Head and Neck Medicine by Alexandros G.Sfakianakis: 01/13/17

Παρασκευή 13 Ιανουαρίου 2017

Chapter 7 Rye: Grain-Quality Characteristics and Management of Quality Requirements

Publication date: 2017
Source:Cereal Grains
Author(s): Colin Wrigley, Walter Bushuk
Rye is an important crop in regions where rye breads are popular, especially in Poland, Germany, Russia, Belarus and Ukraine. However, world rye production is only about 3% that of wheat. Traditional rye bread is made exclusively from rye flour or rye wholemeal, but rye bread is more often made from a grist of wheat and rye flours, because of the need for wheat gluten to compensate for the weakness of rye gluten. Nevertheless, the analytical and management procedures for rye are similar to those for wheat. Nutritionally, the thick cell walls of rye aleurone and endosperm cells are a rich source of fibre, including pentosans and β-glucan.

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The role of bone marrow aspirate cells in the management of atrophic mandibular fractures by mini-invasive surgical approach: Single-institution experience

The treatment of fractures involves addressing the biology of fracture repair and the mechanical stability of fracture fixation. Traditionally it has included the addition of bone graft to enhance healing. New advances in the understanding of the cellular and molecular mechanisms of fracture repair have led to the use of growth factors to accelerate bone healing. This study aimed to assess the advantages of autologous stem cell use for atrophic mandibular fracture treatment in comparison to standard technique.

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Presentation of a Conserved Adenoviral Epitope on HLA-C*0702 Allows Evasion of Natural Killer but Not T Cell Responses

Viral Immunology , Vol. 0, No. 0.

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Distribution of RET Mutations in Multiple Endocrine Neoplasia 2 in Denmark 1994–2014: A Nationwide Study

Thyroid , Vol. 0, No. 0.

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Risks in surgery-first orthognathic approach: complications of segmental osteotomies of the jaws. A systematic review

OBJECTIVE: To date, no systematic review has been undertaken to identify the complications of segmental osteotomies. The aim of the present systematic review was to analyze the type and incidence of complications of segmental osteotomies, as well as the time of subjective and/or clinical onset of the intra- and post-operative problems.

MATERIALS AND METHODS: A search was conducted in two electronic databases (MEDLINE – Pubmed database and Scopus) for articles published in English between 1 January 2000 and 30 August 2015; only human studies were selected. Case report studies were excluded. Two independent researchers selected the studies and extracted the data. Two studies were selected, four additional publications were recovered from the bibliography search of the selected articles, and one additional article was added through a manual search.

RESULTS: The results of this systematic review demonstrate a relatively low rate of complications in segmental osteotomies, suggesting this surgical approach is safe and reliable in routine orthognathic surgery.

CONCLUSIONS: Due to the small number of studies included in this systematic review, the rate of complication related to surgery first approach may be slightly higher than those associated with traditional orthognathic surgery, since the rate of complications of segmental osteotomies must be added to the complication rate of basal osteotomies. A surgery-first approach could be considered riskier than a traditional one, but further studies that include a greater number of subjects should be conducted to confirm these findings.

L'articolo Risks in surgery-first orthognathic approach: complications of segmental osteotomies of the jaws. A systematic review sembra essere il primo su European Review.

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Erratum to: Abstracts

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An Interleukin 12 Adjuvanted Herpes Simplex Virus 2 DNA Vaccine Is More Protective Than a Glycoprotein D Subunit Vaccine in a High-Dose Murine Challenge Model

Viral Immunology , Vol. 0, No. 0.

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Hypermethylation of IFN-γ in oral cancer tissues

Abstract

Objectives

The study aimed to evaluate the methylation pattern of the interferon-gamma (IFN-γ) gene in oral cancer tissues compared with normal and benign oral disease tissues.

Materials and methods

The oral tissues were gained from the patients of 85 cases of oral squamous cell carcinoma (OSCC), 47 cases of oral dysplastic lesions, and 53 normal biopsies. IFN -γ methylation in oral tissues was verified through methylation-specific polymerase chain reaction (PCR) and DNA sequencing analyses, and the expression levels of IFN-γ messenger RNA (mRNA) and protein were detected using real-time reverse transcription (RT)-PCR and enzyme-linked immunosorbent assays, respectively. IFN-γ was localized in macrophages from oral tissues and detected via immunostaining.

Results

IFN-γ mRNA and protein expression levels were evidently decreased in oral cancer tissues, whereas the IFN-γ methylation rate was significantly higher in malignant tumors than in benign and normal tissues (normal, 22.6%; benign, 38.3%; and cancer, 55.3%; P < 0.05). Furthermore, the expression of IFN-γ mRNA was significantly downregulated in oral tumors with methylation compared with tumors without methylation, as determined by real-time RT-PCR (4.76-fold difference; P < 0.05). Likewise, mRNA expression was downregulated by 6.79-fold in oral epithelial dysplasia tissues with methylation compared with those without methylation (P < 0.01). Co-immunostaining to detect MAC2 and IFN-γ demonstrated that macrophages comprised the main source of IFN-γ in oral tissues. IFN-γ methylation demonstrated a significant association with the clinical stage, histopathology grade, and primary tumor.

Conclusions

Aberrant IFN-γ promoter methylation may be involved in the process of tumorigenesis of oral cancer.

Clinical relevance

IFN-γ hypermethylation during the process of oral carcinogenesis could be useful for the clinical diagnosis and treatment for OSCC.

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The influence of dental treatment on the development of osteoradionecrosis after radiotherapy by modern irradiation techniques

Abstract

Objectives

The aim of this study was to analyze the influence of dental treatment on the development of osteoradionecrosis (ORN) of the jaw.

Methods

This study included the data of 776 patients who underwent 3D-CRT or IMRT because of head and neck cancer. Sex, dental status before and after radiotherapy (RT), tumor site, bone surgery during tumor operation, concomitant chemotherapy, and the development of an advanced ORN were documented for each patient. The patients' dentitions before and after RT were classified into four groups with regard to the number and localization of the remaining teeth. Differences between the patients with ORN and patients without ORN with regard to the teeth's condition before and after RT, and with regard to the extent of dental treatment were determined descriptively. Cox proportional hazards regression to study the association between dentition and the development of ORN.

Results

The extent of dental treatment in patients with and without ORN did not differ in a clinically relevant way. The highest risk of developing ORN was observed in patients who had undergone primary bone surgery during the tumor operation (HR = 5.58, 95%CI 2.91–10.7) and patients who had a tumor in the oral cavity (HR = 4.84, 95%CI 1.37–17.11).

Conclusions

Based on the results of this study, tumor localization and its required treatment are prognostic factors for the development of ORN.

Clinical significance

After implementing a consequent dental treatment scheme, no influence of dentition on the risk of developing ORN could be demonstrated. Patients with a lower risk could prospectively benefit from a more moderate dental treatment scheme.

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The effect of veneering on the marginal fit of CAD/CAM-generated, copy-milled, and cast metal copings

Abstract

Objective

This in vitro study investigated the marginal fit of metal and zirconia copings before and after veneering on dies with shoulder/chamfer (s/c) finish lines.

Materials and methods

Using CAD/CAM, ten (n = 10) each s/c zirconia (NZ) copings and ten (n = 10) each s/c metal (MM) copings were generated. As controls, ten (n = 10) each s/c zirconia copings were copy-milled (ZZ) and ten (n = 10) each s/c metal copings were cast (CC). The vertical marginal discrepancy of the copings was measured at 20 predefined spots of the circular shoulder and chamfer finish lines in microns (μm) before and after a first and a second veneering firing using a stereomicroscope at ×40 magnification. Data were statistically analyzed, and the comparisons of CAD/CAM-milled (NZ, MM), copy-milled (ZZ), and cast (CC) copings before and after veneering were made at a significance level of p < 0.05.

Results

Gap width at s/c finish lines of ZZ was (91 ± 11/100 ± 28) and increased significantly (109 ± 21/141 ± 18) after the first firing (ZZ1). NZ showed significantly smaller gaps than ZZ (36 ± 6/46 ± 12) and (NZ1) after the first firing (61 ± 16/71 ± 29). Gap widths of CC groups (36 ± 8/25 ± 4) were not significantly different from NZ but were significantly lower after the (CC1) first veneering firing (40 ± 8/42 ± 7). MM copings showed gap values similar to NZ. Second firings did not significantly increase gaps in all groups except ZZ2 of chamfer finish line.

Conclusion

Veneering increased the marginal gap width of copings.

Clinical relevance

Within the limits of this in vitro study, aesthetic ceramic veneering of CAD/CAM-generated copings caused a statistically significant but tolerable loss of marginal fit precision.

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Woman Who Acquired Zika Locally in US Had Unusual Rash

Reddish macules and papules were spread across her abdomen, back, and arms, with pink papules on her palms and petechiae on her hard palate.
Medscape Medical News

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Editorial Board

Publication date: January 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 1

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Reviewer thank you list

Publication date: January 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 1

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Prognostic impact of the level of nodal involvement: retrospective analysis of patients with advanced oral squamous cell carcinoma

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Publication date: January 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 1
Author(s): R. Murakami, H. Nakayama, A. Semba, A. Hiraki, M. Nagata, K. Kawahara, S. Shiraishi, T. Hirai, H. Uozumi, Y. Yamashita
We retrospectively evaluated the prognostic impact of the level of nodal involvement in patients with advanced oral squamous cell carcinoma (SCC). Between 2005 and 2010, 105 patients with clinical stage III or IV oral SCC had chemoradiotherapy preoperatively. Clinical (cN) and pathological nodal (pN) involvement was primarily at levels Ib and II. We defined nodal involvement at levels Ia and III–V as anterior and inferior extensions, respectively, and recorded such findings as extensive. With respect to pretreatment variables (age, clinical stage, clinical findings of the primary tumour, and nodal findings), univariate analysis showed that extensive cN was the only significant factor for overall survival (hazard ratio [HR], 3.27; 95% CI 1.50 to 7.13; p=0.001). Univariate analysis showed that all pN findings, including the nodal classification (invaded nodes, multiple, and contralateral) and extensive involvement were significant, and multivariate analysis confirmed that extensive pN (HR 4.71; 95% CI 1.85 to 11.97; p=0.001) and multiple pN (HR 2.59; 95% CI 1.10 to 6.09; p=0.029) were independent predictors of overall survival. Assessment based on the level of invaded neck nodes may be a better predictor of survival than the current nodal classification.

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Training Groups

Publication date: January 2017
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 1

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Primary malignant melanoma of the middle ear mucosa: A case report

Publication date: Available online 13 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Anuar Idwan Idris, Mohd Khairi Daud, Zulkifli Yusof, Masaany Mansor
Malignant melanoma is a neoplasm of melanocytes or a neoplasm of the cells that develop from melanocytes. Primary mucosal melanomas of the head and neck are very uncommon as it only represents less than two percent out of all melanomas. Surgery remained as a definitive treatment for early-stage melanoma, with medical management generally reserved for adjuvant treatment of advanced melanoma. Here we report a very rare case of a malignant melanoma of the middle ear mucosa with no other primary site.

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Spontaneous Intraventricular Pneumocephalus.

Backgroud: Pneumocephalus without a known underlying cause is defined as spontaneous pneumocephalus. Few patients of intraventricular pneumocephalus have been reported. Patient Presentation: An 84-year-old man presented with dysarthria and incontinence. Computed tomography revealed an intraventricular pneumocephalus, thinning in the petrous bone, fluid in the air cells, and cleft in temporal lobe. A right subtemporal extradural approach was taken to detect bone-/-dural defects, and a reconstruction was performed using a musculo-pericranial flap. Conclusion: This is the first patient of an isolated intraventricular spontaneous pneumocephalus without any other site air involved. Surgical approaches to repair such bone and dura defects should be considered an appropriate option. (C) 2017 by Mutaz B. Habal, MD.

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Quantitative Correlation Between Hyaluronic Acid Filler and Hyaluronidase.

The hyaluronic acid-based filler (HA filler) is used worldwide in various applications. In particular, the HA filler is used in the plastics and cosmetic medical field for facial rejuvenation and contouring. In this setting, it is injected into the skin or underlying tissue. Complications of HA filler injection have been relieved using hyaluronidase. However, there is no standard dose to adjust for undesirable HA filler lumpness. In this study, the authors tried to analyze any quantitative correlation between HA filler and hyaluronidase. The back of each rat (total 14 rats) was divided into 4 sites. A volume of 0.5 mL HA filler was injected into the subdermal layer at each site and HA filler nodules were created on the dorsum of each rat. Each nodule was allocated to groups 1, 2, 3, and 4 according to the different concentrations of hyaluronidase. As a result, the injected HA filler volume doubled within 4 days of injection, and then decreased slowly thereafter in group 1 (control group with normal saline only). A 30 unit hyaluronidase treatment compensated for the initial volume increase (approximately 30%) with HA filler (0.5 ml) at the fourth day. Sixty units of hyaluronidase reduced the initial volume (0.5 mL) of overinjected or misplaced HA filler on the fourth day. Approximately 90 units of hyaluronidase can reduce to the volume by 0.25 mL (50%) of the injected HA filler on the fourth day. The authors believe that this quantitative analysis of hyaluronidase concentration is helpful to plan the amount of hyaluronidase for correction of HA filler injection errors. (C) 2017 by Mutaz B. Habal, MD.

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Development of One-Step Drill-Tap for a Resorbable Screw.

No abstract available

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Review of "The Future of the ACA and Health Care Policy in the United States" by Wilensky GR in JAMA 317: 21-22, 2017.

No abstract available

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Use of Pedicled Buccal Fat Pad for Cranial Base Reconstruction.

Craniofacial reconstruction for closure of skull base defects after removal of anterior cranial base lesions is challenging. Persistent skull base defect produces extremely high risk of cerebrospinal fluid leaks and consecutive infectious complications. The authors' article focuses on the use of pedicled buccal fat pad for the reconstruction of anterior cranial base defects using combined endoscope-assisted approach and Lefort I access osteotomy. High effectiveness and minimal invasiveness are principal advantages of the technique. Other benefits include proximity of donor site to defect, simplicity of surgical technique, minimal postoperative discomfort, and very low risk of benign complications. Local pedicled grafts are the preferred material for plasty, adding aesthetic results in an ablative surgery using intraoral incision and access osteotomy. Thus, the technique solves the problem of relying on complex alloplastic reconstruction of anterior craniobasal defects. (C) 2017 by Mutaz B. Habal, MD.

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Laparoscopic Free Omental Flap for Craniofacial Reconstruction: A Video Article Demonstrating Operative Technique and Surgical Applications.

The omental flap is a well described pedicled flap for surgical reconstruction of multiple body locations. As a laparoscopically harvested free flap, the omentum offers a minimally invasive solution to many reconstructive problems including extremity and head and neck wounds. This video article highlights the operative technique involved in flap harvest and inset for a cranial defect. An illustrative case involving a 23-year-old female's traumatic scalp degloving injury that was resurfaced by free omental flap and split-thickness skin graft is presented. This patient had stable long-term wound coverage for a very severe injury. Through video media we demonstrate that the laparoscopically harvested free omental flap is a minimally invasive, 2-team operation that provides soft tissue coverage of severe, remote wounds. This video demonstrates a safe operative technique and nuances specific to laparoscopic harvest of this flap. (C) 2017 by Mutaz B. Habal, MD.

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Endoscopic-Assisted Palatal Surgery Via Transoral and Intranasal Approach.

Palate carcinoma often challenges to the treatment options. It depends on the histologic type, local invasion, and nodal or distant metastasis. Hard palate tumors that invade the nasal cavity can be operated by midfacial degloving approach, lateral rhinotomy approach, and lip splitting incision with infrastructure maxillectomy. These approaches inevitably coincide with facial scars, nerve injuries, facial swelling, and long hospital stay. Transoral robotic assisted surgery can be applied; however, this needs high price and has a weakness of accurate handling about intranasal lesion. The authors have performed transoral and intranasal endoscopic-assisted palatal removal of recurrent palatal carcinoma for a patient and herein report their technique and result. (C) 2017 by Mutaz B. Habal, MD.

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Review of "Revised CIOMS International Ethical Guidelines for Health-Related Research Involving Humans" by van Delden JJ and van der Graaf R in JAMA published online ahead of print December 6, 2016, doi 10.1001/jama.2016.18977

No abstract available

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The Use of Double-Layer Collagen Membrane for the Improvement of Nasal Dorsum Skin Thickness and Texture in Primary Nose Surgery.

Objectives: To place a collagen membrane containing crushed nasal septal cartilage over the nasal dorsum to see how this graft can improve the results of visible postsurgical irregularities in thin skinned patients. Methods: Fifty-seven patients were treated between 2006 and 2010 (26 males and 31 females) whose ages ranged between 31 and 55 years old. They were divided into group a, defect 3 mm. These patients presented intraoperative nasal dorsum irregularities that were corrected with 57 cartilage grafts in conjunction with collagen membrane. Results: All of our patients showed an initial over-correction. A dense network of collagen fiber bundles was observed running parallel to the surface of the membrane at the connective tissue-membrane interface. The clinical percentage of volume reabsorption was about 5% after 6 months, measured with clinical pictures and a clinical follow-up. No infection was noted, only 1 patient of dislocation was observed, and 5 patients required some refinements at the long-term follow-up. Conclusions: In the authors' experience the use of bilayered combined cartilage and collagen membrane grafts gives the best aesthetic results with balanced tip projection and dorsum fullness, and avoids thickness and texture modification of the skin above the graft. The use of Bio-gide membrane avoids all problems related to the donor site and shortens surgical time. (C) 2017 by Mutaz B. Habal, MD.

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Essentials of Our Current Understanding: Abdominal Wall Blocks.

Abdominal wall blocks rely on the spread of local anesthetic within musculofascial planes to anesthetize multiple small nerves or plexuses, rather than targeting specific nerve structures. Ultrasonography is primarily responsible for the widespread adoption of techniques including transversus abdominis plane and rectus sheath blocks, as well as the introduction of novel techniques such as quadratus lumborum and transversalis fascia blocks. These blocks are technically straightforward and relatively safe and reduce pain and opioid requirements in many clinical settings. The data supporting these outcomes, however, can be inconsistent because of heterogeneity of study design. The extent of sensory blockade is also somewhat variable, because it depends on the achieved spread of local anesthetic and the anatomical course of the nerves being targeted. The blocks mainly provide somatic analgesia and are best used as part of a multimodal analgesic regimen. This review summarizes the anatomical, sonographic, and technical aspects of the abdominal wall blocks in current use, examining the current evidence for the efficacy and safety of each. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Reporting of Design Features and Analysis Details in Randomized Clinical Trials of Procedural Treatments for Cancer Pain: An ACTTION Systematic Review.

Background and Objectives: The objective of this study was to assess the reporting of randomized clinical trials investigating procedural treatments (eg, nerve blocks, targeted drug delivery) for cancer pain, with a focus on aspects that are particularly challenging in these trials. Methods: This article presents results from a systematic review of reporting of randomized clinical trials of procedural interventions for cancer pain. Articles were identified by searching PubMed from 1966 to June 2014. Data related to quality of reporting are presented for early (1985-2004) and late periods (2005-2014). Results: A total of 35 published trials were included. Approximately two-thirds of the articles clearly indicated the level of blinding. Only 26% reported a primary outcome measure. Less than half explicitly reported the number of patients who completed the trial, and only 1 reported a method that was used to accommodate missing data. Almost one-third of articles included a responder analysis, all of which specified the definition of a responder. Conclusions: The goal of highlighting these deficiencies in reporting is to promote transparent reporting of details affecting the completion and interpretation of procedural cancer pain trials so that their quality can be more easily evaluated. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Subcutaneous immunization with Streptococcus pneumoniae GAPDH confers effective protection in mice via TLR2 and TLR4

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Xiaoyu Sun, Jichao Wang, Jie Zhou, Hong Wang, Xiaofang Wang, Jingwen Wu, Yujuan He, Yibing Yin, Xuemei Zhang, Wenchun Xu
The surface localized Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) of Streptococcus pneumoniae is best known as housekeeping protein. Currently, GAPDH has been recognized as moonlighting protein and virulent factor. Therefore, we investigate whether GAPDH can act as a suitable vaccine candidate protein to prevent pneumococcal infection. In this study, mice received subcutaneous vaccination with recombinant GAPDH followed by challenge with D39 and 19F showing higher survival rate and lower bacterial loads in nasal washes and lung homogenates than control. Meanwhile, high titers of rGAPDH specific antibody and elevated titers of IgG subtype indicated that rGAPDH could elicit immune response in mice. Then, we investigated the mechanism that immunization with rGAPDH conferred protection against Streptococcus pneumoniae in host. In vitro experiments, rGAPDH induced phenotypic and functional maturation of BMDCs, because the high expression of CD40, CD86 and MHC II and the production of IL-12p70, IL-6 and TNF-α were observed after treatment with rGAPDH. However, the costimulatory molecules and cytokines declined significantly in TLR2^−/− and TLR4^−/− mice, indicating rGAPDH can be a potential ligand for both TLR2 and TLR4. Subsequent investigations suggested that rGAPDH could also activate the phosphorylation of MAPKs, PI3K-Akt and NF-κB. Meantime, upregulation of mir-146a and downregulation of mir-27a in BMDCs were observed. Taken together, our findings confirm that rGAPDH, a housekeeping protein, is also qualified as a vaccine candidate protein and rGAPDH activates BMDCs in a TLR2 and TLR4 dependent manner.

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A novel combination treatment to stimulate bone healing and regeneration under hypoxic conditions: photobiomodulation and melatonin

Abstract

Melatonin has anabolic effects on the bone, even under hypoxia, and laser irradiation has been shown to improve osteoblastic differentiation. The aim of this study was to investigate whether laser irradiation and melatonin would have synergistic effects on osteoblastic differentiation and mineralization under hypoxic conditions. MC3T3-E1 cells were exposed to 1% oxygen tension for the hypoxia condition. The cells were divided into four groups: G1-osteoblast differentiation medium only (as the hypoxic condition), G2-treatment with 50 μM melatonin only, G3-laser irradiation (808 nm, 80 mW, GaAlAs diode) only, and G4-treatment with 50 μM melatonin and laser irradiation (808 nm, 80 mW, GaAlAs diode). Immunoblotting showed that osterix expression was markedly increased in the melatonin-treated and laser-irradiated cells at 48 and 72 h. In addition, alkaline phosphatase activity significantly increased and continued to rise throughout the experiment. Alizarin Red staining showed markedly increased mineralized nodules as compared with only melatonin-treated or laser-irradiated cells at day 7, which significantly increased by day 14. Moreover, when melatonin-treated cells were laser-irradiated, the differentiation and mineralization of cells were found to involve p38 MAPK and PRKD1 signaling mechanisms. However, the enhanced effects of laser irradiation with melatonin were markedly inhibited when the cells were treated with luzindole, a selective melatonin receptor antagonist. Therefore, we concluded that laser irradiation could promote the effect of melatonin on the differentiation and mineralization of MC3T3-E1 cells under hypoxic conditions, and that this process is mediated through melatonin 1/2 receptors and PKRD/p38 signaling pathways.

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Neurofibromatose

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Lipoma de pescoço e cisto de Torward

Lipoma de pescoço e cisto de Torward1 Lipoma-de-pesco%C3%A7o-e-cisto-de-Torwar

Lipoma-de-pesco%C3%A7o-e-cisto-de-Torwar

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Hipertrofia de parótida com linfonodo

Hipertrofia de parótida com linfonodo Hipertrofia-de-par%C3%B3tida-com-linfono

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Venous anastomosis in free flap reconstruction after radical neck dissection: is the external jugular vein a feasible option?

Abstract

Free microvascular tissue transfer has become a reliable and wellestablished technique in reconstructive surgery. Success rates greater than 95% are constantly reported in the literature. End-to-end anastomosis to the external jugular vein (EJ) is supposed to be equally successful as anastomosis to the internal jugular vein (IJ) in patients treated with selective neck dissection. No data has been published so far when the IJ had to be resected during neck dissection. The purpose of this study was to evaluate the success rate and complications of end-to-end anastomosis to the EJ in cases of (modified) radical neck dissection with resected IJ. A retrospective mono-center cohort study was performed. All patients with end-to-end anastomosis to either the IJ or EJ-system were reviewed. 423 free-tissue transfers performed between 2009 and 2016 were included. The overall success rate was 97.0% with an anastomotic revision rate due to venous thrombosis of 12.3%. In patients when the IJ had to be resected and the venous anastomosis was performed at the ipsilateral side to the EJ (n = 53), overall flap loss was significantly higher (5/53; 9.4%). The revision rate in these cases was 22.6%. Success rate of anastomosis to the EJ when the ipsilateral IJ was still intact was 100% (n = 20). Success rate when the anastomosis was performed at the contralateral side was 100%. End-to-end anastomosis to the EJ in cases with resected IJ is more likely to result in free flap loss. Furthermore, it is associated with a higher revision rate. Therefore, in cases with resected IJ, we suggest to plan the operation beforehand with anastomosis at the contralateral side whenever possible.

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Marijuana Exposure is Associated with Minimal Changes in Thyroid Function in NHANES Surveys

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 22-24.

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Does Meta-Analysis Prove Which Factors Predict Relapse After Antithyroid Drugs Are Discontinued?

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 5-7.

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Bleeding of Papillary Thyroid Recurrent Carcinoma in the Parapharyngeal and Nasopharyngeal Spaces Is Markedly Improved After Treatment with Lenvatinib

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 35-37.

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Thyroid Cancer Overdiagnosis Is a Result of Screening Programs in South Korea

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 8-10.

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Women with Gestational Thyroid Dysfunction  May Be at Higher Risk for Thyroid Disease Developing Postpartum

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 28-31.

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The Increased Incidence of Thyroid Cancer Is Worldwide

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 11-12.

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What's Ahead in Clinical Thyroidology in 2017

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 3-4.

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Clinical, Sonographic, and Pathological Characteristics of BRAF-Positive Differs from RAS-Positive Thyroid Carcinoma

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 13-15.

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Subclinical Hypothyroidism Among Those 85+ Years Old Is Not Associated with Increased Mortality

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 25-27.

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Lymph Node Mapping with Ultrasound Is Highly Useful in the Preoperative Workup of Patients with Thyroid Cancer

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 16-18.

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Fetal Hyperthyroidism Resulted from TSI in a Mother with Hashimoto's Hypothyroidism

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 32-34.

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Transoral Endoscopic Thyroidectomy Is a Novel Experimental Technique

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 19-21.

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An Unexpected Finding in a Thyroid Cancer Patient with Rising Thyroglobulin

Clinical Thyroidology Jan 2017, Vol. 29, No. 1: 38-41.

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Complicação de cole com paquimeningite 1

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Symptomatic oral lesions may be associated with contact allergy to substances in oral hygiene products

Abstract

Objective

Dental materials and oral hygiene products may be responsible for oral contact allergic reactions. We aimed to determine the occurrence of allergies in patients with symptomatic oral lichen planus (OLP), oral lichenoid lesions (OLLs) and stomatitis and investigate if patch testing could identify contact allergies to dental materials and oral hygiene products in these patients.

Methods

Forty-nine patients (7 men, 42 women) aged 31 to 77 years (61 ± 10.3 years) with symptomatic OLP, OLL or stomatitis and 29 healthy age- and gender-matched control subjects were included. They underwent an interview, clinical examination, oral mucosal biopsy and epicutan testing to the European baseline series, a toothpaste and dental material series.

Results

Nineteen patients had OLP, 19 OLL and 11stomatitis. Oral burning/itching was the most common symptom (83.7%), and 65.3% patients had more than one symptom. Patients visited their dentist more often than the healthy subjects and had statistically higher DMF-T and DMF-S scores. Nineteen patients (38.8%) and 10 healthy control subjects (34.5%) had allergic contact reactions primarily to fragrance ingredients. No differences could be found between OLP, OLL, stomatitis and healthy controls with regard to allergic contact reactions. However, contact allergy to aroma substances differed significantly between the patients and the healthy control subjects (p = 0.02). This type of contact allergy was most common in patients with OLP and OLL (p = 0.01). Avoidance cleared symptoms in all cases.

Conclusion/clinical relevance

Allergic reactions to aroma substances in oral hygiene products are common in patients with symptomatic OLP, OLL and stomatitis.

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A novel AMELX mutation causes hypoplastic amelogenesis imperfecta

Publication date: Available online 12 January 2017
Source:Archives of Oral Biology
Author(s): Young-Jae Kim, Youn Jung Kim, Jenny Kang, Teo Jeon Shin, Hong-Keun Hyun, Sang-Hoon Lee, Zang Hee Lee, Jung-Wook Kim
OBJECTIVESAmelogenesis imperfecta (AI) is a hereditary genetic defect affecting tooth enamel. AI is heterogeneous in clinical phenotype as well as in genetic etiology. To date, more than 10 genes have been associated with the etiology of AI. Amelogenin is the most abundant enamel matrix protein, most of which is encoded by the amelogenin gene in the X-chromosome (AMELX). More than 16 alternative splicing transcripts have been identified in the murine Amelx gene. The purposes of this study were to identify the genetic cause of an AI family.MATERIALS AND METHODSWe recruited a family with hypoplastic AI and performed mutational analysis on the candidate gene based on the clinical phenotype.RESULTSMutational analysis revealed a missense mutation in exon 6 (NM_182680.1; c.242C > T), which changes a sequence in a highly conserved amino acid (NP_872621.1; p.Pro81Leu). Furthermore, a splicing assay using a minigene displayed that the mutation changed the mRNA splicing repertory.CONCLUSIONSIn this study, we identified a novel AMELX missense mutation causing hypoplastic AI, and this mutation also resulted in altered mRNA splicing. These results will not only expand the mutation spectrum causing AI but also broaden our understanding of the biological mechanism of enamel formation.

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A novel AMELX mutation causes hypoplastic amelogenesis imperfecta

Melasma

Zusammenfassung

Als Melasma (Synonyme: Chloasma, Schwangerschaftsflecken) werden Hyperpigmentierungen bezeichnet, die als Folge einer erhöhten Synthese von Melanin meist in umschriebenen Arealen der Gesichtshaut entstehen. Aufgrund seiner hohen Inzidenz, den häufig stigmatisierenden Folgen und der eingeschränkten Wirksamkeit der aktuell zur Verfügung stehenden Therapieoptionen hat das Melasma gravierende Konsequenzen für die Lebensqualität betroffener Patienten/innen und stellt die behandelnden Ärzte vor große Herausforderungen. Obwohl neben Schwangerschaft und UV-Exposition zahlreiche weitere Risikofaktoren identifiziert werden konnten, ist die Pathogenese bislang noch weitestgehend ungeklärt, und die Therapie gestaltet sich oft sehr schwierig. Von entscheidender Bedeutung für den klinischen Verlauf ist ein konsequentes Meiden der UV-Exposition. Unter einem konsequenten Sonnenschutz sollte unbedingt auf eine ausreichende Vitamin-D-Versorgung geachtet werden, in der Regel ist eine orale Vitamin-D-Supplementierung erforderlich. Die etablierten Therapieoptionen, darunter die topische Anwendung von Depigmentierungsmitteln, führen häufig lediglich zu einer Besserung, aber nicht zur völligen Rückbildung der Hautveränderungen. Auch der Einsatz unterschiedlicher Lasersysteme führt oft nicht zum gewünschten Erfolg, hier sind durch die Entwicklung optimierter Therapiesysteme in den nächsten Jahren aber deutliche Verbesserungen zu erwarten. Diese Übersichtsarbeit fasst unseren aktuellen Kenntnisstand zu Klinik, Pathogenese und Therapie des Melasmas zusammen und gibt einen Ausblick auf zukünftige Entwicklungen.

http://ift.tt/2jEPn42

Clotrimazol und Ciclopiroxolamin jeweils in Kombination mit Methylprednisolonaceponat in magistralen Rezepturen

Zusammenfassung

Zur Behandlung kutaner Mykosen mit starker entzündlicher Begleitreaktion hat sich die kombinierte topische Applikation von Antimykotikum und Glukokortikoid insbesondere in der Initialphase der Therapie bewährt. In einer Vielzahl nationaler und internationaler Therapieleitlinien wird diese Vorgehensweise empfohlen. Vor diesem Hintergrund wurden magistrale Rezepturen mit Methylprednisolonaceponat, einem topischen Glukokortikoid mit einem therapeutischen Index von 2,0 sowie Clotrimazol bzw. Ciclopiroxolamin erarbeitet und auf Stabilität geprüft. Dabei wurden die Erfordernisse einer qualitätsgeprüften, standardisierten Rezeptur (Magistralrezeptur) sowie die Rahmenbedingungen der Apothekenbetriebsordnung beachtet. So konnten 2 mikrobiologisch, physikalisch und chemisch stabile Kombinationsrezepturen entwickelt werden, die für die klinische Anwendung die Vorteile des im Nutzen-Risiko-Verhältnis günstigen Glukokortikoids Methylprednisolonaceponat und die antimykotische Breitspektrumwirkung von Clotrimazol sowie erstmalig auch von Ciclopiroxolamin verbinden.

http://ift.tt/2jfmTBm

Haut und Schwangerschaft

http://ift.tt/2jEMdgy

Endoscopic Tympanoplasty Using Nasal Septal Cartilage Allograft

Abstract

The purpose of the study was to analyze the morphological and functional outcomes in a series of 60 patients for whom Type I tympanoplasty was done using alcohol preserved nasal septal cartilage allograft through endoscopic permeatal route. The study was a prospective, interventional (surgical) study of 60 patients between October 2012 and September 2014. Patients were operated using 0°, 4 mm, 18 cm long Hopkin's rod endoscope through permeatal route. 70% ethyl alcohol preserved allogeneic nasal septal cartilage with thickness of around 0.5 mm was used for grafting. At the end of 6 months, final assessment of morphological outcome i.e. intact tympanic membrane and functional outcome i.e. reduction in Air Bone gap, was done. At the end of 6 months, 57 patients (95%) had intact tympanic membrane. Mean ABG in postoperative patients was 11.83 dB. The operative time taken in 42 patients (70%) was 30–45 min. 42 patients (70%) returned to normal activity in 3–5 days. Endoscopic cartilage tympanoplasty using allogenic nasal septal cartilage can be safely and effectively used for Type I tympanoplasty with good anatomical and audiological results with benefits of reduced operating time, morbidity, pain and 'No scar'.

http://ift.tt/2iQ3aET

Nasal Irrigation as Treatment in Sinonasal Symptoms Relief: A Review of Its Efficacy and Clinical Applications

Abstract

Nasal irrigations have been used for centuries without any scientific data to determine its efficacy. Despite their widespread use, much confusion exist about the mechanism of action, preparation, indications and therapeutic advantage of nasal irrigations. Anecdotal evidence and poorly controlled studies add to the confusion. Recent evidence provides strong scientific justification of the benefits and advantages of using nasal irrigations in sinonasal symptoms relief. The present review of the evidence based literature highlights its efficacy and clinical applications.

http://ift.tt/2jMEbWT

Neuroendocrine Tumour of the Middle Ear: A Case Report

Abstract

Neuroendocrine tumour of the middle ear is a rare entity. Here we present a case of a 50 year old male who presented with a polyp in the left external auditory canal. Surgical excision followed by immunohistochemistry confirmed it to be a neuroendocrine tumour.

http://ift.tt/2iPWlTA

Does Chlorhexidine Prevent Alveolar Osteitis after Third Molar Extractions? Systematic Review and Meta-Analysis

Publication date: Available online 13 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Fabio Rodríguez Sánchez, Carlos Rodríguez Andrés, Iciar Arteagoitia Calvo
The prevention of alveolar osteitis (AO) in dental extractions remains a controversial issue. Chlorhexidine is one of the most widely studied antiseptics for the prevention of AO. The purpose of this systematic review and meta-analysis was to assess the efficacy and effectiveness of chlorhexidine in the prevention of AO following third molar extractions. We searched databases and the references of each article retrieved up to December 2015. Randomized controlled clinical trials (RCTs) using only chlorhexidine were included. The predictor variable was whether or not chlorhexidine was used in any formulation, concentration, or regimen. The outcome measure was the incidence of postoperative AO. We also recorded variables describing the characteristics of the included studies. The statistical analysis was performed using Stata version 12.0. Meta-analysis of binary data was conducted using a fixed-effects model. Risk ratios and 95% confidence intervals (CI) were estimated. Forest, l'Abbe, and funnel plots were constructed. Overall, 23 studies published from 1979 to 2015 corresponding to 18 trials, 16 parallel-group and 2 split-mouth RCTs, were included, with 2824 extractions (1458 in the experimental group and 1366 in the control group), involving third molars. The overall relative risk (RR) is 0.53 (95% CI 0.45 to 0.62) (P<0.0001). There was no evidence of heterogeneity (I² 9.3%; chi-squared test, P=0.336). The number needed to treat was 8 (95% CI 7 to 11). There were no significant differences between chlorhexidine formulations: rinse (RR 0.58; 95% CI 0.47 to 0.71) and gel (RR 0.47; 95% CI 0.37 to 0.60). Chlorhexidine did not cause a higher proportion of adverse reactions than placebo. To conclude, the use of chlorhexidine, in any formulation, concentration or regimen is efficacious and effective in preventing AO in patients who have undergone third molar extraction. Chlorhexidine gel was found to be more efficacious than the rinse formulation, but not significantly.

http://ift.tt/2jEAdf6

Beneficial redundancy - did we forget the benefit of auscultation of breath sounds?

Publication date: Available online 13 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jeffrey Bennett

http://ift.tt/2jf6nRS

To Evaluate the Efficacy and Safety of SCB01A in Subjects With r/m Squamous Cell Head and Neck Cancer

Condition: Head and Neck Neoplasms
Intervention: Drug: SCB01A
Sponsor: SynCore Biotechnology Co., Ltd.
Not yet recruiting - verified January 2017

http://ift.tt/2iPE1u1

Laser Fluorescence in Cancer Surgical Treatment

Conditions: Esophageal Cancer; Gastric Cancer; ColoRectal Cancer; Prostatic Neoplasms; Uterine Cancer; Head and Neck Cancer; Breast Neoplasm
Intervention: Device: Green indocianine
Sponsors: Instituto do Cancer do Estado de São Paulo; Ministério da Saúde; Fundação Faculdade de Medicina
Not yet recruiting - verified January 2017

http://ift.tt/2isheXk

Induction Chemotherapy in Young Patients With Locoregionally Advanced Nasopharyngeal Carcinoma

Conditions: Nasopharyngeal Carcinoma; Children
Interventions: Drug: Paclitaxel; Drug: Cisplatin; Drug: 5-fu; Radiation: Radical radiotherapy
Sponsor: Sun Yat-sen University
Not yet recruiting - verified January 2017

http://ift.tt/2iPCRyA

Ropidoxuridine in Treating Patients With Advanced Gastrointestinal Cancer Undergoing Radiation Therapy

Conditions: Bile Duct Carcinoma; Stage III Colon Cancer; Stage III Esophageal Cancer; Stage III Gastric Cancer; Stage III Liver Cancer; Stage III Pancreatic Cancer; Stage III Rectal Cancer; Stage III Small Intestinal Cancer; Stage IIIA Colon Cancer; Stage IIIA Esophageal Cancer; Stage IIIA Gastric Cancer; Stage IIIA Rectal Cancer; Stage IIIA Small Intestinal Cancer; Stage IIIB Colon Cancer; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIB Rectal Cancer; Stage IIIB Small Intestinal Cancer; Stage IIIC Colon Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer; Stage IIIC Rectal Cancer; Stage IV Colon Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer; Stage IV Liver Cancer; Stage IV Pancreatic Cancer; Stage IV Rectal Cancer; Stage IV Small Intestinal Cancer; Stage IVA Colon Cancer; Stage IVA Esophageal Cancer; Stage IVA Liver Cancer; Stage IVA Rectal Cancer; Stage IVB Colon Cancer; Stage IVB Esophageal Cancer; Stage IVB Liver Cancer; Stage IVB Rectal Cancer
Interventions: Radiation: Intensity-Modulated Radiation Therapy; Other: Laboratory Biomarker Analysis; Other: Pharmacological Study; Drug: Ropidoxuridine
Sponsor: National Cancer Institute (NCI)
Recruiting - verified October 2016

http://ift.tt/2isek4R

Examination of high-antibiotic users in a multi-institutional cohort of chronic rhinosinusitis patients

Background

In addition to known concerns regarding antibiotic overuse, recent research indicates that excessive antibiotic use is associated with poorer long-term health. Given that rhinosinusitis is the leading condition accounting for antibiotic prescriptions in the ambulatory setting, we aimed to evaluate characteristics associated with greater antibiotic use in chronic rhinosinusitis (CRS).

Methods

Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study evaluating treatment outcomes were included in this analysis. Study participants were asked to report the number of days out of the previous 90 days that systemic antibiotics were taken for sinus disease. Patient demographics, disease characteristics, and measures of disease severity were evaluated.

Results

A total of 561 patients from 4 institutions were included in the analysis, with mean antibiotic use of 17.4 ± 22.4 out of the prior 90 days. No differences between antibiotic-use groups were found for objective measures of disease severity (computed tomography [CT], endoscopy, Brief Smell Identification Test [BSIT] scores), however, increased patient-reported symptom burden (22-item Sino-Nasal Outcome Test [SNOT-22], Rhinosinusitis Disability Index [RSDI]) was associated with more antibiotic use. Patients reporting the most antibiotic use were older (p = 0.004) but no ethnic or gender differences were seen. Comorbid diagnoses of allergy, asthma, diabetes, depression, or fibromyalgia were not associated with increased antibiotic use. In accordance with literature recommendations, CRS with nasal polyps (CRSwNP) patients were less likely to have used antibiotics. Endoscopic sinus surgery (ESS) significantly decreased antibiotic use.

Conclusion

Variability in antibiotic use in CRS appears to be driven by symptom burden, independent of objective measures of disease severity, patient demographics, and presence of comorbid disease. Clear guidelines are essential to define appropriate antibiotic use in CRS.

http://ift.tt/2jEvDNY

Parents’ Childhood Socioeconomic Circumstances are Associated with their Children’s Asthma Outcomes

Publication date: Available online 13 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Edith Chen, Madeleine U. Shalowitz, Rachel E. Story, Katherine B. Ehrlich, Erika M. Manczak, Paula J. Ham, Van Le, Gregory E. Miller
BackgroundPrevious literature documents associations between low socioeconomic status (SES) and poor health outcomes, including asthma. However, this literature has largely focused on the effects of current family circumstances.ObjectiveTo test an intergenerational hypothesis, that the childhood SES that parents experience will be associated with asthma outcomes in their children, independent of effects of current family SES. Secondly, to test whether this association is in part due to difficulties in current parent-child relationships.MethodsObservational study, whereby 150 parents were interviewed about their childhood SES, and their children (physician-diagnosed with asthma, ages 9-17) were interviewed about current family stress. Asthma control was assessed by parent- and child-report (primary outcome), and blood was collected from children to measure cytokine production relevant to asthma (secondary outcomes).ResultsTo the degree that parents had lower childhood SES, their offspring showed worse asthma outcomes across multiple indicators. This included lower asthma control scores (parent and child-report, p's<.05), and greater stimulated production of Th-2 and Th-1 cytokines by peripheral blood mononuclear cells (PBMC) (p's<.05). These associations were independent of current family SES. Mediation analyses were consistent with a scenario wherein parents with low childhood SES had current family relationships that were more stressful, and these difficulties in turn related to worse asthma control and greater cytokine production in children.ConclusionsThese results suggest the potential 'long reach' of low socioeconomic status across generations, and the importance of expanding theories of how the social environment can affect childhood asthma to include characteristics of earlier generations.

Teaser

The childhood socioeconomic background that parents grow up in predicts their children's asthma clinical and immune outcomes, suggesting a need to better understand parent childhood environments and their potential contribution to children's health.

http://ift.tt/2jEw1Mc

Patterns of Immune Development in Urban Preschoolers with Recurrent Wheeze and/or Atopy

Publication date: Available online 13 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): James E. Gern, Agustin Calatroni, Katy F. Jaffee, Henry Lynn, Amy Dresen, William W. Cruikshank, Howard M. Lederman, Hugh A. Sampson, Wayne Shreffler, Leonard B. Bacharier, Peter J. Gergen, Diane R. Gold, Meyer Kattan, George T. O'Connor, Megan T. Sandel, Robert A. Wood, Gordon R. Bloomberg
BackgroundDisadvantaged urban children have high rates of allergic diseases and wheezing, which are diseases associated with Type 2-biased immunity.ObjectiveTo determine whether environmental exposures in early life influence cytokine responses which affect the development of recurrent wheezing illnesses and allergic sensitization.MethodsA birth cohort of 560 urban families was recruited from neighborhoods with high rates of poverty, and 467 (83%) children were followed until 3 years of age. Cytokine responses were measured in blood cell samples obtained at birth (cord blood) and ages 1 and 3 years. Cytokine responses were examined in relation to personal characteristics and environmental exposures to allergens and endotoxin, and also to the development of allergic sensitization and recurrent wheeze assessed at age 3 years.ResultsCytokine responses generally increased with age, but responses at birth were poorly predictive for those at ages 1 and 3 years. Exposure to certain allergens (cockroach, mouse, dust mite) was significantly associated with enhanced cytokine responses at age 3 years, including IFN-α and IL-10 responses to certain stimulants, and responses to phytohemagglutinin. Regarding the clinical outcomes, reduced LPS-induced IL-10 responses at birth was associated with recurrent wheeze. In contrast, reduced RSV-induced IL-8 responses, and increased CpG-induced IL-12p40 and allergen-induced IL-4 responses were associated with atopy.ConclusionsThese findings suggest that diverse biologic exposures, including allergens and endotoxin, in urban homes stimulate the development of cytokine responses in early life, and that cytokine responses to specific microbial and viral stimuli are associated with the development of allergic sensitization and recurrent wheeze.

Teaser

Understanding factors that influence immune development in early life have the potential to offer new preventive strategies for allergic sensitization and recurrent wheeze, two important risk factors for childhood asthma.

http://ift.tt/2jf6NY8

Identification of Airway-Mucosal Type-2 inflammation by Clinical Biomarkers in Asthma

Publication date: Available online 13 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Philip E. Silkoff, Michel Laviolette, Dave Singh, J Mark FitzGerald, Steven Kelsen, Vibeke Backer, Celeste M. Porsbjerg, Pierre-Olivier Girodet, Patrick Berger, Joel N. Kline, Geoffrey Chupp, Vedrana S. Susulic, Elliot S. Barnathan, Frédéric Baribaud, Matthew J. Loza
Background and ObjectiveThe Airways Disease Endotyping for Personalized Therapeutics (ADEPT) study profiled mild, moderate and severe asthma, and non-atopic healthy controls. We explored this dataset to define Type-2 inflammation based on airway-mucosal IL-13-driven gene expression and how this related to clinically-accessible biomarkers.MethodsIL-13-driven gene expression was evaluated in several human cell lines. We then defined Type-2 status in 25 healthy subjects, 28 mild, 29 moderate, and 26 severe asthmatics, based on airway-mucosal expression of 1) CC-motif chemokine ligand (CCL)-26, (the most differentially expressed gene), 2) periostin, or 3) a multi-gene IL-13 in-vitro signature (IVS). Clinically accessible biomarkers included fractional exhaled nitric oxide (FENO), blood eosinophils (bEOS), serum CCL26, and serum CCL17.ResultsExpression of airway-mucosal-CCL26, periostin, and IL-13-IVS all provided segregation into Type-2-high and -low asthmatics, but in the ADEPT population, CCL26 was optimal. All airway-mucosal-CCL26-high subjects with moderate-severe asthma were FENO-high (≥35 ppb) and/or blood eosinophils-high (≥300cells/mm³), compared to a minority (36%) of airway-mucosal- CCL26-low subjects. A combination of FENO, blood eosinophils, serum CCL17 and CCL26 had 100% positive-predictive-value and 87% negative-predictive-value for airway-mucosal-CCL26-high status. Clinical variables did not differ between Type-2 high and –low subjects. Eosinophilic inflammation was associated with, but not limited to, airway-mucosal Type-2 gene expression.ConclusionA panel of clinical biomarkers accurately classified Type-2 status based on airway-mucosa CCL26, perisotin or IL-13-IVS gene expression. Use of FENO, blood eosinophils and serum markers e.g. CCL26, CCL17 in combination may allow patient selection for novel Type-2 therapeutics.

Teaser

A panel of clinically-accessible biomarkers (FENO, blood eosinophils, serum CCL17 and CCL26) identified asthma patients with an airway 'Type-2-high' or 'Type-2-low' phenotype based on expression of airway-mucosal-CCL26, periostin, or an IL-13 multigene signature. This combination may prove useful in selecting patients for novel therapies targeting Type-2 inflammation.

http://ift.tt/2jf9Dwm

Three-dimensional finite element model to predict patterns of pterygomaxillary dysjunction during Le Fort I osteotomy

Publication date: Available online 12 January 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): H. Fujii, N. Kuroyanagi, T. Kanazawa, S. Yamamoto, H. Miyachi, K. Shimozato
The aim of this study was to determine whether non-linear three-dimensional finite element analysis (3D-FEA) can be applied to simulate pterygomaxillary dysjunction during Le Fort I osteotomy (LFI) not involving a curved osteotome (LFI-non-COSep), and to predict potential changes in the fracture pattern associated with extending the cutting line. Computed tomography (CT) image data (100 snapshots) after LFI were converted to 3D-CT images. 3D-FEA models were built using preoperative CT matrix data and used to simulate pterygomaxillary dysjunction. The pterygomaxillary dysjunction patterns predicted by the 3D-FEA models of pterygomaxillary dysjunction were classified into three categories and compared to the pterygomaxillary dysjunction patterns observed in the postoperative 3D-CT images. Extension of the cutting line was also simulated using the 3D-FEA models to predict the risk and position of pterygoid process fracture. The rate of agreement between the predicted pterygomaxillary dysjunction patterns and those observed in the postoperative 3D-CT images was 87.0% (κ coefficient 0.79). The predicted incidence of pterygoid process fracture was higher for cutting lines that extended to the pterygomaxillary junction than for conventional cutting lines (odds ratio 4.75; P<0.0001). 3D-FEA can be used to predict pterygomaxillary dysjunction patterns during LFI-non-COSep and provides useful information for selecting safer procedures during LFI-non-COSep.

http://ift.tt/2iPuV02

Cortical bone thickness of the mandibular canal and implications for bilateral sagittal split osteotomy: a cadaveric study

Publication date: Available online 12 January 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): L. Promma, N. Sakulsak, P. Putiwat, P. Amarttayakong, S. Iamsaard, H. Trakulsuk, K. Hirunyakorn, S. Suarbua, Y. Wattanaraeungchai
Preoperative delineation of the mandibular canal and surrounding cortical bone thickness is mandatory prior to bilateral sagittal split osteotomy (BSSO). The cortical bone thickness of 101 cadaveric mandibles was measured to define the mandibular canal. The mandibles were cut at the anterior ramus, at the third, second, and first molar, and at the premolar. The cortical bone thickness was measured between the mandibular canal and inferior border, buccal cortex, and lingual cortex at each cutting point. No difference was found between the right and left sides of the mandible, or between males and females, with one exception: males were found to have thicker inferior cortical bone at the premolar site than females. The implications for BSSO are: (1) for sagittal bone cutting, the maximum cutting depth of the buccal cortex at the ramus is 4.5mm, at the second and third molars is 6.5mm, and at the first molar is 5mm; (2) for vertical bone cutting at the first molar, the maximum cutting depth from the inferior border is 7.5mm. The measurement of cortical bone thickness from cadaveric mandibles provides useful preoperative information and confirms the results of computed tomography.

http://ift.tt/2jMecza

Parasympathectomy increases resting salivary secretion in normal and irradiated submandibular glands of rats

Fluid and ion secretion from the submandibular gland (SMG) is mainly regulated by parasympathetic nerves. This study evaluated the effect of parasympathectomy on salivary secretion from normal and irradiated rat SMGs from 1 to 24 wk after denervation. Although stimulated salivary secretion was significantly lower in denervated SMGs compared with contralateral self-controls, the resting salivary flow rates were markedly higher in the denervated SMGs at 1, 12, and 24 wk after denervation. The levels of muscarinic acetylcholine M1 and M3 receptors, as well as of aquaporin 5, were up-regulated. Notably, although irradiated SMGs showed significantly lower resting and stimulated salivary secretion rates than non-irradiated SMGs, the resting salivary secretion rates of the irradiated and denervated SMGs were markedly higher than seen in the irradiated self-control SMGs at 1, 12, and 24 wk after parasympathectomy, and were even higher than seen in the non-irradiated sham-operated rats. The expression of M1 and M3 receptors was similarly elevated. Taken together, our results suggest that parasympathetic denervation increases resting salivary secretion of both normal and irradiated SMGs. This approach might provide a potential modality for relieving radiation-induced xerostomia, which is a common complication following treatment of head and neck cancer.

http://ift.tt/2irTKl9

Enamel and dental anomalies in latent-transforming growth factor beta-binding protein 3 mutant mice

Latent-transforming growth factor beta-binding protein 3 (LTBP-3) is important for craniofacial morphogenesis and hard tissue mineralization, as it is essential for activation of transforming growth factor-β (TGF-β). To investigate the role of LTBP-3 in tooth formation we performed micro-computed tomography (micro-CT), histology, and scanning electron microscopy analyses of adult Ltbp3-/- mice. The Ltbp3-/- mutants presented with unique craniofacial malformations and reductions in enamel formation that began at the matrix formation stage. Organization of maturation-stage ameloblasts was severely disrupted. The lateral side of the incisor was affected most. Reduced enamel mineralization, modification of the enamel prism pattern, and enamel nodules were observed throughout the incisors, as revealed by scanning electron microscopy. Molar roots had internal irregular bulbous-like formations. The cementum thickness was reduced, and microscopic dentinal tubules showed minor nanostructural changes. Thus, LTBP-3 is required for ameloblast differentiation and for the formation of decussating enamel prisms, to prevent enamel nodule formation, and for proper root morphogenesis. Also, and consistent with the role of TGF-β signaling during mineralization, almost all craniofacial bone components were affected in Ltbp3-/- mice, especially those involving the upper jaw and snout. This mouse model demonstrates phenotypic overlap with Verloes Bourguignon syndrome, also caused by mutation of LTBP3, which is hallmarked by craniofacial anomalies and amelogenesis imperfecta phenotypes.

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Corrigendum

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Author Guidelines

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Relationship between gustatory function and average number of taste buds per fungiform papilla measured by confocal laser scanning microscopy in humans

The aim of this study was to elucidate the relationship between the gustatory function and average number of taste buds per fungiform papilla (FP) in humans. Systemically healthy volunteers (n = 211), pre-operative patients with chronic otitis media (n = 79), and postoperative patients, with or without a chorda tympani nerve (CTN) severed during middle ear surgery (n = 63), were included. Confocal laser scanning microscopy was employed to observe fungiform taste buds because it allows many FP to be observed non-invasively in a short period of time. Taste buds in an average of 10 FP in the midlateral region of the tongue were counted. In total, 3,849 FP were observed in 353 subjects. The gustatory function was measured by electrogustometry (EGM). An inverse relationship was found between the gustatory function and average number of fungiform taste buds per papilla. The healthy volunteers showed a lower EGM threshold (better gustatory function) and had more taste buds than did the patients with otitis media, and the patients with otitis media showed a lower EGM threshold and had more taste buds than did postoperative patients, reflecting the severity of damage to the CTN. It was concluded that the confocal laser scanning microscope is a very useful tool for using to observe a large number of taste buds non-invasively.

http://ift.tt/2irOkqb

Strategies to alter the natural history of childhood asthma.

Purpose of review: Asthma exhibits significant heterogeneity in occurrence and severity over the lifespan. Our goal is to discuss recent evidence regarding determinants of the natural history of asthma during childhood, and review the rationale behind and status of major efforts to alter its course. Recent findings: Variations in microbial exposures are associated with risk of allergic disease, and the use of bacterial lysates may be a promising preventive strategy. Exposure to air pollution appears to be particularly damaging in prenatal and early life, and interventions to reduce pollution are feasible and result in clinical benefit. E-cigarette use may have a role in harm reduction for conventional cigarette smokers with asthma, but has undefined short-term and long-term effects that must be clarified. Vitamin D insufficiency over the first several years of life is associated with risk of asthma, and vitamin D supplementation reduces the risk of severe exacerbations. Summary: The identification of risk factors for asthma occurrence, persistence and severity will continue to guide efforts to alter the natural history of the disease. We have reviewed several promising strategies that are currently under investigation. Vitamin D supplementation and air pollution reduction have been shown to be effective strategies and warrant increased investigation and implementation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2iOC157

Prenatal exposures and the development of childhood wheezing illnesses.

Purpose of review: To critically evaluate and summarize studies published between July 2015 and June 2016 linking prenatal exposures and the onset of childhood wheezing illnesses and to discuss future research directions in this field. Recent findings: The aggregated evidence indicates a consistent detrimental effect of prenatal exposure to parental smoking, outdoor air pollution, and maternal stress on childhood wheezing illnesses. Less consistent evidence suggests an adverse impact of maternal obesity during pregnancy and prenatal exposure to antibiotics on these outcomes. There is insufficient evidence to support an association between in-utero exposure to acetaminophen or prenatal levels of specific nutrients (such as vitamin D, folic acid, or polyunsaturated fatty acids) and childhood wheezing illnesses. Summary: Several common potentially modifiable prenatal exposures appear to be consistently associated with childhood wheezing illnesses (e.g. parental smoking, outdoor air pollution, and maternal stress). However, the effect of many other prenatal exposures on the onset of childhood wheezing illnesses remains unclear. The existing scientific evidence from the past year does not allow us to make any new recommendations on primary prevention measures. Intervention studies will best demonstrate whether changing the prenatal environment can prevent childhood wheezing illnesses and asthma. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Linear nonpalpable purpura in a young male: a unique presentation of leukemia cutis in T-cell prolymphocytic leukemia

http://ift.tt/2irvsrm

Pectoral nerve blocks are useful for axillary sentinel lymph node biopsy in malignant tumors on the upper extremities

http://ift.tt/2in84Ii

Acute generalized exanthematous pustulosis: clinical characteristics, etiologic associations, treatments, and outcomes in a series of 28 patients at Mayo Clinic, 1996–2013

Abstract

Background

Acute generalized exanthematous pustulosis (AGEP) is a rare skin condition typically caused by medications. The objective of this study was to examine the clinical features, causes, and outcomes of AGEP at a sole tertiary care center.

Methods

A retrospective review of patients with AGEP (European Study of Severe Cutaneous Adverse Reactions score of ≥ 5) seen at Mayo Clinic (Rochester, MN, USA) between January 1, 1996, and December 31, 2013, was conducted.

Results

Of 28 patients (mean age at onset: 56 years), 17 (61%) were women. The development of AGEP was attributed to medications in 25 patients (89%), with clindamycin the most common culprit (six patients). Three patients (11%) had mucous membrane involvement, and 21 (75%) showed systemic involvement. Ten patients (36%) received systemic corticosteroids for treatment of AGEP. Skin findings resolved within 15 days in 26 patients (93%) (mean time to resolution: 7.6 days). In three patients (11%), generalized skin eruptions or dermatitis developed weeks to months after the resolution of AGEP. Twenty-four patients (86%) had a personal history of drug reactions before the development of AGEP.

Conclusions

A previous history of drug reactions and clindamycin causation were more common in the present cohort than in prior reports. A small subset of patients experienced new-onset non-AGEP skin eruptions within a few months of the resolution of AGEP.

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Piperacillin–tazobactam-induced linear IgA bullous dermatosis presenting clinically as Stevens–Johnson syndrome/toxic epidermal necrolysis overlap

Summary

Linear IgA bullous dermatosis (LABD) is a subepidermal autoimmune bullous disease characterized by linear IgA deposition at the basement membrane zone, which is visualized by direct immunofluorescence. Patients with LABD typically present with widespread vesicles and bullae; however, this is not necessarily the case, as the clinical presentation of this disease is heterogeneous. LABD clinically presenting as Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) is an infrequent, yet well-described phenomenon. Most cases of LABD are idiopathic, but some cases are drug-induced. Multiple drugs have been implicated in the development of LABD. We report a case of piperacillin–tazobactam-induced LABD presenting clinically as SJS/TEN overlap. This is the first reported case of a strong causal association between piperacillin-tazobactam and the development of LABD.

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Pneumatização justa carotídea

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Cole do meato

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Ozena

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Cole do meato

http://ift.tt/2jqGhIG

Expiratory muscle strength training evaluated with simultaneous high resolution manometry and electromyography

Objective

To examine feasibility of a simultaneous high-resolution pharyngeal manometry (HRM) and electromyography (EMG) experimental paradigm to detect swallowing-related patterns of palatal, laryngeal, and pharyngeal muscle activity during expiratory training.

Study Design

Technical report.

Methods

Simultaneous HRM, surface submental, and intramuscular EMG were acquired in two healthy participants during five tasks: 10-cc water swallow, maximum expiratory pressure (MEP) testing, and expiratory muscle strength training (EMST) at three pressure levels (sham, 50%, and 75% MEP).

Results

Experimental conditions were feasible. Velopharyngeal closing pressure, palate EMG activity, and pharyngeal EMG activity increased as expiratory load increased. In contrast, thyroarytenoid EMG activity was low during the expiratory task, consistent with glottic opening during exhalation. Submental EMG patterns were more variable during expiratory tasks. Intraluminal air pressures recorded with HRM were correlated with measured expiratory pressures and target valve-opening pressures of the EMST device.

Conclusion

Results suggest that a simultaneous HRM/EMG/EMST paradigm may be used to detect previously unquantified swallowing-related muscle activity during EMST, particularly in the palate and pharynx. Our approach and initial findings will be helpful to guide future hypothesis-driven studies and may enable investigators to evaluate other muscle groups active during these tasks. Defining mechanisms of action is a critical next step toward refining therapeutic algorithms using EMST and other targeted treatments for populations with dysphagia and airway disorders.

Level of Evidence

4. Laryngoscope, 2017

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Concurrent external and intraluminal vacuum-assisted closure in head and neck necrotizing fasciitis

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Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes

Objective

Although vocal fold (VF) leukoplakia is commonly treated with in-office laser, there is no data on its long-term effectiveness. This study hypothesizes that VF leukoplakia treated by serial in-office laser results in long-term disease control with maintenance of voice and minimal morbidity.

Study Design

Retrospective review (2008–2015).

Methods

Forty-six patients with VF leukoplakia treated by in-office KTP (potassium titanyl phosphate) or PDL (pulsed dye laser) were included. Median follow-up from final laser treatment was 19.6 months. Main outcomes included: 1) rate of disease control, 2) percentage of disease regression using ImageJ analysis. Secondary outcomes included vocal assessment using the Voice Handicap Index-10 (VHI-10).

Results

Patients underwent a median of 2 (range: 1–6) in-office laser treatments. Time between treatments was median 7.6 months. After final treatment, 19 patients (41.3%) had no disease; two patients (4.3%) progressed to invasive cancer; overall disease regression was median 77.1% (P < 0.001); and VHI-10 score decreased by median 5 (P = 0.037). Thirty-one patients (67.4%) were responders (controlled with in-office treatment only); failures were 13 patients (28.3%) who required operative intervention and two patients (4%) who underwent radiation. Compared to responders, failures demonstrated significantly shorter duration between treatments (median 2.3 vs. 8.9 months, P = 0.038) and significantly less regression (median 49.3% vs. 100%, P = 0.006).

Conclusion

Serial outpatient KTP or PDL treatment of VF leukoplakia is effective for disease control with minimal morbidity and preservation of voice quality. We suggest that patients requiring repeated in-office treatment every 6 months may benefit from earlier operative intervention; other factors associated with in-office success remain unclear.