Bilateral Tensor Fasciae Suralis Muscles in a Cadaver with Unilateral Accessory Flexor Digitorum Longus Muscle

Muscle variants are routinely encountered in the dissection laboratory and in clinical practice and therefore anatomists and clinicians need to be aware of their existence. Here we describe two different accessory muscles identified while performing educational dissection of a 51-year-old male cadaver. Tensor fasciae suralis, a rare muscle variant, was identified bilaterally and accessory flexor digitorum longus, a more common muscle variant, was present unilaterally. Tensor fasciae suralis and accessory flexor digitorum longus are clinically relevant muscle variants. To our knowledge, the coexistence of tensor fasciae suralis and accessory flexor digitorum longus in the same individual has not been reported in either cadaveric or imaging studies.

http://ift.tt/2jDdcdz

Comparison of the local effects of a 600-μm bare fibre at high laser power on lung parenchyma: Nd:YAG laser 1320 vs. 1064 nm

Abstract

Lung metastases are often resected non-anatomically with a laser using a diode-pumped Nd:YAG laser at a wavelength of 1320 nm with a laser output of up to 60 W. Usually the removal of lesions is carried out in contact mode by means of a bare fibre. We compared the local effects of an Nd:YAG laser at a wavelength of 1064 nm with those at a wavelength of 1320 nm using a 600-μm bare fibre in contact mode in an experimental model. The investigations were carried out on porcine lungs freshly withdrawn at the abattoir. The 600-μm laser fibre was fixed vertically in contact with the lung surface on a fibre holder. The fibre holder was connected to a feeding device that advances the laser fibre at constant speeds (5, 10 or 20 mm/s). In each case, two laser powers were examined: 20 and 60 W. The lung lesions produced by the laser fibre were excised for histological examination. After haematoxylin–eosin staining, the depth of the vaporisation and coagulation zones (in μm) from the laser cuts was measured. For each setting, an average value was calculated. The individual groups were compared for significance using a non-parametric Mann–Whitney U test (p < 0.05). At a low speed of the bare fibre of 5 mm/s and a laser output of 20 W, the average depth of the vaporisation zone was 858 ± 3.3 μm (λ = 1064 nm) compared to 766.0 ± 7.5 μm (λ = 1320 nm) (p < 0.01). Upon faster movement (20 mm/s), the extension of the vaporisation zone decreased to 320.3 ± 7.1 μm (λ = 1064 nm). The depth of the vaporisation zone increased significantly at 60 W, both at λ = 1064 and 1320 nm with 1517.0 ± 1.7 μm and 1414.0 ± 4.9 μm, respectively. The extent of the coagulation zone was significantly smaller at 20 W and the low speed of 5 mm/s, namely, 200.4 ± 3.7 μm (λ = 1064 nm) and 224.1 ± 2.8 μm (1320-nm laser). Upon faster movement of the laser fibre at the same output, the extent of the coagulation zone decreased in both groups. At a laser power of 60 W, the extent of the coagulation zone was significantly less with the 1064-nm laser (110.3 ± 2.4 μm) than with the 1320-nm laser (324.8 ± 1.9 μm; p < 0.001). When the laser fibre moves more rapidly, the extent of the coagulation zone decreases further. The Nd:YAG laser with a wavelength of 1320 nm still has the optimal ratio of cutting and coagulation capacity on the resection surface. With the 1064-nm Nd:YAG laser, a higher cutting capacity is associated with a decrease of the coagulation capacity.

http://ift.tt/2jLhNwk

It is important to measure changes in the bone-conduction threshold when evaluating whether FGF-2 can be used to repair blast-induced total or near-total tympanic membrane perforations

We would like to comment on the manuscript entitled "Utility of basic fibroblast growth factor in the repair of blast-induced total or near-total tympanic membrane perforations: A pilot study" by Lou et al. [1]. The authors investigated whether basic fibroblast growth factor (bFGF) could be used to repair blast-induced total or near-total tympanic membrane perforations (TMPs) [1]. The authors concluded that direct application of bFGF was a promising minimally invasive alternative to conventional tympanoplasty, affording a comparable success rate.

http://ift.tt/2iZdLN4

Cochlear duct length–one size fits all?

Recent studies demonstrated the utility of high-resolution computed tomography (HRCT) scans in measuring basal cochlear length and cochlear insertion depths. These studies showed significant variations in the anatomy of the cochlea amongst humans. The aim of our study was to investigate for gender and racial variations in the basal turn length of the human cochlea in an Asian population.

http://ift.tt/2jLPNZv

MYSM1 deficiency - genotoxic stress-associated bone marrow failure and developmental aberrations

Publication date: Available online 21 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Ehsan Bahrami, Maximilian Witzel, Tomas Racek, Jacek Puchałka, Sebastian Hollizeck, Naschla Greif-Kohistani, Daniel Kotlarz, Hans-Peter Horny, Regina Feederle, Heinrich Schmidt, Roya Sherkat, Doris Steinemann, Gudrun Göhring, Brigitte Schlegelbeger, Michael H. Albert, Waleed Al-Herz, Christoph Klein
BackgroundMyb-Like, SWIRM and MPN domains 1 (MYSM1) is a transcriptional regulator mediating histone deubiquitination. Its role in human immunity and hematopoiesis is poorly understood.ObjectivesTo investigate the clinical, cellular and molecular features in two siblings presenting with progressive bone marrow failure, immunodeficiency and developmental aberrations.MethodsWe performed genome-wide homozygosity mapping, whole-exome sequencing (WES) and Sanger sequencing, immunophenotyping studies as well as analysis of genotoxic stress responses. p38 activation, reactive oxygen species (ROS), rate of apoptosis and clonogenic survival and growth in immune and non-immune cells were assessed. Outcome of allogeneic HSCT was monitored.ResultsWe report two patients with progressive bone marrow failure associated with myelodysplastic features, immunodeficiency affecting B-cells and neutrophil granulocytes, and complex developmental aberrations including mild skeletal anomalies, neurocognitive developmental delay, and cataracts. Whole exome sequencing revealed a homozygous premature stop codon mutation in the gene encoding the histone deubiquitinase Myb-Like, SWIRM and MPN Domains 1 (MYSM1). MYSM1-deficient cells are characterized by increased sensitivity to genotoxic stress associated with sustained induction of phosphorylated p38 protein, increased ROS production, and decreased survival upon UV light-induced DNA damage. Both patients were successfully treated using allogeneic hematopoietic stem cell transplantation (HSCT) with sustained reconstitution of hematopoietic defects.ConclusionsWe here show that MYSM1 deficiency is associated with developmental aberrations, progressive BMF with myelodysplastic features, and increased susceptibility to genotoxic stress. HSCT represent a curative therapy for patients with MYSM1 deficiency.

Graphical abstract

Teaser

MYSM1-deficiency causes a rare bone marrow failure syndrome


http://ift.tt/2jkiObN

Damaging heterozygous mutations in NFKB1 lead to diverse immunological phenotypes

Publication date: Available online 21 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Meri Kaustio, Emma Haapaniemi, Helka Göös, Timo Hautala, Giljun Park, Jaana Syrjänen, Elisabet Einarsdottir, Biswajyoti Sahu, Sanna Kilpinen, Samuli Rounioja, Christopher L. Fogarty, Virpi Glumoff, Petri Kulmala, Shintaro Katayama, Fitsum Tamene, Luca Trotta, Ekaterina Morgunova, Kaarel Krjutškov, Katariina Nurmi, Kari Eklund, Anssi Lagerstedt, Merja Helminen, Timi Martelius, Satu Mustjoki, Jussi Taipale, Janna Saarela, Juha Kere, Markku Varjosalo, Mikko Seppänen
BackgroundThe NF-κB signaling pathway is a key regulator of immune responses. Accordingly, mutations in several NF-κB pathway genes cause immunodeficiency.ObjectiveWe sought to identify the cause of disease in three unrelated Finnish kindreds with variable symptoms of immunodeficiency and autoinflammation.MethodsWe applied genetic linkage analysis and next generation sequencing, and functional analyses of NFKB1 and its mutated alleles.ResultsIn all affected individuals, we detected novel heterozygous variants in NFKB1, encoding for p50/p105. Symptoms in variant carriers differed depending on the mutation: Patients harboring a p.I553M variant presented with antibody deficiency, infection susceptibility, and multi-organ autoimmunity. Patients with a p.H67R substitution developed antibody deficiency and suffered from autoinflammatory episodes including aphthae, gastrointestinal disease, febrile attacks, and small vessel vasculitis characteristic of Behcet's disease. Patients with a p.R157X stop-gain experienced hyperinflammatory responses to surgery and showed enhanced inflammasome activation. In functional analyses, the p.R157X variant caused proteasome-dependent degradation of both the truncated and wild-type proteins, leading to a dramatic loss of p50/p105. The p.H67R variant reduced nuclear entry of p50, and showed decreased transcriptional activity in luciferase-reporter assays. The p.I553M mutation, in turn, showed no change in p50 function, but exhibited reduced p105 phosphorylation and stability. Affinity-purification mass spectrometry also demonstrated that both missense variants led to altered protein-protein interactions.ConclusionOur findings broaden the scope of phenotypes caused by mutations in NFKB1, and suggest that a subset of autoinflammatory diseases such as Behcet's disease may be caused by rare monogenic variants in genes of the NF-κB pathway.

Teaser

In addition to antibody deficiency, mutations in NFKB1 may lead to excessive inflammatory response and manifest as Behcet's disease, inflammatory gastrointestinal disease, or severe autoinflammatory postoperative complications.


http://ift.tt/2jklRAA

Re: Re: Patients experience of temporary tracheostomy after microvascular reconstruction for cancer of the head and neck

Publication date: Available online 20 January 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Rogers




http://ift.tt/2kdeYRB

Implementation of an oral and maxillofacial surgery trauma team in a major trauma centre

Publication date: Available online 20 January 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. Haq, F. Gately, R. Bentley
In 2010, King's College Hospital in London was designated as a major trauma centre. To deal with the increasing number of patients, an integrated oral and maxillofacial team of the week was established in 2012 to provide a consultant-led, emergency service dedicated to acute care, and it was anticipated that this would reduce the duration of stay by 0.3 bed-days. To assess the effect of the new system, we compared the duration of stay between 1 October and 31 January 2011-2012 with the same period in 2012-2013. We also assessed the activity and training of registrars, and the department's perception of the post of trauma registrar. The mean total duration of stay had decreased significantly by 0.84 days (p=0.03), the mean delay to operation had decreased by 0.3 days, and the mean postoperative stay had decreased by 0.5 days. During one week, the trauma registrar did 12 operations at various sites in the hospital. The new system was a cost-effective way of improving emergency OMFS care and it can be recommended to other centres with similar profiles.



http://ift.tt/2iP3E25

Chorda tympani nerve management in endoscopic stapes surgery

Publication date: Available online 20 January 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Ahmed Amin Omran, Ahmed Aly Ibrahim, Wael K.A. Hussein, Yasser Osman
ObjectivesTo demonstrate different techniques in manipulating the chorda tympani nerve during endoscopic stapedotomy for otosclerotic patients.MaterialsTwenty patients presented with clinically diagnosed otosclerosis were randomly selected from outpatient ENT clinic in a tertiary referral Hospital over a period of 2years (2013–2015) for endoscopic stapes surgery.MethodsThis prospective study demonstrates different management modalities of chorda tympani nerve in endoscopic stapes surgery according to the endoscopic anatomical relationship between the length of the chorda tympani nerve and the degree of scutum overhanging the oval window niche structures (endoscopic scutum- chorda tympani relationship).ResultsThree management techniques were carried out to deal with chorda tympani based on its endoscopic anatomical relationship with the scutum (no manipulation, upward-displacement, downward-displacement). All patients had significant improvement of postoperative hearing. Only 2 patients were managed by downward displacement technique had postoperative change in taste sensation and tongue numbness that improved over a period of 6months.Conclusiontrans-Canal fully endoscopic stapedotomy provides feasible and safe handling of the chorda tympani nerve with best postoperative taste sensation preservation.



http://ift.tt/2iYtCLL

Tumor necrosis factor-alpha inhibitors suppress CCL2 chemokine in monocytes via epigenetic modification

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Yi-Ching Lin, Yu-Chih Lin, Ming-Yii Huang, Po-Lin Kuo, Cheng-Chin Wu, Min-Sheng Lee, Chong-Chao Hsieh, Hsuan-Fu Kuo, Chang-Hung Kuo, Wen-Chan Tsai, Chih-Hsing Hung
The treatment of rheumatoid arthritis (RA) with tumor necrosis factor-alpha (TNF-α) inhibitors could lead to adverse effects. Therefore, the identification of downstream therapeutic targets is important. Monocyte chemoattractant protein-1 (MCP-1, also called CCL2) is related to RA disease activity, and epigenetic modifications are hypothesized to regulate gene expression in RA pathogenesis. We studied the effects of two TNF-α inhibitors, etanercept and adalimumab, on CCL2 expression and the potentially associated intracellular mechanisms, including epigenetic regulation. Etanercept and adalimumab decreased CCL2 production in THP-1 cells and human primary monocytes, as detected using enzyme-linked immunosorbent assays, and these changes in the CCL2 levels were independent of the TNF-α levels. Etanercept and adalimumab suppressed mitogen-activated protein kinase (MAPK) phospho-p38, phospho-JNK, phospho-ERK and nuclear factor-κB (NF-κB) phospho-p65, as demonstrated using western blot analyses. The investigation of epigenetic modifications using chromatin immunoprecipitation revealed that etanercept and adalimumab down-regulated acetylation of histone (H)3 and H4 in the CCL2 promoter region by decreasing the recruitment of the NF-κB associated acetyltransferases p300, CBP and PCAF. Etanercept and adalimumab also down-regulated trimethylation of H3K4, H3K27, H3K36 and H3K79 in the CCL2 promoter region by decreasing the expression of the related methyltransferases WDR5 and Smyd2. We demonstrated that TNF-α inhibitors exert immunomodulatory effects on CCL2 expression in human monocytes via MAPKs, NF-κB and epigenetic modifications. These findings broaden the mechanistic knowledge related to TNF-α inhibitors and provide novel therapeutic targets for RA.

Graphical abstract

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Effect of Mastoid Drilling on Hearing of the Contralateral Normal Ear in Mastoidectomy

Abstract

To evaluate hearing of the contralateral normal ear before and after mastoidectomy in a longitudinal manner and to assess whether the hearing loss is transient or permanent and to find out the duration of temporary hearing loss. This was a clinical longitudinal observational study involving 50 patients with unilateral chronic suppurative otitis media requiring mastoidectomy operation over a period of 18 months after satisfying the inclusion criteria. During the part of the mastoidectomy surgery involving drilling of the mastoid bone, noise levels were recorded at multiple points in the surgery using a digital sound level meter. Postoperatively, beginning from Day 1 to Day 7, PTA and OAE of the contralateral ear were recorded for all patients. The patients were then followed up at 1, 3 and 6 months postoperatively, at which times PTA and OAE were repeated. There is an increase in the absence of High Frequency DPOAEs on the first and second postoperative days, but this increase is higher than that of Low Frequency DPOAEs and gradually returns to normal by 72 h. OAEs were found to be more sensitive at diagnosing and tracking the progress of affected patients. All affected ears only had a temporary postoperative hearing loss, primarily affecting the higher frequencies and returning to normal within 72 h. Drill-generated noise and vibration during mastoidectomy operation is associated with a significant temporary shift in hearing thresholds of the contralateral normal ear in susceptible individuals, affecting the higher frequencies, and is best evaluated using DPOAEs.

http://ift.tt/2iNr5IS

Functional magnetic resonance imaging in dermatology: The skin, the brain and the invisible

Abstract

The skin and brain have a close bi-directional anatomical and functional connection. Historically, the skin-brain axis and the brain-skin axis have been well described. However, brain function in this context has only recently been demystified with the introduction of functional neuroimaging in dermatology. Functional neuroimaging, especially functional magnetic resonance imaging (fMRI), allows indirect visualisation of brain function. This review looks back to the beginnings of functional neuroimaging in dermatology, summarises the currently available dermatology-related fMRI-studies and discusses the potential future role of fMRI as a stratifying tool in clinical dermatology and in the development of novel therapies. According to the main body of research made in this field, the focus is placed on experimental itch studies, which described the brain structures involved in itch processing, the regulation of the scratch response, contagious itch and itch suppression.

This article is protected by copyright. All rights reserved.

http://ift.tt/2jjxasX

The effect of the Physical Consistency of the Diet on the Bone Quality of the Mandibular Condyle in Rats

Publication date: Available online 20 January 2017
Source:Archives of Oral Biology
Author(s): Shawna Kufley, James Elliot Scott, German Ramirez-Yanez
ObjectiveThis study aimed to analyze how the physical consistency of the diet affects the bone quality at the mandibular condyle.DesignSixty-three Wistar rats were randomly assigned to three groups. Twenty-two animals composed each group and they were fed with either a liquid, soft or hard diet. Seven animals were sacrificed from each group at days 7, 20, and 40 respectively. Their mandibles were removed and scanned at the postero-superior area of the condyle with a micro-CT scan.Resultsshowed a statistically significant difference for the bone mineral density (p <0.01) and total mineral density (p<0.01), when comparing the hard against the liquid group after seven days. After 20days both, the soft and the liquid diet groups, computed a statistically significant difference demonstrating a significant decrease in the measured values for bone mineral density, bone mineral content, total mineral density, and total mineral content. At day 40, the values stayed lower for the soft and liquid diets, even though they did not reach a significant difference.ConclusionsThis study supports the idea that a soft or liquid diet has a negative impact on the bone quality of the mandible, particularly during the periods of more active growing.



http://ift.tt/2kcuKwq

Similarities and Differences between Porcine Mandibular and Limb Bone Marrow Mesenchymal Stem Cells

Publication date: Available online 20 January 2017
Source:Archives of Oral Biology
Author(s): Brandon Lloyd, Boon Ching Tee, Colwyn Headley, Hany Emam, Susan Mallery, Zongyang Sun
ObjectiveResearch has shown promise of using bone marrow mesenchymal stem cells (BMSCs) for craniofacial bone regeneration; yet little is known about the differences of BMSCs from limb and craniofacial bones. This study compared pig mandibular and tibia BMSCs for their in vitro proliferation, osteogenic differentiation properties and gene expression.DesignBone marrow was aspirated from the tibia and mandible of 3-4 month-old pigs (n=4), followed by BMSC isolation, culture-expansion and characterization by flow cytometry. Proliferation rates were assessed using population doubling times. Osteogenic differentiation was evaluated by alkaline phosphatase activity. Affymetrix porcine microarray was used to compare gene expressions of tibial and mandibular BMSCs, followed by real-time RT-PCR evaluation of certain genes.ResultsOur results showed that BMSCs from both locations expressed MSC markers but not hematopoietic markers. The proliferation and osteogenic differentiation potential of mandibular BMSCs were significantly stronger than those of tibial BMSCs. Microarray analysis identified 404 highly abundant genes, out of which 334 genes were matched between the two locations and annotated into the same functional groups including osteogenesis and angiogenesis, while 70 genes were mismatched and annotated into different functional groups. In addition, 48 genes were differentially expressed by at least 1.5-fold difference between the two locations, including higher expression of cranial neural crest-related gene BMP-4 in mandibular BMSCs, which was confirmed by real-time RT-PCR.ConclusionsAltogether, these data indicate that despite strong similarities in gene expression between mandibular and tibial BMSCs, mandibular BMSCs express some genes differently than tibial BMSCs and have a phenotypic profile that may make them advantageous for craniofacial bone regeneration.



http://ift.tt/2iNRKW4

Dental occlusion analysis in the Mesolithic–Neolithic Age, Bronze Age, and Roman to Medieval times in Serbia: Tooth size comparison in skeletal samples

Publication date: Available online 20 January 2017
Source:Archives of Oral Biology
Author(s): Tina Pajević, Branislav Glišić
ObjectiveAnthropological studies have reported that tooth size decreases in the context of diet changes. Some investigations have found a reverse trend in tooth size from the prehistoric to the modern times. The aims of this study were to analyze tooth size in skeletal samples from Mesolithic–Neolithic Age, Bronze Age, and Roman to Medieval times to determine sex differences and establish a temporal trend in tooth size in the aforementioned periods.DesignWell-preserved permanent teeth were included in the investigation. The mesiodistal (MD) diameter of all teeth and buccolingual (BL) diameter of the molars were measured. Effects of sex and site were tested by one-way ANOVA, and the combined effect of these factors was analyzed by UNIANOVA.ResultsSexual dimorphism was present in the BL diameters of all molars and MD diameters of the upper first and the lower third molar. The lower canine was the most dimorphic tooth in the anterior region. The MD diameter of most teeth showed no significant difference between the groups, (sample from: Mesolithic–Neolithic Age-group 1; Bronze Age-group 2; Roman times-group 3; Medieval times-group 4), whereas the BL diameters of the upper second and the lower first molar were the largest in the first group. Multiple comparisons revealed a decrease in the BL diameter of the upper second and the lower first molar from the first to the later groups. Lower canine MD diameter exhibited an increase in the fourth group compared to the second group.ConclusionOn the basis of the MD diameter, a temporal trend could not be observed for most of the teeth. The lower canine exhibited an increase in the MD diameter from the prehistoric to the Medieval times. Changes of BL diameter were more homogeneous, suggesting that the temporal trend of molar size decreased from the Mesolithic–Neolithic to Medieval times in Serbia.



http://ift.tt/2kcvQIz

The effect of the Physical Consistency of the Diet on the Bone Quality of the Mandibular Condyle in Rats

Publication date: Available online 20 January 2017
Source:Archives of Oral Biology
Author(s): Shawna Kufley, James Elliot Scott, German Ramirez-Yanez
ObjectiveThis study aimed to analyze how the physical consistency of the diet affects the bone quality at the mandibular condyle.DesignSixty-three Wistar rats were randomly assigned to three groups. Twenty-two animals composed each group and they were fed with either a liquid, soft or hard diet. Seven animals were sacrificed from each group at days 7, 20, and 40 respectively. Their mandibles were removed and scanned at the postero-superior area of the condyle with a micro-CT scan.Resultsshowed a statistically significant difference for the bone mineral density (p <0.01) and total mineral density (p<0.01), when comparing the hard against the liquid group after seven days. After 20days both, the soft and the liquid diet groups, computed a statistically significant difference demonstrating a significant decrease in the measured values for bone mineral density, bone mineral content, total mineral density, and total mineral content. At day 40, the values stayed lower for the soft and liquid diets, even though they did not reach a significant difference.ConclusionsThis study supports the idea that a soft or liquid diet has a negative impact on the bone quality of the mandible, particularly during the periods of more active growing.



http://ift.tt/2kcuKwq

Similarities and Differences between Porcine Mandibular and Limb Bone Marrow Mesenchymal Stem Cells

Publication date: Available online 20 January 2017
Source:Archives of Oral Biology
Author(s): Brandon Lloyd, Boon Ching Tee, Colwyn Headley, Hany Emam, Susan Mallery, Zongyang Sun
ObjectiveResearch has shown promise of using bone marrow mesenchymal stem cells (BMSCs) for craniofacial bone regeneration; yet little is known about the differences of BMSCs from limb and craniofacial bones. This study compared pig mandibular and tibia BMSCs for their in vitro proliferation, osteogenic differentiation properties and gene expression.DesignBone marrow was aspirated from the tibia and mandible of 3-4 month-old pigs (n=4), followed by BMSC isolation, culture-expansion and characterization by flow cytometry. Proliferation rates were assessed using population doubling times. Osteogenic differentiation was evaluated by alkaline phosphatase activity. Affymetrix porcine microarray was used to compare gene expressions of tibial and mandibular BMSCs, followed by real-time RT-PCR evaluation of certain genes.ResultsOur results showed that BMSCs from both locations expressed MSC markers but not hematopoietic markers. The proliferation and osteogenic differentiation potential of mandibular BMSCs were significantly stronger than those of tibial BMSCs. Microarray analysis identified 404 highly abundant genes, out of which 334 genes were matched between the two locations and annotated into the same functional groups including osteogenesis and angiogenesis, while 70 genes were mismatched and annotated into different functional groups. In addition, 48 genes were differentially expressed by at least 1.5-fold difference between the two locations, including higher expression of cranial neural crest-related gene BMP-4 in mandibular BMSCs, which was confirmed by real-time RT-PCR.ConclusionsAltogether, these data indicate that despite strong similarities in gene expression between mandibular and tibial BMSCs, mandibular BMSCs express some genes differently than tibial BMSCs and have a phenotypic profile that may make them advantageous for craniofacial bone regeneration.



http://ift.tt/2iNRKW4

Dental occlusion analysis in the Mesolithic–Neolithic Age, Bronze Age, and Roman to Medieval times in Serbia: Tooth size comparison in skeletal samples

Publication date: Available online 20 January 2017
Source:Archives of Oral Biology
Author(s): Tina Pajević, Branislav Glišić
ObjectiveAnthropological studies have reported that tooth size decreases in the context of diet changes. Some investigations have found a reverse trend in tooth size from the prehistoric to the modern times. The aims of this study were to analyze tooth size in skeletal samples from Mesolithic–Neolithic Age, Bronze Age, and Roman to Medieval times to determine sex differences and establish a temporal trend in tooth size in the aforementioned periods.DesignWell-preserved permanent teeth were included in the investigation. The mesiodistal (MD) diameter of all teeth and buccolingual (BL) diameter of the molars were measured. Effects of sex and site were tested by one-way ANOVA, and the combined effect of these factors was analyzed by UNIANOVA.ResultsSexual dimorphism was present in the BL diameters of all molars and MD diameters of the upper first and the lower third molar. The lower canine was the most dimorphic tooth in the anterior region. The MD diameter of most teeth showed no significant difference between the groups, (sample from: Mesolithic–Neolithic Age-group 1; Bronze Age-group 2; Roman times-group 3; Medieval times-group 4), whereas the BL diameters of the upper second and the lower first molar were the largest in the first group. Multiple comparisons revealed a decrease in the BL diameter of the upper second and the lower first molar from the first to the later groups. Lower canine MD diameter exhibited an increase in the fourth group compared to the second group.ConclusionOn the basis of the MD diameter, a temporal trend could not be observed for most of the teeth. The lower canine exhibited an increase in the MD diameter from the prehistoric to the Medieval times. Changes of BL diameter were more homogeneous, suggesting that the temporal trend of molar size decreased from the Mesolithic–Neolithic to Medieval times in Serbia.



http://ift.tt/2kcvQIz

Cell cycle-tailored targeting of metastatic melanoma: challenges & opportunities

Abstract

The advent of targeted therapies of metastatic melanoma, such as MAPK pathway inhibitors and immune checkpoint antagonists, has turned dermato-oncology from the 'bad guy' to the 'poster child' in oncology. Current targeted therapies are effective; although here is a clear need to develop combination therapies to delay the onset of resistance. Many anti-melanoma drugs impact on the cell cycle but are also dependent on certain cell cycle phases resulting in cell cycle phase-specific drug insensitivity. Here, we raise the question: Have combination trials been abandoned prematurely as ineffective possibly only because drug scheduling was not optimized? Firstly, if both drugs of a combination hit targets in the same melanoma cell, cell cycle-mediated drug insensitivity should be taken into account when planning combination therapies, timing of dosing schedules and choice of drug therapies in solid tumors. Secondly, if the combination is designed to target different tumor cell sub-populations of a heterogeneous tumor, one drug effective in a particular sub-population should not negatively impact on the other drug targeting another sub-population. In addition to the role of cell cycle stage and progression on standard chemotherapeutics and targeted drugs, we discuss the utilization of cell cycle checkpoint control defects to enhance chemotherapeutic responses or as targets themselves.

We propose that cell cycle-tailored targeting of metastatic melanoma could further improve therapy outcomes and that our real-time cell cycle imaging 3D melanoma spheroid model could be utilized as a tool to measure and design drug scheduling approaches.

This article is protected by copyright. All rights reserved.

http://ift.tt/2j7YIUr

CD4+TCRγδ+FoxP3+cells: An unidentified population of immunosuppressive cells towards disease progression leprosy patients

http://ift.tt/2k05Q3E

Langerhans cell markers CD1a and CD207 are the most rapidly responding genes in lesional psoriatic skin following adalimumab treatment

Abstract

TNFα-, IL-23- and IL-17-targeting drugs are highly effective in the treatment of psoriasis. However, the precise molecular mechanism remains unknown. In psoriatic skin the presence of Langerhans cells (LC) is reduced, but the role of LC is poorly understood. The purpose of this study was to investigate the impact of TNFα and IL-23/IL-17 on the presence of LC in the skin during treatment. Therefore, psoriatic skin was investigated before and after 4 days of adalimumab or ustekinumab treatment. Furthermore, TNFα and IL-17A stimulation was investigated in an ex vivo model of epidermis and dermis from healthy normal skin kept in cultures at an air-liquid interphase for 4 days.

In a gene array analysis we found that the two LC markers, CD1a and CD207, were among the most up- or downregulated genes in psoriatic skin after anti-TNFα therapy. Validation showed that both mRNA expression and protein level followed the same pattern and became significantly upregulated after 4 days of treatment. No changes were seen after ustekinumab treatment. In the ex vivo skin model, a decrease in the CD1a level was seen after TNFα stimulation and it was caused by LC migration from epidermis. No response in LC migration was seen after IL-17A stimulation. Taken together, we demonstrated that changes in the LC level in epidermis precede the histological and clinical changes during adalimumab treatment in psoriatic skin. Furthermore, TNFα plays a prominent role in orchestrating LC migration in the skin. This seems not to be the true for the IL-23/IL-17A pathway.

This article is protected by copyright. All rights reserved.

http://ift.tt/2j7Nvn2

In-vitro performance of CAD/CAM-fabricated implant-supported temporary crowns

Abstract

Objectives

The aim of this study was to investigate the in-vitro performance and fracture resistance of a temporary computer-aided designed and computer-aided manufactured polymethylmethacrylate (CAD/CAM-PMMA) material as implant or tooth-supported single crown with respect to the clinical procedure (permanently bonded/temporarily cemented).

Materials and methods

Sixty-four crowns were fabricated on implants or human molar teeth simulating (a) labside procedure on prefabricated titanium-bonding base ([TiBase] implant crown bonded in laboratory, screwed chairside), (b) labside procedure ([LAB] standard abutment and implant crown bonded in laboratory, screwed chairside), (c) chairside procedure ([CHAIR] implant crown bonded to abutment), and (d) reference ([TOOTH] crowns luted on prepared human teeth). Crowns were made of a CAD/CAM-PMMA temporary material (TelioCAD, Ivoclar-Vivadent). For investigating the influence of fixation, half of the crowns were permanently (P) or temporarily (T) bonded. Combined thermal cycling and mechanical loading (TCML) was performed simulating a 5-year clinical situation. Fracture force was determined. Data were statistically analyzed (Kolmogorov-Smirnov test, one-way ANOVA; post hoc Bonferroni, α = 0.05).

Results

All restorations survived TCML without visible failures. Fracture results varied between 3034.3 (Tooth-P) and 1602.9 N (Tooth-T) [TOOTH], 1510.5 (TiBase-P) and 963.6 N (TiBase-T) [TiBase], 2691.1 (LAB-P) and 2064.5 N (LAB-T) [LAB], and 1609.4 (Chair-P) and 1253.0 N (Chair-T) [CHAIR]. Tested groups showed significantly (p < 0.001) different fracture values. Failure pattern was characterized by fractures in mesial-distal, buccal-oral, or mixed (mesial-distal/buccal-oral) directions, with differences for the individual groups.

Conclusions

Temporary CAD/CAM crowns showed no different in-vitro performance but provided different fracture results that depended on cementation, screw channel, and type of abutment.

Clinical relevance

All bonded and screwed PMMA crowns were in a range where clinical application seems not restricted.

http://ift.tt/2jLAfFC

Gingival recessions of lower incisors after proclination by orthodontics alone or in combination with anterior mandibular alveolar process distraction osteogenesis

Abstract

Objectives

The aim of this study was to longitudinally compare periodontal conditions in consecutive patients who had orthodontic treatment with proclination of lower incisors either by orthodontics alone or in combination with anterior mandibular alveolar process distraction osteogenesis (DO).

Materials and methods

Nineteen patients had orthodontic treatment with DO, 18 with extraction of lower premolars (Ex), and 18 without extractions (Nonex). Lateral cephalograms were used to evaluate lower incisor proclination, while study casts and intraoral photographs were used to evaluate labial and lingual gingival recessions before (T1) and at an average of 4.5 years (T2) after treatment.

Results

No differences in labial recessions on lower incisors were present between the patient groups despite greater lower incisor proclination in the Nonex and DO groups. The Ex group showed no new development of lingual recessions in contrast to the Nonex (eight sites; two subjects) and DO groups (seven sites; three subjects). Severe lingual recessions (increased ≥1 mm) were more present in the Nonex group (five sites; two subjects) compared to the Ex group (no sites). Proclination of lower incisors of 10° or more either by orthodontic tooth movement or displacement of the whole alveolar process increased the risk of lingual gingival recessions 17 times. This was not the case with labial gingival recessions.

Conclusions

Orthodontic or surgical proclination of lower incisors beyond a 10° limit increases the risk of inducing lingual gingival recessions.

Clinical relevance

During orthodontic treatment, with or without DO, one should avoid proclining lower incisors more than 10° to decrease the risk of gingival recessions.

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Effect of Mastoid Drilling on Hearing of the Contralateral Normal Ear in Mastoidectomy

Abstract

To evaluate hearing of the contralateral normal ear before and after mastoidectomy in a longitudinal manner and to assess whether the hearing loss is transient or permanent and to find out the duration of temporary hearing loss. This was a clinical longitudinal observational study involving 50 patients with unilateral chronic suppurative otitis media requiring mastoidectomy operation over a period of 18 months after satisfying the inclusion criteria. During the part of the mastoidectomy surgery involving drilling of the mastoid bone, noise levels were recorded at multiple points in the surgery using a digital sound level meter. Postoperatively, beginning from Day 1 to Day 7, PTA and OAE of the contralateral ear were recorded for all patients. The patients were then followed up at 1, 3 and 6 months postoperatively, at which times PTA and OAE were repeated. There is an increase in the absence of High Frequency DPOAEs on the first and second postoperative days, but this increase is higher than that of Low Frequency DPOAEs and gradually returns to normal by 72 h. OAEs were found to be more sensitive at diagnosing and tracking the progress of affected patients. All affected ears only had a temporary postoperative hearing loss, primarily affecting the higher frequencies and returning to normal within 72 h. Drill-generated noise and vibration during mastoidectomy operation is associated with a significant temporary shift in hearing thresholds of the contralateral normal ear in susceptible individuals, affecting the higher frequencies, and is best evaluated using DPOAEs.

http://ift.tt/2iNr5IS

An Overview of Autosomal Dominant Tumour Syndromes with Prominent Features in the Oral and Maxillofacial Region

Abstract

Several autosomal dominant inherited tumour syndromes demonstrate prominent features in the oral and maxillofacial region. Although multiple organ systems are frequently involved, the target organs more frequently affected are the skin (nevoid basal cell carcinoma syndrome, Brooke–Spiegler syndrome, Birt–Hogg–Dube syndrome and Muir–Torre syndrome), gastrointestinal tract (Peutz–Jegher syndrome and Gardner syndrome) or endocrine system (multiple endocrine neoplasia type 2b and hyperparathyroidism-jaw tumour syndrome). In some syndromes, the disease is multisystem with skin index lesions presenting in the head and neck (Cowden syndrome and tuberous sclerosis complex). The pertinent features of these syndromes are reviewed with a systems-based approach, emphasising their clinical impact and diagnosis.

http://ift.tt/2jKVp6F

An Overview of Autosomal Dominant Tumour Syndromes with Prominent Features in the Oral and Maxillofacial Region

Abstract

Several autosomal dominant inherited tumour syndromes demonstrate prominent features in the oral and maxillofacial region. Although multiple organ systems are frequently involved, the target organs more frequently affected are the skin (nevoid basal cell carcinoma syndrome, Brooke–Spiegler syndrome, Birt–Hogg–Dube syndrome and Muir–Torre syndrome), gastrointestinal tract (Peutz–Jegher syndrome and Gardner syndrome) or endocrine system (multiple endocrine neoplasia type 2b and hyperparathyroidism-jaw tumour syndrome). In some syndromes, the disease is multisystem with skin index lesions presenting in the head and neck (Cowden syndrome and tuberous sclerosis complex). The pertinent features of these syndromes are reviewed with a systems-based approach, emphasising their clinical impact and diagnosis.

http://ift.tt/2jKVp6F

Assessment of biological, psychological and adherence factors in the prediction of step-down treatment for patients with well-controlled asthma

Abstract

Objectives

Inhaled corticosteroids (ICS) and inhaled corticosteroids combined with long-acting beta2-agonist (ICS/LABA) are standard treatments for asthma. However, factors that might help reduce medication in well-controlled asthma are unknown. We classified problems of asthma patients into biological, psychological and adherence factors, and investigated factors associated with the indication and failure of a medication step-down treatment.

Methods

Two hundred twenty two well-controlled asthma patients receiving ICS or ICS/LABA were assessed for physical and psychiatric problems and followed up for one year from adjustment of their treatment step. Factor B was defined as a presence of chronic upper airway complications. Factor P was defined as presence of psychiatric complications such as sleep disorder, depression, anxiety and somatoform disorders. Factor A was defined as poor adherence to ICS or ICS/LABA inhaler of 75% or less. Success in step-down treatment was defined as maintenance of well-controlled status for over one year after step-down.

Results

Factor B was the most important single negative predictive factor for indication for step-down treatment (Odds ratio; 0.19). Factor A increased the risk of failure to maintain step-down treatment most significantly by 23-fold, and factor B increased it by 11-fold. The combination of factors B and A increased failure by 24-fold, factors P and A by 21-fold, all three factors by 36-fold. Factor P only interacted with the other factors to reduce chances of stepping down, but did not constitute a problem factor when present alone.

Conclusions

The evaluation of biological, psychological and adherence problems may lead to a more proactive and targeted approach to step-down treatment for patients with well-controlled asthma.

This article is protected by copyright. All rights reserved.

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Chloride ion transport and overexpression of TMEM16A in a guinea pig asthma model

Abstract

Background

TMEM16A, a Ca-activated Cl channel, regulates various physiological functions such as mucin secretion. However, the role of TMEM16A in hypersecretion in asthma is not fully understood.

Objective

The aim of this study is to evaluate Cl ion transport via TMEM16A and determine the localization of TMEM16A in a guinea pig asthma model.

Methods

Guinea pigs were sensitized with OVA ip. on Day 1 and Day 8. On Day 22, we assessed OVA challenge-induced Cl ion transport in the sensitized tracheas ex vivo in an Ussing chamber, compared with the non-sensitized tracheas. We then examined the effect of T16Ainh-A01, a TMEM16A inhibitor, on the increase in Cl ion transport. The tracheal epithelium was immunostained with an anti-TMEM16A antibody. Epithelial cells from guinea pig tracheas were cultured at the air-liquid interface in the presence of IL-13 for in vitro study. We studied the effect of TMEM16A inhibitors on Ca-dependent agonist, UTP-induced increases in Cl ion transport in the cultured cells. The cells were immunostained with an anti-TMEM16A antibody, an anti-MUC5AC antibody, and an anti-α-tubulin antibody.

Results

OVA challenge induced an increase in Isc within 1 min in the OVA-sensitized tracheas but not in the non-sensitized tracheas, which was inhibited by pretreatment of T16Ainh-A01. Sensitized tracheas showed goblet cell metaplasia with more positive TMEM16A immunostaining, particularly in the apical portion compared with the non-sensitized tracheas. The in vitro UTP-induced increase in Cl ion transport was strongly inhibited by pretreatment with T16Ainh-A01, benzbromarone, and niflumic acid. TMEM16A was positively immunostained at the apical portion and in the MUC5AC-positive area in IL-13-induced goblet cell metaplasia.

Conclusions

Antigen challenge and Ca-dependent agonist treatment increased Cl ion transport via the overexpression of TMEM16A in goblet cell metaplasia in a guinea pig asthma model. TMEM16A inhibitors may be useful for the treatment of hypersecretion in asthma.

This article is protected by copyright. All rights reserved.

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Use of baked milk challenges and milk ladders in clinical practice: a worldwide survey of healthcare professionals

Abstract

In previous years, the cornerstone of the management of Cow's Milk Allergy (CMA) was solely based on the strict avoidance of all cow's milk (CM) and foods containing CM from the patient's diet [1]. More recently, the importance of baked milk (BM) introduction into the diet of children with CMA has become well-recognised as a part of CMA management. Current research suggests that 75% of children become tolerant to baked/heated forms of CM such as muffin and waffles before they become tolerant to pure/uncooked forms of CM [2].

This article is protected by copyright. All rights reserved.

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Maternal psychiatric symptoms during pregnancy and risk of childhood atopic diseases

Abstract

Background

Maternal psychiatric symptoms during pregnancy might affect the developing immune system and subsequent risk of childhood atopic diseases.

Objective

Our aim was to examine the associations of maternal psychiatric symptoms during pregnancy with allergic sensitization, allergy and eczema in children until age 10 years.

Methods

This study among 5,205 children was performed in a population-based prospective cohort from fetal life onwards. We assessed maternal and paternal psychiatric symptoms (overall, depressive, anxiety) during pregnancy and at 36 months after delivery, and maternal psychiatric symptoms at 2 and 6 months after delivery using the Brief Symptom Inventory. Inhalant and food allergic sensitization were measured by skin prick tests, and physician-diagnosed inhalant and food allergy or eczema by questionnaires from birth until age 10 years. We used multivariate logistic regression, multinomial logistic regression or generalized estimating equation models where appropriate.

Results

We observed no association of maternal psychiatric symptoms during pregnancy with allergic sensitization. Maternal overall psychiatric, depressive and anxiety symptoms during pregnancy were associated with an increased risk of inhalant allergy only (adjusted odds ratio (95% confidence interval) 1.96 (1.44, 2.65), 1.58 (1.25, 1.98), and 1.61 (1.27, 2.03), respectively, per 1-unit increase). Maternal overall psychiatric and anxiety symptoms during pregnancy were associated with an increased risk of eczema (1.21 (1.05, 1.39) and 1.15 (1.02, 1.29), respectively, per 1-unit increase). Effect estimates did not materially change when maternal psychiatric symptoms after delivery, or paternal psychiatric symptoms during pregnancy and after delivery were taken into account.

Conclusions & Clinical relevance

Maternal psychiatric symptoms during pregnancy were associated with increased risks of childhood inhalant allergy and eczema, independent of maternal psychiatric symptoms after delivery and of paternal psychiatric symptoms.

This article is protected by copyright. All rights reserved.

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Cadherin-11 as a therapeutic target in chronic, inflammatory rheumatic diseases

Publication date: Available online 21 January 2017
Source:Clinical Immunology
Author(s): Petros P. Sfikakis, Nikolaos I. Vlachogiannis, Panagiotis F. Christopoulos
Cadherin-11 has been identified as a key regulator of synovial architecture mediating contact between Fibroblast-like Synoviocytes and organization in the lining layer. A central role for cadherin-11 has also been suggested in the formation of the rheumatoid pannus. Therapeutic targeting of cadherin-11 results in amelioration of autoimmune experimental arthritis, as well as of experimental fibrosis. In addition, cadherin-11 expression is upregulated in the synovium of patients with chronic inflammatory arthritis, whereas detection of cadherin-11 mRNA transcripts in the peripheral blood has been associated with more severe disease phenotypes in two prototypic conditions of chronic joint inflammation and fibrosis, namely, rheumatoid arthritis and systemic sclerosis, respectively. Currently, a monoclonal antibody against cadherin-11 is in early phases of clinical trials in patients with rheumatoid arthritis. Herein, we review the current knowledge regarding the potential role of cadherin-11 in pathogenesis, as well as a biomarker and therapeutic target in chronic inflammatory rheumatic diseases.



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Les néoplasies intra-épithéliales bowénoïdes HPV-induites du pénis

Publication date: Available online 20 January 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-.N. Dauendorffer, B. Cavelier Balloy, M. Bagot, C. Renaud-Vilmer




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Vomero-premaxillary joint: A marker of evolution of the species

Publication date: Available online 20 January 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): S. Botti, C. Rumeau, P. Gallet, R. Jankowski
ObjectiveAccording to evolutionary developmental (evo-devo) theory, the vomers are bones derived from the secondary palate. Growth of the palatine processes of the maxillae, including the precursors of vomer bones, results in midline fusion posteriorly to the primary palate, which forces the ascension of the vomer bones towards the primary nasal septum, formed by septal cartilage and the perpendicular plate of the ethmoid. According to this hypothesis, the anterior border of the vomer articulates with the posterior surface of the premaxilla in the incisive canal (IC).Material and methodThe objective of this retrospective study was to measure the degree of impaction of the anteroinferior angle of the vomer in the IC on CT scans showing a non-deformed nasal septum. Thirty-two out of a series of 506 nasal sinus CT scans were used to obtain measurements on coronal sections of non-deformed septa through the IC.ResultsThirty-one of the 32 vomers were impacted in the IC. In the case of a Y-shaped vomer (n=26), 43% of the length of the vomer was impacted in 41% of the length of the IC. In the case of I-shaped vomers (n=6), 34% of the length of the vomer was impacted in 41% of the length of the IC. The only vomer that did not impact into the IC was Y-shaped.ConclusionImpaction of the vomer in the IC posteriorly to the premaxilla can be explained by the evo-devo concept of the formation of the nasal cavities. In contrast, the classical embryological description of the formation of the nasal septum cannot provide an explanation for impaction of the vomer.



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Quality of life impairment in patients with head and neck cancer and their caregivers: a comparative study

Publication date: November–December 2016
Source:Brazilian Journal of Otorhinolaryngology, Volume 82, Issue 6
Author(s): Laís Rigoni, Raphaella Falco Bruhn, Rafael De Cicco, Jossi Ledo Kanda, Leandro Luongo Matos
IntroductionHead and neck cancer represents 3% of all the types of malignant neoplasms and squamous cell carcinoma (SCC) is responsible for 90% of these cases. There have been some studies evaluating the quality of life of these patients, but little is known about the physical and emotional effects on their caregivers.ObjectiveTo evaluate the quality of life of patients with head and neck cancer and their caregivers by applying validated questionnaires.MethodsThirty patients with advanced tumors (SCC stage III or IV) and their 30 caregivers were included. Specific questionnaires (Coop/Wonca, EORTC QLQ–C30, EORTC H&N35, Coop/Wonca, and Caregiver Strain Index – CSI) were applied during routine medical consultations.ResultsOf the 30 patients, 28 were males and 25 had stage IV tumors, with mean age of 56.6 years. 36.7% had the primary tumor in the oropharynx and 70% reported pain. The functional cognitive, physical, and emotional scales were the most affected. Pain, fatigue, and sleep disorders were the most prevalent symptoms. Of the 30 caregivers, 23 were females and 70% were the primary caregivers. 36.7% of the caregivers had high levels of stress, mainly related to the feeling of incapacity. The comparison between patients and caregivers demonstrated that the two groups had similar quality of life impairment: physical fitness (p=0.487), mental health (p=0.615), daily activities (p=0.793), social activities (p=0.301), changes in health (p=0.649), and overall health (p=0.168).ConclusionQuality of life impairment is similar between patients and their caregivers. This result demonstrates that not only the patients show quality of life impairment, but their caregivers also have it and at similar proportions.



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Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

With improving surgical techniques for total elbow arthroplasty clinical outcomes have improved and its utilization continues to increase. Despite these advances, complication rates remain as high as 24%. Of t...

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Vertical Alveolar Distraction Osteogenesis of the Atrophic Posterior Mandible Prior to Dental Implant Insertion

Publication date: Available online 21 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adi Rachmiel, Dekel Shilo, Dror Aizenbud, Omri Emodi
PurposeAugmentation of deficient mandibular posterior alveolar ridges poses a great challenge due to extensive bone deficiency and presence of the inferior alveolar nerve. The present study sets its focus on vertical alveolar distraction osteogenesis (ADO) at the posterior mandible prior to dental implant placement.Materials & Methods21 sites in 18 patients with severe mandibular posterior alveolar ridge deficiency were included. A trapezoid osteotomy was performed and an extraosseous alveolar distraction device was fixed and activated following four days of latency period at a rate of 0.5mm/day. Following four month of retention period the distraction device was removed and titanium dental implants were placed.ResultsA mean vertical augmentation of 14.47mm was gained. The newly formed bone was demonstrated using panoramic radiography and CT imaging. 56 dental implants were placed and during a minimum follow-up of 36 months two implants were lost; 96.42% success rate.ConclusionsADO offers significant vertical ridge augmentation with simultaneous soft tissue expansion and stable results. ADO diminishes the need for autogenous bone graft, thus sparing donor site morbidity. ADO of the deficient posterior mandibular alveolar ridge is useful in moderate-severe bony deficiencies and allows for adequate bone formation which allows implant insertion.



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Position statement of the Brazilian Academy of Rhinology on the use of antihistamines, antileukotrienes, and oral corticosteroids in the treatment of inflammatory sinonasal diseases

Publication date: Available online 21 January 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Olavo de Godoy Mion, João Ferreira de Mello, Daniel Lorena Dutra, Nilvano Alves de Andrade, Washington Luiz de Cerqueira Almeida, Wilma Teresinha Anselmo-Lima, Leonardo Lopes Balsalobre Filho, Jair de Carvalho e Castro, Roberto Eustáquio dos Santos Guimarães, Marcus Miranda Lessa, Sérgio Fabrício Maniglia, Roberto Campos Meireles, Márcio Nakanishi, Shirley Shizue Nagata Pignatari, Renato Roithmann, Fabrizio Ricci Romano, Rodrigo de Paula Santos, Marco César Jorge dos Santos, Edwin Tamashiro
IntroductionInflammatory conditions of the nose and paranasal sinuses are very prevalent in the general population, resulting in marked loss of quality of life in affected patients, as well as significant work, leisure, and social activity losses. These patients require specific and specialized treatment. A wide range of oral medications are available.ObjectiveThe present document is aimed to clarify, for professionals treating patients with inflammatory sinonasal diseases, both specialists and general practitioners, specific oral therapies in noninfectious nasal inflammatory conditions.MethodsThe methodology used to create this article included the search for the key words: oral corticosteroids, antihistamines, antileukotrienes, rhinitis, rhinosinusitis in the MEDLINE and EMBASE databases in the last 5 years. Since no relevant article was found for the text on the subject of interest in the last 5 years, the search was extended for another 5 years, and so on, according to the authors' needs.ResultsRelevant literature was found regarding the use of antihistamines, antileukotrienes and oral corticosteroids in these conditions. The Brazilian Academy of Rhinology emphasizes, after extensive discussion by the collegiate, key points in the treatment with these drugs.ConclusionThere is support in the literature for the use of these drugs; however, final considerations about the role of each of them have been made.



http://ift.tt/2kbIDej

An Overview of Autosomal Dominant Tumour Syndromes with Prominent Features in the Oral and Maxillofacial Region

Abstract

Several autosomal dominant inherited tumour syndromes demonstrate prominent features in the oral and maxillofacial region. Although multiple organ systems are frequently involved, the target organs more frequently affected are the skin (nevoid basal cell carcinoma syndrome, Brooke–Spiegler syndrome, Birt–Hogg–Dube syndrome and Muir–Torre syndrome), gastrointestinal tract (Peutz–Jegher syndrome and Gardner syndrome) or endocrine system (multiple endocrine neoplasia type 2b and hyperparathyroidism-jaw tumour syndrome). In some syndromes, the disease is multisystem with skin index lesions presenting in the head and neck (Cowden syndrome and tuberous sclerosis complex). The pertinent features of these syndromes are reviewed with a systems-based approach, emphasising their clinical impact and diagnosis.

http://ift.tt/2jKVp6F

Valoración audiológica y subjetiva del dispositivo Baha® Attract

Publication date: Available online 20 January 2017
Source:Acta Otorrinolaringológica Española
Author(s): Tomàs Pérez-Carbonell, Ignacio Pla-Gil, Jaume Redondo-Martínez, Antonio Morant-Ventura, Francisco Javier García-Callejo, Jaime Marco-Algarra
Se incluyeron en el estudio 9 pacientes implantados con el dispositivo Baha^® Attract. A todos los pacientes se les realizó, con y sin el dispositivo, una audiometría tonal en campo libre, una audiometría verbal en campo libre, y una audiometría verbal con ruido de fondo, así como la aplicación de los cuestionarios Glasgow Benefit Inventory (GBI) y Abbreviated Profile of Hearing Aid Benefit (APHAB).Las valoraciones audiológicas con el dispositivo mostraron unos umbrales auditivos promedios de 35,8dB, con ganancias medias de 25,8dB. El umbral de recepción verbal promedio con el dispositivo se situó en 37dB, mostrando una ganancia de 23dB. Los resultados promedio del umbral de discriminación máxima fueron de 60dB con el dispositivo.El Baha^® Attract logra alcanzar unas ganancias auditivas en los pacientes indicados correctamente, con una consiguiente valoración subjetiva positiva por parte de los pacientes, presentando no obstante un efecto atenuativo en su transmisión transcutánea, que le impide alcanzar mayores ganancias.We included 9 patients implanted with Baha^® Attract. All our patients were evaluated by free field tonal audiometry, free field verbal audiometry and free field verbal audiometry with background noise, all the tests were performed with and without the device. To evaluate the subjective component of the implantation, we used the Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB).The auditive assessment with the device showed average auditive thresholds of 35.8dB with improvements of 25.8dB over the previous situation. Speech reception thresholds were 37dB with Baha^® Attract, showing improvements of 23dB. Maximum discrimination thresholds showed an average gain of 60dB with the device.Baha^® Attract achieves auditive improvements in patients for whom it is correctly indicated, with a consequent positive subjective evaluation. This study shows the attenuation effect in transcutaneous transmission, that prevents the device achieving greater improvements.



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Manual of ICU Procedures.

No abstract available

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Smartphone-based behavioural intervention alleviates children's anxiety during anaesthesia induction: A randomised controlled trial.

BACKGROUND: Preoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial. OBJECTIVE(S): To verify whether nonpharmacological strategies, that is, leaflet and distraction with smartphone application presented to parents/guardians and children, respectively, were effective in preventing children's anxiety during anaesthesia induction. DESIGN: Randomised clinical trial. SETTING: A tertiary care teaching hospital. PATIENTS: In total, 84 children (aged 4 to 8 years; American Society of Anesthesiologists I and II) undergoing minor-to-moderate elective surgical procedures and their parents/guardians. INTERVENTIONS: Children were randomised into four groups: control group, in which the parent/guardian was verbally informed about the anaesthetic procedure; the informed group, in which the parent/guardian was also provided with an information leaflet about the anaesthetic procedure; the smartphone group, in which the parent/guardian was verbally informed and the child received a smartphone application to play with while in the holding area before entering the operating room and the smartphone and informed group, in which the parent/guardian also received an information leaflet and the child, a smartphone application to play with while in the holding area before entering the operating room. MAIN OUTCOME MEASURES: Children's anxiety at two time points: in the holding area of the surgical centre and in the operating room during induction of anaesthesia by facemask. RESULTS: Median (IQR) anxiety levels were greater at time point operating room for children in the control group (55.0; range: 30.0 to 68.4) than in the other groups: informed group, 28.4 (23.4 to 45.0); smartphone group, 23.4 (23.4 to 30.0); smartphone and informed group, 23.4 (23.4 to 25.9). CONCLUSION: The behavioural distraction strategies using smartphones were effective in preventing an increase in children's anxiety during anaesthesia induction. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02246062. (C) 2017 European Society of Anaesthesiology

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Moderate hyperoxia induces inflammation, apoptosis and necrosis in human umbilical vein endothelial cells: An in-vitro study.

BACKGROUND: Perioperative oxygen (O2) therapy can cause hyperoxia. Extreme hyperoxia can injure the cardiovascular system and remote organs. OBJECTIVE: Our primary objective was to test the hypothesis that exposure to moderate hyperoxia will induce injury to human umbilical vein endothelial cells (HUVECs), a model for studying the vascular endothelium under controlled conditions. DESIGN: In-vitro cell culture study. SETTING: Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Austria. Study period from the beginning of October 2013 to the end of July 2014. CELLS: HUVECs were isolated from fresh umbilical cords. INTERVENTIONS: HUVECs were exposed to constant hyperoxia (40% O2), cyclic hyperoxia/anoxia (40%/0% O2, average 20% O2), constant normoxia (21% O2) and constant anoxia (0% O2) using a cell culture bioreactor. MAIN OUTCOME MEASURES: Cell growth, viability and release of IL-6, IL-8 and macrophage migration inhibitory factor were assessed at baseline and after 6, 12, 24 and 48 h of treatment. A phosphokinase array was performed after 60 min of treatment to identify activated cellular signalling pathways. RESULTS: Constant hyperoxia and cyclic hyperoxia/anoxia impeded cell growth, reduced viability, triggered a proinflammatory response, proven by IL-6, IL-8 and migration inhibitory factor release, and induced apoptosis and necrosis. The inflammatory and cytotoxicity responses were highest in the constant hyperoxia group. Phosphokinase arrays revealed that different O2 concentrations activated distinct sets of cytoprotective and cell death-associated kinases, including mitogen-activated protein kinases, Src kinases, p53, Akt, mitogen-activated and stress-activated kinase, Lyn, Lck, p70S6, signal transducers and activators of transcription 5b and 6, glycogen synthase kinase 3a/b and 5' AMP-activated protein kinases 1/2. CONCLUSION: Continuous moderate hyperoxia and cyclic moderate hyperoxia/anoxia-induced endothelial inflammation, apoptosis and necrosis. Given the large surface area of the vascular endothelium, moderately elevated O2 levels may contribute to cardiovascular inflammation and injury. TRIAL REGISTRATION: This in-vitro study was not registered in a database. (C) 2017 European Society of Anaesthesiology

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The nerve: A fragile balance between physiology and pathophysiology.

Regarding nerves as simple cables and electrical conduits is a gross error that does not allow us to understand the anomalies and disorders observed postoperatively. Instead, nerves should be seen as a living tissue of which physiological regulation is as complex as that of the blood-brain barrier. This review describes the basic structure and functions of this blood-nerve barrier and highlights the mechanisms of its breakdown and the resultant disorders. For clinical practice, it is important to note that the diffusion of molecules from the perineurium or from the blood is very limited, and so the blood-nerve barrier is a major pharmacologic barrier. Any stress upon neural physiological balance, particularly the terminal vascular blood supply, will induce the classic inflammatory cascade. Due to the complexity of the vascular system, nerve ischaemia will occur more quickly when the terminal blood supply is compromised. This blood supply can adapt in a variety of ways but when these possibilities of adaptation are exceeded, tissue ischaemia may be more extensive. Also, even after the initial injury has subsided, inflammation can cause a secondary insult. This could be particularly important in some patients with subclinical neuropathy. (C) 2017 European Society of Anaesthesiology

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Time course of copeptin during a model of experimental pain and hyperalgesia: A randomised volunteer crossover trial.

BACKGROUND: A reliable biomarker for quantifying pain or hyperalgesia has yet to be found. A surrogate marker of arginine vasopressin, copeptin, is elevated in a number of states of physiological and psychological stress and may have a role in quantifying pain and/or hyperalgesia. OBJECTIVES: To evaluate copeptin as a biomarker for pain or hyperalgesia developing after 120 min of sustained electrical stimulation. DESIGN: Secondary analysis of a randomised, double-blinded, crossover trial. SETTING: Single, tertiary university hospital from September 2014 to January 2015. PARTICIPANTS: A total of 16 healthy, opioid-naive white men with no confounding medication or history of pain. INTERVENTIONS: Copeptin and cortisol were measured five times during an established model of transdermal electrical stimulation designed to assess pain and hyperalgesia. MAIN OUTCOME MEASURES: The primary outcome was the change in copeptin concentration after 120 min of sustained electrical stimulation. Secondary outcomes were copeptin and cortisol concentrations after a subsequent period of rest and analyses of copeptin and cortisol concentrations were made in high-dose and low-dose fentanyl groups separately. RESULTS: Total copeptin concentrations were not significantly elevated after 120 min [9.15 pmol l-1 (interquartile ranges (IQR), 3.45 to 35.45 pmol l-1); P = 0.0150] compared with baseline [6.15 pmol l-1 (IQR, 3.60 to 10.62 pmol l-1)]. In the high-dose fentanyl group, there was a significant increase in copeptin within individuals [P = 0.001; median, 37.9 pmol l-1 (IQR, 8.1 to 62 pmol l-1)] after 120 min, and in the low-dose fentanyl group a significant decrease in copeptin concentrations within individuals [P = 0.006; median, 4.7 pmol l-1 (IQR, 3.13 to 9.35 pmol l-1)]. No correlation between copeptin concentration and either the area under the pain curve or area under the hyperalgesia curve could be found, indicating that the observed differences may be due to other fentanyl-mediated effects. CONCLUSION: Copeptin concentrations do not appear to be associated directly with pain and hyperalgesia. Instead, some fentanyl-mediated effect or effects appear to have greatly increased copeptin concentrations from baseline to 120 min. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02252458. (C) 2017 European Society of Anaesthesiology

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The impact of dermoscopy on melanoma detection in the practice of dermatologists in Europe: Results of a pan-European survey

Abstract

Background

Dermoscopy is a widely used technique that can increase the sensitivity and specificity of melanoma detection. Information is lacking on the impact of dermoscopy use on the detection of melanoma in the real-life practice of European dermatologists.

Objective

To identify factors that influence the benefit of using dermoscopy for increasing melanoma detection and lowering the number of unnecessary biopsies in the practice of European dermatologists.

Methods

We conducted a survey of dermatologists registered in 32 European countries regarding: the demographic and practice characteristics, dermoscopy training and use, opinions on dermoscopy and the self-estimated impact of dermoscopy use on the number of melanomas detected and the number of unnecessary biopsies performed in practice.

Results

Valid answers were collected for 7480 respondents, out of which 6602 reported using dermoscopy. Eighty-six percent of dermoscopy users reported that dermoscopy increased the numbers of melanomas they detected, and 70% reported that dermoscopy decreased the number of unnecessary biopsies of benign lesions they performed. The dermatologists reporting these benefits were more likely to have received dermoscopy training during residency, to use dermoscopy frequently and intensively, to use digital dermoscopy systems and pattern analysis compared to dermatologists who did not perceive any benefit of dermoscopy for the melanoma recognition in their practice.

Conclusions

Improving dermoscopy training especially during residency and increasing access to digital dermoscopy equipment are important paths to enhance the benefit of dermoscopy for melanoma detection in the practice of European dermatologists.

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Intralesional immunotherapy compared to cryotherapy in the treatment of warts

Abstract

Background

Warts are the most common clinical manifestation of the human papilloma-virus infection in the skin and mucous membranes. In spite of the various therapeutic modalities for nongenital skin warts, there is still no single method to be used as an approved treatment. In this study, we compared the efficacy of immunotherapy and cryotherapy on wart lesions.

Methods

Sixty patients with verruca vulgaris and plantar warts were randomly divided into two groups. One group received intralesional injection of candida antigen repeated every 3 weeks until complete improvement of all warts or for a maximum of three sessions. The second group was treated by cryotherapy with liquid nitrogen for a maximum of ten sessions or until clearance of all lesions. T-test and chi-square test were used for statistical analysis, and P < 0.05 was considered statistically significant.

Results

The patients showed a significant therapeutic response to immunotherapy compared to cryotherapy (P = 0.023). Moreover, a significant difference was observed between the time-elapsed before treatment and the therapeutic response between both groups (P = 0.041). 76.7% of patients were completely cured with immunotherapy, while only 56.7% responded to cryotherapy. Complete remission was observed with fewer sessions (20.17 ± 0.65) in immunotherapy compared to cryotherapy (3.82 ± 2.481), but no statistically significant difference was shown between groups. Immunotherapy was well-tolerated except for the pain during injection that was the most common side effect.

Conclusions

Intralesional immunotherapy is an effective treatment of warts. This method has a better therapeutic response, needs fewer sessions, and is capable of treating distant warts.

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Perioperative Care of the Patient With the Total Artificial Heart.

Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns. (C) 2017 International Anesthesia Research Society

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Perimembranous Ventricular Septal Defect Complicated by Aorto-Right Ventricular Fistula: The Role of Multimodal Echocardiography.

No abstract available

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Influence of Depth of Hypnosis on Pupillary Reactivity to a Standardized Tetanic Stimulus in Patients Under Propofol-Remifentanil Target-Controlled Infusion: A Crossover Randomized Pilot Study.

BACKGROUND: Pupillometry allows the measurement of pupillary diameter variations in response to nociceptive stimuli. This technique has been used to monitor the balance between analgesia and nociception. Under general anesthesia, the amplitude of pupillary dilation is related to the amount of administered opioids. The objective of this study was to determine whether at a constant infusion rate of opioids, the pupillary response was influenced by depth of hypnosis assessed by the bispectral index (BIS). METHODS: Twelve patients (14-20 years) anesthetized for orthopedic surgery were included. Under propofol-remifentanil target-controlled infusion, remifentanil effect site target concentration was fixed at 1 ng/mL. Two measures of pupillary reflex dilation were performed on each patient in a randomized order: one at BIS 55 and one at BIS 25. These levels of BIS were obtained by adjusting propofol target concentration and maintained for 10 minutes before each measure. For each measure, we applied a standardized tetanic stimulation on the patient's forearm (60 mA, 100 Hz, 5 seconds). All measures were performed before the beginning of surgery. RESULTS: Pupillary dilation was significantly greater at BIS 55 than at BIS 25: 32.1% +/- 5.3% vs 10.4% +/- 2.5% (mean difference estimate [95% confidence interval]: 21.8% [12.9-30.6], P

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The SLUScore: A Novel Method for Detecting Hazardous Hypotension in Adult Patients Undergoing Noncardiac Surgical Procedures.

BACKGROUND: It has been suggested that longer-term postsurgical outcome may be adversely affected by less than severe hypotension under anesthesia. However, evidence-based guidelines are unavailable. The present study was designed to develop a method for identifying patients at increased risk of death within 30 days in association with the severity and duration of intraoperative hypotension. METHODS: Intraoperative mean arterial blood pressure recordings of 152,445 adult patients undergoing noncardiac surgery were analyzed for periods of time accumulated below each one of the 31 thresholds between 75 and 45 mm Hg (hypotensive exposure times). In a development cohort of 35,904 patients, the associations were sought between each of these 31 cumulative hypotensive exposure times and 30-day postsurgical mortality. On the basis of covariable-adjusted percentage increases in the odds of mortality per minute elapsed of hypotensive exposure time, certain sets of exposure time limits were calculated that portended certain percentage increases in the odds of mortality. A novel risk-scoring method was conceived by counting the number of exposure time limits that had been exceeded within each respective set, one of them being called the SLUScore. The validity of this new method in identifying patients at increased risk was tested in a multicenter validation cohort consisting of 116,541 patients from Cleveland Clinic, Vanderbilt and Saint Louis Universities. Data were expressed as 95% confidence interval, P 0 (average 13.8) was found in 40% of patients who had twice the mortality, adjusted odds increasing by 5% per limit exceeded. When tested in the validation cohort, a SLUScore > 0 (average 14.1) identified 35% of patients who had twice the mortality, each incremental limit exceeded portending a 5% compounding increase in adjusted odds of mortality, independent of age and Charlson score (C = 0.73, 0.72-0.74, P

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Abnormal Intraprosthetic Regurgitation After Tricuspid Valve Replacement With a Mechanical Prosthesis.

No abstract available

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The Effect of Deep Versus Moderate Neuromuscular Block on Surgical Conditions and Postoperative Respiratory Function in Bariatric Laparoscopic Surgery: A Randomized, Double Blind Clinical Trial.

BACKGROUND: In recent literature, it has been suggested that deep neuromuscular block (NMB) improves surgical conditions during laparoscopy; however, the evidence supporting this statement is limited, and this was not investigated in laparoscopic bariatric surgery. Moreover, residual NMB could impair postoperative respiratory function. We tested the hypotheses that deep NMB could improve the quality of surgical conditions for laparoscopic bariatric surgery compared with moderate NMB and investigated whether deep NMB puts patients at risk for postoperative respiratory impairment compared with moderate NMB. METHODS: Sixty patients were evenly randomized over a deep NMB group (rocuronium bolus and infusion maintaining a posttetanic count of 1-2) and a moderate NMB group (rocuronium bolus and top-ups maintaining a train-of-four count of 1-2). Anesthesia was induced and maintained with propofol and remifentanil. The primary outcome measures were the quality of surgical conditions assessed by a single surgeon using a 5-point rating scale (1 = extremely poor, 5 = optimal), the number of intra-abdominal pressure increases >18 cmH2O and the duration of surgery. Secondary outcome measure was the postoperative pulmonary function assessed by peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity, and by the need for postoperative respiratory support. Data are presented as mean +/- standard deviation with estimated treatment effect (ETE: mean difference [95% confidence interval]) for group comparisons. RESULTS: There was no statistically significant difference in the surgeon's rating regarding the quality of the surgical field between the deep and moderate NMB group (4.2 +/- 1.0 vs 3.9 +/- 1.1; P = .16, respectively; ETE: 0.4 [-0.1, 0.9]). There was no difference in the proportional rating of surgical conditions over the 5-point rating scale between both groups (P = .91). The number of intra-abdominal pressure increases >18 cmH2O and the duration of surgery were not statistically different between the deep and moderate NMB group (0.2 +/- 0.9 vs 0.3 +/- 1.0; P = .69; ETE: -0.1 [-0.5, 0.4] and 61.3 +/- 15.1 minutes vs 70.6 +/- 20.8 minutes; P = .07, ETE: -9.3 [-18.8, 0.1], respectively). All the pulmonary function tests were considerably impaired in both groups when compared with baseline (P

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Incidental Detection of an Intracardial Floating Thrombus by Echocardiography During Coronary Artery Bypass Surgery.

No abstract available

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Symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors: A cohort analysis

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Angela T.T. Wong, Stephen Y. Lai, G. Brandon Gunn, Beth M. Beadle, Clifton D. Fuller, Martha P. Barrow, Theresa M. Hofstede, Mark S. Chambers, Erich M. Sturgis, Abdallah Sherif Radwan Mohamed, Jan S. Lewin, Katherine A. Hutcheson
ObjectiveThe purpose is to examine the relationship between mandibular osteoradionecrosis (ORN) and chronic dysphagia in long-term oropharynx cancer (OPC) survivors, and to determine the perceived symptom burden associated with ORN.Materials and methodsMedical records of 349 OPC patients treated with bilateral IMRT and systemic therapy were reviewed. ORN was graded using a published 4-point classification schema. Patients were considered to have chronic dysphagia if they had aspiration pneumonia, stricture or aspiration detected by fluoroscopy or endoscopy, and/or feeding tube dependence in long-term follow-up ⩾1year following radiotherapy. MD Anderson Symptom Inventory – Head and Neck Module (MDASI-HN) scores were analyzed in a nested cross-sectional survey sample of 118 patients.Results34 (9.7%, 95% CI: 6.8–13.3%) patients developed ORN and 45 (12.9%, 95% CI: 9.6–16.9%) patients developed chronic dysphagia. Prevalence of chronic dysphagia was significantly higher in ORN cases (12/34, 35%) compared to those who did not develop ORN (33/315, 11%, p<0.001). ORN grade was also significantly associated with prevalence of dysphagia (p<0.001); the majority of patients with grade 4 ORN requiring major surgery (6 patients, 75%) were found to have chronic dysphagia. Summary MDASI-HN symptom scores did not significantly differ by ORN grade. Significantly higher symptom burden was reported, however, among ORN cases compared to those without ORN for MDASI-HN swallowing (p=0.033), problems with teeth and/or gums (p=0.016) and change in activity (p=0.015) item scores.ConclusionsORN is associated with excess burden of chronic dysphagia and higher symptom severity related to swallowing, dentition and activity limitations.



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Validation of the ICON-S staging for HPV-associated oropharyngeal carcinoma using a pre-defined treatment policy

Publication date: March 2017
Source:Oral Oncology, Volume 66
Author(s): Sandro V Porceddu, Rob Milne, Elizabeth Brown, Anne Bernard, Reza Rahbari, Bena Cartmill, Matthew Foote, Margaret McGrath, Jermaine Coward, Benedict Panizza
ObjectivesTo determine whether the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S) for HPV associated oropharyngeal carcinoma (HPV+OPC) is a better discriminator of overall survival (OS), compared with the 7th edition (7th Ed) AJCC/UICC TNM staging following curative radiotherapy (RT).Material and methodsThe 5-year OS for all patients with non-metastatic (M0) p16-confirmed OPC treated between 2005 and 2015 was determined and grouped based on the 7th Ed AJCC/UICC TNM and ICON-S staging.ResultsA total of 279 patients met the inclusion criteria. The 5-year OS with the 7th Ed TNM classification were Stage I/II 88.9% (95% CI; 70.6–100%), Stage III 93.8% (95% CI; 85.9–100%), Stage IVa 86.4% (95% CI; 81.6–91.5%) and Stage IVb 62.3% (95% CI; 46.8–82.8%). On multivariate Cox regression analysis there was no statistically significant OS difference when comparing Stage I/II with, Stage III (p=0.98, HR=0.97, 95% CI; 0.11–8.64), IVa (p=0.67, HR=1.56, 95% CI; 0.2–11.94) and IVb (p=0.11, HR=5.54, 95% CI; 0.69–44.52), respectively.The 5-year OS with ICON-S staging were Stage I 93.6% (95% CI; 89.4–98.0%), Stage II 81.9% (95% CI; 73.7–91.1%) and Stage III 69.1% (95%; 57.9–82.6%). There was a consistent decrease of OS with increasing stage. On multivariate Cox regression analysis, when compared to Stage I, OS was significantly lower for stage II (p=0.007, HR=2.84, 95% CI; 1.33–6.05) and stage III (p<0.001, HR=3.78, 95% CI; 1.81–7.92), respectively.ConclusionThe ICON-S staging provides better OS stratification for HPV+OPC following RT compared with the 7th Ed TNM staging.



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