell MyD88 also resulted in mild but statistically significant soft tissue inflammation and bone loss even in the absence of a polymicrobial infection. Together these data demonstrate that oral epithelial cell MyD88-dependent TLR signaling regulates the immunological balance within the oral cavity under conditions of health and disease.

http://ift.tt/2BSN8mZ

MyD88-mediated innate sensing by oral epithelial cells controls periodontal inflammation

Location of the euryon in scaphocephalic vs. non-scaphocephalic controls: A novel assessment of cranial vault remodeling outcomes

Publication date: Available online 29 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ryan Winters, Sherard A. Tatum
We describe a novel measurement of cranial morphology in pre- and post-operative scaphocephalic patients to complement the cephalic index. This will better describe restoration of normal skull and head shape, further defining the nuances of the corrected skull. In this retrospective comparative study the location of the euryon on the skull was statistically significantly different in preoperative scaphocephalic patients versus non-scaphocephalic controls. This difference was resolved with surgical cranial vault remodeling, indicating restoration of a normal skull profile. Additional measurements of the location of the euryon in relation to the forehead prominence, combined with validated cephalic index measurements, can further describe postoperative outcomes in scaphocephaly. More sensitive clinical measurements such as these can aid the craniofacial surgeon in assessing outcomes in cranial vault remodeling. Further, large-scale study is needed to determine if additional anterior skull metric points may be useful in documenting skull shape restoration.

http://ift.tt/2zMqhaS

Bioabsorbable plates versus metal miniplate systems for use in endoscope-assisted open reduction and internal fixation of mandibular subcondylar fractures

Publication date: Available online 29 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Dong-Yul Kim, Iel-Yong Sung, Yeong-Cheol Cho, Eun-ji Park, Jang-Ho Son
PurposeTo compare bioabsorbable plates with metal miniplate systems for use in endoscope-assisted open reduction and internal fixation (EAORIF) of mandibular subcondylar fractures.Materials and MethodsThis retrospective cohort study included patients with mandibular subcondylar fractures treated with EAORIF using bioabsorbable unsintered hydroxyapatite/poly L-lactide composite plates or titanium miniplate systems. The outcome variables included preoperative fracture conditions, postoperative stability during fracture healing, and complications during the follow-up period. Other variables included clinical characteristics (age, sex, fracture site, and total follow-up duration) and intra- and postoperative data (surgical duration, duration of intermaxillary fixation/elastic band guidance). Variables were evaluated using descriptive statistics and compared between groups using the Mann–Whitney test and the chi-square test or Fisher's exact test, as appropriate.ResultsIn total, 28 patients were analyzed, including 13 who underwent EAORIF using bioabsorbable plates and 15 who underwent EAORIF using titanium miniplates. With the exception of second surgery for plate removal, none of the assessed variables showed significant differences between the two groups (p < 0.05).ConclusionsOur results suggest that EAORIF using biodegradable plates is a stable and reliable method for the management of mandibular subcondylar fractures and eliminates the need for secondary surgery for plate removal.

http://ift.tt/2C8EsNH

Volumetric mandibular change after angle ostectomy and outer cortex grinding

Publication date: Available online 29 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Jingyi Zhao, Guodong Song, Xianlei Zong, Xiaonan Yang, Le Du, Xiaoshuang Guo, Chenzhi Lai, Zuoliang Qi, Xiaolei Jin
BackgroundMandibular angle ostectomy is one of the most common surgical procedures for facial contouring in Asian women. However, some patients complain about mandibular angle hypertrophy recurrence after surgery. The present study evaluated volumetric change of the mandible after angle ostectomy and outer cortex grinding.MethodsTwenty-four patients who underwent bilateral mandibular angle ostectomy and outer cortex grinding from 2013 to 2016 were enrolled. Three-dimensional computed tomography data were used to evaluate the preoperative, immediate postoperative, and long-term follow-up (≥12 months) volume of the mandible. The volumetric change between different groups was analyzed.ResultsThe results of software measurements showed that the preoperative mandible volume was significantly larger than immediate and long-term postoperative volumes (P = 0.000), and there was no significant difference between immediate and long-term postoperative mandibular volume (P > 0.05). Mean bone regeneration at long-term follow-up was 1.42% ± 3.84% for those who underwent mandibular angle ostectomy with outer cortex grinding alone and 1.69% ± 2.45% on the left and 2.59% ± 3.61% on the right sides of patients who underwent this procedure along with advancement genioplasty.ConclusionMandibular angle ostectomy can effectively change the facial contour to achieve a more oval-shaped face favored by most Asians. Postoperative bone remodeling is mostly regenerated, although bone absorption did occur. However, the mean bone volume did not reach preoperative levels, and the difference between preoperative and long-term postoperative bone volume at follow-up (≥12 months) was significant.

http://ift.tt/2zNkiTj

Causes of higher symptomatic airway load in patients with chronic rhinosinusitis

Chronic rhinosinusitis display a variety of different phenotypes. The symptoms of disease are characterised by various signs and symptoms such as nasal congestion, nasal discharge, pressure sensation in the fa...

http://ift.tt/2lsYJ5o

Reliability and validity study of Sino-nasal outcome test 22 (Thai version) in chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is one of common health conditions that affects patients' health-related quality of life. Our purpose is to assess the reliability and validity of Thai-version of Sino-Nasal Outcom...

http://ift.tt/2Eg0sUj

Pre-operative detailed coagulation tests are required in patients with Noonan syndrome

Publication date: Available online 29 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): A. Morice, A. Harroche, P. Cairet, R.-H. Khonsari
PurposePatients with Noonan syndrome often require surgery at early ages, They are at high risk of peri-operative bleeding due to coagulation defects that may not have been detected by routine screening. These risks are rarely described in the specific field of oral and maxillofacial surgery (OMS). The aim of our study was to evaluate the peri-operative bleeding risks associated with Noonan syndrome and to propose pre-operative guidelines.MethodsHere we report a retrospective case series of patients with Noonan syndrome who underwent oral and maxillofacial procedures during a continuous observational period (2013-2016) in our center. Clinical data, blood screening tests and peri-operative bleeding were analyzed.ResultsFive patients (aged 4-20) with Noonan syndrome who underwent OMS procedures were included into our study. One patient presented spontaneous bleeding tendency (epistaxis requiring cauterization). Blood screening revealed clotting defects in three patients. One patient presented abnormal peri-operative bleeding due to a mild defect in factor XI.ConclusionPatients with Noonan syndrome must be referred to a haematologist for specific pre-operative investigations and for adapted peri-operative management.

http://ift.tt/2DuF10A

Gamma-aminobutyric acid-B limbic encephalitis and asystolic cardiac arrest: a case report

Gamma-aminobutyric acid-B receptor autoantibodies are becoming an increasingly recognized contributor to the spectrum of autoimmune limbic encephalitis. They are classically associated with seizures and behavi...

http://ift.tt/2Efcdu6

Pulmonary arterial hypertension in a patient treated with dasatinib: a case report

There have been several reports on dasatinib-induced reversible pulmonary hypertension. This is the first reported case in Latvia; the patient did not discontinue the drug after the first adverse effects in th...

http://ift.tt/2pUTsZX

Cytotoxicity of propofol in human induced pluripotent stem cell-derived cardiomyocytes

Abstract

Purpose

Propofol infusion syndrome (PRIS) is a lethal condition caused by propofol overdose. Previous studies suggest that pathophysiological mechanisms underlying PRIS involve mitochondrial dysfunction; however, these mechanisms have not been fully elucidated. This study aimed to establish an experimental model of propofol-induced cytotoxicity using cultured human induced pluripotent stem cell (iPSC)-derived cardiomyocytes to determine the mechanisms behind propofol-induced mitochondrial dysfunction, and to evaluate the protective effects of coenzyme Q10 (CoQ10).

Methods

Human iPSC-derived cardiomyocytes were exposed to propofol (0, 2, 10, or 50 µg/ml) with or without 5 µM CoQ10. Mitochondrial function was assessed by measuring intracellular ATP, lactate concentrations in culture media, NAD⁺/NADH ratio, and the mitochondrial membrane potential. Propofol-induced cytotoxicity was evaluated by analysis of cell viability. Expression levels of genes associated with mitochondrial energy metabolism were determined by PCR. Intracellular morphological changes were analyzed by confocal microscopy.

Results

Treatment with 50 µg/ml propofol for 48 h reduced cell viability. High concentrations of propofol (≥ 10 µg/ml) induced mitochondrial dysfunction accompanied by downregulation of gene expression of PGC-1alpha and its downstream targets (NDUFS8 and SDHB, which are involved in the respiratory chain reaction; and CPT1B, which regulates beta-oxidation). Cardiomyocytes co-treated with 5 µM CoQ10 exhibited resistance to propofol-induced toxicity through recovery of gene expression.

Conclusions

Propofol-induced cytotoxicity in human iPSC-derived cardiomyocytes may be associated with mitochondrial dysfunction via downregulation of PGC-1alpha-regulated genes associated with mitochondrial energy metabolism. Co-treatment with CoQ10 protected cardiomyocytes from propofol-induced cytotoxicity.

http://ift.tt/2zMtB5V

Long-term effect of intensive prevention on dental health of primary school children by socioeconomic status

Abstract

Objectives

Children in a German region took part in regular toothbrushing with fluoride gel during their time in primary school after having received a preventive program in kindergarten. The study aimed at determining the dental health of the students as a function of prevention in kindergarten and at school while taking into account their socioeconomic status and other confounders.

Materials and methods

The subjects were in six groups: groups 1 and 2, intensive prevention in kindergarten with and without fluoride gel at school; groups 3 and 4, basic prevention in kindergarten with and without fluoride gel at school; groups 5 and 6, no organized prevention in kindergarten with and without fluoride gel at school. Two dental examinations were performed for assessing caries experience and calculating caries increment from second grade (7-year-olds) to fourth grade (9-year-olds). A standardized questionnaire was used to record independent variables. To compare caries scores and preventive measures of various subgroups, non-parametric tests and a binary logistic regression analysis were performed.

Results

A significant difference was found in the mean decayed, missing, and filled tooth/teeth (DMFT) depending on socioeconomic status (no prevention in kindergarten, fluoride gel at school in children with low SES: DMFT = 0.47 vs. DMFT = 0.18 in children with high SES; p = 0.023). Class-specific differences were no longer visible among children who had taken part in an intensive preventive program combining daily supervised toothbrushing in kindergarten and application of fluoride gel in school.

Conclusions

Early prevention, focusing on professionally supported training of toothbrushing in kindergarten and at school, has a positive effect on dental health and is able to reduce class-specific differences in caries distribution.

Clinical relevance

Early training of toothbrushing and fissure sealing of first permanent molars are the most important factors for the dental health of primary school children.

http://ift.tt/2pV8lv3

Anti-inflammatory and antiresorptive effects of Calendula officinalis on inflammatory bone loss in rats

Abstract

Objective

The aim of this work was to evaluate the anti-inflammatory and antiresorptive effects of Calendula officinalis (CLO) on alveolar bone loss (ABL) in rats.

Material and methods

Male Wistar rats were subjected to ABL by ligature with nylon thread around the second upper left molar. The contralateral hemimaxillae were used as control. Rats received saline solution (SAL) or CLO (10, 30, or 90 mg/kg) 30 min before ligature and daily until the 11th day. The maxillae were removed and prepared for macroscopic, radiographic, micro-tomographic, histopathologic, histometric analysis, and immunohistochemical localization of receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG). The gingival tissues were used to quantify the myeloperoxidase (MPO) activity, tumor necrosis factor-alpha (TNF-α), and interleukin-1β (IL-1β) concentrations by ELISA. Blood samples were collected for leukogram and to evaluate the bone-specific alkaline phosphatase (BALP) activity and serum levels of aspartate and alanine transaminases (AST/ALT).

Results

The bone loss induced by 11 days of ligature induced bone loss, reduced levels of BALP, leukocyte infiltration, increased MPO activity, gingival concentrations of TNF-α and IL-1β, and RANKL while reduced OPG immunoexpressions in the periodontal tissue and leukocytosis. Of the CLO, 90 mg/kg reduced bone loss, neutrophilia, the levels of pro-inflammatory mediators, and RANKL expression, while it increased OPG immunopositive cells and BALP serum levels, when compared to SAL. CLO did not affect either kidney or liver function, indicated by serum AST/ALT levels.

Conclusion

The present data suggests that CLO reduced inflammatory bone resorption in experimental periodontitis, which may be mediated by its anti-inflammatory properties and its effects on bone metabolism.

Clinical relevance

CLO can be a potential therapeutical adjuvant in the treatment of periodontitis.

http://ift.tt/2zLXsLW

X-ray diffraction analysis of MTA mixed and placed with various techniques

Abstract

Objectives

The aim of this study was to evaluate the effect of various mixing techniques as well as the effect of ultrasonic placement on hydration of mineral trioxide aggregate (MTA) using X-ray diffraction (XRD) analysis.

Materials and methods

One gram of ProRoot MTA and MTA Angelus powder was mixed with a 0.34-g of distilled water. Specimens were mixed either by mechanical mixing of capsules for 30 s at 4500 rpm or by manual mixing followed by application of a compaction pressure of 3.22 MPa for 1 min. The mixtures were transferred into the XRD sample holder with minimum pressure. Indirect ultrasonic activation was applied to half of the specimens. All specimens were incubated at 37 °C and 100% humidity for 4 days. Samples were analyzed by XRD. Phase identification was accomplished by use of search-match software utilizing International Centre for Diffraction Data (ICDD).

Results

All specimens comprised tricalcium silicate, calcium carbonate, and bismuth oxide. A calcium hydroxide phase was formed in all ProRoot specimens whereas among MTA Angelus groups, it was found only in the sample mixed mechanically and placed by ultrasonication.

Conclusions

Mechanical mixing followed by ultrasonication did not confer a significant disadvantage in terms of hydration characteristics of MTA.

Clinical relevance

Clinicians vary in the way they mix and place MTA. These variations might affect their physical characteristics and clinical performance. For ProRoot MTA, the mixing and placement methods did not affect its rheological properties, whereas for MTA Angelus, mechanical mixing combined with ultrasonic placement enhanced the calcium hydroxide phase formation.

http://ift.tt/2Ecn1Ji

Radiotherapy With Pembrolizumab in Metastatic HNSCC

Condition: Head and Neck Squamous Cell Carcinoma
Interventions: Combination Product: A (pembrolizumab+RT); Drug: B (pembrolizumab)
Sponsor: University of Erlangen-Nürnberg Medical School
Not yet recruiting

http://ift.tt/2lj4YcS

An Immuno-therapy Study of Nivolumab in Combination With Experimental Medication BMS-986205 Compared to Standard of Care EXTREME Regimen in First-line Recurrent/Metastatic Squamous Cell Carcinoma of Head and Neck

Condition: Head and Neck Cancer
Interventions: Biological: Nivolumab; Drug: BMS-986205; Biological: Cetuximab; Drug: Cisplatin; Drug: Carboplatin; Drug: Fluorouracil
Sponsor: Bristol-Myers Squibb
Not yet recruiting

http://ift.tt/2ltqOts

Living in lower income zip codes is associated with more severe chronic rhinosinusitis

Publication date: Available online 28 December 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Christopher D. Codispoti, David E. Tapke, Phillip S. LoSavio, Pete S. Batra, Mahboobeh Mahdavinia

http://ift.tt/2BSYmIr

Mevalonate kinase deficiency presenting as recurrent rectal abscesses and perianal fistulae

Publication date: Available online 28 December 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Kara Dunn, Brad Pasternak, Judith R. Kelsen, Kathleen E. Sullivan, Noor Dawany, Benjamin L. Wright

http://ift.tt/2Cl08VU

Risk factors and clinical outcomes associated with fixed airflow obstruction in older adults with asthma

Publication date: Available online 28 December 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Gregory H. Bennett, Laurie Carpenter, Wei Hao, Peter Song, Joel Steinberg, Alan P. Baptist
BackgroundAsthma in older adults is associated with increased morbidity and mortality compared with asthma in younger patients. Fixed airflow obstruction (FAO) is associated with decreased survival in younger patients, but its significance remains unclear in older adults with asthma.ObjectiveTo identify risk factors and outcomes related to FAO in older adults with asthma.MethodsSubjects older than 55 years with a physician diagnosis of persistent asthma were evaluated. Collected data included participant demographic information, medications, asthma exacerbations, Asthma Control Test (ACT) score, Asthma Quality of Life (AQLQ) score, comorbidities, spirometry, atopic status, and fractional exhaled nitric oxide. Clinical characteristics and outcomes associated with FAO (defined as post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity ≤70%) were assessed.ResultsA total of 186 participants were analyzed (48 men and 138 women, mean age 66 years). FAO was demonstrated in 30% of participants. Using regression analysis, predictors of FAO included advanced age, African American race, male sex, and longer duration of asthma. In outcomes analysis, FAO was associated with worsened ACT and AQLQ scores; however, after controlling for confounding factors, logistic regression showed no association. No significant association was found between FAO and exacerbations, fractional exhaled nitric oxide, atopy, rhinitis, education level, depression, smoking, or body mass index.ConclusionRisk factors associated with FAO in older adults with asthma include advanced age, African American race, increased asthma duration, and male sex. Unlike younger patients, FAO is not independently associated with worsened asthma control, quality of life, or exacerbations in older patients with asthma.Trial RegistrationClinicalTrials.gov identifier: NCT01979055.

http://ift.tt/2lra31X

Efficacy of omalizumab treatment in a man with occupational asthma and eosinophilic granulomatosis with polyangioitis

Publication date: Available online 28 December 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Cristiano Caruso, Giorgia Gencarelli, Francesco Gaeta, Rocco Luigi Valluzzi, Gabriele Rumi, Antonino Romano

http://ift.tt/2CiQcMM

Impact of alcohol dehydrogenase-aldehyde dehydrogenase polymorphism on clinical outcome in patients with hypopharyngeal cancer

Abstract

Background

The purpose of this research was to investigate the association between alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2) polymorphisms and hypopharyngeal squamous cell carcinoma (SCC) survival.

Methods

We genotyped ADH1B (rs1229984) and ALDH2 (rs671) single nucleotide polymorphisms (SNPs) in 85 Japanese male patients with hypopharyngeal SCC. The independent prognostic values of ADH1B-ALDH2 genotypes were analyzed by univariate and multivariate proportional hazard Cox regression, taking well-known clinical risk factors into account.

Results

Heavy drinkers with ALDH2*2 allele resulted in significantly worse overall survival (OS; P = .028) and disease-free survival (DFS; P = .029) compared with other patients. Heavy drinkers with ALDH2*2 allele remained statistically significant in multivariate analysis for OS and DFS, indicating independent poor prognostic factor (hazard ratio [HR] 2.251; 95% confidence interval [CI] 1.018-4.975 and HR 2.261; 95% CI 1.021-5.006, respectively).

Conclusion

We conclude that heavy drinkers with the ALDH2*2 allele are associated with poor outcome in hypopharyngeal SCC.

http://ift.tt/2BROfUb

Computer-aided system for diagnosing thyroid nodules on ultrasound: A comparison with radiologist-based clinical assessments

Abstract

Background

The purpose of this study was to compare the diagnostic efficiency of a thyroid ultrasound computer-aided diagnosis (CAD) system with that of 1 radiologist.

Methods

This study retrospectively reviewed 342 surgically resected thyroid nodules from July 2013 to December 2013 at our center. The nodules were assessed on typical ultrasound images using the CAD system and reviewed by 1 experienced radiologist. The radiologist stratified the risk of malignancy using the Thyroid Imaging Reporting and Data Systems (TIRADS) and the American Thyroid Association (ATA) guidelines.

Results

The radiologist, using TI-RADS and ATA guidelines, performed better than the CAD system (P < .01). The sensitivity of the CAD system was similar to that of an experienced radiologist (P > .05; P < .01; and P > .05). However, we found that the CAD system had lower specificity (P < .01).

Conclusion

The sensitivity of a thyroid ultrasound CAD system in differentiating nodules was similar to that of an experienced radiologist. However, the CAD system had lower specificity.

http://ift.tt/2CkgrCq

In vitro biofilm growth on modern voice prostheses

Abstract

Background

Biofilm formation on voice prostheses in laryngectomized patients usually limits the lifetime of the device. The purpose of this study was to compare the biofilm resistance of different valve flaps of modern voice prostheses in an in vitro simulation of an oropharyngeal biofilm.

Methods

Growth of biofilm deposits on valve flaps (n = 12) removed from Provox 2, Provox Vega, Provox ActiValve, Blom Singer Advantage, and Phonax voice prostheses was evaluated and compared to medical-grade silicone (n = 12) in an in vitro biofilm model (22 days) after incubation with a multispecies bacterial-fungal biofilm composition.

Results

The Provox ActiValve and the Blom Singer Advantage prostheses showed significantly less surface biofilm formation than the other prostheses and then silicone.

Conclusion

The use of silver oxide and Teflon as valve flap materials proves to reduce long-term biofilm formation in vitro. The applied model allows rapid screening for novel biofilm-inhibitive materials and durable coatings designated for more biofilm resistant medical devices.

http://ift.tt/2BWmiup

Leiomyosarcoma of the head and neck: A 17-year single institution experience and review of the National Cancer Data Base

Abstract

Background

Leiomyosarcoma is a rare neoplasm of the head and neck. The purpose of this study was to present our single-institution case series of head and neck leiomyosarcoma and a review of cases in the National Cancer Data Base (NCDB).

Methods

Patients with head and neck leiomyosarcoma at the University of Pennsylvania and in the NCDB were identified. Demographic characteristics, tumor factors, treatment paradigms, and outcomes were evaluated for prognostic significance.

Results

Nine patients with head and neck leiomyosarcoma from the institution were identified; a majority had high-grade disease and cutaneous leiomyosarcoma, with a 5-year survival rate of 50%. Two hundred fifty-nine patients with leiomyosarcoma were found in the NCDB; macroscopic positive margins and high-grade disease were associated with poor prognosis (P < .01), and positive surgical margins were related to adjuvant radiation (P < .001).

Conclusion

Head and neck leiomyosarcoma presents at a high grade and is preferentially treated with surgery. Several demographic and tumor-specific factors are associated with outcomes and prognosis.

http://ift.tt/2Cm6VyE

Pityriasis rubra pilaire

Publication date: Available online 28 December 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): S. Quenan, E. Laffitte
Le pityriasis rubra pilaire est une dermatose hétérogène rare qui associe trois éléments sémiologiques à divers degrés : une papule cornée folliculaire, une kératodermie palmoplantaire orangée et des lésions érythématosquameuses parfois très étendues, avec des intervalles de peau saine. L'origine est peu claire, avec dans la majorité des cas des facteurs déclenchants traumatiques ou infectieux, probablement sur un terrain prédisposé. Dans d'autres cas, on retrouve une association à des désordres immunologiques ou bien dans des cas familiaux des anomalies génétiques de la kératinisation proches d'une ichtyose. Devant la grande variabilité sémiologique, plusieurs classifications ont été proposées, sur des critères cliniques et évolutifs. L'évolution est variable en fonction des formes cliniques. La prise en charge thérapeutique est mal codifiée et il n'y a pas d'essai thérapeutique disponible du fait de la rareté de la maladie. Les meilleurs résultats semblent cependant être obtenus avec les rétinoïdes oraux, avec en seconde ligne le méthotrexate et la ciclosporine. Les nouveaux inhibiteurs du tumor necrosis factor et les anti-interleukines 12/23 semblent changer la stratégie thérapeutique.Pityriasis rubra pilaris is a rare heterogeneous dermatosis associating three clinical signs to different degrees: follicular corneal papules, reddish-orange palmoplantar keratoderma and erythematosquamous lesions that may in some cases be very extensive, interspersed with patches of healthy skin. The aetiology is unclear, and in most cases, the trigger factors consist of trauma or infection, probably in subjects with an existing predisposition. In other cases, the condition is associated with immunological disorders or, in familial cases, genetic keratinisation abnormalities similar to ichthyosis. Given the widely varying signs, several classifications have been proposed, based on clinical criteria and outcomes. The outcome varies in accordance with the clinical forms involved. Therapeutic approaches are poorly qualified and there have been no clinical trials due to the rarity of the disease. However, the best results appear to have been obtained using oral retinoids, with second-line therapy comprising methotrexate and cyclosporine. The landscape of therapeutic strategy seems to be changing with the advent of new anti-tumour necrosis factor and anti-interleukin-12/23 antibodies.

http://ift.tt/2pUa18f

Αρχειοθήκη ιστολογίου

Σάββατο 30 Δεκεμβρίου 2017

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Παρασκευή 29 Δεκεμβρίου 2017

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