Developing a dedicated Dermatology Service for allogeneic bone marrow transplant recipients

Following allogeneic stem cell transplantation, graft versus host disease (GVHD) is a major cause of morbidity and mortality with the commonest organs affected being the skin and oral mucosa. Clinical presentation of cutaneous GVHD is widely variable and 13/30 patients attending a dedicated GVHD clinic were referred to Dermatologists with a specialist interest in GVHD (1). The British Committee for Standards in Haematology GVHD guidelines recommend organ-specific management and supportive care (2) recognising that early input from a Dermatologist is likely to improve clinical outcomes (3). JACIE 6^th Edition standards also recommend access to certified specialist trained Dermatologists (4).

This article is protected by copyright. All rights reserved.

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Accuracy, Yield and Clinical Impact of a Low-Cost HRME in the Early Diagnosis of Esophageal Adenocarcinoma

Condition:   Barrett's Esophagus
Intervention:   Drug: Proflavine, high resolution imaging
Sponsors:   Anandasabapathy, Sharmila, M.D.;   William Marsh Rice University
Recruiting - verified January 2017

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In reference to Butterfly myringoplasty for total, subtotal, and annular perforations

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In reference to “Stomal maturation does not increase the rate of tracheocutaneous fistulas”

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New bismuth-containing quadruple therapy in patients infected with Helicobacter pylori: A first Italian experience in clinical practice

Abstract

Background

Rising antibiotic resistance requires the evaluation of new and effective therapies.

Aims

To test the efficacy and safety of the new bismuth-containing quadruple therapy in patients infected with Helicobacter pylori.

Material and Methods

Consecutive H. pylori-positive dyspeptic patients were enrolled, either naïve or with previous failure treatment. Patients were treated with Pylera^® (three-in-one capsules containing bismuth subcitrate potassium 140 mg, metronidazole 125 mg, and tetracycline 125 mg) three capsules q.i.d. plus omeprazole 20 mg or esomeprazole 40 mg b.i.d. for 10 days. Eradication was confirmed using an urea breath test (at least 30 days after the end of treatment). Efficacy was assessed by UBT and safety by means of treatment-emergent adverse events.

Results

One hundred and thirty-one patients were included in the study: 42% of patients were naïve, and 58%, with previous failure treatment. H. pylori eradication was achieved in 124 patients (94.7%, 95% confidence intervals (CIs) 89.3-97.8) in ITT population. In the PP population, the percentage was 97.6% (95%, CIs 93.3-99.2). No difference in eradication rate was found either between naïve and previously treated patients (92.7% vs 96.0%, P=.383), or smoking and nonsmoking ones, or in patients taking omeprazole or esomeprazole.

Treatment-emergent adverse events occurred in 35 patients (26.7%, 95% CIs 19.9-34.9). They were mild in all cases except in four, who discontinued the study due to diarrhea (three patients) and diffuse urticarial rush (one patient).

Conclusions

Pylera^® achieved a remarkable eradication rate in clinical practice, irrespective if it was used as first treatment or as a rescue therapy. Treatment-emergent adverse events were uncommon generally mild.

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Janus-kinase inhibitors display broad anti-itch properties – a possible link via the TRPV1 receptor

Publication date: Available online 26 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Tomoki Fukuyama, Joy Rachel Ganchingco, Santosh K. Mishra, Thierry Olivry, Ignacy Rzagalinski, Dietrich A. Volmer, Wolfgang Bäumer

Teaser

The antipruritic effect of JAK inhibitors is fast and sustained in dogs with atopic dermatitis and in human patients with psoriasis. The inhibitory profiles of these molecules might be more related to their direct inhibition of TRPV1 rather than that of JAKs.


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Vergleich von klinischem und histopathologischem Staging bei Patienten mit Oropharynxkarzinom

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-114990

Trotz der Fortschritte in Diagnostik und Therapie ist die Prognose von Oropharynxkarzinomen weiterhin ungünstig. Deshalb ist es entscheidend, das klinische Staging weiter zu verbessern, um darauf basierend Therapiemodalitäten festzulegen.In einer retrospektiven, pseudonymisierten Untersuchung aus einem 13 Jahreszeitraum wurde bei 84 primär operierten Patienten mit einem Oropharynxkarzinom die klinische Klassifikation (cTNM) mit der histopathologischen Beurteilung (pTNM) verglichen. Auch das Vorhandensein von okkulten Metastasen sowie das Gesamtüberleben in Abhängigkeit von der histopathologischen Tumorausdehnung und des regionären Lymphknotenbefalls wurden betrachtet.Die höchste Übereinstimmung zwischen cTNM und pTNM konnte bei der Computertomografie erreicht werden. Eine definitive Bewertung mit histopathologischer Zuverlässigkeit ist durch das cTNM nicht möglich. Die MRT-Untersuchungen zeigten die Tendenz, die T- und N-Kategorien und das UICC-Tumorstadium klinisch ausgedehnter einzuschätzen als durch die definitve histopathologische Beurteilung nachgewiesen. Im Rahmen der Untersuchung des Überlebens getrennt nach Geschlecht, histopathologischer T- und N-Kategorien zeigte sich bei den höheren T- bzw. N-Kategorien ein geringeres Gesamtüberleben.Trotz aller Fortschritte in der bildgebenden Diagnostik bei Patienten mit Oropharynxkarzinomen ist das cTNM im Vergleich zum pTNM nur partiell in der Lage, mit klinisch geforderter Akkuratesse die TNM-Klassifikation der Tumorerkrankung zu bestimmen. Bei tendenziell sinkenden Prognosen ist es trotz moderner Therapieverfahren entscheidend, das prätherapeutische klinische Staging weiter zu verbessern und zu optimieren.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Audiologische Ergebnisse bei transkranieller CROS-Versorgung in Abhängigkeit von der Ertaubungsdauer

Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-111079

Bei einseitiger Taubheit ermöglicht eine transkranielle CROS-Versorgung ein pseudostereophones Hören. Jedoch zeigt die Literatur eine große Streuung für den zu erwartenden Alltagsnutzen, gemessen als Sprachaudiometrie im Störgeräusch. Mögliche Einflussfaktoren sind Zeitraum und plastische Umbauprozesse innerhalb der Hörbahn zwischen dem Beginn der Ertaubung bis zur CROS-Versorgung. An 18 Patienten mit einseitiger Taubheit wurde eine transkranielle CROS-Versorgung erprobt. Dabei wurden die Sprachverständlichkeitsschwellen (SVS) in 2 räumlichen Anordnungen jeweils mit und ohne CROS-Versorgung verglichen. Wurde das taube Ohr mit Sprache und das hörende Ohr mit Störgeräusch beschallt, konnte durch die CROS-Versorgung eine signifikante Verbesserung der SVS nachgewiesen werden. Länger ertaubte Patienten zeigten im Unterschied zu kurzzeitig ertaubten Patienten höhere Gewinne von im Mittel −4,0 dB. In der umkehrten Situation, d. h. Sprache auf das hörende Ohr und Störgeräusch auf das ertaubte Ohr, konnte eine signifikante Verschlechterung festgestellt werden. Im Vergleich zu kurzzeitig ertaubten Patienten zeigten sich hier bei länger ertaubten Patienten deutliche Verschlechterungen von durchschnittlich 3,1 dB. Zudem fand sich eine hochsignifikante Korrelation bei den individuellen Veränderungen der SVS zwischen beiden Hörsituationen. Die Ertaubungsdauer ist ein wesentlicher Faktor bei der individuellen Nutzenprognose einer transkraniellen CROS-Lösung. Der Zeitraum für audiometrisch nachweisbare plastische Umbauprozesse innerhalb der Hörbahn infolge einseitig fehlender akustischer Stimulation kann aufgrund der vorliegenden Ergebnisse auf ca. 1–3 Jahre geschätzt werden. Patienten mit kurzer Ertaubungsdauer haben keinen oder nur sehr wenig Nutzen von dieser Versorgungsoption.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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The TH2-polarizing function of atopic interleukin 17 receptor B–positive dendritic cells up-regulated by lipopolysaccharide

Recent studies suggest that epithelial cell (EC)-derived cytokines contribute to allergic airway disease exacerbation.

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Management of children with anaphylaxis in an urban emergency department

Anaphylaxis is a rare but severe systemic allergic reaction that affects multiple organ systems and can be life-threatening.1 Reactions to foods have been well documented to cause the most frequent anaphylactic reactions in children.2 Recent studies suggest minority children are more likely to report having a food allergy but less likely to have these allergies diagnosed.3,4 Appropriate recognition and management of anaphylaxis are therefore critical, especially among minority children. We performed a study that describes the management of anaphylaxis among children treated in an urban pediatric emergency department (ED) that primarily cares for minority children.

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First-line treatment of hymenoptera venom anaphylaxis: a 23-year real-life experience

Anaphylaxis represents a significant health care burden and occurs in approximately 1% to 3% of people annually.1,2 Allergy to hymenoptera venom occurs in 0.15% to 0.8% of children and 0.3% to 8.9% of adults.3 The complex management of anaphylaxis consists of emergency treatment of acute episodes, follow-up procedures including the prescription of epinephrine, and referral to an allergist. Therefore, it was of interest to investigate the medical care given to patients with systemic reactions after hymenoptera insect stings in Silesia, a southern region of Poland.

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Erratum

In the article entitled "Rate of recurrent anaphylaxis and associated risk factors among Olmsted County, Minnesota, residents" (Ann Allergy Asthma Immunol 2016;117:655–660), the affiliation for author Sangil Lee, MD, MS, should be Department of Emergency Medicine, The University of Iowa Carver College of Medicine, Iowa City, Iowa.

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Copyright

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1





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Contributors

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1





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Contents

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1





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Forthcoming Issues

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1





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Anesthesiologists in Obstetric Care: Beyond Labor Epidurals and C-Section Care

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1
Author(s): Lee A. Fleisher




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Obstetric Anesthesia

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1
Author(s): Onyi C. Onuoha, Robert R. Gaiser




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Embracing the Next Phase in Obstetric Anesthesiology

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1
Author(s): Onyi C. Onuoha, Robert R. Gaiser




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Identification and Management of Obstetric Hemorrhage

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1
Author(s): Emily J. Baird

Teaser

Obstetric hemorrhage remains the leading cause of maternal death and severe morbidity worldwide. Although uterine atony is the most common cause of peripartum bleeding, abnormal placentation, coagulation disorders, and genital tract trauma contribute to adverse maternal outcomes. Given the inability to reliably predict patients at high risk for obstetric hemorrhage, all parturients should be considered susceptible, and extreme vigilance must be exercised in the assessment of blood loss and hemodynamic stability during the peripartum period. Obstetric-specific hemorrhage protocols, facilitating the integration and timely escalation of pharmacologic, radiological, surgical, and transfusion interventions, are critical to the successful management of peripartum bleeding.


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The Use of Ultrasonography in Obstetric Anesthesia

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1
Author(s): Chiraag Talati, Cristian Arzola, Jose C.A. Carvalho

Teaser

This article provides an overview of the use of ultrasonography in obstetric anesthesia. It discusses the indications, benefits, and techniques of using ultrasonography to optimize the delivery of anesthesia and provide safe and efficacious clinical care. More specifically, it discusses the use of ultrasonography to facilitate neuraxial anesthesia, abdominal field blocks, central and peripheral vascular access, as well as the assessment of the lung fields and gastric contents, and identification of the cricothyroid membrane.


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Obstetric and Anesthetic Approaches to External Cephalic Version

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1
Author(s): Stephanie Lim, Jennifer Lucero

Teaser

Breech presentation is the most common abnormal fetal presentation and complicates approximately 3% to 4% of all pregnancies. External cephalic version (ECV) should be recommended to women with a breech singleton pregnancy, if there is no maternal or fetal contraindication. ECV increases the chance of cephalic presentation at the onset of labor and decreases the rate of cesarean delivery by almost 40%. The success rate of ECV is approximately 60%. Review of the risks and benefits for performing an ECV and for both the timing of ECV and the number of attempts should be should be discussed with the patient.


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Should Nitrous Oxide Be Used for Laboring Patients?

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1
Author(s): Michael G. Richardson, Brandon M. Lopez, Curtis L. Baysinger

Teaser

Nitrous oxide, long used during labor in Europe, is gaining popularity in the United States. It offers many beneficial attributes, with few drawbacks. Cost, safety, and side effect profiles are favorable. Analgesic effectiveness is highly variable, yet maternal satisfaction is often high among the women who choose to use it. Despite being less effective in treating labor pain than neuraxial analgesic modalities, nitrous oxide serves the needs and preferences of a subset of laboring parturients. Nitrous oxide should, therefore, be considered for inclusion in the repertoire of modalities used to alleviate pain and facilitate effective coping during labor.


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Postdural Puncture Headache

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1
Author(s): Robert R. Gaiser

Teaser

Headache after dural puncture is a common complication accompanying neuraxial anesthesia. The proposed cause is loss of cerebrospinal fluid through the puncture into the epidural space. Although obstetric patients are at risk for the development of this headache because of female gender and young age, there is a difference in the obstetric population. Women who deliver by cesarean delivery have a lower incidence of headache after dural puncture compared with those who deliver vaginally. Treatment of postdural puncture headache is an epidural blood patch. Departments should develop protocols for management of accidental dural puncture, including appropriate follow-up and indications for further management.


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Index

Publication date: March 2017
Source:Anesthesiology Clinics, Volume 35, Issue 1





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The impact of anesthesia on hemodynamic and volume changes in operative hysteroscopy: a bioimpedance randomized study

Operative hysteroscopy is accompanied by the use of distention medium. Its absorption can lead to volume overload and hemodynamic disturbances that can lead to serious complications. We investigated the impact of the type of anesthesia on decreasing these complications with the use of noninvasive thoracic bioimpedance.

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Aflatoxin B 1 levels in groundnut products from local markets in Zambia

Abstract

In Zambia, groundnut products (milled groundnut powder, groundnut kernels) are mostly sold in under-regulated markets. Coupled with the lack of quality enforcement in such markets, consumers may be at risk to aflatoxin exposure. However, the level of aflatoxin contamination in these products is not known. Compared to groundnut kernels, milled groundnut powder obscures visual indicators of aflatoxin contamination in groundnuts such as moldiness, discoloration, insect damage or kernel damage. A survey was therefore conducted from 2012 to 2014, to estimate and compare aflatoxin levels in these products (n = 202), purchased from markets in important groundnut growing districts and in urban areas. Samples of whole groundnut kernels (n = 163) and milled groundnut powder (n = 39) were analysed for aflatoxin B₁ (AFB₁) by competitive enzyme-linked immunosorbent assay (cELISA). Results showed substantial AFB₁ contamination levels in both types of groundnut products with maximum AFB₁ levels of 11,100 μg/kg (groundnut kernels) and 3000 μg/kg (milled groundnut powder). However, paired t test analysis showed that AFB₁ contamination levels in milled groundnut powder were not always significantly higher (P > 0.05) than those in groundnut kernels. Even for products from the same vendor, AFB₁ levels were not consistently higher in milled groundnut powder than in whole groundnut kernels. This suggests that vendors do not systematically sort out whole groundnut kernels of visually poor quality for milling. However, the overall contamination levels of groundnut products with AFB₁ were found to be alarmingly high in all years and locations. Therefore, solutions are needed to reduce aflatoxin levels in such under-regulated markets.

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Subscriptions

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In This Issue

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Important Announcement

<span class="paragraphSection"><span style="font-style:italic;">International Immunology</span> is the official journal of the Japanese Society for Immunology (JSI) and was launched in partnership with Oxford University Press in 1989 with Professor Tomio Tada as its inaugural Editor-in-Chief. Through Professor Tada's efforts <span style="font-style:italic;">International Immunology</span> firmly established itself as an internationally renowned, first rate immunology journal.</span>

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Cover

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Table of Contents

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Mycobacterium indicus pranii ( Mw )-mediated protection against visceral leishmaniasis by reciprocal regulation of host dual-specificity phosphatases

<span class="paragraphSection"><div class="boxTitle">Abstract</div><span style="font-style:italic;">Leishmania donovani</span> resides within the host macrophages by dampening host defence mechanisms and thereby it modulates the host cell functions for its survival. Multiple host cell factors compete during the interplay between the host and the parasite. Roles for dual-specificity phosphatases (DUSPs) are implicated in various pathological conditions. However, the reciprocity of these DUSPs was unknown in <span style="font-style:italic;">L. donovani</span> infection in a susceptible model. Here, we show that <span style="font-style:italic;">Mycobacterium indicus pranii</span> (<span style="font-style:italic;">Mw</span>), an immunomodulator, reciprocally regulates DUSP1 and DUSP6 through the TLR4 pathway. Association of PKC-β with DUSP6 increases after <span style="font-style:italic;">Mw</span> treatment resulting in decreased IL-10, phosphorylation of ERK1/2 and Arginase-1, whereas <span style="font-style:italic;">Mw</span> treatment decreases the association between PKC-ε and DUSP1 resulting in increased IL-12, phosphorylation of p38 and inducible nitric oxide synthase expression. Silencing of DUSP1 or over-expression of DUSP6 in <span style="font-style:italic;">L. donovani</span>-infected BALB/c mice decreases the parasite burden by inducing IL-12 and reducing IL-10 production. Therefore, we identify DUSP1 and DUSP6 as therapeutic targets, functions of which could be favourably modulated by <span style="font-style:italic;">Mw</span> during <span style="font-style:italic;">L. donovani</span> infection.</span>

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Corrigendum

<span class="paragraphSection"><strong>Differentiation and function of group 3 innate lymphoid cells, from embryo to adult</strong></span>

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Immunoreceptor CD300a on mast cells and dendritic cells regulates neutrophil recruitment in a murine model of sepsis

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Sepsis is a life-threatening syndrome caused by abnormal host immune responses against bacterial infection. Although innate immune cells are known to be important in the pathogenesis of sepsis, how their activation is regulated during sepsis remains incompletely understood. Here, we examined the role of the inhibitory immunoreceptor CD300a, which is expressed on various types of myeloid cells, in the pathogenesis of sepsis induced by cecal ligation and puncture (CLP). To this end, we used mice in which CD300a was specifically deleted on mast cells (MCs; <span style="font-style:italic;">Cd300a</span>^fl/fl<span style="font-style:italic;">Mcpt5</span>-Cre), dendritic cells (DCs; <span style="font-style:italic;">Cd300a</span>^fl/fl<span style="font-style:italic;">Itgax</span>-Cre), or macrophages and neutrophils (<span style="font-style:italic;">Cd300a</span>^fl/fl<span style="font-style:italic;">Lyz2</span>-Cre). We show that mice with CD300a-deleted MCs or DCs but not macrophages survived significantly longer than did control <span style="font-style:italic;">Cd300a</span>^fl/fl mice. In addition, whereas neutrophil recruitment into the peritoneal cavity was increased within 1 h after CLP in mice with CD300a-deleted MCs, peritoneal neutrophils did not increase in number until the 12 h time point in mice with CD300a-deficient DCs. These results indicate that CD300a on MCs and DCs regulates neutrophil recruitment into the peritoneal cavity after CLP.</span>

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Allergin-1 inhibits TLR2-mediated mast cell activation and suppresses dermatitis

<span class="paragraphSection"><div class="boxTitle">Abstract</div>TLR2 recognizes cell wall components of <span style="font-style:italic;">Staphylococcus aureus</span>, which colonizes >90% of atopic eczematous skin lesions. The regulatory mechanisms of TLR2 signaling in the skin remain unclear. Allergin-1, an inhibitory immunoglobulin-like receptor containing an ITIM, is expressed on mast cells (MCs) and inhibits IgE-mediated anaphylaxis in mice. Here, we show that Allergin-1 inhibits TLR2-mediated activation of, and inflammatory cytokine production by, MCs <span style="font-style:italic;">in vitro</span>. Compared with wild-type mice, Allergin-1-deficient mice showed enhanced ear swelling with enhanced collagen deposition and greater Ly6G⁺ neutrophil recruitment after intra-dermal injection of Pam2CSK4 into pinnae. Using Mas–TRECK mice, which is an MC deletion system based on <span style="font-style:italic;">il4</span> enhancer elements, we also demonstrated that Allergin-1 on MCs is responsible for the Pam2CSK4-induced ear swelling. These results suggest that Allergin-1 on skin MCs suppresses TLR2-induced dermatitis.</span>

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The role of α4 integrin in Theiler’s murine encephalomyelitis virus (TMEV)-induced demyelinating disease: an infectious animal model for multiple sclerosis (MS)

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Natalizumab, which is an antibody against α4 integrin, has been used for the treatment of multiple sclerosis. In the present study, we investigated both the role of α4 integrin and the therapeutic effect of HCA3551, a newly synthesized orally active small molecule α4 integrin antagonist, in the development of Theiler's murine encephalomyelitis virus-induced demyelinating disease (TMEV-IDD). The mRNA levels of α4 integrins were significantly up-regulated in the central nervous system (CNS) of mice with TMEV-IDD as compared with naive mice (*<span style="font-style:italic;">P</span> < 0.05). HCA3551 treatment in the effector phase significantly suppressed both the clinical and histological development of TMEV-IDD. The number of infiltrating mononuclear inflammatory cells in the CNS was significantly decreased in the mice treated with HCA3551 (**<span style="font-style:italic;">P</span> < 0.01). The labeling indices for CD68 antigen and the absolute cell numbers of TNF-α-producing CD4⁺ T cells and IFN-γ-producing CD8⁺ T cells were significantly decreased in the CNS of mice treated with HCA3551 (*<span style="font-style:italic;">P</span> < 0.05). HCA3551 treatment in the effector phase might inhibit the binding of α4 integrin to vascular cell adhesion molecule-1, thereby decreasing the number of mononuclear cells in the CNS.</span>

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Tolerogenic immunoreceptor ILT3/LILRB4 paradoxically marks pathogenic auto-antibody-producing plasmablasts and plasma cells in non-treated SLE

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Plasmablasts and plasma cells (PBs and PCs) producing pathogenic auto-antibodies in patients with systemic autoimmune diseases could be a better target for specific therapies for the disease than general immunosuppression or pan- or activated B-cell targeting. Our previous study indicated that leukocyte immunoglobulin-like receptor (LILR) B4 (B4, also known as ILT3/LIR-5/CD85k), a tolerogenic receptor in antigen-presenting cells, is ectopically expressed on the PB/PC surface in healthy individuals. Here, we show that the enlarged population size of PBs/PCs with augmented B4 expression is characteristic in non-treated systemic lupus erythematosus (SLE). Paradoxically, the transcription frequency of the anti-double-strand DNA immunoglobulin-coding V_H sequence in the B4⁺ population of non-treated SLE was significantly higher than that in B4⁻ cells. B4⁺ and B4⁻ PBs/PCs were suggested to be developmentally equivalent based on the simultaneous generation of these populations upon activation of memory B cells <span style="font-style:italic;">in vitro</span>. B4 expression was found to be induced efficiently by IL-2, while IFN-α effectively induced B4⁺ PBs/PCs <span style="font-style:italic;">in vitro</span>. Utilizing the elevated B4 will support opening a new avenue for identifying the mechanism for generation of, and additional molecular markers for, pathogenic cells.</span>

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Repetitive Transcranial Magnetic Stimulation for Tinnitus

This Viewpoint discusses evidence of the efficacy of repetitive transcranial magnetic stimulation for treatment of tinnitus and the need for a randomized clinical trial.

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Permanent 3D-Printed Tracheal Splint for Severe Tracheomalacia

This case report describes the treatment of severe acquired tracheomalacia with a patient-specific, 3D-printed, permanent tracheal splint.

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Prognostic Performance of a New Staging Category for Oral Cancer Survival Prediction

This study compares the prognostic performance of the routinely used pathologic TNM staging with a new staging category that incorporates the neutrophil to lymphocyte ratio and histopathologic features for disease-specific survival in nonmetastatic oral cancer.

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Laser-assisted topical corticosteroid delivery for the treatment of keloids

Abstract

Laser-assisted drug delivery has generated intense interest. The objectives of this study are to evaluate the clinical benefit of laser-assisted corticosteroid delivery and to compare this technique to corticosteroid intralesional injection, a standard treatment for keloids. Patients with keloids on the left shoulder after BCG vaccination were enrolled in this study. The entire lesion was first treated with an ablative fractional erbium-YAG laser. After this treatment, the lesion was divided into two halves. The first half received an intralesional injection of corticosteroid, whereas the second half received topical application of corticosteroids that were occluded for 3 hours. Four treatment sessions were conducted, with treatments occurring once every 6 weeks. Treatment outcomes were evaluated using the Vancouver Scar Scale (VSS). Pain was self-assessed by the patient during the procedure. The mean keloid VSS score before treatment was 8.59 ± 1.23 for the corticosteroid injection site and 8.31 ± 2.09 for the topical site. After treatment, the mean keloid VSS score was decreased on both sides (4.56 ± 1.09 vs 5.02 ± 0.87, respectively, P > 0.05). Patients rated their satisfaction level as "moderate" on both sides. However, the mean pain score was 1.1 out of 10 on the topical side versus 6.1 on the corticosteroid injection site. The combination of ablative fractional laser treatment and topical corticosteroid application is a promising modality for the treatment of keloids. Moreover, this procedure was not associated with any serious adverse reactions or unbearable pain.

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Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis

Abstract

Swelling is the most common symptom of extremities lymphedema. Clinical evaluation and laboratory analysis were conducted after far infrared radiation (FIR) treatment on the main four components of lymphedema: fluid, fat, protein, and hyaluronan. Far infrared radiation is a kind of hyperthermia therapy with several and additional benefits as well as promoting microcirculation flow and improving collateral lymph circumfluence. Although FIR therapy has been applied for several years on thousands of lymphedema patients, there are still few studies that have reported the biological effects of FIR on lymphatic tissue. In this research, we investigate the effects of far infrared rays on the major components of lymphatic tissue. Then, we explore the effectiveness and safety of FIR as a promising treatment modality of lymphedema. A total of 32 patients affected by lymphedema in stage II and III were treated between January 2015 and January 2016 at our department. After therapy, a significant decrease of limb circumference measurements was noted and improving of quality of life was registered. Laboratory examination showed the treatment can also decrease the deposition of fluid, fat, hyaluronan, and protein, improving the swelling condition. We believe FIR treatment could be considered as both an alternative monotherapy and a useful adjunctive to the conservative or surgical lymphedema procedures. Furthermore, the real and significant biological effects of FIR represent possible future applications in wide range of the medical field.

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Remerciements aux experts

Publication date: January 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 1





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Editorial board

Publication date: January 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 1





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Bonne année 2017 !

Publication date: January 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 1
Author(s): B. Cribier




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GAD-specific T cells are induced by GAD-alum treatment in Type-1 diabetes patients

Publication date: Available online 26 January 2017
Source:Clinical Immunology
Author(s): Mikael Pihl, Hugo Barcenilla, Stina Axelsson, Mikael Chéramy, Linda Åkerman, Ingela Johansson, Johnny Ludvigsson, Rosaura Casas
Administration of Glutamic Acid Decarboxylase (GAD)65 formulated in aluminium hydroxide preserved insulin secretion in a phase II trial in recent onset Type 1 Diabetes. A subsequent European phase III trial was closed at 15months after failing to reach primary endpoint, but the majority of the Swedish patients completed the 21months follow-up. We studied the frequencies and phenotype of T cells, suppressive capacity of Tregs, GAD65-induced proliferation, and frequencies of T cells with a GAD65-specific TCR in Swedes participating in the trial. Stimulation with GAD65 induced activated T cells and also cells with a suppressive phenotype. Activated GAD65-specific effector T cells were detected by tetramer staining while the frequency of GAD65-specific Treg was not affected by the treatment. Additional doses of GAD-alum increased frequencies of CD25⁺CD127⁺, but had no effect on CD25^hiCD127^lo. Our findings indicate that GAD-alum treatment primarily induced activated T cells. GAD65-specific cells were mainly of activated phenotype.



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Advanced Squamous Cell Carcinoma of the Head and Neck: The Current Role of Cetuximab

We review clinical trials of squamous cell carcinoma of the head and neck (SCCHN) to address the current and potential uses of cetuximab (CTX). PubMed was reviewed to identify papers published between 2010 and 2016. The search terms used were "cetuximab" and "head and neck cancer." A total of 634 articles were identified. Phase II or III studies with CTX in patients with advanced SCCHN without treatment or with recurrent/metastatic tumors were selected. Forty-six registries were obtained. Information was critically reviewed and relevant information presented. As definitive treatment of advanced squamous cells carcinomas and as palliative treatment of recurrent/metastatic disease, CTX alone or associated with chemotherapy and/or radiotherapy is an alternative to chemoradiotherapy because of its distinct and favorable toxicity profile.
ORL 2016;78:320-333

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Influence of solvents on the bond strength of resin sealer to intraradicular dentin after retreatment

Abstract This study evaluated the removal of filling material with ProTaper Universal Rotary Retreatment system (PTR) combined with solvents and the influence of solvents on the bond strength (PBS) of sealer to intraradicular dentin after canal reobturation. Roots were endodontically treated and distributed to five groups (n = 12). The control group was not retreated. In the four experimental groups, canals were retreated with PTR alone or in combination with xylol, orange oil, and eucalyptol. After filling material removal, two specimens of each group were analysed by SEM and µCT to verify the presence of filling remnants on root canal walls. The other roots were reobturated and sectioned in 1-mm-thick dentin slices that were subjected to the push-out test. Data were analysed by two-way ANOVA and Tukey's test (α = 0.05). SEM and µCT analysis revealed that all retreatment techniques left filling remnants on canal walls. The control group (3.47 ± 1.21) presented significantly higher (p < 0.05) PBS than the experimental groups. The groups retreated with PTR alone (2.59 ± 0.99) or combined with xylol (2.54 ± 0.77) and orange oil (2.32 ± 0.93) presented similar bond strength (p > 0.05), and differed significantly from the group with eucalyptol (1.89 ± 0.63). The solvents reduced the PBS of the sealer to dentin and no retreatment technique promoted complete removal of filling material.

http://ift.tt/2j8hixy

Effects of platelet-rich fibrin on healing of intra-bony defects treated with anorganic bovine bone mineral

Abstract Anorganic bovine bone mineral (ABBM) is extensively used in the treatment of intra-bony defects. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with a simplified technique. Although certain studies have reported the use of PRF in the treatment of intra-bony defects, to date, none of them have evaluated its additive effects with ABBM. Therefore, a randomised, split-mouth clinical trial was conducted to compare healing of intra-bony defects treated with an ABBM-PRF combination with healing of those treated with ABBM alone. By using a split-mouth design, 15 paired intra-bony defects were randomly treated with either ABBM alone (control group) or ABBM-PRF combination (test group). Following clinical parameters and radiographical measurements were recorded at baseline and 6 months after treatment: plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), clinical attachment level (CAL), vertical bone loss, depth of defect and defect angle. Preoperative clinical and radiographical measurements were similar for the test and control groups. Statistically significant reductions in GI, PD, CAL, vertical bone loss, depth of intra-bony defect and widening of defect angle were detected after treatment in both groups. With respect to inter-group analysis, gain in CAL was significantly greater in the test group than in the control group, whereas no inter-group differences were observed in any other parameter. The results of this study indicate that both therapies are effective in the treatment of intra-bony defects.

http://ift.tt/2jVhixW

PAR-2 expression in the gingival crevicular fluid reflects chronic periodontitis severity

Abstract Recent studies investigating protease-activated receptor type 2 (PAR-2) suggest an association between the receptor and periodontal inflammation. It is known that gingipain, a bacterial protease secreted by the important periodontopathogen Porphyromonas gingivalis can activate PAR-2. Previous studies by our group found that PAR-2 is overexpressed in the gingival crevicular fluid (GCF) of patients with moderate chronic periodontitis (MP). The present study aimed at evaluating whether PAR-2 expression is associated with chronic periodontitis severity. GCF samples and clinical parameters, including plaque and bleeding on probing indices, probing pocket depth and clinical attachment level, were collected from the control group (n = 19) at baseline, and from MP patients (n = 19) and severe chronic periodontitis (SP) (n = 19) patients before and 6 weeks after periodontal non-surgical treatment. PAR-2 and gingipain messenger RNA (mRNA) in the GCF of 4 periodontal sites per patient were evaluated by Reverse Transcription Polymerase Chain Reaction (RT-qPCR). PAR-2 and gingipain expressions were greater in periodontitis patients than in control group patients. In addition, the SP group presented increased PAR-2 and gingipain mRNA levels, compared with the MP group. Furthermore, periodontal treatment significantly reduced (p <0.05) PAR-2 expression in patients with periodontitis. In conclusion, PAR-2 is associated with chronic periodontitis severity and with gingipain levels in the periodontal pocket, thus suggesting that PAR-2 expression in the GCF reflects the severity of destruction during periodontal infection.

http://ift.tt/2j8xH4P

Osteogenic potential of periodontal ligament stem cells are unaffected after exposure to lipopolysaccharides

Abstract Periodontitis develops as a result of a continuous interaction between host cells and subgingival pathogenic bacteria. The periodontium has a limited capacity for regeneration, probably due to changes in periodontal ligament stem cells (PDLSCs) phenotype. The aim of this study was to evaluate the effects of lipopolysaccharides from Porphyromonas gingivalis (PgLPS) on mesenchymal phenotype and osteoblast/cementoblast (O/C) potential of PDLSCs. PDLSCs were assessed for Toll-like receptor 2 (TLR2) expression by immunostaining technique. After, cells were exposed to PgLPS, and the following assays were carried out: (i) cell metabolic activity using MTS; (ii) gene expression for IL-1β, TNF-α and OCT-4 by real-time polymerase chain reaction (RT-qPCR); (iii) flow cytometry for STRO-1 and CD105, and (iv) osteogenic differentiation. PDLSCs were positive for TLR2. PgLPS promoted cell proliferation, produced IL-1β and TNF-α, and did not affect the expression of stem cell markers, STRO-1, CD105 and OCT-4. Under osteogenic condition, PDLSCs exposed to PgLPS showed a similar potential to differentiate toward osteoblast/cementoblast phenotype compared to control group as revealed by mineralized matrix deposition and levels of transcripts for RUNX2, ALP and OCN. These results provide evidence that PgLPS induces pro-inflammatory cytokines, but does not change the mesenchymal phenotype and osteoblast/cementoblast differentiation potential of PDLSCs.

http://ift.tt/2jVtnmD

"Clinical Evaluation of Opto-Acoustic Tomography for Detection and Diagnostic Differentiation of Thyroid Nodules"

Condition:   Feasibility Study for Thyroid Indication
Intervention:   Device: Imagio Imaging System
Sponsor:   Seno Medical Instruments Inc.
Not yet recruiting - verified January 2017

http://ift.tt/2jATIpa

Khon Kaen University's Thyroidectomy Registry

Conditions:   Thyroid Nodule;   Thyroid Neoplasms;   Thyroid Cancer
Intervention:   Procedure: Endoscopic approach thyroidectomy
Sponsor:   Khon Kaen University
Recruiting - verified January 2017

http://ift.tt/2k7jPrs

Prepare to Care Kit in Improving Caregiver Support in Patients With Stage I-IV Head and Neck Cancer

Conditions:   Caregiver;   Malignant Head and Neck Neoplasm;   Paranasal Sinus Squamous Cell Carcinoma;   Salivary Gland Squamous Cell Carcinoma;   Stage I Hypopharyngeal Squamous Cell Carcinoma;   Stage I Laryngeal Squamous Cell Carcinoma;   Stage I Lip and Oral Cavity Squamous Cell Carcinoma;   Stage I Oropharyngeal Squamous Cell Carcinoma;   Stage II Hypopharyngeal Squamous Cell Carcinoma;   Stage II Laryngeal Squamous Cell Carcinoma;   Stage II Lip and Oral Cavity Squamous Cell Carcinoma;   Stage II Oropharyngeal Squamous Cell Carcinoma;   Stage III Hypopharyngeal Squamous Cell Carcinoma;   Stage III Laryngeal Squamous Cell Carcinoma;   Stage III Lip and Oral Cavity Squamous Cell Carcinoma;   Stage III Oropharyngeal Squamous Cell Carcinoma;   Stage IV Hypopharyngeal Squamous Cell Carcinoma;   Stage IV Laryngeal Squamous Cell Carcinoma;   Stage IV Lip and Oral Cavity Squamous Cell Carcinoma;   Stage IV Oropharyngeal Squamous Cell Carcinoma;   Stage IVA Hypopharyngeal Squamous Cell Carcinoma;   Stage IVA Laryngeal Squamous Cell Carcinoma;   Stage IVA Lip and Oral Cavity Squamous Cell Carcinoma;   Stage IVA Oropharyngeal Squamous Cell Carcinoma;   Stage IVB Hypopharyngeal Squamous Cell Carcinoma;   Stage IVB Laryngeal Squamous Cell Carcinoma;   Stage IVB Lip and Oral Cavity Squamous Cell Carcinoma;   Stage IVB Oropharyngeal Squamous Cell Carcinoma;   Stage IVC Hypopharyngeal Squamous Cell Carcinoma;   Stage IVC Laryngeal Squamous Cell Carcinoma;   Stage IVC Lip and Oral Cavity Squamous Cell Carcinoma;   Stage IVC Oropharyngeal Squamous Cell Carcinoma
Interventions:   Other: Communication Intervention;   Other: Educational Intervention;   Other: Educational Intervention;   Other: Quality-of-Life Assessment;   Other: Survey Administration
Sponsors:   Wake Forest University Health Sciences;   National Cancer Institute (NCI)
Not yet recruiting - verified January 2017

http://ift.tt/2kwSVFU

Self-Care for Head and Neck Cancer Survivors With Lymphedema and Fibrosis

Conditions:   Head and Neck Cancer;   Lymphedema;   Fibrosis
Interventions:   Other: Usual Care;   Other: Usual Care plus LEF-SCP;   Other: Usual Care plus LEF-SCP plus Follow-up
Sponsors:   Vanderbilt-Ingram Cancer Center;   American Cancer Society, Inc.;   National Cancer Institute (NCI)
Not yet recruiting - verified January 2017

http://ift.tt/2jB1fnT

Diagnostic and therapeutic modalities for 287 malignant and benign salivary tumors: a cohort study

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yair Israel, Adi Rachmiel, Gil Ziv, Rafael Nagler
BackgroundSalivary gland tumors (SGT's), 3-10% of head/neck tumors, exhibit a striking range of morphological diversity. This minimally symptomatic disease can be challenging to diagnose, and therapeutic policy is still controversial.MethodsWe compared benign and malignant cohorts according to diagnostic modality utilized and therapeutic modality administered over 20 years in a single medical center.ResultsOf 287 cases, 216 had benign tumors and 71 had malignant tumors. Treatment was surgery-based in 99% of cases, often accompanied by radiotherapy and/or chemotherapy. Rates of imaging and biopsy for diagnosis were significantly higher in malignant than benign tumors. Fine-needle aspiration (FNA) was used in 90.3% of benign tumors. Of 71 malignant tumors, 69 underwent surgery to fully remove the malignant tumor. Adjuvant therapy included 22 neck dissections (30%), 28 radiotherapy (39.4%), 12 chemotherapy (16.9%) and 10 combined radio-chemotherapy (14.1%). Partial parotidectomy, submandibular sialoadencetomy and local excision were used in 78.1%, 8.3% and 6.9% of benign cases. Total parotidectomy, sub-total maxillectomy and wide excision were used in 16.9%, 12.7% and 22.6% of malignant cases.DiscussionDiagnostic and therapeutic modalities for treatment of salivary tumor at our hospital are presented and discussed with respect to others. A paradigm of therapy administered in our institute is presented.



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Calculation of resected orbital wall areas in the treatment of endocrine orbitopathy

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Matthias Krause, Heike Hümpfner-Hierl, Daniel Kruber, Ina Sterker, Thomas Hierl
PurposeOrbital wall decompression is routinely used to treat proptosis in endocrine orbitopathy. Until now, however, there has been no investigation to measure the area/extent of the removed walls.Materials and MethodsThe inner areas of 154 orbital walls (lateral, inferior, medial) which had been resected in 38 patients were measured using pre- and postsurgical computed tomographic data in Brainlab iPlan software. Furthermore the effect of concomitant centrolateral orbital rim advancement was calculated in 48 cases. Surgery was performed after preoperative planning using intraoperative navigation.ResultsThe mean area of resected inferior and medial orbital walls lay at 6.7 cm² and 6.2 cm², while the area of the lateral orbital wall was 6.9 cm². Rotation-advancement of the lateral rim added an area of 1.8 cm² (∼25 % of the lateral orbital wall). Comparison of the pre- and postsurgical computed tomographic data showed excellent conformity of the presurgical planning and postsurgical results.ConclusionsThis investigation is a first step in analyzing the potential surgical effect of bony decompression surgery by stating the metric amount of orbital wall removal. Using these data, further studies will be performed in the future.



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Lymph node involvement predicts poor prognosis in primary tongue adenoid cystic carcinoma: A preliminary study of 54 cases

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Nannan Han, Huishan Ong, Zhihui Liu, Min Ruan, Wenjun Yang, Chenping Zhang
PurposePrimary tongue adenoid cystic carcinoma (ACC) is extremely rare. The relationship between the patient's prognosis and the tumor's clinicopathological characteristics is uncertain. The aim of this study was to identify the prognostic factors and analyze the overall outcomes for patients with tongue ACC.Patients and MethodsA retrospective analysis of the medical records of patients diagnosed with primary tongue ACC between 1998 and 2008 was conducted. The study comprised 54 patients, with a median age of 53.4 years. The incidence of ACC in the base of the tongue was almost 3.5 times in comparison to that in the mobile portion of the tongue. The 3-year and 5-year overall survival rates were 87.4% and 65.3%, respectively, whereas the 3-year and 5-year disease-free survival rates were 54.3% and 32.8%, respectively. Significant prognostic factors regarding overall survival in univariate analyses included tumor size and lymph node status.ResultsA multivariate model identified lymph node status as the only significant independent predictor of overall survival. Further analysis showed that tumor size (P=0.034), histological grade (P=0.021), and perineural invasion (PNI, P=0.023) were three important factors affecting lymph node metastasis. Patients with lymph node metastasis have a higher tendency of developing distant metastasis (P<0.01).ConclusionsLymph node status was a significant determinant of prognosis in primary tongue ACC and could be used for a rational design of treatment strategies in future.



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Early volumetric changes after vertical augmentation of the atrophic posterior mandible with interpositional block graft versus onlay bone graft: A retrospective radiological study

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Antonio Barone, Paolo Toti, Giovan-Battista Menchini-Fabris, Pietro Felice, Saverio Marchionni, Ugo Covani
PurposeThe aim of this study was to evaluate volumetric and clinical outcomes of atrophic posterior mandibles treated with inlay or onlay bone grafting techniques.Materials and MethodsIn posterior mandibles, alveolar ridges were treated either with interpositional equine cancellous bone block (inlay group) or with onlay autogenous bone block (onlay group). Bone volumes at baseline and at 4 months after surgery were measured by computed tomography.ResultsA total of 20 subjects were enrolled in the present study: 10 in the inlay group and 10 in the onlay group. After surgery, atrophic posterior mandibles showed a mean vertical augmentation height of 6.0 mm in the inlay group and 7.4 mm in the onlay group. No significant differences were recorded between the two groups regarding volume loss of the grafted bone or decrease in vertical bone height of the augmented site (29% and 1.9 mm for the onlay group, and 35% and 1.7 mm for the inlay group) during healing. Two complications (1 wound dehiscence and 1 mandibular fracture) occurred postoperatively in the inlay group; on the other hand, the onlay group had three complications (wound dehiscence). A total of 80 dental implants were placed in augmented areas: 46 in the inlay group with a peri-implant marginal bone loss of 0.8 mm, and 34 in the onlay group with a peri-implant marginal bone loss of 1.3 mm (p=0.0006).ConclusionsInlay xenogeneic grafts showed volumetric bone remodeling similar to that recorded for onlay autogenous bone. The success of the autogenous onlay blocks (82.4%) appeared to be lower than that registered for the inlay group (93.8%), but the difference was not significant.



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Clinical course and therapeutic outcomes of operatively and non-operatively managed patients with denosumab-related osteonecrosis of the jaw (DRONJ)

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sebastian Hoefert, Anna Yuan, Adelheid Munz, Martin Grimm, Ashraf Elayouti, Siegmar Reinert
PurposeDetails regarding risk factors, onset, and outcomes for denosumab-related osteonecrosis (DRONJ) are sparse. This study examines the clinical characteristics and operative and non-operative therapeutic outcomes in patients with DRONJ not previously exposed to other antiresorptives.MethodsA retrospective medical record review was conducted, and data were collected, including clinical findings, management, healing outcomes, and radiologic, histologic, and micro-computed tomography (CT) analyses.ResultsSeventeen patients were treated with denosumab, with 14.1 ± 8.3 doses before DRONJ onset. The majority of lesions were observed at sites of dental prostheses (41%) and dental extractions (35%). Sixteen patients were managed non-operatively (10/16) or operatively (6/16) with either major (5/6) or minor surgery (1/6) and included in the follow-up analysis. Complete healing was significant in patients treated with major surgery (80%) compared to the non-operative group (20%; p<0.035). Denosumab was discontinued in 60% of non-operative patients and major surgery patients with no effect on healing. Histologic findings of 4 patients analysed exhibited a decreased number of osteocyte lacunae, and micro-CT of 3 patients scanned revealed trabecular thickening.ConclusionDRONJ lesions occurred mostly at sites of prostheses sores after a mean of 14 doses of denosumab. Major surgery demonstrated more complete healing than non-operative management, and denosumab cessation did not improve healing outcomes.



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Elective neck dissection in unilateral carcinomas of the tongue: Unilateral versus bilateral approach

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Christopher-Philipp Nobis, Sven Otto, Tamara Grigorieva, Mohamed Alnaqbi, Matthias Troeltzsch, Jakob Schöpe, Stefan Wagenpfeil, Michael Ehrenfeld, Klaus-Dietrich Wolff, Marco Rainer Kesting
PurposeElective neck dissection (END) is a common primary treatment strategy for oral tongue squamous cell carcinoma (OTSCC), although uncertainty remains regarding the necessary extent of END for strictly unilateral early stage OTSCC. The authors evaluated two END variations, unilateral and bilateral, to determine the optimal extent.Materials and MethodsA retrospective cohort study was performed on patient data from two departments of oral and maxillofacial surgery. All previously untreated patients from both clinics who were diagnosed with early-stage (pT1-2) unilateral OTSCC were included. The following variables were collected: age, gender, END type/extent, tumor localization, later nodal metastasis, and TNM status. Statistical analyses were performed (p < 0.05).ResultsA total of 150 patients were identified, 105 receiving unilateral END and 45 bilateral END. The rates of postoperative positive lymph nodes were 21.9% for ipsilateral END and 26.7% for bilateral END (bilateral END: all positive nodes ipsilateral). In all, 14 patients in the ipsilateral group developed nodal metastasis during tumor aftercare (11 patients ipsilateral, 3 patients contralateral neck). In the bilateral group, nodal metastasis was later observed in 4 cases (8.9%; 3 cases ipsilateral, 1 case contralateral neck). Statistical analysis could not detect significant differences between the END procedures.ConclusionAs both procedures lead to similar results in preventing or omitting possible later nodal metastasis, the two methods seem to be valuable alternatives. In conclusion, we recommend bilateral END because of advantages with regard to oncologic safety and aesthetic outcome, but the decision for END should always be according to the patient's general health status, comorbidities, and individual tumor risk profile.



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Magnetic resonance imaging of the inferior alveolar nerve with special regard to metal artifact reduction

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Monika Probst, Vivien Richter, Jochen Weitz, Jan Stefan Kirschke, Carl Ganter, Matthias Troeltzsch, Mathias Nittka, Carl-Peter Cornelius, Claus Zimmer, Florian Andreas Probst
PurposeMagnetic resonance imaging (MRI) is an excellent imaging modality for displaying peripheral nerves. Since the knowledge about MRI of the inferior alveolar nerve (IAN) is limited, this pilot study aims to identify the prospects and limitations of MRI of the IAN, with special consideration of metal artifacts.Materials and MethodsInitially, in vitro MRI of a dental implant was performed to establish an optimized protocol for metal artifact reduction using WARP sequences (a software package provided by Siemens Healthcare, Erlangen, Germany) including view angle tilting (VAT) and slice-encoding metal artifact correction (SEMAC) techniques. MRI with this optimized protocol was performed in three volunteers and four patients presenting with postoperative IAN impairment. Measuring the evaluable area and the artifact size was performed to assess the benefit of the specific artifact reduction sequences.ResultsIn vitro imaging of a dental implant demonstrated that WARP sequences with VAT and SEMAC techniques led to a volume reduction of the artifact of up to 69.1%. Observations in both volunteers and patients with neurosensory IAN impairment showed a distinct artifact reduction with the MRI protocol adapted to metallic materials. Additionally VAT and SEMAC techniques improved the imaging due to further artifact reduction. As a main drawback of the VAT technique, the image quality was compromised by a blurring effect. Still, on 3-Tesla MRI the resolution was high enough to reveal even fine structures. Imaging of the IAN was successful in all cases despite metallic material in the region of interest, and structural IAN changes could be detected in correlation with clinical symptoms.ConclusionIn contrast to conventional radiography and computed tomography, MRI can directly depict the IAN and provide reliable information on its position and exact course within the mandible. MRI offers an objective assessment of IAN injuries, supporting the decision-making process regarding surgical exploration and microneural repair. With the advent of specialized MRI techniques such as VAT and SEMAC, reduction of metal artifacts is considerably improved.



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Cephalometric comparison of early and late secondary bone grafting in the treatment of patients suffering from unilateral cleft lip and palate

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Andrzej Brudnicki, Ewa Sawicka, Renata Brudnicka, Piotr Stanisław Fudalej
The study was based on a retrospective cephalometric assessment of 10-year-olds in order to evaluate the influence of early secondary bone grafting on craniofacial development in patients suffering from non-syndromic complete unilateral cleft lip and palate.The study consisted of 79 patients in the early and 67 patients in the late secondary bone grafting group. The mean age at alveolar bone grafting was 2.5 years (SD 0.03) in the first group and 9.8 years (SD 2.3) in the second group. The primary cleft repair of these 146 patients was always performed in accordance with the one-stage method. Additionally, the non-cleft control group was comprised of 56 children of the same ethnicity and age.The cephalometric analysis performed at age 10 revealed similar overall characteristics of observed growth disturbances in both cleft groups in comparison to the control group, such as: inhibition of vertical and anterior maxillary development, the tendency of the mandible to rotate clockwise, and a prevalence of vertical over horizontal facial growth. The comparison between the cleft groups revealed a lack of growth differences in the vertical dimension and more pronounced anterior maxillary development inhibition in the early bone grafting group.This study will be followed by a similar evaluation after craniofacial development is complete by a significant number of these patients in order to ascertain our conclusions.



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Evaluation of the role of splint therapy in the treatment of temporomandibular joint pain on the basis of MRI evidence of altered disc position

Publication date: Available online 25 January 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yoko Hasegawa, Naoya Kakimoto, Seiki Tomita, Masanori Fujiwara, Reichi Ishikura, Hiromitsu Kishimoto, Kosuke Honda
ObjectiveTo clarify whether altering temporomandibular joint (TMJ) condyle and disc positions by occlusal splint (splint) therapy relieves TMJ pain and to determine whether splint therapy facilitates improvement of the ranges of condyle and articular disc motions.Study DesignA total of 150 joints of 75 patients admitted with TMJ pain/discomfort were evaluated. A visual analog scale for TMJ pain was administered during visits following the start of splint treatment. At the start of splint treatment, MRI was performed with/without splint insertion, after which condyle/disc movements were evaluated. Disc position and function, disc configuration, joint effusion, osteoarthritis, and the bone marrow were evaluated. Pearson's correlation coefficients, linear regression, and multiple regression analyses were used for statistical analysis.ResultsSplint-related anterior movement of the condyle was related to TMJ pain. With a biconvex disc and/or bone marrow abnormality, splint treatment was ineffective for reducing TMJ pain.ConclusionSplint therapy was not likely to be successful for any kind of TMJ abnormalities, such as bone marrow abnormalities and/or a biconvex disc appearance on MRI.



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An Undiagnosed Case of Hypothalamic Hamartoma with a Rare Presentation

Background. Hypothalamic hamartomas (HHs) are rare tumor-like malformations that may present with complex partial seizures refractory to anticonvulsants in adulthood. The condition may be misdiagnosed because of rarity. Case Presentation. We report a 25-year-old man with complaint of seizures presented by falling, tonic spasm of limbs, oral automatism, vocalization, and hypermotor activities. His seizures started at the age of one month and presented as eye deviation and upper limbs myoclonic jerk, followed by frequent seizures with variable frequency. The patient had delayed developmental milestones and was mentally retarded. He was hospitalized and underwent video-EEG monitoring and neuroimaging, and the diagnosis of HH was made. The patient became candidate for surgery after that. Conclusion. In this case, the underlying etiology of seizures was diagnosed after 25 years. HH is a rare condition and neurologists may encounter very small number of these cases during their practice. Therefore, they should consider it in patients who present with suspected signs and symptoms.

http://ift.tt/2k3FAb5

Case 3-2017: A 62-Year-Old Man with Cardiac Sarcoidosis and New Diplopia and Weakness

Presentation of Case. Dr. L. Nicolas Gonzalez Castro (Neurology): A 62-year-old man with sarcoidosis and heart disease was admitted to this hospital because of new-onset diplopia and weakness. The patient was in his usual health until approximately 2 weeks before admission, when nausea, dizziness,…

http://ift.tt/2k3jJAJ

Species-specific immunity to Helicobacter suis

Abstract

Background

Helicobacter (H.) suis is mainly associated with pigs, but is also the most prevalent gastric non-H. pylori Helicobacter species found in humans. Both H. pylori and H. suis may cause persistent infection of the stomach. Several immune evasion mechanisms have been proposed for H. pylori, which focus to a great extent on its major virulence factors, which are absent in H. suis. The aim of this study was to gain more knowledge on immune evasion by H. suis.

Materials and Methods

Cytokine expression kinetics were monitored in the stomach of BALB/c mice experimentally infected with H. suis. The cytokine expression profile in the stomach of naturally H. suis-infected pigs was also determined. Subsequently, the effect of H. suis on murine and porcine dendritic cell (DC) maturation and their ability to elicit T-cell effector responses was analyzed.

Results

Despite a Th17/Th2 response in the murine stomach, the inflammatory cell influx was unable to clear H. suis infection. H. suis-stimulated murine bone marrow-derived dendritic cells induced IL-17 secretion by CD4⁺ cells in vitro. Natural H. suis infection in pigs evoked increased expression levels of IL-17 mRNA in the antrum and IL-10 mRNA in the fundus. In contrast to mice, H. suis-stimulated porcine monocyte-derived dendritic cells were unable to express MHCII molecules on their cell surface. These semimature DCs induced proliferation of T-cells, which showed an increased expression of TGF-β and FoxP3 mRNA levels.

Conclusions

Helicobacter suis might evade host immune responses by skewing toward a Treg-biased response.

http://ift.tt/2kmxnMZ

Helicobacter pylori infection is an independent risk factor of early and advanced colorectal neoplasm

Abstract

Background

The role of Helicobacter pylori (H. pylori) in the development of colorectal neoplasm remains controversial. We examined the association between H. pylori infection and colorectal neoplasm in a large sample of healthy participants who underwent screening colonoscopy.

Methods

A cross-sectional study of 8916 men, who participated in a regular health-screening examination that included an H. pylori-specific immunoglobulin G antibody test and colonoscopy, was conducted to evaluate the association between H. pylori and colorectal neoplasm.

Results

Multivariable analyses adjusted for age, body mass index, smoking status, alcohol intake, regular exercise, regular aspirin use, and family history of colorectal cancer showed that the odds ratio (OR) (95% confidence interval [CI]) for any adenoma and advanced neoplasm was 1.32 (1.07-1.61) and 1.90 (1.05-3.56) in participants with H. pylori infection and without H. pylori infection, respectively. The association persisted after further adjustment for inflammatory markers or metabolic variables including fasting blood glucose, triglycerides, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol. Regarding the location, a positive association was confined to cases with proximal adenomas and was observed similarly in all the evaluated subgroups.

Conclusions

In a large-scale study, carefully controlled for confounding factors, involving asymptomatic participants without a history of colonoscopy, H. pylori infection was significantly associated with the risk of any colorectal adenoma and advanced colorectal neoplasm. Prospective studies are necessary to determine whether H. pylori eradication can reduce this risk.

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Surgical Management of a Patient with Anterior Megalophthalmos, Lens Subluxation, and a High Risk of Retinal Detachment

The early development of lens opacities and lens subluxation are the most common causes of vision loss in patients with anterior megalophthalmos (AM). Cataract surgery in such patients is challenging, however, because of anatomical abnormalities. Intraocular lens dislocation is the most common postoperative complication. Patients with AM also seem to be affected by a type of vitreoretinopathy that predisposes them to retinal detachment. We here present the case of a 36-year-old man with bilateral AM misdiagnosed as simple megalocornea. He had a history of amaurosis in the right eye due to retinal detachment. He presented with vision loss in the left eye due to lens subluxation. Following the removal of the subluxated lens, it was deemed necessary to perform a vitrectomy in order to prevent retinal detachment. Seven months after surgery, an Artisan^® Aphakia iris-claw lens was implanted in the anterior chamber. Fifteen months of follow-up data are provided.
Case Rep Ophthalmol 2017;8:61–66

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A Case of Syphilitic Uveitis in Which Vitreous Surgery Was Useful for the Diagnosis and Treatment

Purpose: To report a case of atypical syphilitic uveitis complicated with retinal vasculitis, proliferative retinopathy, and vitreous hemorrhage in which vitreous surgery was useful for the diagnosis and treatment. Case Report: A 38-year-old female was referred to our hospital after noticing visual disturbance in her right eye. Fundoscopy examination of that eye revealed retinal phlebitis accompanied by retinal hemorrhage and soft exudate, and remarkable exudative changes in the retinal vessels from the upper arcade to the macula region. After a blood examination, a serological test showed positive for syphilis; however, systemic findings were scarce. Syphilitic uveitis was suspected, so we administered treatment for syphilis, anticoagulant treatment for retinal vasculitis, steroids for intraocular inflammation, and photocoagulation for the retinal nonperfusion area. However, her visual acuity (VA) decreased to 30 cm/counting fingers due to vitreous hemorrhage resulting from fibrovascular membrane at the optic disc. Since the vitreous hemorrhage was insufficiently absorbed, vitreous surgery was performed to remove the hemorrhage and fibrovascular tissue. Following surgery, the uveitis and retinal vasculitis subsided, and her corrected VA improved to 0.3. Postoperative examination of a fixed quantity of collected vitreous fluid for syphilis showed a Treponema pallidum hemagglutination value of 5,120 times the normal amount, thus confirming the syphilitic uveitis diagnosis. Conclusions: Our findings show that when observing patients with obstructive retinal vasculitis of unknown causes, syphilitic uveitis should be considered as a differential diagnosis, and that vitreous surgery is useful for the diagnosis and treatment of atypical syphilitic uveitis which has progressed to proliferative retinopathy.
Case Rep Ophthalmol 2017;8:55–60

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Effective Intravitreal Injections of Bevacizumab in a Case of Serous Macular Detachment from the Superior Border of the Posterior Staphyloma

Purpose: We present an atypical case of submacular fluid leading to serous macular detachment. Method/Patient: A 69-year-old man was evaluated for metamorphopsia in the left eye. Results: Best-corrected visual acuity was 20/25 in both eyes. He had undergone cataract surgeries in both eyes 12 years ago. The axial length was 25.93 mm (OD) and 24.12 mm (OS). Optical coherence tomography showed posterior staphylomas and subretinal fluid on the superior border of the staphylomas in both eyes; in the left eye, submacular fluid was noted extending up to the macula. Fundus fluorescein angiography revealed leakage from the superior border of the staphylomas in both eyes. The fluid persisted for 4 months. Four consecutive, monthly injections of bevacizumab (1.25 mg/0.05 mL) were administered in the left eye; subsequently, the subretinal fluid gradually dissipated from the macula and became localized at the superior border of the staphyloma. This localization persisted for 12 months. Conclusions: We have detailed a case of submacular fluid that spread from the superior border of the posterior staphyloma in a patient with macular detachment, in whom intravitreal injections of bevacizumab were highly effective in eliminating the fluid.
Case Rep Ophthalmol 2017;8:49–54

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